Advantage Health Systellls, Inc. Offering Industry the Advantage Margot Miller, PT Occupational Health Specialist Advantage Health Systems, Inc. Cloquet, Minnesota
Business & Health (Fruen, 1992) reports that employers and their insurers say they can reduce disability and related costs through prevention strategies and early intervention. Employers are finding that by integrating their short- and long-term disability programs and focusing on managing the early stages of illness and injury, employees can return to work earlier, short-term disability cases can be kept from becoming long-term disability cases, and thousands and thousands of dollars can be saved. For the providers of early intervention and prevention programs and services, this is good news, indeed! For years, therapists and other professionals have been trying to "sell" industry on such programs, often meeting resistance from management. That situation, however, has changed: employers are beginning to recognize the value of early intervention and prevention and are even seeking out providers of these programs and services. Employers are taking a proactive approach in an effort to cut costs and better manage workrelated injuries and illnesses. Actions by the Occupational Safety and Health Administration (OSHA) have influenced employers as well. The Occupational Safety and Health Act of 1970 (OSH Act; U. S. Department of Labor, 1991) states that it is the general duty of all employers to provide employees with a workplace free from recognized hazards. The OSH Act was passed in an effort to provide safe working conditions for all American workers. It grants OSHA the authority to authorize stiff penalties for those employers who fail to provide safe working conditions. This includes the prevention and control of ergonomic risks and hazards.
A few years ago, many industries began noticing an increase in injuries and illnesses related to repeated exposures to risk factors that exist in the workplace. These injuries and illnesses are known as cumulative trauma disorders (CTDs). OSHA has recognized the importance of preventing injuries and illnesses that are a result of employee exposure to ergonomic risk factors and therefore has published guidelines and recommendations to assist industry in implementing safety and health programs that include ergonomics. The goal is to reduce employee exposure to conditions that lead to CTDs and related injuries and illnesses. The Ergonomic Program Management Guidelines for Meatpacking Plants (U. S. Department of Labor, 1991) suggest the following components be included in an ergonomic program: worksite analysis, ergonomic controls, medical management, and training and education. These four components should include a high level of management commitment and employee involvement as well. Finding solutions to the problems posed by ergonomic hazards may well be the most significant workplace safety and health issue of the 1990s. Advantage Health Systems, Inc., is one company that is dedicated to preventing injuries and illnesses in the workplace by eliminating and controlling their causes. Advantage Health has specialized in occupational health and employment issues since 1984. Advantage Health offers employers of employees who report a high incidence of CTDs a comprehensive medical ergonomics program. Services include medical management, worksite analysis, ergonomic controls, training and education, and data systems. Services are delivered to a broad spectrum of clients ranging from manufacturing to service industries. While clients' often seek out Advantage Health because of high workers' compensation claims or OSHA compliance concerns, the company's orientation to preWORK 1993; 3(2):48-52 Copyright © 1993 by Andover Medical
The Advantage Health Systems Advantage
vention has attracted clients interested in taking a proactive approach as well: "Give Your Company the Advantage" and implement an effective, systematic control program for CTDs (Advantage Health Systems, Inc., 1991).
49
3. Develop internal staff capabilities to implement and monitor control measures. 4. Establish a cost-effective prevention program. 5. Maintain concise, accurate, and defensible records.
SYSTEMATIC CONTROL PROGRAM ERGONOMIC HAZARDS Hazardous factors in the workplace are often due to poor workstation layouts, improper biomechanical work methods, use of improperly designed tools, and job-flow design problems. Identified risk factors include repetition of motion, force, angle or body posture, vibration, temperature, and gloves and other protective equipment. Even where the ergonomic hazards of cumulative trauma exist in the workplace, it is believed that only a small segment of the work force will actually develop disabling CTDs. Unfortunately, treating only the symptoms of CTDs is unsatisfactory, as it results in the high cost of medical evaluation and treatment, lost work time, and production slow down. This results in abuse of the workers' compensation system and certainly does not address identification and control of the ergonomic hazards.
