Case Study: Transforming the Worker's Compensation Experience


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The ideal worker’s compensation experience should encompass
three ecology items that must be integrated as the basis for
the transformation. By understanding the outcomes of all three
areas in conjunction, with one another sustainable change can
take place allowing for a patient-specific, effective, time-saving

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Case Study: Transforming the Worker's Compensation Experience

  1. 1. Case Study: Transforming the Worker’s Compensation Experience “As co-creators of the worker’s compensation process; physicians, clinical assistants and associatepractitioner’s modeled the new inspiration of how it could look, feel and ultimately provide better care. Eachprocess was detailed, understood and broken down. We then transformed how it could be, how it should be.” ~ Curt Kubiak, Executive Director
  2. 2. Transforming the Worker’s Compensation Experience...Emerging Trends: Page Patient Focused Healing Environment 3 Experience Ecology 4-5 So What’s Different 6 Executive Summary 7-10 Experience Based Design - Orthopedic M.D. 11-12 Patient Advocacy Difference 13-17 Generated Protocols 18-19 Total Cost Containment 20-21 Pre-registration Intervention 22-23 Tracking System Solution 24-25 Onsite Prevention 26-27 Not Just Another Building 28 The Institute Solution 29-30
  3. 3. Patient Focused Healing EnvironmentComfort Healing gardensIf you think of a health care facility as a bleak environment withinsensitive lighting, stiff furniture and views of ceiling tile from Therapeutic art and sculpturea rigid bed, read on. Picture a medical facility highlighted inwarm, tender colors, which integrate the exterior feel with the Exam room patient schedulingheart of your medical experience. How about an atmospherethat creates patient outcomes of comfort, ease, warmth, Oversized private roomscontentment, and a truly welcome feeling. Is this a vision? Yes. Isthis reality? Yes. Discrete storage of supplies and equipmentWith the help of Miron Construction, progressive medical Integration of the natural environment into the facilityorganizations have re-invented the concept of health careand are creating the spirit of the ideal patient experience. “Village” campuses of ambulatory facilitiesThis revolutionary approach to patient experience design andpatient attachment, places emphasis on healing design. It is Integrated physician officesbased on how patients feel and how quickly they are brought serving multiple functionsback to productivity as they are immersed into our process. Cafe, library,Caregivers in the healing environment understand that patients’ bookstores andsurroundings affect their well-being. Below are ideas that this health-relatedprocess uncovered: services Wellness, ‘I Spot’ Patient Registration Areas fitness and complementary Natural lighting throughout the interior medicines Noise reduction design elements Patient environment control
  4. 4. Experience EcologyThe ideal worker’s compensation experience should encompass specifically for each patient. Staffing a Workers Compensationthree ecology items that must be integrated as the basis for Liaison as the primary contact and project managementthe transformation. By understanding the outcomes of all three resource, saves time and creates, efficiencies in communication..areas in conjunction, with one another sustainable change cantake place allowing for a patient-specific, effective, time-saving Informationalexperience. How well has the process been optimized to eliminateThe three critical elements are required to build this type of redundancies and handoffs and ensure that poor practices havetransforming healing environment are: Physical, Behavioral, not been automated to create rework?Informational. It is important to align each element with theneeds of the patient and his organization. However, it is even Informational elements include all forms, reports,more critical that each element is designed to support and communication collateral, signage, and internet technology.compliment the other elements. One or more of these main All information elements are provided online with easy accesselements are often forgotten, executed poorly, leaving their for the patient, case manager and company. Patients withoutuniqueness unappreciated and separate. internet access should be contacted to complete forms prior to arrival at the medical care facility. Physical “We used the expected emotional outcomes fromHow convenient, accessible and effective is the physical layout process users connected with the optimizedtoward delivering the service that the patient needs? patient flow from functional owners, to create value for patients, employers and physiciansPhysical elements include all aspects of spatial integration. alike.” What was once a sacred space was up PhysicalThese include the facility, access to all services, one point for discussion. Anything was possible,” saidregistration, on-site services such as physical therapy, MRI,, orthotics, imaging, and patient preparation and postoperative care. Behavioral Behavioral ECOLOGYHow friendly, thoughtful and respectful are the Individualsdelivering the care to meet patient needs?Behavioral elements include all interactions between the patient Informationaland facility staff in progressing medical care as prescribed
  5. 5. So What is Different?An opportunity for Workers Compensation transformation Great processes transform your focus…Health care providers have long been working on improving People want to feel better. People from all walks of life have ancare processes and staff efficiencies. The notion of placing innate desire to feel part of something, to believe they matter.patient outcomes first, complimented by provider and partner At essential moments in which individuals connect with a healthefficiencies creates an experience that is uniquely different. care provider, healing opportunities become available.Innovative companies want to fulfill customer needs and build Ask the tough questions…strong bases of loyal employees, and business partners whoare also advocates for the company. Companies have long Review patient scenarios, analyze sequential movement,understood that employee and partner health is vital to the long examine people interchanges and emotional connectivity.term success of any organization. Identify exactly what patients need, precisely how to provide the appropriate care and deliver it in a way that all users won’t forget.According to the most recent health care research, workercompensation patients are 50% more likely to return to work Re-design the experience from start to finish.through innovative patient experience design as compared tothe more traditional process. (cite) By providing injured workersappropriate care more quickly and by efficiently managing thetreatment process with a single resource the entire process canbe completed in less time saving more money.What will remain. . .We live in a world of over-stimulation, pressure, insecurities andeconomically fragmented lifestyles. The Orthopedic & SportsInstitute has developed a methodical, workers compensationapproach for delivering the experience in a brand new way.We have embraced the complexity of the process, dismantledconnectivity flaws and integrated design tools so injuredemployees feel great about the experience and return to workfaster.
