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 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)
21