Archive for the ‘History’ Category

Thanksgiving And Freedom From Want

Tuesday, November 22nd, 2016

During his 1941 State of the Union address, Franklin Roosevelt articulated what he considered humanity’s four essential freedoms: Freedom of Speech, Freedom of Worship, Freedom from Fear and Freedom from Want. In American recent history those freedoms have been attacked in different ways and in different degrees. At this moment we are a hurting country in many respects.

But right around the corner comes Thanksgiving, my favorite holiday. A holiday on which families come together, put aside their petty disagreements and bond once again with love. No one tries to sell Thanksgiving paraphernalia, except maybe a recently sacrificed turkey. And for a few hours the Christmas shopping season that kicked off around Labor Day doesn’t exist.

Following Roosevelt’s Four Freedoms speech, American artist Norman Rockwell set out to depict them on canvas. Rockwell was a humble man; he called himself an “Illustrator,” not an artist. Didn’t think he was good enough for that.

On 3 March 1942, his Freedom From Want graced the cover of The Saturday Evening Post magazine. He decided the best way to portray Freedom From Want was through a family’s Thanksgiving dinner. His painting, as well as the three other Freedom covers he painted for The Saturday Evening Post that year, has become iconic.

freedom-from-want

We whose job it is to push the workers’ compensation rock up the Sisyphean mountain, all the while trying our best to help men and women who have had their lives interrupted by workplace injury or illness, have taken it on the chin lately. We’re not alone in that, of course.  So many of our fellow citizens are bruised also. Perhaps we, and all Americans, should put that aside and take a moment to ponder Roosevelt’s Four Freedoms and Rockwell’s sometimes loving, sometimes searing, portrait of them and recommit ourselves to the existential exceptionalism that is the American Dream. Perhaps we should grasp tightly the good feelings that ooze out of Thanksgiving and in that moment dedicate ourselves to helping not only those who place their trust in our professional competence but also all who are momentarily lost and searching for better lives for themselves and their loved ones.

Happy Thanksgiving.

What life was like for U.S. workers in 1915

Wednesday, February 24th, 2016

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To commemorate its centennial, editors at the Monthly Labor Review have produced an excellent and fascinating report on The life of American workers in 1915 and the progress we have seen in the workplace since then. We think it’s worth your time to check it out!

The context of the era is first established with a list of news events that were occurring at the time: a bill to give women the right to vote was rejected; labor leader Joe Hill was charged with murder, a charge that would lead to his execution; Alexander Graham Bell made his famous call to Thomas Watson in San Francisco, Typhoid Mary was arrested, Einstein formulated his theory of general relativity -these and several other key events shaped the era.

The report goes on to discuss the demographics of the day and paint a portrait of daily life with many interesting facts about daily life ranging from where and how people lived (mortgages typically ranged from 5 to 7 years, but required 40-50% down) to how they commuted to work each day (streetcar, by foot or by horse) , what they typically ate for breakfast (corn flakes and puffed wheat cereals), what they wore for work clothing, how many hours they worked, what an average worker was paid ($687 a year), how they spent their leisure time, and more. It’s a fascinating and well-researched historical document.

For our purposes, we were most interested in work conditions and safety. Here’s one excerpt:

Although working in mines was notoriously dangerous, mill work could also be quite hazardous. BLS reported about 23,000 industrial deaths in 1913 among a workforce of 38 million, equivalent to a rate of 61 deaths per 100,000 workers. In contrast, the most recent data on overall occupational fatalities show a rate of 3.3 deaths per 100,000 workers. Regarding on-the-job safety, Green notes, “There was virtually no regulation, no insurance, and no company fear of a lawsuit when someone was injured or killed.” Frances Perkins, who went on to become the first Secretary of Labor (1933–45), lobbied for better working conditions and hours in 1910 as head of the New York Consumers League. After witnessing the 1911 Triangle Shirtwaist Factory fire, which caused the death of 146 mainly young, immigrant female garment workers in New York’s Greenwich Village, Perkins left her job to become the head of the Committee on Public Safety, where she became an even stronger advocate for workplace safety. From 1911 to 1913, the New York State legislature passed 60 new safety laws recommended by the committee. Workplaces have become safer, and technology has been used in place of workers for some especially dangerous tasks.

In addition to this excellent article, there are a few noteworthy accompanying reports and articles in the sidebar, as well. Occupational changes during the 20th century charts how farmers, craftsmen, laborers and private household workers gave way to professional, managerial and service workers over the course of the century. Labor law highlights, 1915–2015 runs through legislation and trends that improved the worker’s lot – ranging from legislation that regulated child labor to laws prohibiting discriminatory practices for women and minorities. Two key legal initiatives were the introduction and adoption of workers compensation laws and workplace safety initiatives being legislated in 1970 with the passage of the birth of the Occupational Safety and Health Act (OSHA).

