The United States Postal Service (USPS) looks to employ people in the best jobs suited for their skills, abilities interests and experience. They also want to keep them safe and healthy. In the past, approximately 200,000 candidates were screened annually by a physician. The medical assessment was costly, took too long (10-12 days), and was not a good predictor of future illness or injury.

Determined to make the medical assessment more time- and cost-efficient, a re-engineering team of nurses and physicians analyzed data including customer evaluation and benchmarking with other companies. They came up with an alternative that used a computerized questionnaire as an initial medical assessment screener. Initial findings from the first pilot revealed that of the first 1,000 people using the new process, 400 were cleared automatically based on the results of the questionnaire analysis and the functional physical requirements for the position. The remaining 600 were examined by an USPS occupational health nurse with an in-depth interview and review of medical documentation. One-sixth of these 600 were directed by the occupational health nurse to a physician for an exam. This medical exam focused on the medical problems identified by the computer and assessed by the nurse.

The new medical assessment process has been highly successful and is now utilized by numerous sites. The new health screening process is saving in excess of $8 million dollars annually on the actual costs of the assessments, and is creating extensive savings on productivity by reducing the physical assessment screening cycle time from almost 12 to less than three days. Program reviews have found no indication of increased injuries or illnesses by new hires that have participated in the new medical assessment process by the USPS' occupational health nursing staff.

This new questionnaire and screening process is completely nurse driven and has clearly demonstrated the added value nurses bring to the USPS business functions. The USPS occupational health nurses are the gatekeepers of the process and key to the program's success. They have become integral participants in helping the USPS achieve a goal of hiring a healthy workforce.

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The first long-term evaluation of the financial and health impact of a large-scale corporate health and wellness program has shown that participating employees have significantly lower medical expenses and achieve overall improvements in several health risk categories, such as high cholesterol, hypertension and cigarette smoking. 

The two-part study was conducted for Johnson & Johnson and included a financial analysis of medical insurance claims for 18,331 domestic employees who participated in the company's Health and Wellness Program from 1995 to 1999. Reduction in medical care costs amounted to a savings per employee of $225 annually, an average total savings of $8.5 million. The savings, which were realized in the third or fourth year after the program began, came from reductions in hospital admissions, mental health visits and outpatient service use.

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At Sioux Valley Hospital University of South Dakota Medical Center, lost days and restricted days caused by back injuries increased 30 percent and 165 percent from 1997 to 1998.  The hospital created a multidisciplinary team including occupational and environmental health nurses to examine the problem, and they established a lift team. 

By 2001, average cost per recordable back injury related to client handling decreased from $6,294 to $1,099; direct costs decreased from $182,520 to $9,894; and indirect costs had decreased from $730,080 to $39,576.  Using the specially trained lift team as a tool for recruitment and retention has helped the institution limit its registered nurse vacancy rate to 8.76 percent compared to the national rate of 11 percent (AHA, 2001) and the turnover rate to 0.68 percent compared to the national rate of 15.7 percent (Watson Wyatt Data Services, 2001). 

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A small manufacturing facility in North Dakota demonstrated its commitment to workplace safety and health by becoming the first workplace in North Dakota to be recognized under the Occupational Safety and Health Administration's Safety and Health Achievement Recognition Program (SHARP).

The company had to undergo a comprehensive audit, correct all identified hazards, demonstrate that effective safety and health programs were in place and maintain injury rates below the national average for three years. The company has gone two years without having an injury that required time away from work and has saved more than $45,000 on its premiums from North Dakota Workers Compensation in the past five years.

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Following the 1991 consolidation of several businesses, Siemens became a unified company with 12,000 employees in 37 states. Consequently, the company was faced with the task of streamlining various benefit processes and programs. This also afforded the company with an opportunity to ensure that these services were more easily accessible.

Siemens Information and Communication Networks, Inc. Health Services team, which was created after the consolidation, handles all of the company's health issues. It is comprised of four occupational health nurses and an administrative assistant, who together have taken creative and progressive steps to manage loss programs (i.e. workers' compensation, short/long-term disability, absence management) and promote preventative health programs. The team's goal is to reduce the health care costs of the company by conducting programs addressing each area that impacts this volatile area of the bottom line.

The new approach has been extremely successful, particularly in reducing the illness and injury profile of its employees. The costs associated with salaried absences were reduced by $1.6 million in the first two years of the effort and since 1993 have saved Siemens approximately $300,000 in salaried absences every year.

To target the area of workers' compensation, the health services team created an illness and injury management program to help employees who are out of work for an extended period due to illness or injury. The health services team works closely with the employee's physician to best understand the employee's diagnosis and treatment, analyzes the diagnosis and recovery plan using a national average recovery profile, and provides the employee with appropriate re-education, training, and assistance in returning to work.

