Sunday, December 23, 2012

Is bullying or harassment just a school or workplace health and safety concern?


Sunday, December 2, 2012

What is the “right” premium rate for workers’ compensation?

Most people would agree that workers’ compensation is an important form of social insurance. How should it be administered, what benefits should be offered, and how permanent partial and total disability ought to be calculated are all matters of debate. Every jurisdiction makes up its own rules on workers’ compensation through public policy, legislation, and practice. The unique combination of these public policy positions and how they are administered set the stage but work-related injuries are what drive the financial cost of workers’ compensation in each jurisdiction. And costs are mainly met by premiums paid (almost) exclusively by employers.

Premium levels and the cost of workers’ compensation have been in the news a lot lately. The Oregon Workers’ Compensation Premium Rate Ranking study and the National Academy of Social Insurance’s publication on Workers’ Compensation Benefits, Coverage and Costs are perhaps the highest profile studies to hit the headlines, but there are many jurisdictions where workers’ compensation premium levels have been the focus of attention. Morley Gunderson’s report, The Impact of High Worker's Compensation Premiums on Newfoundland & Labrador, WorkComp Strategies’ Consultation Services on Workers’ Compensation Laws, Processes, and Costs in Tennessee, and the recently announced external review by Paul Petrie on Workers’ Compensation Process for Setting Employer Rate in Manitoba are but a few of the many examples recently garnering attention.

At the basis of all this attention is the fundamental question: “What is the right premium for workers’ compensation?”

As with all insurance, premiums must ultimately cover benefits and administration costs. There are other costs in workers’ compensation that may be included in premiums (reserve funding, second injury funds, uninsured employer protection, insurance guarantee funds, prevention, oversight, appeal bodies, and more) although many jurisdictions pay for these through additional assessments. Premiums may also be adjusted up or down to cover changes in funded status, investment returns, or changes in actuarial valuations. These costs generally pale to the main financial costs of medical, indemnity, rehabilitation, and permanent disability benefits.

In the best possible world, workers and workplaces are safe, healthy, and free from work-related injury, illness, disease, and death. In that world, a workers’ compensation premium at or near zero makes perfect sense. However, in the real world of today, workers and their families pay a huge personal cost for work-related injuries and the total cost of compensation is significant. Without slashing benefits or externalizing costs to others, what is the right workers’ compensation premium?

Perhaps the best way to approach this question is to first look at the extremes, while assuming the true benefit cost is somewhere in between. Suppose workers’ compensation premiums paid by an employer to cover one employee were greater than the payroll cost of that employee for a year —don’t laugh, this sort of premium has existed for certain classifications in certain states in the recent past. What sort of behaviour would we expect this high rate to incentivize?

On the positive side, such high rates may spur technological innovation, training, investment in new plant, improved supervision — all aimed at reducing the costs associated with workplace injuries in this sector. On the negative side; however, the extremely high premiums set up conditions where underreporting of payroll, hours of exposure, and injuries may have extremely high payoffs. Think about it: if I have to pay $100 in premium for every $100 of payroll, then for every $100 of payroll I pay under the table I cut my effective labour cost at least in half.

On the other hand, what if premiums were effectively $0.00 per $100 of payroll? The employer pays nothing, zilch, nada. Some classification are close to that. In B.C., for example, the Interior Design classification’s base premium is $0.10 per $100. On the positive side, there would be no incentive to hide or suppress the report of a workplace injury. We would have, perhaps, a more accurate grasp of what is happening in the workplace. On the flip side, extremely low premiums could lead to under-investment in health and safety. In the extreme case, a very uncaring (and unethical employer) would ask, “why buy safety equipment, invest in safety training, or purchase safer technology if the cost to the employer of workplace injuries is essentially zero? Assuming replacement labour is readily available, why not spend money elsewhere on expansion or other initiatives to raise profit or shareholder value?”

I’ve presented the moral hazards at the extremes to make a point. The “right” workers’ compensation premium is not necessarily the lowest possible one. High variation in competing jurisdictions may be an issue for concern but a relatively low dispersion rate among nearby competitors may simply indicate that the employers and workers in these jurisdictions are facing similar risks and cost structures. The right base premium, in my view, should always be close to the total benefit cost. It's at that point where the investment in safety, health and return-to-work/stay-at-work initiatives will have their greatest impact.
That’s my perspective. I would be interested in hearing yours.

Wednesday, November 21, 2012

How do leading indicators fit into the planning and implementation of health and safety plans?

I’ve had a lot more questions about leading indicators and how they fit into the planning and implementation of health and safety plans, and so, I thought a further example and simple graphic organizer may help.

A few years ago, I was speaking with the head of the safety and wellness program for a large US manufacturing firm. The company has factories in several states. I asked her how she knew her programs were working. Her responses gave me a practical insight how leading indicators fit into that process. 
Central to her approach, was a sound theory of behavioural change and a clear logic model of the factors that lead to injuries.

Occupational injuries and illnesses, near misses, and individual health issues like obesity, diabetes, and hearing loss are usually multi-causal. The physical plant, equipment design, training, and behaviours such as the adherence to safe work procedures, were very important but underlying these are attitudes. She pointed out that behaviours such as violating safe-work procedures had a feedback effect: the more violations of safe-worker procedures that occur and tolerated or ignored, the more they will occur. Before she could change the behaviours that opened employees to injury, she needed a model of what drives behaviour and a way to integrate that into planning and implementation of health, safety and wellness. 
From a planning perspective, the “theory of reasoned action” and its revised version, the “theory of planned behaviour,” suggest that attitudes and beliefs determine much of voluntary behaviour. Changing behaviour must rely on changing attitudes and beliefs. This is consistent with concepts such as “bounded rationality” and safety culture. Workers and managers act rationally and if safety and health are demonstrably important to supervisors and upper management, that will get translated to the shop floor.
My US contact described her approach to eliminating eye injuries in their plants. Her model included many components. She and her staff looked at design (including guards), considered awareness sessions, worked to have supervisors insist on and reinforce compliance with wearing eye protection, as well as consistently modelling the behaviour will likely contribute to your goal.
Her final planning step was to decide the inputs, resource, activities, and products her plan would encounter (and to seek budgetary approval where required).
Remember, her goal was to eliminate eye injuries. Counting the number of workers who suffer eye injuries is a trailing indicator. She developed several possible leading indicators including the percentage of staff participating in awareness sessions and observational data on violations detected by her safety officers. She also made the inspection of guards and shields routine with a plant manager report on guards filed monthly.
I hope this example helps. Leading indicators are a powerful prevention tool that may make your prevention program more effective.

Thursday, October 18, 2012

How do you develop leading indicators for occupational safety and health?

Most of us are familiar with the concepts of “lagging” (sometimes referred to as “trailing”) and “leading” indicators from the world of economics. GDP and “average duration of unemployment claims” tell us about where we have been and, therefore, are generally considered lagging indicators of the relative health of the economy. Housing starts and permits are great examples of leading indicators. If these are rising, the demand for labour and supplies to build the new housing units is likely to rise in the near future. As the housing units are completed, demand for consumer goods like furnishings to fill them is also likely to rise.

The power of leading indicators is obvious to those gauging current conditions and making plans. If housing starts are rising, retailers of furniture and appliances are more likely to increase orders and hire new staff; manufacturers are likely increase production and inventories in anticipation of rising demand.

