Public Risk May/June 2020 Issue

PUBLISHED BY THE PUBLIC RISK MANAGEMENT ASSOCIATION MAY/JUNE 2020

MEET SHERI SWAIN PRIMA’S NEW PRESIDENT PAGE 6

ALSO IN THIS ISSUE

TELEMEDICINE TOOLS FOR ENHANCED CLINICAL SUPPORT IN WORKERS’ COMPENSATION PAGE 12

WHAT YOGA TAUGHT ME ABOUT RISK MANAGEMENT

PAGE 16

SUMMER EDUCATION SPOTLIGHTS 1–4

PAGES 20–26

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MAY/JUNE 2020 | Volume 36, No. 3 | www.primacentral.org

CONTENTS

The Public Risk Management Association promotes effective risk management in the public interest as an essential component of public administration.

PRESIDENT Scott J. Kramer, MBA, ARM County Administrator Autauga County Commission Prattville, AL PAST PRESIDENT

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Meet Sheri Swain, PRIMA’s New President

By Teal Griffey, MBA

Telemedicine Tools for Enhanced Clinical Support in Workers’ Compensation

By Tammy Bradly

Tempe, AZ

DIRECTORS Forestine W. Carroll Manager of Risk Management Memphis Housing Authority Memphis, TN Lori J. Gray, RMPE Risk Manager County of Prince William Woodbridge, VA JamiAnn N. Hannah, RMPE Risk Manager City of Gallatin Gallatin, TN Laurie T. Kemper Sr. Risk Management Consultant City/County Insurance Services Salem, OR

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What Yoga Taught Me about Risk Management

By Sarah Creighton, CPCU, ARM-E

SESSION SPOTLIGHT 1:

Creating a Culture of Risk Management................ PAGE 20 SESSION SPOTLIGHT 2:

The Curse of Critical Incident Stress....................... PAGE 22 SESSION SPOTLIGHT 3:

Best Practices in Pool Loss Control......................... PAGE 24 SESSION SPOTLIGHT 4:

One Straw Too Many: How to Address Employee Bullying Claims....................................... PAGE 26 IN EVERY ISSUE

Jani J. Jennings, ARM FOR ENHANCED Risk Manager City of Bellevue CLINICAL Bellevue, NE SUPPORT IN PRESIDENT-ELECT Sheri D. Swain WORKERS’ Director, Enterprise Risk Management Maricopa County Community College COMPENSATION

Michael S. Payne, ARM, HEM Risk Manager City of Fresno Fresno, CA Melissa R. Steger, MBA, CRM Asst. Dir., WCI & Unemployment Ins. University of Texas System Austin, TX NON-VOTING DIRECTOR Jennifer Ackerman, CAE Chief Executive Officer Public Risk Management Association Alexandria, VA EDITOR Teal Griffey, MBA Manager of Marketing and Communications 703.253.1262 • tgriffey@primacentral.org ADVERTISING Teal Griffey, MBA 703.253.1262 • tgriffey@primacentral.org

Public Risk is published 6 times per year by the Public Risk Management Association, 700 S. Washington St., #218, Alexandria, VA 22314 tel: 703.528.7701 • fax: 703.739.0200 email: info@primacentral.org • Web site: www.primacentral.org Opinions and ideas expressed are not necessarily representative of the policies of PRIMA. Subscription rate: $140 per year.

Back issue copies for members available for $7 each ($13 each for non-PRIMA members). All back issues are subject to availability. Apply to the editor for permission to reprint any part of the magazine.

POSTMASTER: Send address changes to PRIMA, 700 S. Washington St., #218, Alexandria, VA 22314.

Copyright 2020 Public Risk Management Association

| 4 NEWS BRIEFS | 27 ADVERTISER INDEX

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PRIMA 2020 MAY BE CANCELED BUT THE EDUCATION

MUST GO ON!

INTRODUCING PRIMA’S VIRTUAL

Summer Education Sessions

FEATURING 2020 ANNUAL CONFERENCE EDUCATION AS VIDEOS, PODCASTS, AND BLOGS.

COMING THIS JUNE

MESSAGE FROM PRIMA PRESIDENT SCOTT J. KRAMER, MBA, ARM

I Shall Pass This Way But Once recently ran across our theme from last year's conference—Think, Share, and Transform. In dealing with Coronavirus in our respective entities, we have all done our share of thinking, sharing, and transforming.

