Machine operator being coached by on-site ergonomic consultant/physical therapist Suzanne Poppen, PT, MA, MPT, CSCS, on how to squat and use modified lumbar flexion to carry out tasks in order to reduce the risk of injury and forces on the lumbar spine.

Machine operator being coached by on-site ergonomic consultant/physical therapist Suzanne Poppen, PT, MA, MPT, CSCS, on how to squat and use modified lumbar flexion to carry out tasks in order to reduce the risk of injury and forces on the lumbar spine.

by Kristen L. Cederlind, OTR/L Providing care at an employer’s work site goes well beyond simply staffing a therapy clinic that happens to be located at the workplace. In fact, what happens beyond the clinic walls may be more important than what occurs within the clinic space. Many employers are seeing the value of having healthcare providers available on-site to aid in their workplace injury prevention and management efforts, as well as to enhance wellness program offerings and to create a more positive employee experience. While a variety of healthcare providers may partner with employers for on-site care, physical and occupational therapists, as musculoskeletal experts, are uniquely qualified to support employers in addressing all of these initiatives. In this rapidly expanding niche of occupational health, therapists can focus on promoting their services and advancing their skills needed to deliver a successful on-site program offering, which benefits both employees and employers and can lead to a high level of job satisfaction for themselves. In the context of this article, on-site services refers to a model that includes a set, weekly schedule of hours at a work site, as opposed to occasional consultations by therapists at a work site. The number of hours may vary from week to week or site to site based on size, industry, and location, but the primary goal of all interventions is to keep the employees healthy and free from musculoskeletal injuries that can impair not only their productivity at work, but also their happiness outside of work.

Services On Both Sides of the Wall

On-site services that may happen inside the clinic walls include OSHA-compliant first aid and post-injury treatment, when indicated. At the first sign or symptom of musculoskeletal discomfort, the therapist can screen the employee and provide first aid (if appropriate) or refer the employee for further injury assessment/management. In those first aid visits, the therapist can also explain the natural course of healing for minor musculoskeletal issues, instruct in symptom management, and provide reassurance to the employee throughout the healing process. Most importantly, the therapist can monitor and even enhance the healing process by going outside the clinic and visiting the work area, observing work tasks, and coaching the employee in alternate methods of task performance to reduce discomfort. Follow-up visits (inside or outside of the clinic) can ensure the employee is healing as expected and, if not, can ensure the employee gets directed to the appropriate level of care. On-site therapists also engage in a variety of other activities beyond the clinic walls. These activities may include completing formal functional job analyses to document the essential functions and critical physical demands of jobs, performing workstation ergonomic assessments, assisting the employer with finding suitable job modifications for employees returning to work, educating the work force in injury prevention strategies through job coaching, implementing warm-up or microbreaking stretch programs, creating general fitness programs, and much more. Many employers also allow on-site therapists to help address employees’ non-work-related musculoskeletal discomfort since, left untreated, these issues can lead to work-related injuries. If an on-site therapist is sitting in the clinic waiting for their next appointment to show up, they’re missing the point. There is no shortage of work to be done, and going outside of the clinic walls is the most effective way to build a successful program.

Appeal to Employers and Employees

Why are on-site services so appealing? We’ll answer this question from the perspective of the employer, the employees, and the therapist. It’s a winning proposition with tangible and intangible benefits for all parties. Employers, as a whole, are dealing with not only a high number of injuries, but also a high percentage of musculoskeletal injuries, which often prove to be both costly and disabling. According to the US Bureau of Labor Statistics (BLS), more than 30% of all injuries are musculoskeletal in nature, with the top cause of these injuries being “overexertion.” Strains and sprain injuries are often preventable, when there is ongoing effort to evaluate and mitigate risks and hazards that might lead to injury. Therapists working on-site can assist with functional job analysis or ergonomic assessment of tasks in order to aid in risk identification. These processes can help kick-start the generation of solutions to reduce risk. In addition to the number and severity of work-related injuries, employers are also dealing with other challenges such as a shortage of qualified labor, an aging workforce, and the compromised general health of the population (including diabetes and obesity). These factors, combined, create barriers for maintaining a healthy and productive work force. For the employer, having a therapist on-site can boost injury-prevention efforts through easy access to early intervention right at the workplace and ergonomic recommendations to identify and help mitigate the sources of musculoskeletal discomfort. Employees also benefit from having on-site therapists at their workplace. Rather than having to leave the workplace for appointments, losing valuable work time in the process, they have easy access to care. As they build a trusting relationship with the therapist, through casual interactions in the workplace or personal experience (or report of a co-worker’s experience) in the clinic, employees are more likely to feel comfortable reporting discomfort and getting it addressed before it turns into an injury. According to Deloitte Global Human Capital Trends for 2017, the “employee experience” trend urges employers to focus on creating environments that make people genuinely want to come to work. Employees are “looking at everything that happens at work as an integrated experience that impacts daily life in and outside the workplace, including overall physical, emotional, professional, and financial well-being.” Creating that desirable environment requires addressing physical workspace, organizational culture (which included focusing on work/life balance), and the use of updated technology and tools. Organizations must design their workplace practices to fit their people, not the other way around. By having on-site services available, employees gain a positive and productive employee experience through (1) easy access to care, (2) building of a trusting relationship with the therapist, and (3) knowing there is a friendly advisor who has a meaningful understanding of their work by virtue of being present in the space, observing and analyzing job tasks. Employees who gain musculoskeletal wellness are better equipped to balance the demands of work and life.

