Nursed back to health

Risk & Insurance, Nov, 2004 by Paula L. Green

With persistence, discipline and the use of statistics, Florida State Hospital has slashed its monthly workers' comp claims to 20 down from the 70 claims each month. The dramatic improvements in worker safety and other areas has helped the hospital collect more than 40 awards over the past 13 years. It also earned the hospital the top award in the public sector category of the 2004 Best Workers' Compensation contest.

It may be more than a century old and tucked away in a sleepy rural town in northwestern Florida near the Georgia border, but Florida State Hospital has a cutting edge workers' compensation program in place that has reduced monthly claims by 285 percent over the past 26 years.

The administration at this state facility that treats about 1,800 mentally ill patients conducted a laser-focused analysis of statistics to cut the average number of monthly workers' comp claims down to 20. That number is for the fiscal year that ended in June of this year and is a significant drop from the 70 claims that were usually filed by employees each month for the 1978-1979 fiscal year as well as throughout the ensuing decade. It was a time when reams of paperwork were being processed by supervisors and their assistants, but claims were not being managed, says Richard Wilhelms, who has been risk manager at the 2,700-employee facility since 1989.

The most dramatic drop in claims was registered after an intensive six-month training period was held for 45 senior and middle managers in the summer of 1997. Consultants from an outside management team hired by the state came in to show managers at the 127-year-old institution a quality improvement and control method they could use to reduce the number of claims.

"I was very negative about this and thought, 'Well, if you're a manager and have a degree, why do you need to be trained to manage?'" says the 61-year-old Ohio native. "I was wrong."

The consulting sessions and intensive training proved to be a turning point for the Chattahoochee, Fla., facility as the analysis and training helped the managers develop the specific measures they needed to cut back on workers' comp claims.

"We changed the mindset. The process took months to complete. But we didn't take away from people's creativity," says Wilhelms, who joined the facility in 1982 after two decades with the U.S. military, including a tour in Vietnam in 1963 and work as a military attache at U.S. embassies around the world.

"But we got all the managers to understand the same process and to use that same process to communicate with each other."

That strong learning curve helped produce a 51.9 percent decline in monthly claims over a three-year period that began with the 1997-1998 fiscal year and ended in June of 2001. Claims at the college campus-like facility--which sprawls over 620 acres and includes 223 buildings--dropped to 26.5 claims each month. Like many state governments, Florida's fiscal year begins in July and ends the following June.

In addition to helping shift workers' mindsets, the quality improvement and control method was a data-driven process that used charts, diagrams and matrixes to analyze the factors behind the incoming workers' comp claims. If 30 of 100 claims were related to physical falls, for example, managers would study the date, time, location and other details of each incident to pick up patterns.

"We would let the data drive the decision but then the manager would get involved to make the decision and decide what we need to do to curtail the accidents. We looked at issues like whether it's more equipment or the training of employees," says Wilhelms. "This lets them (managers) manage workers' comp injuries in a significant way."

In the last two years, the hospital administration has increasingly zeroed in on employees' own responsibility for their accidents.

"We're developing an attitude of accountability on the part of everyone, the staff and the managers," says Wilhelms, adding that the administration analyzed the breakdown of workers' comp claims that resulted front hazardous conditions, assaults, human error and other causes. The analysis showed a high portion of injuries, at times more than 40 percent, stemmed from human error. That knowledge prompted the administration to look at the employee discipline process--and strengthen it.

For example, if a food service worker is trained not to pick up boxes more than 20 pounds and then is injured picking up a 40-pound box, he can face disciplinary action if a medical claim is filed, Wilhelms says.

"What has been unique for the last two years has been an increased attitude of accountability among everyone," says Wilhelms. "It's a change in attitude and mind-set."

The more stringent focus has helped cut workers' comp claims another 24.5 percent in the last two-year period that ended in June of this year.

Wilhelms says it is not easy to pinpoint the financial savings that the state Department of Insurance, which pays out the hospital's workers' comp costs, has gained by the reduction in claims at the hospital. But using an average cost per claim of $3,470 and the fact that 551 claims were filed between 1991-2004 (rather than the 10,920 claims that could have been filed using the average of 70 claims filed per month between 1978 and 1989) the department potentially saved about $35 million over the 13-year period.