Health and Safety Success Requires Cultural Change
Dustin G. Richartz spends much of his time lately helping organizations develop the leadership necessary to drive health and safety within their companies.
The senior loss control consultant with Kansas City-based Lockton Companies, Richartz was recently awarded the 2015 Monsanto Queeny Safety Professional of the Year Award by the American Society of Safety Engineers for his work in developing safety and health programs.
Edgar Monsanto Queeny was president of Monsanto in 1947 when an explosion aboard a French freighter destroyed the company’s Texas City plant, killing 512 people, including 145 Monsanto employees. Queeny took the loss and devastation to heart and put greater emphasis on safety in the company’s operations. The company sponsors the Edgar Monsanto Queeny Safety Professional of the Year Award in his memory.
“It’s an extreme honor, as ASSE is one of the largest safety and health organizations with some 37,000 members globally,” he said. “To be recognized as safety professional of the year is a huge honor and one I definitely don’t take lightly.”
Richartz began his career in safety and health in the manufacturing industry and eventually joined the insurance side. He’s helped organizations create programs to keep their employees safe.
“A lot of time is spent on injury prevention programs, developing tools and techniques organizations can use to protect their workers,” he said. “Some are OSHA regulatory programs, and some are environmental programs; environmental evaluations to make sure organizations are adequately protecting their employees. It really is broad based. Safety and health is not just focused on one specific area. A lot of different things go into it.”
In the 15 years he’s been in the safety and health industry, Richartz has seen a change in focus. Keeping workers free of injury and illness now involves all aspects of an organization.
“One of the biggest changes I’ve seen with a lot of organizations, especially those more progressive, is a shifting away from safety and health being a regulatory entity and allowing it to be a component of the business operations and minimizing risk,” Richartz said. “For the first couple of years that was the way the profession was focused — on regulations and compliance rather than on risk mitigation.”
Part of the reason for the shift is because of what Richartz and other safety and health experts say are outdated regulations. Many of the OSHA mandates, for example, were developed in the 1970s and have not been updated to reflect changes in the workplace. Much more is necessary to fully develop an effective safety and health program.
“You’d start with the compliance. It really is a foundational piece,” he said. “Then you’d develop the cultural aspects, leadership that would really help drive the risk unit. So it’s not focused on just the foundation but building it up and integrating it in every aspect of the organization from the front line to your CEO.”
Changing the culture of an organization is not an easy or quick process. It requires the involvement and commitment of organizational leaders.
“Grassroots activities can help move the needle, but it really takes a senior executive to commit to hold their operations teams accountable to make the changes necessary,” Richartz said. “The middle managers influence the activities of the front line workers, but senior executives drive the overall culture.”
Where Richartz often sees companies making the necessary cultural change is in smaller businesses. “They are often more family run organizations,” he said. “Some businesses and industries may push back more than others. But as we see more and more attention placed on occupational safety and health, more organizations are understanding if they don’t do that it will impact their business in a negative way.”
Getting an organization to focus on safety and health requires strong leadership, Richartz explained. It’s an area that can be the key to preventing injuries and illnesses.
“It’s something I’m passionate about,” he said. “It really helps individuals and organizations move the needle, especially if they are stuck in the regulatory mindset. Focusing on developing middle and upper management to understand what it means to lead in safety and get more involvement and buy-in from their mid-level and front line employees. That’s where a lot of my time has been spent with clients and ASSE and other organizations.”
Leadership is one of the qualities that make for an effective safety and health professional, Richartz said. He mentors young people on developing that and other necessary skills.
“A big part is understanding that a lot of occupational safety and health is really based about people and developing soft skills necessary to influence change and influence individuals, not just try and direct but get them to buy into your ideas and thoughts,” Richartz said. “It takes time for you as a professional to develop those skills.”
With aging workers leaving the industry, safety and health professionals are focused on ways to attract new people. Richartz spends much of his time doing just that.
“One of the things I’ve done a lot of work with is partnering with [ASSE’s] Future Safety Leaders Conference Committee to really help develop leaders and invest in those educational programs that are out there to make sure students when they do come out understand the people side as well as the book side,” he said. “A lot of what we do is not just regulatory based … but focuses on the soft skill side.”
Among the changes he sees on the horizon is the trend to focus on the sustainability side of operations, especially for organizations in manufacturing processes and that have global suppliers.
Fire Risks Simmer in New Construction
Lightweight wood construction has enabled developers to use unused and underused properties to build multi-family structures quickly and inexpensively.
The downside is that in a fire, the thin wood and laminate burns quickly, as graphically demonstrated last year when complexes under construction in San Francisco and Houston were destroyed. (See R&I story: Hot Targets: Upscale Urban Projects.)
The vulnerability of mid-rise wooden structures was brought more ominously to national attention earlier this year by a fast-moving fire that gutted the fully occupied AvalonBay residential complex in Edgewater, N.J.
The fire was clearly visible across the Hudson River in Manhattan. There were no serious injuries but more than 1,000 residents lost everything.
