Tag Archives: performance evaluation

Even More Tips For Building A Workers Compensation Medical Provider "A" Team

Fact
Significant dollars can be saved by getting injured workers to the best doctor. Evidence supporting this fact is the mounting Workers' Comp industry research clearly stating treatment by well-informed and well-intentioned medical doctors results in lower costs and better outcomes.

Belaboring A Point
As repeatedly stated in this series, many doctors in networks are not well-informed or well-intentioned regarding management of Workers' Comp claimants. As a consequence of their involvement, claim results are lacking, costs are high, and outcomes are precarious. This series of articles, “Tips for Building a WC Medical Provider A Team,” is intended to describe how to identify doctors who know the ropes in Workers' Comp using indicators in the data.1

Beyond the indicators discussed in the previous articles in this series, additional salient data elements are available in the data to broaden the scope of medical management evaluation. What makes this approach so feasible is that solid knowledge of who demonstrates best practices is revealed in the data. However, to find that knowledge, some operational processes and the data itself need refinement. Access to the data and its quality must be addressed.

Getting To The Knowledge In The Data
Regrettably, access to the data by the right persons is often a problem. Those who know best what to look for, the business and clinical professionals, cannot use current data in a practical, work-in-progress manner. The reasons are many.

First, relevant data resides in separate databases that must be integrated to understand all activity in a claim. Moreover, in most organizations, provider records are simply inaccurate and incomplete. Until now, the need for them was for reimbursement purposes only, not performance evaluation. Yet another problem is that provider records are frequently duplicated in the data, making it difficult to accurately evaluate individual medical providers' treatment process and results.

Data Silos
Critical data for analyzing medical provider performance is still fragmented in most payer organizations. While people have long complained about data silos in Workers' Comp, little has been done to correct the problem. If anything, data sources have increased. Pharmacy databases have been added, for instance. Yet the databases are not integrated on the claim level, thereby portraying the claim as a whole. Data silos too often lead those who are attempting to evaluate provider performance to rely on a single data source.

Single Source Analysis
Relying on one source of provider performance data is foolhardy. Nevertheless, bill review data is often used, but by itself is inadequate to tell the whole story. Claims level data is also critical to weigh return to work data, indemnity payments, and legal involvement associated with claims and ultimately, to individual doctors. None of these data items are found in bill review data, yet these are essential to complete analysis of provider performance. Because in Workers' Comp, doctors drive the non-medical claim costs as well as the direct medical costs, these data items are essential to evaluating the quality of their performance.

Data Quality
The problem of data quality can be even stickier. Traditionally, medical provider records are kept in the claims database, along with records of other vendors for payment purposes. All that is needed for bill payment is a name, address, and tax ID. Unfortunately, the same provider is frequently added to the database when a new bill is received. This outdated database management practice leads to slightly different records added for the same provider.

Data Optimization
To evaluate medical provider performance, more information about individual providers is needed such as accurate physical addresses. PO Boxes will suffice for mailing checks, but injured workers cannot be sent there for treatment.

Merge Duplicate Records
Tax ID's are still important for reimbursement and 1099 purposes, but often multiple doctors are represented by one Tax ID. To evaluate provider performance, individuals must be differentiated in the data. State medical license numbers and NPI (National Provider Identification) numbers are needed. Frankly, some doctors deliberately obfuscate the data by operating under multiple Tax ID's and multiple NPI numbers. Consequently, provider records must be merged, scrubbed, and optimized before any analysis can begin.

What To Do
For most organizations, choosing best practice providers by analyzing the data is challenged by the shortage of accurate and complete data. Therefore, those wanting to control costs by choosing the best providers should obtain provider performance analysis and scoring from a specialty third party, one that is expert in data integration from multiple sources, as well as provider data scrubbing and optimization.

When behaviors of doctors are analyzed using clean, integrated data, the well-informed and well-intentioned in Workers' Comp will rise to the surface.

1 Tips for Building a Medical Provider “A” Team and More Tips for Building a WC Medical Provider “A Team”

Breaking Through The Barrier Of Hardnosed Workers, Part 4

Winning Them Over
In Part 3 of this series, safety officer Ken Malcolm talked about the importance of building trust between hardnosers and those who try to change them. To this, Malcolm adds respect.

“Give them [hardnosers] respect,” he says, “and problems go away. They might not like you, but when you handle people accordingly, someone is always watching, and that tough but fair method gets you respect.”

