On the Right Track

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April 2003

By C.A. Wolski

The Johns Hopkins team, from left: Clifford Mitchell, MS, MD, MPH; Susan Rovnak, PT; Tricia Roberts; Stephen Wegener, PhD; David Salkever, PhD; Linda Ware, OTR, CHT; Keith Kuhlemeier, PhD, MPH.

The old stereotype of business and organized labor caught in constant combat has become a thing of the past—at least at the Ford Motor Company. Since the early 1980s, the company and the United Automobile, Aerospace, and Agricultural Implement Workers of America (UAW) have worked side-by-side to administer the UAW-Ford Physical Rehabilitation Project. The program, which also receives quality assurance from a team at Johns Hopkins University, is administered jointly by the organizations through the UAW-Ford Program Center, an entity created during the collective bargaining agreement of 1984, and was among the items agreed to during 1990’s negotiations.

“The union brought to the table fitness centers. [Ford] said that was a good idea, how about rehab centers with the motivation being [to find out if we] can provide the same care or even better care in-house than what we are getting out in the community for occupational injury,” says Steve Cherniak, Ford human resources associate. “The union agreed, and we piloted [the program] at a couple of plants over a 3-year period and saw great successes.”

Currently, the program is in operation at 18 Ford plants across the United States, and is open to all salaried and hourly Ford employees at those plants who may suffer either an on-site or off-site injury. “It is a voluntary program,” says Cherniak. “However, in some states, such as here in Michigan, workers’ compensation laws allow the company to direct medical attention for the first 10 days. After that, it is the employee’s choice as to whether they would like to continue there or go down the street.” The average plant in the program has 2,000 employees.

The program has been as popular with employees as it has with corporate executives, lowering absenteeism and raising morale. “The workers feel like Ford cares about them as workers in the workplace, that’s the main thing,” says Bill Sullivan, UAW International representative, Employee Support Services Program. “And it’s working. It has also helped [employees] work better, to build quality cars.”

Cherniak adds that the on-site rehab project is part of a continuum of programs that reflects the company’s commitment to worker safety. “This is an offshoot of doing things that help employees, and obviously the union and company reap those benefits by doing it,” he says. “It has been a win-win situation.”

Though the program is open to any Ford plant in the country, officials at the plant have to request it. The reason behind this is one of commitment. “We found the biggest thing first is that they have to want it,” says Cherniak. “If we try to force a unit on a plant, it’s not going to work. It’s got to be a mutual commitment from the local management, the local union leadership, as well as the on-site doctors, to have it work successfully.”

When a plant requests a rehab unit, it has to provide injury data from the previous 3 years including information on firsttime visits, types of injuries, workers’ compensation costs, details about the plant’s medical department, and its placement program for restricted workers. If this data fits the rehab criteria, then the plant can have the program implemented.

Sullivan says that the UAW-Ford Program Center not only exists to administer programs such as the Physical Rehabilitation Project, but to encourage plants to apply for the program and help them do so.

SPEEDY RECOVERIES

Rehab services are provided by two physical and occupational therapy groups—TheraMatrix and Brooks Rehab Solutions. Rob Macek, PT, of TheraMatrix, who works at Ford’s Rawsonville, Mich, plant says its services are similar to those offered by traditional rehab centers with one important difference, the quickness with which employees can access treatment. “It is well documented that the sooner an illness or injury is treated, the better the results are going to be and the sooner that individual is going to be healthier again,” he says.

The Rawsonville facility occupies the space of the plant’s former executive dining room and includes state-of-the-art exercise equipment, Macek says. The plant—like most Ford plants—has a wellness center, which was once the executive garage. After finishing therapy, employees can continue their regimen in the fitness center. The Rawsonville facility has two full-time therapists, a PT technician, a part-time PT assistant, a part-time certified athletic trainer, and a part-time receptionist.

In 2002, Macek and his colleagues treated 453 cases. In 2001, the last year for which there are comprehensive statistics, a total of 5,500 workers at all the 18 sites were treated, with an average of 342 patients per site. Most of the injuries were to the upper extremity with backs, shoulders, and elbows being the most common. The average number of treatments is nine, with attendance rates of 80%. About 90% of the patients return to full duty, at their same job, without any restrictions. Though Macek and his colleagues are available all day, employees still need a prescription from a physician to see them for treatment. The on-site team also visits workers on the manufacturing floor and are an element in Ford’s ongoing safety efforts.

While on-site rehab differs from its off-site cousins in some ways, particularly in the speed with which it begins, there are other, more fundamental ways in which it is the same. “We’re bound by the same laws—such as confidentiality between patients and practitioners,” says Macek. “So if someone comes in with a personal injury, that’s their personal injury. UAW and Ford have no interest in or right to the particulars of that injury.”

The UAW-Ford Physical Rehabilitation Project is not the only way the company and union assist workers. Under the umbrella of its Employee Support Services Program, workers have access to a variety of other wellness programs including weight loss, smoking cessation, and stress management classes.

