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Director of Risk Management
PetSmart Inc.
Phoenix

Risk manager David Jewell's pet peeve: getting the proper amount of care to the right person.

Whether it is a mom-and-pop store with five employees or a giant nationwide enterprise with nearly 50,000, getting proper care to the injured as quickly and efficiently as possible is always a priority.

But in the latter case, systems and procedures using the most up-to-date technology can make or break the ultimate success or failure of that worthy goal.

David Jewell, Phoenix-based director of risk management for PetSmart since 2006, recognized from the outset the need for an enterprisewide reporting system that would facilitate the efficient delivery of medical care for workplace injuries.

The system he put into place puts the injured worker in immediate contact with a nurse to get the right level of care as quickly as possible without the redundant handling and needless costs that Jewell saw happening with traditional triage arrangements.

PetSmart operates more than 1,100 retail outlets and nine distribution centers in the U.S. and Canada, and employs a workforce of about 45,000 people.

Sedgwick CMS vice president Michelle Chambers worked with Jewell in devising the new system. "Jewell and management of PetSmart are very serious about doing the right thing for its associates in terms of medical care," she said.

On a personal level, Chambers described Jewell as "decisive without being autocratic." "He is thoughtful in the manner of someone who does not take change lightly but is well aware of the potential benefits of making change when it is needed," she said.

Chambers found Jewell eager to gather as much input as possible before making a decision while considering all angles of a problem.

Among the problems Jewell had to consider was the fact that in the old system, the existing triage protocol also served as the intake reporting platform, which slowed things considerably.

"This arrangement placed a high cost burden on the program by using clinicians to perform administrative intake tasks, and also allowed minor incidents to spiral out of control due to lack of appropriate filtering," Jewell said.

Store managers completed a manual worksheet in which incident characteristics were poorly defined. "There was no data warehouse to capture reports of critical events, and the information provided to PetSmart stakeholders was minimal," Jewell said.

Moreover, data was unavailable when needed at a later date to respond to lawsuits and third-party liability cases were still being reported manually using handwritten forms and fax machines to claims providers.

Jewell also said that medical care was poorly managed, with associates getting not the correct amount of care or sometimes the wrong kind. "Too many self-treatable minor ailments that should have been addressed with antibiotic ointment and a Band-Aid were migrating to workers' compensation medical triage programs, as were nonoccupational health issues," he said. Oftentimes store managers were involved in authorizing and managing medical care in a manner outside their core competency and core responsibility.

"This not only added to claims handling expenses for PetSmart, but additionally, there was a risk that the cumbersome process might delay care for more serious injuries," Jewell said.

Under the system developed with Jewell's leadership, injured associates answer customized injury intake questions geared to accepted clinical guidelines. When deemed appropriate by the answers, the caller is transferred to a nurse for clinical consultation.

Jewell said the success of the program could be seen in the fact that intake calls requiring clinical consultation have dropped by 24 percent.

"The new program is driving more appropriate medical care for injured associates and reducing costs for PetSmart," he said.

For Jewell, installing a risk management process and team where none existed before, and then watching accident and cost metrics improve remains his greatest satisfaction. "We have seen our safety group grow from one professional to six and seeing great integration with our store operations, supply chain and loss prevention teams," he said.

Turning around any structure within a Fortune 500 company does not come without strain. "I would not call it resistance as much as communication and education challenges throughout the organization that the risk management program needed a major overhaul in terms of both cost and process," Jewell said.

He added that a lack of strong risk management "had led to a culture of malaise and poor communication that took some time to turn around."

--By Steve Tuckey

Risk Analyst
Nike Inc.
Beaverton, Ore.

Risk Analyst
Nike Inc.
Beaverton, Ore.

A pair of Nike analysts centralize exposure data and give their sportswear company a leg up on comparing risk coverage from different carriers.

Nike risk analysts Nick Troxel and Marny Maahs had a simple goal when it came time to overhaul their company's risk management system: bring it all under one roof.

"The only way to become the innovative, lean and efficient company that Nike has become is to have control, visibility and understanding of what their risk is," said Chad Levine, an account executive with Aon eSolutions, who worked with Maahs and Troxel to bring the system to fruition. "Marny and Nick are taking control of that risk and making the company a stronger organization."

