Do you save your hospital money? Then prove it!
Use time study, cost analysis to show EH value
With low staffing and growing regulatory demands, coping from day to day is a struggle for many in employee health. But do your hospital administrators have a clue about your valiant efforts?
Demonstrating your value is essential, especially if you hope to gain more resources and support, says Annette B. Haag, MA, RN, COHN-S/CM, FAAOHN, an occupational health and safety consultant based in Simi Valley, CA.
"We have to start to look at our role from a completely different perspective; otherwise, we aren’t going to survive," says Haag, who spoke at a recent conference of the Association of Occupa-tional Health Professionals in Health Care in Pittsburgh. "[Administrators] have no idea what we juggle [or about] the regulations — the knowledge we have to have."
That may be one reason why employee health departments find themselves short-handed. In a recent Hospital Employee Health salary survey, 44% of respondents said they had no change in staffing in the past year, and 13.5% reported a reduction in staff. (See HEH, November 2001, Salary Survey Results supplement.)
"If we do not do our homework, we are going to be outsourced, and then we won’t be there for our employees," she says.
"Demonstrating value is not a new problem. It’s been an ongoing problem for occupational nurses to show how we’re doing risk management activities that really do save the dollar in the short term and the long term," agrees Barbara Burgel, RN, MS, COHN-S, FAAN, clinical professor and adult nurse practitioner in the occupational and environmental health nursing graduate program at the University of California-San Francisco School of Nursing.
One common problem is that employee health often is viewed as a resource drain rather than a revenue producer. Employee health professionals need to change that perspective, says Haag. "We may not bring in revenue, but we have to use the term cost avoidance.’ What costs are we avoiding [the hospital from incurring]?"
Here are some basic steps to take to demonstrate your value:
• Develop a business plan for your department. "It is critically important for you to run your occupational health service as a business," Haag says.
That is a new concept for most employee health professionals, she acknowledges. "They don’t really look at their unit as a business unit, but ideally it is. It contains all the components.
"Most business plans are written to show to investors in order to get loans," she explains. "The company’s going to be investing revenue in them. That’s why they need to justify the benefit of the unit and how additional resources will add even more cost savings for the company."
A business plan details how you operate day to day, including a marketing plan and budget. For employee health professionals, a marketing plan would address the main customers of the department and the services provided to them.
"How do our management and employees know what we do and how we do it?" Haag asks. "You have to have a good marketing plan."
For example, employee health nurses may take carts to the employees to provide certain services, such as flu shots. One nurse sent out a birthday card to each employee and offered a blood-pressure check. The simple gesture raised the profile of employee health and helped make employees aware of the department’s role in promoting wellness, Haag says.
Courses in creating a business plan may be available from a local college or business association. The American Association of Occupational Health Nurses in Atlanta also offers a product called "Success Tools," which includes basic business information for employee health nurses.
• Conduct a time study. You spend your days doing an innumerable number of tasks, from conducting pre-placement screenings to meeting with the safety committee for disaster planning. But while your workload may seem obvious to you, hospital administrators may have little knowledge about the demands on employee health services.
By conducting a simple time study, you may be able to demonstrate your need for additional staff. You also can set a dollar value to the tasks you accomplish, says Haag. (See sample time study, inserted in this issue.)
A time study also may help you reorganize tasks to accomplish them for efficiency. For example, some tasks, such as respirator fit-testing, may be delegated to a technician.
"So many of the nurses get so involved in the everyday tasks, they don’t realize they’re spending time in [certain] areas," says Haag. "I would think it would be more important for a nurse to case manage a case than fit test a respirator."
The University of California-San Francisco still uses a benchmark of one full-time equivalent occupational health nurse for every 1,000 employees in the service sector, Burgel says. But those employee health professionals also need other backup, such as clerical help and non-nursing staff. Employee health also should have access to expertise in other departments, such as physical therapists who can assist with the ergonomics program, she says.
"I would attempt to quantify the resource requirements for every single programmatic component, at least for the big manpower areas, [such as] TB screening, post-exposure prophylaxis, safe needle devices, and back injury prevention."
Delegating non-nursing tasks
If employee health professionals are able to free themselves from tasks that can be handled by non-nursing staff, they could focus on nonoccupational injury and illness as well as work-related events, Haag advises. "That’s the whole push of integrated disability cases management. You’re tracking absences and injuries and illnesses in both areas," she says. "If you’re doing aggressive return to work for occupational cases, you should do the same for nonoccupational." (For more information on integrated disability management, see HEH, April 2001, p. 45.)
• Focus on the top three injuries and illnesses. "We can’t be all things to all people," Haag says. "We have to look at priorities." You can make the greatest impact by addressing the high-risk and high-cost areas. Your department’s goals should include a reduction in those areas, she says.
That may include a nonoccupational illness that is high-cost and can affect absenteeism or workplace productivity, such as high-risk pregnancies or sleeping disorders. For example, helping employees manage their diabetes will reduce absenteeism and medical costs while it improves the employees’ quality of life.
"We are basically the solution to not only better health care for employees, but to bring down the cost of health care in general," Haag says.
Employee health professionals should provide the hospital CEO with monthly reports that detail the encounters with employees, Burgel says.
"I would include a trend analysis," she says. "For the month of November 2001 compared to November 2000, this is an X% increase.’ I would identify the employee risk-reduction training the nurses participate in and the goals of return to work."
Workers’ compensation data can be particularly useful, Burgel points out. A workers’ compensation claims adjuster can provide data on how much was spent for medical costs and temporary disability for each claim, she says.
• Measure the cost savings of reductions in injuries. "Take a couple of your injuries and illnesses and cost them out," Haag advises.
For example, how many lost days occur due to a back injury related to patient handling? The cost of that injury includes fees for agency staff or overtime for other nurses, plus medical claims.
Your ergonomics program may be reducing those injuries, or your return-to-work program may enable employees to ease back into their jobs more quickly. "See what the savings are from having you there," Haag says, and make sure your administrators know about them. That analysis should occur on a continuous basis. "That’s the only way you’re going to be able to determine if your outcomes are still producing results."
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