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 safety1. 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 health2.

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 health2.

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.

Source: VHA ASISTS Database

1,164 1,188 1,247 1,223

1,164 1,106 1,084

1,023 947

874 815

0

500

1000

1500

2000

FY04 FY05 FY06 FY07 FY08 FY09 FY10 FY11 FY12 FY13 FY14

Events per 10,000 FTE

Work Injuries and Illnesses per 10,00 FTE

Chart X-X

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.

Physician 8%

Chiropractor Podiatrist Dentist Pharmacist Optometrist 3%

Professional Nursing 25%

Allied Health Care 20%

Admin Undefined 36%

Maintenance Transport Warehouse Other trades 8%

Occupational Distribution of VHA Employees

Chart X-X

Age Distribution of VHA Workforce Compared to the US healthcare workforces as a whole, VHA employees are older*.

Percent of VHA employees by age group FY13

Median Age of Employees: VHA versus US healthcare sector

7.2%

18.5%

25.3%

33.1%

15.9%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

<30 30-39 40-49 50-59 60+

43.4

53

US HCWs VHA

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

25.3%

15.2%

32.5%

21.6% 20.4%

27.9%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

% Physically Inactive % Smokers % Obese

VHA

U.S.Population

12%

15%

Healthy People 2010

Chart X-X

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.

98

92

99

91

Pre-placement exams

Treatment of work-related injury

Vaccinations

DEMPS/NEMRT

Chart X-X

Employee health clinic performance

Occupational Health/Medicine Specialty Provider Staffing

Access

OEM Physician

Certified OHNurse

Non-Certified95%

45%

31%

66%

0% 50% 100%

Axis Title

Secure Email

Telephone Visits

Extended Hours

Open Access

Chart X-X

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

Chart X-X

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.

89%

56%

44%

83%

67%

78%

54%

32%

70%

51%

73%

23%

9%

55%

36%

45%

32%

23%

66%

30%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

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)

Chart X-X

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

Chart X-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

294

323 337 328

298 294 271 263

233

204

154

0

100

200

300

400

500

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Patient handling related injuries during fiscal year

Events 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

practical nurses facing the greatest risk.

0

100

200

300

400

500

600

700

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Inju

ry R

ate

per

10

,00

0 F

TE

Nurse

Practical Nurse

Nursing Assistant

Chart X-X

Incidence of assault in the VHA workplace The majority of reported workplace violence events involve verbal threats, indicating opportunities for violence

de-escalation and prevention

58.29

66.82 67.25 63.21

66.34 69.21

65.14 62.09 60.62

55.54

50.75

0

20

40

60

80

100

FY04 FY05 FY06 FY07 FY08 FY09 FY10 FY11 FY12 FY13 FY14

Chart X-X

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%

16%

13% 13%

8%

4% 3% 4%

Verbal Only

Verbal and Criminal

Physical Only

Verbal and Physical

Verbal, Criminal, Physical

Physical and Criminal

Criminal Only

Other Combinations/NotSpecified

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.*

Chart X-X

Workers’ compensation injuries by occupation Frontline healthcare workers in VHA are most likely to suffer work-related injuries and enter the workers’

compensation system

35%

17% 12%

8%

7%

4% 6%

3% 5%

3%

1. Nurse

2. Nursing Assistant

3. Practical Nurse

4. Housekeeping Aid

5. Health Aid

6. Medical Support

7. Food Service Worker

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)

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