Every employer wants to keep their workers safe and healthy. But some of the latest data suggests their efforts are falling short, and it comes at a steep cost.

The Bureau of Labor Statistics (BLS) shows that 2.9 workplace injuries occurred for every 100 full-time employees in 2017, totaling about 3.3 million nationally. Collectively, workplace injuries cost the U.S. economy roughly $52 billion to $60 billion per year — that’s at least $1 billion per week.

The impact comes not just from expensive medical treatment, but from absenteeism, decreased productivity, and increased employee turnover as well.

“According to BLS data, 30 percent of injured workers are placed off-duty, while 23 percent are placed on restricted duty or transferred to another position. That comes with replacement costs. New workers have to be hired and trained; turnover impedes productivity and impacts employee engagement,” said Giovanni Gallara, senior vice president of Therapy and Ancillary Services at Concentra, the nation’s largest occupational health provider. What makes those numbers even more shocking is that many workplace injuries can be prevented. High injury persistence demonstrates that standard safety training may not be enough.

“Employers need to prioritize injury prevention for the sake of their workers’ health, and their own financial health,” Gallara said. “That requires taking a hard look at the role that safety plays in your day-to-day operation and identifying the injury drivers where the employer can proactively make an impact.”

Here’s how employers can begin establishing a true injury prevention program:

Assess Safety Shortcomings and Identify a Goal

Giovanni Gallara, Senior Vice President of Therapy and Ancillary Services at Concentra

Step one is to evaluate the culture of safety at the worksite. Safety must be embraced by both frontline workers and leadership. No injury prevention program can succeed if safety is treated as ancillary rather than a central component of business operations.

“If the workplace culture truly reinforces safety, then safety will be a topic of daily discussion at the worksite, workers will be aware of the safety challenges they face in every task, and leadership will incorporate employee safety and engagement into key business metrics,” Gallara said.

Baseline metrics are also key to step number two: defining success.

“There must be organizational agreement around what success will look like for your safety and prevention program. What baseline metrics do you want to improve and what metrics will be used to measure success?” Gallara said. Those metrics could include injury frequency, type, or severity; cost per claim; rates of off-duty or restricted-duty accommodations; or rates of employee retention or turnover.

“For example, maybe you’ve historically experienced high turnover within the first six months of employment due to injury rates, safety challenges, or workplace fatigue. As a business leader, success metrics could include increased employee retention or decreased turnover rates from historical or baseline trends,” Gallara said. “Once you define what success looks like, you can take a more granular look at baseline data to identify tactics and milestones for the success of your safety program.”

Additionally, baseline metrics also help employers see where they stand compared to their competitors in terms of OSHA-recordable incidents and their workers’ comp experience modification factor. This can help directly correlate safety efforts with their impact on workers’ comp premiums and serve as a point of differentiation from a recruiting standpoint.

“Success from an injury prevention program can come in the form of direct cost savings from reducing injuries, or indirectly from greater employee engagement and reduced turnover and absenteeism,” Gallara said.

While there are many ways to improve safety and approach injury prevention, two effective approaches are human performance evaluations (HPEs) and use of on-site athletic trainer programs.

“We see great impact from these two programs because they are not episodic. These approaches require commitment and planning from the employer to improve worker health and safety. They require greater collaboration between the employer and the occupational medicine provider, which can drive focus on the success of the program and really integrate all parties into the overall safety strategy of the employer,” Gallara said.

How to Develop a Gold-Standard Human Performance Evaluation Program

Also called post-offer or pre-employment functional testing, HPEs are designed to test potential employees’ ability to perform essential tasks of their prospective position.

“In a gold-standard HPE program, the physical therapist who will be conducting the testing spends time to understand the physical tasks associated with a position as well as any unique environmental, ergonomic, and biomechanical factors,” Gallara said.

The therapist will interview current employees and managers. They’ll observe the work to understand rates of activity, material handling details and body position requirements, taking note of the layout of the workspace and any equipment that may impact mobility or safety.

