If I mention the Scaffold Law, what springs to mind?
One answer is scaffolding — the pipes, boards and ladders that go up around tall buildings to enable the exterior to be worked upon.
The word “scaffold” has another meaning, the one I thought it had when I recently started reading an article on the Scaffold Law. The scaffold I was thinking of was the platform to which you send a man or a woman to be hanged. One would be sent to the scaffold to be executed for one’s crimes or, at less enlightened stages of history, for the amusement of others.
The article, by Don Riggin, principal at The Art of Captives LLC consultancy, suggested that captive insurance companies can be very helpful to those involved with the scaffold. Brilliant, I thought. Hang your opponents, victims, whatever, offshore. It’s statistically nearer the water, in which the hanged man may be deposited, thus lowering the cost of the whole exercise. What profit may remain is fed into a captive insurer, which operates in a tax-neutral environment, maximizing the rate of return.
This was not the direction Mr. Riggin took in his article, however. The Scaffold Law, he wrote, “imposes ‘absolute liability’ for elevation-related injuries to construction employees on any and all parties associated with construction, repair, and demolition projects.”
(Elevation-related injuries are also known as gravity-related injuries, or, in say-what-you-mean language, falls.)
In a way, of course, gravity-related incidents are the workers’ fault.
If people managed their lives better, so that they didn’t need to work, they wouldn’t have applied for the job in the first place, and then they couldn’t have been hurt.
“Absolute liability means that any employee who falls from one level to another and sustains injury is almost guaranteed a settlement,” Mr. Riggin wrote, and who among us would disagree with that? Not paying the costs of a person who is hurt at work doesn’t sound fair at all.
“The Scaffold Law, according to its detractors, provides a strong incentive for the employee to file an action-over liability claim against the property owner, project manager, and general contractor (assuming the injured claimant is employed by a subcontractor),” the article said. I don’t know exactly what that means, but it suggests that some people feel that those hurt at work should fend for themselves from there on out.
In a way, of course, gravity-related incidents are the workers’ fault. If people managed their lives better, so that they didn’t need to work, they wouldn’t have applied for the job in the first place, and then they couldn’t have been hurt. In certain countries, laws using that logic relate to foreigners driving, but in sane places, injured workers are usually helped by employers who make money off the work achieved before the worker is injured doing it.
Here’s the punch. The Scaffold Law is apparently held directly responsible by some for rising insurance costs and the withdrawal of many insurers that used to cover New York contractors’ liability.
Such risks could be more efficiently carried in a captive, Mr. Riggin said, “at rates commensurate with the loss exposure and not driven by market capriciousness.” By golly, he’s right, except that “caprice” is the word he was reaching for.
You can’t help feeling, though, that those pesky construction workers, pants worn too low, bellies too big, would do everyone a favor if they’d just stop working. If they must work for some obscure reason, then surely they could stop hurting themselves doing the work and costing their employers time, money and aggravation.
Is that too much to ask?
The Engagement Factor
Employers face a crisis with recent studies showing that worker disengagement has reached 70 percent.
Fortunately, I’m an engaged worker, according to a predictive tool that helps employers learn more about job recruits and existing employees by measuring their “sense of good judgment” in more than 70 areas.
I learned of the predictive tool called the Judgment Index while reporting on integrated disability management. Renee Mattaliano, VP and practice lead of workforce management at HUB International, told me how employers can apply the index to learn whether a certain job will engage a specific job recruit.
The more engaged a worker, the less likely they are to be injured. The more engaged, the sooner they will return to the job should they suffer an injury.
That’s valuable insight for an employer.
Predictive information about how people will behave is being applied across more areas. A non-traditional loan company, for example, now uses a judgment tool to lend money to recent college grads lacking credit histories.
That tool evaluates grade point averages, SAT scores and colleges attended, among other data. It then determines the value credit applicants will place on their obligation to repay debt.
“Who you are is going to drive what you do.” — Roger D. Wall, chief marketing officer, The Judgment Index
Such technology is opening up a world where employers and others will know much more about us, including what we value.
“Who you are is going to drive what you do,” said Roger D. Wall, chief marketing officer for the Judgment Index.
Interest in how worker engagement might be measured and its influence on disability management led me to accept an offer to learn firsthand how the Judgment Index works. That involved having to prioritize several, sometimes odd-seeming, statements according to how much I agreed with them.
From the lengthy results report, I learned that managing difficult people is not one of my strengths. No surprise there.
But I am very strong on absorbing information, processing it and solving problems. I’m an engaged employee, according to the index results, because I value work and have a high degree of reliability. I also am process- or task-oriented.
The outcome also showed I rank strongly for self-care by paying attention to my physical, mental and emotional health. Obviously, the index didn’t ask how many needless calories I nervously consume at my desk while writing.
Still, information about my attitude toward my overall health could prove valuable to an employer customizing a wellness program or building a return-to-work strategy for my specific needs.
It can provide a lot of information about how you might behave under certain circumstances, as well as advice when improvement or caution may be necessary.
For example, the Judgment Index showed I am “moderately idealistic.” I might be good at helping team members see new possibilities for improving things, but I must make sure my ideas are backed by convincing evidence so people with a strong realist bent don’t write me off as naive.
No wonder I’m engaged by my work. The job allows the moderately idealistic in me to write about how the workplace might be made better.
Now, what to do about the 70 percent who don’t value their work as much as I?
Managing Patient Safety in a New Health Care World
Much like regular screenings, exercise and a healthy diet, patient safety in health care institutions should be thought of as preventive medicine.
