Muscular Skeletal (MS) injuries to nurses and nursing aides have become an epidemic in America. At least, according to the American Society of Safety Engineers (ASSE) recent Safety Culture in Healthcare, The $13 Billion Case, a peer-reviewed feature in the October issue of Professional Safety, the Society’s journal .
The article’s author, Scott Harris, Ph. D., MSPH, says, “Pick any other industry, and the injury rate is less.” And he’s pretty much right.
Patient handling is the driver. According to NIOSH (National Institute for Occupational Safety & Health), the most a nurse or aide in the 90th percentile of strength should lift at any one time is 46 pounds. But a typical 8-hour workday in this field involves lifting about 1.8 tons. Twelve percent of registered nurses who quit the field report that they do so because of back pain due to patient handling.
This resonates with me. Lynch Ryan opened its doors in 1984. Our very first paying client was a community hospital, where patient handling injuries had caused the hospital’s experience modification factor to balloon to 2.77. Working with the nursing staff and Human Resources VP, we were able to introduce necessary management policies and procedures as well as a sophisticated modified duty program that cut workers comp losses by more than 80%. However, the muscular skeletal injuries kept happening, because patients kept having to be moved. So, the hospital bought two Hoya Lifts – yes, there were Hoya Lifts in 1984.
Getting staff to use the Hoya Lifts was an entirely different problem. It was actually harder than creating and systematizing the modified duty program, because using the lifts significantly increased the time it took to move the patient, and one thing nursing staff didn’t have a lot of, and still don’t, was time. Instituting the new patient handling protocols involved a lot of training. We had to create rules, procedures, metrics and accountability. Even so, it was incredibly difficult.
Over the year’s we’ve worked successfully for more than 120 hospitals, from tertiary care systems to single site community hospitals. But regardless of how much we’re able to help reduce workers comp loss costs, the patient handling problem never goes away.
Back to the Future
Now, nearly thirty years from that first engagement, the only thing that seems to have changed is that the problem has become more dire, turning into an industrial many-head Hydra.
The average age of a registered nurse is now nearly 47. For Home Health Aides (HHA), it’s 46; for Certified Nursing Assistants (CNA), 39. Wages for the aides and assistants average between $11 and $12. Forty percent have been on food stamps and many get their own healthcare through Medicaid. (See: HHS Direct Care Workforce) The BLS (Bureau of Labor Statistics) estimates that the demand for HHAs between 2010 and 2020 will grow by 69%; CNAs, 40%. Collectively, we are confronted with a critical shortage of healthcare talent. According to the U.S. Department of Health & Human Services, “Direct care work is difficult, the wages are low and fringe benefits are often limited.”
It’s the same with registered nurses where, oftentimes, the shortage is self-inflicted. A study of 21 hospitals in the Twin Cities found that when registered nursing positions were decreased by 9%, work-related illnesses and injuries among nurses increased by 65% (Trinkoff, et al., 2005).
Nonetheless, the BLS reports that between 2010 and 2020 the fastest growing occupation in America will be Registered Nursing (HHAs and CNAs follow close behind). The need is an additional 1.2 million nurses. In 2011 one out of every five new jobs created in America was in Healthcare. We should be graduating 30% more nurses than we are per year. But a shortage of nursing faculty prevents nursing schools from expanding to accommodate the demand. In 2011, nearly 76, 000 otherwise qualified candidates were turned away by nursing schools. This means that there will be fewer nurses and aides to go around at a time when hospital populations are growing much larger (both in numbers and size), meaning that the stresses involving patient handling will continue to intensify.
Patient handling injuries account for 53% of healthcare workers compensation loss costs. The mean average costs are five times higher for injured employees over the age of 45 than for those under the age of 25. Muscular skeletal losses per full time equivalent are well over $300, regardless of age.
I asked Rick Graham about this. Rick is Corporate Director, Insurance & Risk Control for Crozer Keystone Healthcare System in Delaware County, PA, and a Lynch Ryan client. Patient handling bedevils Crozer Keystone in general and Rick in particular. Crozer, like many hospital systems has been wrestling with the issue for decades. Through Rick’s efforts, the system has introduced a number of initiatives to deal with the issue, and, while many have proven somewhat successful, the problem remains. Rick now concludes that the only answer is to remove the people factor from the lift factor.
He also realizes that having lifting equipment built into every patient room is the only way to significantly increase patient handling protocol compliance. The system has done this in an acute care setting and has seen a significant decrease in injuries and costs. It’s the simplest solution, but the costliest. Trained lift teams could work (they’ve been shown to in one California hospital study dating from 1997), but lift team members get hurt, too, and they present logistical difficulties. Rick estimates that the ROI from installing the equipment is two years, but the budget issue is still daunting.