Trust and respect form the pivot point that directs difficult employees away from dysfunction, toward responsibility. Hardnosed workers will never trust or respect you more than when you demonstrate to them that you have their best interest at heart.

You do this when you create intentionally interpersonal safety training to meet the intensely interpersonal weaknesses of workers.

Intentionally Interpersonal Safety Training
Not all worker resistance is of the severe magnitude experienced by the desperate general manager described in Part 1. But to any manager who suddenly realizes that “good employees” in his organization are on the verge of spinning into the Cycle of Rejection (see Part 2), the situation can seem as serious.

Such was the panicky attitude of a global manufacturing company's operations excellence director when he realized that his plants' safety representatives, were, for no apparent reason, beginning to resist his carefully crafted 5-year safety excellence plan. Midway through the plan, he found that the ability of his safety representatives to engage employees — younger employees in particular — was less than he initially believed.

The harder he pushed them to engage employees, the more they resisted. Sound familiar? The interpersonal skills of his representatives required improving in a manner that did not risk further alienating them, so he called the author for help.

Since hazard recognition was the next focus of the 5-year plan, it was decided to integrate relational skill development into the safety representative's hazard recognition training program. An emphasis on reaching younger workers was included. One of the company's values, integrity, served as the drumbeat.

The human development goal was to help the representatives understand the difference between the preferred behavioral tendencies of older workers, such as themselves, and the preference of the plants' predominately younger workers. An easy four-part behavior profile was incorporated to help the participants understand the difference. From earlier articles in this series, you may recognize this goal as helping the hardnoser understand why people do what they do.

The safety management goal was to teach the representatives a simple 1-2-3 hazard recognition process that could be persuasively communicated to employees.

The resulting outline for the 8-hour training course delivered by this author is as follows.

Course Achieving Safety Integrity through Hazard Recognition
Length 8 hours
Format Live presentation; interactive workshop
Section 1 Hazard Recognition: A Matter Of Integrity
Participants are asked to think of hazard recognition as a matter of integrity, as a way of “doing the right thing.”
Section 2 Clearing the Value Path to Hazard Recognition
Participants learn about a “perfect storm” of negative social influences that hinder employee “buy-in” to hazard recognition. How to turn these negatives into positives is taught.
Section 3 Capitalizing On Communication Desires to Jump-Start Haz Rec
Participants learn a behavioral approach to hazard communication — capitalizing on the communication craving of Generations X and Y — in order to achieve employee engagement in hazard recognition.
Section 4 Making Haz Rec Work Simply
Participants learn a simple 3-step process for Haz Rec — observe, interpret, apply — that engages everyone in the routine practice of hazard recognition. A 3-question mechanism for gaining accountability is taught.
Section 5 Using Behavior Recognition Skills to Build Haz Rec Effectiveness
Participants learn the strengths and weaknesses of each behavior type so that they may better recognize how employees allow hazards development and loss to occur. Correcting unacceptable behaviors before an incident happens is taught.

Learning Objectives

  1. A review of the company value of integrity in relation to hazard recognition
  2. A simple effective 3-step method of hazard recognition
  3. A knowledge of the participant's own core behavior tendencies
  4. A method to accurately recognize (read) the behavior tendencies of others
  5. An understanding of how to 'sell' hazard recognition to others via persuasive communication skills targeted to the behavior tendencies of others
  6. A strategy for maximizing hazard recognition through the networking behavior of Gen X and Y

The effectiveness of the intentionally interpersonal approach to safety training was immediately evident in the participants' feedback. Hardnosed safety representatives are not easily fooled. Most have seen a dozen lackluster varieties of the “safety flavor” of the month.

“He left no stone unturned,” said one. Grasping the dual nature of the training, another said, “Not only did I learn about safety recognition but I also learned more about my own personality and the personality of coworkers.” [The course emphasized behavior, but the common use of “personality” is close enough.]

Still another of the 75 participants said, “It wasn't what I expected.” No, it isn't, which is the point. It met felt needs, unlike other safety training. Added the participant, “I liked the straight talk.”

Most telling is the participant who stated that she will “use these ideas at work and at home.” It is a reminder that the greatest needs are life skills. Another participant said that he would use the course material to “make personal changes.”

Intentional Results
Success is never guaranteed. But the intentionally interpersonal safety training advocated in this article has proved successful in every work environment from which the T-JTA data that defines a hardnosed worker was extracted.

