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.
- By Frank Pennachio
- May 01, 2009
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
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
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
This article originally appeared in the May 2009 issue of Occupational Health & Safety.