The taming of the health-care giant: crafting a cohesive workers' comp program to cover 300 operating units and nearly 200,000 employees has been a daunting task, to say the least. Nashville, Tenn.-based Hospital Corp. of America has done just that by staying focused

Rainbow letters sprawl across the cover of a 2006 calendar produced by Hospital Corporation of America (HCA Inc.), above and around a family of four stick figures, standing in front of a house with two blue windows, a purple roof and a green door. "Safety at work," the calendar reads, "brings Mama and Daddy home."

The "Safety at Work" 2006 calendar--cobbled together from a collection of winners and finalists in a children's poster contest run by HCA--is part of the company's far-reaching and intricate safety and workers' compensation program.

It's a program that has achieved a 32 percent reduction in lost-time claims over the past five years, while the average cost of lost-time claims has increased just 6 percent over the same period.

Tim Portale, HCA's assistant vice president of environmental and employee safety, says that the company's emphasis on safety and its meticulous collection of claims data are keys to its successful workers' comp and loss prevention plan.

"I think the No. 1 thing is focus. You definitely cannot address every problem that you're experiencing," Portale says. "So you have to have very reliable data to trend it, to identify outliers, and to allocate your resources to control those outliers."

CENTRAL FIGURE AT EACH SITE

With almost 200 hospitals and 91 outpatient centers in 23 states, HCA Inc. is the nation's leading provider of health-care services. The company and its affiliates employ approximately 190,000 people--including nurses and other clinical staff, dietary staff, housekeeping and janitors, and warehousing and distribution workers, as well.

Maintaining almost 300 operating units and managing almost 200,000 employees, therefore, makes traditional loss prevention and safety--and the opportunity for Portale and his peers to visit each site--virtually impossible.

So while HCA's Environmental and Employee Safety Department works at the corporate level to design a responsive loss prevention and safety agenda, the people actually implementing that plan at HCA hospitals and centers are the appointed injury coordinators at each site.

Portale says each hospital has complete control in identifying the injury coordinator, who then attends a two-day orientation class at HCA's corporate headquarters in Nashville, where they are immersed in the specifies of the HCA program.

Then, workers' comp supervisors visit the injury coordinators at their respective locations, making sure each hospital has the necessary materials, equipment and products to efficiently implement the program. HCA's Workers' Comp Advisory. Committee, comprised of six of the company's most experienced injury coordinators, oversees the work of a new injury. coordinator and makes suggestions for how to educate new employees and how to roll out the broad aspects of the company's plan in specific ways at each facility.

Portale also says that HCA maintains an intranet database for Injury Coordinators and safety officials, which outlines the company's policies and procedures and provides a forum for horizontal and vertical communication--between hospitals and also with the Environmental and Safety Department.

Because implementing the company's program would be impractical from the corporate level, the injury coordinator has become the central figure in HCA's safety efforts.

"We ask them to keep ergonomics and other prevention programs at the forefront," Portale says, "by providing education to everyone at the hospital and, in particular, senior leadership, so that they can have some accountability and buy into the program."

And HCA's senior management, Portale says, has noticed.

"We have saved them a lot of money," he says bluntly.

PATIENT MANAGEMENT

HCA's most significant safety risks, Portale says, are those arising from patient management.

Managing patients--lifting, transferring and moving them between beds, stretchers and wheelchairs--engages employees in often stressful and delicate physical work, Portale says. And it places employees at risk for a host of problems--strains, sprains and other muscular injuries that could keep them from doing their jobs for extended periods of time.

There are also risks associated with needles and other surgical equipment--all things that nurses and doctors have to be ready to use at any point throughout any given day and hundreds of times throughout any given a week.

To control these volatile patient-management risks, Portale says, HCA has invested extensively--and continues to invest--in equipment designed to do much of the heavy. lifting, so nurses and others don't have to worry about physically managing and moving patients.

The company has also rolled out a Safety in Patient Lifting program aimed at creating the safest possible circumstances for employees managing and moving patients. Hospitals initializing the program averaged a 46 percent reduction in the frequency of patient lifting and transfer claims and a 64 percent reduction in lost-time claims.

"We can take a hospital into what we call a controlled-lifting environment," Portale says. "So any planned lift equipment is available to manage the patients."

Despite the company's success in reducing claims and losses associated with patient management, aspects of HCA's loss prevention initiative--such as the Safety in Patient Lifting program--hint at a dilemma inherent in safety programs implemented by hospitals and managed care providers, Portale says.

Two forces collide in hospital rooms, cafeterias and workplaces, as companies like HCA struggle to balance employee safety with the natural focus of the health-care industry: keeping patients healthy.

It is difficult at times, therefore, to convince hospital teams and senior management to allocate money away from patient care needs and towards safety awareness, education and development programs.

"A nurse is taught all his or her life that the patient is number one, the patient comes first," Portale says. "What we try to do is encourage nurses to be as safe as possible when managing that patient."