In workers’ compensation and OH&S, traditional measures tend to be lagging indicators. Injury rates, injury counts, and “days injury free” are, at best, lagging indicators of safety—they may tell us something about where we were but little (if anything) about where we are going. These measures are heavily weighted to the past and may mask serious safety and health risks in the current workplace. Developing leading indicators at the operational, sectoral and even jurisdictional levels helps focus resources and attention where it is most needed and provides early signals of the effectiveness of current programs or initiatives.

To design a leading indicator, you need a logic model, a framework that takes into account the near-term, mid-term and long-term objectives that will lead you to your goal.

Suppose your goal is a safer, healthier workplace and you have an objective of reducing strain injuries in your manufacturing plant. You might want to start by identifying the factors that lead to these injuries. Ergonomics is an obvious factor but you could get more granular or more general in your consideration. Loads, repetitions, and workstation design might be factors at the individual level while work procedures, the pace of work, and safety culture might be important factors at the operational or corporate levels.

Now that you have a model of how the injuries occur, you can think about interventions at the causative level that will contribute to greater prevention. Perhaps you have been convinced as I have that safety culture is vitally important and you have initiatives to improve safety culture in your operation. Annual external audits or random quarterly surveys could help you determine both the current climate and trend over time. If your model is correct, improvements in your safety culture will lead to outcomes like improved adherence to safe work procedures, more safety-oriented content in supervisor-worker interactions, more rapid time from hazard identification to removal—all of which have been proven to reduce injuries and make workplaces safer and healthier.

Other examples of leading indicator metrics for the objective of reducing strain injuries I’ve come across in industry include:

• % of workstation ergonomic evaluations completed

• % of employees/supervisors trained in ergonomics

• % of ergonomic action items addressed

• % of employees engaged in fitness and wellness program

Developing a logic model and selecting a leading indicator forces you to understand your business, how injuries occur and what research tells us will prevent them. That understanding is critical for good management as well as OH&S.

Don’t bother developing logic models, selecting leading indicators, and continually measuring indicators if you think it will be easy. Making the time and effort is hard but worthwhile.

My favourite quote on this topic makes the point very well:

"Measurement is the first step that leads to control and eventually to improvement.

If you can't measure something, you can't understand it.

If you can't understand it, you can't control it.

If you can't control it, you can't improve it.”

- H. James Harrington (Author, columnist, a Fellow of the British Quality Control Organization and the American Society for Quality Control).

Wednesday, October 10, 2012

Can you rewire your safety culture?

I was invited to deliver the keynote presentation at the “Make It Safe” conference a few days ago. The event was hosted by the FIOSA-MIOSA Safety Alliance of BC, the Canadian Manufacturers & Exporters of BC, and WorkSafeBC.

The FIOSA — MIOSA Safety Alliance of BC, is a not-for-profit industry organization that seeks to address challenges and opportunities specific to food & beverage processing and manufacturing and to set industry standards for health and safety.

The industries represented in the room were ideal for my topic, “Rewiring your Safety Culture.” Most participants had great safety backgrounds, but my goal was to take their thinking about safety beyond the lagging indicators such as injury free days, injury counts, and reportable injury frequency rates. The manufacturing sector has made huge strides in improving safety and health but to take the industry to the next level of safety will mean rewiring the way we think about safety and how we measure our progress.

Manufacturing has been the focus of much research on safety culture. The rich research in this sector provided me with examples from oil refineries, commercial bakeries, electronics manufacturing, and metal fabrication to illustrate my point.

I also happen to like James Reason’s work on human factors because I find it connects with audiences. Briefly, his “Swiss Cheese” model is widely used and easy to visualize. Reason conceptualizes the barriers, safeguards and defences (like training, supervision, safe work procedures, and equipment design) that protect workers as being imperfect with holes of varying sizes and location representing active and latent gaps in the protection. Workers can only get hurt when the hazard in the work environment follows a trajectory through the holes to harm the worker.

Adding “Six Sigma” (an innovation born in the manufacturing sector) to Reason's model allowed the audience to visualize my argument for a rewired safety culture. They agreed that active defects in training, supervision, adherence to safe work procedures can be eliminated or reduced by applying the Six Sigma methodology.

Taking Reason’s model, I argued for a re-conceptualization of the holes as “defects” in the barriers, safeguards, and defences that would protect workers from harm. Six Sigma methodologies are all about reducing variation and improving processes to ensure defects fall below the 3.4 million per million level. Through improvements in training, supervision, and adherence to safe work procedures, we can reduce the number, and size, of defects in these defences and reduce the probability of harm to workers. As defects approach Six Sigma levels, injuries to workers will approach zero. Selecting leading indicators consistent with the approach completes a rewired approach to safety and safety culture.

In this competitive world, the one big question audiences ask about rewiring their thinking about safety and changing their safety culture, relates to costs. The good news is that most of this rewired thinking about safety is not expensive. Small investments and equipment can have a big effect. The big change is in mindset; the big benefit is in saved lives, lowered costs, and improved productivity.

Because my job for much of the last thirty years has involved environmental scanning, I collect stories and examples from other jurisdictions. One of my current favourites from the manufacturing world is for Simms Fishing Products. WorkSafeMT has highlighted this small manufacturing firm in a video available on YouTube that makes the point: it is possible — and worth it — to rewire your safety culture.

Take a look at the video and take the next step: start rewiring!

Friday, September 21, 2012

What were the rehabilitation and return-to-work highlights from the PIEF Conference?

I’ve recently returned from speaking at the Personal Injury Education Foundation (PIEF) conference in Brisbane, Queensland, Australia. PIEF has no exact counterpart in Canada or the United States. It was established in 2006 as a not-for-profit organization by a consortium of Australian and New Zealand accident compensation regulators, insurers, and claims management organisations. They wanted to create programs, initiatives and events focused to raise the common standard of knowledge, skills, and professionalism in the personal injury industry, which covers what North Americans would think of as workers’ compensation, transport accidents compensation, and other injury compensation programs.

My assignment as a keynote speaker was to give a North American perspective on rehabilitation and return to work. (In the interest of full blog disclosure, PIEF funded my travel and registration costs while WorkSafeBC funded salary and other expenses). Highlights for me included hearing the other presenters in the concurrent sessions, other keynote speakers in plenary sessions, and the discussions in the halls, meals, and social events.

The conference opened with a brief talk from an injured worker, Edward Bailey — an ex-pat Canadian who suffered severe back injuries and surgeries that left him unable to work in his 30-year career as a mechanic. He relayed how scary this was, how depressed he became and how the assistance he received to be a trainer and assessor as well as his additional work he does as a technical writer have made all the difference. He said the pain is still there but the rewards of his work allow him to carry on.

That theme of "work being important and good for you and your recovery" was echoed in many sessions. The employer representative who spoke next was Amy Sproule, the Health and Wellness coordinator for Carlton United Brewers — supplier or a quarter of Australia’s beer. She outlined their extensive program which includes on-site physiotherapists (PT) and access to Occupational Therapy (OT), physiatrists, and other allied professionals. She noted that some of the costs for referrals are picked up by WorkCover or by their benefits program but some are just absorbed as an HR cost. She acknowledge that onsite PT was expensive but said it was a visible commitment to early intervention, prevention and RTW — part of a culture they have and want to foster. She concluded that the program makes good business and good moral sense.