EMPLOYERS CAN TAKE CONTROL Advantage Health specializes in programs to prevent and control CTDs in industry. Advantage's team of professionals includes occupational and physical therapists, certified safety professionals, ergonomists, vocational specialists, nurses, and physicians, each with extensive experience in industrial programs. The relationship between the Advantage team and the client is a partnership to achieve the desired control objectives. There are five program objectives: 1. Determine if current procedures are appropriate and cost effective. 2. Identify and monitor employees who are currently at risk, developing problems, or possibly abusing the system.
Advantage Health's systematic control program for CTDs is a comprehensive medical ergonomics program consisting of medical management, worksite analysis, ergonomic controls, training and education, and data systems. Each component will be reviewed separately.
Medical Management Medical management can be defined as the process of moving an injury or illness from beginning to end in an efficient and effective manner. Medical management includes monitoring the activity in a case and determining and implementing a plan of action to maximize the outcome and minimize the total cost of a case. Control is achieved through management commitment, early identification and intervention, policies and procedures, trained and adequate staff, development of a local occupational health network, and case management. Each of these factors is critical for effective medical management. Management commitment. The support of top management indicates that the company has been "sold" on the program and officially endorses its implementation, that the necessary resources have been committed, and that authority has been vested in company personnel to ensure that the program proceeds. Certainly, the more consistent a medical ergonomics program is with the prevailing values of the company, the more likely it is to be endorsed. To be a healthy company, healthy employees are needed. To have healthy employees, health and safety must be valued as highly as productivity. With the visible involvement of top management, employees will realize that management has a serious commitment to the ergonomics program. Early identification and intervention. Effective management hinges on the ability of the organization to identify and treat workplace injuries
50
WORK / SPRING 1993
and illnesses in their early stages. An early intervention program is an in-house employee assessment and treatment program that is designed to recognize problems early and take care of them. Early identification of CTDs and appropriate intervention can prevent short-term impairments from becoming long-term disabilities. Strategies such as flexible work schedules, job accommodation, job modification, and alternate or modified duty positions foster stay-at-work or prompt return-to-work outcomes. Policies and procedures. Existing company policies and procedures must support a medical ergonomics program. A company's culture is reflected in the various policies it adopts; therefore, policies supportive of medical ergonomics indicates a company commitment to human resources, a company that recognizes employees as its most important asset, and a company striving to do the best for its employees. Within this context, a disability that interferes with an employee's productivity becomes a matter of serious moral, legal, and financial concern and requires prompt attention. Trained and adequate staff. Companies must be willing to devote resources to adequately train staff interacting with injured employees or employees reporting CTDs. Poorly executed interventions by managers or supervisors can have a disastrous effect on the entire disability process. Often, attitudes and expectations regarding disability create bias and can hinder the process as well. Open communication and education of personnel at every level within the company regarding the medical ergonomics program will insure that all buy into the new initiative. Development of local occupational health network. Another key issue in effective medical management is the relationship of the company with its outside medical providers. Establishing a local network of physicians, therapists, and other medical providers that are able to communicate with and meet the specific needs of the company in the management of workplace injuries and illnesses will help ensure that employees receive high quality and medically effective health care in a cost-effective manner. The system works to prevent excessive or inappropriate treatment, return
employees to full duty more quickly, and save costs. In fact, a study conducted by the Northwestern National Life Insurance Company found that rehabilitating disabled workers can save companies as much as $30 for every $1 spent (Employee Rehab Can Save Millions for U. S. Companies, 1989). A network composed of quality occupational health providers can effectively control lost productivity, maximize an employee's recovery, reduce time lost from work, and prevent escalating disability costs within the company. Case management. Companies are now applying the case management model to the return-to-work process and experiencing positive results. Case management most simply describes a number of approaches to planning, coordinating, and providing health care. It is a process concerned with more than simply monitoring and limiting the volume of services. Its prime focus is the organization and sequence of services and resources to respond to an employee's individual health care needs. A variety of mechanisms are used to monitor the use of services by employees and evaluate their quality, appropriateness, and cost effectiveness. Such mechanisms include utilization review, second surgical opinions, auditing services, telephone coordination of care, on-site coordination of medical care, direct assistance in returning to work, etc. The biggest payoff for companies is that their employees receive highquality, medically effective health care in the most appropriate and cost-effective way possible.