 Theodore Roosevelt, arguing in favor of workers’ compensation (then known as workmen’s compensation) laws in 1913, offered the story of an injured worker that summed up the legal recourse available for workplace injuries at the time. A woman’s arm was ripped off by the uncovered gears of a grinding machine. She had complained earlier to her employer that state law required the gears be covered. Her employer responded that she could either do her job or leave. Under the prevailing common-law rules of negligence, because she continued working she had assumed the risk of the dangerous condition and was not entitled to compensation for her injury.

As the example illustrates, common-law negligence was not ideal for handling workplace injuries. Workers who noticed hazards could either “assume the risk” and continue working, or leave work; they were powerless to change the condition. Employers were at risk as well: they were vulnerable to negligence suits that could yield large, unanticipated awards for injured workers. Workers’ compensation, where employers insure against the cost of workplace injuries and workers have defined benefits in the case of injury, significantly reduced the risk for both parties.

Our brief excepts don’t do these report justice. Kudos to all the people who produced these great documents and congratulations on 100 years of reporting on the American workplace!

Peter Rousmaniere’s Seismic Shifts in Workers’ Comp: A Thought-Provoking Call To Arms

Monday, February 23rd, 2015

In the mid-1980s, workers’ compensation underwent a management revolution. Until then, employers bought insurance policies, and when injuries occurred passed the baton to their carriers. Then they went back to making widgets trusting that the carriers would take care of everything.

That didn’t work out so well, and costs took a rocket ride to the moon. Across America, employers looked for help. Why would injured workers remain out of work long after it was medically necessary for them to do so. The answer, as we all know, was found in the mirror. Employers, themselves, were the key to getting injured workers back into the bosom of the workplace, but they’d never been taught how to do that. Didn’t know it was their job.

Thus was the workers’ comp management consulting industry born. My company, Lynch Ryan, was first out of the gate. We were the Pathfinders, and Peter Rousmaniere was Employee Number 3 in what was to become a 55 person firm. Peter – Groton School, Harvard BA, Harvard MBA – wanted to join us because he was looking for a challenge. I wanted Peter to join us because he was really smart, and his brain worked like nobody’s I’d ever met. Peter thought “outside the box” before there was an outside the box.

Peter still thinks like nobody else, and today Work Comp Central has published his Seismic Shifts: An Essential Guide for Practitioners and CEOs in Workers’ Comp, subtitled, How Technology and Demographics Will Impact Workers’ Comp From Today Through 2022. This self-funded, year-long venture looks out into the future and envisions another revolution, one that we ignore at our peril.

In Seismic Shifts, Rousmaniere catalogues the nearly unnoticed, but drumbeatingly steady, changes in workers’ compensation since the early 1990s. He shows that since 1991 lost time injuries have declined by 60% and projects that by 2022 there will be a further decline of at least another 35%. He is perplexed about how the insurance industry has missed this decline in injuries and claims, what he calls ‘the elephant in the room,” and suggests that it has done so because for more than a decade it has been obsessively fixated on medical costs, an observation with which I agree. Rousmaniere contends that the insurance industry does not understand how this has happened or why.

His thesis is that this sea change, this seismic shift, is the result of employer improvements in safety engineering, information technology, telematics, robotic design, predictive modelling analytics and the continuous yearning for enhanced productivity. And most important, this natural gravitational movement will continue inexorably. Further, he believes that the workers’ compensation insurance industry has not considered where all of this will lead, how it can be part of and optimize this transformational movement and what kind of workforce it will need to take advantage of this new paradigm.

In Rousmaniere’s view, workers’ compensation practitioners, as well as occupants of the C-Suite, would be well-advised to understand what’s happening and embrace, rather than resist, these evolutionary developments. In his mind, the embracers will succeed and control the future; the resisters will be swept away. It’s as simple as that. He describes, as example, the profound employer movement toward total absence management, rather than merely occupational absence. The move toward total absence management is gathering steam at larger employers, and workers’ comp insurers don’t know what to do about that. Neither do they have a plan for coping with the “opt out” phenomenon. First Texas, then Oklahoma, and just last Friday legislators in Tennessee filed opt-out legislation built on the Oklahoma model. This is becoming a trend.