The next speaker was Jon Schubert, the president and CEO of the Insurance Corporation of British Columbia (ICBC). He gave a detailed talk focused on transport accidents but some of the research he presented certainly got a reaction from the delegates. For example, he showed how whiplash claims frequency were the lowest in Quebec, a province with a no fault system. He spoke about the Quebec taskforce on whiplash that is widely used for neck pain and the work he was involved in with Saskatchewan that has gone beyond that to focus on a functional model. Interestingly, following the research leads to some surprising outcomes. He noted that some interventions, such as early fitness programs, actually delay recoveries and others have no effect. It raises important questions about what should be funded. Are we doing harm by funding interventions that delay recover, increase disability, or have no effect?

The third keynote speaker in this two-day conference was Professor Sir Mansel Aylward CB, Chair, Public Health Wales and Director, Centre for Psychosocial and Disability Research, Cardiff, Wales. His talk was primarily based on the bio-psycho-social model but his message was clear: We have to change our current thinking and models of disability. He called this focus on outcomes, on health and work, “a moral obligation”. He noted that the bio-psycho-social model is now supplanted the standard medical model and has the published, peer-reviewed data with biochemical, neurotransmitter, and other evidence to back it up. “There is a limited correlation with illness, disability and the capacity for work,” he said — a statement that most in the field of vocational rehabilitation would agree with. He advocates return-to-work outcomes becoming an objective of primary care.

Other topics at the conference included how to define and measure client outcomes, the effects on health, psychological, and work status following compensable injury, and predicting common law claims. I took copious notes at this event and know I will be following up on much of what was presented.

Although the event is only held every two years, based on having attended two of the last three I have no hesitation in recommending the PIEF conference. The next one will be Auckland and will be held in conjunction with the International Forum on Disability Management (IFDM). ​

Wednesday, September 12, 2012

Is there only one way to keep workers safe?

Last week I was in Brisbane, Queensland on Australia’s east coast. Here’s a jurisdiction a bit bigger in population than British Columbia, a little smaller than Washington State, with a low injury rate and low workers’ compensation premiums (“workcover” as it’s called in Australia).

Brisbane is a modern, cosmopolitan city of three million. There are obvious signs of a vital economy. Buildings are going up, transportation networks are expanding, and unemployment is around five percent (vs. B.C. and Washington state where unemployment is hovering around the eight percent mark).

The workers that keep this economy running are engaged in similar activities to those in any large city. Perhaps because I’m aware of occupational safety and health issues, I couldn’t help but notice some similarities and differences.

Above the city, the complex choreography of cranes carries on as it does over urban construction sites everywhere. The cranes; however, are predominantly luffing jib cranes rather than the straight boom, hammerhead slewing cranes more commonly seen in many North American cities.

Brisbane South Bank construction - August 2012

Workers wear hardhats, but given the greater exposure to the sun, many have wide brim tinted visors and neck shades. Brightly coloured safety garments are seen everywhere. Fluorescent green or orange and contrasting blue polo shirts, fleece, and jackets are common on, and, off the jobsite. Delivery drivers, traffic patrol, baggage handlers — even cyclists — can be seen wearing these distinctive (from a North American perspective), high-visibility garments. It’s not that wearing hi-viz garments in jobs other than construction or traffic control is unheard of in North America, it’s just that wearing of this type of apparel outside the usual job sites is more common in Brisbane.

I’m not certain if Australians generally have a richer “safety culture” than North Americans. Overall, the workers’ compensation injury and fatality rates appear lower than most North American jurisdictions, although true “apples to apples” comparisons are, in my view, absent from the published, peer-reviewed literature.Perhaps an experience I had at the convention centre might be an indicator of something different in the way Aussies manage risk. Before several of the banquets I attended, a server came to our table and instructed us on safety procedures in the event of an emergency. That was something I’ve experienced occasionally at events in many countries. The server also explained a safety rule about always wearing shoes because of the risk posed by errant shards from occasionally broken glassware. I’ve attended a lot of conferences and this was an entirely new caution to me. It was a perfectly logical and important rule when you think about it, but (to be honest) I had never thought of broken glass as a risk in a carpeted banquet hall. And this in a brand new, spotless facility: Brisbane Convention and Exhibition Centre, on Grey Street.

I mention these examples to illustrate a point. Regardless of our national context, employers, workers, and OH&S regulators face similar workplace safety and health challenges. Each jurisdiction has developed solutions to manage risks to workers and other persons in the workplace. Not all solutions are the same. Sure, exit signs are ubiquitous, but the green and white graphic signs in Australia seemed just as clear to me as the red and black text-based exit signs we see in North America.

I’m not sure you could say any given solution is the only right way to protect workers, nor am I saying that you can simply transplant a standard from one jurisdiction to another. What I’m saying is that the diversity among developed western societies creates an opportunity for OH&S professionals to consider solutions others have implemented. Another important reason for building relationships across our jurisdictions.

Tuesday, August 28, 2012

What keeps workers safe?

I’ve spent many days enjoying the view of False Creek and the Roundhouse Community Centre from an apartment near the top of a residential tower in Vancouver’s Yaletown district. The stunning views of sparkling waters, emerald parks and gleaming residential towers are amazing. The natural beauty of the area has a lot to do with that but I can’t help but notice the thousands of workers that are involved in building and maintaining the structures, green spaces, waterways and infrastructure.
Recently, I’ve focused on the crews refurbishing the exterior decks and maintaining the rails on neighbouring towers. As I look down from the 26th floor, I can see the swing stages raise and lower workers to the various levels. What was keeping these workers safe on the job? There are standards in the regulation that apply but words on paper are not what keep these workers safe. So, what does?
Clearly, design is a big factor. The scaffolding and rigging are carefully designed to match the structure’s shape, secure and stabilize the scaffold, and minimize gaps through which a worker could fall. The guardrails and fall restraint systems are designed with worker protection in mind.

Design alone is not enough to keep these workers safe. For design to be effective there has to be safe work procedures. I watched as workers transferred their tethers, donned masks during grinding, descended during windy spells or approaching thunderstorms. Design and adherence to safe work procedures work together. But was that really what was keeping these workers safe?

I began to think about the human elements that were involved. These workers knew what they were doing. They appeared to be well trained, knew how to handle the work stage and the order in which things were to be done. Still, knowing what to do is only part of what was keeping the workers safe. Attitude plays a role, too.

Supervision was certainly present on the site. I observed interactions between workers and supervisors and, when the wind was blowing in the right direction, could overhear what was said. Safety-oriented content was often part of those conversations—not always the main point but usually part of the discussion. There was the occasional direction to check a cable or adjust a load but was supervision what kept these workers safe? Or was it a cultural thing—was it a strong safety culture that was really what was protecting these workers from harm?

The old locomotive turntable at the Roundhouse has now been equipped with a mechanical retractable canopy for shade and performances. At the rear of the canopy mechanism in meter-high letters are the words “Safety First”. Whether you interpret these words as an admonishment, a reminder or an aspiration, “safety first” fits well with what I see through the window: It is not one thing that keeps workers safe, it is all of these. Safeguards, barriers, and defences like training, supervision, design and safe work procedures are essential but a strong safety culture—putting safety first—is what keeps workers safe

Sunday, July 29, 2012

Part 2 Do the words we use to describe WC claims matter?

The basic terms we use in workers’ compensation have meanings, associations and connotations whether we like them or not. I received a lot of questions and comments on my last post about terms such as “old dog” and “long tail” claims and I want to explore the idea that the other basic terms we use in workers’ compensation can influence how we and other stakeholders think and potentially act.

If you ask someone about the purpose of workers’ compensation, you generally get a response about compensation for accidents and a few will add something about prevention. “Accident” is often defined or understood to mean a “fortuitous event” and has the connotation of randomness and inevitability. An analysis of work-related injuries shows that the vast majority of work-related events that result in injury are preventable. Calling the specifics of a work-related injury event an “accident” may subtly shift thinking away from causation and prevention and towards inevitability and “bad luck”.