  6. 6. Transforming the Worker’s Compensation ExperienceExecutive Summary Experienced-Based Design accomplishes three objectives:For over 80 years, the worker’s compensation system in the United promotes healing through a wellness-designed environment.States was created with one end in mind. To provide a healing provides measurable outcomesenvironment, one in which a worker is cared for and back to work ina timely manner. Over the years much has changed; the bureaucracy reduces operational costsof the insurance system, the inadequacy of medical system We have integrated the patient vision into the process, giving anadministration and the lack of understanding of the process have extraordinary experience-based design application which advocatesall caused system failure. What was once an efficient and effective actively managing healing time and creating cost savings.methodology, is now a frustration, a process of complexity andconcern. The Miron Construction Experience-Based Design team Patient Advocacy Differencewas asked to assist in creating a solution that didn’t exist... Through a revolutionary Workers Compensation Liaison GuidedReinvent the experience... Solution, worker and company needs are understood at the beginning of the process as opposed to the middle or end.Through the understanding of desired user outcomes and the “We understand the needs for a patient designed experience”,identification of (7) seven key solution areas, leading worker’s commented Diane, Dappern Workers Compensation Liaison. “Wecompensation providers embrace what makes a difference for understand the need for a new way of thinking.”patient’s , case managers, insurance providers and companiesrevealing a new way of thinking. Throughout a four month period, Generated Protocolswe researched, detailed and illustrated what worked and whatdidn’t work with the current worker’s compensation system. What Rarely have clinics and health care providers outlined the expectedwe found was astonishing. Our research showed that very little had healing process and time line for recovery from an injury. Advancedchanged throughout the past years. “We were curious of how it processes require protocols for 10 different surgical procedures ascould be”, commented Dave Eggert, MD. “We knew that through the baseline for a patients recovery. Unprecedented for the industry,the changes we imagined, the difference could be felt, by our protocols serve as the basis, the foundation for expected back topatients their companies and ultimately in the bottom line for every work dates.organization we serve.” Experience Based DesignThe Institute realized that the worker’s compensation environmentmust be therapeutic, supportive of family involvement, efficient for staffperformance, and restorative for workers under stress. We made decisionsbased on the best information available from research and case evaluations.Critical thinking was required to develop appropriate solutions withexperience to back up the changes.
  7. 7. Transforming the Worker’s Compensation Experience Advanced Total Cost Containment Plan Tracking System SolutionThe economics of health care in the United States are changing. According to The Institute research, it is critical that case managersBaby boomers are headed into their high-maintenance years, and and company representatives know the status of patientswhile they’re living longer than their parents, they will need and throughout the duration of the medical care plan including: injuryexpect a state-of-the-art health care experience. The 18 to 40 age diagnosis, treatment and follow-up care. Leading facilities havepopulation will be decreasing by 3% over the next 10 years. The developed a web-based tracking system, that allows for access tofact remains...there won’t be enough workers for the current pro- expected treatment times and the return to work date . Orthopedicduction capacity. The time for transformation is now. Our research M.D. Brian Lohrbach agrees, “The tracking system identifies processallows for these changes and quantifies the outcomes, serving the owners and treatment cycle times to better manage return toneeds for the short and long-term. work dates. Any breakdowns, system fragmentation and overall inefficiencies are addressed proactively. Our team knows what is Pre-Registration Intervention working and what needs assistance. There is never a finish line with the journey of continuous improvement.”Registration processes are typically the first opportunity for majorbreakdown in any health care system. It is often overlooked and By understanding where a patient is in the process and what ismisunderstood. The current system is cumbersome and anxiety next, plans can be formulated, demonstrating the best possibleridden. Medical facilities need to recognize that the traditional outcome, patient health and recovery.system is broken. It is time for a change and to create a plan whichallows for the growth and efficient treatment of the patient.