But the workers’ compensation industry has never distinguished itself in the race to the future. It will be interesting, indeed, to see if Rousmaniere’s clarion call is even acknowledged by today’s potentates. To help it along Work Comp Central is hosting a 4-part webinar series during which Peter will lay out his thesis and try to persuade others in the workers’ comp community to join him in his effort to drag the industry kicking and screaming into the future. Check with Work Comp Central for dates of the Webinars.

Seismic Shifts is an important work, one deserving of your attention and consideration.

Bagpiper’s Fungus, Cheesewasher’s Lung & other obsolete occupational maladies

Friday, March 22nd, 2013

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Did you ever hear of rose gardener’s disease, nun’s chastity of fiddler’s neck?
All apparent names for occupational maladies of yesteryear. Watch this fascinating short video clip charting 10 strange occupational hazards.
Some of these conditions are associated with professions that are confined to the dustbins of history – becoming a loblolly boy isn’t a career path for young boys anymore. And some of these conditions may still exist, they are likely just rebranded. Others may have just adapted to modern tastes – cheesemaker’s lung may be largely a hazard of the past, but unfortunately, Popcorn Lung is not.

Lessons from Ernest Shackleton’s Medical Kit

Tuesday, October 2nd, 2012
“Men wanted for hazardous journey. Low wages, bitter cold, long hours of complete darkness. Safe return doubtful. Honour and recognition in event of success.”

That is the ad that was allegedly posted to attract crew to Sir Ernest Shackelton’s Arctic Expedition on the Nimrod in 1907-09. There’s been a lot written about this adventure to one of the then-most remote corners of the earth. It is still among the most remote wilderness locations today – contemporary workers who agree to stint at Antarctic bases have to prepare for a long haul since some locations only afford a two to three month window when bases are reachable.
A few years ago, when Gavin Francis accepted the position as a medical doctor ‘wintering’ at Halley Base, a profoundly isolated research station on the Caird Coast of Antarctica, he had to plan accordingly since the base is unreachable for ten months of the year. He’s written a pretty fascinating article in Granta magazine comparing the preparations he took in terms of supplying a medical kit with the list of supplies in Shackleton’s Medical Kit.

“In the well-stocked polar section of the little base library I unearthed the packing list for Shackleton’s medical kit – the drugs and dressings he took on the sledge trips of his Nimrod Expedition of 1907, the one that turned back only ninety-seven miles from the South Pole. It added up to a weight of about three kilos, less than a sixth of the modern kit, and to my technomedical mind read more like a witch’s grimoire than the best medical advice of just a century ago.”

It’s a pretty fascinating read, one that we think might tickle the fancy of occupational physicians. We enjoyed the author’s observations about how the practice of medicine has changed, particularly in regards to the challenges of caring for a workforce in a remote location.
Chances are, no matter how remote your workplace, planning for employee health and safety program doesn’t have quite the same extremes in parameters. But one thing remains true: advance planning can still mean the difference between life and death; knowing how to respond quickly can be the difference between a relatively minor event and a life-changing tragedy.
What’s the status of your workplace first aid kit?
In Fundamentals of a Workplace First-Aid Program (PDF), OSHA suggests:

“Employers should make an effort to obtain estimates of EMS response times for all permanent and temporary locations and for all times of the day and night at which they have workers on duty, and they should use that information when planning their first-aid program. When developing a workplace first-aid program, consultation
with the local fire and rescue service or emergency medical professionals may be helpful for response time information and other program issues.”

The booklet outlines OSHA Requirements, recommended First-Aid Supplies, including Automated External Defibrillators, guidance on First-Aid Courses and Elements of a First-Aid Training Program. In addition to evaluating their own organization’s risk factors, employers should be aware of any state laws governing workplace first aid.
ANSI/ISEA Z308.1-2009 is the current minimum performance requirements for first aid kits and their supplies that are intended for use in various work environments. You can purchase these through the American National Standards Institute (ANSI) or the International Safety Equipment Association (ISEA). If you want to save a few dollars, you may be able to find a free copy, such as the one we found minimum contents list from the Minnesota Department of Labor and Industry.
Automated external defibrillators (AEDs) programs are an increasingly common component in a workplace health and safety program to address sudden cardiac arrest. These programs require some medical guidance and training to put in place.
Arguably, one of the most parts of your emergency planning should be to prepare your employees and your supervisors about what to do in the case of a medical emergency. Put your policies and protocols writing and communicate them to your employees frequently. Don’t forget to include solitary and remote workers in your emergency planning.