The bottom line is this: As Crozer Keystone is demonstrating, the healthcare industry, confronted with a tsunami of personnel, safety and workers comp issues, has got to begin – finally – to meet these challenges with the resources necessary to overcome them. Anything less will send healthcare in America to a far worse place than the rocky place it now inhabits.
Posts Tagged ‘healthcare industry’
Patient Handling: Another Big Log on the Healthcare Fire
Tuesday, November 26th, 2013Health literacy: employees at risk
Wednesday, February 28th, 2007Last week, Ezra Klein put the issue of health literacy back on our radar screen with a link to a recent Washington Post article, A Silent Epidemic. The article discusses the complexity of the health care system, and how a huge swath of the population is unprepared to effectively engage that system because of functional illiteracy, language, or culture. The article cites a 1999 report by the American Medical Association finding that most medical forms are written at a graduate school level while the average U.S. adult has eighth-grade level literacy skills. Another study cited painted a bleaker picture:
A study published in the Journal of the American Medical Association in 1995 found that more than 80 percent of patients treated at two of the nation’s largest public hospitals could not understand instructions written at the fourth-grade level for the preparation of gastrointestinal X-rays known as an upper GI series. A 1999 study of more than 3,200 Medicare recipients found that one in three native-born patients could not answer a question about normal blood sugar readings even after being given a paper to read that listed the correct answer. And a study of 2,500 elderly patients published last year in the Journal of General Internal Medicine reported that patients with low health literacy were twice as likely to die during a five-year period as those with adequate skills, regardless of age, race or income.
The Joint Commission recently issued a report 65-page report on this issue entitled “What Did the Doctor Say?”: Improving Health Literacy to Protect Patient Safety (PDF), but if you’d like a quick executive summary, see recent press release on Low Health Literacy Puts Patients at Risk, which offers a summary of the issue along with some specific recommendations for healthcare providers to address the problem. These include:
- The sensitization, education and training of clinicians and health care organization leaders and staff regarding health literacy issues and patient-centered communications.
- The development of patient-friendly navigational aids in health care facilities.
- The enhanced training and use of interpreters for patients.
- The re-design of informed consent forms and the informed consent process.
- The development of insurance enrollment forms and benefits explanations that are “client-centered.”
- The use of established patient communication methods such as “teach back.”
- The expanded adaptation and use of adult learning centers to meet patient health literacy needs.
- The development of patient self-management skills.
- Health care organization assessment of the literacy levels and language needs of the communities they serve.
- The design of public health interventions that are audience-centered and can be communicated in the context of the lives of the target population.
- The integration of the patient communication priority into emerging physician pay-for-performance programs.
- The provision of medical liability insurance discounts for physicians who apply patient-centered communication techniques.
Workers compensation implications
This issue has great relevance to employers for the implications that health literacy can have on workers compensation, general disability, and general work force wellness. Good outcomes require good communication. If you want to ensure that your workers get good medical care and return to health and to work as soon as possible, effective communication between the injured worker and the treating physician is essential. And it would appear that if the average reading comprehension is at eighth grade level, few employers are immune. The challenges for employers with a high population of unskilled workers or workers who have or no English are even greater.
First and foremost, employers and managers should understand the risks inherent in their work force. Illiteracy is also an issue that with enormous implications for safety and training. Organizations with a work population that is at high risk from a health literacy perspective should also take particular care to select physicians who have cultural competence. And when a work injury occurs, there may be a need for a health care liaison to help and advocate for the injured worker. For complex cases, this might be a nurse case manager. For simple injuries, employers might assign a workers comp injury coordinator who would follow up with the injured worker frequently during the recovery process, and verify that medical instructions are understood and being followed. A translator might also be part of the care team if the worker has limited English.
Related posts:
When it comes to safety, make sure you speak the same language!
A health literacy crisis looming?
Cultural competence in healthcare and beyond
Google New Hires!
Monday, June 20th, 2005If you were to Google the name “Dr. Jayant Patel,” you would find over 20,000 references going back a number of years. The more recent entries are undoubtedly the most alarming. “Dr. Death” has been implicated in the demise of 87 patients at a municipal hospital in Bundaberg, Australia. He has become infamous for not washing his hands between surgeries, for failing to use anesthesia during surgery and perhaps most famously, for performing a colostomy backwards (I’m not sure what that would look like, and I don’t really want to know). If you do take a few moments to google his name, you would be more diligent in researching the doctor than were his previous employer and the executive recruitment firm that brought him to Australia. Therein lies our tale.
