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Partnering with a liability insurer: The carillon story

September 1, 2001
by root
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This nursing home got help from its insurer in improving safetyBy Shep Tapasak
By SHEP TAPASAK TO HELP A CLIENT FACILITY KEEP ITS INSURANCE PREMIUMS UNDER CONTROL, THIS INSURER DEVELOPED AN ACTIVE COLABERATION


The task of lifting residents at Carillon Nursing and Rehabilitation Center in Huntington, New York, was causing 8 to 18 back injuries a year among its 375 staff members during the late 1990s. As any administrator knows, the results were painful in more ways than one. Staff members were losing time from work in an industry already facing staff shortages. Workers' compensation costs were high. The injuries were affecting morale.

At the same time, my company, which provides insurance to several thousand U.S. nursing homes including Carillon, was redefining how we serve the long-term care industry. We knew that the only way for us to meet the needs of these customers was to go beyond the ordinary and provide services that improve not only their business, but the lives of their staff and residents.

After we approached Carillon and offered hands-on assistance, Carillon management adopted a no-tolerance stance toward accidents in the workplace. The policy eventually gained wide support from employees and dramatically raised their morale. During 1999, the program's first year, Carillon staff experienced just one back injury, and the number of injuries has remained low ever since. This initiative, called Zero Accident Culture«, or ZAC« by Royal & SunAlliance, is based on a relatively simple concept: An organization does not have to accept workplace accidents as a normal by-product of day-to-day operations.

When we first approached administrator Joe Carillo with our ZAC proposal, we recommended that his first major step in reducing injuries should be to purchase state-of-the-art resident transfer devices. We presented it as a business investment: We had developed an approach in which we would commit to keeping insurance costs more stable, but they would have to make an initial investment in equipment based on that commitment.

As lift devices of various types were put in place, geared toward individual resident need, our company and Carillon worked hand in hand on a long-range program to make staff members aware of how accidents happen and ways to prevent them. We encouraged every staff member to take an active role in making suggestions on safety. On a more formal level, we and the equipment vendor provided training materials for Carillon to use in "training the trainers," and this they did with complete commitment. Carillon realized that new equipment is only 10% of the safety story-the other 90% comes from proper training in the use of that equipment. The extensive orientation and training continue today.

However, while lifting devices can mitigate the risks and are certainly important, we recognize that buying such expensive equipment is not possible in every situation. So the basic focus of ZAC is on creating a culture shift. Here's a closer look at the steps involved:

Management must display leadership by clearly stating that its number one priority is keeping people safe. This might sound like a clichT but it's true: The business of long-term care is the business of people caring for people. Recognition of this has to be shown by the facility's actions every day-for example, by working to develop safety teams within the facility and having an open-door policy for staffers with questions, problems or solutions. We helped in developing an interdepartmental safety committee-the elements were already in place, but needed a more thorough approach and honing-and we sat in on committee meetings, joined in the discussions and did a lot of listening. We tried to function more as business consultants than safety consultants. Acceptance of this was a tribute to Carillo, who throughout the project demonstrated that he was the sort of supervisor who really cares about his employees and values them.

Long-term care facilities must identify all sources of accidents and adverse resident outcomes and develop business plans to address these issues. There are two ways to do this. One is to look at accident history-and almost everyone does. But we take another step.
The most effective incentive is showing people how their efforts affect their own lives.... We try to identify potential sources of injury-ones not yet on the radar screen.
A good general example-this didn't necessarily pertain to Carillon-is the relationship between accidents and the increasing use of agency staff. This is not a criticism of agency personnel, who generally are good, caring people. But with rapid staff turnover, communication can and does break down. When communication breaks down, both residents and staff are placed at risk. In short, to improve safety, you have to look at much more than just accident history.

Long-term care facilities must empower employees to take an active role in executing business plan objectives. This is really a question of how one creates an incentive for people to become involved. This was initially a "tough sell".
ZAC represented a fundamental shift in practice. There were caregivers who had been performing resident lifts for years without equipment and didn't see the need for change. The most effective incentive is showing people how their efforts affect their own lives, as well as the outcomes for their employers and the residents. We slowly tried to foster that recognition as the program developed.

There are several other steps necessary to being successful with ZAC: creating effective ways to measure results; constantly updating business plans to reflect changing safety concerns; and taking the time to celebrate your successes.

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