In the beginning, it felt like we were making decisions and adjustments that changed daily.

Now, I'm encouraged that most U.S. states have enacted shelter-at-home ordinances that have reduced the spread of this virus. While our lives have changed in the present, our actions and thoughts will be irrevocably changed for the future as well.

We all have our different stories. My high school senior realized that no prom or graduation is scheduled, which means she'll be missing key experiences. For some, it allowed us to slow down and smell the roses, or spend time with family, or volunteer to deliver meals to the elderly. For others, it has given nothing but illness, financial insecurity, and grief. I hope that in time, we can share and reflect on some of those stories together.

Most of all, it is crucial to follow CDC guidelines and help those in need. Etienne de Grellet, a Quaker missionary, said: "I shall pass this way but once; any good that I can do or any kindness I can show to any human being; let me do it now." During this challenging time, it is imperative we be good and kind to those around us, especially the workers who ensure our grocery stores and other essentials services continue.

As I conclude my year of serving as president, there are a few people I wanted to thank for making this year so personally rewarding for me.

“any good that I can do or any

I shall pass this way but once;

kindness I can show to any human being; let me do it now.

• Board of Directors – This Board is a special group, and I have genuinely enjoyed getting to know their passions toward this organization. We have worked together cohesively to continue the great work of the PRIMA staff and Board members before us.

• PRIMA staff – Jennifer Ackerman has done an excellent job in leading this organization and her team. Her leadership has been evident, and she has adjusted to the many changes we have experienced while continuing to provide the excellent services and resources our members need.

• Volunteers – There are so many behind the scenes volunteers that share their experiences and expertise on various committees and task forces that shape the direction of this organization. Thank you for giving your time!

• Corporate Partners – A special thanks to all the Corporate Partners for providing

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FINAL PRESIDENT’S COLUMN

speakers and resources for our conferences, chapters, webinars, and other educational opportunities. Also, the time spent on conference planning has been invaluable over the years.

Lastly, I want to thank each one of you, the members, for making this association what it is. PRIMA is truly the go-to resource to assist in your risk management questions and concerns. I have truly enjoyed this experience and will continue to volunteer and be a big part of PRIMA. I am proud to have served as your PRIMA president and to be a part of this great organization.

Sincerely,

Scott J. Kramer, MBA, ARM PRIMA President 2019–2020 County Administrator Autauga County Commission Prattville, AL

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NEWS BRIEFS

NEWS Briefs

INSURANCE CONTRACTS MERIT CAREFUL SCRUTINY IN CRISIS

Amid a crisis, it may be tempting to rapidly scan language in insurance contracts and arrive at conclusions about what business losses may or may not be covered. This approach carries with it a risk that coverage for some exposures may be missed. A leading approach is to develop a well-crafted process for identifying the scope of exposures, then consider through careful examination which insurance contracts may cover specific impacts.

Losses stemming from a pandemic may not be as readily identified or quantified, so a careful approach is warranted. Organizations should collaborate with their brokers and insurers all along the way to share information and clarify coverage implications.

To help claim what is covered under their policies, organizations may need to take two approaches—upfront assessment and continual monitoring. Organizations also can evaluate whether a given claim seems likely to produce the intended result, which often helps determine at an early stage whether the effort warrants further investment of time and resources. If insured organizations contact their insurers without a thoughtful plan, or fail to contact them in a timely way, they risk negatively affecting outcomes with miscommunications or other missteps.

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“

When organizations look back on the

current disruption, they may revisit some of their historic decisions regarding insurance coverage. Looking forward, they may

“

Kathryn Pavlovsky and Ben Solomon, The Wall Street Journal, 4/6/2020 Closures, cancellations, shutdowns, and supply chain disruption are straining capital markets and the economy as a whole, leading to financial consequences that could take months or years to fully measure. Many organizations have likely contemplated certain financial risks as part of their risk management strategies, so they may have insurance contracts in place to provide some relief.

discover gaps or redundancies in coverage that may give rise to new approaches.

