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Rainbow letters sprawl across the cover of a 2006 calendar produced by Hospital Corporation of America (HCA Inc.), above and around a family of four stick figures, standing in front of a house with two blue windows, a purple roof and a green door. "Safety at work," the calendar reads, "brings Mama and Daddy home."

The "Safety at Work" 2006 calendar--cobbled together from a collection of winners and finalists in a children's poster contest run by HCA--is part of the company's far-reaching and intricate safety and workers' compensation program.

Tim Portale, HCA's assistant vice president of environmental and employee safety, says that the company's emphasis on safety and its meticulous collection of claims data are keys to its successful workers' comp and loss prevention plan.

"I think the No. 1 thing is focus. You definitely cannot address every problem that you're experiencing," Portale says. "So you have to have very reliable data to trend it, to identify outliers, and to allocate your resources to control those outliers."

CENTRAL FIGURE AT EACH SITE

With almost 200 hospitals and 91 outpatient centers in 23 states, HCA Inc. is the nation's leading provider of health-care services. The company and its affiliates employ approximately 190,000 people--including nurses and other clinical staff, dietary staff, housekeeping and janitors, and warehousing and distribution workers, as well.

Maintaining almost 300 operating units and managing almost 200,000 employees, therefore, makes traditional loss prevention and safety--and the opportunity for Portale and his peers to visit each site--virtually impossible.

So while HCA's Environmental and Employee Safety Department works at the corporate level to design a responsive loss prevention and safety agenda, the people actually implementing that plan at HCA hospitals and centers are the appointed injury coordinators at each site.

Portale says each hospital has complete control in identifying the injury coordinator, who then attends a two-day orientation class at HCA's corporate headquarters in Nashville, where they are immersed in the specifics of the HCA program.

Then, workers' comp supervisors visit the injury coordinators at their respective locations, making sure each hospital has the necessary materials, equipment and products to efficiently implement the program. HCA's Workers' Comp Advisory Committee, comprised of six of the company's most experienced injury coordinators, oversees the work of a new injury coordinator and makes suggestions for how to educate new employees and how to roll out the broad aspects of the company's plan in specific ways at each facility.

Portale also says that HCA maintains an intranet database for Injury Coordinators and safety officials, which outlines the company's policies and procedures and provides a forum for horizontal and vertical communication--between hospitals and also with the Environmental and Safety Department.

Because implementing the company's program would be impractical from the corporate level, the injury coordinator has become the central figure in HCA's safety efforts.

"We ask them to keep ergonomics and other prevention programs at the forefront," Portale says, "by providing education to everyone at the hospital and, in particular, senior leadership, so that they can have some accountability and buy into the program."

And HCA's senior management, Portale says, has noticed.

"We have saved them a lot of money," he says bluntly.

PATIENT MANAGEMENT

HCA's most significant safety risks, Portale says, are those arising from patient management.

Managing patients--lifting, transferring and moving them between beds, stretchers and wheelchairs--engages employees in often stressful and delicate physical work, Portale says. And it places employees at risk for a host of problems--strains, sprains and other muscular injuries that could keep them from doing their jobs for extended periods of time.

There are also risks associated with needles and other surgical equipment--all things that nurses and doctors have to be ready to use at any point throughout any given day and hundreds of times throughout any given a week.

To control these volatile patient-management risks, Portale says, HCA has invested extensively--and continues to invest--in equipment designed to do much of the heavy lifting, so nurses and others don't have to worry about physically managing and moving patients.

The company has also rolled out a Safety in Patient Lifting program aimed at creating the safest possible circumstances for employees managing and moving patients. Hospitals initializing the program averaged a 46 percent reduction in the frequency of patient lifting and transfer claims and a 64 percent reduction in lost-time claims.

"We can take a hospital into what we call a controlled-lifting environment," Portale says. "So any planned lift equipment is available to manage the patients."

Despite the company's success in reducing claims and losses associated with patient management, aspects of HCA's loss prevention initiative--such as the Safety in Patient Lifting program--hint at a dilemma inherent in safety programs implemented by hospitals and managed care providers, Portale says.

Two forces collide in hospital rooms, cafeterias and workplaces, as companies like HCA struggle to balance employee safety with the natural focus of the health-care industry: keeping patients healthy.

It is difficult at times, therefore, to convince hospital teams and senior management to allocate money away from patient care needs and towards safety awareness, education and development programs.

"A nurse is taught all his or her life that the patient is number one, the patient comes first," Portale says. "What we try to do is encourage nurses to be as safe as possible when managing that patient."

HELP WHERE IT'S NEEDED

Another important element of HCA's safety and loss prevention program, Portale says, is the Focus Program, which aims to identify hospitals whose employee injury costs are not in line with average costs for other HCA sites in that state.

Portale says the program's goal is the identification of hospital outliers--HCA sites whose costs stand out among peer sites and whose workers' comp program needs more specific study and attention.

Once a hospital agrees to participate in the Focus Program, HCA conducts an onsite evaluation and develops a two-year action plan for the reduction of that hospital's employee injury costs. The company follows through by providing ongoing assistance and performance reviews as the hospital works through the program.

And while other parts of the HCA program--financial incentives for individual hospitals to keep their claims and losses down, for instance--have had positive effects on individual site performance, Portale says that the Focus program has been most successful in lowering corporate spending on employee injury costs.

A major factor in this, Portale says, is HCA's extensive claims management data.

"It's huge," Portale says of HCA's claims management database. "We have very specific health-care-related workers' comp injury data."

The database, Portale adds, is the basis of HCA's extensive program--a program that, by necessity, must flow evenly from the corporate level to the injury coordinator to every HCA nurse, administrator, cook and janitor.

"We have been very successful in demonstrating with our data that we can reduce costs and reduce injuries," Portale says. "I think it says everything."

JOHN McDONALD is a writer living in Pennsylvania.

November 1, 2005

Copyright 2005© LRP Publications