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2017 Teddy Award Winner

Workers’ Compensation Improvements in Health Care

The Valley Health System shifted its philosophy on workers’ compensation, putting employee and patient safety at the forefront.
By: | November 1, 2017 • 6 min read

The Valley Health System embarked on a journey to completely transform its workers’ compensation program. Now, five years later, Valley can boast it did just that.

Valley Health  is a regional healthcare system that serves residents in northern New Jersey and southern New York. From 2012 to today, Valley reduced its annual workers’ compensation budget by 69 percent while the number of employees increased 14 percent. Lost-time claims per year went from 171 to 79 and workplace violence injuries decreased by 50 percent in just one year.

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“This culture of safety has really made everybody, from the top down, more aware of their areas to see what’s in place for the safety of our employees,” said Linda Carey, a registered nurse at Valley who witnessed the changes firsthand.

In 2011, Valley’s workers’ comp budget reached a staggering $2.1 million and its incident rate was 5.72, leading to a two-and-a-half month-long site evaluation by OSHA. At the end, OSHA presented the health system with a list of safety recommendations.

It was just the catalyst Valley needed.

“Back in 2011, the workers’ comp program — while our nurses give excellent care — was not being run as it should be and a lot of our claims were going to the excess carrier,” explained Barbara Schultz, director of employee health and wellness, Valley Health.

When OSHA gave its recommendations, Valley began its own assessment to move in a more proactive and strategic direction.

Enhancing Safety

Health care workers are highly susceptible to workplace violence, whether it be a combative patient, a confused patient or even an outside force like an active shooter.

“Hospitals are soft targets. We embrace the role of the family,” explained Schultz.

Barbara Schultz, director, employee health and wellness, Valley Health

“Visiting hours are almost around the clock. We are a welcoming institution, which makes us very porous in terms of access.”

On top of that, regulations and rules have changed for hospitals over the past few decades. Where once a nurse or physician could use restraints to hold back a combative patient, laws prevent the use of such force unless in extreme circumstances.

“More staff is vulnerable. We’re caregivers, we’re meant to be there, and sometimes these patients lash out and swing.”

Once OSHA gave its recommendations, Valley tracked incidences of patient-on-caregiver violence, benchmarking the unit, the shifts incidences occurred and the type of patient involved. They used this data to further educate and train employees on safe work practices, creating the Safety and Security Director role in the process. This role reviews best safety practices across the system’s facilities.

Dan Coss, Valley’s Director of Security, Public Safety and Environmental Services, is an important asset to the safety protocols at Valley, Schultz said. With a PhD in the science of safety and security, Coss made employee safety paramount.

“He strengthened relationships with local authorities,” said Schultz, “he helped with workplace violence as a whole and brought in the Code Atlas team.”

Code Atlas is a 50-member team of trained staff members ready to address combative patients 24/7. This team is prepared to handle disruptive patients from the moment they arrive to the point where they are stabilized and cooperative. Overall, this team reduced workplace violence claims by half.

Also included in Coss’s job was incorporating active shooter training.

Valley hosts three to four small drills per month and one large drill per year involving local law enforcement.

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During the smaller drills, “Dan will come in as a relative with a bill complaint or someone who’s lost a loved one. He comes in yelling at the top of his lungs. The whole point is to get out of the situation safely,” Schultz explained.

“The staff is expected to respond by fleeing — run and get out of the way. If they don’t have the ability to run, they’re told to hide. If Dan sees you, he will pretend to shoot you.”

“I’ve been briefed on the drill [afterwards],” said Carey.  “It’s frightening even when you know it’s a drill. It gives people an idea of what they’ll feel and how they might react.”

Lissette Carcano, workers’ compensation care coordinator, Valley Health, once volunteered to be a patient during a drill.

“Visiting hours are almost around the clock. We are a welcoming institution, which makes us very porous in terms of access.” — Barbara Schultz, director, employee health and wellness, Valley Health

“I was an ER patient locked in a room with a nurse. You shake in your boots. It becomes real, but I felt very comfortable with the nurse,” she said.

The larger drill takes a year to plan. Valley must get EMS, fire rescue and local law enforcement on board before enacting an active shooter drill. Instead of Coss acting as the perpetrator, the police volunteer an officer to enter the selected facility holding a red gun to indicate that it is fake.

Sometimes, Schultz added, they will use simulation rounds, or training ammunition. In these instances, the fake gun makes a loud sound — similar to the sound of a real gun being fired — but the ammunition is fake and non-lethal.

“It’s scary for the employees, but they have an opportunity to handle the situation in a relatively safe way,” said Schultz.

“We’re looking at patient safety and employee safety like never before.”

Aligning Comp Philosophies

The biggest challenge Valley faced was aligning each individual nurse case manager with the new philosophy for safety and security. Before, Schultz said, each nurse had their own way of providing care to injured workers. To get workers back safely and efficiently, Valley knew it had to set one standard of care.

Lissette Carcano, workers’ compensation care coordinator, Valley Health

The Workers’ Compensation Care Coordinator role was created to oversee the entire workers’ comp process, guaranteeing that the quality and type of care was uniform across the Valley network. This role, according to Schultz, was pivotal for the success of the workers’ comp program.