Scope of Possibilities – Losses might arise as a result of business interruption, including supply chain and transportation disruption, work-related illnesses, or cancellations of special events. Some organizations may face product recalls or contamination claims. Others may lose inventory, such as food that spoils. Some may face allegations of negligence, mismanagement, or employment discrimination, or they may experience a cyber breach or other fraudulent activity.

A Measured, Proactive Response – A first step in preparing an appropriate response to possible insured losses is to establish a task force and a loss accounting center to begin identifying possible exposures. The goal is to isolate loss impacts from business as usual.

This would be a cross-functional group that works closely with accounting, finance, legal, supply chain functions, and operations, with input from business units and geographies to obtain broad insight. This task force would

be charged with taking stock of the varied consequences the organization is experiencing as a result of COVID-19 disruption and considering their effects on revenue and expenses, whether positive or negative.

Internal and external communications with respect to the business effects of the current environment is a critical element for organizations to consider. Wayward messaging can lead to confusion, exacerbating an already chaotic landscape. It also can affect prospective claims and recoveries through insurance or other mechanisms.

When organizations look back on the current disruption, they may revisit some of their historic decisions regarding insurance coverage.

Looking forward, they may discover gaps or redundancies in coverage that may give rise to new approaches.

HACKING AGAINST FIRMS SURGES AS WORKERS TAKE COMPUTERS HOME Thomson Reuters, Business Insurance, 4/17/2020 Hacking activity against corporations in the United States and other countries more than doubled by some measures last month as digital thieves took advantage of security weakened by pandemic work-fromhome policies, researchers said.

Corporate security teams have a harder time protecting data when it is dispersed on home computers with widely varying setups and on company machines connecting remotely, experts said. Even those remote workers using virtual private networks (VPNs), which establish secure tunnels for digital traffic, are adding to the problem, officials and researchers said.

Software and security company VMWare Carbon Black said this week that ransomware attacks it monitored jumped 148% in March from the previous month, as governments worldwide curbed movement to slow the novel coronavirus, which has killed more than 130,000.

“There is a digitally historic event occurring in the background of this pandemic, and that is there is a cybercrime pandemic that is occurring,” said VMWare cybersecurity strategist Tom Kellerman. “It's just easier, frankly, to hack a remote user than it is someone sitting inside their corporate environment. VPNs are not bullet-proof, they're not the be-all, end-all.”

Using data from U.S.-based Team Cymru, which has sensors with access to millions of networks, researchers at Finland's Arctic Security found that the number of networks experiencing malicious activity was more than double in March in the United States and many European countries compared with January, soon after the virus was first reported in China.

The biggest jump in volume came as computers responded to scans when they should not have. Such scans often look for vulnerable software that would enable deeper attacks.

Rules for safe communication, such as barring connections to disreputable web addresses, tend to be enforced less when users take computers home. That means previously safe networks can become exposed. In many cases, corporate firewalls and security policies had protected machines that had been infected by viruses or targeted malware. Outside of the office, that protection can fall off sharply, allowing the infected machines to communicate again with the original hackers.

That has been exacerbated because the sharp increase in VPN volume led some stressed technology departments to permit less rigorous security policies. The U.S. Department of Homeland Security's (DHS) cybersecurity agency agreed this week that VPNs bring with them a host of new problems. The agency said it is harder to keep VPNs updated with security fixes because they are used at all hours, instead of on a schedule that allows for routine installations during daily boot-ups or shutdowns.

Other security experts said financially motivated hackers were using pandemic fears as bait and retooling existing malicious programs such as ransomware, which encrypts a target's data and demands payment for its release.

RISK MANAGER IS SUDDENLY A HOT JOB Arianne Cohen, Bloomberg Businessweek, 4/14/2020 Twenty years ago, corporate risk managers had near-zero public visibility.

Most were back-office staffers who focused on securing insurance for environmental and real estate problems. Young people didn’t aspire to be risk managers: there were just a dozen small academic programs in the U.S. focused on the career. The pandemic has catapulted the field into prominence almost overnight. Boards are quickly creating risk committees focused on crisis planning and remote work data privacy—and they want a chief risk officer on speed dial.

The role is complex and demands a wide range of skills. Chief risk officers need the analytical might to evaluate everything from supply chains to staffing; the ability to maintain many relationships (to law firms, insurance brokers, industry peers); the power of persuasion to sway fellow executives; the communication savvy to handle employees and media in a crisis; and financial literacy. All this while answering to the government regulators and investors who are inquiring about preparations for global catastrophes.

