2017 Teddy Award Winner

Carrots, Not Sticks

At Rochester Regional Health, the workers’ comp and safety team champion employee engagement and positive reinforcement.
By: | November 1, 2017 • 6 min read

When Monica Manske does rounds at Rochester Regional Health’s five hospitals and six long-term care facilities, she looks at shoes, among other things.

Her interest is safety — not fashion. However, offering employees more fashionable options helped increase the compliance rate in RRH’s mandatory safety shoe program from 35 percent a few years ago to 85 percent in 2016, said Manske, RRH’s senior manager of workers’ compensation and employee safety.

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Safety shoes are an important factor in preventing slips and falls, which are a major loss driver for health care facilities, especially for employees in food service, environmental and housekeeping and direct patient care.

In the five years since its inception, the safety shoe program contributed to a 42 percent reduction in lost-time claims and a 46 percent reduction in employee injuries.

That change came only with deliberate and concerted use of one-on-one communications, surveys, budget adjustments and historical claims data, Manske said.

By virtue of mergers and acquisitions, RRH grew during the past decade from about 10,000 employees to almost 17,000.

As it grew, the workers’ comp and safety team — three employees dedicated to workers’ compensation, two for ergonomics, plus physical therapy and clinical education staff partners and 150 safety champions — educated waves of new employees in safety protocols, including the shoe program.

The team is strategic in its approach to shoe compliance. Rather than punish non-compliant employees, it launched a survey asking workers to disclose why they chose not to wear the safety shoes. The responses helped facilitate program refinements.

Monica Manske, senior manager of workers’ compensation and employee safety, Rochester Regional Health

As a result of the feedback, the shoe subsidy grew substantially, as did the quality and variety, including more-fashionable Sketchers and Reeboks. Compliance now approaches 90 percent, Manske said.

When she does rounds and sees a non-compliant employee, “I introduce myself in a friendly way and ask about the shoes.” Maybe they don’t fit right. Maybe the employee is new and hasn’t been fitted yet.

The same process applies to other programs, she said, such as direct patient care where soft tissue and musculoskeletal disorders are common and largely avoidable. Housekeeping is a key focus as well due to its potential factor in infections such as MRSA.

Frequent, direct employee contact is essential to spreading the safety gospel, said Laurie Muratore, injury prevention clinic manager, RRH. “We don’t just train at first hire and then cut them loose. It takes daily involvement.”

Sometimes she puts on scrubs and spends a few days on a unit to immerse herself in the staff’s struggles and challenges. “If you’re not out there in the mix, it’s hard to teach and preach and be accepted.”

“I like to be the carrot. Not the stick. We don’t punish mistakes. This is fact finding, not fault finding.” — Monica Manske, senior manager of workers’ compensation and employee safety, Rochester Regional Health

The safety team works hard to cultivate its image as “good cops” rather than “bad cops.” It encourages individuals to report mistakes so the precursors to errors can be better understood to fix system issues.

“I like to be the carrot. Not the stick,” said Manske. “We don’t punish mistakes. This is fact finding, not fault finding.”

“When they see me coming, they say, ‘Here’s the back lady!’ ” said Muratore, who has a background in physical therapy. Back injuries are the scourge of nurses, who lift, pull, push and shift patients, often in 12-hour shifts.

Sometimes Muratore shows up with new safety devices, such as slings and straps that RRH is thinking of buying. “They say, ‘Got any new toys for us?’ ”

What Gets Measured

A measure of a good workers’ compensation safety program is how quickly claims are reported, said Charles Bolesh, senior account executive, PMA Management Corporation, the health system’s TPA.

Delays, he said, are understandable since each hospital’s first priority is to care for patients. But delays are often symptoms of stretched resources and lack of leadership focus. They’re a red flag for weak injury prevention. “Delays can lead to bad outcomes.”

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For example, he said, injured workers facing a long reporting delay may not have a return-to-work plan, let alone testing, medical care and therapies. They may retain an attorney.

“There’s a direct correlation between reporting delays and higher-cost claims,” he said.

When PMA first partnered with RRH in 2000, claims reporting could take a full month. Bolesh offered some advice: Report faster. “They ran with it,” he said. Now, reporting to PMA takes place within a few days, and injured workers get treatment and a return-to-work plan in short order.

Incident reports are detailed, Manske said. RRH measures every department, the day of week, the shift, the time of the event.

“Do weekend nights appear to have more injuries? Where do we lose money and time? That’s where we focus time and effort.”

Marsh, RRH’s broker, performs a gap analysis to measure the company’s practices against industry best practices. PMA reports back to RRH and provides monthly and quarterly benchmarks to executive committee, line managers and supervisors.

