Returning Starfish to Wellness

“Once upon a time, there was a wise man who used to go to the ocean to do his writing. He had a habit of walking on the beach before he began his work.

One day, as he was walking along the shore, he looked down the beach and saw a human figure moving like a dancer. He smiled to himself at the thought of someone who would dance to the day, and so, he walked faster to catch up.

As he got closer, he noticed that the figure was that of a young man, and that what he was doing was not dancing at all. The young man was reaching down to the shore, picking up small objects, and throwing them into the ocean.

He came closer still and called out, "Good morning! May I ask what it is that you are doing?"

The young man paused, looked up, and replied, "Throwing starfish into the ocean."

"I must ask, then, why are you throwing starfish into the ocean?" asked the somewhat startled wise man.

To this, the young man replied, "The sun is up and the tide is going out. If I don't throw them in, they'll die."

Upon hearing this, the wise man commented, "But, young man, do you not realize that there are miles and miles of beach and there are starfish all along every mile? You can't possibly make a difference!"

At this, the young man bent down, picked up yet another starfish, and threw it into the ocean. As it met the water, he said, "It made a difference for that one.”
― Loren Eiseley


In an industry riddled with challenges, competing interests and seemingly endless uphill battles, we should always remember "the starfish story."  As insurance professionals, we are given the opportunity to apply our expertise and experience to  positively influence the lives of others-- to help an employer retain an employee despite their work restrictions, to help an injured worker return to wellness through productive, meaningful work, to prevent injuries from occurring.  We have the knowledge and skills to help guide our insured employers and their injured workers through the workers' compensation system.  A system that is rife with black holes -- one in which an injured worker can, far too easily, slip through the cracks.  We can't convince every employer to offer modified duty work, nor can we convince every injured worker to take the steps to get off of their narcotic pain medications, nor prevent every injury from happening, but we can help in this case...and the next one...and the next one...

It may not always feel like it, but everyday we are presented with a unique opportunity to make a difference in our employers' worlds, our injured workers' worlds, and our own.  What we do on a day to day basis may prevent us from seeing the impact we can have on the lives of thousands of injured workers and employers each year.  Within the confines of our system, we can have a positive impact and successfully fulfill our promise to deliver a better outcome. 

There will always be another starfish to toss back into the water, and with each one we have the responsibility to help them get back into the ocean.

It's a good thing Punxsutawney Phil isn't a doctor...

Punxsutawney Phil has prognosticated that there will be six more weeks of winter.  Apparently, this is not just a Pennsylvania thing -- we must give a shout out to Birmingham Bill in Alabama, who apparently this year has deferred his recommendation to Phil.

You're probably wondering where we're going with this.  This annual tradition is not unlike the course of a workers' compensation claim -- hear me out.

An injured worker and their employer are often left to wait and see what the doctor says at the next appointment.  We're left waiting to learn if the injured worker will be out of work for another six weeks or if they will be release to modified duty.

Sometimes, as in the case of Birmingham Bill, the doctor defers the disability determination to another physician (enter Punxsutawney Phil).  This can lead to more frustration for the injured worker and employer who simply want to know what is going to happen next. 

Sometimes attorneys get involved (as evidenced in the Washington Post article I referenced earlier).
This can cause additional delays and confusion if all parties are not on the same page.

Alas, the injured worker is left to sit at home and watch re-runs of Groundhog Day. Not that Bill Murray isn't entertaining, but like the movie depicts -- the same old, day in, day out routine can wear on a person.

Aside from getting someone else to press the "snooze button," there are some simple things employers and injured workers can do to avoid the repetitiveness and delay associated with the quest for a release to return to work (restricted or otherwise).

• Provide a modified and pre-injury job description or list of tasks at the first doctors visit.
• Clarify early on who will be addressing the injured worker's ability to return to work (the surgeon or the treating physician?)
• Request treatment and recovery projections at each office visit.  Additionally, clarify some of the things that may delay recovery so that everyone can plan accordingly.
• Communicate the availability of modified work often!  Don't leave it up to the doctor's office to remember that you're an employer who can offer modified duty restrictions.
• If the delays seem unreasonable, consider obtaining a second opinion (if that option is available).  Like Birmingham Bill, sometimes you must consult with another colleague.

More tips to ensure your RTW program is worth more than the paper on which it's written

Last week we wrote a post about ways to measure the effectiveness of your return to work (RTW) program.  As you may recall, the prior week's post gave some tips to measure the effectiveness of a newly implemented RTW program.

Let's discuss the more mature RTW program.
For employers who have had more experience with modified duty and lost time claims, the methods to evaluate the effectiveness mentioned in the prior post will also apply.  If you're looking for more targeted or "next level" metrics, there are some simple ways to accomplish this.

• The window of opportunity to positively impact the outcome of a workers' compensation claim is very short and it begins closing the day the injured worker is taken out of work. Employers must create a sense of urgency with regards to RTW.  Most of our insured employers feel that they are "pretty good" "in most cases" at identifying modified duty.  Assuming this is how you perceive your company, and this judgment is factually substantiated, you may want to start measuring the days until a RTW opportunity is found/offered.  Measure the days that pass between the time the claim representative or injured worker provided a RTW note and the date they received an offer to RTW.  Employers can be even more aggressive in their standards and measure from the actual date the injured worker was released to modified duty until the day they returned.  This would assume that the expectation is for any release to modified duty to be reported to the employer as soon as possible, likely by the injured worker.  These "lag time" days are wasted days of productive, meaningful work -- and days where temporary total disability are unnecessarily being paid.  Setting a goal and starting the clock will create that sense of urgency that is essential in an effective RTW program, and give you something to measure against.
• If you're an employer who really wants to challenge themselves, take a look at the Occupational Disability Guidelines (ODG) return to work recommendations. These are evidence-based guidelines for expected RTW targets based on diagnosis and categories of work (light, heavy, very heavy, etc.).  Holding your RTW outcomes to these standards gives you a benchmark to measure against.  Obviously there are going to be scenarios that don't comport to a set of guidelines, but it gives you an opportunity to look at a benchmark and investigate what the deviation stemmed from -- was it due to complications with treatment, or lack of a modified duty offer?  Another benefit of using guidelines is that it gives realistic projections for various timeframes of when an injured worker reaches different levels of work.  The guidelines also consider certain comorbidities (things that will impact recovery times).  Here's an example:
• ODG Treatment and Return to Wellness guidelines: 724.2  Lumbago
• Severe, manual work:  14-17 days
• Severe, heavy manual work:  35 days
• Obesity comorbidity (BMI >= 30), multiply by 1.31
• Because this particular injured worker was considered obese, ODG projects their recovery time to take about 31% longer than an injured worker who has a BMI of 29 or lower.