While the global spread of the new coronavirus has thrust risk management into the spotlight, the field has been steadily expanding for years, spurred by a succession of national tragedies, starting with 9/11. Fortune 1000 companies began to employ a risk manager, and perhaps a staffer or two, usually seated among lawyers in the depths of the legal department and reporting to the chief legal officer or perhaps camped out in the finance department reporting to the treasurer or chief financial officer.

Their job was to collect extensive information from across the organization for insurance and risk analysis. Ambitious risk managers diplomatically communicated vulnerabilities to their bosses, who often ignored the issues.

The 2008 housing market crash focused the profession more on enterprise risk management, and recent cybersecurity breaches extended risk managers’ oversight into new areas including hacking and privacy, but the career path remained stunted. A career risk manager could aspire to the rank of vice president or, if lucky, maybe senior vice president. Apart from those in finance and insurance, “very few companies had chief risk officers,” says Nancy Green, executive vice president at insurer Aon Plc. “Too many organizations viewed it as an insurance-buying position.”

Only 80 university programs exist in the U.S., compared with more than 5,000 accounting programs. As recently as two months ago, business degree programs didn’t include mandatory risk management coursework.

With the pandemic rattling boardrooms and head offices globally, that’s about to change. Graduate and certificate programs are already seeing a shift under way. The one-year graduate program in emergency management and continuity planning at the University of Illinois at Chicago enrolls 10 students annually; recently, a recruitment webinar attracted 28, the largest crowd ever, and the program is expanding to meet demand.

Zach Finn, who directs the risk management and insurance program at Butler University in Indianapolis, says his program has also seen a surge in interest. He’s thrilled to see his profession emerge from the sidelines. “We’ll finally be respected for holding the world together,” he says.

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PUBLIC RISK | MAY/JUNE 2020

MEET SHERI SWAIN PRIMA’S NEW PRESIDENT

BY TEAL GRIFFEY, MBA

J

UNE 2020 IS AN EXCITING TIME FOR PRIMA as we begin our new, virtual

Summer Education Series and welcome PRIMA’s new 2020–2021 president,

Sheri Swain, director of enterprise risk management at Maricopa Community Colleges in Arizona.

Sheri Swain’s career path started in the mid-1980s at Unigard Insurance in Bellevue, WA. Swain was a Claims Administration Manager overseeing a department of 30, including two supervisors and more than eight different functions. In this position, she learned how much she liked property and casualty insurance, and loved the fast pace and variety.

“However, I did not know about risk management back then. I think most of us ‘seasoned’ folks fell into risk management as many, like me, didn’t know it was a career path. I believe my early training and knowledge working for an insurance carrier set me up to expand into the exciting world of risk management,” said Swain.

In 1999, Swain returned to her hometown of Tucson, AZ, and took a year off to decide

what she wanted to do with the next phase of my career and life. When she began to job hunt in 2000, Sheri applied to a local property and casualty broker. Swain remembers, “The Producer that interviewed me said I was overqualified for the position (first time, I had been told that) but she knew of a place that needed someone with my skillset, Tucson Airport Authority (TAA).” Swain began working for TAA as an Insurance Coordinator shortly after.

“My insurance and claims background really came in handy. It was at TAA, where I not only learned everything there is to know about airports, but I poured myself into learning everything I could about risk management. I had to alternate attending airport conferences and risk management conferences, but it did not take me long to realize where my passion was,” Swain explains.

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MEET SHERI SWAIN, PRIMA’S NEW PRESIDENT

After eight years, Swain left the airport and became the Risk Manager for the City of Prescott, AZ, for five years. From there, she worked with the State of Arizona before securing the position she has now, Director of Enterprise Risk Management for Maricopa Community Colleges, starting in 2015.

1 HOW LONG HAVE YOU BEEN INVOLVED WITH PRIMA? Fortunately, I have a supportive manager that believed in continuing education and giving back to the community. I joined both PRIMA and the Arizona chapter in 2000 and immersed myself in everything PRIMA.