Laurie Muratore, injury prevention clinic manager, Rochester Regional Health

Initial analysis of incident reports showed two primary loss leaders: slips and falls and safe patient handling. The data then identified the departments and shifts with frequent incidents.

To effectively communicate the data as well as its implications, RRH managers meet with supervisors and employee groups of affected cohorts and train them to use the safety tools available. When necessary, RRH adds internal float pool personnel and/or equipment to help reduce claims.

Communication and collaboration are essential to creating a safe workplace, Manske said. “We’re high-engagement leaders.” Daily department huddles address safety issues, as well as other concerns. And rather than delegating communications responsibilities to department leaders, the safety team meets one-on-one with supervisors and staff. “We want to hear what the issues are. I want to see and hear.”

“What gets measured gets done.” — Charles Bolesh, senior account executive, PMA Management Corporation

Manske said she’s not always “the solutions person.” Often that role goes to the front-line manager in a department or a staff member.

“We collaborate. If a remedy doesn’t work, we reconvene. It’s a check-back cycle.”

These communications and a willingness to learn from failure, Manske said, are best practices among high-reliability organizations, those that avoid catastrophes in high-risk and complex areas.
And RRH reduced claims dramatically over the years, Bolesh said. “What gets measured gets done.”

ROI on Safe Patient Handling

RRH utilizes a different species of technology — some very low-tech — for safe patient handling. It may use slide boards, friction-reducing sheets and air mats to reduce wear and tear on staff involved in direct patient care, said Muratore.

Most equipment is close at hand, outside patients’ rooms, in accordance with fire code.

Typically, hospital floors are equipped with one patient lift per eight patients. Some rooms are equipped with expensive overhead lifts for safe transfer of heavier patients, and every intensive care unit has at least one.

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Nursing homes, where patients are more dependent, may have two or three lifts per unit.

Is this prohibitively expensive for leaner facilities? No, said Muratore.

RRH, a community-based hospital system, shops strategically to find equipment that’s well within budget while still achieving safety goals.

Even cash-poor hospitals “do have funding but don’t realize it,” Muratore said. Yes, they must invest in the equipment, but “ROI is very quick. We realized savings in patient and staff safety right away.”

Do some staff skip safety steps because of time pressure or old habits?

“Yes, and then we participate with them,” Muratore said. She may perform patient care alongside the resistant staff member to demonstrate. “Once they practice the safe way, a lightbulb goes off.”

With luck, the lightbulb goes off before injury, she said, but “sometimes an injured colleague is the best safety advocate on the floor. We want staff to work smarter, not harder.” &

_______________________________________________________

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.

 

Susannah Levine writes about health care, education and technology. She can be reached at [email protected]

More from Risk & Insurance

More from Risk & Insurance

Exclusive | Hank Greenberg on China Trade, Starr’s Rapid Growth and 100th, Spitzer, Schneiderman and More

In a robust and frank conversation, the insurance legend provides unique insights into global trade, his past battles and what the future holds for the industry and his company.
By: | October 12, 2018 • 12 min read

In 1960, Maurice “Hank” Greenberg was hired as a vice president of C.V. Starr & Co. At age 35, he had already accomplished a great deal.

He served his country as part of the Allied Forces that stormed the beaches at Normandy and liberated the Nazi death camps. He fought again during the Korean War, earning a Bronze Star. He held a law degree from New York Law School.

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Now he was ready to make his mark on the business world.

Even C.V. Starr himself — who hired Mr. Greenberg and later hand-picked him as the successor to the company he founded in Shanghai in 1919 — could not have imagined what a mark it would be.

Mr. Greenberg began to build AIG as a Starr subsidiary, then in 1969, he took it public. The company would, at its peak, achieve a market cap of some $180 billion and cement its place as the largest insurance and financial services company in history.

This month, Mr. Greenberg travels to China to celebrate the 100th anniversary of C.V. Starr & Co. That visit occurs at a prickly time in U.S.-Sino relations, as the Trump administration levies tariffs on hundreds of billions of dollars in Chinese goods and China retaliates.

In September, Risk & Insurance® sat down with Mr. Greenberg in his Park Avenue office to hear his thoughts on the centennial of C.V. Starr, the dynamics of U.S. trade relationships with China and the future of the U.S. insurance industry as it faces the challenges of technology development and talent recruitment and retention, among many others. What follows is an edited transcript of that discussion.


R&I: One hundred years is quite an impressive milestone for any company. Celebrating the anniversary in China signifies the importance and longevity of that relationship. Can you tell us more about C.V. Starr’s history with China?

Hank Greenberg: We have a long history in China. I first went there in 1975. There was little there, but I had business throughout Asia, and I stopped there all the time. I’d stop there a couple of times a year and build relationships.

When I first started visiting China, there was only one state-owned insurance company there, PICC (the People’s Insurance Company of China); it was tiny at the time. We helped them to grow.

