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Two factors have contributed to my feeling that the topic of injury prevention required a second column. (Read Maddy's first column on injury prevention here.)

What is this "new demographic"? Consider these statistics.

-- The National Council on Compensation Insurance (NCCI) and the California Workers' Compensation Insurance Rating Bureau have hinted that 2009 combined ratios are expected to be higher than 2008. We are on the upswing of our cycle.

-- The Bureau of Labor Statistics tells us that, in the next few years, more than 20 percent of the working population will be over the age of 55. (Count me in!) This population, when injured on the job, has longer disability durations and higher medical costs due in no small part to their pre-existing and degenerative conditions.

-- The Centers for Disease Control tells us that one in four Americans is considered obese. In a few states, the number is one in three. The Insurance Information Institute reports that obese workers file twice as many claims and have 13 times more lost workdays. In addition, there are delays in treatment, specifically surgeries, due to the lack of success without presurgery weight loss.

-- NCCI reports that approximately 20 percent of medical costs on fully developed claims come from pharmaceuticals. More frightening still is the dramatic change in the percentage of dollars going to the narcotic analgesics and central nervous system drug classes. We have moved from 36 percent in those categories in 2002 to almost 50 percent today.

-- We are experiencing a major ethnicity and cultural change in our country that will impact our workplaces. The Census Bureau believes that, by 2050, Hispanics, African Americans and Asian Americans will be 54 percent of our population. How will we prepare ourselves in this industry for this kind of change?

I liken these trends to the descriptions of the tsunami danger we all avidly watched on live TV a few weeks ago after the Chile earthquake on Feb. 27. A tsunami builds under the surface of the ocean and you cannot see it until it hits land as an enormous wave.

These above mentioned trends are building similarly and, in combination with one another, could have tremendous impact on the frequency and severity of workplace injuries. We must prepare as Hawaii did. They evacuated locations and moved people to higher ground, thereby reducing the risk of injuries. We need to understand our changing employee populations and focus on reducing our risk of injuries.

My second reason for this second column on prevention is the positive reaction to my first column on prevention. I communicated with a few employers who have achieved outstanding results from a program called PreCare Inc., which places clinicians (ergonomists, athletic trainers, physical therapists) right in the workplace a few times each week. These clinicians participate with the safety team; assess and reduce risks; provide safety, wellness and conditioning coaching and education; provide early intervention screening with employees experiencing discomfort; assist with ergonomic redesign of the particular work environment or tools being utilized; and provide physical therapy treatment as needed on-site.

All services are provided at the worksite, enabling these clinicians to get to know the employees. Rather than simulating work tasks, the employee actually performs appropriate work tasks as part of the education, assessment or treatment process.

Given our approaching tsunami, this program seemed like one potentially positive way to respond to prevention, especially considering the "new demographic."

For example, in 62 Costco warehouses (where strain and sprains are the top nature of injury), clinicians from PreCare interfaced with employees, supervisors, management, physicians, case managers and claims examiners to facilitate injury prevention and efficient return-to-work. According to Katrina Zitnik, director of workers' compensation for Costco, in several of the PreCare staffed warehouses, the clinicians, while on-site working with employees and managers pre-injury, have developed ideas for ergonomic improvements that reduced discomfort and injuries. Many of these improvements have now been adopted by the Costco Safety Department and exported to other warehouses where appropriate.

Zitnik is closely monitoring the results from this program and notes that in the state of Washington, where the PreCare program has been up and running the longest, she has compared results between warehouses with the program and those without the program. After controlling for injury diagnosis and severity, the rate of claims with lost time in warehouses with the PreCare program was 13 percent compared with a 53 percent lost-time rate in the other warehouses.

Zitnick went on to say that perhaps the results of Costco's employee satisfaction surveys are even more revealing. In the warehouses with the PreCare program, employees reported feeling that the company really cares about them and is willing to invest in programs focused on keeping them safe.

A similar program is in place for Fairmont Hotels, where the number one source of injury is the housekeeping department. PreCare placed clinicians on-site in the hotels and had them work alongside the housekeepers, as well as the other departments. Through risk and ergonomic assessment, PreCare staff identified mattress lifting as the activity most frequently causing injuries. Fairmont Hotels knew that, because their workforce was aging and mattresses were getting heavier, they needed a solution.

Working in partnership, PreCare and the San Francisco Fairmont Hotel, including the housekeeping department employees, engineered a set of lifting tools they are calling "Bed Toolzzz."

The regional vice president of Fairmont Hotels, Thomas Klein, reported that, in the last year, since they have been using the Bed Toolzzz in California, they have not had a single injury in that department. They are now rolling out this ergonomic improvement to all of their hotels. Best of all, according to Klein, the employees feel a sense of ownership, accomplishment and appreciation for what their employer was willing to do to "take care of them."

Clearly, there are many ways to enhance our workplace safety and prevention, and hopefully by mentioning a few interesting programs in my last and current column, I have encouraged you all to go into "Emergency Prevention Preparedness." We need to heed the tsunami warnings and work harder to prevent workplace injuries!

MADDY BOWLING is a principal of Maddy Bowling Consulting Inc.

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March 18, 2010

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