First, I focused on the PRIMA Arizona Chapter, and it did not take long before we built a once failing chapter into a strong one, which continues to this day. I attended PRIMA’s training Foundations in Risk Management in Redondo Beach in 2001, then attended my first PRIMA Annual Conference in Reno in 2003. I knew then that PRIMA was going to be home.

Eventually, I came to be known as the historian for the chapter and a go-to risk professional for Arizona. So, I turned my attention to learning everything about PRIMA national. Since then, I have served on or chaired on every single PRIMA committee and several task forces, including the Leadership Development Committee (LDC), for three consecutive years. The LDC was a catalyst; I learned how much members of PRIMA care about the risk management profession and the organization by interviewing and selecting the future leaders of PRIMA. I met a group of lifetime friends in a matter of a couple of days. It will always remain a true highlight and a gift that keeps on giving.

With these experiences, I was determined to become a PRIMA ambassador and give this organization everything I can, as a small token of receiving so much from PRIMA. It wasn’t always a goal of mine to run for President, but once I earned a place on the PRIMA Board of Directors, I knew I had to!

2 WHAT ARE YOUR GOALS FOR THE TERM OF YOUR PRESIDENCY?

I believe in PRIMA’s core values and mission, and I strive to do everything to move the organization forward.

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PUBLIC RISK | MAY/JUNE 2020

• Continue the excellent work that the Board of Directors has been working on, including membership initiatives, to make our organization the go-to for education opportunities.

It is vital to recruit members and then retain them by offering a variety of educational opportunities. Blogs, podcasts, PRIMA Talk, and webinars are just a few ways. Attending PRIMA Institute and an Annual Conference provide opportunities to build professional relationships and personal friendships.

You will always find someone that has encountered the same challenges you are dealing with.

• Good balance of creating programs for the next generation, and those new to the profession, as well as ensuring seasoned risk professionals continue to learn and feel fulfilled as well.

• Focus on education for non-risk professionals. In many respects, the risk manager role is changing. As risk managers are retiring or leaving for other opportunities, many entities are not replacing them, and I believe much of this is due to how the risk manager performed in their role. Did they sell risk management while they were there? I also think it is the lack of understanding and the importance of risk management on behalf of the entity; it is essential to target training for them. Part of my role is to help think of innovative ideas for that training.

3 TELL ME ABOUT YOUR CURRENT JOB AND ENTITY— SIZE, RESPONSIBILITIES, YOUR DEPARTMENT.

I am the Director of Enterprise Risk Management for the Maricopa Community Colleges I am responsible for planning, organizing, directing, evaluating, implementing, and overseeing of centralized and district-wide enterprise risk management for 10 accredited colleges, two skill centers, and two high schools, with 13,000+ employees and 200,000 students. I have a staff of four.

4 WHAT SKILLS DO RISK MANAGERS NEED TODAY THAT THEY DID NOT NEED IN THE PAST?

Risk managers need to keep pace with changes in the industry. I am not advocating a complete move to an all enterprise risk environment, as it can be challenging in the public sector. Still, I think many of the concepts must be incorporated. Risk managers must instill a sense that everyone in your organization is a risk manager. You, as the official risk manager, are an advisor. It’s imperative to get out and visit departments and build relationships.

A risk professional can never get complacent in honing their skills. Risk professionals, in my opinion, do not receive enough credit, as you have to wear many different hats and juggle many various topics, all while protecting your entity.

5 WHAT IS THE BIGGEST CHALLENGE YOUR ENTITY HAS FACED IN THE LAST FIVE YEARS?

Today, it is COVID-19 and having to react very quickly to what would become a new living and learning environment for the students, faculty, and staff.

Before the coronavirus, it was cyber security.

Maricopa Community Colleges had an alleged cyber breach in 2013 and did not have cyber insurance. It resulted in a multi-million dollar loss. When I started in January 2015, my first order of business was to procure a cyber-policy. With the help of my broker and several underwriter and carrier meetings, including meeting with the president of one carrier, it was successful! In addition to the insurance, I was and still remain an integral role in working with Legal and IT to set up directives, training, and an Incident Response Team (IRT).

My years of experience and training I have received at PRIMA prepared me to take on these challenges. You have to pull out your bag of tools and put them to use.