In addition to improving the measures of traditional safety management — recordables, lost times, observations — several measures of human resource management effectiveness were improved, including personnel turnover rate, workers' compensation claim rate and various measures of employee engagement or attachment.

One large maritime company saved over $20 million during a 2-year period as the author and his colleagues worked with them to conduct a company-wide interpersonal safety training program.

An organization committed to breaking down the barrier presented by hardnosers may reap the unimaginable “better results” spoken about by John Bennett in Part 3. But to do so requires a shift in management perspective — from a reactive posture in which the hardnoser is viewed as an object to be conquered to a proactive policy of ministering to the hardnoser's needs.

Below is the story of one company that made this commitment. It's the company whose desperate general manager initially called the author in Part 1. Remember him? He is the one who thought that his supervisors were acting like troubled kids. And he was right. So was his inclination to react in the right way.

Enabling A Safe And Profitable Transition
One beneficiary of the blended safety training approach was Chotin Carriers, Inc., now a part of the Kirby Corporation. Kirby's impending buy-out of Chotin, a small company of 120 employees, only added to the human resource and safety management challenges faced by Chotin's general operations manager, Arnie Rothstein.

Chotin's overall personnel turnover rates for the years previous to the buy-out were respectively 47%, 40%, 44%, 35% and 41%. Rothstein conservatively estimated that each employee turnover cost Chotin a minimum of $4,300, or an average annual turnover cost of $349,760.

Starting in Chotin's buy-out year, the author administered a series of training programs that addressed both the safety need of Chotin and its human resource development challenges. The result was that Chotin's turnover rates dropped to 20.3% and 2% respectively over a two-year period, saving Chotin thousands of dollars in personnel turnover costs.

During the same period of time, Chotin's safety performance was also improved. The company's total injury index rate (per 200,000 man-hours) dropped from 8.0 to 4.32, a 46% reduction. With an estimated cost of over $30,000 per lost time back injury, special emphasis was placed on reducing lost time injuries. The result was a 64% reduction in Chotin's lost time injury frequency rate.

Better than these results to Rothstein was the sweet aroma of employee cooperation, evidenced by one of the company's reformed hardnosers, who said, “I've learned more from this training than I've learned in all the other training put together.”

Why Bother?
It is convenient to be like the skeptical Cleveland-area businessman in Part 3 who views everything in this presentation as silly “social work.” But the evidence presented here suggests that you can not pretend that a sub-culture of hardnosed workers does not exist.

Take it from an expert in destructive behaviors. If there is one thing that delights a hardnoser — that encourages his resistance — it is knowing that management will ignore him, allowing him to run amok. Such tolerance provides him with a complete sense of control. It justifies his retreat into emotional isolationism, disengagement, and dysfunction.

Ignorance by management is not bliss. There is a price to pay for such folly.

Massive amounts of money are spent on strategies that, at best, merely limit the ongoing damage done by change-resistant employees.

No amount of pre-employment screening can solve the problem. No human resource policy, employee management strategy, or performance evaluation criteria can deter it.

Nothing short of a purposeful, committed effort to provide hardnosers a path to healthy personal development will decrease their resistant nature. Safety is the open door to that end.

Bibliography

“Focus On Teamwork, Attitude Improves Quality And Safety.” The Waterways Journal. April 25, 1994: 41-44

Newton, Ron. No Jerks On The Job. Irving, TX. PenlandScott Publishers, 2010.

Riddle, Glenden P. An Evaluation Of The Effectiveness Of Stress Camping Through The Use Of The Taylor-Johnson Temperament Analysis Exam. Research Project. Dallas Theological Seminary, December 1978.

Taylor, Robert. Taylor-Johnson Temperament Analysis Manual. Thousand Oaks: Psychological Publications, Inc., 1992.

Breaking Through The Barrier Of Hardnosed Workers, Part 2

Righting The Ship Wrongly
For torturous purposes, let’s say that you are an executive manager who has inherited the type of hardnosed workforce described in Part 1 of this series.Your laborers are largely emotionally repressed, unsympathetic, narcissistic, uncontrollable and prone to permanently go AWOL. Ditto for your supervisors and managers. Collectively, your work force constitutes a change-resistant barrier that thwarts every attempt at achieving continuous improvement.

As risk strategist Greg Pena suggests, you set about to correct the obstructionist nature of your workforce. Otherwise, your best management efforts are “doomed from the start.”

Which quick-action strategy do you choose?