To target prevention and wellness, Siemens Health Services developed a very progressive approach, creating the Wellness Incentive Program (WIP), an eight-week online behavior-modification regimen offering modules on such health issues as nutrition, fitness, stress management, safety in the home and prevention of repetitive and one-time stress injuries. The program is accessed through the company's Intranet, with participating employees receiving credits toward their share of dental, medical and life insurance costs. This "cyberwellness" program was extremely cost efficient (with Web site design and development costing $30,000, $170,000 less than a "live" one-day seminar covering the same topics in multiple locations). It was well received by employees. As a result, health club membership at on site gyms and participation in corporate nutritional education increased 12 percent and the company credits the program for decreasing 3-5 percent of its annual company-wide absenteeism due to illness.

With this comprehensive and strategic approach to employee health that the Siemens Health Services team uses, they are not only playing an important role in the productivity of employees, but in their emotional and physical well-being. These efforts are contributing to the company's ability to attract and maintain high-caliber staff and a culture that cares for its employees.

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J.W. Marriott often said "take care of our associates and the associates will take care of our guests." Since Marriott Corporation instituted its Occupational Health Services program in 1978 to control workers' compensation costs in a few select hotels, the program has grown from a pilot to an entire company division devoting 54 nursing professionals to every aspect of employee health and compensation.

The evolution of the occupational health services program has afforded Marriott the ability to successfully reduce injury frequency by 20 to 30 percent and decrease overall workers' compensation by 20 to 30 percent. It has even played an important role in developing managed care in Florida. A team of occupational health nurses provides injury and illness management, preventive health strategies, wellness education, referrals for medical treatment, peer review, quality provider networks, cost containment programs, ergonomics, and disability and case management. As the company's needs have grown, so has the role of the occupational health services professional nursing staff. Currently, nurses are involved with one of the following practice areas: associate health nurse managers, interdivisional nurse practitioner clinic, nurse CARE managers, nurse review specialist and manager managed care arrangement.

Each hotel location has unique needs and culture, and the hotel occupational health nurse tailors his/her practice to meet the needs of the property. Marriott also has instituted interdivisional nurse practitioner clinics to serve all its businesses in larger market areas.

Different Marriott businesses may have need for nursing services but not have funding for one full-time. So Marriott developed the nurse care managers to serve multiple small units ranging from a few associates to 500 that are scattered over a wide geographic area. Through telephone case management following an injury, associates are assisted by professional nurses who work to see that accidents are treated in a cost-effective but high quality manner. This model has saved Marriott more than $750,000 over the past five years.

Marriott's program for workers' compensation has been helped by medical reviews performed on difficult cases by professional nursing staff and their insights provided to adjusters. Marriott claims offices have a nurse review specialist on staff and the program has $6 million savings per year for the company.

In response to Florida legislation mandating managed care for workers' compensation, Marriott created a plan with a nurse review specialist to include quality assurance, grievance committee, physician peer review and case management. The plan was accepted and instituted in 1997 in the state. Its success and savings are leading the plan to be rolled out in Ohio and Oklahoma.

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Glaxo Wellcome, Inc., based in Research Triangle Park, N.C., is a leading research-based pharmaceutical firm. The company employs approximately 9,000 people across the United States and operates a manufacturing facility in Zebulon, N.C. The company prides itself on its commitment to fighting disease by bringing innovative medicines and services to patients, to health care providers who serve them, and to its employees.

The company instituted its occupational health services program to provide employees with clinical health care management, examinations, medical surveillance, worksite and hazard evaluations, disability case management, wellness screening and educational programs, disaster planning and business recovery, confidential health recordkeeping, psychological counseling, and consultation regarding work- and home-life balance. The occupational health services program uses a primary, secondary, and tertiary (i.e. prevention, intervention and treatment) health care model. The workplace environment, the nature of jobs, health care claims data, and health Epidemiology principles guide program planning.

Two unique programs contribute greatly to the success of the occupational health services program. They are the "Contract for Health & Wellness" and the "Work/Life Initiatives." In 1996, "Wellness Credits" were offered to employees to reduce the cost of their health benefits if they agreed to not smoke, have their cholesterol and blood pressure checked, and complete a health risk appraisal. Based on a review of the 1996 program, along with medical and pharmacy claims data, the program was changed to a rewards-based program—the "Contract for Health & Wellness." The Contract was implemented to focus on health promotion/disease prevention and wellness programming to encourage and facilitate healthy behaviors.

This program continues to provide an integrated wellness program encouraging healthy behaviors and personal empowerment. Open to all employees, 60 percent have now chosen to participate. Participant surveys demonstrate that they found the program valuable, that it rewarded commitment to a healthy lifestyle, and that it was an effective way to help people to adopt, improve or maintain good health habits. Based on feedback from employees, benefits utilization data, and program experience, Glaxo Wellcome expanded the program to target stress/depression, tobacco use, nutrition/weight management, and fitness. The program required a commitment by employees at the beginning of the year and used an incentive-based reward to encourage adoption or maintenance of good health behaviors.