The blaze was caused by maintenance workers using a blowtorch for plumbing work in the walls, and spread quickly through connected attic spaces. Insurance sources familiar with the claim said that partitions in the complex designed as fire breaks had been penetrated for utility access.
“The purpose of [fire] codes is not to prevent the building from burning down, but rather to ensure that there is sufficient time and opportunity for all occupants to exit safely in the event of a fire.” —Michael Feigin, chief construction officer, AvalonBay
“There is a lot of light, quick construction these days, because it is cheaper and faster,” said Michael Pilla, CEO of Technical Risk Underwriters (TRU), part of Ryan Specialty Group Underwriting Managers.
“For owners, the sooner they can lease the property, the better. On a $100 million project, an extra 15 percent for steel structural units is not just $15 million, it is also more time and expense to build, because skilled labor is stretched thin in the construction trades. Nail gunning is easier and faster and there are more workers who can do it.”
The complex was built in compliance with fire and safety codes, said Michael Feigin, chief construction officer for developer AvalonBay, after the fire.
He added that “the purpose of those codes is not to prevent the building from burning down, but rather to ensure that there is sufficient time and opportunity for all occupants to exit safely in the event of a fire.”
Therein lies the problem for residents and underwriters: how best to protect structures that are not built to withstand more than a few minutes of fire.
“We say the choice is to build to code or to build to last,” said Brion Callori, senior vice president of engineering and research at FM Global. “The Edgewater fire is a perfect example of that. It was built in compliance with National Fire Protection Association [NFPA] codes.”
The best option, said Callori, is sprinklers, but retrofitting those into existing structures is difficult. Treatments also have their limitations.
“Wood burns,” he said. “Passive fire protections, such as coatings, are a challenge in original construction because they may not last the life of the building.”
Coatings are also a challenge in retrofits because it is difficult to get to all surfaces. At best, coatings will slow a fire, but cannot stop it, he said.
“We have seen a lot of treated lumber and sprays for fire resistance,” said Pilla, “but it’s still wood — and wood burns. We write a large amount of large structures and we have found that the best practice is for owners and managers to stick rigorously to the NFPA codes.
“We inspect every property as frequently as every three months for every NFPA code and cite ‘SCARE’ instances — serious conditions affecting risk exposures. We note them and let the owners or operators know we will be back. You would be surprised how often you see the same issues over and over.”
Based on lessons learned from actual losses as well as at FM Global’s research and testing center in Providence, R.I., Callori said, “We are focusing on ways to reduce the cost of sprinkler systems in both original construction and in retrofits. They look simple, but they are really very complex systems.”
The current focus for FM Global is original and retrofit sprinklers for warehouses, where ceilings and shelves are going higher and higher, and more plastic is being used.
Shortcuts Turn Into Tragedies
Beyond the challenges of physics, chemistry and engineering, the biggest hurdle for insurers may be the soft market, said Callori. “Our underwriting is tied to engineering, and upgrades or retrofits can lead to lower premiums, but that is not what drives things. Rates are market driven and currently there is a soft market.”
Another complication reported by both carriers and owners is the complexity of the codes.
TRU has consolidated the NFPA mandates into a summary booklet called the Builders Risk Tool Box. “Our engineers have written protocols using the NFPA codes, and even included sample permits. Our tack is prevention. There are a lot of competitors in this market and a lot of capacity.”
Pilla is quick to note that contractors, owners and operators with better loss histories usually have their own protocols.
“The prudent contractor exceeds the standards. Where we find problems is when someone skips a step, like having a fire extinguisher at hand during hot work. In the time it takes to run and find a fire extinguisher, a fire can grow. We also see situations where crews left the job too soon and something smoldering flared up.”
The problem is worse with renovations, rehabs and retrofits, because those are often done with far fewer people and on a much smaller scale.
“In a new build,” said Pilla, “there are lots of people on the job. There are inspectors, and you can see almost everything. In a rehab, it could just be a few workers working in one space at a time. [There is] often less supervision and less ability to see potential hazards.”
One industry source with close knowledge of the Houston, San Francisco, and Edgewater fires said that uncontrolled hot work, such as was the case in Edgewater, is one of the top causes of fires.
“Hot work is nasty, and problems are common,” the expert said. “The codes and best practices are sound, but they are often not followed, especially in rehab and retrofit work because crews are often in a rush and are rarely observed.”
Managing Chronic Pain Requires a Holistic Strategy
Chronic, intractable pain within workers’ compensation is a serious problem.
The National Center for Biotechnology Information, part of the National Institutes of Health, reports that when chronic pain occurs in the context of workers’ comp, greater clinical complexity is almost sure to follow.
At the same time, Workers’ Compensation Research Institute (WCRI) studies show that 75 percent of injured workers get opioids, but don’t get opioid management services. The result is an epidemic of debilitating addiction within the workers’ compensation landscape.