6 WHAT ARE SOME OF THE BEST THINGS PRIMA OFFERS ITS MEMBERS?

Educational opportunities and value-added membership. PRIMA has grown so much over the years by listening to its members and offering a variety of ways to learn. Every member should have a good balance of online opportunities, in-person education sessions, and networking opportunities. Risk managers have other association choices, but I feel, out of other risk organizations, PRIMA does a great job of targeting the needs of their members.

The variety of educational offerings. Some members always use PRIMA Talk but barely look at the blogs or Public Risk magazine, others attend webinars but don’t listen to podcasts.

I don’t always have time to listen to a live webinar, but I love that I can go back and view a recording, and this is the same with most of their education. My biggest suggestion to a member is to make sure they are sampling all of PRIMA’s educational offerings in its different forms.

8 WHERE DO YOU SEE YOURSELF IN FIVE YEARS?

I am incredibly passionate about risk management. In a few years, I am eligible to retire, and I would love to do some consulting work.

I genuinely enjoy helping and teaching people, and I would love to share my knowledge.

Last, I have always talked about writing a book that includes some comedy. You can always bring levity to risk management, and I have 35 years of stories. Whenever something crazy happens, I say to my team, another chapter for the book!

“

My insurance and claims background really came in handy. It was at TAA, where I not only learned everything there is to know about airports, but I poured myself into learning everything I could about risk management. I had to alternate attending airport conferences and risk management conferences, but it did not take me long to realize where my passion was.

“

7 WHAT IS THE ONE THING PRIMA OFFERS THAT ITS MEMBERS DO NOT TAKE ENOUGH ADVANTAGE OF?

Sheri Swain, director of enterprise risk management at Maricopa Community Colleges in Arizona

PRIMA members need to take advantage of all the value-added benefits from their membership.

It is very easy to get buy-in and support from your entity when you can show the benefits you receive. There is so much help out there; all you need to do is reach out.

Teal Griffey, MBA, is the Manager of Marketing and Communications at PRIMA.

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Register at primacentral.org/webinars

FOR ENHANCED CLINICAL SUPPORT IN WORKERS’ COMPENSATION

BY TAMMY BRADLY

O

NCE UPON A TIME, DOCTORS ARRIVED AT ONE’S DOORSTEP carrying a black bag packed with a thermometer, a stethoscope, and other tools.

Today, we can all benefit from virtual house calls and other technologies that increase access to clinicians, facilitate appropriate care, supports the safety and well-being of your workforce, as well as better outcomes.

While telemedicine and telehealth aren’t new, the emergence of wireless technology and the need to improve access have combined to form a perfect storm of opportunity for new teleservices. And now in today’s climate, insurers and employers are facing challenges we’ve never seen before—entire workforces working remotely, many states ordering stay-home orders, and the healthcare system feeling the intense pressure of the COVID-19 spread. Thus, making this an opportune time to apply telemedicine and telehealth in workers’ compensation.

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TELEMEDICINE AND WORKERS’ COMPENSATION

Virtual connections offer many benefits in workers’ compensation. The Official Disability Guidelines (ODG) currently recognize their use for treating pain, diabetes, back pain, and mental health disorders. The availability of video consultations with a board-certified occupational medicine physician offers injured employees and employers several benefits, including: • Rapid access when treatment is needed— with 24/7/365 availability • Cost savings by reducing unnecessary emergency room and urgent care visits • Less time away from work, decreased absenteeism, improved productivity • Greater employee satisfaction

available during the nurse triage process. It is particularly useful for employees with minor injuries or those who are ambivalent about self-care vs. seeking treatment.

Virtual Triage and Video-Telephonic Case Management are two types of virtual connections designed to support clinical staff. Virtual Triage allows triage nurses to connect via secure video to enhance their ability to assess the extent of the injury accurately. Virtual Triage also provides the most appropriate recommendation for the level of care needed and targets burns, lacerations, scrapes/ scratches, bruising, rashes, and insect bites.

Telemedicine video visits can effectively manage many non-emergency diagnoses, including the most common occupational injury diagnoses.

Telemedicine is also an option when an employee is at a remote location and a clinic might not be immediately available. Or when an injury occurs on an overnight shift and the only other option is to visit the emergency room for evaluation. Looking beyond the initial injury, telemedicine also has the potential to provide follow-up care, including post-operative visits or even second surgical opinions.

