RTW in the Health Care Setting - it can be done

Identifying modified duty options is incredibly important for those employers in the health care industry.  According to the Bureau of Labor Statistics, in 2012, employees in health care support occupations lost time from work due to a workplace injury or illness more than 2 times more often than all other occupations reported (U.S. Bureau of Labor Statistics, 2014).  

Barriers to RTW in hospitals and health care settings

While the incidence rate alone is a challenge, the usual 24/7 operations of hospitals can also be a barrier.  Employers are concerned about patient safety and cite this as a reason for not returning nurses with restrictions.  One of the most frequent obstacles is how hospital employers budget and account for wages paid while an injured worker is working on restricted or transitional duty.
 
Opportunities for RTW in hospitals and health care settings
Every industry has its unique challenges.  Generally speaking, there are always options for modified duty if one looks hard enough and thinks outside the box.  Recently, the Office of Disability Employment Policy (U.S. Department of Labor) funded a study to “identify promising practices and success stories related to RTW efforts and outcomes in the health care industry” (p. vi, 2015).  The following is a high level summary of some of their findings.  You are encouraged to read the full report here.

Health care employers and subject matter experts relayed several “best practices” that may benefit other employers:

·         Communication and training regarding RTW

o   Ensure that management and supervisors fully understand RTW, its benefits, and best practices 

·         Working with physicians  

o   Provide doctors with RTW plans or RTW options for the injured worker they are treating

·         Consider the utilization of occupational health providers and/or vocational rehabilitation  providers to assist with RTW

·         Identify outside sources for transitional work if no work can be found in-house

·         Support the case for RTW with financial figures

·         Create a system that pays for the transitional duty/modified duty work that ensures accountability for to motivate managers

o   Return injured workers to their department

o   Reduce injury rates

o   Employers may want to consider excluding injured workers on modified duty from productivity rates/counts

Some other highlights of the article include suggestions regarding a modified duty/transitional duty job bank.  We’ve always recommended employers maintain a list of tasks that need to be done in the event they have an injured worker on modified duty but these suggestions take it a step further.

Creating and maintaining a “living” job bank

The participants in the interview reported that they train supervisors and managers to find and share any modified duty positions prior to posting them.  These are often short-term jobs that need to be filled.  The respondents also reported that they contact the central staffing unit when looking for potential RTW opportunities within the hospital.  When long term or permanent restrictions are likely, the employers work with the injured worker, and sometimes a vocational counselor, to identify interests of the injured worker and their knowledge, skills and abilities.  If the injured worker would like to work in a different position that suits his/her restrictions, but requires training, the employer works to implement that training or provides unpaid volunteering in a particular department to train and trial the injured worker in that role.  The focus is upon retaining current employees.

 
Here is a link to the report for your own reading pleasure. The report also highlights seven very interesting and creative RTW success stories.

References:

 

U.S. Bureau of Labor Statistics. (2014) Number, incidence rate, and median days away from work for nonfatal occupational injuries and illnesses involving days away from work by summary occupational groups and ownership.  Available at:  http://www.bls.gov/new.release/osh2.t03.htm.  Accessed May 14, 2015.

 

Denne, J., Kettner, G., and Ben-Shalom, Y. (March, 2015).  Return to Work in the health care sector:  Promising practices and success stories.  Washington, D.C.:  Mathematica Policy Research.  Retrieved from Mathematica Policy Research  at http://www.mathematica-mpr.com/~/media/publications/pdfs/disability/rtw_health_care_sector.pdf

Why you should care about RTW for direct-care workers

According to US News and World Report, it is estimated that in 2013, roughly 3.3 million Americans called a nursing home their place of residence.  For these millions of residents, there must also be millions of people to care for them. 

Productive modified duty for nursing staff

Nursing homes are rated on various aspects of their operations by Medicare.  Nursing homes are rated on health inspections, staffing, and other quality measures.  One element of staffing criteria that is measured is the number of staffing hours per resident.  A facility reports the number of hours of care on average provided to each resident, each day, by its nursing staff.  It is important that RNs and LPNs, for example, are providing care to residents as opposed to “non-care” hours.  This is important when considering modified duty opportunities for long and short term care facilities.

When considering modified duty options for health care staff, a great place to start is their job descriptions.  What aspects of their jobs fit, or can be modified to fit, within their work abilities?  Consider other areas or departments for opportunities.  While there may be some initial resistance, some of the duties that other health care employees perform may also yield modified duty opportunities.  An example of this would include having an RN perform duties that an LPN could do.  Another great source of modified duty suggestions is to ask the injured worker what they believe they could do.  This will provide suggestions, but also foster support of the return to work process.

Keeping injured workers at work doesn’t just help your workers’ compensation insurance costs

When an employee is injured, the repercussions are felt throughout an organization and the community.  Maintaining a staff of qualified and skilled employees is a challenge in any industry, but is particular evident in the health care field.  According to one study, the cost of turnover in the direct-care industry was found to be 25% of an employee’s total annual compensation.¹ The Bureau of Labor Statistics estimates in 2003 that costs associated with turnover in this industry ranged between $4,200-5,200.

            Direct costs:

·          separation

·         vacancy, replacement, training and injuries

Indirect costs:

·         lost productivity

·         reduced service quality

·         lost clients revenues due to lost existing and potential clients

·         impact on the culture, morale, facility reputation and service quality

Service delivery level costs:

·         Consumers/Clients

o   quality of care

o   quality of life

o   care hours not provided

·         Employees

o   increased work injuries (doing more with less)

o   increased physical and emotional stress

o   reduced working conditions may lead to higher turnover

Suggested resources

There are many resources available to employers who wish to offer modified duty to one of their injured workers.  The Job Accommodation Network (JAN) is a great resource for ideas and modification suggestions.  We previously wrote about it in this post.   Our website also has a variety of tools to help, in addition to lists of suggestions for health care employees who are given restrictions as the result of a work injury.

You can also check out the studies and resources referenced in this post by clicking here.

1.  Seavey, D. (Oct., 2004).  The cost of frontline turnover in long-term care. Washington, D.C.:  Better Jobs Better Care.