A Simpler Way to Practice

Finally, therapists receive benefit from providing on-site services. Many therapists report a high degree of personal job satisfaction by being able to focus on proactive and creative problem-solving for injury prevention, rather than solely reactive injury management in the traditional clinic. They value being able to work autonomously, practicing to the fullest extent of licensure, and benefit by creating a diversified revenue stream through cash-based, recurring revenue. Compared to today’s hospital and private practice environments, where it seems documentation and coding are driving the provision of care, documentation and billing for on-site services are dramatically simplified. Most on-site services contracts are billed at an hourly rate. The outcomes are measured in injury or injury cost reduction and employee satisfaction. Providing on-site services can be a welcome change of scenery from traditional practice and enhance personal work-life balance. Providing on-site services is not for everyone, however. Therapists who are considering expanding their service offerings to include on-site should have the following characteristics: (1) a genuine interest in helping employees and employers, (2) strong communication skills, (3) experience with treatment of a variety of musculoskeletal issues, (4) a high level of self-motivation, and (5) upskilling in value-added services that happen within and beyond the clinic walls. Therapists must have a solid understanding of OSHA recordkeeping and guidelines for first aid. Additionally, therapists should seek specialized training in job analysis and ergonomics.

Make Marketing Successful

When marketing your services, these key concepts should drive your efforts—know what you do, be able to talk about what you do and how you can help in language the employer would understand, ask the employer what they need, and then listen to their responses. Develop a list of your service offerings. Develop a 1-minute version of how your services can help a potential employer. Avoid using technical jargon or describing techniques you are trained in, but rather discuss how you can help employers save on their bottom line spend or save their employees’ HSA dollars through on-site injury prevention and treatment. Examine which employers in the area may be potential candidates for on-site services based on your own therapy caseload and referral sources. In conversations with potential candidates, listen to their needs and only then develop a proposal for your services.

Partner In the Work Force

As a therapist, there has never been a better time to investigate on-site services. APTA’s 2017 official “Position on Direct-to-Employer Population Health Services by Physical Therapists” proposed that PTs work directly with employers or employer groups as part of a larger fundamental shift in healthcare which focuses on providing prevention through health risk reduction. Focusing on the work site is effective because (1) people need to be treated where they are, (2) employers and employees shoulder a great financial burden for healthcare costs, and (3) PTs are already part of the occupational wellness team. Working on-site, therapists are able to integrate into the culture of the organization and become an effective partner to the employer for injury prevention. They learn to speak the language of the workplace. They learn how management and employees collaborate and relate to one another. They see and hear issues impacting employees’ physical comfort on the job. They are able to utilize both their relationships with key site contacts and knowledge of the employees’ perspective to make recommendations that improve the physical workspace and reduce risk of musculoskeletal discomfort. When employees experience the impact of these changes, it continues to foster an environment of mutual trust, which can positively energize the culture and improve active, voluntary participation in workplace injury-prevention processes. More employers are recognizing the value of bringing healthcare providers directly to the work site for purposes of work injury prevention and management. Physical and occupational therapists, especially when embedded into the workplace, can be that expert partner in both clinical and nonclinical interventions. RM Kristen L. Cederlind, OTR/L, currently serves as the director of the WorkWell Quality Provider (WQP) Network at WorkWell Prevention & Care, based in Duluth, Minn. Her more than 25 years of experience includes program development, rehabilitation department management, and collaboration with employers and therapists in the provision of on-site services. For more information, contact [email protected].