I also received the first foreign life insurance license in China, for AIA (The American International Assurance Co.). To date, there has been no other foreign life insurance company in China. It took me 20 years of hard work to get that license.

We also introduced an agency system in China. They had none. Their life company employees would get a salary whether they sold something or not. With the agency system of course you get paid a commission if you sell something. Once that agency system was installed, it went on to create more than a million jobs.

R&I: So Starr’s success has meant success for the Chinese insurance industry as well.

Hank Greenberg: That’s partly why we’re going to be celebrating that anniversary there next month. That celebration will occur alongside that of IBLAC (International Business Leaders’ Advisory Council), an international business advisory group that was put together when Zhu Rongji was the mayor of Shanghai [Zhu is since retired from public life]. He asked me to start that to attract foreign companies to invest in Shanghai.

“It turns out that it is harder [for China] to change, because they have one leader. My guess is that we’ll work it out sooner or later. Trump and Xi have to meet. That will result in some agreement that will get to them and they will have to finish the rest of the negotiations. I believe that will happen.” — Maurice “Hank” Greenberg, chairman and CEO, C.V. Starr & Co. Inc.

Shanghai and China in general were just coming out of the doldrums then; there was a lack of foreign investment. Zhu asked me to chair IBLAC and to help get it started, which I did. I served as chairman of that group for a couple of terms. I am still a part of that board, and it will be celebrating its 30th anniversary along with our 100th anniversary.

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We have a good relationship with China, and we’re candid as you can tell from the op-ed I published in the Wall Street Journal. I’m told that my op-ed was received quite well in China, by both Chinese companies and foreign companies doing business there.

On August 29, Mr. Greenberg published an opinion piece in the WSJ reminding Chinese leaders of the productive history of U.S.-Sino relations and suggesting that Chinese leaders take pragmatic steps to ease trade tensions with the U.S.

R&I: What’s your outlook on current trade relations between the U.S. and China?

Hank Greenberg: As to the current environment, when you are in negotiations, every leader negotiates differently.

President Trump is negotiating based on his well-known approach. What’s different now is that President Xi (Jinping, General Secretary of the Communist Party of China) made himself the emperor. All the past presidents in China before the revolution had two terms. He’s there for life, which makes things much more difficult.

R&I: Sure does. You’ve got a one- or two-term president talking to somebody who can wait it out. It’s definitely unique.

Hank Greenberg: So, clearly a lot of change is going on in China. Some of it is good. But as I said in the op-ed, China needs to be treated like the second largest economy in the world, which it is. And it will be the number one economy in the world in not too many years. That means that you can’t use the same terms of trade that you did 25 or 30 years ago.

They want to have access to our market and other markets. Fine, but you have to have reciprocity, and they have not been very good at that.

R&I: What stands in the way of that happening?

Hank Greenberg: I think there are several substantial challenges. One, their structure makes it very difficult. They have a senior official, a regulator, who runs a division within the government for insurance. He keeps that job as long as he does what leadership wants him to do. He may not be sure what they want him to do.

For example, the president made a speech many months ago saying they are going to open up banking, insurance and a couple of additional sectors to foreign investment; nothing happened.

The reason was that the head of that division got changed. A new administrator came in who was not sure what the president wanted so he did nothing. Time went on and the international community said, “Wait a minute, you promised that you were going to do that and you didn’t do that.”

So the structure is such that it is very difficult. China can’t react as fast as it should. That will change, but it is going to take time.

R&I: That’s interesting, because during the financial crisis in 2008 there was talk that China, given their more centralized authority, could react more quickly, not less quickly.

Hank Greenberg: It turns out that it is harder to change, because they have one leader. My guess is that we’ll work it out sooner or later. Trump and Xi have to meet. That will result in some agreement that will get to them and they will have to finish the rest of the negotiations. I believe that will happen.

R&I: Obviously, you have a very unique perspective and experience in China. For American companies coming to China, what are some of the current challenges?

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Hank Greenberg: Well, they very much want to do business in China. That’s due to the sheer size of the country, at 1.4 billion people. It’s a very big market and not just for insurance companies. It’s a whole range of companies that would like to have access to China as easily as Chinese companies have access to the United States. As I said previously, that has to be resolved.

It’s not going to be easy, because China has a history of not being treated well by other countries. The U.S. has been pretty good in that way. We haven’t taken advantage of China.

R&I: Your op-ed was very enlightening on that topic.

Hank Greenberg: President Xi wants to rebuild the “middle kingdom,” to what China was, a great country. Part of that was his takeover of the South China Sea rock islands during the Obama Administration; we did nothing. It’s a little late now to try and do something. They promised they would never militarize those islands. Then they did. That’s a real problem in Southern Asia. The other countries in that region are not happy about that.

