Introduction to Early Intervention

The traditional approach to musculoskeletal health management is to reactively treat injuries as they occur. This treatment model is failing. It fails people who work hard for a living and it fails organizations who collectively spend over $1 billion per week treating musculoskeletal injuries. There is only so much cost control you can manage after an injury has already occurred.

We know that MSDs develop over the course of time as the result of exposure to risk factors. Carpal tunnel doesn’t happen overnight. Tendonitis doesn’t develop in a day. This means the early warning signs of these injuries are present long before an MSD develops to the point of lost function and pain requiring medical treatment.

Armed with this knowledge, we can implement a proactive strategy to discover the early warning signs of MSDs and fix the underlying causes. This is exactly what early intervention does.

Early intervention is a proactive strategy designed to discover early warning signs of MSDs and prevent the early warning signs from developing into an injury.

The early warning signs of the next 2-3 years’ worth of MSDs are present in your workforce today. The question is, what are you going to do about it?

Perhaps you’ve heard that early intervention has proven to be successful for many other companies. Naturally, you have some questions about how it might work for you.

Sound familiar? Here are the most frequently asked questions we get from prospective clients, answered.

Let’s start at the beginning …

What is early intervention?

The early warning signs of future injuries are present in your workforce today. Early intervention is a proactive strategy designed to discover early warning signs of MSDs and prevent the early warning signs from developing into an injury.

This process has five parts:

1. Awareness and Education
2. Encourage Early Reporting
3. React Positively and Respond Quickly
4. Conduct the Early Intervention Consultation
5. Follow Up and Report

(For more, read A Safety Manager’s Guide to Early Intervention.)

What happens during an early intervention consultation?

The goal of the early intervention consultation is to identify the contributing risk factors to the worker’s fatigue and discomfort and remove them.

This consultation has three parts:

1. Listen to the employee and understand the problems they are having.
2. Review the self-care program for the employee and make them aware of the prevention tools available to them.
3. Evaluate the job and remove any causative risk factors present through the ergonomics improvement process and implementing ergonomic controls.

Once the injury prevention specialist has identified risk factors, they remove them by implementing controls. Ergonomic controls reduce ergonomic risk factors. Individual controls such as reviewing good work practices, good health habits and injury prevention tools reduce individual risk factors.

(For more, read Early Intervention – The Critical Difference Between an MSD and a Healthy, Productive Worker.)

On average, how often does an early report result in an injury? In other words, what is the success rate of early intervention consultations?

By identifying risk factors and putting controls in place, most early intervention consultations successfully resolve and the worker is returned to peak health.

For example, so far in 2013 96% of early reports have been resolved without a medical injury through early intervention consultations with an Ergonomics Plus injury prevention specialist.

If employees are encouraged to report fatigue and discomfort, won’t they take advantage of that?

Before getting the early intervention process off the ground, some of our clients and prospects are concerned about allowing early reporting of fatigue and discomfort.

They were worried that employees would take advantage of early reporting and over report fatigue and discomfort. They thought this would create an avalanche of reports that would eventually become injuries.

These would have become more significant and severe injuries down the road if not reported early. Right now is always the best time to seek help for combating discomfort that can lead to an injury. Risk factors can be identified and (workplace and individual) controls can be implemented to prevent the need for the employee to seek medical evaluation and treatment.

Will employees really utilize the self-care program?

A recommended self-care program and injury prevention tools should be available to all employees.

These tools include:

• Preventive warm-up exercises
• Proper lifting techniques
• Proper body mechanics
• Identification of ergonomics improvement opportunities
• Preventive counteractive stretching exercises
• Proper resting/sleeping posture
• Strengthening exercises
• Fatigue recovery and sleep
• Proper nutrition and hydration
• Good health habits
• Personal fitness and wellness

Some people are skeptical that employees will be compliant with their self-care program and utilize these tools. After all, things like good health habits, proper hydration and counteractive stretching aren’t mandatory and accountability is difficult.

Here’s the thing. When employees recognize the early warning signs of an MSD, they become very motivated. An abnormal amount of fatigue and discomfort is not an enjoyable experience. They know if their issue progresses into an injury it will be very painful. Employees understand that they need to take responsibility for their part in the prevention process.

After doing thousands of early intervention consultations, I can confidently state that most employees are compliant and do a great job implementing a self-care program. Of course, every once in a while there is an outlier who isn’t compliant.

But is that going to stop you from helping the ones that are?

Who should perform early intervention consultations?

Early intervention consultations should be conducted by an experienced injury prevention specialist. At Ergonomics Plus, we use Certified Athletic Trainers. They’re specifically trained in injury prevention and human performance, and make the perfect partner for your OHS process.

(For more, read Five Reasons Why an Athletic Trainer Deserves a Spot on Your OHS Team.)

Is an early intervention consultation a recordable injury?