  8. 8. Transforming the Worker’s Compensation Experience On-site Primary PreventionIt is no secret that the key to controlling health care costs is avoiding Creating hardier employees is the secondary prevention aspect of theincurring these costs in the first place. Therapists must start by process. Connecting to the PCP early assists in many ways. Includingreviewing the ergonomics of the existing workplace to see if there arejobs that may be prone to injury. In addition, visit the workplace with The identification of barriers to recovery, which are also predictorsmedical staff regularly (minimum once per week) in order to address of re-injury and referring these personal medical conditions forany minor issues early in the process before they progress into more treatment.serious issues. Patient education, empowerment, self-treatment and wiseEmergency room visits have become common place as work consumption.related injuries get referred on to the ER more often than any othermedical provider. Avoiding the ER will save cost in the visit, but more Teaching patients how to distinguish “discomfort” from injury.importantly, reducing recordable accidents is a realistic target of on-site first aid/nursing/medical care.The key is to provide incentive for employees to choose the mosteffective and economical choice in medical care from the start. Thestakes are high when it comes to worker’s compensation prevention.Through on-site intervention, worker and company needs areunderstood at the beginning of the process as opposed to themiddle or end. This early intervention allows for the employee to feelconfident in the provider and the employer to be confident that thecare is provided in an integrated fashion to avoid unnecessary costs,or time off.
  9. 9. Competencies of the Transformed Experience Experience Based Design Generated Protocols Patient Advocacy DifferenceTime Cost Advanced Total Cost Containment Pre-Registration Intervention Tracking System Solution Onsite Prevention
  10. 10. Experience Based DesignExperience based health care centers create environments that One Mind, One Processare therapeutic, supportive of family involvement, efficient forstaff performance, and restorative for workers under stress. In To address these traditional issues, the following keyresearching the best outcomes for patients, consistent access components were designed in this and the remaining 6to orthopedic trained physicians was viewed as the single most competencies:critical element by patients and case managers alike. Orthopedicphysician care delivery embodies how functional groups and One Mind, One Process: All points of care are aligned withpatient focused process owners collaborate to fulfill patient- the same outcome based vision and this is communicated forcentric strategies and tactics. For example, it is important adjust every point of contact. The workers compensation process isorganizational boundaries and measurements to facilitate not complete until staff deliver a solution consistent with thepatient healing activity by redefining days to healing. By doing protocol with any exceptions clearly noted and plainly, 20 days of healing can be saved over a more traditional Build the process that take the concept to reality.approach (see figure 2). Segment-Influenced Operating Model: Redefine expectations, silos and divisional boundaries are removed so that decisionCurrent Issues making can be made in the best interest of the patient outcomes, not departmental profit objectives.An experience based design focused organization relies onempirical data in managing and nurturing a patient driven Cross-Functional Transparency: Enable departments andenterprise. The following issues were identified by reviewing the channels to collaborate together for the effectiveness anddata: efficiency of the process. With a redefined process in place, automation through IT resources can make the tough tasks of Diagnose Causation driving data easier to manage. Complete & Timely Documentation Return to Work - Limited Duty Process-Focused Architecture: Define the foundational elements that align the business expectations and patient Too Many People/Undefined Roles/Accountability experience outcomes. The optimal comprehensive solution OSHA Log - Recordable combines the optimal process, the appropriate tools and the requisite staff to bring the service to life. From the beginning, Consistency of Message Among Providers plan for the people, systems, and data to define the healing IME Process process. Contained Costs
  11. 11. Experience Based Design - Orthopedic M.D. AccessEffective worker’s compensation solutions and strategies areoriginal and authentic. After researching over 160 individualtreatment plans and surgeries, it was apparent that access toOrthopedic M.D. was one of the most important elements to aneffective and efficient healing process. With the initial access toa surgeon and not a associate practitioner or orthopedic mid-level, 10 days of wait time - ultimately 20 days can be saved. Thisultimately provides a tremendous savings of time and costs forall stakeholders. (see figure 2).Figure 2OTHERS:ORTHOPEDIC & SPORTS:
  12. 12. Patient Advocacy DifferenceAttached patients feel better... about their company, the provider and The key competencies and indicators of the patient advocacyultimately their healing. difference are designed to capture information from patient interactions at the start to help create a patient treatment time line toThe Workers Compensation Liaison process begins with an drive the design of the healing environment include:understanding of what patient and company needs are andsubsequently creates a plan specific to them based on the ideal Patient Understanding: In recognizing the best method forpatient healing outcome. treatment, the Workers Compensation Liaison must ask 10 fundamental baseline questions which serve as the blueprint for the individual plan.Resolve Inconsistency Outside-in Treatment Design: Patient treatment plans are based onCommunication is identified as the most frequent source of a full discovery of the baseline expectations and desired outcomesbreakdown between the provider, worker and company. Inconsistency combined with expected tactile and protocol information gathered and reported can create fragmentationbetween the three groups. The Workers Compensation Liaison Feedback Loop: A communications matrix is established to ensureserves as the liaison within the system allowing for a consistent that all parties involved are identified and their contact informationcommunication process, eliminates any adversarial relationships. and area of expertise are readily available. Formal means are established to learn about the patient and company information andEmotions tell the brain what issues to pay attention to throughout the use them - at both the patient and aggregate levels - to continuouslyprocess. A system that requires immense mental effort to navigate will update treatment the plan.frustrate users and provide a negative experience. Patients, who findit complicated to obtain information, experience detached employees Personalized Treatment Plan: Patients are given a unique, relevantor have difficulty maneuvering through a process, will often become treatment plan that aids in the healing allowing for a quicker return toaggravated. This negative experience reflects directly on the time work.taken to heal and time away from work. Worker’s Compensation Research: A system comprised of highlyCompanies who work in a patient advocacy system are able to trained individuals, operating the latest technology is devised to “learn”approach the worker’s compensation process in a way that builds about changes that occur which will affect the workers compensationefficiency and confidence through knowing at all times where the system including: reporting needs, communication requirementspatient is in the system, while simultaneously understanding the time and most significantly patient needs, emotions and behaviors whichand cost ramification to decision making. are utilized to advance the designs of the worker’s compensation experience.
