PT Classroom - An Ounce of Prevention  ׀ by Matt Jeffs, DPT, PSM, CEAS

Matt Jeffs, DPT, CHC, CEAS is an onsite preventive care specialist and a certified rehab ergonomist. He holds two professional clinical degrees in physical therapy (Bachelors of Health Science in Physical Therapy, from the University of Florida in Gainesville, FL and his Doctorate in Physical Therapy from Chatham University in Pittsburgh, PA) and is licensed in Florida and North Carolina. Dr. Jeffs has over 25 years of clinical and management experience and has directly overseen the successful rehabilitation of over 20,000 individuals in the clinical setting. As a Lean Practitioner equipped with over 12,000 hours of direct onsite experience serving clients in corporate and industrial settings, he applies continuous improvement methodology to all onsite projects and processes. Dr. Jeffs holds a leadership role in the First Coast Manufacturers Association as its Workforce Education Director and Consultant to FCMA’s Board of Directors. FCMA is an industrial trade group consortium of some 300 manufacturers and companies in North Florida.

When considering health and safety prevention is the most logical approach. Whether we incorporate task-specific Ergonomics, job-specific Physical Demand Analysis, or a host of services designed to drive down incident rates and compress lost time, we realize lagging indicators crudely tell less than half the story.

We’ve long recognized driving continuous improvement in applicant screening, onboarding personnel, and coaching incumbent workers pays dividends. There’s a method behind this commitment. It’s an acknowledgment that our present healthcare delivery system isn’t only overly expensive. There’s ample evidence to suggest it’s ALSO very dangerous.

‘To Err is Human?’

Guess it depends on whom you ask, but according to a now (in)famous publication from the Institute of Medicine in 1999, healthcare delivery in the United States is not safe. At least 44,000 people to as many as 98,000 people die in US hospitals each year from medical errors that could have – and should have – been prevented.

More recently in 2016, researchers from Johns Hopkins Medical School published in the British Medical Journal a study that estimates a range of more like 210,000 to 400,000 deaths a year occur from preventable medical errors in US hospitals. These researchers used studies from 1999 onward, and extrapolated to the total number of US hospital admissions in 2013.

Thus, they calculated a mean rate of death from preventable medical errors of 251,454 per year. Every year. When compared to the annual causes of death compiled by the Centers for Disease Control and Prevention (CDC), medical errors in US hospitals rank third as the most common cause of death in the United States.

‘But They Take Care of Their Own, Right?’

Well – in a word – no. OSHA and BLS statistics themselves show that a hospital is one of the most hazardous places to work. Anywhere. In 2011 alone, US hospitals recorded 253,700 work-related injuries and illnesses, which computes to a case rate of 6.8 work-related injuries and illnesses for every 100 fulltime employees.

US hospitals also have a higher rate of ‘days away’ cases than construction, manufacturing, or private industry. Hospitals also experienced injuries at nearly three times the rate of professional and business services, or traditional white-collar jobs. It’s not only dangerous to be their customer. It’s also dangerous to be their employee.

A ‘days away from work’ data breakdown shows hospitals suffer most from large numbers of musculoskeletal disorders (MSDs), usually categorized as sprains and strains. Most commonly, ‘overexertion or bodily reaction’ is the stated cause for these MSDs. These injuries account for 54 percent of all hospital injuries. We call them preventable ergonomic exposure.

‘Surely, We’re Still the Best Healthcare in The World, Aren’t We?’

Um. No. Life expectancy has increased some in the US, but less so than many other industrialized countries. There’s a gap of almost two years at birth in the US compared to average first-world countries (78.8 years in the US in 2013 compared with 80.5 years for the WHO average).

In 1970, life expectancy in the US was one year ABOVE the WHO average. Now, life expectancy for US men in 2013 was 4.3 years SHORTER than Switzerland. For US women, that gap was 5.4 years shorter than in Japan in 2013. The fragmentation of our US healthcare system, with relatively few resources devoted to public health, primary care AND prevention are key factors in this growing gulf.

‘Do We Get Our Healthcare Money’s Worth?’

Afraid not. US health spending remains much higher per capita than in all other WHO countries. It’s two-and-a-half-times greater than the WHO average in 2013. The share of GDP allocated to healthcare spending in the US was 16.4% in 2013, compared with a WHO average of 8.9%. This has remained unchanged since 2009, as spending growth matched overall economic growth. Essentially, we’re being asked to pay off a new Porche, while we’re given a Ford Pinto to drive.

‘Is All the News ‘Bad’ News?’

Not completely. It depends on how you look at it. We’re still very good at ‘crisis medicine’. US hospitals perform very well providing acute care for people admitted with life-threatening conditions like heart attack or stroke. We’re at our best when patients are at their worst. Preventing them from dying has almost become routine. Once things get financially lucrative enough to intervene, that is.

US hospitals also do well in treating and saving the lives of those diagnosed with breast cancer and colorectal cancer. However, we’re not performing at all well in preventing hospital admissions for chronic conditions, like asthma, chronic obstructive pulmonary disease or diabetes. Improving the management of these conditions in primary care could go a long way in keeping people from being exposed to the dangerously high medical error rate we described above

‘So, What’s the Take-Away?’

Now that we’ve taken a sober, lucid inspection of our troublesome healthcare delivery model, it’s incumbent upon us – as health and safety professionals – to chart our best path forward. Expanding our understanding of workforce members beyond the 20th century biomedical model would be a good start. While it served us well up to mid-century in the 1900’s, the ‘biology explains all’ mantra has surely outlived its usefulness here in the 2000’s.

Imagining the arrows of causation only point in one direction is an outdated notion crumbling under the weight of 21st century evidence in the scientific literature. Take epigenetics, for instance. ‘Nature vs. Nurture’ is a quaint holdover from a simpler, binary world with a one-way train of thought. We now know both nature AND nurture play key roles in the interplay between genotypes and phenotypes. The arrows of cause and effect point in BOTH directions.

Similarly, neuroscience now teaches us neuroplasticity is lifelong. That is, our grey matter can be rerouted and rewired by deliberately and craftily employing our mind-body connection in unique and creative ways. Recent studies in the lasting effects of mindfulness, breath-work, meditation, yoga, tai chi and more now show us two-way interplay between cause and effect AND between mind and body. Our software (mind) can reconfigure our hardware (brain).

What this opens for us in workplace prevention is a whole new quiver of tools we can use to benefit our work, our workforce and our workplace. Engendering a more calm, focused and clearer-thinking work life for ourselves, our colleagues and our clients helps steer us clear of a healthcare delivery industry that still has some heavy lifting to do in terms of preserving our safety.

Primum Non Nocere (‘First, Do No Harm’) is an idiom we in Prevention live by. Until our healthcare delivery industry can offer us assurances it too has rediscovered AND rededicated itself to this most primary of promises, we must mitigate our exposure to it. We do ourselves, our partners and our customers the most good by insuring they never need lagging-indicator ‘healthcare’ services in the first place. The stakes are too high. And the stats are too disturbing.