QUALITY FIRST

To make sure workers are getting benefits from the on-site rehab program, the UAW-Ford Program Center insisted that it be subject to review by a quality assurance program. After sending out a request for proposals in the mid 1990s, UAW-Ford chose the Department of Physical Medicine and Rehabilitation at Johns Hopkins University to monitor the quality of the on-site rehab program.

“Our desire to be part of this project is not surprising, considering Johns Hopkins is about the discovery of new knowledge,” says Stephen T. Wegener, PhD, associate professor and vice chairman of Johns Hopkins’ Department of Physical Medicine and Rehabilitation. “We believe that part of the hospital’s mission is developing new ways to deliver health care. And we believed early on that UAW-Ford were on to a novel and effective way of providing rehabilitation care in a work-site environment.”

The team at Johns Hopkins not only provides quality assurance for the UAW-Ford program, but also does outcomes studies—including cost/benefit analysis—and provides a yearly conference for those involved in the program. The union-management collaboration has made providing quality assurance very easy, says Wegener. “To start with, [UAW-Ford] was very committed to quality assurance jointly, so it wasn’t an idea we had to suggest to them,” he says. “They had agreed together to do this. They had agreed that there would be a third party in the role that Johns Hopkins played. They also committed to make data-based decisions. They wanted to do outcomes studies and look at the data and determine if the program was working or not.”

Aiding the collection of data has been the development by Johns Hopkins of its Software for Occupational Rehabilitation Epidemiology (SORE) program by Keith Kuhlemeier, PhD, MPH, associate professor in the Department of Physical Medicine and Rehabilitation. SORE is the linchpin of the quality assurance program and would be impossible to do without it, says Kuhlemeier.

Based on Microsoft Access and created to mimic paper records, SORE’s intuitive design has ensured that it is easily understood by TheraMatrix and Brooks Rehab Solutions physical therapists. “We have a manual that goes with it, and I would swear that nobody has ever picked it up,” says Kuhlemeier. “You really don’t need to. It is intuitive enough that they can just follow it step by step.”

Among those evaluating the records is Susan Rovnak, PT, lead physical therapist on the Johns Hopkins team. After they are reviewed, Rovnak contacts the on-site therapists to go over problem areas. “There are some reasonable explanations that the therapist might have, some [areas] that are out of their own control,” she says. “We try to take everything in perspective based on what the whole medical team is looking at there. The majority are doing good therapy, good-quality documentation, but could fine-tune it.”

Evaluation does not end there. Rovnak and an occupational therapist make approximately 11 scheduled site visits per year. At each site, they meet with the plant’s rehab committee, and make sure that equipment is being used properly and that medications are up to date.

Though standards are high, Rovnak does not view the Johns Hopkins team as being in an adversarial role with the UAW or Ford. “I’m not hesitant to provide feedback,” she says. “My standards are high, but I don’t have any reason to be hard-nosed about anything. I’m asked to do a job. I want to be a resource for them.” The therapists are encouraged to call Rovnak or her colleagues throughout the year if they have questions about coding or other issues, such as new equipment acquisitions. After reviewing the documentation and making site visits, the team submits a written report that is presented to Ford by Wegener.

Kuhlemeier adds that these yearly report cards, which are shared throughout Ford, inspire improvement in other ways. “Each center gets a report on how it is doing and how it is doing compared to the entire program,” he says. “So there’s a certain amount of camaraderie and a certain amount of competition among the centers. And that’s to everybody’s advantage.”

BEYOND THE AUTO PLANT

The quality assurance program also measures worker satisfaction with services provided, which Wegener says has been very high. “No matter what criteria you use—whether you look at how satisfied workers are, how convenient the facility is, appearance and condition [of the facility], professionalism of the staff, accessibility, effectiveness of the therapy program, how it would compare to treatment they received from other therapists, how valuable the program is—it all ranks between 9.4 and a perfect 10.0,” he says.

From Rovnak’s perspective, there is no doubt that the program is beneficial to employees. “It’s a shame that there aren’t more companies out there doing this,” she says. “It really is a benefit to the working community. It also helps to minimize that idea of the employer against the employee when it comes to injuries.”

According to Wegener, statistics suggest that less than 7% of companies have an on-site rehabilitation program like Ford’s. And there is no reason that other companies—large or small—could not have similar programs, says Cherniak. “I don’t think there’s anything special about [Ford’s] environment, so other companies with similar situations, meaning occupational injuries, should look at it,” he says. “It’s something that makes sense.”

The program has had benefits beyond Ford. “The reward for [Johns Hopkins] is to be participating in the development of new ways of delivering health care, that’s an important endeavor,” says Wegener. “The second advantage is that it allows us to move outside of the traditional academic environment, and study rehabilitation problems in another setting.”

Wegener says he hopes other large companies will consider this model of providing rehabilitation services to injured workers. “The key to success is emphasizing quality care and using data to drive decision-making,” he says. He adds that no matter how many sites take part in the UAW-Ford program, the quality of services will be maintained.

C.A. Wolski is associate editor of Rehab Management.

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April 2003