  13. 13. Patient Advocacy DifferenceThe good news for injured workers is that interest in improving the Total Time - Return to Workquality of workers’ compensation medical care is expanding.The Workers Compensation Liaison process aids in this expansion bydifferentiating the return to work system as well as the aggressivenessof limited duty.Diagnose Causation 70%The challenge is not only to continue to advance this area, but to Time Off Worktranslate the knowledge gained throughout the process into atreatment schedule which provides the best outcomes while bringingthe injured worker back to their place of employment. Driving thedesign of the return include: 30% Treatment Return to Work: Early intervention for the injured worker requires the Processadvocate difference by connecting the individual to the proper careprovider. This speeds up the often weighted down traditional process,allowing a rapid deployment time line and added company value. Limited Duty: The differentiation is establishing protocols andguidelines to allow the patient to return to work in some capacityduring the healing process. This value added activity limits theexposure the company has, reducing down time and adding to theoverall productivity of the working environment. Causation Guidance and Determination: Resource availability for themedical staff to assist in determining causation of the injury. Accessto this resource ensures that treatment plans can be executed withconfidence and accuracy. No Extra Charges: Early resolution of causation will allow a providerto determine the correct payor for the injured worker. This eliminatesextra (often overlooked) expenses associated with a treatment plan.
  14. 14. Patient Advocacy DifferenceFragmentedCommunicationTypically, the worker’scompensation process involvesmultiple locations, registrationsystems, information sources,people and confusing channels.Research indicates that it is oftenthe most misguided system inthe entire process.Effective systems create onesource for patient, case manager andcompany communication allowingfor consistent communication, feedbackand correspondence. Without this clearsource, information and points of access areconfusing adding stress and anxiety to theinjured worker (see figure 3).Figure 3
  15. 15. Patient Advocacy Difference Phone / PCPLiaison Concierge ReferralConnectionThe Workers Compensation WorkersLiaison serves as the Compensationliaison within the system Figure 4 Liaisonallowing for a smoothcommunication process, aless adversarial connection. Orthopedic M.D.Communication is thefirst source of breakdownbetween the provider,worker and company. The X-RayAdvocate follows a precise,guided path avoidingfragmented communication. Noninvasive MRI Care Surgery Physical Therpay
  16. 16. Patient Advocacy Difference10 Fundamental Baseline Questions 5. Describe/provide information on the hazard/incident or other causative agent involved in this injury/illness.That Need to be Asked. . . 6. What is the resulting injury/illness?1. What are the patient/employee demographics of the case: 7. Describe your job: Name, address, DOB, phone, etc. What hours/shifts How many hours per shift2. What is your employer data: Other environmental elements ( wet, hot, cold, Who is employer cement, etc.) Who do you report to regarding injuries (supervisor, HR, EHS) 8. Describe other activities you participate in: Employer address, phone, fax etc Sports Hobbies3. Has the incident/injury been reported? Secondary jobs To Whom When 9. Describe pain and or discomfort elements: Do you have a copy of a written report? Use of pain chart for area Have you been treated for this incident (whom, Pain level where, etc) Limitations because of discomfort4. What is the WC carrier info? 10. Past History: Name of company Any similar incidents Name of adjuster This joint vs, other joints Name of case manager File number Contact info. Have you been contacted by the WC carrier to give a statement?