A few years ago, WorkSafeBC shifted its terminology with respect to work-related injuries involving motor vehicles from Motor Vehicle Accidents (MVAs) to Motor Vehicle Incidents (MVIs). Unless referring to a specific term in legislation (such as the Accident Fund), WorkSafeBC actively avoids using the term accident in its annual report and services plan as well as other publications.

The word “claim” as a noun has several possible meanings, the most common of which has a connotative meaning of a statement that is not yet substantiated, doubted or contested. By extension, the connotation of the word “claimant” can be similar to that of supplicant—a connotation that sets up a power relationship that can be problematic. Even the synonyms of Plaintiff and Complainant set up an adversarial relationship. Although terms like claimant may be necessary in some very specific contexts, I use “injured worker” in place of claimant wherever possible. Workers’ compensation systems are there for injured workers. “Worker” generally has a positive connotation, a sense of dignity and attachment to an occupation and employer. “Injured” speaks to the the consequences of a work-related event rather than the bureaucratic process of filing a “claim” for workers’ compensation. This may not be a perfect alternative, but in my view, it is preferable. (As an aside, in the British Columbia, the word “claimant” only occurs in Schedule B to the Workers Compensation Act and only in the context of certain occupational cancers and hand-arm vibration).

Finally, the term “benefit” connotes something different from “compensation” in common parlance. “Benefit” is often thought of as an advantage or profit gained from something; it is hard to think of an injured worker profiting or gaining from a work-related injury particularly a serious one. Do we really need to tack on the word “benefit” to workers’ compensation?

My advice is use words that keep the focus on the needs of person and his or her family. Just think about the way the words sound and how they make you feel in the sentences below:

a) The injured worker requested assistance in obtaining a wheel chair to aid in recovery

b) The claimant made a claim for medical aid benefits to cover the cost of a wheel chair.

Both sentences convey similar meeting but the first is focused on the worker and the worker’s needs while the second is focussed on a claim for a benefit with a tone, to my ear, that questions entitlement and focuses on costs.

Not every situation will allow you to avoid the terms mentioned in this series. Even if you cannot avoid the terms, thinking about the words we use may help improve understanding of how words influence perceptions and actions in workers’ compensation

Monday, July 16, 2012

Do the words we use to describe WC claims matter?

Workers’ compensation is an extremely complex form of social insurance. Those who specialize in workers’ compensation tend to adopt jargon as a kind of shorthand to express concepts to those in the know. I’m sure you have heard (maybe even said), “I have this back claim…” when what is really meant is, “I am assisting a person with a work-related injury to the back…”. Unfortunately, this use of jargon can have unintended and negative consequences.

Recently, I have read blog posts and heard speakers at conferences referring to “old dog” claims. I have heard many explanations for the source of this idiom. One commentator said the term arose from the dog-eared corners of the large paper files that are the inevitable consequence of serious injuries and long-term claims management. Another suggested the term related to those serious and long-term claims that “hound” adjudicators and frustrate administrators due to their lack of resolution. Regardless its origin, those unfamiliar with the term may interpret “old dog” claims as somehow disparaging the people who made them. Worse yet, the internal use of a term with such a negative connotation may influence the way we think about or act on some claims.
A related term, “long-tail” claims can create barriers between workers’ compensation insurers and those the system intends to help. The “long tail” in workers’ compensation refers to the statistical property of the distribution of claims, particularly as it relates to duration. The vast majority of claims are very short duration but a few go on much longer and a very few go on with some benefits that may last a lifetime. It is impossible to know just how long a particular claim for a particular injury might require active claims management, adjudication of medical costs, and payment of benefits. Insurers use actuarial estimates based on experience to quantify the costs. Claims at the far end of the claim duration distribution—the “long tail” of a graphical depiction—will generally have the greatest costs.

Most of us are not actuaries or statisticians. Those of us who endured rather than enjoyed the statistics courses in our academic careers can probably still recognize the statistical aspect of the “long tail” and recall vaguely the problems of asymtopical distributions, skewing, and corrections for right-hand truncation. For those without statistical knowledge, the term “long tail” has a somewhat negative connotation, an implied variance from some level of “normal” or “typical”. To those individuals, the use of the term may create a barrier or put them on the defensive with the insurer, adjudicator, case manager or other workers’ compensation personnel. It is not hard to imagine people worrying that adjudicators in WC would be actively working to terminate claims in the interests of shortening that long tail—not a recipe for a trusting relationship.
A 2010 survey had good news and bad news for insurers regarding trust. The headline read “Trust in Canadian insurance industry jumps 17%”. The article revealed this significant increase was on a base of only 38%. At 51% of opinion leaders trusting insurers, this improved standing is still well down the in the ranking behind other sectors like health care and technology. Given this significant lack of trust in insurers, it is time we stopped using terms that have such negative connotations even in internal discussions.
I believe workers’ compensation professionals in state funds, private carriers, TPAs and related agencies are sincerely working in the best interests of those WC was created to serve. Abandoning jargon and shorthand terms like “old dog” and “long tail” claims may seem like a small thing but words matter. Words create perceptions and perceptions create reality.

Tuesday, July 10, 2012

Can we use workers’ compensation data as an effective occupation health and safety tool?

A few days ago, I was at a CDC-NIOSH workshop in Washington DC on the topic of using workers’ compensation data for occupational safety and health. This event was organized around six draft white papers that really illustrate the potential, the barriers, and the pitfalls of this pursuit.

The first session highlighted some of the successes in using workers’ comp data in health care injury prevention. Several papers demonstrated the advantages of linking workers’ comp data with other data files. Duke University, for example, has 30,000 employees and the data in its various electronic systems can be linked on employee ID. The research presented, while preliminary, showed an elevated relative risk of musculoskeletal injuries for certain health care employees over what might be expected. It also showed that certain administrative changes have a big impact on injury rates.

The second of the themed white papers looked at the burden of occupational injuries, illnesses and fatalities. By burden, we mean the total impact on society not just the dollar impact of claims, employer cost, or loss to the worker or family. Each of these components is important and needs to be part of the equation. When that total burden is calculated, the benefit-to-cost ratio of prevention becomes more evident. In this session, there were a number of papers. For me, Seth Seabury’s presentation on the work RAND and others have done through the linking of earnings data was a highlight. The research shows that workers who suffer a work-related injury lose income relative to their non-injured counterparts. The research technique that yields this result has been tried in CA, MN, MI, NM, OR, WA, WI, Ontario and BC. While far from a national or full North American perspective, the similarity of findings is helping to quantify that loss and allow policy makers to assess the adequacy of compensation.

The third white paper dealt with the contingent workers, a growing segment of the workforce. By “contingent workers”, we mean those without an explicit or implicit contract for employment. Day labour on a construction site might be an example. In some cases, contingent workers are hired to do jobs that are considered of lower value but may be of higher risk. Contingent workers are often not captured in data sets such as the Survey of Occupational Injuries and Illnesses (SOII). Temp agencies, professional employee organizations (PEOs) and some labour contractors pose challenges for prevention, enforcement, and underwriting.

Our white paper on the use of workers’ compensation data for loss prevention provided a backdrop for presentations from WorkSafeBC, Ohio BWC, and the California Department of Industrial Relations, among others. It also fit in well with NIOSH Director, John Howard’s remarks on the importance of workers’ compensation and its data to primary, secondary and tertiary prevention. His remarks were consistent with many of the presentations that underscored the need for better metrics and standards for the data.

