Occupational Health in the Veterans Health Administration: A Chart Book [DRAFT]

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1 Occupational Health in the Veterans Health Administration: A Chart Book [DRAFT]

2 Occupational Health in the VHA: A Chartbook Jennifer Lipkowitz Eaton MD MPH, David C Mohr PhD, Christina Gerstel-Santucci MPH MID, Tamara Schult PhD, Kathleen McPhaul PhD RN COHN-S VHA Office of Public Health, Occupational Health Surveillance & Analytics Group January 2015

3 Introduction Access to timely, actionable public health data is one of the cornerstones of monitoring and improving employee health. A common understanding of key employee population health metrics and available services provides a framework for communication among stakeholders committed to worker health and safety 1. It is our hope that this chart book can serve as a ready resource for stakeholders seeking population and/or health issue specific indicators for policy, organizational and clinical decision-making related to VHA employee health 2.

4 Intended Audiences It is our hope that this chart book can serve as a ready resource for stakeholders seeking population and/or health issue specific indicators for policy, organizational and clinical decision-making related to VHA employee health 2. Policy makers Facility and VISN Leadership Program Managers and Clinicians VA Labor Union Partners Veteran Service Organizations VHA Employees

5 Chart 1-1 Trend in Occupational Injury & Illness Incidence VHA cumulative work-related injury and illness rate declining on average over the past decade, but notable inter-facility variation presents opportunities for improvement Events per 10,000 FTE Work Injuries and Illnesses per 10,00 FTE 1,164 1,188 1,247 1,223 1,164 1,106 1,084 1, FY04 FY05 FY06 FY07 FY08 FY09 FY10 FY11 FY12 FY13 FY14 Source: VHA ASISTS Database

6 Employee Population Occupational Risk Profile The majority of VHA employees work in physically demanding positions, ranging from direct healthcare occupations to facility maintenance, transportation and other trades. Occupational Distribution of VHA Employees Physician 8% Maintenance Transport Warehouse Other trades 8% Chiropractor Podiatrist Dentist Pharmacist Optometrist 3% Admin Undefined 36% Professional Nursing 25% Allied Care 20% Health

7 Age Distribution of VHA Workforce Compared to the US healthcare workforces as a whole, VHA employees are older*. Median Age of Employees: VHA versus US healthcare sector Percent of VHA employees by age group FY % 30.0% 33.1% % 25.3% 20.0% 15.0% 18.5% 15.9% 10.0% 7.2% 5.0% US HCWs VHA 0.0% <

8 Chart XX-X Prevalence of Health Risk Behaviors VHA employees report higher rates of smoking, obesity and physical inactivity. Worksite wellness programs can be effective interventions to decrease sick leave and maintain adequate staffing for optimal care 35.0% 32.5% 30.0% 27.9% 25.0% 25.3% 20.0% 21.6% 20.4% 15% 15.0% 15.2% Healthy People % 5.0% 12% VHA U.S. Population 0.0% % Physically Inactive % Smokers % Obese

9 Employee Occupational Health Clinical Services The majority of VAMCs provide on-site occupational medical services that increase workability among staff. Room for improvement remains, particularly for work-related injuries and emergency preparedness. DEMPS/NEMRT 91 Vaccinations 99 Treatment of work-related injury 92 Pre-placement exams 98

10 Employee health clinic performance Occupational Health/Medicine Specialty Provider Staffing Access OEM Physician Certified OH Nurse Non-Certified 31% 45% 66% 95% Secure Telephone Visits Extended Hours Open Access 0% 50% 100% Axis Title

11 OEMedicine Consult Program Reach In 2014, the teleconsult program expanded access to occupational medicine specialty care for VHA healthcare workers by more than 200%. Year 1 Year 2 VAMC

12 Employee Health Promotion Results from the VHA EHPDIP program show that dedicated health coaches can be critical supports to establish and maintain a culture of health in the hospital workplace. 100% 90% 80% 70% 89% 78% 73% 83% 70% 66% 67% 60% 50% 45% 56% 54% 44% 55% 51% 40% 30% 23% 32% 32% 23% 36% 30% 20% 10% 9% 0% Wellness Committee Wellness Plan Healthy Food Environment Employee Wgt Management Comp Tobacco Cessation Coach with FTE and training (n = 36) Coach with no FTE but Training (n = 37) Coach with no FTE and no Training (n = 22) No Coach (n = 45)

13 Impairment Prevention Program Impact Since implementation of the EHPDIP program evaluation process, drug testing errors have decreased by X%.

