Short Article: Big Topic
Jun 30, 2022

Red flags of one sort or another have been much in the news lately. Once upon a time, a red flag was a big piece of red cloth my grandfather tied to the end of a load of lumber piled up in the stake bed of his 1934 Dodge truck* so other drivers wouldn’t crash into the long pieces hanging out past the rear bumper. carried a short article on the current meaning of red flags with a lot of heft a week ago — “5 Red Flag Behaviors of Workplace Violence & Preventive Practices for Employer Liability Protection”. The point of the article is startlingly clear: “The concept of abrupt mental health instability is generally false. People don't just ‘lose it’ – there are always signs and precipitating events that contribute to these breaks.” Those signs and events are the meat of the discussion. What should you be looking for? What are the real red flags, beyond someone having a bad day and being grouchy? We all have bad days once in a while. What constellation of unusual behaviors might nudge you to pick up the phone?**


Here’s a quick list:

  1. Performance deterioration and oversensitivity to feedback/criticism
  2. Obsession with a coworker or employee grievance
  3. Tragic event fascination and recent acquisition of weapons
  4. Dramatic mood swings including belligerent/angry outbursts
  5. Ominous threats of harming self or others

OSHA regs make it clear that you have a duty to provide a safe working environment. This has been true for some time, but a couple of stats strongly suggest how hard it is to meet that simple goal. According to the National Institute for Occupational Health and Safety, homicide was the second leading cause of death due to workplace injury in recent years. Meanwhile non-fatal workplace assaults resulted in nearly 900,000 lost workdays. That’s a pretty hard potential hit on your workers’ comp and employer’s liability budget.


This is another risk area where your people and HR need to coordinate closely. If you have an internal security department and/or industrial hygiene and employee health specialists, make certain that all are on the same page and know what to do when anyone thinks they see a red flag waving. The worst case scenario occurs when risk and HR both assume that the other party has this issue well in hand.


The potential for employee violence in the workplace is an intensely unpleasant subject none of us enjoy and many folks may be tempted to look the other way and hope someone else is taking care. Don’t fall into that trap. Don’t condemn yourself to an endless cycle of “if only…” regrets by letting something ominous slide.


*That old Dodge had a mechanical semaphore arm on the cab instead of turn signals. Grandpa would tell six-year-old me when to pull the lever for stop, left turn or right turn. I loved it.

**No simple list is 100%, obviously. The idea is to help you develop a sense of what questions to be asking and then follow through on the answers.

1934 Dodge skate bed - a workhorse but also beautiful. 


What Does Hardiness Have To Do With Anything?

“Hardiness” is not a word you hear much nowadays. Shakespeare gives us a clue why: ‘Plenty and peace breed cowards; hardness ever of hardiness is mother.”* As the bard tells us, hardiness is a virtue of difficult times, called out by stress and tumult. Well, we might just be having some of that stress and tumult stuff right here and now.


Perhaps that’s why the Journal of Occupational and Environmental Medicine (JOEM) just published a research paper on “Hardiness and Burnout in Adult U.S. Workers”. The abstract states the objectives of the study plainly: “Burnout is a costly problem, and it appears to be getting worse due to COVID-related stressors. It is thus important for organizations to find better tools to prevent and mitigate worker burnout.” The abstract goes on to posit the development and cultivation of hardiness as an effective method for mitigating burnout. In fact, the study stresses that a distinct point of attachment for burnout is among younger workers who are “less hardy.”


Here’s what we see as the payoff in this research project: “Chronic occupational stress can lead to burnout, resulting in exhaustion and a loss of interest, confidence, and effort.” That looks like a major point of employment based risk to us. Listless employees make mistakes and neglect proper industrial hygiene, like using lockout tags consistently, securing loads properly, or just keeping their eyes on the road.


The core of the study’s conclusions should probably be a centerpiece for your next meeting with HR and Training and Safety :

One's sense of personal and professional effectiveness is enhanced by a strong sense of purpose and meaning in the job (commitment), a belief that one's actions matter (control), and a positive “I can do this” perspective on obstacles and problems that come up in the work environment (challenge).

We recommend reading the Discussion section of the abstract in detail. If anyone in your organization is a member of the College of Occupational and Environmental Medicine, they can pull this paper for you. Feel free to skip the sections on the statistical apparatus. The Discussion section is the meat for risk purposes. There’s some good stuff here, including a discussion of the superior hardiness of older workers. Yes, turns out years of “been there—done that” actually have a positive impact on worker effectiveness and productivity.


Burnout and a lack of hardiness can be a silent risk that undermines so many conventional risk mitigation efforts. Let’s give the researchers the last word here: “Every person has a breaking point, and even those quite high in hardiness may eventually succumb to burnout or other stress-related disorders.”


Got that?