Labor Day Roundup: Here’s to the Workers

Tuesday, September 4th, 2012

As a belated tribute to Labor Day, we offer a smorgasbord of items about work, worker safety, and some of our favorite tributes to workers.
Celebrating the American Worker
America at Work – Alan Taylor compiles superlative photo essays for The Atlantic’s In Focus series. This collection of images from the recent Recession and its years of uncertainty — of men and women both at work and out of work in the United States.
Earl Dotter, Photojournalist – A remarkable portfolio of work documenting American workers. In the author’s words:
“For more than thirty five years the camera had enabled me to do meaningful work. Starting with Appalachian coal miners, and continuing through the years over a broad array of occupations in all regions of the country, I have observed and documented the working lives of Americans. Standing behind the lens, I have celebrated their accomplishments. I seek out those who are taking steps to improve their lives and their effectiveness at work, and use the camera to engage them by giving testimony to their achievements. The images that result tell of the satisfactions their work brings as well as its everyday challenges.”
Lost Labor – For more than 20 years, visual artist Raymon Elozua has been assembling a vast collection of company histories, pamphlets, and technical brochures that document America’s industrial history. This site features 155 photos from that collection – images of factories, machinery, and laborers hard at work. Many of the jobs depicted have faded into history. The artist grew up in the South Side of Chicago in the shadow of the giant steel mills and factories. His dad worked at U.S. Steel and his first job was at U.S. Steel, triggering a life long interest in everything about these industrial behemoths, from the architecture to the people who worked the jobs within. His interest in documenting this bygone era of American working life was sparked by the demise of the South Works industries.
Worker Safety
Hard Labor – The Center for Public Integrity says: “Each year, some 4,500 American workers die on the job and 50,000 perish from occupational diseases. Millions more are hurt and sickened at workplaces, and many others are cheated of wages and abused. In the coming months the Center for Public Integrity will publish, under the banner Hard Labor, stories exploring threats to workers — and the corporate and regulatory factors that endanger them.”
In particular, we point you to two recent stories:
Fishing deaths mount, but government slow to cast safety net for deadliest industry
Kentucky death case: Another black eye for state workplace safety enforcement
The Best Reporting on Worker Safety – ProPublica compiled “12 pieces of great reporting on workplace safety: from slaughterhouse diseases to lax regulatory oversight and deadly vats of chocolate.”
Workers in Popular Culture

From our archives

When it Comes to Safety, This is Just Ducky…

Monday, May 14th, 2012

We begin the week on a somewhat bizarre note, as Donald Duck does safety in this vintage 1959 cartoon clip entitled “How to Have an Accident at Work.” When it comes to safety, Donald is everyone’s nightmare worker. For those of us in the workers comp field, this may seem more horror film than cartoon, but Donald, unlike ordinary workers, is literally indestructible.

This clip was a sequel to “How to Have an Accident in the Home”

Safety Nets, Hard-Boiled Hard Hats & The Halfway to Hell Club: Safety Innovations in the Golden Gate Bridge Construction

Friday, April 20th, 2012

In an era when one death per million dollars spent on bridge construction was axiomatic, chief engineer of the Golden Gate Bridge Joseph Strauss decided his project would be different. He refused to accept the conventional wisdom that worker deaths were just a normal cost of doing business and introduced a series of safety innovations – you can see an overview in this brief video clip:

More on his commitment to safety during construction is presented in the PBS American Experience documentary “Golden Gate Bridge.” Perhaps the innovation that was most touted was the introduction of a safety net, “… similar to a circus net — suspended under the bridge. The safety net extended ten feet wider than the bridge’s width and fifteen feet further than the roadway’s length.” While there was one deadly accident when a scaffold platform fell and broke through the net resulting in 10 fatalities, there is no doubt the net saved many other lives. Nineteen survivors whose falls were stopped by the net became de facto members of “The Halfway to Hell Club.”
Strauss employed many other fascinating safety innovations, ranging from sauerkraut juice “cures” for men suffering from hangovers to special hand and face cream to protect against winds. But next to safety nets, the other noteworthy safety practice that emerged during the bridge’s construction was the reliance on hard hats. The hard hats of the era were called “hard-boiled hats,” and were made of leather and canvas. You can read more about the history of the hard hat at the Bullard site. Edward W. Bullard first introduced the hats in 1919, based on a doughboy hat he had worn in WWI. His hats were originally created to protect miners. The Bullard history says:

America’s first designated “Hard Hat Area” was set up at the San Francisco Golden Gate Bridge construction site. “The project’s chief engineer, Joseph B. Strauss, shared a vision with my grandfather that the workplace could be a safer environment for the worker. One problem the bridge project faced was falling rivets, which could cause serious injury,” said Bullard. “My grandfather transformed the mining helmet into a durable industrial hard hat.”

