Getting back in the game

Diligence, planning and solid communication can help get employees back to work after injury strikes

Story by Lee Marie Reinsch

IT’S SELDOM GOOD NEWS when an employee is injured at work.

No boss wants to pay out medical bills, face potential legal action, or endure lowered productivity from a hurt worker.

Yet, it’s a reality: Every week, U.S. businesses pay $1 billion for direct costs related to workplace injury, according to the Occupational Safety and Health Administration of the U.S. Department of Labor. That $1 billion goes to direct costs – worker’s compensation insurance premiums, medical bills and legal costs.

It doesn’t include costs considered to be indirect – such as loss of productivity, training for temporary or replacement workers, cost of accident investigation and correction, repair of damaged equipment or property, or lower workplace morale and increased absenteeism due to workplace injury.

But sometimes workplace injuries come with the territory. Accidents happen.

Miller Electric Manufacturing Co. in Appleton is among those companies working to perfect the science of getting employees well fast, nixing repeat injuries, and encouraging employees to want to return to work.

“The results we get from the corrective actions we take are incredible,” said Tim Kinney, safety manager for Miller Electric.

In 2007, Miller documented fewer than nine lost-time injuries thoughout its 1,500-employee Appleton sites. That computes to an injury rate of fewer than 0.6 injuries per 100 employees – a rate that’s half the national average of 1.2 injuries per 100 employees. Had Miller been “average,” 2007 would have seen 18 employees hurt on the job.

Thank goodness it’s not average, from Kinney’s perspective. He attributes his company’s safety program, which focuses on prevention, prompt attention and damage control, with the lower-than-average rate of injury.

But of course, even a better-than-average record is not enough for Miller.

“Our goal is zero,” Kinney said.

Keys to Miller’s safety success
IN A NUTSHELL, the Miller Electric injury review program involves a team analysis of the injury, medical assessment and accommodation of the employee’s limitations.

It involves the following three components:
1. A team analysis of what happened and why it happened aims to prevent the same kind of injury in the future.
Miller’s analysis is an investigation, Kinney notes, but there’s no finger-pointing.

“We call it fact-finding, not fault-finding,” Kinney said, adding that fault-finding doesn’t work because it leads everyone involved to get defensive.

About 99 percent of the time, the injury was caused by a breakdown in some process along the way and is not the employee’s fault, Kinney said.

“It’s too bad when somebody gets hurt once; shame on us if it happens twice,” he said.

2. Getting a medical opinion on what kinds of reduced activities the employee might be able to do in place of his or her normal duties instead of staying home from work.

Miller Electric has a pre-written reduced-activities list that Kinney said helps slash time off for work-related injuries.

Miller Electric was a test site for ThedaCare At Work’s occupational health and safety program for employers and remains one of its largest clients. Dr. Constantine “Gus” Dumas, medical director of ThedaCare At Work, said his program focuses on the positives.

“Our philosophy is to focus on what you can do, not what you cannot do; together, we come up with what you can do safely,” said Dumas.

It usually doesn’t mean giving the employees time off from work altogether.

Dumas indicated that whereas 30 years ago, the prevailing medical advice for back strains started with bed rest, that’s not the case anymore.

“Now we feel (bed rest) is almost as bad as going out and lifting a heavy object right away again.”

Rather than banish a worker from a specific type of work, Dumas prefers to make general physical restrictions based on anatomy and not on a particular job.

“We try to avoid saying things such as ‘Don’t work on Line 4’ but keep (restrictions) very generic in terms of postures and weight and repetition,” Dumas said. “Often the patient may try to direct that (asking the doctor to take them off work or off a particular job), and we try to avoid that.”

For many injuries, staying active is part of the way back to good health, Dumas said.

3. Accommodation of limitations.
A group consisting of representatives from Miller management, the medical field and the injured employee arrives at ways the company can accommodate the employee’s limitations.

“Many minds are better than one,” Kinney said. “We want to take corrective action as soon as possible and hopefully this will not result in (lost productivity time).”

If the employee has to be off work, a department nurse will advise how the employee’s restriction can be accommodated. Sometimes, depending on the type of injury, an engineer might be present to troubleshoot the functioning of a machine or the way a duty is carried out.

Kinney said getting the employee’s input helps the employee feel better about the pathway to recovery and, in turn, helps the employer.

“Employee buy-in is essential; that’s the only way you will be successful,” Kinney said.

Managing injuries
“FIRST WE FIND OUT HOW it happened, because that is useful information in terms of preventing future injuries,” said Dr. Dumas of ThedaCare At Work.

He aims for open communication and rapport with the companies that contract with ThedaCare At Work occupational health services. Often developing that rapport involves visiting the companies to see what’s going on and how duties are being performed. Site visits also help physicians like Dumas determine whether an injury is truly work-related.