*Cymbeline, in case you were wondering, one of the bard’s last plays. See Words to remember below for more.

There's one way to reduce stress.


Quick Take 1:
Heat Wave

Our Journal has carried a number of articles concerning the impacts of our changing weather on various risks. We’ve tended to focus on the obvious issues of more frequent and intense hurricanes or other types of storms or the growing potential for weather-induced grid failures. Joe Paduda added to the meteorological risk pile a couple of weeks ago with his thoughts on heat waves and workers’ comp. Like a good journalist, Joe starts this issue of Managed Care Matters with a no-nonsense bang: “The impact of global warming on climate change is happening faster than anyone thought. And that will lead to more occupational injuries and illnesses.”


Weather intersects comp in many ways. Heat stroke is the most obvious danger, but intense weather events, of course, carry their own dangers. Windstorms and floods make most aspects of working outside—including driving and operating heavy equipment—more dangerous. Potential power grid failures bring their own risks for people on the job. Classes of industry at risk include: public safety, manufacturing, healthcare, construction, logistics, agriculture, forestry, mining, and transportation. As far as we can tell, risk departments themselves are pretty safe.


A shameless plug: Joe and Jeff Rush of the California Joint Powers Insurance Authority will be giving a panel on this very topic at the National Comp 2022 conference October 19 – 21 in Las Vegas.* Climate change infiltrates everything we do in risk management. Don’t forget to include comp on your action list.


*A great place to practice for global warming.

Quick Take 2:
So Easy, Even A Dog Can Do It

An essay in caught our attention the other day. Perhaps you read it as well. If not, it only takes a couple of minutes to read Harvey Warren’s engrossing essay, “Something Ancient Is New Again”. We found it both useful and reassuring-- useful because it reminds us of an inexpensive and effective form of RTW therapy for injured employees and reassuring because it is based on one of the most ancient truths of humanity*, that the essence of care is personal communication and contact.


The message is simple: “non-medical services can be just as important to the recovery of an injured worker as the latest medical technology.” The essay speaks, in part, to the well documented positive impact of therapy dogs, how having a few minutes of communion with a friendly pup can boost a patient’s spirits in meaningful ways. We have often speculated that some of the very real benefit of nurse case management comes not just from the practical clinical interventions of the skilled nurse but also from the simple fact that the nurse is taking a sincere interest in the patient, asking important questions and responding in caring ways.


Read this little essay and ask yourself whether your comp program is using contact effectively to help the injured person feel cared for and wanted. Keep in mind that for the average American, many of their most meaningful social relationships are work-based. What happens when those seem to go away? Imagine yourself plunked on the couch at home, injured, on meds, and totally out of the loop while all sorts of important stuff is going forward in your risk operation. How would you feel?


The author quotes a manager at Zurich Insurance about how “she and her colleagues have been providing non-medical support to the injured for quite some time with great success and more rapid recoveries.” How radical, expressing care.


*We do mean ancient. The burials at Shanidar Cave in Iraq show that our Neanderthal cousins cared for and supported their injured clan members more than 35,000 years ago.

Say It Isn't So

Maybe you saw it too—a brief video clip on a news program, an item on the second page of the newspaper or in the newsfeed on your smartphone a couple weeks ago. The last payphone in Manhattan was removed, yanked from the sidewalk, a useless antique still looking chipper in its brushed stainless steel box. One more contribution to the trash heap of history, one last reminder of the days when pocket change could be the difference between calling for help or walking home in the driving rain after the streetcar split the switch and left you stranded.


The New York Times had a neat little epitaph the following day which said, in part, “Pay phones may be nearly obsolete, but there’s nothing stopping us from reinstituting some of their boundaries in a post-pay-phone world.” As the writer noted, you don’t get distracted on a payphone while walking—or driving. No one ever pulled in front of a truck because he or she had a pay phone glued to his or her head. Pay phones enforce the discipline of monotasking. Do one thing at a time and focus on what you’re doing.


Got us to thinking about the humble pay phone’s boundaries, the way it made us think about that specific call and communicate briskly before we ran out of quarters, and what we lose when we think we can talk to the boss at length about strategic priorities while simultaneously knocking out an email or navigating cross-town traffic-- and doing neither task well. Thinking back, it’s amazing how succinct and effective we could be when we were down to our last quarter.

Goodbye, old friend.


Words To Remember

Cymbeline is one of Shakespeare’s lesser known plays today, but it includes one of the best funeral verses to be found anywhere in the bard’s work. Let’s end with this often quoted fond farewell.


Fear no more the heat o' the sun,
Nor the furious winter's rages;
Thou thy worldly task hast done,
Home art gone, and ta'en thy wages:
Golden lads and girls all must,
As chimney-sweepers, come to dust.

From a performance of Cymbeline in Africa. 

Great art has something to say in all cultures. 


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