Having a physical therapist conduct this comprehensive examination on site also lends itself to real-time improvement opportunities. The therapist may make real-time suggestions to the employer if easily remedied ergonomic issues are observed, and/or if biomechanic or material handling recommendations can be immediately implemented to avoid or prevent overuse or overexertion injuries.

“The therapist can make significant improvement to the overall safety of day-to-day operations, before the formal HPE testing is implemented,” Gallara said.

Based on the findings from their site analysis, the therapist will start to tease out the essential job functions associated with each position and develop specific tests targeting those tasks. Depending on the complexity of the job description, a single HPE could consist of several different tests and measures.

The employer then validates the tests by having incumbents and managers perform the HPE at the job site. If the test adequately addresses the day-to-day execution of that job, it’s ready to be put into practice with potential hires. Results are then reported to the employer to understand pass/fail rates. Literature demonstrates failure rates range between low single digit to 20+ percent depending on the intensity of essential job functions.

The Value of HPE for Safety, Compliance and Injured Worker Recovery

By ensuring only capable candidates are placed into future employment roles, HPEs can cut down injury rates significantly. A 2008 study of post-offer, pre-employment testing showed a 41 percent reduction in injury rate, coupled with a 21 percent increase in employee retention over two years.

“The research and our internal data reinforce the idea that front-loading an emphasis on safety at the onset of employment can have an impact on overall employee engagement and safety,” Gallara said.

Other studies have shown a return on investment of $18 for every $1 spent on post-offer, pre-employment testing and a 33 percent reduction in future injury costs.

“The immediate impact of HPE implementation is to divert folks who would otherwise be unsafe in their future role,” Gallara said. “Research has demonstrated when employees do unfortunately get injured after HPE implementation, their injuries tend to be less severe because they start from a higher baseline of fitness than historic hires that have not gone through a pre-employment testing process.”

HPEs also have value beyond safety.

Even when a candidate does not meet all the requirements of the HPE, results can help employers comply with the Americans with Disabilities Act’s reasonable accommodation requirement.

“HPEs must comply with the Americans with Disabilities act, Equal Employment Opportunity Commission (EEOC) regulations and the uniform guidelines for hiring. So, the HPE is solely designed to test the candidate’s true ability to perform essential job functions, regardless of race, gender, age, or ethnicity,” Gallara said.

“When the therapist provides information back to the employer specific to measures the candidate couldn’t satisfy, it comes with objectivity. This helps the employer determine what type of reasonable accommodation they can and cannot provide without undue hardship, without fear of noncompliance or a safety risk to the employee.”

The HPE process can also be applied to return-to-work scenarios. If a worker began employment with an HPE and became injured during employment, the worker can repeat the HPE to determine if he or she can safely return to full duty, or help employers identify reasonable accommodations during the recovery or rehabilitation process.

Preventive Benefits of an On-Site Athletic Training Program

As with an HPE program, employers can take proactive steps to reduce injury frequency and severity through an on-site athletic training program. These programs leverage the expertise of the rehab professional to address musculoskeletal disorders before they progress to OSHA-recordable injuries.

“These programs drive a culture of prevention and early symptom management. If you wait to implement care until the worker is injured, you now have a potential OSHA-recordable event with potential costs from a medical standpoint and indirect costs from a productivity standpoint,” Gallara said.

Athletic trainers have expertise across general wellness, illness prevention, and musculoskeletal evaluations. Trained in both emergency and rehabilitative care, they are uniquely positioned to help employees address the aches and pains that precede more serious injuries, and to administer immediate care in more serious situations.

“Think about your favorite professional sports team. When a player gets hurt, the trainer is one of the first responders on the field to assess the injury. The ability to triage and get the individual connected to the right care in a timely fashion, when an unfortunate on-site injury occurs, is a huge benefit of having an athletic trainer on site,” Gallara said.

Just like they focus on driving total health and optimal performance in professional athletes, trainers can play an integral role in developing corporate wellness programs that keep workers in top shape.

“The athletic trainer is looking at the responsibilities of the employee and working to ensure that the environment, ergonomic, and biomechanic conditions are optimal for performance, thus reducing the factors that can contribute to overexertion or overuse injury – both of which are key drivers of occupational injuries,” Gallara said.