  17. 17. Generated ProtocolsEffective worker’s compensation solutions and strategies are based Expected to Actualupon a standard protocols of expected outcomes based uponhistorical treatment plans and actual recovery times. Each patient If you don’t know where you’re going how will you know when youtreatment plan is then gauged against the protocol and any variances get there?explained to ensure that the system progresses timely and accuratelywithout compromising quality. After researching over 160 (validate) Every challenge requires a plan, and workers compensation challengesindividual treatment plans and surgeries, it was apparent that are no different. Immediately following the injury, the employeeprotocols must deliver needs-based solutions that contribute to the should be directed to a medical staff member that assigns a teamholistic patient care expected. of professionals to the workers compensation case. The first team members would be the Workers Compensation Liaison and theKey competencies and solution indicators enhance the ability to orthopedic physicians medical staff member. These medical staffdevelop and provide relevant, integrated and personalized treatment members will ensure that all relevant information is retrieved andplans. recorded properly and that the patient is seen as soon as practical after the incident. At this initial visit a treatment plan should be putTotal Cost Containment in place based upon standard protocols to clearly define the desired outcome and time line of the process.Workers compensation costing activities often concentrate onthe cost of the medical treatment alone. Companies request and The higher-level challenge to the organization as a whole is makingsometimes even pay employees for second opinions and shop for the this practice a routine part of the corporate culture. By have thelowest procedure cost. Our analysis demonstrated that the procedure existing team members create detailed process flow documentscost, while significant, was only a fraction of the Total Treatment Cost. of existing the workers compensation process, including activities,By far the most significant cost of the treatment plan was the lost owners, value-added time and queue times areas of change -productivity and replacement cost related to employee time off the including when, where and how were identified. The employees thatjob. The Workers Compensation Liaison not only ensures accuracy we asked to implement the changes were an integral part of craftingof treatment plan and ensures communication of progress, but the solution, so that they not only knew what they needed to doalso measures progress toward the desired outcome to explain any differently, but why it must change as well.unexpected variances.
  18. 18. Generated Protocols Expected outcomes must be aligned to fuel the change across the Protocol Based Expectations: Communication from the medicalentire organization. Providers must establish an environment that care facility is triggered proactively based upon expected outcomespromotes a systematic capability to cultivate the expected treatment spelled out in the customized treatment plan based upon industry-plan. Each of the protocols must be driven through innovation during wide protocols. The protocols ensure that the medical facility isthe deployment (see figure 5). actively managing the employee progress with a single point of communication and accountability. Define and maintain a library Real Time Information: Motivate internal providers to access of event-based rules that trigger communication events based oninformation and outline process expectations and owners up front. company and patient actions.This method ensures accountability for timely turnaround of ‘after visitsummaries’, and company follow-up. Innovation comes to life through the eyes of the user experience and helps to ensure outcomes happen every time, without fail. Solutions Realistic Segment Treatment: Encourage internal feedback must be diagnosed from the collected data and causation outlined toto leverage the change required to accomplish the outcomes. achieve the expected results.Ensure that this will be a continuous change process rather than adestination. Active Guided Discovery: Teams meet regularly to review potentialareas of improvement based upon metrics and actual results.The executive management team evaluates suggested areas ofimprovement from the user groups in order to prioritize and resourcethe greatest opportunities for improvement. Create a nurturingstructure that not only avoids turf battles, but rewards processefficiency and effectiveness. Value Exchange: In order to ensure that the team is working onthe root cause of any inefficiency, data is collected, analyzed andreviewed in a systematic fashion. Cross-functional innovation teamsensure that any impact up or down stream from the change in theprocess Is considered. Invest in measuring in and aligning out theright technology and tools to drive the environment and protocoldelivery models.
  19. 19. Generated ProtocolsFigure 5 Phase II – Active Motion Phase (Week 4-10)Effective worker’s compensation solutions and strategies are originaland authentic. After researching over 160 individual treatment plans Goals: Improve shoulder strengthand surgeries, it was apparent that protocols must deliver needs-based Improve range of motionsolutions that contribute to the holistic patient care expected. Decrease pain/inflammation Increase functional activitiesAn example of the protocol philosophy includes the following totalshoulder replacement: Exercises Active assisted ROM exercises with L-BarKnee Arthroscopy with Portized Medical Menisectiomy o Flexion o ER (not past 30 degrees for 6-8 weeks post-op)Phase I – Immediate Motion Phase (Week 0-4) o IR Rope and pulleyGoals: Increase passive range of motion o Flexion Decrease shoulder pain Pendulum exercises Retard muscular atrophy and prevent RTC shutdown AROM exercises o Seated flexion (short are 45-90 degrees)Exercises: o Supine flexion (full available range) Passive range of motion o Seated abduction (0-90 degrees) o Flexion (0-90 degrees) Exercise tubing ER (week 4), IR to begin week 6 o ER (at 30 degrees abduction) 0-20 degrees Dumbbell bicep/tricep o IR (at 30 degrees abduction) 0-35 degrees Scapulothoracic strengthening Elbow/wrist ROM Joint mobilization Grasping exercises for hand Ice & modalities Isometrics (day 10) For more information on phases 3 & 4, click on for a o Abductors complete listing of all 10 worker’s compensation protocols. o ER Electrical muscle stimulation (if needed) Rope and pulley (2nd week)