HELP WHERE IT'S NEEDED

Another important element of HCA's safety and loss prevention program, Portale says, is the Focus Program, which aims to identify hospitals whose employee injury costs are not in line with average costs for other HCA sites in that state.

Portale says the program's goal is the identification of hospital outliers--HCA sites whose costs stand out among peer sites and whose workers' comp program needs more specific study and attention.

Once a hospital agrees to participate in the Focus Program, HCA conducts an onsite evaluation and develops a two-year action plan for the reduction of that hospital's employee injury costs. The company follows through by providing ongoing assistance and performance reviews as the hospital works through the program.

And while other parts of the HCA program financial incentives for individual hospitals to keep their claims and losses down, for instance--have had positive effects on individual site performance, Portale says that the Focus program has been most successful in lowering corporate spending on employee injury costs.

A major factor in this, Portale says, is HCA's extensive claims management data.

"It's huge," Portale says of HCA's claims management database. "We have very specific health-care-related workers' comp injury data."

The database, Portale adds, is the basis of HCA's extensive program--a program that, by necessity, must flow evenly from the corporate level to the injury coordinator to every HCA nurse, administrator, cook and janitor.

"We have been very successful in demonstrating with our data that we can reduce costs and reduce injuries," Portale says. "I think it says everything."

RELATED ARTICLE: Judging Teddys a real bear.

"This is very, very difficult," fretted Risk & Insurance[R] workers' comp columnist Peter Rousmaniere, running his hand through his hair. "Very, very difficult." That was a common refrain this year from the judges of the 2005 Theodore Roosevelt Workers' Compensation and Disability Management Awards. The caliber of the entries received was so high that trying to pick just one winner in each category was a relatively grueling task.

Rousmaniere accepted the call to serve as a judge for this year's competition, alongside Dr. Tom Leamon, director of the Liberty Mutual Research Institute for Safety; nationally recognized workers' comp and disability management consultants Milt Wright and Richard Pimentel of Milt Wright & Associates; Yolanda Romero, director of workers' comp for the Southeastern Pennsylvania Transportation Authority and winner of the workers' comp and disability awards for the public sector in 2003; Nancy Grover, managing editor and program chair for the National Workers' Compensation and Disability Conference & Expo; Jack Roberts, editor-in-chief of Risk & Insurance[R]; and Michelle Kerr, associate editor and workers' comp reporter for Risk & Insurance[R]. The judges were asked to evaluate entries based on four primary criteria: performance, transferability, teamwork and vision. Performance was perhaps the most heavily weighted factor. The judges were looking to see if a significant challenge had been addressed, and whether applicants had been able to meet (and master) that challenge, as well as back it up with documentation. Judges considered the environment in which the organizations operated, the degree of difficulty they faced in meeting their challenges, the degree of the success achieved, and the credibility of the documentation provided.

Transferability was another key criterion. This refers to the frequency with which the same challenges are faced by other employers as well as the ease with which other employers could draw upon the applicants' experiences. Judges were asked: Can the tools and know-how acquired and applied by the entity be feasibly transferred to other employers? That was a particular point of concern with this year's winners, both hospital systems with challenges unique to the health-care industry. But in the end, the metrics of each of the winners' programs could be applied to nearly any industry.

Teamwork is another criteria the judges looked at closely. Real results aren't generated by an isolated executive handing down treatises on how everyone else should be doing their jobs. Real, lasting results can only be achieved when everyone is working toward the same goal--that means everyone from the company president to the department heads to the rank-and-file employees to third party administrators and all other outside vendors. The judges looked closely at how team members were brought on board and developed.

Last, but not least, is vision, an esoteric-sounding criteria that encompasses clarity and ambition of thought. The best workers' comp programs are based upon the understanding that one good practice or policy does not a success make. What's required is a fundamental shift in the way the company does business--a shift that makes workers' comp a factor in everything the company does. Without question, our two winners possess just such a vision; the results are obvious.

In Their Own Words

Although the judging was difficult, it was also energizing and exciting to see the great strides many companies have made. The judges had a lot to say about what drew them to their respective choices.

Said Roberts once all the votes had been tallied, "It's not altogether surprising that the judges decided to honor two health care organizations with the Roosevelt award. Hospitals face unusual challenges, ranging from such seemingly mundane issues as heavy lifting, to far more difficult challenges like controlling in-hospital infections. I think what came across with (private sector Teddy winner) HCA, in addition to the breadth of its effort and the superb results, is that their cost-allocation model was especially compelling along with an ongoing record of commitment to long-term efforts to constantly improve their program, even if the results varied from year to year."

Wright, writing on why he and Pimentel both chose Catholic Healthcare West in the public sector category, said, "This is a rare combination of depth of understanding of the cost drivers associated with workers' comp and the identification of the disability management methods of controlling them. While some programs are tilted towards safety and prevention and others to disability management and return to work, this program is well balanced."

--Michelle Kerr

JOHN MCDONALD is a writer living in Pennsylvania. He can be reached at [email protected].

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