As CEO and founder of Integrated Prescription Solutions Inc. (IPS), Greg Todd understands how pain is a serious challenge for workers’ compensation-related medical care. Todd sees a related, and alarming, trend as well – the incidence rate for injured workers seeking permanent or partial disability because of chronic pain continues to rise.
Challenges aside, managing chronic pain so both the payer and the injured worker can get the best possible outcomes is doable, Todd said, but it requires a holistic, start-to-finish process.
Todd explained that there are several critical components to managing chronic pain, involving both prospective and retrospective solutions.
Prospective View: Fast, Early Action
“Having the wrong treatment protocol on day one can contribute significantly to bad outcomes with injured workers,” Todd said. “Referred to as outliers, many of these ’red flag’ cases never return to work.”
Best practice care begins with the use of evidence-based UR recommendations such as ODG. Using a proven pharmacological safety and monitoring opioid management program is a top priority, but needs to be combined with an evidence-based medical treatment and rehabilitative process-focused plan. That means coordinating every aspect of care, including programs such as quality network diagnostics, in-network physical therapy, appropriate durable medical equipment (DME) and in more severe cases work hardening, which uses work (real or simulated) as a treatment modality.
Todd emphasized working closely with the primary treating physician, getting the doctor on board as soon as possible with plans for proven programs such as opioid Safety and Monitoring, EB PT facilities, patient progress monitoring and return-to-work or modified work duty recommendations.
“It comes down to doing the right thing for the right reasons for the right injury at the right time. To manage chronic pain successfully – mitigating disability and maximizing return-to-work – you have to offer a comprehensive approach.”
— Greg Todd, CEO and founder, Integrated Prescription Solutions Inc. (IPS)
Alternative Pain Management Strategies
Unfortunately, pain management today is practically an automatic move to a narcotic approach, versus a non-invasive, non-narcotic option. To manage that scenario, IPS’ pain management is in line with ODG as the most effective, polymodal approach to treatment. That includes N-drug formularies, adherence to therapy regiment guidelines and inclusive of appropriate alternative physical modalities (electrotherapy, hot/cold therapy, massage, exercise and acupuncture) that may help the claimant mitigate the pain while maximizing their ongoing overall recovery plan.
IPS encourages physicians to consider the least narcotic and non-invasive approach to treatment first and then work up the ladder in strength – versus the other way around.
“You can’t expect that you can give someone Percocet or Oxycontin for two months and then tell them to try Tramadol with NSAIDS or a TENS unit to see which one worked better; it makes no sense,” Todd explained.
He added that in many cases, using a “bottom up” treatment strategy alone can help injured workers return to work in accordance with best practice guidelines. They won’t need to be weaned off a long-acting opioid, which many times they’re prohibited to use while on the job anyway.
Chronic Pain: An Elusive Condition
Soft tissue injuries – whether a tear, sprain or strain – end up with some level of chronic pain. Often, it turns out that it’s due to a vascular component to the pain – not the original cause of the pain resulting from the injury. For example, it can be due to collagen (scar tissue) build up and improper blood flow in the area, particularly in post-surgical cases.
“Pain exists even though the surgery was successful,” Todd said.
The challenge here is simply managing the pain while helping the claimant get back to work. Sometimes the systemic effect of oral opioid-based drugs prohibits the person from going to work by its highly addictive nature. In a 2014 report, “A Nation in Pain,” St. Louis-based Express Scripts found that nearly half of those who took opioid medications for more than a month in their first year of treatment then refilled their prescriptions for three years or longer. Many studies confirm that chronic opioid use has led to declining functionality with reduced ability to recover.
This can be challenging if certain pain killers are being used to manage the pain but are prohibitive in performing work duties. This is where topical compound prescriptions – controversial due to high cost and a lack of control – may be used. IPS works with a reputable, highly cost-effective network of compound prescription providers, with costs about 30-50 percent less than the traditional compound prescription
In particular compounded Non-Systemic Transdermal (NST) pain creams are proving to be an effective treatment for chronic pain syndromes. There is much that is poorly understood about this treatment modality with the science and outcomes now emerging.
Retrospective Strategies: Staying on Top of the Claim
IPS’ retrospective approach includes components such as periodic letters of medical necessity sent to the physician, peer-to-peer and pharmacological reviews when necessary, toxicology monitoring and reporting, and even addiction rehab programs specifically tailored toward injured workers.
Todd said that the most effective WC pharmacy benefit manager (PBM) provides much more than just drug benefits, but rather combines pharmacy benefits with a comprehensive ancillary suite of services in a single portal assisting all medical care from onset of injury to RTW. IPS puts the tools at the adjustor fingertips and automates initial recommendations as soon as the claim in entered into its system through dashboard alerts. Claimant scheduling and progress reporting is made available to clients 24/7/365.
“It comes down to doing the right thing for the right reasons for the right injury at the right time,” Todd said, “To manage chronic pain successfully – mitigating disability and maximizing return-to-work – you have to offer a comprehensive approach,” he said.
This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with IPS. The editorial staff of Risk & Insurance had no role in its preparation.