Win-win: Hospital proves success of EH programs
November 1, 2002
Win-win: Hospital proves success of EH programs
Vanderbilt program receives top ACOEM award
All your efforts to immunize workers, provide protective devices, and reduce hazards produce a healthier, more productive work force. But can you prove it?
Vanderbilt University Occupational Health Clinic in Nashville, TN, took on that challenge and ended up with better employee compliance rates and an occupational health award.
TB skin test compliance rose from about 70% to 83%. Compliance with medical surveillance rose from 84% to 96%. New sharps disposal boxes led to a reduction in injury of about 40%. This spring, Vanderbilt University, including the medical center occupational health, became the first academic institution or medical center to receive the Corp-orate Health Achievement Award from the American College of Occupational and Environmental Medicine in Chicago.
"[The award] validates to the staff that what we are doing is recognized," says Mary Yarbrough, MD, MPH, director of health and wellness for Vanderbilt. "We’re on the right path here."
Vanderbilt’s improvement project began with a basic goal. Yarbrough wanted to show the value of occupational safety and health to the faculty and staff as well as to the administration. Simply saying, "We have to do this because of [Occupational Safety and Health Administration] regulations" wasn’t enough to inspire support.
"After hitting them with that so many times, you see their eyes start to glass over," she says. "This really came about as a need to be able to state what it was we needed and why we needed it — to make that argument for resources."
Yarbrough decided to set goals by a process that would blend the best of CQI (continuous quality improvement) and the scientific method.
"Everybody had to state a null hypothesis, [but] nobody wants to think their program doesn’t work," she says. For example, the null hypothesis states that conducting reminder calls to make sure people returned to have their TB skin tests read would not improve compliance.
"Everybody was challenged to think about how they would prove to someone that what they did was successful," Yarbrough says.
Fortunately, they disproved the null hypothesis and showed that efforts to improve occupational health can make a difference.
Often, making progress requires sustained attention to details. To raise TB skin test compliance, clerical staff made reminder phone calls to people who hadn’t had their results read within 48 hours. The effort had to be ongoing. If they stopped making the calls, the compliance rate dropped. "Our clerical staff have a list of people who haven’t shown up, and they call them every day," Yarbrough says.
A similar strategy worked with other types of compliance, such as annual hearing tests for hearing conservation. The occupational health staff sent e-mails to supervisors, reminding them why it was important for employees in the department to receive the tests. "I think sometimes we have so many programs out there, it gets confusing why we have to do this," Yarbrough says. "It’s because we’ve tested the noise in their area and it is above the threshold."
The occupational health clinic also sent out e-mails telling supervisors about their compliance rates with medical surveillance, such as hearing tests, and how they compared with other departments. With that extra motivation, compliance rose from 83% to 94%.
An improvement team evaluated needlestick injuries associated with sharps disposal and found some common problems. Many of the injuries were occurring at the time of disposal or after disposal. The hospital purchases disposal boxes with a "letter box" design that shields the contents, and moved some boxes to more convenient locations.
"The letter box is more expensive, but if we ever had the cost of a conversion [to HIV], it would blow the budget," Yarbrough notes. "And it’s the right thing to do. Our administration here is incredibly supportive of the right thing to do."
Injuries related to sharps disposal dropped from 2.8 per month to 1.6 per month.
For Vanderbilt, improvement went beyond injury reduction and cost savings. Several physicians had suffered personal emotional crises, and Yarbrough and others realized that the existing employee assistance program wasn’t designed to meet their needs.
The university created a Physician Wellness Program that offered the services of a psychiatrist for physicians who needed another professional to consult.
The number of physicians seeking help rose from about six or seven a year to 64. They came for help resolving marital problems and other conflicts, before the problems became severe. "We do a lot of problem resolution, and we give them the support they need to set their own boundaries and make decisions for themselves," she says.
Meanwhile, ergonomic workstation assessments targeted worker satisfaction. After a year, about 40% of employees said the assessments "greatly improved" their work environment. After two years, the program was able to justify a full-time ergonomist.
A reduction in injuries goes hand in hand with job satisfaction, Yarbrough says. "When people are happier with their work environment, they have fewer ergonomic events," she says.
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