  20. 20. Total Cost ContainmentReduced Down Time Integrated execution is how effective worker’s compensation organizations deliver a consistent treatment plan that allowsTo uncover the total cost of the workers compensation process the intelligent, cross-channel execution. By simply altering process,analysis starts with the initial phone call to the medical provider modeling impression areas and attachpoints, understandingpost injury and continues until the worker is back to his prior desired outcomes and shifting behaviors, the processes areposition without restrictions. understood and subsequently, non-value-added steps reduced.*Note: The outcome may not end with return to work without Key understandings and indicators of Total Cost Containment arerestrictions for all employees, but our analysis focused on patients integrated with channels to drive seamless integration:that fall into this category. Cross Channel Interaction: Enable patients to move from oneThrough the use of lean-sigma tools such as decision trees and channel to another, allowing for a saving of time and movement.value stream maps the team identified all potential causes fordelay and inefficiency. Then by process of elimination team Operational Profile: Create a consistent profile of all treatmentmembers identified the root causes of the delay. The team noted plans and the connected profiles associated with the costthat the environment can hide patients from or expose patients to containment.their subsequent healing. Component-Based Systems: Design patient systems in aBy identifying the main impression areas and the many attach modular fashion such that components of the treatment plan canpoints associated with the selected impression area, process steps, be seamlessly inserted, or removed based upon specific patienthandoffs and queue (wait) times can be determined. Without needs.this breakdown, the task is unmanageable and generally focusesefforts on the transactional portions of care which are less likely Distributed Delivery: Deploy resources to reduce the need forto be the significant areas for improvement in a process that has repetition. Often plans are redesigned for each patient, whilebeen reviewed many times before. consistent protocol management can reduce queue times and allow for greater return to work efficiency.Fewer Steps & Handoffs Method of Choice: Allow patients and providers to personalize and choose channels in the treatment plan that best fit theirOutcomes become integrated within the behaviors needs as prescribed by the orthopedic physician.of the providers creating a transparent “pull” deliverysystem. Providers focus on the larger outcome ofgetting employees back to work, rather than just whatit will take to get the patient to their next appointment.
  21. 21. Total Cost ContainmentEffective worker’s compensation solutions and strategies areoriginal and authentic. After researching over 160 individualtreatment plans and surgeries, it was apparent that wait timeand handoffs must be understood and reduced. A realizedsavings can be gained by delivering a needs-based solution thatcontributes to the holistic patient care expected.Figure 6 Process Improvement 200 150 Before 100 After 50 0 Handoffs Steps
  22. 22. Pre-Registration InterventionSolution BasedBarriers to the worker’s compensation experience must be Solution based thinking is about delivering needs-basedidentified and understood. Average registration time can solutions like pre-registration that contribute to the holisticbe reduced from 14 minutes to 45 seconds through the patient plan. The objective of SBT is to translate the designtransformation of solution based thinking and pre-registration. elements established to directly impact patients’ physicalWithout the pre-registration process, patients line up in the and psychological health, thus reducing patient stress andcare reception areas at peak times and wait to be assisted. promoting rapid recovery.Similar to lines at an amusement park where stanchions keeppeople in line and weaving forward. Due to the questions Key competencies and indicators of pre-registration interventionmandated by federal, state and health care protocol, the desired enhance the ability to develop and provide relevant, integratedpatient outcomes of “cared for, welcomed, respected and outcomes for patient care:acknowledged” were lost and patient anxiety increased from themoment they entered the experience. Knowing they may have Needs-based Orientation: Transform traditional delivery toa serious health concern, the traditional process added to their address the needs of the individual patient and their recoverystress and healing time (see figure 7). program versus a one-size-fits-all registration process.In creating this new approach to registration, three main Patient & Case Focused Design: Bring the voice of thequestions were posed: patient and case insights into the solutions. Understand tactile expectations to speed up the process, allowing for less down How can we best understand patient health history and time.information? On Demand Availability: Refine the system to allow for a How can wait time be reduced when registering? registration process that provides real-time information back to the case manager and company. What are the outcomes we want patients to feel about the process thus aiding in their healing? On-Line Reporting: Channels which are designed to provide on-line reporting for easy access to information required forOutcome based thinking becomes integrated within the insurance authorization.behaviors of the providers creating a transparent and effectivedelivery system.
  23. 23. Pre-Registration InterventionBy offering an alternative to the traditional method of capturing Thirty-three vs. Three Questionsworker information, pre-registration can effectively reduce thetime required to obtain needed this needed information by over OTHERS:70%. This advance equates to a savings of time and dollars bythe company and worker.Often registration processes ask the same questions over amultitude of departments or providers. By offering this state-of-the-art system, information is captured once allowing for greatermovement within the system aiding in the speed and healing ofthe patient. This reduces the questions asked from 33 to 3 (seefigure 7).Figure 7Forty-five seconds vs. Fourteen minutes ORTHOPEDIC & SPORTS:
  24. 24. Tracking System SolutionHealth Status By taking the current process and documents and making them available online companies can allow real-time“As cocreators of the workers compensation process, communication to all of the parties involved in the patientphysicians, clinical assistants and associate practitioner’s healing process. Starting with the treatment componentsmodeled the new inspiration of how it could look, feel and and time line based upon the injury protocol, patientultimately provide better care. Each process was detailed, progress can be charted and documented to the protocolbroken down and understood. We then transformed how it and any variances explained in a written summary.should be, how it could be.” ~ Curt Kubiak, The Institute Executive Director Critical milestone dates are captured such as initial visits, diagnosis, treatment and follow-up care to ensure thatOnce the systems were in place, illustrated and identified, the progress toward the desired outcome can be clearly tracked.creativity could begin. Cycle times can then be calculated between any two“In researching and asking our patients what they expected, milestone dates in the process to gauge timeliness against ait was clear that communication and understanding of next desired outcome. Any outliers to the acceptable cycle timessteps was paramount”. are analyzed as opportunities for improvement. Explanation for any cycle time variance is captured to reveal one-off issues versus chronic system failures.Reduced Cycle TimesOnce the process is reviewed and optimized, the systemmust contain the proper tools to allow the greatestefficiency. In reviewing the current standard tools:documents, forms, phones, copiers and fax machines, theteam realized that there was a better answer.Patients, case managers and employers alike wanted toknow “next steps” in the employee treatment plan andultimately when the employee could reasonably beexpected to return to work.