Risk management, risk finance and employee relations were among the teams brought into the new system with the new ability to share data with few hurdles. "I picture Nick and Marny running around the Nike campus bringing internal clients into the system in order to break down barriers where data never used to be shared," Levine said.

The pair, based at the company's Beaverton, Ore. headquarters, were always thinking on a long-term basis about how users, particularly outside the risk management department, could benefit from the system. "Nick and Marny are doing different things at Nike," said Levine. "They have the ability to step back and think big picture about ways to push the RMIS envelope outside standard claims and reporting."

They started from the ground up to help these groups design processes and solutions that solve business problems, "while they are always looking ahead about how this data can interact to provide a bigger picture to manage risk," he added.

Troxel said that Global Risk Management had the challenge of looking at risk issues for a diverse organization that integrated a large portfolio of companies and products. "Internal risk management processes were manual with data integrity and validation issues," he said.

He noted his unit had mastered the fundamentals of data management to support the core risk control and finance needs such as policy renewal and claims. "However, opportunities existed to integrate that information with that being derived from our risk prevention and loss control initiatives," he said.

The vast quantity of data, which needed to be collected, vetted, analyzed and assessed, did not make things easy. As a result, time was wasted on data collection and data management issues. "In order to support the business going forward, Global Risk Management needed the ability to shift our focus to data analysis and critical risk decision-making," Maahs said.

Like most challenges today, the main impediments were limited resources. "The philosophy that problems are good wasn't well understood by all stakeholders," he said. Moreover, the ailing risk management insurance system (RMIS) did not make things any easier.

"Internal stakeholders were skeptical," Maahs said. "They questioned the intentions of the Global Risk Management team supporting them, posing the question of 'Why are you doing this for us?' "

Troxel also had to fight the urge to run before they could walk. "With the 'Just Do It' culture, Global Risk Management needed to slow down the pace to make sure the RMIS solution was built in the proper stages to support both the internal stakeholders and the larger organization," he said.

Despite, or maybe because of the difficulties, the rewards of getting the new system in place were palpable.

Troxel cited the enhanced risk awareness of the various stakeholders in the Nike universe in the top rank. "We were also able to shift our time allocation to analyzing data from gathering data," he said.

Maahs listed the one-stop shopping now available for exposure data in its new centralized location as among the greatest benefits. In addition, the automated reporting capabilities proved far superior to merely consolidating spreadsheets or dealing with the various homegrown IT solutions.

"RMIS is now becoming the data source of record for Global Risk Management," she said. "Other function teams and business units are looking to Global Risk Management for information."

To sum up, Troxel said the ability to provide a more holistic view of risk across Nike was his greatest challenge; and its achievement his greatest satisfaction.

"At Nike, it's our nature to innovate and our RMIS allows Global Risk Management to innovate in ways that we were never able to in the past," he said.

--By Steve Tuckey

Director of Risk Control
Macy's
Paramus, N.J.

Macy's and Bloomingdale's risk control officer consolidates retail giant's databases.

If you are one of the millions of shoppers or employees in the more than 800 Macy's or Bloomingdale's stores throughout the nation you have Doug Pangburn to thank that your experience remains a safe one.

As director of risk control for Macy's Inc., Pangburn directs a staff of 22 professionals who periodically inspect store locations to ensure all safety measures are enforced and figure out what new ones can be developed to meet changing conditions.

About two years ago, Pangburn streamlined the entire reporting operation so that all data flowed into one source where it could be put to quicker and more efficient use. To reach that goal Pangburn saw the need to improve the database as it relates to safety and property surveys and the information that comes from them.

In general, safety audits result in three data points including any recommendations that may be deemed appropriate, documenting safety procedures by the auditors, and finally any loss analysis. "Before we put in this system, those three data pieces were in all different places," he said.

For the most part a soft-spoken self-effacing man, Pangburn had a hard time pinning down his greatest satisfaction in the job. "It is just not something you think about or talk about that often," he said with a chuckle. After some reflection he was able to put it in words.

"My greatest satisfaction is being of the group that makes all of our stores safer for our customers and employees," Pangburn said.

While it may seem that his entire job consists of coordinating data flows and implementing procedures, he realizes that at the end of the day, if it results in one less employee or customer suffering a serious injury, it can't get much more rewarding than that.

Since he can't be in 840 locations at once ready to catch a customer who just slipped on a banana peel, Pangburn will just have to settle making sure the systems do the job.