We would be remiss if we did not note that the status of being “the first official hard-hat area” is under some dispute – some contest that the Hoover Dam construction was the first work site to mandate hard hats:

The Bullard Company asserts that the first official “Hard Hat Area” was the Golden Gate Bridge project in San Francisco. The project’s chief engineer, Joseph B. Strauss, beginning on January 5, 1933, directed all the workers to wear hard hats to protect themselves from falling rivets and other materials. However, the Six Companies constructing Hoover Dam first required all its workers to wear hard hats by November 1931.Bullard-Hard-Boiled-Hats

Here’s a picture of the vintage “Bollard hard boiled hats” of the era, courtesy of Hal’s Lamp Post, a site with an excellent and very interesting collection of mining artifacts.

Original image source

100 Years of Workers Comp

Tuesday, April 3rd, 2012

vintage photo of ambulance and injured worker
We’re happy to bring you this 12-minute, must-watch video commemorating the 100th Anniversary of Workers Comp. The video highlights progress in worker safety, treatment of injured workers and risk management in the past 100 years. In addition to telling the history of comp, it also features three visionary women who were instrumental in furthering health and safety of workers…one of whom witnessed the Triangle Shirtwaist fire. Until this clip, I did not realize the strong role that women played in this history.
Kudos go to Sedgwick as well as to our colleague and friend Peter Rousmaniere. who wrote the script.
Here’s some additional information about the women highlighted in the video clip:
Crystal Eastman
Frances Perkins
Alice Hamilton MD

From imagination to reality in less than a century: Telemedicine and Electronic Health Records

Tuesday, March 20th, 2012

1925-feb-science-and-invention-sm-cover

Today, we slip back in time to 1925 and put on our Flash Gordon glasses to speculate about the future, a time when a doctor not only “sees what is going on in the patient’s room by means of a television screen” but also employs a robotic-like instrument called the Teledactyl (Tele, far; Dactyl, finger — from the Greek) to “feel at a distance.”

This image and the story comes from a delightful Smithsonian blog called Paleofuture in a post entitled Telemedicine Predicted in 1925. The post discusses an article by Hugo Gernsback that appeared in the February, 1925 issue of Science and Invention. You can read more about the intriguing robotoic Teledactyl device and Gernsback’s predictions for medicine of the future.
Fast forward to 2010, and we see how remarkably prescient Mr. Gernsback’s predictions were. Courtesy of a blog comment by Christoph Hadnagy, we find this link to a New York Times story on Denmark Leads the Way in Digital Care, in which 77-year old patient Jens Danstrup talks about what it’s like to be a telemedicine patient:

“You see how easy it is for me?” Mr. Danstrup said, sitting at his desk while video chatting with his nurse at Frederiksberg University Hospital, a mile away. “Instead of wasting the day at the hospital?”

He clipped an electronic pulse reader to his finger. It logged his reading and sent it to his doctor. Mr. Danstrup can also look up his personal health record online. His prescriptions are paperless — his doctors enters them electronically, and any pharmacy in the country can pull them up. Any time he wants to get in touch with his primary care doctor, he sends an e-mail message.

All of this is possible because Mr. Danstrup lives in Denmark, a country that began embracing electronic health records and other health care information technology a decade ago.

Adoption of Electronic Health Records in the US
The Centers for Disease Control issues an annual survey on the use of electronic health records in physician’s offices. Last year, partly bolstered by meaningful use incentives in the Affordable Care Act, use grew by 6%. Dr. Elliot King blogs on the EHR increase, noting that:

“In 2011, 57 percent of office-based doctors used electronic medical records/electronic health records (EMR/EHR), according to the CDC. That number compares to the 50.7 percent of physicians’ offices using EMR/EHR’s in 2010 and 48.3 percent in 2009.”

Some physicians are also taking to telemedicine via Skype, FaceTime and other video conferencing services. In Doctors who Skype: Renegades or Heroes?, Jean Riggle looks at the pros and cons of video chat as used by physicians. She notes that there currently aren’t any guidelines for electronic communication between physicians and patients and there there are several important questions yet to be solved:

  • How can these chats be integrated into the patient’s medical record?
  • Can the actual video be captured and inserted into the record or should a summary of the call suffice?
  • How should physicians be reimbursed for the time they spend using social media?

To follow developments in telemedicine, we offer a few sources:
HealthIT.hhs.gov
Federal Health IT programs
American Telemedicine Association
iHelathBeat
Healthcare IT News