W orksite Analysis The second component of a medical ergonomics program is worksite analysis. A comprehensive risk analysis determines where ergonomic hazards exist and identifies potential ergonomic controls. In addition, work site analysis provides comprehensive job descriptions for use in medical management of injured employees and compliance with the Americans with Disabilities Act. Worksite analysis is a process of gathering information about the worker, task, machines, environment, and the interaction that occurs between each component. Observations, surveys, and interviews are collected from employees, supervisors, engineers, and others. Measurements and
The Advantage Health Systems Advantage
videotape recordings are taken to get an exact description of these interactions. These measurements are formulated into a logical explanation. The results of worksite analysis are used to evaluate how jobs, work methods, work practices, tasks, and workstation design may affect employee comfort. This data collection method is used for describing workplace risk factors such as force, repetition, and awkward posture to isolate the problem areas of the job. The work site analysis data, once analyzed, indicate how each risk factor affects employee comfort while performing the job. This is the first step to eliminating and controlling exposures. The results of work site analysis are also used in the medical management component of the ergonomics program to assist in safe and effective return to work after injury. In addition, the results can be used to describe the job in terms of its physical requirements for the purpose of compliance with laws requiring nondiscriminatory hiring practices.
Ergonomic Controls Ergonomic intervention to control CTDs includes modifications that workers and management can implement as well as items that require engineering expertise to provide the most effective and safe working environment. Advantage Health uses a problem-solving model that includes employee participation and a systematic documen'ation process that identifies the best combination of control measures based on the company's unique situation. Ergonomic controls are methods of modifying problem jobs identified in work site analysis. There are three primary types of ergonomic controls: worker controls, administrative controls, and engineering controls. Worker controls are controls that the workers can make themselves, such as using proper lifting techniques. Administrative controls are controls that management can make, such as changes in policies and procedures. Engineering controls are changes that are made by the engineering or maintenance department, such as changes to equipment. Workplace injuries and illnesses can be controlled when workers, managers, and engineers
51
work together. Each of the three control areas overlaps with the others. For example, changing the layout of a workstation could be done by the employee in some instances, but may require engineering changes in others. Developing and using ergonomic controls are team efforts, requiring a coordinated approach and a sense of shared responsibility.
Training and Education In training and education, each level of the organization receives necessary information on CTDs and the ergonomics program. Emphasis is on a team approach. Training and education allow managers, supervisors, and employees to understand ergonomic and other hazards associated with ajob or production process, their prevention and control, and their medical consequences. The purpose of training and education is to ensure that employees are sufficiently informed about ergonomic hazards to which they are exposed and therefore able to participate actively in their own protection. Upper management receives an overview of the program, information on measuring the success of the program, and information on when to expect bottom-line results. Medical department employees receive training in the medical management aspects of the program. Engineering personnel receive training in ergonomic principles and implementation of engineering controls to prevent workplace injuries and illnesses. Employees receive training in general ergonomic concepts, what they can do to prevent injury, and how they can participate in the process of implementing ergonomic controls. Supervisors receive training in general ergonomic concepts and issues specific to appropriate supervision for prevention and management of injuries and illnesses. A single department within an organization cannot successfully manage injuries and illnesses. A coordinated approach involving all levels of the organization is necessary for successful program outcomes.
Data Systems The ability to collect and analyze disability data is crucial to managing disability costs. Companies
52
WORK / SPRING 1993
are turning to data collection and analysis to assist in cost management, objectify patient assessments, and provide information regarding rehabilitation program outcomes. J. C. Bisgard, M.D., corporate medical director for Pacific Bell, reports that to manage health-related costs, the costs must first be tracked. "An effective health data management system provides us with the critical capability to monitor and link health-related costs through all corporate health systems" (Moser, Wilkerson, and Yeater, 1991). Effective disability intervention and return-to-work programs start from an organized cost-control strategy. Of most benefit to employers are data collection and analysis systems that track short- and longterm disabilities, flag "problem-oriented" diagnoses, compute trends, calculate return-to-work dates, and monitor employee demographic information (Carbine, Schwartz, and Watson, 1989). Employers can use the data much like a "decision tree" and determine the best path to follow to achieve optimal disability management outcomes. Advantage Health's data management system incorporates comprehensive data collection and analysis. The data systems provide maintenance and reporting for OSHA log reporting, lost/restricted duty days, outside medical provider tracking, training program tracking, job matching, workers' compensation, Americans with Disabilities Act, case management, early intervention programs, monitoring, and employee health status tracking. Experts agree that a program's data base will
be only as good as the kind and quality of data available to the system (Carbine and Schwartz, 1987). Top-quality comprehensive data systems offer numerous advantages to industry. First, they can be used to identify opportunities for becoming more aggressive in managing disability costs. Second, they can be used to analyze costs and develop more realistic cost projections. Third, they can be used to help establish priorities for intervention. Finally, they help companies evaluate their disability management programs to find out if they really make a difference.