“I needed someone who was kind, compassionate but firm. Someone who could manage with consistency,” said Schultz. Carcano fit the bill.

“She’s one of the best I’ve ever seen,” said Cari Burhenne, regional claims service manager, PMA Companies.

Carcano entered Valley and provided the adjusters with what they needed while continuing to care for each worker, Burhenne explained.

Valley’s philosophy used to be “full-duty or no duty.” Carcano worked to get injured workers into temporary duty roles suitable for them while they recovered, and thanks to her return-to-work advocacy, Valley’s lost-time claims decreased from 171 per year to 79.

“The focus on return to work, I think, is number one in what reduced Valley’s overall claims costs,” said Burhenne.

“Valley is very invested in doing what’s right for their employees. There’s the business sense but also that sense of caring for their employees. It’s a great combination.”

When a worker is injured on the job, Schultz and Carcano have worked hard to get their employees seen by physicians and other health care providers as quickly as possible.

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“The way Barbara and Lissette established great relationships with physicians has made the [workers’ comp] process streamlined and effective; it’s very expeditious,” said Carey. “They are looking for the best care for employees and patients.”

The health care system also implemented a full-scale safe patient handling program, overhauled its dining and environmental services safety committees and implemented health awareness among its employees.

Carey added, “When our employees are healthy and safe at work, our patients benefit.” &

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More coverage of the 2017 Teddy Award Winners and Honorable Mentions:

Advocacy Takes Off: At Delta Air Lines, putting employees first is the right thing to do, for employees and employer alike.

 

Proactive Approach to Employee SafetyThe Valley Health System shifted its philosophy on workers’ compensation, putting employee and patient safety at the forefront.

 

Getting It Right: Better coordination of workers’ compensation risk management spelled success for the Massachusetts Port Authority.

 

Carrots: Not SticksAt Rochester Regional Health, the workers’ comp and safety team champion employee engagement and positive reinforcement.

 

Fit for Duty: Recognizing parallels between athletes and public safety officials, the city of Denver made tailored fitness training part of its safety plan.

 

Triage, Transparency and TeamworkWhen the City of Surprise, Ariz. got proactive about reining in its claims, it also took steps to get employees engaged in making things better for everyone.

A Lesson in Leadership: Shared responsibility, data analysis and a commitment to employees are the hallmarks of Benco Dental’s workers’ comp program.

 

Autumn Heisler is the digital producer and a staff writer at Risk & Insurance®. She can be reached at [email protected]

More from Risk & Insurance

More from Risk & Insurance

Cyber Resilience

No, Seriously. You Need a Comprehensive Cyber Incident Response Plan Before It’s Too Late.

Awareness of cyber risk is increasing, but some companies may be neglecting to prepare adequate response plans that could save them millions. 
By: | June 1, 2018 • 7 min read

To minimize the financial and reputational damage from a cyber attack, it is absolutely critical that businesses have a cyber incident response plan.

“Sadly, not all yet do,” said David Legassick, head of life sciences, tech and cyber, CNA Hardy.

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In the event of a breach, a company must be able to quickly identify and contain the problem, assess the level of impact, communicate internally and externally, recover where possible any lost data or functionality needed to resume business operations and act quickly to manage potential reputational risk.

This can only be achieved with help from the right external experts and the design and practice of a well-honed internal response.

The first step a company must take, said Legassick, is to understand its cyber exposures through asset identification, classification, risk assessment and protection measures, both technological and human.

According to Raf Sanchez, international breach response manager, Beazley, cyber-response plans should be flexible and applicable to a wide range of incidents, “not just a list of consecutive steps.”

They also should bring together key stakeholders and specify end goals.

Jason J. Hogg, CEO, Aon Cyber Solutions

With bad actors becoming increasingly sophisticated and often acting in groups, attack vectors can hit companies from multiple angles simultaneously, meaning a holistic approach is essential, agreed Jason J. Hogg, CEO, Aon Cyber Solutions.

“Collaboration is key — you have to take silos down and work in a cross-functional manner.”

This means assembling a response team including individuals from IT, legal, operations, risk management, HR, finance and the board — each of whom must be well drilled in their responsibilities in the event of a breach.

“You can’t pick your players on the day of the game,” said Hogg. “Response times are critical, so speed and timing are of the essence. You should also have a very clear communication plan to keep the CEO and board of directors informed of recommended courses of action and timing expectations.”

People on the incident response team must have sufficient technical skills and access to critical third parties to be able to make decisions and move to contain incidents fast. Knowledge of the company’s data and network topology is also key, said Legassick.

“Perhaps most important of all,” he added, “is to capture in detail how, when, where and why an incident occurred so there is a feedback loop that ensures each threat makes the cyber defense stronger.”

Cyber insurance can play a key role by providing a range of experts such as forensic analysts to help manage a cyber breach quickly and effectively (as well as PR and legal help). However, the learning process should begin before a breach occurs.