Bundaberg is a farming community on the eastern coast of Australia, just south of the Great Barrier Reef. They are famous for “Bundy Rum” — an alcoholic beverage that presumably bears no relationship to the star of the dubious sitcom, “Married with Children.” The local municipal hospital was delighted to find a former professor of surgery at the State University of New York who was willing to relocate to Australia. Unfortunately, his tenure down under was not unlike his work in Oregon and New York. He had been suspended in New York and his license had been revoked in Oregon, where he had once worked for Kaiser Permanente.
Whistleblower Blown Off
One of the striking aspects of the story as presented in the New York Times (registration required) involves the head nurse at the hospital, Toni Ellen Hoffman. She continuously raised her concerns about Dr. Patel’s performance with hospital administrators, only to be told that she had a “personality problem.” After a particularly shocking incident, where a 9 year old girl watched her father die through Patel’s neglect, the nurse requested an inquiry. The administration’s response? They named Patel as the employee of the month!
Finally, as the result of a legislative inquiry, Dr. Patel’s name was published in a paper. An enterprising reporter Googled the name and the scandal finally exploded. Dr. Patel fled the country, returning to Oregon where he lives in a mansion and appears to be unenthusiastic about returning to Australia, where he could face charges of homicide.
Management Lessons
We often talk about the potential negligence involved in hiring and entrusting incompetent or dangerous people to carry out their responsibilities. Here we certainly have a case of negligence in hiring: the hospital in Bundaberg was so excited to find a credentialed foreigner willing to join their staff, they did not look beyond the documents he presented about himself. As we have seen, a simple Google search would have exposed Patel as both incompetent and dangerous.
In addition, Patel carried letters of reference from several of his Oregon colleagues. These letters were provided after his termination for cause; the doctors who wrote them are likely to find themselves involved in the many lawsuits that are going to come out of this situation, under the legal concept of “negligent reference.” Then again, perhaps the colleague who described Patel as “above average” has a very low opinion of the average doctor!
Beyond these examples of negligence, hospital administrators really messed up when they failed to respond to the alarms raised by a trusted member of the staff. The administration went into a denial mode that will severely compound their negligence in hiring: it’s bad enough to drop the ball on reference checking, but far more serious to ignore the evidence right in front of your eyes. The lawyers will have a field day.
Some are calling Patel a psychopath. Others think he is simply incompetent. The bottom line is that he did not belong in any operating room, anywhere in the world, including one in a relatively remote town on the shores of Australia. With the advent of the internet, the HR folks in Australia had access to the same data available in New York City. So here’s our advice: google new hires. It doesn’t cost anything, it only takes a few moments, and it might save you a whole lot of pain, suffering and trouble.
Managers’ tool kit: new healthcare, socioeconomic, and interactive resources
Monday, February 7th, 2005It’s been awhile since we’ve added new resources to the toolbar on the right. We hope to create a one-stop shop of valuable workers compensation, HR, medical, and health & safety resources for industry practitioners, as well as for workers. Here are some recent finds:
Since 1997, Pam Pohly’s management guide for healthcare executives has been seeking and posting a broad array of healthcare resources, including legislative and compliance updates, professional association directories, employment search services, practice management tools, healthcare news and more. The site contains hundreds of links, including toolkits for health administrators, physician executives, HR managers and nursing managers. The glossary of managed care terms is a handy tool for workers comp managers, and the calendar of health observances is good reference for safety and wellness programs.
EconData.Net has thousands of links to socioeconomic data sources, arranged by subject and provider, pointers to the Web’s premiere data collections, and a list of the ten sites they judge as being the best sites for finding regional economic data. Need to find population or demographic data or trends? Employment statistics? Labor force by occupation? Wage trends? You’ll find resources at this deep site.
Interactive Tools
The Liberty Mutual incidence calculator allows you to determine your own incident rates and compare your rates to other companies in your SIC group.
American Express has an interactive hiring tool that helps you to think through the skills and characteristics you need to create a job description, and lets you generate a worksheet to use in your interviewing process, and provides questions that may be helpful in interviews.
If you are an employer in Michigan, you can use an online calculator to estimate your workers’ compensation costs. This analytic tool uses ” … your work force data to provide you with a general case study looking at your potential costs. Your actual results in the “open market” will vary depending on a number of factors.”
