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2016 Teddy Awards: Honorable Mention

Saving Time and Money

Applying Lean Six Sigma to its workers' comp processes earned Atlantic Health an Honorable Mention Teddy Award.
By: | November 2, 2016 • 3 min read

Putting together a Lean Six Sigma Project at Atlantic Health System made all the difference to its workers’ compensation results.

A retrospective review in 2014 of 2013 work injuries revealed that back and shoulder injuries were the most frequent and had the highest costs, said Linda Reiher, manager of occupational medicine service, at the organization that has five hospitals and nearly 16,000 employees in New Jersey.

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The average days out of work for these types of injuries was 41 days in 2013, she said. “Having an employee out of work costs AHS money.”

After analyzing the data, Atlantic Health realized that there were delays in various steps in their workers’ compensation process.

“From reviewing our data, I noticed obtaining imaging and specialist appointments were responsible for some of these delays,” she said.

To provide more focused care, the nonprofit organization hired Donna Brucker, a registered nurse, to fill the newly created position of RN workers’ compensation case manager. In the past, nurse practitioners did most of the case management for workers’ comp cases, but they had a great many other responsibilities as well, thus leaving little time for effective case management, Reiher said.

“Although case management was important, things were not operating as efficiently as they should ,” Reiher said.

The Atlantic Lean Team: left to right, bottom row: Margaret Skurka, Linda Reiher. Top row: Beth Del Pino, Laureen O'Rourke, Joanne Brubaker, Rachel Leibu, Donna Naturale, Donna Brucker

The Atlantic Lean Team: left to right, bottom row: Margaret Skurka, Linda Reiher. Top row: Beth Del Pino, Laureen O’Rourke, Joanne Brubaker, Rachel Leibu, Donna Naturale, Donna Brucker

That has changed with the addition of Brucker, as well as Laureen O’Rourke as the coordinator who is responsible for assisting with the management of some of the sites, she said.

“Case management is Donna Brucker’s primary focus and both nurses are vigilant about shepherding the patient throughout the recovery process,” Reiher said.

“The Lean Project’s initial goal was to reduce out-of-work days [lost time] from 41 days to 35 days,” she said. “We were able to reduce our out-of-work days from our goal of 35 days to just 9 days, an 80 percent decrease.”

Atlantic Health System also saw a 70 percent reduction in the amount of time it took to schedule appointments to see a specialist, and a significant reduction in time from injury date to the first Occupational Medicine Service (OMS) appointment. This metric was reduced from eight days to 1.4 days.

The Lean project pilot had an estimated savings of more than $900,000 in workers’ compensation costs.

“The Lean project was a big success,” Reiher said, noting that it earned an Organizational Effectiveness President’s Award from Atlantic Health System.

“The most important thing,” said Dr. Rachel Leibu, medical director, OMS, “is we maintained continuity of patient care and we were able to effectively manage workers’ compensation injuries, minimize costs and provide excellent care to employees.”

“The Lean Project’s initial goal was to reduce out-of-work days [lost time] from 41 days to 35 days. We were able to reduce our out-of-work days from our goal of 35 days to just 9 days, an 80 percent decrease.” — Linda Reiher, manager, occupational medicine service, Atlantic Health System

To help protect the health of its patients and employees, OMS instituted a mandatory vaccination program in 2013 to protect against influenza and pertussis. They also more recently introduced iPad technology to help control costs related to its mandatory flu vaccine campaign. The new system better tracks compliance with the initiative by reducing the number of illegibly signed paper consent forms and potentially misplaced lost paperwork, as well as decreasing data entry and electronic medical record scanning time.

An electronic Flu Dashboard assists management with tracking employee vaccination status. The dashboard also provides for efficient identification of employees who were granted vaccine exemptions for medical or religious reasons, Leibu said. Exempt employees who are not vaccinated must wear masks when entering an AHS clinical facility when a threshold level of activity exists in the community.

Technology has also aided Atlantic Health in tracking injuries that are trending upward, so that safety initiatives can be instituted when a hazard is revealed, she said.

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For example, dim lighting and multiple electric cords in operating rooms were causing tripping hazards. A process to bundle the device cords together while increasing education about the hazard reduced incidents, Leibu said.

Atlantic Health also began mandatory classes for nurses and other employees to help protect them from workplace violence, which is a national safety hazard in the health care field. The classes include education on how to diffuse situations when visitors or patients act out as well as self-defense methods.

For its success in enhancing its workers’ compensation processes, Atlantic Health System was awarded a 2016 Teddy Award Honorable Mention. &

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Read more about the 2016 Teddy Award winners:

target-150x150Bringing Focus to Broad Challenges: Target brings home a 2016 Teddy Award for serving as an advocate for its workers, pre- and post-injury, across each of its many operations.

 

hrt-150x150The Road to Success: Accountability and collaboration turned Hampton Roads Transit’s legacy workers’ compensation program into a triumph.

 

excela-150x150Improve the Well-Being of Every Life: Excela Health changed the way it treated injuries and took a proactive approach to safety, drastically reducing workers’ comp claims and costs.

 

harder-150x150The Family That’s Safe Together: An unwavering commitment to zero lost time is just one way that Harder Mechanical Contractors protects the lives and livelihoods of its workers.

 

More coverage of the 2016 Teddy Awards:

Recognizing Excellence: The judges of the 2016 Teddy Awards reflect on what they learned, and on the value of awards programs in the workers’ comp space.

Fit for Duty: 2013 Teddy Winner Miami-Dade County Public Schools is managing comorbid risk factors by getting employees excited about healthy living.

Saving Time and Money: Applying Lean Six Sigma to its workers’ comp processes earned Atlantic Health a Teddy Award Honorable Mention.

Caring for the Caregivers: Adventist Health Central Valley Network is achieving stellar results by targeting its toughest challenges.

Advocating for Injured Workers: By helping employees navigate through the workers’ comp system, Cottage Health decreased lost work days by 80 percent.

A Matter of Trust: St. Luke’s workers’ comp program is built upon relationships and a commitment to care for those who care for patients.

Keeping the Results Flowing: R&I recognizes the Metropolitan Water Reclamation District of Greater Chicago for a commonsense approach that’s netting continuous improvement.

Anne Freedman is managing editor of Risk & Insurance. She can be reached at [email protected]

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]