  25. 25. Tracking System SolutionReal-time access to data: Align the expected steps of the process Early Warning System: The online system will alert participantsto the actual steps providing a basis for alignment. Every day, each when a critical due date is pending and encourage action bestep of the treatment can be viewed online and is outlined and taken to stay on track with the prescribed protocol. Any missedunderstood. milestone dates require a written explanation and subsequent follow-up analysis to ensure that variances are not chronic issues. Security: Few data sources currently contain detailed informationaddressing the quality of workers’ compensation medical care. Capability to Attach Notes & Documents for Single Access: ToOnce the systems are developed, security of the information is ensure that important information reaches affected stakeholders,paramount. Access of this proprietary information should be notes and documents should be communicated quickly. Thisavailable to all stakeholders real-time. improves workers’ compensation medical care for the benefit of the injured workers, employers, insurers, and health care providers. Data Access: Align interests and motivations enabling resourcesthe ability to leverage cycle time knowledge quickly and Easy access to patient information and treatment plan progresssystemically. Provide a basis for continuous learning about the enable providers down stream to view patient records in advancepatient treatment plan to eliminate unwanted surprises. of an appointment and pull the patient into the next phase of the treatment plan. Timely access to data allows each team member On-site cycle time reporting: Provide web-based tools that allow to be efficient in delivering his service as part of the overall plan.for a unique interchange of cycle time information from the usersfinger tips. Allows for a greater understanding of times deployedreducing the variability in the system (see figure 8). Figure 8 Cycle Time Role Alignment: Provide patients and case managers withdevelopment progression planning capabilities based on personal 35and lifestyle objectives. Build the ability to redeploy resources as 30required to meet patient needs.. 25 20 Business Days 15 Cycle Time Functional Ownership and Accountability: Environment has the 10ability to strengthen or impair a patients’ health status by reducing 5or encouraging existing conditions and feelings. Each functional 0owner in the process is responsible for entering the cycle time data Jan Feb Mar Apr May Junand letting other members in the plan how they may be impacted. Months
  26. 26. On-Site PreventionTimely Preventive Care The next best solution is to have a medical advisor on-site to evaluate injuries at the workplace. Part of the workersAs the saying goes, “An ounce of prevention is worth a compensation solution should include on-site evaluation ofpound of cure”. A comprehensive workers compensation injuries, such that the injured worker gets the appropriateplan must include up-front workplace evaluation, training medical attention required as soon as practicaland maintenance designed to keep a work force healthy andincident-free. By providing an analysis of existing working Workplace evaluation is how companies foster sustainedconditions and on-site follow-up care, this first phase of the employee commitment and attachment to allows employeesworkers compensation solution can help to save time and to better meet personal and organizational objectives, all whilemoney by reducing work related injuries, time off the job and serving and being advocates.OSHA recordable incidents. The key competencies and indicators of on sight preventionPrevention is such a golden opportunity, sadly accidents speak include the evaluation, training and coaching of employeesfor themselves. When an employee has the misfortune of include:suffering a work injury, co-workers must take note of how easilythe same could happen to them. Nothing gets that message Agile Workforce: Provide employees with prevention planningacross as clearly as does thorough post-accident follow-up. capabilities based on company objectives and personal habits.Safety specialists know this and do this routinely. Post-accident Construct the ability to best use the prevention techniques.investigations and de briefings are the norm. But, whenergonomic experts and human motion specialists are called in Delivering Tactile Performance: Based on the outcomesto the “post-accident SWAT Team”, employees see the full picture; expected, create an environment of ‘guided discovery’namely that in order to save them from the same fate, the immersing employees in the understood behaviors that willemployer is serious about safety. prevent the injury from reoccurring again.A critical evaluation of workplace ergonomics by a trained eyecan detect potentially problematic issues such as repetitivemotion and work station misalignment. The objective of thisprocess is to prevent injury from occurring.
