Secondary Prevention Strategies: A Closer Look

If the relationship between the employee and supervisor is strained, or worse, then you can reasonably espect higher costs.

In the first of this series of articles (March 2009, pages 66-67), we explored the difference between primary and secondary prevention strategies of employee injuries. As we stated, the dramatic reduction of employee injuries in the past 15 years demonstrates the employer's success in preventing an injury from occurring. However, when an injury does occur, the cost of that injury continues to spiral upward. We find ourselves in an environment where the frequency of injuries is down, but severity is up.

A reasonable explanation for the increased cost of an employee injury would be the rising costs of medical care. However, medical infl ation accounts for only part of the problem. We have to look deeper and discover more and better ways to contain costs after an injury occurs. This is the objective of secondary prevention.

An often-overlooked area of secondary prevention is the role and responsibility of the front-line supervisor. The impact of the supervisor's response to the work-related injury is often more important than the medical conditions arising from the accident or the quality of medical care. Yet supervisors are frequently not aware of their critical role and lack training to improve disability outcomes.

Supervisors are already burdened with multiple responsibilities and working under significant pressure, especially during an economic downturn. In addition, they are frequently too uncomfortable or not trained well enough to speak with employees about personal medical and behavioral issues. The common reaction is to hand off the injured employee to the human resources department, request a fully productive replacement, and get back to the tasks at hand. However, the injured employee perceives the front-line supervisor, not the human resources manager, to be his or her boss. The employee expects the supervisor to actively engage in the process of his recovery and resents the hand-off.

Bad Relationship, Bad Results

When the relationship between the injured employee and supervisor turns negative, so does the injury management process, and costs go up. A proven, leading indicator of a bad outcome is the relationship between the employee and their supervisor, both before and after the injury occurs. If the relationship is strained, or worse, then you can reasonably expect higher costs.

It is not sensible or practical to expect supervisors to become professional disability managers, but there is much they can and should do. The first step is to raise awareness of their importance to this process. There is no substitute for their role, and no other person is better suited to facilitate the best outcome.

Next, we must train supervisors. The training must be focused on meeting or exceeding injured employee's expectations. Most injured employees are reasonable, although there are exceptions. In most cases, they just want what anyone would want in the event of an injury on the job.

What do injured employees want from their supervisors? First, they want to be heard, validated, and not treated with suspicion. Supervisors often take a skeptical view when an employee reports an injury, especially when they feel they have been burned in the past. It is best to assume the injury is legitimate at the outset. There will be time to scrutinize later.

In addition, employees want to be included in the decision-making process related to their injuries. They want to discuss their physical restrictions and explore the opportunities for accommodations, including transitional, modified duty. Including the employees in this process helps them maintain a sense of empowerment during a disruptive time.

Rallying support from co-workers is another role of the supervisor. Overworked and stressed co-workers may not respond favorably to their injured counterpart. They see an increased workload and pressure for themselves. The atmosphere of the workplace must remain non-toxic; otherwise, the injured employee will find multiple ways to stay off work.

Sometimes the injured employee will have some problems with his doctor or claims administrator and will turn to the supervisor for help. If the supervisor does not respond in a positive way, it is likely the employee will seek out someone else, usually an attorney. Litigated claims are among the most costly. Employers don't want a situation where the only place the employee feels comfortable going for help is to an attorney.

Of course, none of these things will work if a venomous relationship between the employee and the supervisor exists before an injury occurs. Dealing with human resources and performance issues after an injury, instead of before, is not a good practice. If an employee reports an injury and the first thing you think is that you should have terminated this employee long ago, then prepare for a challenging, costly injury. Performance appraisals and structured discipline processes are part of the secondary prevention process, but they should not be conducted during the injury management phase.

Supervisors also need to be alert to employees who are not fit to do the job, and it is not a matter of if an injury will occur, but when. The safest workplace in the world will not prevent an injury if the employee is not physically or mentally fit to perform the essential functions of the job. Avoiding the hiring of unfit workers is the best defense.

A post-offer, pre-placement medical exam is a powerful tool to prevent hiring someone not fit for the job. In tough economic times, employees will risk their health and bodies to get a job. One of the most ethical positions an employer can take is to make sure it is not putting employees into situations where they pose a high risk to themselves or their co-workers.

Cooperation between human resources and the supervisor is essential in assessing fitness for duty. It should go without saying that compliance with federal and state employment laws is essential. The aging Baby Boom population, increases in obesity, and increased use of prescription and illegal drugs create a greater need for attention to this issue.

Ensuring Supervisors' Engagement

How do we get supervisors engaged in these critical business processes? The most effective way is to include these standards in their position descriptions and reinforce them through their performance appraisals. Supervisor performance is not just about production or meeting deadlines. Health, safety, and prompt return to work and recovery after an employee injury must be part of their job.

Of course, they need training and support. Supervisor training should be formalized and results should be measured against agreed-upon benchmarks. Following a supervisor training initiative, you would want to see, among other measurements, fewer lost work days, lower injury costs, and reduced turnover after an employee injury, as well as recovery times consistent with expectations.

These are tough times. Employers can ill afford the added costs and lost profits due to employee injuries. There is no more important time than the present to incorporate or enhance secondary prevention strategies such as supervisor training, improved hiring practices, and performance appraisals.

The number of injuries is down, but the ones that do occur are more costly. These secondary prevention strategies and methods can go a long way toward reversing the trend of rising injury costs. Hazard abatement and traditional loss control engineering are the foundation, but we cannot stop there. We must move beyond primary prevention and include secondary prevention strategies.

This article originally appeared in the May 2009 issue of Occupational Health & Safety.

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