The fifth white paper focused on state-level analysis of workers’ compensation data for public health purposes. The presentation by Jennifer Wolf-Horejsh, executive director for IAIABC, highlighted the work of that organization in standardizing reporting through its EDI (electronic data interchange) standard and training. Presentations from various groups during this session also revealed the degree to which data from other sources and innovative techniques may be used to confirm workers’ compensation data particularly estimating the cases not captured by various data sets. The examination OSHA recordkeeping practices and workers’ compensation claims in Washington was particularly revealing and points to some of the sources of error (undercounting) that may well exist in reported work injuries.

The final white paper on leading indicators provided a great opportunity to reflect on how we might better use data for prevention purposes. One intriguing approach was Allard Dembe’s paper on O*Net. O*Net, the Occupational Information Network, (an outgrowth of the old Dictionary of Occupational Titles so many of us used in the past). It describes nearly a thousand occupations with 277 descriptors for each occupation. His research, while very preliminary, demonstrated how some of these factors might be used to predict workers’ compensation claim outcomes.

The two-day workshop provided the hundred or so researchers with a wonderful opportunity to focus on some leading edge research. When the white papers and presentations are finalized and proceedings published, I am sure they will prove a valuable resource for other researchers, policy makers, and practitioners

Monday, June 25, 2012

When did you last witness safety trumping other considerations?

In popular culture, the opening sentence of a bad novel begins with the clichĂ© phrase, “It was a dark and stormy night…”. Returning late last week from Washington, DC and a NIOSH workshop on the use of workers’ compensation data for occupational safety and health, I was stuck in Toronto-Pearson International Airport at dusk as the clouds darkened ominously. Through the boarding lounge window, I could see a wall of rain sweeping towards the terminal. On the top of every jetway, white strobes began flashing in unison. Over the handheld communicator a ground agent was carrying, I heard the announcement: the tarmac and apron were being cleared for safety reasons: lightning strikes from the dark storm clouds approaching YYZ.

The safety equation on this dark and stormy night was particularly evident. The inbound plane at our gate was a mere five meters from the jetway with a full manifest of passengers. At other gates, flights had been loaded and doors closed. Planes were still landing but backing up, still burning fuel, and clock time for aircrews. Connections were being missed, overtime incurred, and schedules overturned. Despite all these costs, all activity on the field stopped for the protection of ground crews.

Our lounge was full of passengers for Vancouver, BC or carrying on to Sydney, Australia. In almost perfect unison, thousands of people in Terminal 1 pulled smartphones and began checking connections and informing friends, families and colleagues of the indeterminent delay.

Here was an actual example of safety trumping other considerations. You can’t fuel an aircraft, load it with baggage and cargo, or push it back from the gate without workers and the risk of injury to a worker during a lightning storm is significant; an average of 57 people are killed each year in the US due to lighting strikes. Canada has shorter lightning seasons than in the US, yet lightening kills 9 or 10 people and injures between 100 and 150 people each year. Safety is about managing risks and managing the risks in this case means stopping airside operations.

How did people in my very crowded waiting lounge react? Most took the delay in stride. I heard one passenger actual say to the gate agent, “Worker safety should come first.”
After a couple of hours with intermittent starts and stops due to the storm, operations got going again. There was a huge backlog of flights. Our Air Canada flight 033 was fully loaded and had to wait 45 minutes after the doors closed before a crew was available for pushback.

Yes, we arrived home three or four hours later than planned… but we were safe and so were the crews that served us along the way.

There is nothing inherently safe about air travel. What makes it safe is a culture that values safety at every point, in the air and on the ground. Wouldn’t the world be a better place if we could day the same thing about every industry?

“There is nothing inherently safe about [building a bridge, lifting a patient, felling a tree…] what makes it safe is a culture that values safety.”

Monday, June 11, 2012

"what does the research tell us about...?"

Three times in the last week, I received calls or emails that contained a question that began, “What does the research tell us about…?” Each question related to a current issue in workers’ compensation and prevention. One wanted to know which prevention strategies have the best evidence as being effective. Another was interested in the degree to which financial “secondary gain” might be a factor in claim duration. Another asked about the elevated risk victims of a certain common occupation disease claims might have for other serious illnesses (with the implication of compensability).

These are all good questions. Each has real-world implications for policy, case management and prevention. In some cases, there are solid answers from the published literature; in others, the question is unanswered or there is too little information to provide a clear answer at this time.

Behind each question lie important assumptions:
1. Valid, peer reviewed research matters to policy makers and practitioners

2. Scientific hypothesis testing and data analysis in properly designed and ethically applied research provides better information for decision making than conjecture

3. Research that has been subject to scrutiny and review by other researchers is defensible as a basis for decision making

4. The synthesize of the many pieces of research necessary to arrive at valid answers to such questions has taken place.

There is often a fifth assumption: research is “costless”. It is “free” in that most research policy makers need will eventually be published in peer-reviewed journals. However, I get the impression that anyone asking a policy analyst the questions above assumes the information is “out there” and will only take a little scratching about to summarize in a briefing note.

I know that most policy makers and practitioners would never say research is costless if they gave it any thought, but I am certain not one of the people asking me these important questions could put a dollar figure on a given piece of research. Even if they could, (I know I couldn’t), I doubt they would take into account the costs beyond the dollars involved. Every scientist, Master’s student and Ph.D. candidate who applies their intellectual resources to research questions in workers’ compensation, prevention and rehabilitation is foregoing other research topics—an opportunity cost that can have huge implications.

I had the pleasure of welcoming nearly 200 researchers, students and policy makers to the Canadian Association for Research on Work and Health (CARWH) to their conference in Vancouver a few days ago. WorkSafeBC has funded research and researchers for more than 40 years and was proud to be the host organization for this event. WSIB Ontario, WCB Nova Scotia, and IWH Ontario also directly supported this event. Many other organizations were represented through the research presented that was the product of their financial support (the IRSST in Quebec and WCB Manitoba among them). Far from being “free riders”, these organizations understand that research is not costless and have made a commitment to paying a share of that cost. It is not the “price of admission” but it is an admission that there is a price worth paying for answers that will make a difference in workers’ compensation and prevention.

Along with guests from the US, Australia, New Zealand and the United Kingdom, I had the opportunity to meet with researchers, ask questions and discuss areas for further research. The abstracts for this event are still available online. Just skimming through the titles speaks volumes about the new answers to important questions researchers are now investigating.

So, what does the research tell us about these important questions? A lot more than a blog post can do justice. Next time you find your self asking (or being asked) a question that begins this way, ask what you and your organization are doing to support research, researchers and the sharing of data that will make a difference.

Thursday, May 31, 2012

Do random workplace inspections reduce worker injuries?

Occupational safety and health inspectorates have a challenging task. The number of workplaces far exceeds the capacity of the inspectors to visit each one. Most inspectorates manage the challenge by allocating resources to programmed interventions and responsive work arising because of serious workplace incidents or complaints. Random, unannounced inspections are often used as part of the targeting procedure but do random inspections actually reduce worker injuries?