When athletic trainers are working on site, they should also be embedded into the employer’s safety culture — meaning they collaborate with other environmental health and safety programs to address systemic challenges from a musculoskeletal or environmental standpoint.

With individual employees, they can implement mobility, flexibility, and strength and conditioning interventions when a worker’s early symptoms are reported.

“The other benefit is when an employee does get injured in the workplace and requires treatment beyond first aid, the athletic trainer is in a great position to triage and facilitate the continuum of care,” Gallara said. “If the employer has a trusted occupational medicine provider or injury care workflow process, the trainer can assist patients as they navigate an unfamiliar and often frightening workplace injury event and funnel the patient to appropriate care in a timely manner. The ability to bridge that connectivity of care is a tremendous asset.”

Athletic Training Programs Show Promising Results

Results from athletic training programs have been favorable. “We’ve seen a decrease in overall injury incidence rates and decreases in cost of injury care due to reductions in injections, MRIs, and specialist visits,” Gallara said.

“Industry research shows that the average range for return on investment is anywhere from a 3:1 to a 7:1 ratio, with roughly 94 percent of companies reporting at least a 25 percent reduction in lost time and injury severity. Some companies have seen a significant reduction of recordability rates, reporting that 70 to 85 percent of their musculoskeletal cases have been managed using first-aid level intervention only,” Gallara said.

In 2006, a complete literature review of 15 scholarly articles provided very strong support for the effectiveness of on-site occupational interventions to reduce pain, disability, and lumbar injury rates, as well as expediting return to work.

Occupational Medicine Expertise Matters

Of the 3.3 million workplace injuries that occur every year, Concentra cares for roughly 20 percent of all injured workers nationally, nearly 700,000 injured workers per year.

“Concentra is the largest occupational medicine provider in the country, with a national footprint. We have roughly 520 medical centers across 44 states. And within those practices, we employ nearly 1,100 physicians and roughly 800 physical therapists to deliver injury care and employer services. Additionally, we partner with 600+ specialists to assist our physicians and therapist manage clinically complex workers’ comp cases,” Gallara said.

“In addition to our medical centers, we have clinicians and colleagues on more than 120 onsite clinics, where they work very closely with the employer to provide everything from injury care, employer services, urgent care services, athletic training and HPEs,” Gallara said.

Physical therapists at Concentra have been performing HPEs for more than 20 years, conducting more than 2 million exams in total.

“There’s a significant track record, and we’ve gained a lot of learnings that allow us to continue to progress the program and bring value to employers and drive the safety of the worker,” Gallara said.

In addition to experience and expertise, Concentra also recognizes the vital role of communication and collaboration in the workers’ compensation ecosystem. The employer, injured worker, carrier/TPA, nurse case manager, and clinician must be in agreement regarding the treatment plan to ensure optimal patient outcomes, patient satisfaction, and cost savings.

Espousing an integrated care delivery model, Concentra’s clinicians habitually initiate follow-up communications with employers and other stakeholders, updating every party on an injured worker’s status and progress. Often, patients are directly engaged with a team of multidisciplinary clinicians to ensure they are engaged with their care plans and positive recovery expectations are clearly established.

“Customers must be engaged in the recovery process. We really empower our clinicians to engage both patients and employers with clear communication to ensure an optimal patient outcome and customer experience. For example, roughly 85 percent of our initial injuries that come through our clinics are followed up with a phone call from our physicians directly to the employer to ensure the employer and patient have clear understanding of relevant clinical findings and treatment plan,” Gallara said.

“In summary, occupational medicine experts have a tremendous opportunity to better partner across the workers’ compensation continuum to optimize patient outcomes and experience, and most importantly, implement validated cost-effective preventive programs to optimize patient safety and employee engagement, and decrease the financial and social burden caused by workplace injuries and illnesses.”

To learn more about Concentra’s injury prevention programs, visit https://www.concentra.com/physical-therapy/. 

This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with Concentra. The editorial staff of Risk & Insurance had no role in its preparation.