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By Dan Reynolds

Anyone who has ever grown impatient with the pace of change in government can take heart from the career of Gary Eastes, the risk and benefits manager for the City of Knoxville, Tenn.

In reducing the self-insured, self-administered city's workers' comp annual costs from a recent high of $5.92 million in 2002 to $1.29 million in 2011, Eastes has learned to pick his battles and apply pressure where he sensed there could be some give.

"In our job, to be effective you have got to know how much you can push, because there is a level of pushing that you can do and you can go too far and you can just ruin your credibility," said Eastes.

The evidence shows that Eastes has known where and when to push.

For their work in bringing together a cohesive and integrated approach to workers' comp risk management, Eastes and his team are the recipients of the 2012 Theodore Roosevelt Workers' Compensation and Disability Management Award for the nonprofit sector.

Knoxville's risk management team, through hard work and patience, have reached a place where city department administrators and staff members trust that they are indeed looking out for their best interests: Trying to return them back to work and helping to keep them in good physical condition.

But it wasn't always that way. Injury claims above $75,000 for the city numbered a scant six in 2011, but there were 27 such claims for the city to contend with in 2004.

In finding ways to get city employees to work safer, Eastes and his team encountered misunderstanding, based in fear, that made the going difficult for a while.

"I think that their thought process was that risk management was trying to find a way to get rid of them," said Ginger Huskey, the city's risk coordinator, in describing attitudes toward risk management on the part of injured employees and their department heads -- attitudes that were historically less than cooperative.

"I think you have to build a trust so that they see that we are there to prevent them from having accidents because their well-being is what we are concerned about," Huskey said.

From a prevention standpoint, one of the places where the city has made up solid ground is in the use of seat belts.

Police, fire and emergency medical personnel put in hours on the road on a daily basis. The least one would hope a public safety supervisor could do would be to convince public safety personnel to use seat belts. But surprisingly, many injuries and fatalities occur among public sector workers that weren't wearing them.

A National Highway Traffic Safety Administration study found that at least 43 percent of police officers killed nationwide in vehicle crashes in the line of duty over the last three decades were not wearing seat belts.

Eastes clearly saw that dynamic playing out in Knoxville. Police are shot at, sometimes killed by those they are paid to arrest. Firefighters run into burning buildings and public service workers need to manage dangerous chain saws and bush hogs, but none of these activities, statistically, is as dangerous as going out in traffic.

"The most dangerous thing our employees do is drive," Eastes said.

It took time, but eventually Eastes got department heads to see that he wasn't meddling with them. He simply wanted their workers to wear seat belts. "That was a major factor in our safety program to get to the point that departments enforced their employees wearing seat belts," Eastes said.

Huskey said the city now has an employee whose job it is to check whether city employees are wearing their seat belts when they are driving on the job.

What was first viewed as nit-picking has now become a way to boost morale.

Huskey said the city has become more active with the program in the past year, as employees have become more receptive. "They are seeing that it is not a way to get them in trouble. We are educating them as to why we are so intent on that policy because it does prevent injuries," Huskey said.

The city's largest departments now have dedicated safety positions. Rather than see Eastes and his team as interlopers, those departments welcome dialogue with Eastes.

"As time goes by and managers are replaced you get more and more people in place who are open," Eastes said.

"Management has become more professional and willing to listen," he said.

A CASE FOR INTEGRATION

On the case management side, Knoxville has built an integrated system that combines health screening, wellness guidance, on-site medical attention and physical therapy.

Because these services are in-house and not outsourced, communication among team members on how to best manage the case of an injured worker is superior, team members said.

Dr. Warren Sayre is the city's part-time medical director who is also the medical director of integrated health services for the Summit Medical Group of East Tennessee.

Sayre said he has been able to use the model of a team-based home Summit uses for personal health, and apply some of its precepts in the public sector.

Under the city's contract with Summit, getting hard-working and stressed out police officers and firefighters healthier and preventing injuries was a priority.

Expanding the program beyond management of acute injuries and triage, and then setting standards for police and firefighter physicals was a shared goal of Eastes and Sayre.

"I think the administrative team for those two departments in particular knew that they wanted to hold a higher standard to develop that but they weren't really sure where to go," Sayre said.

Making smart hires, ordering annual physicals and offering plenty of physical therapy has shown results.

"One of my favorite pieces of the program is with our physical therapy because it is the cost of it rolled into the bundled cost of the contract we have with the city," Sayre said.

Under the city's in-house case management program, Sayre, a representative of risk management, a nurse practitioner and a physical therapist meet every few weeks to discuss cases and treatment plans face to face.

This creates a better atmosphere for clear communication, said Sandra Pollock, a physical therapist with the city.

Pollock, who has been with the city for more than a year and a half, said this is the best case management team communication she has seen in her 26 years as a physical therapist.

Being in-house has given her the chance to ride along in police cars and fire trucks to see how injuries result from the work and how she can modify her therapies to help workers get back to the job and not get reinjured.

Pollock has also encouraged workers to open up to her about more than just the ergonomics that affect their jobs. Being a sounding board for whatever else is going on in a worker's professional or personal life she considers a key part of the job.

"It's not just about treating their knee or their ankle," Pollock said.

"You have to treat the whole person and if they are happy that will help them be more motivated," Pollock said.

That personal touch was a piece of how Eastes won hearts and minds to the importance of safety as he first sought to bring city officials over to his way of thinking.

A few years back, a Knoxville public service worker conducting roadside maintenance was badly injured when he was hit by an automobile. On his visits to the hospital to see the injured worker, Eastes frequently brought city officials along with him -- the deputy mayor in one instance -- to help drive home the human impact of worker injury; who exactly it hurts and what a major injury looks like.

"It helped change their side of it. It was just different from seeing the numbers," said Eastes, the pragmatist and humanist.

Make change where you can, he advises, and don't break your bones repeatedly running up against brick walls.

"There are probably 100 things that could be improved at any point in time," Eastes said.

"You really need to not spend yourself trying to fix things that it is just not the right time to change."

DAN REYNOLDS is managing editor of Risk & Insurance®. He can be reached at riskletters@lrp.com.

November 1, 2012

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