NIOSH issues alert for healthcare workers who are exposed to hazardous pharmaceuticals
Friday, June 11th, 2004If you asked the average “man on the street” to name dangerous professions, chances are nursing and other healthcare professions wouldn’t make the list. Yet according to the Bureau of Labor Statistics, hospitals have the second highest rate of nonfatal injury or illness cases. Many of the risks are well known: back injuries and musculo-skeletal disorders from lifting patients; exposure to blood-borne pathogens; and injuries resulting from assault by patients.
Somewhat less obvious are the risks posed by exposure to hazardous drugs. Recently, NIOSH released a lengthy alert about chemotherapeutics and other drugs. As many as 5.5 million healthcare workers — including nurses, pharmacists, physicians, and veterinarians — are exposed to antineoplastic and other hazardous drugs in the course of their work:
“Healthcare workers who prepare or administer hazardous drugs or who work in areas where these drugs are used may be exposed to these agents in air or on work surfaces, contaminated clothing, medical equipment, patient excreta, or other sources. Studies have associated workplace exposures to hazardous drugs with health effects such as skin rashes and adverse reproductive events (including infertility, spontaneous abortions or congenital malformations) and possibly leukemia and other cancers. The health risk is influenced by the extent of the exposure and the potency and toxicity of the hazardous drug. Potential health effects can be minimized through sound procedures for handling hazardous drugs, engineering controls and proper use of protective equipment to protect workers to the greatest degree possible.”
The NIOSH alert is a “prepublication” report that will undergo further editing before a final release sometime this year. The final report will present a voluntary guideline that will include information on more than 100 drugs and will offer detailed recommendations for control measures that should be taken by employers and employees to reduce risks. Many measures assumed to be adequate in the past may not be sufficient protection in response to the risk.
In an article in entitled Do more to protect health workers from chemo agents that appeared in Hospital Employee Health, Thomas Connor, PhD, a research biologist with NIOSH in Cincinnati and an author of the alert indicated that workers may not be aware of the risk:
“Exposure may occur in these situations: Drugs are reconstituted or diluted. Nurses or others expel air from syringes or give injections, and small amounts are aerosolized. Uncoated tablets are counted or dosed in a unit-dose machine. Health care workers touch contaminated surfaces, patients’ body fluids, or contaminated clothing and linens. Workers prime the IV with drug-containing solution or administer the drug with the IV.
Every step along the way, you have the potential for release and exposing the workers, says Connor. I don’t think people are aware of it. They can’t see it [because the drugs are colorless] and don’t think there can be a spill.”
Requests for printed copies when they become available can be made through the NIOSH toll-free information number, 1-800-35-NIOSH, or by contacting the NIOSH Publications Office through the NIOSH web page.
A health literacy crisis looming?
Friday, April 16th, 2004A few weeks ago, we featured an article that discussed the need for cultural competence in healthcare – “the ability of providers and organizations to effectively deliver health care services that meet the social, cultural, and linguistic needs of patients.”
More recently, The Health Show pointed us to a recent report by the Institute of Medicine (IOM) suggesting that 90 million Americans face significant health literacy issues. The IOM emphasizes taht this is not simply an issue that faces the uneducated or the poor. According to the report:
“Health literacy skills are needed for discussing care with health professionals; reading and understanding patient information sheets, consent forms, and advertising; and using medical tools such as a thermometer. Over 300 studies indicate that health-related materials cannot be understood by most of the people for whom they are intended.
Individuals are increasingly responsible for managing their own health care, the committee noted. They are assuming new roles in seeking information, measuring and monitoring their own health, and making decisions about insurance and options for care. Patients’ health often depends on their ability and willingness to carry out a set of activities needed to manage and treat their disease. This self-management is essential to successful care of chronic diseases such as diabetes, HIV, and hypertension. Patients with chronic illness who have limited health literacy are less knowledgeable about disease management and less likely to use preventive measures.
Limited health literacy is not a problem that starts and ends with patients, the committee added. Health systems are becoming increasingly complex, involving new technologies, scientific jargon, and complicated medical procedures and forms. All of these aspects of the health system can be confusing to patients.”
In the midst of this increasing complexity, throw the $3 billion in annual drug advertising that pharmaceutical companies spend on direct-to-consumer advertising into the mix. While ads previously focused on discretionary types of treatments, pharmaceutical companies are increasingly advertising complex treatments for serious health conditions.
To remedy the health literacy issue, the IOM suggests that practical health education and skills be added to the curricula from kindergarten through high school, as well as in adult education and community programs.
From a workers comp perspective, this makes the case for nurse case managers as health care advocates and educators, particularly in complex cases. However, case managers are often introduced too late in a claim after the treatment trajectory has been set. Also, their role is too often viewed as mere “cost control” when the most effective goal would be to foster recovery and return to work.