“Patient safety aims to relieve the burden of fixing mistakes by taking steps to prevent them from happening in the first place,” said Aileen Killen, head of casualty risk consulting, AIG.
With the right strategies and protocols in place, human error in delivering patient care can, to some degree, be factored out, mitigating the risk of things like falls or medication mistakes. And the outcomes-based reimbursement model enforced by the Affordable Care Act provides extra incentive to improve patients’ overall experience and reduce readmission rates.
Some challenges stand in the way, though, of achieving better safety.
For one thing, increased consolidation in the industry has brought risks associated with integrating disparate safety cultures and ensuring continuity of care if patients are moved to a new doctor. The trend of shifting more care out of main hospitals to ambulatory sites instead also creates concern that those outpatient facilities are not up to the same safety standards as larger organizations.
Finally, advancing technology — while offering great promise to eventually make health care more efficient and error-free — presents significant risks in its implementation while doctors, nurses and other health care professionals learn how to best use it.
Lexington Insurance, a member of AIG, is meeting the demand for more innovative tools to navigate the changing environment with a suite of safety assessment programs that identify problem areas and provide recommendations for improvement.
Assessing Safety Culture
The first step in overcoming any challenge is assessing the situation in order to create the best strategy.
“Every health care organization should aim to become a ‘high reliability organization,’ or HRO,” said Brenda Osborne, division executive, health care, Lexington. “It’s a term borrowed from the airline and nuclear power industries, in which any employee has the right to shut down operations if they spot a safety issue.”
Lexington’s Best Practice Assessment tool allows organizations to compare their own protocols against evidence-based best practices and identify weak spots in their safety culture.
“We survey employees and ask if they feel free to speak up to people in authority,” Killen said. “If they can all say yes, you’re on the road to a safety culture. Then we drill down into specific high-risk areas.”
Clients can conduct specific assessments for error-prone areas like the emergency department, obstetrical department and operating room.
We give organizations recommendations on how they can improve in areas where they are deficient, and we can benchmark their performance against the best practice as well as against other institutions that have done the same assessment,” Killen said.
Those benchmark comparisons are key for securing leadership buy-in. Executives often need to see what other institutions are doing in order to feel confident in their decisions to make changes or invest more heavily in patient safety measures.
If another competitive hospital has better staffing ratios, for example, benchmark stats will show that and support the C-suite’s decision to hire more nurses to achieve a similar ratio.
“What it basically does is give the risk management, patient safety and quality improvement staff a roadmap for which areas to focus their activities for improving patient safety and risk management at their organization,” Killen said.
Acquisitions and Physician Employment
The flurry of merger and acquisition activity in the health care industry creates new risks for large hospital networks that acquire physicians’ practices. The integration of different patient safety and risk management practices can prove difficult.
“You have to take multiple approaches and mindsets and meld them into one fluid organization,” Osborne said. “That has a big impact on physicians’ ability to treat patients and deal with the appropriate hand-offs.”
“Patient hand-off is one of the biggest safety challenges,” Killen said. “Assigning a patient’s care to a different doctor leaves room for gaps in communication, which is so critical to making the correct diagnosis and keeping a medication schedule.”
Lexington’s Office Practice Assessment tool scores acquired practices on 14 different domains, including risk management and patient safety, communication, infection control and prevention, incident reporting and medication safety, among others. Recommendations are provided for any domain that scores less than a perfect 100 percent.
“We’ve been able to go in and help these growing organizations benchmark each of these acquired physician offices to show where they are at in terms of their safety protocols,” Osborne said. “It helps risk managers know where they need to start.”
Another major challenge for patient safety is the movement of care away from main hospitals to ambulatory care settings, an area that previously did not concern hospital-based risk managers very much.
“Historically, there has not been a big focus from a patient safety standpoint on outpatient services,” Osborne said. “The office practice assessment that AIG’s been doing for the last two or three years has actually put us out in front. Few other resources out there can assist hospital-based risk managers in dealing with outpatient-type services.”
“Now more people are thinking about safety in ambulatory areas, and we have more knowledge and experience there,” Killen added.
The same office assessment tools that survey physician practices can also be applied to ancillary services like ambulances, blood banks, and outpatient surgery centers, though benchmarking is not yet available for these sites.
Adapting to new technology is an ongoing challenge for health care risk managers.
“Everyone thought electronic health records were going to solve all our patient safety issues, but they’ve come with some unintended and dangerous consequences,” Killen said. Employees may accidentally order medications for or even discharge the wrong patient, for example, if they have multiple records open at once.
The upside to technology advancements, though, is more streamlined documentation and more opportunities for communication between doctors and patients via telemedicine, which is slowly growing in popularity for remote and elderly patients.
“When we’re underwriting, we look at these areas of growth in technology and the many ways it can be applied,” Osborne said. “We consider all the pros and cons.”
Lexington’s dedication to improving safety in health care shines through in their thorough assessment tools, expert recommendations, and attention to insureds’ changing risk management needs.
“Our unique tools help insureds identify risks and minimize potential claims,” Killen said.
“These services are homegrown and developed by a lot of very knowledgeable people over a period of time,” Osborne said. “They’re not available out in the market, and only Lexington insureds have access to them.”
For more information about Lexington Insurance’s risk management services for the health care industry, please visit www.lexingtoninsurance.com.
This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with Lexington Insurance. The editorial staff of Risk & Insurance had no role in its preparation.