SUMMARY Industry is looking to occupational health and rehabilitation service providers for assistance in implementing comprehensive medical ergonomics programs to prevent and control work-related injuries and illnesses. The goal of any safety and health program is to prevent injuries and illnesses by eliminating and controlling their causes. For ergonomic hazards, this goal is achieved through taking steps to eliminate or reduce employee exposure to conditions that lead to CTDs and other associated injuries and illnesses. Advantage Health offers industry a comprehensive medical ergonomics program to address ergonomic hazards and CTDs through a systematic control program. Advantage Health provides industry the advantages and the means to control CTDs and other work-related injuries and illnesses resulting from ergonomic hazards.
REFERENCES Advantage Health Systems, Inc. (1991). Isyourcompany suiferingfrom cumulative trauma disorders? Kansas City, MO. Carbine, M. E., and Schwartz, G. E. (1987, November). Data analysis. Strategies for Managing Disability Costs. (7-28).
Carbine, M. E., Schwartz, G. E., and Watson, S. D. (1989, July). Cost-effective disability intervention and management strategies. Disability Intervention and Management Strategies for the 1990s. (7-20).
Employee rehab can save millions for US companies. (1989). NARPPS News, II, 21-22.
Fruen, M. (1992, October). Disability management focuses on prevention. Business & Health, p. 24-29. Moser,J., Wilkerson, D., and Yeater, D. (1991). Using data as a management tool. Annu Rev Disabil Manage, 43-49.
U.S. Department of Labor. Occupational Safety and Health Administration. (1991). Ergonomic program management guidelines for meatpacking plants. Washington, DC: US GPO.
Business & Health (Fruen, 1992) reports that employers and their insurers say they can reduce disability and related costs through prevention strategies and early intervention. Employers are finding that by integrating their short- and long-term disability programs and focusing on managing the early stages of illness and injury, employees can return to work earlier, short-term disability cases can be kept from becoming long-term disability cases, and thousands and thousands of dollars can be saved. For the providers of early intervention and prevention programs and services, this is good news, indeed! For years, therapists and other professionals have been trying to "sell" industry on such programs, often meeting resistance from management. That situation, however, has changed: employers are beginning to recognize the value of early intervention and prevention and are even seeking out providers of these programs and services. Employers are taking a proactive approach in an effort to cut costs and better manage workrelated injuries and illnesses. Actions by the Occupational Safety and Health Administration (OSHA) have influenced employers as well. The Occupational Safety and Health Act of 1970 (OSH Act; U. S. Department of Labor, 1991) states that it is the general duty of all employers to provide employees with a workplace free from recognized hazards. The OSH Act was passed in an effort to provide safe working conditions for all American workers. It grants OSHA the authority to authorize stiff penalties for those employers who fail to provide safe working conditions. This includes the prevention and control of ergonomic risks and hazards.