In 2011, OSHA published an interpretation relating to exercise that has caused some confusion and concern among safety and human resource managers.

Specifically, the interpretation request asked if “exercise is considered medical treatment” as defined in OSHA’s recordkeeping regulations. OSHA’s response was, “If a physician or licensed health care professional recommends therapeutic exercise in response to a work-related injury or illness, the case is considered to involve medical treatment and the case is recordable.”

Note that although the question posed to OSHA asked if “exercise is considered medical treatment”, OSHA’s response specifies “therapeutic exercise in response to a work-related injury or illness.” OSHA states in its response that it considers “therapeutic exercise” a form of physical therapy, and that physical therapy is considered medical treatment for recordkeeping purposes.

The early intervention strategy employed by the Injury Prevention Specialists at Ergonomics Plus is about prevention, not treatment.

Preventive consultations are available to each and every employee. The self-help techniques recommended are not therapeutic in nature, and serve as a means to help employees counteract daily fatigue.

Employees are encouraged to seek self-help advice to prevent injury and illness. When an employee requests self-help advice for any concern (related to work activities or not) and does not desire or request a medical evaluation, our injury prevention specialists will consult with the employee to review and encourage a variety of prevention tools and techniques. These techniques are advocated and reviewed in our injury prevention training program and in handouts or publications that are available to all employees.

(For more, read Exercise – Is it a Recordable or Not?)

Why should I consider adding early intervention to our OHS process?

These are just a few of the benefits of adding early intervention to your OHS process:

1. Early intervention identifies and removes MSD risk factors.
2. Early intervention prevents injuries.
3. Early intervention is the right thing to do for your people.
4. Early intervention is a cost-effective prevention strategy for your business.
5. Early intervention can help you build the safety culture you’ve always wanted.

(For more, read Five Reasons Why You Need to Get Started With Early Intervention Today.)

Proactive On-site Healthcare

More and more organizations are realizing the value of moving healthcare upstream and addressing the root causes of MSDs before an injury occurs.

As stated above: “The traditional approach to musculoskeletal health management is to reactively treat injuries as they occur. This treatment model is failing. It fails people who work hard for a living and it fails organizations who collectively spend over $1 billion per week treating musculoskeletal injuries. There is only so much cost control you can manage after an injury has already occurred.”

More and more organizations are realizing the value of moving healthcare upstream and addressing the root causes of MSDs. But if the current state of musculoskeletal health, as outlined above, is any indication — there is still a long way to go.

Successfully managing musculoskeletal health hinges on your organization’s resolve to move to a prevention-focused, upstream model of care.

Moving healthcare upstream

There is a growing movement of organizations moving healthcare into the workplace. Onsite clinics are commonplace with healthcare providers embedded directly into the workplace to care for injured employees as they return to work.

The benefits of delivering care directly into the workplace have been well documented:

• Closer proximity of care saves time
• Closer proximity of care improves compliance
• Closer proximity of care improves outcomes

While there are benefits and advantages to this approach, this form of “health” care is still the reactive model of “sickness” care. Medical treatment is delivered in response to injuries — all that has changed is that it is delivered in closer proximity to where the injury occurred and where the worker is returning to work.

Delivering healthcare onsite is good. It’s a big step in the right direction and we recommend it. But why stop there? We encourage organizations to also move even further upstream to a prevention-focused model of care. This approach amplifies and expands the benefits of onsite healthcare listed above.

Musculoskeletal injuries are preventable with a total worker health approach

The proactive and comprehensive approach we recommend for musculoskeletal health has been validated by an increasing amount of research done over the last two decades. In fact, the Total Worker Health initiative from NIOSH validates a “total” approach to worker safety and well-being.

Here is a quote that sums up the total worker health view:

“Today, emerging evidence recognizes that both work-related factors and health factors beyond the workplace jointly contribute to many health and safety problems that confront today’s workers and their families. Traditionally, workplace health and safety programs have been compartmentalized. Health protection programs have focused squarely on safety, reducing worker exposures to risk factors arising in the work environment itself. And most workplace health promotion programs have focused exclusively on lifestyle factors off-the-job that place workers at risk. A growing body of science supports the effectiveness of combining these efforts through workplace interventions that integrate health protection and health promotion programs.”

By implementing a proactive ergonomics improvement process with a proactive, upstream model of healthcare, you are implementing a total solution that has the greatest chance at providing the most value to your organization and its people.

This model of proactive, preventive healthcare will create far more value for your organization than reactively waiting to treat the injuries that will inevitably occur in the traditional, reactive model.

Early Intervention Process

A proactive early intervention process uncovers early warning signs of fatigue and discomfort in time to control causative risk factors and prevent injuries.

Early signs of fatigue and discomfort should immediately be reported so proactive measures can be taken. Don’t wait until it’s too late!