Video-Telephonic Case Management allows the telephonic case manager and individual to connect via video conference. This method enables the nurse to more closely mirror a face-to-face visit and quickly establish an element of trust and rapport with the injured or ill person. Utilizing the video connection allows the telephonic nurse to: • Pick up on non-verbal cues such as body language, which is essential in engaging with patients • Appeal to a younger generation or anyone comfortable using video technology to communicate • View the injured body part and the healing process

INTEGRATING TELEMEDICINE WITH NURSE TRIAGE

TELEHEALTH USE FOR CHRONIC HEALTH PROBLEMS

Another option for incorporating telemedicine into workers’ compensation is to make it

Telehealth has primarily been used to improve the management of chronic health problems—

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TELEMEDICINE TOOLS FOR ENHANCED CLINICAL SUPPORT IN WORKERS’ COMPENSATION

the kinds of conditions that can jeopardize recovery and return-to-work following an injury, or that could lead to injury, particularly in an older workforce. Both chronic conditions and age can have a significant impact on outcomes and costs.

Illness rates in the general population are increasing, and this trend is also reflected in workers’ compensation. The number of work comp claims identified as also having a comorbid diagnosis within the first 12 months of a claim are increasing, with hypertension, drug abuse, and diabetes being the most prevalent cause.1 Comorbid conditions in workers’ comp are highly underreported; however, claims with one or more comorbid conditions are more costly than other claims.

receiving the recommended care and prolonging recovery?

• Do the conditions pose a higher risk of re-admission post-surgery?

• Are there other risk factors, such as functional limitations, lack of caregiver, poor living conditions, low health literacy, narcotic use for more than 30 days, or other psycho-social issues?

RPM is only applicable to a small population of high-risk workers’ compensation claims. However, paired with case management to monitor, educate, and coach the individual, it can make a powerful impact.

This combination of technology and clinical service could help reduce medical spending on high-dollar claims.

Offering telemedicine as an option at the time of injury allows for quick and convenient access to a physician around the clock, every day of the year. These “virtual house calls” can go a long way toward reducing or eliminating unnecessary absence from the workplace, lowering medical costs, improving productivity, increasing employee satisfaction and improving access to care.

REMOTE PATIENT MONITORING FOR HIGH-RISK CLAIMS Remote patient monitoring (RPM) can play a key role in managing high-risk claims and reduce re-admission rates. Consider the patient who has insulin-dependent diabetes and an open wound after surgery. Monitoring insulin levels is critical to proper healing and preventing infection. With RPM, the patient can check his or her insulin levels and transmit the information to the case manager. The case manager can then advise the employee to contact the primary care provider if necessary, for additional treatment.

The first step is identifying the right candidates for remote patient monitoring—those at higher risk for complications and prolonged recoveries.

Key questions to consider include: • Are comorbid conditions delaying or preventing the injured employee from

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TELEMEDICINE AND TELEHEALTH ADOPTION

As with all new technology, some people will be hesitant to take part, so participation in these programs is entirely voluntary. It is also not expected for adoption to occur overnight.

Like telemedicine, it takes time for people to get accustomed to a new idea and embrace it.

We are seeing a sudden and substantial uptick in the use of telemedicine and tele-rehab as a result of COVID-19. Many providers are using telemedicine as a safe alternative to in-person visits. Some occupational telemedicine providers are also available to conduct telemedicine assessments for patients who need screening for COVID-19.

The legislative landscape is also still evolving.

Each state has different telemedicine policies, and the types of services covered, provider require-

ments, and reimbursements differ for each, as does medical licensure.2 Some states require physicians to have a special telemedicine license.

As the telemedicine industry continues to boom, we’re seeing more and more new forms of telehealth emerge in the marketplace.

Telehealth variations include tele-rehab, new forms of remote patient monitoring, and even utilization of “avatar-like” nurses by hospital systems and providers.

Offering telemedicine as an option at the time of injury allows for quick and convenient access to a physician around the clock, every day of the year. These “virtual house calls” can go a long way toward reducing or eliminating unnecessary absence from the workplace, lowering medical costs, improving productivity, increasing employee satisfaction and improving access to care. Remote patient monitoring can prevent delays in treatment, complications, and re-hospitalization. In this new world of telehealth, we must continually be looking for innovative modes by which triage nurses and case managers can connect with the individuals they serve and engage them on their road to recovery.