A few years ago, many industries began noticing an increase in injuries and illnesses related to repeated exposures to risk factors that exist in the workplace. These injuries and illnesses are known as cumulative trauma disorders (CTDs). OSHA has recognized the importance of preventing injuries and illnesses that are a result of employee exposure to ergonomic risk factors and therefore has published guidelines and recommendations to assist industry in implementing safety and health programs that include ergonomics. The goal is to reduce employee exposure to conditions that lead to CTDs and related injuries and illnesses. The Ergonomic Program Management Guidelines for Meatpacking Plants (U. S. Department of Labor, 1991) suggest the following components be included in an ergonomic program: worksite analysis, ergonomic controls, medical management, and training and education. These four components should include a high level of management commitment and employee involvement as well. Finding solutions to the problems posed by ergonomic hazards may well be the most significant workplace safety and health issue of the 1990s. Advantage Health Systems, Inc., is one company that is dedicated to preventing injuries and illnesses in the workplace by eliminating and controlling their causes. Advantage Health has specialized in occupational health and employment issues since 1984. Advantage Health offers employers of employees who report a high incidence of CTDs a comprehensive medical ergonomics program. Services include medical management, worksite analysis, ergonomic controls, training and education, and data systems. Services are delivered to a broad spectrum of clients ranging from manufacturing to service industries. While clients' often seek out Advantage Health because of high workers' compensation claims or OSHA compliance concerns, the company's orientation to preWORK 1993; 3(2):48-52 Copyright © 1993 by Andover Medical
The Advantage Health Systems Advantage
vention has attracted clients interested in taking a proactive approach as well: "Give Your Company the Advantage" and implement an effective, systematic control program for CTDs (Advantage Health Systems, Inc., 1991).
49
3. Develop internal staff capabilities to implement and monitor control measures. 4. Establish a cost-effective prevention program. 5. Maintain concise, accurate, and defensible records.
SYSTEMATIC CONTROL PROGRAM ERGONOMIC HAZARDS Hazardous factors in the workplace are often due to poor workstation layouts, improper biomechanical work methods, use of improperly designed tools, and job-flow design problems. Identified risk factors include repetition of motion, force, angle or body posture, vibration, temperature, and gloves and other protective equipment. Even where the ergonomic hazards of cumulative trauma exist in the workplace, it is believed that only a small segment of the work force will actually develop disabling CTDs. Unfortunately, treating only the symptoms of CTDs is unsatisfactory, as it results in the high cost of medical evaluation and treatment, lost work time, and production slow down. This results in abuse of the workers' compensation system and certainly does not address identification and control of the ergonomic hazards.
EMPLOYERS CAN TAKE CONTROL Advantage Health specializes in programs to prevent and control CTDs in industry. Advantage's team of professionals includes occupational and physical therapists, certified safety professionals, ergonomists, vocational specialists, nurses, and physicians, each with extensive experience in industrial programs. The relationship between the Advantage team and the client is a partnership to achieve the desired control objectives. There are five program objectives: 1. Determine if current procedures are appropriate and cost effective. 2. Identify and monitor employees who are currently at risk, developing problems, or possibly abusing the system.
Advantage Health's systematic control program for CTDs is a comprehensive medical ergonomics program consisting of medical management, worksite analysis, ergonomic controls, training and education, and data systems. Each component will be reviewed separately.
Medical Management Medical management can be defined as the process of moving an injury or illness from beginning to end in an efficient and effective manner. Medical management includes monitoring the activity in a case and determining and implementing a plan of action to maximize the outcome and minimize the total cost of a case. Control is achieved through management commitment, early identification and intervention, policies and procedures, trained and adequate staff, development of a local occupational health network, and case management. Each of these factors is critical for effective medical management. Management commitment. The support of top management indicates that the company has been "sold" on the program and officially endorses its implementation, that the necessary resources have been committed, and that authority has been vested in company personnel to ensure that the program proceeds. Certainly, the more consistent a medical ergonomics program is with the prevailing values of the company, the more likely it is to be endorsed. To be a healthy company, healthy employees are needed. To have healthy employees, health and safety must be valued as highly as productivity. With the visible involvement of top management, employees will realize that management has a serious commitment to the ergonomics program. Early identification and intervention. Effective management hinges on the ability of the organization to identify and treat workplace injuries
50
WORK / SPRING 1993
