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The Ford Motor Company
and the United Auto Workers (UAW) believe they're finding answers to
one of the biggest problems facing the industry today-management of
workplace injuries. Each year in the United States, more than 600,000
U.S. workers are injured badly enough to lose at least one day of work,
costing the economy around $50 billion a year in health care fees, workers'
compensation awards and lost productivity. To cut these expenses, this industry giant and the powerful labor union have linked with Johns Hopkins to provide a one-of-a-kind program that provides on-site rehabilitation for musculoskeletal injuries-and to develop data to demonstrate whether this approach makes good sense, fiscally. In fact, in the eight years since the first pilot rehabilitation center opened, the number of workdays lost at Ford plants due to musculoskeletal injuries requiring physical therapy has decreased steadily. At the same time, net savings to the company are estimated to be over $7 million. The novel alliance between the industry giant, a powerful labor union and an academic medical center is another example of a clinical department's entrepreneurial creativity, and contributes approximately $350,000 to the department's research enterprise. Ford and the UAW have a history of negotiating employee support services, including wellness, counseling, and child and elder care, jointly managed through a National Program Center. Still, workplace health, the rising cost of health insurance, and workers' compensation issues always have been major discussion points in contract talks between the automaker and the union. So, it seemed natural during the 1990 negotiations, when both parties were discussing the creation of on-site fitness centers, that talks turned to the need for a better way of treating injured workers. Ford and the union agreed to establish on-site rehabilitation centers at several pilot locations, believing the programs might improve health outcomes for workers and, although not an initial goal, reduce costs. As soon as the first few centers were set up, both parties were impressed by how well they were working. But, they had no hard data to back it up. "We wanted to make sure we were getting the best bang for our buck," explains Frank Gross, UAW's international representative to the joint Employee Support Services Program. Right at that point, Hopkins entered the picture. A team from the Department of Physical Medicine and Rehabilitation, Division of Occupational Medicine and School of Public Health answered a UAW-Ford RFP in 1997 calling for a third party to provide data and quality assurance oversight of the centers. Keith Kuhlemeier, one of the faculty members in physical medicine, had begun developing a database program that could be adequate to meet that task. Called the Software for Occupational Rehabilitation Epidemiology (SORE), it serves as an electronic patient record for physical rehabilitation services and could be used for quality assurance purposes. "Members of our team had experience in occupational injury rehabilitation," says Hopkins rehabilitation psychologist Stephen Wegener, "but the UAW/Ford project was much bigger in scale. It had a more diverse population and many more injuries." Steve Cherniak, Ford Motor human resources associate for the National Program Center, says Hopkins got the nod "because of its enthusiasm and what it brought to the table." Today, Hopkins acts as consultant for the 17-center program, shapes quality of the care, analyzes treatment outcomes, and provides advice on structuring the program. "It's unique, because we're not delivering the health care," Wegener says. "Instead, we're influencing how it is being delivered to a specific group of people-automotive industry workers, who we believe are being served by the largest program it its kind in the world." The Hopkins team visits each of the rehabilitation centers regularly, checking records for quality of care, proper medical documentation and appropriate use of equipment. The group also discusses issues unique to that center with plant union officials, management, and physical and occupational therapy staff. With workers concerned about satisfaction, the union focused on quality of care, the company interested in worker productivity, and all parties invested in the financial implications, Hopkins wanted to demonstrate the success of the program in all of these areas. To do that, Wegener and his team worked out a research contract with UAW-Ford that gives them access to anonymous Ford Motor patient medical records that they use with the SORE software program. The resulting data have formed the basis of a maturing research project. "We just presented our results at the American College of Occupational Medicine meeting in Chicago," Wegener reports, "and are in the process of preparing a major paper based on the findings. We'll have by far the largest study ever to be reported on this aspect of workplace injuries." The major research findings based on data from seven sites show that:
The study's conclusions, Wegener points out, reflect the importance of the rehabilitation program's psychosocial aspect: keeping injured workers tied to their work and to their colleagues. Even when employees are off work, they come into the on-site centers for their physical therapy and stay to have lunch with their friends. "Our research shows," Wegner says, "that at plants having on-site PT centers, very few workers choose to go outside, because the quality of care is perceived to be high." Hopkins' involvement and the use of data to attest to the quality of the program overcame a huge stumbling block for both sides. "One of the big issues in any union/management situation," notes Jerry Kline, president of UAW Local 240 at the Ford Motor truck and SUV assembly plant in Kansas City, "is the question of trust: Are the corporate medical people out to get us? Are we being forced back to work before it's safe? The Hopkins data clearly show that the program is a success for the company and union members." Ford's Cherniak says Hopkins' role also has helped change the relationship between management and union from an adversarial to a collaborative one. "And in today's workforce environment, that means a lot." CHANGE
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