We know that MSDs develop over the course of time as the result of exposure to risk factors. Carpal tunnel doesn’t happen overnight. Tendonitis doesn’t develop in a day. This means the early warning signs of these injuries are present long before an MSD develops to the point of lost function and pain requiring medical treatment.

Armed with this knowledge, we can implement a proactive strategy to discover the early warning signs of MSDs and fix the underlying causes. This is exactly what early intervention does.

Early intervention is a proactive strategy designed to discover early warning signs of MSDs and prevent the early warning signs from developing into an injury.

The early warning signs of the next 2-3 years’ worth of MSDs are present in your workforce today. The question is, what are you going to do about it?

There are five steps to the early intervention process.

Step 1 – Awareness and Education

Workers need to understand the early warning signs of MSDs so they can recognize them when they appear. It’s important that they understand the fundamental principles of prevention as well as the self-care regimen that is recommended for all employees.

Step 2 – Encourage Early Reporting

Employees should be highly encouraged to report early warning signs of MSDs to supervisors, team leads or directly to the on-site injury prevention specialist. Creating a culture that encourages early reporting is critical to this process.

Step 3 – React Positively and Respond Quickly

Supervisors and team leads should be trained to react positively and respond quickly to early reports of fatigue and discomfort. We often mention being “over the top” positive to these early reports. The injury prevention specialist should be notified immediately and quickly respond to the report.

Over the top and on the hop! Sounds cheesy, but it’s extremely effective in practice.

Step 4 – Conduct the Early Intervention Consultation

When an early report is received, the injury prevention specialist conducts a one-on-one consultation with the employee.

This consultation has three parts:

1. Listen to the employee and understand the problems they are having.
2. Review the self-care program for the employee and make them aware of the prevention tools available to them.
3. Evaluate the job and remove any causative risk factors present through the ergonomics improvement process and implementing the necessary ergonomic controls.

Step 5 – Follow up & Report

The injury prevention specialist should follow up with the employee on a weekly basis until the early signs are resolved and the employee is returned to peak health.

Each of these interactions should be recorded. Results of all early intervention consultations should be compiled and reported on a monthly basis. These reports should be used to identify overall trends and workplace improvement opportunities.
 

 

Preventive Healthcare Expertise

Proactive musculoskeletal health initiatives are most successful when deployed through a specialized provider who bridges the discipline gaps that create organizational silos.

Effectively targeting musculoskeletal health requires taking a proactive, upstream approach while also breaking down organizational silos of information, goals, resources, and expertise.

Our experience has been that proactive musculoskeletal health initiatives are most successful when deployed through a specialized provider who bridges the discipline gaps that create organizational silos. Their role is “injury prevention specialist” and their responsibility is exactly that — to prevent injuries through a total, comprehensive approach that incorporates all the musculoskeletal health disciplines. Whether found internally or externally, the injury prevention specialist is a versatile resource for your organization to be proactive and break down organizational silos.

A specialized musculoskeletal healthcare provider

The injury prevention specialists at Ergonomics Plus are Certified Athletic Trainers. Whether you work with us or hire an internal resource, we recommend an athletic trainer because they are a versatile resource capable of implementing a total musculoskeletal health solution.

The following are the musculoskeletal health domains an athletic trainer can fulfill:

Ergonomics: Certified athletic trainers work in occupational companies to identify ergonomic stressors and then can assist in recommending and implementing both engineering and administrative controls. Along with developing control measures, athletic trainers can also provide specific workplace ergonomic training and education. Similar to analyzing the mechanics of an athlete, such as the throwing motion of a pitcher, the knowledge a certified athletic trainer has in biomechanics are valuable skills used to analyze a workstation for potential ergonomic risk factors.

Job Analysis: The goal of the job analysis is to provide detailed information that can create an environment that enhances human productivity and human well being. The primary purpose of the analysis is to identify the root cause of work-related problems that may contribute to musculoskeletal disorders (Albensi, 2002). The athletic trainer’s education in human factors and biomechanics makes the athletic trainer a valuable professional when identifying potential musculoskeletal disorder risk factors through a job analysis.

Wellness: The education and knowledge of a certified athletic trainer make him/her a valuable asset in a wellness program. Along with encouraging and developing healthy lifestyles, the certified athletic trainer can manage fitness, stress management, and smoking cessation programs. The certified athletic trainer can also manage company sports leagues, run incentive programs and obtain guest speakers to present on a wide array of topics.

Nutrition: It has been shown that obesity and insufficient vitamin levels are directly related to musculoskeletal disorders (North Carolina Division of Occupational Safety and Health) and that nutrition is an important component of injury prevention (Arnheim, 1993). Furthermore, being overweight costs over $70 billion a year in unnecessary health care expenses (Ficca and Streator, 2002). The certified athletic trainer can provide valuable information on numerous issues related to nutrition, such as the dietary guidelines established by the US Department of Agriculture and the Department of Health and Human Services. Additional nutrition education can be provided on weight loss and gain, dietary supplements and diets.