  27. 27. On-site PreventionWorkplace EvaluationExperiences must trigger, not close down, creative innovations;identifying the highest form of patient feelings. Environmentsshould sustain positive thoughts and not provoke boredom,anger, apprehension or apathy.Traditional worker’s compensation solutions rarely capture theessence of the reason for reoccurrence in the first place. “Ourresearch data showed that if prevention doesn’t exist within the Accomplisworkplace, the recovery process will be longer.” CommentedRob Worth, Advanced Physical Therapy founder. We capture the Figure 9 hmthree elements and encourage the questions of what if, howshould be, and what is it? “What is it that will continue get your e nt nt nt nt nt ntemployees, healthier quicker.?” “Capabilities must be based on s s s s s scompany objectives and personal habits. Construct the ability tobest use the prevention techniques for your culture, not ours”. Recordable Incidents: Based on the outcomes expected, createan understanding of the incidents that can be reduced througha well-thought out, designed process. (see figure 9). Build a System of Accountability: Develop and validate a setof performance measurement standards for worker’s to rallyaround and celebrate to. Hold all involved to the same level ofaccountability Establish Effective Assessment: Assess routinely the healthstatus of workers and the workplace. Design and test new Recordable Incidentsprocesses for routine safety and construct a ongoing, effective by Monthsystem.
  28. 28. Building the Ideal Worker’s Compensation ExperienceNot Just Another Building Outpatient – Private pre-operative and post-surgical patientLike any building, which has been designed to withstand the rigor rooms for comfortable and seamless recovery, enhancedof customer demands and the enduring test of time, experiences infection control and greater privacy.need to be agile and sustainable as well. Typically, very little thoughtis given as to how the physical space integrates with the behavioral Advanced Data Retrieval System – Providing physicianneeds and requirements of the users. The Orthopedic & Sports information, secure access to patient records via integratedInstitute facility readily accommodates the essence of the worker’s PC. This includes up to the minute lab results, radiologycompensation process, embraces the unique qualities of the clinic reports, vital signs and medication lists.and stimulates the innovation that helps patients return to workquicker Daybeds - Visitors enjoy in-room daybeds to remain connected to their family and friends being treated.Imagine This…. Hospitality Center – Fox River Brewing coffee assists you in preparing the coffee of the day. Juices, coffee and Workers Compensation Liaison- A personal guide leads you sandwiches are available as well. through the process to ease communication and clarify navigation. In-room Scheduling – Rather than sending the patient to another sub waiting area, patients are scheduled for the Prescriptions: Filled immediately through Physician diagnostics and imaging from the exam room. interaction and on-sight dispensing. Community Outreach – Golf, running, joint pain Concierge - Services to assist with direct patient needs while management, strength and flexibility seminars help to ease at the Institute including elderly guidance, and also ancillary your pain and complete your recovery. services at your request. Soundscapes – Music is offered and available through Children’s Activities - Activities for children to stay engaged headphones of their favorite downloaded artists. and entertained while family members are treated. Flex Room – Nurses move patients less often when all operating rooms have equipment that folds out to provide Anything is possible… critical systems such as anesthesia gases, and heart monitors.
  29. 29. The Institute SolutionEmotions pave the way for patient and community attachment. productive contributions as quickly as feasible.Patients make decisions based on how they feel and thetreatment they receive versus services provided to them. Understand what it takes to generate a compelling reason toInnovative thinking in the health care field understands and return, to captivate the patients’ interest and emotions so theyencourages this type of patient/caregiver engagement and must are healed integrated within all facets of the worker’s compensation Understand why the entire process is a reflection on every teamprocess. member of the health care delivery system. Why their thoughts, feelings and ideas need to be incorporated into the process.Based on this notion, a revolutionary solution, unique in Why the research we help to identify serves as the basis for allapproach has been born to combat this often confusing and innovation.typically transactional process. Understand the power of experienced based design and why itMost importantly, apart from a purpose built facility and state- is so important to design an experience that gets patients backof-the-art technology, the significant difference in the health to work quicker saving time and industry are the people. People are the element thatcreates the emotion and connection to all users of the workers Understand the importance of a healing environment and whycompensation process. From the registration team to the post the fabric pattern on the chair, the sounds you hear, the smellsoperative surgery area, the staff must be functionally competent, you have and the sights you witness have tremendous relevanceemotionally aware and responsive and critical thinkers to have to the patient getting better faster.the best understanding of what it takes to create healing.This is not simply another process. It is a systematic approach toexcellence based on your vision and values, which truly identifyand separate this process from the rest.This case study illustrates this approach throughout. Included areproprietary methods, research systems, tools and concepts thatmust be included for complete transformation. Case studies inhealth care prove the viability and sustainability of the ideology.Take the time and research to understand what it takes fromstart to finish to create an original experience that make patientsfeel great, meets case manager needs and returns workers to
  30. 30. The Institute SolutionWe understand that it is about lives. The lives of your teammembers, the community, your company. People rememberexperiences. We live in a world of over-stimulation, pressure,insecurities and economically fragmented lifestyles. They wantto live and be treated in ways they never imagined.This overview has provided an understanding of what it takes, totransform the overall worker’s compensation experience.We understand. . . it has to be different.