and illnesses in their early stages. An early intervention program is an in-house employee assessment and treatment program that is designed to recognize problems early and take care of them. Early identification of CTDs and appropriate intervention can prevent short-term impairments from becoming long-term disabilities. Strategies such as flexible work schedules, job accommodation, job modification, and alternate or modified duty positions foster stay-at-work or prompt return-to-work outcomes. Policies and procedures. Existing company policies and procedures must support a medical ergonomics program. A company's culture is reflected in the various policies it adopts; therefore, policies supportive of medical ergonomics indicates a company commitment to human resources, a company that recognizes employees as its most important asset, and a company striving to do the best for its employees. Within this context, a disability that interferes with an employee's productivity becomes a matter of serious moral, legal, and financial concern and requires prompt attention. Trained and adequate staff. Companies must be willing to devote resources to adequately train staff interacting with injured employees or employees reporting CTDs. Poorly executed interventions by managers or supervisors can have a disastrous effect on the entire disability process. Often, attitudes and expectations regarding disability create bias and can hinder the process as well. Open communication and education of personnel at every level within the company regarding the medical ergonomics program will insure that all buy into the new initiative. Development of local occupational health network. Another key issue in effective medical management is the relationship of the company with its outside medical providers. Establishing a local network of physicians, therapists, and other medical providers that are able to communicate with and meet the specific needs of the company in the management of workplace injuries and illnesses will help ensure that employees receive high quality and medically effective health care in a cost-effective manner. The system works to prevent excessive or inappropriate treatment, return
employees to full duty more quickly, and save costs. In fact, a study conducted by the Northwestern National Life Insurance Company found that rehabilitating disabled workers can save companies as much as $30 for every $1 spent (Employee Rehab Can Save Millions for U. S. Companies, 1989). A network composed of quality occupational health providers can effectively control lost productivity, maximize an employee's recovery, reduce time lost from work, and prevent escalating disability costs within the company. Case management. Companies are now applying the case management model to the return-to-work process and experiencing positive results. Case management most simply describes a number of approaches to planning, coordinating, and providing health care. It is a process concerned with more than simply monitoring and limiting the volume of services. Its prime focus is the organization and sequence of services and resources to respond to an employee's individual health care needs. A variety of mechanisms are used to monitor the use of services by employees and evaluate their quality, appropriateness, and cost effectiveness. Such mechanisms include utilization review, second surgical opinions, auditing services, telephone coordination of care, on-site coordination of medical care, direct assistance in returning to work, etc. The biggest payoff for companies is that their employees receive highquality, medically effective health care in the most appropriate and cost-effective way possible.
W orksite Analysis The second component of a medical ergonomics program is worksite analysis. A comprehensive risk analysis determines where ergonomic hazards exist and identifies potential ergonomic controls. In addition, work site analysis provides comprehensive job descriptions for use in medical management of injured employees and compliance with the Americans with Disabilities Act. Worksite analysis is a process of gathering information about the worker, task, machines, environment, and the interaction that occurs between each component. Observations, surveys, and interviews are collected from employees, supervisors, engineers, and others. Measurements and
The Advantage Health Systems Advantage
videotape recordings are taken to get an exact description of these interactions. These measurements are formulated into a logical explanation. The results of worksite analysis are used to evaluate how jobs, work methods, work practices, tasks, and workstation design may affect employee comfort. This data collection method is used for describing workplace risk factors such as force, repetition, and awkward posture to isolate the problem areas of the job. The work site analysis data, once analyzed, indicate how each risk factor affects employee comfort while performing the job. This is the first step to eliminating and controlling exposures. The results of work site analysis are also used in the medical management component of the ergonomics program to assist in safe and effective return to work after injury. In addition, the results can be used to describe the job in terms of its physical requirements for the purpose of compliance with laws requiring nondiscriminatory hiring practices.
Ergonomic Controls Ergonomic intervention to control CTDs includes modifications that workers and management can implement as well as items that require engineering expertise to provide the most effective and safe working environment. Advantage Health uses a problem-solving model that includes employee participation and a systematic documen'ation process that identifies the best combination of control measures based on the company's unique situation. Ergonomic controls are methods of modifying problem jobs identified in work site analysis. There are three primary types of ergonomic controls: worker controls, administrative controls, and engineering controls. Worker controls are controls that the workers can make themselves, such as using proper lifting techniques. Administrative controls are controls that management can make, such as changes in policies and procedures. Engineering controls are changes that are made by the engineering or maintenance department, such as changes to equipment. Workplace injuries and illnesses can be controlled when workers, managers, and engineers
51
work together. Each of the three control areas overlaps with the others. For example, changing the layout of a workstation could be done by the employee in some instances, but may require engineering changes in others. Developing and using ergonomic controls are team efforts, requiring a coordinated approach and a sense of shared responsibility.