R&I: One thing that has differentiated your company is that it is not a public company, and it is not a mutual company. We think you’re the only large insurance company with that structure at that scale. What advantages does that give you?

Hank Greenberg: Two things. First of all, we’re more than an insurance company. We have the traditional investment unit with the insurance company. Then we have a separate investment unit that we started, which is very successful. So we have a source of income that is diverse. We don’t have to underwrite business that is going to lose a lot of money. Not knowingly anyway.

R&I: And that’s because you are a private company?

Hank Greenberg: Yes. We attract a different type of person in a private company.

R&I: Do you think that enables you to react more quickly?

Hank Greenberg: Absolutely. When we left AIG there were three of us. Myself, Howie Smith and Ed Matthews. Howie used to run the internal financials and Ed Matthews was the investment guy coming out of Morgan Stanley when I was putting AIG together. We started with three people and now we have 3,500 and growing.

“I think technology can play a role in reducing operating expenses. In the last 70 years, you have seen the expense ratio of the industry rise, and I’m not sure the industry can afford a 35 percent expense ratio. But while technology can help, some additional fundamental changes will also be required.” — Maurice “Hank” Greenberg, chairman and CEO, C.V. Starr & Co. Inc.

R&I:  You being forced to leave AIG in 2005 really was an injustice, by the way. AIG wouldn’t have been in the position it was in 2008 if you had still been there.

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Hank Greenberg: Absolutely not. We had all the right things in place. We met with the financial services division once a day every day to make sure they stuck to what they were supposed to do. Even Hank Paulson, the Secretary of Treasury, sat on the stand during my trial and said that if I’d been at the company, it would not have imploded the way it did.

R&I: And that fateful decision the AIG board made really affected the course of the country.

Hank Greenberg: So many people lost all of their net worth. The new management was taking on billions of dollars’ worth of risk with no collateral. They had decimated the internal risk management controls. And the government takeover of the company when the financial crisis blew up was grossly unfair.

From the time it went public, AIG’s value had increased from $300 million to $180 billion. Thanks to Eliot Spitzer, it’s now worth a fraction of that. His was a gross misuse of the Martin Act. It gives the Attorney General the power to investigate without probable cause and bring fraud charges without having to prove intent. Only in New York does the law grant the AG that much power.

R&I: It’s especially frustrating when you consider the quality of his own character, and the scandal he was involved in.

In early 2008, Spitzer was caught on a federal wiretap arranging a meeting with a prostitute at a Washington Hotel and resigned shortly thereafter.

Hank Greenberg: Yes. And it’s been successive. Look at Eric Schneiderman. He resigned earlier this year when it came out that he had abused several women. And this was after he came out so strongly against other men accused of the same thing. To me it demonstrates hypocrisy and abuse of power.

Schneiderman followed in Spitzer’s footsteps in leveraging the Martin Act against numerous corporations to generate multi-billion dollar settlements.

R&I: Starr, however, continues to thrive. You said you’re at 3,500 people and still growing. As you continue to expand, how do you deal with the challenge of attracting talent?

Hank Greenberg: We did something last week.

On September 16th, St. John’s University announced the largest gift in its 148-year history. The Starr Foundation donated $15 million to the school, establishing the Maurice R. Greenberg Leadership Initiative at St. John’s School of Risk Management, Insurance and Actuarial Science.

Hank Greenberg: We have recruited from St. John’s for many, many years. These are young people who want to be in the insurance industry. They don’t get into it by accident. They study to become proficient in this and we have recruited some very qualified individuals from that school. But we also recruit from many other universities. On the investment side, outside of the insurance industry, we also recruit from Wall Street.

R&I: We’re very interested in how you and other leaders in this industry view technology and how they’re going to use it.

Hank Greenberg: I think technology can play a role in reducing operating expenses. In the last 70 years, you have seen the expense ratio of the industry rise, and I’m not sure the industry can afford a 35 percent expense ratio. But while technology can help, some additional fundamental changes will also be required.

R&I: So as the pre-eminent leader of the insurance industry, what do you see in terms of where insurance is now an where it’s going?

Hank Greenberg: The country and the world will always need insurance. That doesn’t mean that what we have today is what we’re going to have 25 years from now.

How quickly the change comes and how far it will go will depend on individual companies and individual countries. Some will be more brave than others. But change will take place, there is no doubt about it.

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More will go on in space, there is no question about that. We’re involved in it right now as an insurance company, and it will get broader.

One of the things you have to worry about is it’s now a nuclear world. It’s a more dangerous world. And again, we have to find some way to deal with that.

So, change is inevitable. You need people who can deal with change.

R&I:  Is there anything else, Mr. Greenberg, you want to comment on?

Hank Greenberg: I think I’ve covered it. &

The R&I Editorial Team can be reached at [email protected]