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If you watch the TV program "ER," in every episode the doctors and nurses have to move severely injured patients from the ambulance's gurney onto an emergency-room bed. You've seen the routine--a handful of doctors and nurses grab the edge of the sheet under the patient, count to three and lift the patient to the bed. But this patient-transfer procedure may not be the best way to move the patient. The doctors and nurses could injure themselves in the process--a workers' comp claim in the making.

"When you have 10 people trying to move a patient, you just multiply the risk by nine," says Bill Wandel, vice president of risk management at Integris Health, Oklahoma's largest nonprofit health organization, and the 2006 Theodore Roosevelt Award nonprofit category winner.

"Our focus is on where our major losses are coming from. The back and shoulder injuries are our loss leaders and not just from a money viewpoint," Wandel says. Perhaps even more important, injured people can lose their careers.

"There are a declining number of people who can replace our current workers, so we need to extend their work lives," he says. "Our job is to minimize those traumas that occur on a daily basis so we can extend their work-life expectancy." And the primary function where employees--primarily nurses--get hurt is during patient transfer.

In fact, Wandel says 60 percent to 70 percent of all losses can be tracked back to lifting weight in general. Even weight-training enthusiasts, who spend hours at the gym bench-pressing hundreds of pounds, can injure their backs when trying to lift or transfer a postoperative patient.

To get a better handle on preventing these common injuries, Integris launched its No-Lift policy in 1997 to shift the culture from just moving patients to moving the patients safely by using new lifting equipment. Since 2000, Integris has invested $2.3 million in safety equipment, so its nurses, orderlies and aides (the primary patient-transfer workers) can move or transfer patients safely.

The purchases include portable lifting equipment for each patient unit, permanently installed ceiling track lifts so one employee can move patients with just a fingertip, a hydraulic bed mover so employees don't have to tug and push beds weighing up to 1,800 pounds, and motorized carts for moving laundry, lasers and prescription carts that could weigh from 400 to 800 pounds when fully loaded.

Consider, too, that patients have been getting bigger, so they've also been getting heavier and more difficult to move. Wandel says patients weighing 600 pounds, 700 pounds or even 800 pounds are no longer that unusual.

For health-care institutional risk and disability managers, these risks present the ultimate problem-solving situation--people are getting hurt by helping other people. So, unlike in other manufacturing or service facilities, you can't just tell your employees to not do that particular job, or remember to bend their knees when lifting--especially when moving an 800-pound postop patient. In many cases Lane has had to work with a device manufacturer to design a piece of equipment that will keep employees from getting hurt.

For example, a small golf cart was the inspiration for the redesigned laundry cart that Lane needed for a laundry employee.

"Her knees were about to give out from pushing carts holding more than 800 pounds of laundry," Lane says. If Lane and her staff didn't come up with some kind of solution, the worker would soon be on an extended worker's comp leave, costing the health-care organization several thousands of dollars.

"We worked with a manufacturer to develop a train engine that hooks up to the cart," she explains. The device allows the laundry employee to sit on the cart instead of pushing or pulling it. It's more than a little engine that could--it's saving the organization literally more than $100,000 in anticipated worker's comp costs for the knee replacement surgery, rehabilitation and recovery.

That's Lane's typical approach to keeping employees safe, now that the health-care firm has adopted its mission to keep its employees safe and its workers' comp costs down. And they haven't had to resort to circus-like incentives to encourage its employees to use the lifting equipment instead of trying to do it themselves.

As Wandel explains, each department supervisor is charged with reminding the employees and reinforcing the message to use the lifting equipment. In many cases that has produced what Wandel calls "system-positive jealousy," when, for example, the employees at several facilities were treated to department big-screen TVs because there were no loss times reported over the course of a fiscal year.

One facility saved more than $100,000 in workers' comp costs over a two-year period. Risk management rewarded those employees with two big-screen TVs. Other facilities hold drawings for big-screen TVs when no loss-time incidents occur during the fiscal year. So the jealousy works as an incentive for other departments.

STICKING IT TO NEEDLE INJURIES

But its No-Lift policy is still not a perfect solution for reducing all workers' comp costs and occurrences. Needle-stick incidents can skew Integris' frequency-of-injury numbers upward now that the Occupational Safety and Health Administration requires hospitals and clinics to report blood-borne pathogens as incidents.

Consequently, while Integris' injury incidents reached a low last year at 320, they were reported at 506 (compared with 2004's 338) due to 186 needle-stick injuries. So, minus last year's needle-stick injuries, Integris' frequency of injuries has declined every year since 2002, from 445 in 2002, 415 in 2003, 338 in 2003 to 320 in 2005.

Average lost-time per claim has recorded an impressive annual drop since 2002--at 5.31 days in 2002, 3.05 days in 2003, 2.84 days in 2004 and 2.29 days in 2005.

But the total dollar savings to Integris from all the safety and No-Lift efforts has been significant. In a benchmark study, the Midwest Employers Casualty Co. this year documented a total savings of $11.9 million at Integris since 2001. That works out to an annual savings of $2.7 million.

NUMBERS TO DROP

Wandel believes these numbers will continue their downward track as employees become more comfortable with the No-Lift and safety policies, accept the culture change and willingly adopt the programs.

"We want them to say, 'Wow, this is good for me,'" Wandel says.

The safety programs also increase productivity because the so-called "walking wounded" are no longer getting hurt and not available to work. The trick is to keep the numbers going down, not up.

"As the chance of injury goes up, we have to change the culture so it says, 'We care about you,' " Wandel says.

He wants to place an even stronger emphasis on safe working as younger workers--those who believe they're invincible--begin to replace the older workers.

"They think they can do anything," he says, including moving patients with no help. One approach has been to have older nurses speak to the younger employees, to convince them to use the devices available to them.

Wandel's goal is for 100 percent compliance, and "we're moving in that direction," he says.

Right now, compliance is running about 60 percent to 70 percent, still much higher than when he launched the No-Lift program nine years ago. "It makes sense to do this--providing our employees a safer way to work," he adds.

SUSAN GUREVITZ, editor of Workers' Compensation Report, an LRP publication, lives in Philadelphia.

November 1, 2006

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