14 Trend in incidence of patient handling injuries Overall incidence of HCW injuries related to patient handling is decreasing, reflecting increasing uptake of Safe Patient Handling culture and technology across VHA Events per 10,000 FTE 500 Patient handling related injuries during fiscal year

15 Injury Rate per 10,000 FTE Chart X-X Patient handling injuries among nursing staff Nurses bear the greatest burden of injuries from moving patients, with frontline nursing assistants and 700 practical nurses facing the greatest risk Nurse Practical Nurse Nursing Assistant

16 Incidence of assault in the VHA workplace The majority of reported workplace violence events involve verbal threats, indicating opportunities for violence 100 de-escalation and prevention FY04 FY05 FY06 FY07 FY08 FY09 FY10 FY11 FY12 FY13 FY14

Types of assault in the VHA workplace The

prevention 39% Verbal Only Verbal and Criminal

Criminal, Physical 16% 13% 13% Physical and

17 Types of assault in the VHA workplace The majority of reported workplace violence events involve verbal threats, indicating opportunities for violence de-escalation and prevention 39% Verbal Only Verbal and Criminal Physical Only Verbal and Physical Verbal, Criminal, Physical 16% 13% 13% Physical and Criminal 8% Criminal Only 4% 3% 4% Other Combinations/Not Specified

18 Workplace Violence Prevention Program PMDB Trainers by VISN

19 Workers Compensation $664,687 per day VHA workers compensation expense in 2013 $340,167 per day VHA workers compensation expense related to disability wage-loss or Lost Productivity! Disability wage-loss could fund another 1,165 medical professionals each year!* * Source: FedScope 0600 series with an average salary of $83,861 annually.*

Nurse 4% 3% 6% 5% 3% 35% 2. Nursing Assistant 3. Practical Nurse 4. Housekeeping Aid 7% 5.

20 Workers compensation injuries by occupation Frontline healthcare workers in VHA are most likely to suffer work-related injuries and enter the workers compensation system 1. Nurse 4% 3% 6% 5% 3% 35% 2. Nursing Assistant 3. Practical Nurse 4. Housekeeping Aid 7% 5. Health Aid 8% 6. Medical Support 7. Food Service Worker 12% 17% 8. Miscellaneous Assistant 9. Social Work 10. Medical Supply Aid

Occupational Health Team Kate McPhaul, Chief Consultant, Office of Public Health Washington DC Clinical Occupational Health/Analytics and Surveillance Program Pam Hirsch, Jen Lipkowitz-Eaton, Bryan

Program Ebi Awosika, Leonard Haas, Sandy Schmunk, Tammy Schult, Brenda Burdette (virtual), Jeremy Senstadt Safe Patient Handling Kate McPhaul/TBD National Program Manager Portland VAMC Workplace

21 Occupational Health Team Kate McPhaul, Chief Consultant, Office of Public Health Washington DC Clinical Occupational Health/Analytics and Surveillance Program Pam Hirsch, Jen Lipkowitz-Eaton, Bryan Richardson, Kevin Grant, Christina Gerstel, Field based: David Mohr (Boston), Sally Foster- Chang (Philadelphia), Christina Bulas (Salem) Minneapolis VAMC Employee Health Promotion/Impaired Provider Program Ebi Awosika, Leonard Haas, Sandy Schmunk, Tammy Schult, Brenda Burdette (virtual), Jeremy Senstadt Safe Patient Handling Kate McPhaul/TBD National Program Manager Portland VAMC Workplace Violence Prevention Lynn Van Male, Kelly Vance (Lexington VAMC), Frank Corbin, Ashley Brodie Virtual Occupational Medicine Consultants Steve Kirkhorn, (Minneapolis), Dan Brustein (Cleveland), Wendy Thanassi (Palo Alto), Amir Mohammed (New Haven), Steve Hunt (Seattle) 21

Total Worker Health TM

Total Worker Health TM Promising and Best Practices in the Integration of Occupational Safety and Health Protection with Health Promotion in the Workplace Veterans Health Administration Perspective Kathleen