Training and Education In training and education, each level of the organization receives necessary information on CTDs and the ergonomics program. Emphasis is on a team approach. Training and education allow managers, supervisors, and employees to understand ergonomic and other hazards associated with ajob or production process, their prevention and control, and their medical consequences. The purpose of training and education is to ensure that employees are sufficiently informed about ergonomic hazards to which they are exposed and therefore able to participate actively in their own protection. Upper management receives an overview of the program, information on measuring the success of the program, and information on when to expect bottom-line results. Medical department employees receive training in the medical management aspects of the program. Engineering personnel receive training in ergonomic principles and implementation of engineering controls to prevent workplace injuries and illnesses. Employees receive training in general ergonomic concepts, what they can do to prevent injury, and how they can participate in the process of implementing ergonomic controls. Supervisors receive training in general ergonomic concepts and issues specific to appropriate supervision for prevention and management of injuries and illnesses. A single department within an organization cannot successfully manage injuries and illnesses. A coordinated approach involving all levels of the organization is necessary for successful program outcomes.
Data Systems The ability to collect and analyze disability data is crucial to managing disability costs. Companies
52
WORK / SPRING 1993
are turning to data collection and analysis to assist in cost management, objectify patient assessments, and provide information regarding rehabilitation program outcomes. J. C. Bisgard, M.D., corporate medical director for Pacific Bell, reports that to manage health-related costs, the costs must first be tracked. "An effective health data management system provides us with the critical capability to monitor and link health-related costs through all corporate health systems" (Moser, Wilkerson, and Yeater, 1991). Effective disability intervention and return-to-work programs start from an organized cost-control strategy. Of most benefit to employers are data collection and analysis systems that track short- and longterm disabilities, flag "problem-oriented" diagnoses, compute trends, calculate return-to-work dates, and monitor employee demographic information (Carbine, Schwartz, and Watson, 1989). Employers can use the data much like a "decision tree" and determine the best path to follow to achieve optimal disability management outcomes. Advantage Health's data management system incorporates comprehensive data collection and analysis. The data systems provide maintenance and reporting for OSHA log reporting, lost/restricted duty days, outside medical provider tracking, training program tracking, job matching, workers' compensation, Americans with Disabilities Act, case management, early intervention programs, monitoring, and employee health status tracking. Experts agree that a program's data base will
be only as good as the kind and quality of data available to the system (Carbine and Schwartz, 1987). Top-quality comprehensive data systems offer numerous advantages to industry. First, they can be used to identify opportunities for becoming more aggressive in managing disability costs. Second, they can be used to analyze costs and develop more realistic cost projections. Third, they can be used to help establish priorities for intervention. Finally, they help companies evaluate their disability management programs to find out if they really make a difference.
SUMMARY Industry is looking to occupational health and rehabilitation service providers for assistance in implementing comprehensive medical ergonomics programs to prevent and control work-related injuries and illnesses. The goal of any safety and health program is to prevent injuries and illnesses by eliminating and controlling their causes. For ergonomic hazards, this goal is achieved through taking steps to eliminate or reduce employee exposure to conditions that lead to CTDs and other associated injuries and illnesses. Advantage Health offers industry a comprehensive medical ergonomics program to address ergonomic hazards and CTDs through a systematic control program. Advantage Health provides industry the advantages and the means to control CTDs and other work-related injuries and illnesses resulting from ergonomic hazards.
REFERENCES Advantage Health Systems, Inc. (1991). Isyourcompany suiferingfrom cumulative trauma disorders? Kansas City, MO. Carbine, M. E., and Schwartz, G. E. (1987, November). Data analysis. Strategies for Managing Disability Costs. (7-28).
Carbine, M. E., Schwartz, G. E., and Watson, S. D. (1989, July). Cost-effective disability intervention and management strategies. Disability Intervention and Management Strategies for the 1990s. (7-20).
Employee rehab can save millions for US companies. (1989). NARPPS News, II, 21-22.
Fruen, M. (1992, October). Disability management focuses on prevention. Business & Health, p. 24-29. Moser,J., Wilkerson, D., and Yeater, D. (1991). Using data as a management tool. Annu Rev Disabil Manage, 43-49.
U.S. Department of Labor. Occupational Safety and Health Administration. (1991). Ergonomic program management guidelines for meatpacking plants. Washington, DC: US GPO.