A unique feature of this program is the completion of a self-assessment using the stages of change model for each of the focal areas. Longitudinal programming was designed in each category to attract employees at different stages.

Another unique program demonstrates a new direction and focus for occupational health nursing. In maintaining a healthy, productive workforce, occupational health nurses are relied upon to assess and understand how the health of workers relates to productivity and to the bottom line. A "Work/Life Initiative" was implemented to enhance the overall health of workers, including an employee assistance program (Personal Support Network); LifeWorks (telephone and online consultation with trained counselors and materials on a wide range of topics including child and elder care, parenting, education, retirement, adoption, dual-career couples, blended families, relocating, and balancing work and personal life); and CALL (convenience and leisure concierge line) program. A corporate-wide survey was used to ascertain commitment, burnout, and flexible scheduling needs, as well as elder and childcare issues. Communications tools in the form of LifeMatters, based on the dimensions of health: intellectual, physical, emotional, financial, social and spiritual, and a Web-based corporate site, "Everyday Living," help keep the message of health in front of employees.

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Blue Cross and Blue Shield of Kansas (BCBSK), one of the leading insurance providers in the state, faced annual compensation costs surpassing $1 million in the early 90s. BCBSK employs approximately 2,000 people who primarily hold customer service, data entry and claims processing positions that require them to spend most of their workday at a computer and desk. Over the years, BCBSK's compensation costs associated with repetitive stress-related injuries greatly increased. In 1992 alone, over 200 claims were filed and estimated to cost the company almost $650,000. Also, many of the claims were for repetitive motion strain injuries. The company felt it was time to take aggressive steps to reduce these injuries which were impacting its bottom line.

It took two steps: adding two full-time occupational health nurses to its current staff of one-part-time nurse, and making a serious commitment to improve the wellness of their employees and reduce rising compensation costs by a comprehensive ergonomics program.

The occupational health nurses staff, began by recommending several low cost ergonomic accessories for employees worksites such as computer glare screens, adjustable keyboards, rearranging manuals to minimize unnecessary straining, document holders to further reduce awkward postures and ergonomic chairs. Within one year, these changes had produced savings in injury rates and costs. But more was needed.

The occupational health nurses worked with the purchasing department to buy ergonomically correct office furniture for new and renovated office space. Managers and supervisors received ergonomic training so they would be more sensitive to their team's work environments.

The occupational health nurses also wanted to increase communication with employees, make themselves more accessible and monitor employee repetitive strain injuries. In 1993, the nurses created an electronic job site questionnaire concerning employees' comfort at their workstation. Employees emailed their responses to the nurses who in turn emailed the employees recommendations to solve the problems.

The aggressive ergonomics program instituted by the nurses has had significant results. By 1998, only 64 claims estimated at $33,493 were reported compared to the 200 claims filed in 1992, which were estimated at $641,108. Also, since 1992, the number of repetitive strain injuries has been reduced by 95 percent.

In addition to the success of the ergonomics program, the nurses also contributed to the BCBSK's overall health and wellness program by instituting such activities as monthly health and wellness education classes, on site blood pressure screenings and nutritional guidance classes.

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In the state of Arizona, one company that stands out as a leader in environmental health and safety is the Arizona Public Service Company (APS). Its over 6,000 employees help provide electric and nuclear power to the state's residents, while addressing environmental health and safety.

The company instituted an integrated Environmental & Safety Management Plan, with 99 employees charged in seven departments with responsibility for occupational and environmental health and safety. A key component of the plan was a comprehensive occupational health program to manage clinic services, case management, employee assistance programs, wellness services, regulatory compliance, and short- and long-term disability management. To accomplish this, APS has five nurse-managed centers in two locations which serve 5,500 employees.

Disability management alone has allowed APS to save $1.6 million! The company has an integrated management approach program dealing with disability which incorporates occupational health nurses, employee assistance programs professionals, corporate management, labor relations personnel, and the employee to develop "stay at work" arrangements for each impacted work group. This also helps build positive team morale and enhanced worker self-esteem, in addition to bottom line contributions.

Furthermore, the group of health services professionals is involved in helping APS deal with FMLA and ADA issues, psychiatric/mental health benefits, preparing information for union negotiations, absentee management and developing wellness programs. Through their efforts, voluntary participation in health promotion and disease prevention programs has risen to over 40 percent in just three years, with the resulting savings that a healthier workforce brings.

As a power supplier, APS also must have an active environmental safety program. Health services professionals insure that employees potentially exposed to occupational health hazards have protective equipment and are screened annually for health changes. Health service representatives are also part of the Safety and Health Advisory Team for the company which consults with senior management on environmental, health and safety issues.

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