A new study [ David I. Levine, Micheal W. Toffel, Matthew S. Johnson, “Randomized Government Safety Inspections Reduce Worker Injuries with No Detectable Job Loss, Science, Vol 336, 18 May 2012] using California data provides a well-researched answer. Michael Toffel, an environmental management expert (Harvard Business School), along with economists David Levine (University of California, Berkeley) and Matthew Johnson (Boston University) created 409 matched pairs of inspected and uninspected workplaces from Cal/OSHA data. Sectors were representative of the higher risk industries in the state and include construction ( general building, special trade contractors), wholesale trade (durable and non-durable goods), metal fabrication (doors, car parts, aerospace products), wood and lumber products, transportation and others. Firms included in the study had at least 10 employees and some had more than 500. The researchers looked at the records for up to four years before and after the year of inspection.

Their study found 9% fewer injuries following the inspection and 26% lower injury costs but no negative impacts on economic factors such as employment, total earnings, or company survival. Importantly, the random-inspection effects endured at statistically significant levels even four years after the year of the inspection.

The study certainly supports the idea that random workplace inspections reduce both minor and major injuries to workers and costs for employers without economic harm to the enterprise or reductions in the labour force.

All studies like this have limitations. There may be other factors peculiar to California that come into play in this study. The selected firms were single establishment firms in high-hazard industries in a specific region. The study does not look at the effects a percieved risk of inspection might have on uninspected firms. Random inspections within a targeted high-risk sector—particularly if well publicized and supported with actual inspections—may increase the perception of detection among all participants in the sector. This may increase the incentives towards improved attention to safety and health. Perhaps a future study will examine this.

The alternatives to random inspections in a sector include targeting firms based on injury rates, geography, severe incidents, and complaints. Each of these strategies has its advantages and disadvantages. Well-publicized blitzes announced in advance for regions, specific industries or equipment theoretically have an impact. Targeting firms with high rates of injury also makes sense but it is hard to know the true injury rate for small firms. On the other hand, firms outside the announced blitz domain and those with lower than average reported injuries may perceive a lower risk of detection of regulatory violations and, for a few, lower incentives to achieve and maintain safety and health in the workplace.

This may not be the last word on the issue but this research offers practical information for the consideration of policy makers and inspectorates.

Thursday, May 17, 2012

What’s the connection between complacency and risk?

It was a small thing, something noticed out of the corner of my eye, but the subsequent discussion got me thinking about what was really going on in the workplace and what it says about safety culture.

I was in a workplace the other day and noted the absence of a ground pin on an extension cord. I asked the worker using the cord about it and the worker told me it had been that way for a long time. He hadn’t said anything to anyone about it. His supervisor had used the same cord and did not say or do anything about it. He had not been shocked and his equipment kept working. “So, what’s the problem?” he asked.
The absence of injury is not the same thing as the presence of safety. The extension cord with the missing ground pin is clearly unsafe. It creates a defect in one of the important safeguards, barriers and defences in the workplace that are there to manage the inherent risks. Why didn’t the worker, the supervisor or somebody else do something about it?
On possibility could be intentional neglect. Perhaps the supervisor knows about the safety implications of the missing pin but puts production at a higher priority. There is no excuse for intentionally putting workers at risk. Intentional neglect should be sought out and regulations enforced. Another possibility is ignorance. Perhaps the worker and the supervisor are truly unaware of the risk posed by the missing ground pin. We can do something about unintentional neglect through awareness building, inspection and education. There is a third possibility, one that is more pervasive and, to my way of thinking, more dangerous: complacency.
Maybe, at some point, someone did notice the missing pin and did intend to do something about it. Perhaps they took the extra precaution of making certain only double-insulated equipment was plugged into the cord. Perhaps the cord was reserved for non-polarized, two-pronged plugs—at least until the cord could be repaired. Perhaps, as the days past, using the damaged cord just became a habit—with and without the precautions.

If every time a worker used a defective cord he or she received a mild shock, there would be immediate feedback about the defect. That, of course, would be ludicrous. We are fortunate that most new equipment is designed with redundancies like double insulation to protect workers. Safety, on the other hand, does not provide such immediate and personal feedback. In this case, every time the defective cord was used, the worker was not shocked (no negative feedback) and the equipment worked (positive reinforcement for continuing to use the defective cord).

An extension cord with a missing ground pin left in use and unrepaired may be symptomatic of complacency. If the corporate safety culture is complacent in small things, then how can we expect larger hazards to be recognized and risks controlled?

I recall one safety director encouraging his employees to submit notices to him about hazards they noted. No matter how small, he wanted to know about these hazards— he wanted hundreds every month. Random draws from submissions and regular recognition for submitters provided reinforcement for the program. Most of the notes he received were about small oil spills, broken guards, and unsecured equipment—and the notes usually indicated that the defect had been immediately fixed. The safety director explained the benefits of this approach. Sure, the minor issues are fixed but, more importantly, the approach fought complacency. Workers were attuned to safety and alert to hazards.

To finish off the story, I was back at the worksite the next day. The extension cord was fully repaired with a new, heavy-duty three-pronged plug. It was a small thing: a few dollars for the part, a few minutes for the repair. A small victory in the battle against complacency

Monday, April 30, 2012

What was new at the Saskatchewan Workers’ Comp Institute?

A few weeks ago, I attended a unique event in Regina. Since 1998, Saskatchewan WCB and the Ministry responsible for workplace inspections have been holding an annual Workers’ Comp Institute. The event is open to employers, union reps, safety officers, and human resource professionals - in fact, anyone with an interest workers’ compensation. Over the course of the two-day event, nearly 400 participants learned more about the Saskatchewan workers' compensation system and stakeholder responsibilities in it. Many of the concurrent sessions had basic titles like “Case Management”, “Employer Services (Assessments)”, and “Best Practices (Prevention and RTW)” but the content was of interest to novices to workers’ compensation and to students of workers’ compensation systems like me.

A highlight was the celebration of the “Safe Worker” and “Safe Employer” awards. The luncheon celebrating the nominees attracted media attention and was a fabulous platform for advancing the idea of changing safety culture. In introducing the Safe Employer award nominees, the Deputy Minister spoke about the importance of leadership noting that research shows about 70% of corporate culture is set from the top. Three nominees for employer and worker awards were highlighted in video presentations that showed how individuals and firms can make a difference in making workplaces safe and healthy.

Another highlight was the frank discussion about a new and controversial initiative: summary offense ticketing. The Ministry is seeking an amendment to the Summary Offence Regulations of the province. These regulations allow peace officers in different fields to issue tickets (like traffic tickets for speeding). The amendment would allow occupational safety officers to issue on-the-spot-tickets to employers, supervisors, contractors, owners, and workers for certain prescribed offences. The benefit of this program is the immediacy of issuing a ticket. If you are trying to change behaviour, a summary offense ticket is an immediate tool with far lower administrative costs than prosecutions or many administrative penalty processes. Still to be worked out would be the schedule of offences and the values of associated fines (large enough to be a deterrent without being overly punitive). Consultations are continuing to decide which behaviours should be targeted.

The event was well run and included a range of representatives from all stakeholder groups. In the plenary and concurrent sessions I attended, there was no grandstanding; yet, questions from all stakeholders were welcomed and respectfully addressed.

I’m not certain the Workers’ Comp Institute idea is right for every jurisdiction but it seems to be working well in Saskatchewan. Other jurisdictions may find inspiration from the the approach and the content of this very successful event.

Friday, April 13, 2012

What are the top workers’ comp concerns among employers?

A recent US survey by Zywave (a Milwaukee-based provider of software-as-a-service solutions for the insurance and financial services industries) asked 3,500 employers about their top workers’ compensation concerns.

