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

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

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

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.

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

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. 2000 Events per 10,000 FTE 1500 1000 Work Injuries and Illnesses per 10,00 FTE 1,164 1,188 1,247 1,223 1,164 1,106 1,084 1,023 947 874 815 500 0 FY04 FY05 FY06 FY07 FY08 FY09 FY10 FY11 FY12 FY13 FY14 Source: VHA ASISTS Database

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

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 FY13 53 35.0% 30.0% 33.1% 43.4 25.0% 25.3% 20.0% 15.0% 18.5% 15.9% 10.0% 7.2% 5.0% US HCWs VHA 0.0% <30 30-39 40-49 50-59 60+

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 2010 10.0% 5.0% 12% VHA U.S. Population 0.0% % Physically Inactive % Smokers % Obese

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

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

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

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)

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

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 400 300 294 323 337 328 298 294 271 263 200 233 204 154 100 0 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

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. 600 500 400 300 Nurse Practical Nurse Nursing Assistant 200 100 0 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

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 80 60 58.29 66.82 67.25 63.21 66.34 69.21 65.14 62.09 60.62 55.54 50.75 40 20 0 FY04 FY05 FY06 FY07 FY08 FY09 FY10 FY11 FY12 FY13 FY14

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

Workplace Violence Prevention Program PMDB Trainers by VISN

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.*

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 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