On-site health care brings healthy bottom-line

Companies that are willing to commit resources to developing a healthy workforce will realize a tidy return on investment.
By Francis Puchalski
|Canadian HR Reporter|Last Updated: 03/30/2001

It is a simple rule: What is good for the employee is good for the employer.

At the same time businesses in several sectors have been suffering from escalating costs for health care, on-site injury and illness prevention, once thought to be impossible to achieve or at least too expensive to attempt, is starting to be confirmed as the most cost-effective route to a healthier, more productive and efficient workforce.

Yes it will cost the company money to get the ball rolling — anywhere from $10,000 a year to $35,000 a year for part-time service, equipment and so on — but the payback begins immediately and research reveals potential returns of three to 10 dollars for every dollar invested.

Wellness, fitness, front-line ergonomics, functional rehabilitation and other on-site services are the low-cost, low-tech but high-impact processes of the future. Reversing the unsettling trend of rising health-care costs requires a unique approach to workplace wellness and rehabilitation previously not well understood and seldom utilized.

First, the entire wellness and prevention effort needs to be understood and undertaken as a process — not a program — with a long-term commitment and a total person focus.

Many workplaces have seen the cost savings of claims management and a few have even put in operation a meaningful return-to-work program. But back programs, blood pressure clinics and return-to-work programs have limited impact by themselves. Extremely few have used these programs as part of a larger prevention strategy.

Those who have implemented one of these on-site processes are leading the way to truly participative injury or illness prevention and management.

Maximizing ROI requires a complete reversal of focus of the typical claims management program. The best return on investment is achieved when a long-term focus is the orientation rather than the short-term dollar. And the starting point of this prevention process is to involve a health professional who specializes in preventive medicine, and make arrangements to allow employees to have regular access to him. Ideally this would mean an office and a small exercise facility, but at minimum it means contact with employees on the floor of the workplace on a regular basis.

The on-site person should be given the freedom to implement the processes, and be involved with all types of programs and services designed to reduce short-term and long-term disability and improve fitness and safety.

The prevention process must take a holistic approach to the health of the employee by focusing on both primary and secondary prevention. Primary prevention through claims management and early intervention are effective short-term money savers, but typically don’t help the employee, only the employer.

Secondary prevention is achieved when the whole employee is the focus and the health problem can be managed for the remainder of her working life.

When an employee asks for help with a back problem the objective should be to heal her back as completely as possible so that the problem doesn’t return again. Only with this long-range approach will recurrent labour, safety and employee health issues be resolved.

Independent operator

The on-site person facilitating this process must have only one bias, the worker. He needs to have the freedom to move between all levels of the organization. As something of an independent operator this person must be able to go between supervisors, management, benefits people and the worker without being restricted by organizational charts and reporting structures

If employees point out a problem in a department that needs attention the on-site professional should not have to report to the safety supervisor who may or may not act on the issue, but should be able to go directly to the departmental supervisor with the recommendations.

Similiarly one must be able to discuss the returning employee’s medical condition with the nurse or doctor and facilitate workplace changes to accommodate the employee’s needs.

He must be able to work equally with hearts, backs and other musculoskeletal and medical issues. One time it’s a non-occupational heart problem, and next time an occupational work related musculoskeletal disorder. One costs the employer more than the other, both cost the employee too much and neither is acceptable.

Goals for on-site care

So what are the goals of this health specialist who will be on-site on a regular or full-time basis?

•To eliminate or minimize the need for themselves. Prevention means fewer musculoskeletal disorders and injuries and less non-occupational illness.

•To cultivate self-reliance. A little personalized ergonomics mixed with some low-tech functional work conditioning and return to work programs eventually become self-sustaining. You’ll know that you are on the right track when the workers on the floor start asking for a little help with their own ideas for improvement.

•Give employees and workplaces the tools to redesign their workplace. They will need education, and the opportunity to make personal and workplace changes, support for any problems they have and commitment to follow through to a resolution.

•When necessary employees rehabilitate themselves. The final “we’ve-made-it” sign is when the least likely employees take care of their own rehabilitation with a minimum amount of coaching or help in the way of guidance. Some will start using the tools for self-rehabilitation immediately while others will take longer. Most employees will come on board within two to five years. Unfortunately, there will be some employees that never will.

•Employees, their spouses and their employers develop their own approach and systems for health and injury prevention.

With such a person-centered process, and the development of trust over time, employees eventually will buy into the process and participate more readily. Whether it be to walk a block a day at home, or to get more involved in the company safety program, this process has an effect first at the individual level then at an organizational level.

As employees participate with positive results in fitness, rehabilitation, ergonomic or safety programs they become convinced that their overall wellbeing is indeed the goal and not just “saving a buck.” All levels within the organization from labour to management to safety and wellness committees must come to understand that what is good for the worker is good for the company.

Generating buy-in

The trust issue is one of the primary reasons that this on-site service needs to be functional rather than diagnostic in nature.

Whether the on-site professional is a kinesiologist, ergonomist or exercise therapist it is important that they are not involved in disputing a claim, but are only there to help resolve it and prevent future occurrences. This way trust destroying conflict is avoided.

By giving employees as much control as they can handle, most of these claims and conflicts are avoided. This entire prevention effort is doomed to failure the minute trust is taken out of the equation.

Simply stated, to maximize a company’s ROI a functionally trained professional is required in the workplace to develop trust and obtain buy-in from all of the workplace parties. This is achieved over months and years by dealing with all issues and people equally and fairly. Upon injury or illness of course you provide effective claims management, but even this opportunity should be used to facilitate the prevention process to target future prevention.


With a return on investment of as much as 10 to one, what are the obstacles to this proven process?

•Many workplaces are downsized or downsizing, with an aging workforce, and there is a lack of movement between jobs which makes WMSD’s (work related musculoskeletal disorders) and co-morbid (more than one problem involved) conditions more likely.

•Management who have priorities other than people first and can’t see the forest for the trees. Those who are willing to win a workers’ compensation board case or claim for short-term gain will save a buck at the cost of trust and future co-operation. If the employee feels ill-treated this time there will come another time when co-operation will not be forthcoming. This will effect production as well as benefit costs.

Other obstacles include health-care people trained to treat not prevent problems. But the key to this whole process is giving people information, opportunity and thereby control of their wellbeing.

For many health-care providers this goes against their training of patient dependence. Often enamoured with the latest diagnostic tools, the multi-player treatment program and the “we will take care of you” school of helping.

Helping others learn to help themselves is a novel but learnable method of operation.

Lastly is management’s poor understanding of rehabilitation and wellness. Most people want more control of their personal and workplace health and when given the opportunity they will make quality informed choices that will benefit the company as well as themselves. Unfortunately, in many workplaces having choices is not an option because management doesn’t understand the benefits this entails and doesn’t want to empower employees.

This on-site functionally oriented injury and illness prevention and rehabilitation model is not for the faint hearted. You have to be ready to be on the floor in all the hot spots and take the challenges head on which usually include some personal emotional investment. This “in your face” model of on-site employee help and outreach is definitely a challenge, particularly for traditionally managed workplaces but the great savings should certainly turn some heads.

Francis Puchalski is a certified kinesiologist with more than 20 years experience in occupational and lifestyle injury illness prevention and rehabilitation. He can be reached at (807) 473-1100 or by e-mail at peerinc@tbaytel.net.

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