Cost containment topped the list. Cost containment in workers’ compensation includes actions employers can take to reduce their workers’ compensation costs. In the US, this generally refers to steps that reduce injuries, shift costs to second injury funds (similar to “relief of costs” in WorkSafeBC terms), control medical costs, and return injured workers to employment (shortening duration, and therefore, claim costs).

It is not surprising that 65% of those surveyed identified “having a safety-minded culture” as the most effective measure to control workers’ comp costs. If you have a safety culture, you know it. Developing a safety culture, however, is not that simple. Many firms don’t, and those that want to develop one often don’t know where to begin. Many workers’ compensation insurers have loss prevention and industry consultation services that can help but ultimately, it will be the workers, supervisors, managers and owners of firms that create a safety culture.

Another obvious measure to control costs is having a light-duty or return-to-work program. In this survey, nearly 60% of employers said they had such programs but only 45% of respondents reported having a written return to work policy.

About a third of employers surveyed were concerned about increasing exposures in the workplace and a perceived rise in fraud behaviours. Other top concerns related to the nature of the competitive market for workers’ compensation insurance in the US: renewals (cost and possibility of an insurer declining coverage), market availability of workers’ compensation insurance, and insurance carrier stability.

According to the survey, nearly 90% of employers had no idea what their “loss-free rating” was or were not familiar with the term. Loss-free ratings (sometimes called “minimum mod”) commonly appear on premium statements and relate to the experience modification part of the premium calculation.

The loss-free rating is the value the experience modification (often abbreviated to “experience mod” and expressed as a multiplier of the base premium) would be if there were no losses in the experience period. A firm with an experience mod of 1.10 on a base premium of $100,000 would have a total premium of $110,000. If the loss-free rating were 0.80, the total premium would be $80,000. Knowing the loss-free rating shows the employer, in this example, there was $30,000 of potential premium savings if there had been no losses.

The concept of loss-free rating may be hard to explain in US states but in WorkSafeBC’s case, the loss-free rating would be the maximum discounted premium. Showing the loss-free rating and the potential savings on a statement may well be a great conversation starter for firms with surcharges or demerit experience ratings. While it ignores the human suffering and costs, it does quantify savings available through prevention efforts. Put another way, many firms would find the cost and effort at prevention to achieve those savings far less than the cost and effort to achieve an equivalent profit from gross sales. There are also hidden costs associated with worker injuries that are not reflected in workers’ compensation premiums: lost time and lost experience or knowledge, for example.

With cost containment issues topping the list of US employer workers’ comp concerns, and given the apparent lack of understanding around the loss-free rating, the time is right for worker’ comp insurers to test new ways of communicating the value of investing in loss prevention, return to work and safety culture.

Sunday, March 4, 2012

What does the future hold for loss prevention and OH&S inspectorates?

I’ve been keeping a list of the issues, trends and ideas that will shape the future of prevention and occupational health and safety from the perspective of loss prevention (education, consultation) and compliance (regulation, enforcement). Here are my top 10 items:

1. Harmonization
The mobility of capital, labour and goods will drive harmonization across jurisdictions regardless of constitutional or sovereign boundaries. This does not mean there will be a race to the bottom but it does mean there will be an emergence of a minimum set of standards within nations and among trading partners. The challenge for regulators will be to agree on external or new standards. Watch for the rise of (and battles between) competing cross-jurisdictional standards.

2. Inter-agency “Task-force” models
No structure is ideally suited to address every problem. If we precisely define the problem in real-world terms, we can then design the interventions we need to actually fix them. We will see more inter-agency taskforces, “deputized” officers from one service to work with others, and letters of understanding between agencies in support of common causes (tracking bad actors across jurisdictions, for example).

3. Data-Driven Risk Intelligence
We live in a connected world. First aid records (or OSHA logs in the U.S.), paper claims records, and regulations that require firms to keep records of exposures are obsolete, wasteful, inaccurate and (almost) useless from a loss-prevention or OH&S regulatory program perspective. Data — not the paper or forms that contain them — are what will drive change. I don’t mean tables full of numbers published once a year but instantly available, continuously updated, visualized data with intuitive drill-down capabilities. These will become the standard mechanism for programmed inspections, blitzes, and targeted prevention interventions.

4. Social Media Response
Complaint phone lines are almost obsolete; yet, prevention agencies have failed to enlist the millions of people with smartphones on and near jobsites to detect and correct imminent risks. Agencies are all very quick to have a web presence going out, to tweet newsroom items and to seek Facebook followers. Embracing social media this way has the added benefit of fostering societal change.

5. Information transparency
Ultimately, it is information in the hands of consumers, workers and investors that will drive change. The Alberta Ministry of Human Services already allows anyone to search a firm's injury rate, fatality count, injury cost, and Certificate of Recognition status, among other things. The U.S. Department of Labor Occupational Safety & Health Administration provides online access to enforcement inspection reports. Workers, shareholders, business partners and others are going to demand this information. Information has the power to shape reputation, and reputation matters. Transparency will drive better safety and health performance. Transparency will detect discrepancies and injury-reporting/claim suppression. More importantly, it will allow for the creation of new approaches to safety and health that we have not yet conceived.

6. Technology-enabled monitoring
For years, safety regulators and insurers have declined receiving copies of documents such as safety minutes, First Aid ledgers, OSHA 300 logs, and exposure records required by regulation. Regulators struggle with the question of what to do with such data. Smart systems change all that. All safety committee minutes can be received and analysed by intelligent software; all OSHA 300 logs (not just a sample) can be retrieved and the sampling error eliminated to reveal new trends; and exposure records can be used for epidemiological “surveillance” particularly for long-latency occupational diseases. Technology-enabled monitoring has the power to protect people.

7. Safety-culture detection
You can’t fake your safety culture. If you have a good one, the safety rules are almost redundant. If you have a bad one, safety rules don’t matter. Yes, promoting and studying safety culture have been around for years. Detecting safety culture in the dozen or so questions inspectors, loss prevention officers, managers or workers can ask will diagnose the state of a safety culture quickly.

8. There’s an app for that!
Black box monitoring in transport vehicles, forklifts, cranes; “setting memories” cached on processing equipment; personal monitors for sound, motion, stress, toxins; worksite cameras capable of recreating three-dimensional scenes; “augmented reality” and “vertuality” capable of overlaying blue prints, floor plans, wiring and systems on camera images from any perspective in real time . . . there will be (and in some cases, there already is) an app for that. Best practice will make such apps common. And some insurers will offer discounts to employers with them in place.

9. Technology-enabled causation tree analysis
Software and intelligent systems will increasingly be used to establish exactly how safeguards, barriers and defences all failed to protect workers from injury. The antecedents that create active and passive defects allowing the inherent risk to harm injured workers will be actively mapped and the information used for prevention (and potentially third-party liability). Technology will enable (insurers will expect, regulators will demand) shorter periods to complete such analysis.

10. Tele-inspection
Insurers for underwriting and loss prevention purposes and OH&S inspectorates for compliance and enforcement purposes will use technology to do inspections at a distance. More worksites will be “visited”, more lives saved by adding this technology to the repertoire. Whether via remote connection or by use of a proxy (via the on-site safety manager with a helmet-mounted camera), inspections with corrective orders, penalties and even stop-work orders will be issued based on this sort on tele-inspection.

That’s the top of my list.

What do you think? What’s on your list?

Monday, February 6, 2012

How does the workplace have to change because of the aging boomers?

Last week I participated in a CBC series entitled, "The Silver Ceiling". The overall series concept was driven by the leading edge of the baby boom generation hitting 65 this year. My contribution was to speak about how workplace safety and health in light of this demographic shift.

