PADRE for superior injury management results

This article appeared in the January 2005 issue of Risk & insurance Magazine.

I hope you like snappy mnemonics as I am about to share one with you. A few years ago, I searched about for a simple means to summarize key tasks in injury prevention and recovery. I stubbed my mental toe upon the word "PADRE,"–meaning father in Spanish.

Each letter stands for the following tasks: prevention, avoidance, duration, relapse and economics. Each task comes with one or more methods to measure performance. PADRE has helped me. Perhaps it can help you.

P stands for prevention. We track injuries using OSHA standards of measuring the number of injuries per 100 full-time equivalent workers. We might be better served by peeling away further layers of prevention, to measure near-misses, discomfort and other phenomena which precede injuries. How many injuries could we prevent by delving into the root causes of complaints or minor mishaps? A is for avoidance of lost time. By lost time, I mean at least one work shift missed completely. Train your eye on the ratio of nonlost time injuries to total injuries. Some doctors think they can treat the vast majority of injuries among many workforces without workers missing a single shift. Improvement might require tighter worksite response, prompter treatment, and easier access to temporary work assignments.

Next is D, for duration of lost time. If you wish to track this for a population of injuries, you need to think how you want to measure D and set improvement targets. Beware of the inclination to measure average duration of lost time, for this may be impractical. We would then have to wait for all injuries to come to closure, which may take months or years, and then horribly skew the average.

Instead, think of calculating the share of all lost-time injuries that return to work within 30, 60, 90 and 180 calendar days. You can then aim to increase the return-to-work rate at 30 days, from say 70 percent to 85 percent.

Tracking duration of lost time by milestones has become a lot easier as risk management information systems acquire the power to do these calculations routinely. We are now at PAD. Two letters remain.

R stands for relapses, summed as the portion of cases that first return to work from lost time, then relapse back into disability. As with P, you want to obtain the lowest possible rate. We must first define the span of days after initial return to work within which return to disabled status is properly a relapse; and beyond which is a fresh injury. Although there is no set standard, the demarcation point appears to fall around the 30-day mark, and in any event no later than 90 days.

E, the last letter, stands for economic outcome of the entire prevention and injury recovery program. Steve Levine, the risk manager of Wild Oats, the retail food chain, pointed out to me that E comes in two parts. First, the worker. Is she made whole? Did she return to her preinjury income? Some large-scale studies of wage income after seeming recovery from injury show that many workers experience a decline of 10 percent or more in income. Second, the employer. What is the employer's economic gain in terms of ROI of prevention and injury management?

For the overall integrity of the workers' comp program, we need to apply the right methods to analyze both worker and employer economics, in fact each element of PADRE. This math can be difficult. Not only do we, but our colleagues also, need to understand the trends; which leads me of another word: LEADERSHIP.