"The system allows us to analyze problem areas, get that information to our safety directors in our stores and continue to try and focus as much as we can on the right people on these areas," Pangburn said.

Not all of Pangburn's superiors got aboard right from the start. "Sometimes the money issue became prohibitive," he said. Making it a priority took all of Pangburn's diplomatic skills and determination to see the system through to reality. "Lots of times it is just a time issue with everyone trying to multitask," he said.

As for results, Pangburn has seen claims per millions of dollars of sales go down over the past year, in terms of numbers and in terms of dollars.

As a self-insured company with policies only covering excess high-end losses, Pangburn savors the fact that the savings from his work go directly to the company's bottom line rather than merely reduced premiums that may or not happen over the years. "The dollars we save are basically our dollars," he said.

Chad Levine of Aon eSolutions worked with Pangburn in developing the new procedures and saw a man determined to cut waste and inefficiency.

"Doug could see that risk managers spent days copying and pasting documents to fit into a specific solution," Levine said. "This was not accurate, efficient or cost effective."

All in all, Levine worked with a person with a clear vision and the ability to communicate it. "He is real easy to work with. He knows what he wants and can translate that to both me and his team and say, 'Here is where we want to go.' ''

Seeing the big picture also means ensuring that the executives responsible for safety don't end up duplicating work. For example, such duplication could occur with the people responsible for employee as opposed to customer safety. In other words, silos are best avoided.

His leadership style allows for general direction from the top. "From what I could see, he lets them become successful on their own," Levine said.

Pangburn has been with Macy's (and its predecessor company Federated Inc.) for 17 years, and in the industry itself for more than two decades. With so much experience it is fairly easy to pinpoint his greatest challenge. "It is keeping the focus on safety with everything else that the business demands," he said.

--By Steve Tuckey

Senior Director, Risk Management
Knowledge Learning Corp.
Portland, Ore.

Telephonic medical triage assigns a nurse-case manager to every claim so patients can speak privately one-on-one with a nurse.

As the chief risk management official for the Knowledge Learning Corp., Ken Wood looks out for the welfare of some 38,000 employees who face unusual workplace injury vulnerabilities.

"You are not really lifting things like boxes. But you are lifting children, or you are bending down to hug children, or you are kneeling down to their level to teach children," he said.

The Portland, Oregon-based KLC Corp. operates child care centers for infants through kindergarten age children in 38 states. About 38,000 employees oversee the welfare of some 200,000 children.

Any workplace injury, no matter how engaging the source, requires the same diligence in not only providing treatment, but ensuring the employee gets back to work in some capacity as soon as possible.

So how do you substitute a hug when that hug could exacerbate an injury? "You engineer different ways in which someone can teach children, without having to say, sit in a child's chair," said Wood.

Wood's team also developed a four-wrung stepladder up to the changing table to avoid having to lift a child in need of a fresh diaper.

"You can minimize the degree to which they have to use their back by putting them in a stationary position in the center somewhere where they can supervise children safely and effectively," he said.

The job remains the same, but must be done a tad differently, Wood said. Wood's team expected some resistance for a more exacting return-to-work policy. "There is always resistance to something new. But we worked through those issues and we don't often encounter huge problems with it," he said.

With about 80 percent of employers having modified duty program, the issue becomes how you administer it and "we administer it at a very high level," Wood said.

In other areas in the workers' comp realm, the exclusive use of preferred provider organizations (PPO) ensures more consistent care and according to Wood, "reduces the likelihood they will encounter a bad physician who will over treat them." Wood seems most proud of the telephonic medical triage his team developed.

"We have assigned a nurse-case manager to every single claim so the individual can have a private conversation with their nurse over the phone. Between them, they can decide if this injury really warrants medical attention or if they can use some self-treatment options," he said.

Again, resistance was negligible.

"The program was embraced because the employee felt they had an advocate in this nurse," he said, noting the nurse had no incentive to dissuade the worker from seeking medical attention. The most critical metric for success remains the 30 percent reduction in medical inquiries, Wood asserts.

Joseph Boures, president of Hartford-based Specialty Risk Services, the third-party administrator for KLC's workers' compensation program, said that Wood's ability keep all the players in a diverse nationwide program on the same page is a tribute to his personal dynamism.