“Some are obvious, but some turn out to be repetitive trauma,” Dumas said. “So having an idea what goes on at the job makes it easier to differentiate. We take a detailed history and document the whole story.”

Dumas divides workplace injuries into two main categories: acute and long-term injuries. Both require figuring out how to manage the injury with those two things in mind.

“Returning to work is always the goal. We understand the importance of keeping people active and returning them to work, but also doing so in a safe manner,” Dumas said. “The longer they are off, the less likely it is that they will return to work.”

If an employee is off work for a whole year, they get into a new routine, Dumas said, and chances are nil they’ll return to work.

“Psychologically, they can take on a disabled mindset” or suffer depression, he said. “Psychologically, it is best for the employee to keep working,” even in a reduced capacity.

A quicker return to work might also be the best physical therapy solution for the employee, and a more cost-effective financial solution for the employer.

Louann Biddick, on occupational health-certified nurse practitioner in the work injury clinic with Agnesian Healthcare in Fond du Lac, said there are very few dangers to returning an employee to work right away.

“For healing purposes, it’s best that the muscles be kept moving,” Biddick said. “Our goal is to assess them, care for them conservatively with the goal of returning them to work but with a limited amount of activity – no lifting above 10 pounds, for example.”

By conservative care, Biddick explained means with ice, physical therapy and anti-inflammatory medications.

“We wouldn’t order an MRI right away,” she said. “We would coordinate the care so that we get them back to work in a cost-efficient manner.”

That conservative initial care can keep workers’ comp premiums down as well as costs associated with temporarily replacing the worker.

Hands-on pain
CHIROPRACTOR DR. MICHAEL FLETCHER deals firsthand with a lot of hurting people. The co-owner of Belville Fletcher Chiropractic in Oshkosh cites nurses lifting patients and prison employees dealing with uncooperative inmates as among the professionals that regularly land in his office.

“The employee wants to be rid of pain and restore normal function,” Fletcher said.

Complicating matters are the varying combinations of factors in each patient’s body, from genetics and posture to recreational activities and the type of job they perform.

“No two individuals are the same. How one responds to medical therapy or physical therapy or chiropractic therapy is different for everyone else,” Fletcher said.

But he can understand the employer’s point of view – they want their worker back.

“As an employer, you always want to get the employee back to doing what they know best... you want to get them back to normal,” Fletcher said.

Seeing both vantage points doesn’t change the fact that everyone’s different, and so is every injury. Fletcher aims to make both sides happy, but that doesn’t always happen.

Ultimately, Fletcher stands by his patients against what he calls “cookbook timeframes” that artificially rush a patient back into the job site and the potential for re-injury.

“Certain companies work well with getting people back to work, but some companies don’t listen, and they push the person beyond their means too soon,” Fletcher said. “Re-injury is a step backward.”

Fletcher also said he’s seen far too many instances of companies taking measures that appear to be proactive from a perspective of safety, but in effect are not.

“When companies are telling their employees that they’ve had (a record number of) injury-free days, it weighs on people’s minds that this is a conscious effort by the company; that this is a good thing (to remain injury-free),” Fletcher said. “But it can be a double-edged sword, because it can make an employee less likely to report that they are hurting.”

After all, who wants to be the party-pooper that breaks the streak?

What’s more, Fletcher said, having on-site medical staff doesn’t necessarily guarantee that employees receive appropriate and timely treatment. In fact, Fletcher ventured to say he “hasn’t found (on-site medical facilities) effective at all.”

“Some of those injuries progress pretty badly, and when we get them later, most people we have seen have been either told you have a low back strain or a pulled muscle, and then (weeks or months down the road) it manifests itself as a herniated disk or worse,” Fletcher said. “They have held off treatment for so long, and we should have seen them right away.”

It makes a difference who evaluates that injury in the workplace, Fletcher said – not all emergency medical technicians or nurses are alike.

“Some are not as good as others. Some are very good,” Fletcher said. “Some (work) groups don’t have the qualified people they should have. If you are going to make judgment calls on people’s health, you don’t want to string them along from the inside out.”

The pitfalls of releasing a patient back to work on light duty is that it’s not uncommon for a supervisor to ignore the restrictions, Fletcher said.

It alarms Fletcher when his patients report receiving negative feedback at work – comments such as “Joe is faking it.” With most of the injuries he treats, there’s no blood, no maiming, no cast and no way for co-workers and supervisors to visually see the pain.

But he’s in agreement with Dumas that open communication between doctor, patient and employer – and with light duty work whenever possible – is the way to make the bad situation move in the right direction.

An alumna of Ripon College, Lee Marie Reinsch is a freelance writer based in Green Bay.