Dennis and Susan Isernhagen, PT, of DSI Work Solutions

DSI Work Solutions was founded by Dennis and Susan Isernhagen, PT, in 2004. Susan Isernhagen recently spoke with Rehab Management (RM) about designing and implementing work injury management systems.

RM: DSI Work Solutions develops best work injury management systems within the United States and internationally. When was the company established, and what was the motivation behind its concept?

Susan Isernhagen: DSI grew out of a need Dennis and I perceived that employers (our customers) and therapists (also, our customers) both had. Therapists are functional experts, and often are not used to their highest professional capacity. Employers are often blocked in return-to-work (RTW) progress by doctor restrictions. What the employers, workers, therapists, and medical team needed was functional information, which is the hallmark of the therapist. Thus, in 2004, I developed a job matching process that involves job analysis, functional job-specific tests, early RTW, and a highly improved capacity assessment. What therapists have always wanted is clear, comprehensive, yet concise and easy-to-use formats. The new DSI programs, licensed to therapists beginning in 2005, have received excellent reviews from both therapists and employers. Dennis continued expansion of these pivotal programs in employer clients. Now, DSI programs are regarded as the hallmark of injury expansion and management.

RM: What process is used when developing workplace injury management and prevention programs? Who are the professional consultants involved?

Isernhagen: This is a very perceptive question, as it involves a team. The therapist is a pivotal participant, as they understand functional requirements of specific work, how to work effectively and with reduced risk, and how to measure functional work performance of a worker. Those who need that information in the workplace are the safety director, human resources, workers' compensation manager, hiring manager, and disability coordinator. Ergonomists, medical professionals, and case managers complete the team. The DSI-trained expert therapist understands that they bring information on worker performance from a capability and safety standpoint. Therapists can evaluate jobs and design specific tests that are short and job-related, and make sense to workers and supervisors. Physicians, who release workers back to their job, appreciate the specificity of the return to work, as it is evidence-based, protects the worker, but also protects the employer from unneeded lost time and disability.

The therapists meet with and understand the needs of the employer, medical team, and the workers. DSI training in proven outcome-based programs gives the therapist significant experience and credibility to build this OCC health business.

RM: How do you convince a company that it should implement a work injury prevention and management program?

Isernhagen: First, the company must be able to identify its barriers to better injury management. Perhaps employers feel that their workers are not released to return to work in a timely fashion. Perhaps they feel that injured workers may have been placed in jobs that they cannot do and that is the reason behind injury. Perhaps the employer knows they need ergonomics for prevention and job modification for early return to work, but do not know how to implement it.

Thus, the therapist must understand the needs of the specific employer with which they wish to work. Worksites are different, employer point of view differs, and workers have varied work methods. To market to a company means that one understands their specific needs and can provide targeted solutions. DSI programs are designed to answer all of the above needs of employers. Employers are usually surprised to know they have providers who can answer their needs. Once in an industry, successful DSI providers find their business growing in broader areas due to the success they bring to the employers on the programs that were first selected by the employer.

It is also critical that workers feel good about the programs. Dennis and I believe strongly that the workers are central, and that employers benefit from workers having a better injury prevention and early return to work system.

RM: When assessing workplace injuries, what are the primary factors the health care provider should take into consideration when advising both employer and health care professional? Are employers always compliant with these recommendations?

Isernhagen: Another important question! If the needs of the employer were the reason programs were implemented, then the employer will see directly how DSI or OCC health programs are meeting the needs. Outcomes can be measured and this is direct proof back to the employer.

Unfortunately, some OCC health providers use the "build it and they will come" approach, which means they "sell" something to the employer.

DSI and its providers do not work in this way. We get very high compliance with our suggestions because they come directly from workers, supervisors, and management. We provide answers to the needs the employer already expressed. The resulting high compliance leads to excellent outcomes and increased use of the OCC health provider who provided programs that answered the needs.

RM: How often is worker retraining or retraining recommended to prevent injury (or future injury)? Universally, what are the most common workplace injuries?

Isernhagen: With DSI programs and training, we identify the possible problems that could cause injury in a job. It could be ergonomics, better training of employees, or fitting workers to jobs in a more effective manner. This is part of the initial training, DSI job function analysis/descriptions. Often recommendations on ergonomics or training are made at the time of the JFK for prevention purposes. Later, however, if there is an injury on the job, the therapist already knows the factors and can address those issues in the return to work process. If additional training is needed, that can be given simultaneously with the job-focused treatment.

If you are referring to retraining in a new job, in the case of a significant injury, this is done as part of the team approach and case management. When DSI job testing as been implemented in a company, it is a relatively easy process to identify new jobs the person can do, as the DSI job function description categories can be matched against any person's abilities. This would be perhaps 1% to 5% of the time.

Once early RTW has been implemented in an industry, however, we rarely see anyone need to go to the disability level and retraining.

Injuries continue to be high for back and upper extremity cumulative trauma. The most important new focus, however, is the shoulder. This can be the highest prevalence and cost for many employers. Whether this is related to the aging worker is not known, but this is an area that requires more attention from employers and health care providers.

RM: What are the most common benefits to employers and health care providers in developing and implementing a work injury management and prevention program?

Isernhagen: Employer benefits are a healthier workforce, safe jobs that retain or improve productivity, decreased lost time, decreased workers' comp medical or disability costs, improved relationships between workers and employer, and effective hiring. Systems that are integrated in the company and do not move on with change of personnel are of importance in today's changing world.

Worker benefits are safer jobs, clearer yet fair hiring criteria, the best medical care ... and care that comes with the therapist or physician being able to know the job. Personalized involvement of the worker in their work management is critical to stop adversarial positions from forming. Workers are involved in the job analysis, so they know they "own" that part of the process.

Health care providers have far less frustration as their relationships with employer customers are clear and improved, and lead to better outcomes for the workers (patients). With the demonstrated improved outcomes to the employers, DSI providers see increased business and expanded service opportunities. There tends to be expansion into early return to work, prevention, ergonomics, and consulting.

DSI and OCC health programs described here are equally effective for workers' comp, health and illness care, disability management, and the aging worker.

Satisfied employers and workers also make excellent references to their counterparts in the community. The market broadens as other employers seek the same good outcomes and workers seek medical/therapeutic care where they have been treated honestly and assisted in a positive work sustainment.

—Rogena Schuyler Silverman