As we age (and as many of us know first hand) our bodies change. Our eyesight and colour perception change beginning in our forties and fifties, muscle strength and hearing acuity decline, and co-morbidities such as high blood pressure and diabetes increase. Obesity is also associated with age. Reaction time slows and recovery times increase.The need for medications often increases and with these often come side effects such as drowsiness.

But it's not all bad news. We certainly gain experience as we age. That experience and knowledge allow us to avoid many of the risks in workplace environments.

How should the workplace change? I'm not suggesting radical steps. Improved task lighting, for example, will allow aging eyes to work more comfortably. Removing clutter from control panel designs to shop bench workstations will prevent errors that may cause injury. Improving ergonomics by limiting weights, supplying lifts (and the training and support so they are actually used), increasing the font size on signs, reducing tripping hazards through high contrast step edges, adding handrails — all of these changes are low cost adaptations that can improve workplaces for all workers not just aging boomers.

I believe we'll see more and more older workers in the workplace. I recently downloaded data from Statistics Canada’s Labour Force Survey that demonstrates a fundamental shift in workplace demographics that I believe will continue for years to come. The following chart shows the number of workers in the B.C. labour force who are younger (under 25) and older (aged 55 and older). The largest core of workers is aged 25 to 55 and is not shown on the chart but as you can see, older workers now outnumber younger workers in the BC employed labour force.
I’m not the only one who is predicting that we'll see more older workers in the labour force in the future. We don’t have enough young people to replace those that are retiring so many older workers will be enticed to work longer. Some will have to work longer for financial reasons but most will want to work to some degree because research has shown, work is good for you. Even if older workers want more flexibility so they can travel and enjoy family, many will also want an opportunity on a part-time basis to be engaged in the labour force, and use the skills and knowledge they've developed over a lifetime.

I gave about a half dozen interviews on this topic and one interviewer turned the question around and asked what older workers can do about their workplace health and safety. The traditional advice still stands: eat right, get plenty of exercise, get regular check ups, etc. Be aware of changes in your body, the effects of aging, age-related health conditions, and the effects of medications you may have to take. When you think about it, that advice applies to everyone.

Monday, January 23, 2012

Why should we care about a privatization proposal for another workers’ compensation fund?

The idea of privatizing workers’ compensation state funds comes and goes regularly. West Virginia’s state fund (BrickStreet), and Nevada’s state fund (Employers Insurance Company of Nevada, Inc. or simply Employers), are recent examples of this trend. In Colorado, Pinnacol, the state workers’ compensation fund is the latest subject of a privatization proposal.

Pinnacol is a competitive state fund. Most state funds are “competitive” but North Dakota, Ohio, Washington, and Wyoming operate as “exclusive” (monopolistic) state funds. All Canadian workers’ compensation systems are similar to this latter group. Pinnacol has 55,000 employer/policy holders, covers about a million workers (57 percent of the market), and is the “insurer of last resort” in Colorado. Pinnacol is the fourth largest of the 25 state funds in the U.S.

At present, Pinnacol is a state entity. The proposal is for Pinnacol to separate from the state and become a “mutual insurance holding company”. The proposal was submitted to the governor in November with the support of Pinnacol’s board of directors and CEO. Under the plan, Pinnacol would be owned by its policyholders (the employers who pay the premiums) although it could be demutualized and become a shareholder-owned and traded corporation at some point in the future.

The advantages for Pinnacol include autonomy from government, the potential to expand market beyond the borders of Colorado, and (suggested) improved value to policyholders. For government, the positives include the creation of a taxpaying entity, a 40 percent stake in the new company, and dividends the state could use as much needed revenue. Denver Post blogger Tim Hoover has gone so far as to say that failing to privatize Pinnacol would be a costly mistake.
Reaction to the proposal is not all positive. A report in the Denver Business Journal suggests many businesses are reluctant to back the plan. According to the Northern Colorado Business Report, one obvious concern is over rates. Privatizing would change Pinnacol’s tax-free status and this alone could put upward pressure on rates.

I strongly believe every state has the right to determine what’s best for its own jurisdiction. There are many examples of well-performing private insurers, competitive state funds, Canadian workers’ compensation boards, and exclusive state funds that deliver excellent value to both workers and employers. That said I have seen no compelling study that shows private provision of workers’ compensation insurance delivers lower employer cost or better results for workers, than existing Canadian workers’ compensation boards or U.S. exclusive state funds, particularly over the long run. The one good study on the topic found a slight advantage in terms of employer cost when provided by exclusive funds (but because of data limitations, the study’s authors concluded there was no clear difference between exclusive and private provision).

Privatization is a one-way solution. While I can recall Hawaii (1996) and Maine (1993) creating new workers’ compensation state funds (HEMIC and MEMIC) in private workers’ compensation markets, I can’t recall any private insurers being bought out or taken over by a state (on an ongoing basis). The drivers in one jurisdiction may signal “coming attractions” for another.

Privatization is often proposed as a quick fix for what are usually more fundamental issues. Access to insurance, competitive rates (often related to funded status and sustainability), cost control, and improved service top the list of drivers behind many proposals to change models. Every workers’ compensation insurer — private, public, competitive or other model — needs to keep an eye on its performance on these important dimensions.

Tuesday, January 10, 2012

What is the true incidence of work-related disease?

The following story from New Zealand (NZ) caught my eye:

New figures reveal work kills 1000 a year
(by Tom Hunt, Fairfax News, 19/12/2011)

Work is killing 1000 of us a year.
New figures, which also show there are 17,000 new case [sic] of work-related disease in New Zealand each year.

Think about that for a minute. New Zealand is a country with a population of 4.3 million — almost identical to the population of British Columbia — yet work-attributed fatalities and diseases in NZ far exceed those we accept at WorkSafeBC. What accounts for the difference?

When I tracked down the source report for the headline, the reasons became clear. NZ is taking a holistic approach to the issue of occupational illness: on a population basis, the incidence of occupational disease that can be attributed to work will always be greater than incident rates calculated from individual cases where causation must be adjudicated.

On a population basis, NZ finds:
about 700–1,000 deaths occur every year in New Zealand from occupational disease, particularly cancer, respiratory disease and ischaemic heart disease (such as coronary artery disease) 2–4 percent of deaths of all people over the age of 20 are due to occupational disease, and 3–6 percent of all cancer deaths in people aged 30 or older are due to occupational cancer
there are about 17,000–20,000 new cases of work-related disease every year.

What the population-incidence approach illustrates is that workers and society are paying a huge price for work-related illness and disease. If B.C. has a similar population-incidence ratio then the true cost of work-related disease is far greater than the 2,750 occupational disease claims first accepted and paid in 2010.

Leaving aside the under-recognition and under-reporting of many occupational diseases, this high incidence alone requires action. The NZ Action Plan proposes a focus on five specific hazards:
• occupational carcinogens;
• respiratory hazards;
• noise;
• skin irritants; and
• psycho-social hazards.

Exactly what actions will be taken to address each of these hazards will depend to some extent on the sector. To assess whether any of the actions has been effective will require data on exposure to health hazards in the working population. NZ is actively developing a surveillance system through the Centre for Public Health Research at Massey University.

Recognizing the true incidence of occupation disease changed the dialogue in NZ. The focus is not on claims costs but human and societal costs. More importantly, there is a refined focus on prevention rather than jurisdiction. It will be interesting to see how their strategy and surveillance systems develop. There may be important lessons for other jurisdictions.