Physical Readiness: Just as certified athletic trainers have been developing conditioning programs for athletes and athletic teams for years, athletic trainers are now applying these same principles to develop programs for occupational athletes. Using the principles of conditioning (warm-up, overload, consistency, specificity, progress, intensity, individuality, and safety) the athletic trainer is a qualified health care professional to develop physical readiness programs for individuals or entire departments.

Safety: The athletic trainer can serve as a valuable member in a safety department. The diverse skills of the certified athletic trainer provides a solid foundation for working with safety issues. For example, the athletic trainer could manage lockout-tagout, hearing protection and machine guarding programs.

Injury Prevention: From their beginning, certified athletic trainers have always focused on injury prevention and patient education. By using the same principles applied to athletes, the certified athletic trainer can develop and manage effective injury prevention programs. The occupational athletic trainer can create and implement a variety of injury prevention programs, such as lifting schools, stretching programs, pre-shift exercises, musculoskeletal disorders recognition and intervention, and injury prevention presentations.

Case Management: Certified athletic trainers are a natural fit to provide case management services as the emphasis is on early detection and intervention in the management of work injuries. The athletic trainer can be a valuable case manager by facilitating on-going communication between employer, physician, rehabilitation providers, insurance and the employee. Additionally, the certified athletic trainer can serve to support the injured employee, monitor medical care, promote efficient reporting and investigation, and assist in finding light-duty work available within physician restrictions (Wickman, 2002).

Employee Advocate: Serving as an employee advocate may be one of the most important roles an athletic trainer can serve in the occupational setting. Employees trust the certified athletic trainer, and this can be beneficial as the ATC serves a liaison between the employee and management. Also, the certified athletic trainer may provide education to management on an employee’s injury and recovery time, thereby assisting in easing pressure on the employee to return to work.

Physician Extender: As musculoskeletal injuries become a larger percentage of all occupationally induced injuries and illnesses, many physicians recognize the benefits of the ATC’s expertise in managing these cases. In the role of physician extender the ATC can employ the skill, knowledge and abilities in managing these conditions earlier in the injury cycle. In the physician extender role, the barrier of “referring to therapy” is brought down to the benefit of all involved.

On-Site Rehabilitation: As health care costs continue to escalate, companies will need to find alternatives to effectively manage injuries. Working under the direction of a physician, athletic trainers are effective health care professionals to provide physical rehabilitation services on-site. The rehabilitation skills of a certified athletic trainer provides numerous benefits for treating injuries on-site, such as no co-pays for employees, avoidance of high health care costs at outside rehabilitation facilities, and no wage loss traveling to and from a facility or sitting in the waiting room. Also, by treating workers like occupational athletes and using aggressive rehabilitation methods honed on athletes that has traditionally been a strong point of sports medicine, businesses can save money because workers will return to work faster (White, 1996).

Return to Work: According to an article in Occupational Health and Safety, an early return to work program is the one single practice that can bring the greatest reduction in direct costs for worker’s compensation programs (Kaplan and Smith, 2000). The skills of a certified athletic trainer in returning athletes to play are precisely the same skills required to return employees to work. There are multiple forms of return to work programs; however, consistent aspects of any return to work program consists of stretching, strengthening, and job simulation (Gatz, 2002). The knowledge and diversity of the athletic trainer in these areas make them attractive health care professionals to implement, manage and conduct return to work programs.

Our onsite injury prevention specialists are Certified Athletic Trainers, and they bring the best principles of sports medicine into the workplace. This approach is driven by engaging employees one-on-one to identify and resolve the root cause of fatigue and discomfort.

Early Intervention Case Study

Learn how early intervention consultations with an injury prevention specialist can help prevent injuries.

Kay’s supervisor (Steve) noticed that something was missing that morning – her smile. Her body language seemed different as well, so he asked her if there was a problem. “Not really, it’s nothing really.” But Steve didn’t let it go, and again he asked, “Are you sure something’s not bothering you?” Kay then told him that she was experiencing some discomfort in her right arm. Steve responded, “I’m glad you told me, thank you. I’ll have Mark (the onsite injury prevention specialist) come talk to you about this and we’ll see if we can get you the help that you need to resolve this.”

I love it when employees are encouraged by well trained and proactive supervisors to let someone know they are beginning to have a problem! For each individual who reports unusual fatigue or discomfort, potential causes are identified and corrected whenever possible. Injury prevention handouts are reviewed with the employee and a self-care program is established to address all potential individual causative factors.

In Kay’s case, potential causes were identified and a self-care program was established. She did a great job of implementing the prevention plan, and within a few days that wonderful smile was back on her face!