Karen Miller

Successful Pilot Program at Hewlett-Packard

September 1998
Karen Miller, a 1980 graduate of COEH's first class of occupation al health nurse practitioners at UC San Francisco, has developed a program  at Hewlett-Packard, Inc., that has reduced the severity of injuries and illnesses on the job. We profile her achievement below.
Karen Miller advising an injured employee in the  Occupational Health Clinic at Hewlett-PackardOccupational Health Nurse Practitioner Karen Miller and her colleagues serve some 5,000 employees at three Hewlett-Packard (HP) manufacturing facilities in Sonoma County. The work that many of the employees do is very intense— handcrafting, much of it performed under a microscope using tweezers and soldering tools—and the incidence of upper extremity repetitive motion injuries like tendinitis is high.
Seeking new ways to control workers' compensation costs, reduce the incidence and severity of injuries, and improve the figures for time lost from work, Miller and two other nurse practitioners developed a pilot Nurse Practitioner Clinic last January to keep more cases under their roof.
For years, injured HP employees had been referred to outside resources, which made it difficult to follow their cases with consistency. Miller and her colleagues developed a new protocol whereby injured employees are offered  the option to see the HP nurse practitioner for treatment. Following a formulary developed with their medical consultant, the nurse practitioners can  prescribe medication and refer employees to physical therapy (PT). The most complex cases are still referred outside.
The key to the PT referral, Miller explained, is that the PT professionals, who are not HP employees, come to the workplace three days a week to treat injured employees, enabling her and the other nurses to track the progress of their patients with the PT team. "We've reduced our PT costs through tight case management and a close working relationship with the physical therapists," Miller said.
An added bonus of the new program is that "employees like being on site for their treatment," Miller said. Employees appreciate the convenience of the new service, and the in-house program lets the HP nurses keep a watchful eye on  their patients, intervene as needed, make suggestions, and answer questions as they arise.
A preliminary study made after the Nurse Practitioner Clinic had been operating for three months showed a seven percent to eight percent decrease in workers' compensation insurance costs per case relative to the costs for  employees sent out for treatment under the conventional program.
Based on these positive preliminary results, the new program may be expanded from Rohnert Park to Santa Rosa. Savings for a Sonoma County-wide program are projected at 14 percent to 16 percent. In addition, HP nurse practitioners in the San Francisco Bay Area have expressed interest in what Miller and her colleagues in Sonoma are doing.
Next Frontier
The next frontier for Miller is behavioral safety.
"We have a very aggressive ergonomics program, but it can't capture everything and solve all the problems," she said. "We are trying to break down the causes of our ergonomic problems. We have a pretty good handle on the  engineering and environmental part, but we haven't zeroed in as much on behavioral safety awareness. The next phase of the program will be helping people to identify risky behaviors that are contributing to the injuries. The nurses won't be doing the training, but we will be trained, so that we know what the employees are being taught."
Returning to Work
To ease the return to work for injured employees, HP has instituted two other new approaches. The company helps settle claims faster by having claims adjusters meet personally with employees to respond to questions and help them through the paperwork.
For employees who need to return to their duties gradually, HP has recently introduced a formal contract spelling out what the employee should or should  not be doing with specific time lines, so that everyone shares the same expectations.
"People like the idea of something in writing," Miller said, "and we build in check points to keep everyone on track." The contract concept reflects the philosophy of sports medicine, she explained: "Get the person back in the game as soon as possible, but without further injury."
For employees who must switch jobs permanently due to injury, HP offers yet another game plan: a 40-day, in-house job search program during which outside vocational rehabilitation counselors work with the employees to help them locate a job elsewhere in the company.
"The nurses play a pivotal role in all the meetings," Miller said. "We advise the employees and help them decide what they might do based on their medical condition."
Beyond giving medical advice, Miller and her colleagues use their contacts extensively to help employees ferret out new work. "Our networking has been very successful," she said. "It's amazing what you can find by word of mouth. The majority of people have been able to find alternative jobs within HP."
PHOTO CAPTION: Karen Miller advising an injured employee in the Occupational Health Clinic at Hewlett-Packard. PHOTO COURTESY OF KAREN MILLER