  1. Create and enforce more rules designed to secure better worker behavior?
  2. Implement a system of rewards and awards designed to reinforce good behavior?
  3. Pursue an aggressive program of quality assurance that requires strict behavioral compliance and reporting?
  4. Institute a behavior observation program that results in establishment of improved work procedures and oversight?

This is not a trick question.

Damage Control

To begin, you might start by quickly doing what others have traditionally done in similar situations.

  1. Assess where the most “damage” is being done by the most resistant workers.
  2. Speed headlong in pursuit of the holy grail of gaining control of those workers.

You do this because you’ve been taught that lack of control is the foundational cause of rebellious behavior. Control is considered a weapon. To heck with human resource management laws and employee management policies. They are slow, ineffective weapons of change. You need something that works quickly.

So to gain instant influence, you deploy whichever of the quick-action strategies (above, a–d) that you think will give you the fastest results. Each approach promises control; all are known quantities. Together, they constitute the bulk of management’s current wisdom in wrestling control from hardnosers.

The strategies are as follows.

a. Control By Directive — create and enforce more rules.
This is an old tactic closely associated with authoritarian or directive leadership style — it is dependent upon the strict use of the chain-of-command for enforcement. The strategy involves using rules and regulations to achieve (by demand) behavior compliance — control. It is the attempt to regulate and regiment behavior.

b. Control By Incentive — implement a system of rewards and awards.
This is a popular method of gaining control because it seems to “make the most sense” when it comes to worker motivation. It is based upon the belief that workers will be motivated to better behavior if they receive objective rewards, incentives or other strokes of positive reinforcement. Typically these take the form of safety awards, cash rewards or financial incentives that depend on the utilization of performance evaluations, merit ratings, or periodic reviews.

c. Control By Quality — pursue an aggressive program of quality assurance.
This is an old but evolving strategy, currently masquerading as the GRC (Governance, Risk & Compliance) movement. It promises the possibility of simultaneously achieving quality assurance, risk control, regulatory compliance, and behavioral control — with a dash of ethics, integrity, and maturity thrown in — if only we pursue the perfect quality assurance processes. This strategy started as the ISO quality certification process in which rigid paperwork and reporting processes are utilized by managers as an accountability tool.

d. Control By Observation — institute a behavior observation program.

This is a relatively new approach to gaining control of worker behavior. It is known by its popular name, behavior-based safety. In this approach, workers are trained to make intense and frequent observations of common work tasks in order that they might consult together and develop better methods for carrying out the work task. Workers are also taught the basics of how to communicate with each other when feedback is given on performance of work tasks. They are typically required to submit observational reports to authorities.

You don’t need to look hard to find assistance in whichever line of attack you choose. Professional pundits and practitioners of each stratagem are plentiful. So you select a plan. And it initially appears to work.

But its effectiveness in providing you anything other than short-term victory is sadly wasteful — your plan does not consider the characteristics of hardnosed behavior described in Part 1 of this series. None of the traditional control strategies do.

Eventually, you join the ranks of the frustrated transportation manager (Part 1) who implemented a safety training observation program, improved his operational policies, and led his organization in the ISO 9000 certification process — all to little avail. He still couldn’t control his hardnosers.

Changing the emotionally insular nature of rejection-prone people is hard. But as the manager stated, “The alternative, letting them continue to drag our company down, is not an option.”

Rejection On Demand
The fundamental mistake made by a majority of managers is assuming that control is the main issue, that control reduces resistance. And while control certainly occupies a high priority, the real issue is how it is obtained and why it is necessary to sustain it.

The tendency is to forget the lesson learned by all authorities. Any attempt to gain and maintain control of people in the wrong way ultimately results in the rejection of the authority.

Historian Page Smith states it this way. “The whole course of history indicates that one of the most potent bases of common action is a common sense of unjust subordination.”

Unjust. Fair or not, that’s how the common hardnoser views your attempt to gain control of him when you employ any of the well-intentioned strategies listed above. Setting aside the perception of justice, the hardnoser makes a valid point. Many times management demonstrates that it doesn’t know how to gain control, nor bother to explain why it is necessary.

What? Is Not The Question
Tom Slattery, Environmental Health and Safety Manager at POET Plant Management, pulls no punches in holding management accountable. “The way management and safety people talk to and treat the workforce,” he says, “is largely responsible for the ‘bad attitudes’ in the workforce.”