Practice Makes Perfect

“Any incident response plan is only as strong as the practice that goes into it,” explained Mike Peters, vice president, IT, RIMS — who also conducts stress testing through his firm Sentinel Cyber Defense Advisors.

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Unless companies have an ethical hacker or certified information security officer on board who can conduct sophisticated simulated attacks, Peters recommended they hire third-party experts to test their networks for weaknesses, remediate these issues and retest again for vulnerabilities that haven’t been patched or have newly appeared.

“You need to plan for every type of threat that’s out there,” he added.

Hogg agreed that bringing third parties in to conduct tests brings “fresh thinking, best practice and cross-pollination of learnings from testing plans across a multitude of industries and enterprises.”

“Collaboration is key — you have to take silos down and work in a cross-functional manner.” — Jason J. Hogg, CEO, Aon Cyber Solutions

Legassick added that companies should test their plans at least annually, updating procedures whenever there is a significant change in business activity, technology or location.

“As companies expand, cyber security is not always front of mind, but new operations and territories all expose a company to new risks.”

For smaller companies that might not have the resources or the expertise to develop an internal cyber response plan from whole cloth, some carriers offer their own cyber risk resources online.

Evan Fenaroli, an underwriting product manager with the Philadelphia Insurance Companies (PHLY), said his company hosts an eRiskHub, which gives PHLY clients a place to start looking for cyber event response answers.

That includes access to a pool of attorneys who can guide company executives in creating a plan.

“It’s something at the highest level that needs to be a priority,” Fenaroli said. For those just getting started, Fenaroli provided a checklist for consideration:

  • Purchase cyber insurance, read the policy and understand its notice requirements.
  • Work with an attorney to develop a cyber event response plan that you can customize to your business.
  • Identify stakeholders within the company who will own the plan and its execution.
  • Find outside forensics experts that the company can call in an emergency.
  • Identify a public relations expert who can be called in the case of an event that could be leaked to the press or otherwise become newsworthy.

“When all of these things fall into place, the outcome is far better in that there isn’t a panic,” said Fenaroli, who, like others, recommends the plan be tested at least annually.

Cyber’s Physical Threat

With the digital and physical worlds converging due to the rise of the Internet of Things, Hogg reminded companies: “You can’t just test in the virtual world — testing physical end-point security is critical too.”

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How that testing is communicated to underwriters should also be a key focus, said Rich DePiero, head of cyber, North America, Swiss Re Corporate Solutions.

Don’t just report on what went well; it’s far more believable for an underwriter to hear what didn’t go well, he said.

“If I hear a client say it is perfect and then I look at some of the results of the responses to breaches last year, there is a disconnect. Help us understand what you learned and what you worked out. You want things to fail during these incident response tests, because that is how we learn,” he explained.

“Bringing in these outside firms, detailing what they learned and defining roles and responsibilities in the event of an incident is really the best practice, and we are seeing more and more companies do that.”

Support from the Board

Good cyber protection is built around a combination of process, technology, learning and people. While not every cyber incident needs to be reported to the boardroom, senior management has a key role in creating a culture of planning and risk awareness.

David Legassick, head of life sciences, tech and cyber, CNA Hardy

“Cyber is a boardroom risk. If it is not taken seriously at boardroom level, you are more than likely to suffer a network breach,” Legassick said.

However, getting board buy-in or buy-in from the C-suite is not always easy.

“C-suite executives often put off testing crisis plans as they get in the way of the day job. The irony here is obvious given how disruptive an incident can be,” said Sanchez.

“The C-suite must demonstrate its support for incident response planning and that it expects staff at all levels of the organization to play their part in recovering from serious incidents.”

“What these people need from the board is support,” said Jill Salmon, New York-based vice president, head of cyber/tech/MPL, Berkshire Hathaway Specialty Insurance.

“I don’t know that the information security folks are looking for direction from the board as much as they are looking for support from a resources standpoint and a visibility standpoint.

“They’ve got to be aware of what they need and they need to have the money to be able to build it up to that level,” she said.

Without that support, according to Legassick, failure to empower and encourage the IT team to manage cyber threats holistically through integration with the rest of the organization, particularly risk managers, becomes a common mistake.

He also warned that “blame culture” can prevent staff from escalating problems to management in a timely manner.

Collaboration and Communication

Given that cyber incident response truly is a team effort, it is therefore essential that a culture of collaboration, preparation and practice is embedded from the top down.

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One of the biggest tripping points for companies — and an area that has done the most damage from a reputational perspective — is in how quickly and effectively the company communicates to the public in the aftermath of a cyber event.

Salmon said of all the cyber incident response plans she has seen, the companies that have impressed her most are those that have written mock press releases and rehearsed how they are going to respond to the media in the aftermath of an event.

“We have seen so many companies trip up in that regard,” she said. “There have been examples of companies taking too long and then not explaining why it took them so long. It’s like any other crisis — the way that you are communicating it to the public is really important.” &

Antony Ireland is a London-based financial journalist. He can be reached at [email protected] Dan Reynolds is editor-in-chief of Risk & Insurance. He can be reached at [email protected]