While it is sometime difficult to measure results, it's best to measure something -- and be sure to do it consistently.  Put some thought into what your goals are and how you're going to measure them.  Communicate these goals (repeatedly -- we mean it, every chance you get!) and share your progress.  The gold standard would be to find a way to make managers/supervisors accountable for their results.  As "they" say, you manage what you measure.

Tips to ensure your RTW program is worth more than the paper on which it's written

A recent survey found that 90% of healthcare employers had a RTW program, but only 65% actually had metrics in place to monitor its effectiveness.  What's the point of putting something in to place if you have no way of knowing how it's working?

This is a common occurrence -- safety committees that are created to obtain a premium discount, a customer satisfaction survey conducted so that companies can say that they did it, or a declaration that a company is going to implement a wellness program to say that they're a healthy workplace.  These are all great things to talk about, but if you don't measure and monitor your results, what's the point?  You may have a safety committee, but if they don't perform or impact safety in the workplace, other employees will see it as a waste or worse yet, not take their recommendations seriously.  This can sometimes have a more harmful effect than not having one at all.  Any wise employer would prefer a highly performing, informal return to work program over a formalized, ineffective program any day.  Results are what matter.

'Tis the season for resolutions to lose weight, eat better, save more money, etc.   If you're trying to lose weight, you're probably weighing yourself at frequent intervals to track your progress and monitor the need for modifications to your routine.  If you're trying to save money, you've probably gotten into the habit of shaking your piggy bank to verify it's heft on a regular basis.  The old adage is, "you manage what you measure."  Why should RTW programs be treated differently?

Your company went through the efforts of putting together a RTW program, so why not measure its progress and make it as effective as it can be?  If you're not measuring your RTW results, then your program is worth about as much as the paper on which it's printed.

As with any goal, you have to decide what a realistic, measureable goal is.  Here are some tips on how to set realistic goals with respect to your shiny new RTW program.

For the fledgling RTW program:
You may need some data to timely demonstrate your program's return on investment.  Money is probably the biggest pressure point.  You can track this in a few ways. 

• Obtain a copy of your loss runs for the prior year.  Record how many lost time claims you had and how much was paid in indemnity (wage loss) benefits per claim.  Your target may be to reduce average indemnity payments per claim by 10%, or something along those lines. 
• Look at the frequency of RTW offers being made compared to the claims where no modified duty was offered. Separate the offers by modified duty offers and full duty RTW offers.  This is a good measure of the success or comprehensiveness of your program.  Sometimes your missed opportunities (and related costs) are more impactful than demonstrating savings, particularly if your program is very new and successes are rare.
• If your program is still getting off the ground, look for very basic areas of opportunity. Is someone at your company following up with the injured worker on a regular basis to check in and discuss potential modified duty options? What is the lag time between the injured worker getting restrictions and the employer finding work? 

Stay tuned for the next post with more tips on how to measure your RTW program's effectiveness.

Injured Workers asking to RTW likely as a Blue Moon?

When an injured worker is out of work for a period of time, more often than not the reason is inaccurately attributed to the injured worker's motives.  They don't want to work.  It's easier to sit at home and "collect a check."  They could work, but they're not.  Please realize this is not always the case.  I've seen injured workers' calls to discuss return to work go unanswered by their employers.  The injured worker may call to update them on the work abilities, or just touch base with them regarding their recovery.

So, what happens when an injured worker doesn't get a call back?

It's no mystery...think about how you would feel.  You'd probably ask yourself some or all of these questions:  Do I have a job to return to?  Did I do something wrong?  Don't they believe that my injury is real?  What happens if I lose my job?  How am I going to pay my bills?  Why won't they even talk to me?

Do these questions sound familiar?

They should, thanks to the ubiquitous attorney commercials.  They promise to answer these questions (along with getting the injured worker the money THEY deserve, which may or may not include atypical financial results). 

This post isn't about how to prevent injured workers from getting attorneys...it's about helping employers understand that returning an injured worker's call (particularly one who is asking to return to work) is extremely important.  Do it not to avoid attorney involvement, but because it's the right thing to do.  Even if you don't have work available, having a discussion with the injured worker about their restrictions and what they think they can do could result in you identifying some options. 

Employers have reputations to maintain that directly impacts the quality and quantity of people who want to work for them.  I'm sure you could name a few places in town that don't treat their employees the greatest and you may have even silently sworn to never work there. 

When someone wants to return to work, the very least you can do is return the call.  You never know how much it may pay off in the end.

I'd be remiss if somehow I didn't tie this post to the New Year.  Make 2015 a year to implement the Golden Rule -- at the very least, when you have an injured worker who wants to return -- after all, lore has it that this only happens once in a blue moon.  (If you read this, you'll learn that blue moons, too, aren't all that rare).