Effective Care Management Minimizes Workplace Injury Severity
Authors: Daniel M. Couch , Albert J. Robb 
Published: March 2016

Leveraging effective Care Management strategies within a strong Safety Leadership framework to manage both acute and chronic conditions has been demonstrated to minimize severity and injury outcomes and foster a more productive work environment. This paper details the Care Management strategies adopted within ExxonMobil Global Services Company (GSC), a subsidiary of Exxon Mobil Corporation. GSC includes approximately 9,000 employees and over 12,000 full time equivalent contracted workers within the following organizations: ExxonMobil Environmental Services Company, Global Real Estate & Facilities, Procurement, Information Technology and GSC Business Services.

Shifting from a "systems influenced" Case Management approach that existed to determine OSHA recordability to a "culture influenced" Care Management approach assuring proper care is provided has changed the mindset of workers as they are no longer hesitant to report injuries. In fact, our GSC's experience demonstrates workers come forward earlier, particularly in chronic musculoskeletal cases, before their conditions become severe or debilitating. Management, ranging from site managers down to the first-line, then has time to review and address vulnerabilities of work tasks, office environment, and tools used, with subsequent early occupational medical intervention that is generally less invasive, sets limitations versus restrictions or avoids time away from work.

This shift in approach within GSC was a significant contributor to minimizing the total number of OSHA defined recordable injuries by 65% from 2010 to 2014. During this same period, the total number of injury incidents reported by workers actually increased 20%. Specifically, field operations diminished recordable injuries by about 60% and office-based workers recordable incidents decreased by almost 75%. With respect to office ergonomic incidents, the emphasis put on early detection, reporting and providing prompt, adequate and appropriate care, contributed to a decrease in recordable injuries by 77%. We also developed a "Care Management Effectiveness" scoring system to measure effectiveness for completing the "system-based" elements of case management. In 2009, effectiveness of the Case Management averaged 59%. The prominent three factors for poor effectiveness was: 1) Timely notification to management, 2) Timely work relationship determinations, and 3) Seeking prompt, adequate, and appropriate medical attention. After implementing Care Management, effectiveness increased to 95%. In summary, following the Care Management approach linked to a Safety Leadership framework has contributed to a significant decline in injury severity and made case management more effective and productive.

A strategy that balances the strengths of both Case and Care Management that puts a greater emphasis on assuring proper care will minimize work place injuries. Case Management is a systems approach and has success factors that have a strong focus on addressing if the injury has reached as defined by the United States Occupational Safety & Health Administration (OSHA) recordable status. Care Management; however, integrates cultural success factors with "Safety Leadership;" this helps to minimize the impact of a worker's injury and promotes an open and productive work environment.