"He has a lot of energy and experience and these combined talents enable him to get the most out of his resources," he said.

Devising a return-to-work program without the traditional options of lighter duty jobs at his disposal required strong communication and diplomatic skills, topped off with a bit of innovation. "It was a bit of a balancing act in that you have to get the buy-in from all the operations so that they we not necessarily missing a beat from a quality of care or education standpoint," he said.

That buy-in remains critical.

"Ken and his team quickly realized that changes would need to be made to ensure that all KLC employees understood their role and felt empowered to take the necessary steps to ensure its success," Boures said. Wood's emphasis on communication can be seen in the risk hotline he set up that enables employees in the field to reach the 21 risk staff members for questions on a host of issues. The program now manages more than 2,500 calls per month on issues such as drug testing, student accidents and illnesses.

--By Steve Tuckey

Corporate Director of Risk Management
The Kroger Co.
Cincinnati, Ohio

Temporary total disability payments plunge by about 10 percent after reforms to a supermarket chain's workers' compensation program.

Successful return-to-work systems are a critical component of workers' compensation programs that truly serve the needs of both the employer and employees.

For that reason Steve King, Cincinnati-based corporate director of risk management for a supermarket industry leader, The Kroger Company, decided to completely revamp Kroger's approach to this function.

At the outset, King saw the advantage of rolling up all return-to-work functions, including vocational rehabilitation and nursing operations into one location. "It was important to bring all players into one location where they could function under one process," he said.

In prior years, the many divisions of the company used differing services and processes with varying outcomes.

"We wanted to get our nurses closer to our injured associates, so we could rehab or work with the doctors better to achieve the goal of getting the associates back to work," he said.

Prior to this, Sedgwick CMS, the company's third-party administrator, had worked individually with the company's 18 divisions.

"It was more triangular at that time and this is more direct. So we really have streamlined the process to work quickly, efficiently, and closer with the injured workers," he said.

Meanwhile, the company is working on a schedule of light-duty jobs that injured employees can perform. The numerous banners under which Kroger stores operate complicates the task since each traditionally has its own operational methods. Moreover, various state laws and union agreements also come into play.

"Basically, the unions work well with us because what we are trying to do is best for the associate," King said.

The chain operates its stores east of the Mississippi under the Kroger banner, and west through numerous other names acquired through acquisitions.

Wherever the location or store banner, getting the injured worker back on the job as quickly as possible is the name of the game. "I think having quality medical care is critical to the assessment and return-to-work process necessary to bring the associate back to work as soon as possible," he said.

In addition, each worker is assigned a return-to-work coordinator, who acts as ombudsman for the injured associate. This person ensures necessary appointments are made and works with local management to find the proper work within the worker's restrictions.

Well into the program's second year, King expressed satisfaction with the results for its pilot year that reduced temporary total disability (TTD) payments by about 10 percent.

So far resistance has been virtually nil.

"We have had return to work in place for a number of years so our associates are familiar with it," King said. "We are just able now to act much quicker and communicate to them much quicker."

Leslie Grever, vice president at Sedgwick CMS, sees King as a leader able to grasp the big picture needed for a $76 billion enterprise with 330,000 employees, and thus deal effectively with the inevitable roadblocks that come up from time to time.

"The major complications to achieving his objectives were the inconsistency of the various Kroger divisions' return-to-work practices," she said.

Grever said that King's effort to have a higher level of expertise available early on in the claim is one more example of the vision needed to achieve the overall goal of lower TTD payments. "This alleviates the need for additional resources later in the claim life when warranted by the claim's need," she said.

King's use of both return-to-work coordinators and certified rehabilitation counselors "reflects the same satisfaction-oriented practices that have made Kroger a leader in customer relations," Grever said.

In the end, the reduced TTD payments that have resulted from the efforts of King and his team are "only a side benefit of doing the right thing for the Kroger associate."

King began his effort in a rosier economic climate than exists today, and the challenge to do the right thing only increases as times get tougher. "He is asking his own employees how the stores, Sedgwick CMS and the doctors are treating them," Grever said.

The surveys that accomplish this goal go to King's desk every quarter. "What Steve is determined to do is to make sure the Kroger associate is getting the right healthcare and when they are ready to come back to work, it is done quickly and efficiently," Grever said.

--By Steve Tuckey