Slattery cites instances in which management says it wants one thing yet subtly rewards the opposite, essentially abusing its control. Placing himself in the mix, he says, “We do not follow through on promises, ask for true employee participation, nor explain the ‘why’ behind policies.”

In the realm of change-resistance, telling someone what to do and how to do it without telling them why they are doing it — why it is to their benefit to do it — is a cardinal sin. As Slattery emphasizes, telling them poorly adds fuel to the fire. It is the equivalent of assuming the listener has no needs other than the need to obey the management. Part 3 of this series explores the depth of the disdain created by this assumption.

Any child knows that asking an uncaring parent the why question (in a response to a command) almost always solicits the brusque answer, “Because I said so.” Yep, that really works.

Ignoring the need of workers to know why they must relinquish autonomy in order to follow the lead of management will provoke resistance from even-tempered people, much less needy hardnosers. Yet historically, that’s what management has done.

In the attempt to gain control of hardnosers, we’ve employed a lot of ‘what to do’ and ‘how to do it’ tactics without first considering the felt needs of the worker. Management asks for the rejection it anticipates.

As a result, a Cycle of Rejection develops. Most organizations that spawn hardnosers are guilty of entering this 6-step cycle. As illustrated below, the black colored steps represent management; red represents workers.

The 6 R’s Leading To Rejection

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Frequently the cycle of management missteps — the six R’s — that reinforce an ever-increasing change-resistant work force is as follows. If the object is control, this is how not to get it.

Revelation — Often using poor and impersonal communication, management tries to educate the worker with bits and pieces of the performance puzzle, most often “what we want you to do” and “how we want you to do it.” These are typically the minimum requirements of compliance — the policies, practices, or procedures that the worker is expected to obey/follow.

Response — The worker responds negatively to poor communication and perceived command-and-control tactics — they remain largely unresponsive to performance expectations. The worker equates poor communication with perceived neglect of both his real and felt needs. He begins to develop an attitude of skepticism/pessimism towards management.

Rationalization — Based upon the worker’s non-response, management perceives a resistance in the worker. Rationalizing that the only way to accomplish its desired performance goals is to use more direct commands, they resort to directive leadership methods designed to seize control of the sources of resistance and to force worker compliance.

Regimentation — Upon rationalizing that the worker will only respond to authoritative command structure, managers put forth a regimented series of operational rules and regulations — more specifics about what to do and how to do it — designed to force the worker to shape up (comply).

Resistance — The worker resists management even further, thinking that management is overbearing and taking away his ability to conduct his job as he sees fit. The process of addressing performance management through poor communication skills and mistaken tactics results in an increasingly change-resistant hardnosed worker.

Repeat — Management redoubles its effort to control the worker without rethinking its strategy. Nor does it stop to analyze the nature of the resistant worker and his felt needs. Repeated failure to do so leads the worker to forthrightly reject any and all attempts by management to seize control. To the worker, management becomes an unjust usurper.

Management’s inclination to simultaneously consider the steps of Rationalization and Regimentation are why they appear back-to-back in the cycle. As management becomes more entrenched, determined to win the control war, the gap between the two steps narrows. It becomes easier to rationalize that more regimentation is needed.

Duck & Cover
What the Cycle of Rejection illustrates is the futility of thinking that command will result in the control of hardnosers. Quite the opposite. But while it’s folly to follow this path of thinking, there is an even more damaging option to choose: doing nothing.

An operations manager whose supervisors had long been on the road to rebellion had this exact strategy in mind — do nothing — when he sheepishly asked the author, “You aren’t going to stir the pot, are you?”

The manager was worried that a few forthright words from the author’s keynote address to the supervisors would enflame the emotions that lay, he thought, comfortably submerged below the thin surface of civility. Yet his boss, the business owner, wanted a permanent solution to his hardnosers’ resistance. He wanted to take back control of his workforce. But no one knew how, much less why. Part 3 of this series will show you both.

Yes, the pot will be stirred.

Bibliography

“Focus On Teamwork, Attitude Improves Quality And Safety.” The Waterways Journal. April 25, 1994: 41-44

Newton, Ron. No Jerks On The Job. Irving, TX. PenlandScott Publishers, 2010.

Riddle, Glenden P. An Evaluation Of The Effectiveness Of Stress Camping Through The Use Of The Taylor-Johnson Temperament Analysis Exam. Research Project. Dallas Theological Seminary, December 1978.

Taylor, Robert. Taylor-Johnson Temperament Analysis Manual. Thousand Oaks: Psychological Publications, Inc., 1992.