Tammy Bradly is the Vice President of Clinical Product Development for Coventry and has over 30 years of industry experience. Her expertise includes medical case management, disability management, and the integration of health, disability, and workers' compensation.

Tammy is responsible for strategic planning and product development for clinical products and is a contributing author to Coventry’s Blog The Sounding Board.

FOOTNOTES 1. NCCI Research Brief. (Oct. 2012) Comorbidities in Workers’ compensation. Retrieved from https://www.ncci.com/Articles/ Documents/II_Research-Brief-Comorbidities-in-Workers-Compensation-2012.pdf 2. American Telemedicine Association.

(2015) State Telemedicine Gaps Analysis: Coverage & Reimbursement. Retrieved from http://www.americantelemed.org/ docs/default-source/policy/50-statetelemedicine-gaps-analysis---coverageand-reimbursement.pdf?sfvrsn=10

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what

yoga

taught me about

risk management

BY SARAH CREIGHTON, CPCU, ARM-E

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PUBLIC RISK | MAY/JUNE 2020

I

'M A RISK MANAGER, AND I ALSO HAPPEN TO BE A STEREOTYPICAL OVERACHIEVER. Regardless of what personality test, work preferences quiz, or strengths finder exam I take, if there's an option for "perfectionist, black-and-white-thinker, overly responsible, always has the right answer," that's the one I am. As it turns out, not everyone around me is a hard-charging, results-driven person too, and my inability to create space in my work for those who think differently than me was problematic.

I took up yoga a few years ago with the intent of working on calmness and stillness to balance out my natural tendencies to become overly wound up. It turns out that creating space in my brain to focus on one thing at a time while on my yoga mat ("don't fall over, don't fall over, don't fall over…") has carried over into my professional life too. Instead of thinking about a thousand things at the same time, I started catching myself performing active listening, both to others and myself (why hello there, self-awareness!).

In the spirit of maintaining my yoga practice and encouraging others towards greater self-care, I launched a grassroots yoga program at my workplace. Twice a week, a small group of us gather in a conference room to follow along to a yoga video. Not too long ago, while in extended child's pose at lunchtime yoga, it dawned on me that yoga and risk management have a lot in common.

LEARNING CURVE

During my first yoga class, I was woefully inexperienced. I didn't bring a water bottle, I didn't know to get yoga blocks out of the cabinet, and I didn't know what to do when the instructor told us to get into Warrior 2.

Did I run away and never come back? Nope, I stuck it out. I took cues from my fellow aspiring yogis and gladly accepted help when offered.

It's been a few years now, and now I get to be the one offering friendly advice and words of encouragement.

Look back at your career as a risk manager.

If you're like me, you took the position without fully understanding all the implications. You may have winged it your entire first year. It's also possible you're still winging it on occasion. (Don't worry, so am I.) There's a HUGE learning curve in the field of risk management, and no one person can do it all perfectly in the beginning.

So, you must learn a bit here, and learn a bit there. Attend a class. Watch webinars. Find peers and ask questions. Reach out within your own organization to find out what experts do.

Build relationships. Before you know it, you'll be the one offering friendly advice and words of encouragement to new risk managers, and it will feel great.

PROPER EQUIPMENT

Can you do yoga without the appropriate equipment? It's possible, but not ideal. Imagine trying to get into Warrior 2 in jeans and heels, or holding a pose wearing socks on a freshly waxed floor. While fancy leggings and a $200 yoga mat aren't going to make you better at yoga, having the proper equipment certainly helps.

It helps to have the proper equipment when doing risk management too. Sometimes that equipment can be a crucial relationship, a wellworded policy, or tangible equipment like PPE or a guard over a drill press. Can you manage risk without the proper equipment? You can try, but it's certainly not recommended!

STRANGE VOCABULARY

Yoga classes have a distinct vocabulary.

"Tadasana, chakravakasana, dandasana, savasana. It's enough to make your head spin.

After a while, the words start making sense, and your body knows what to do when it hears certain words. Instead of hearing gibberish, your brain starts to hear "mountain pose, cat-cow stretch, staff pose, corpse pose."

Likewise, risk managers have their own vocabulary that may take a while to learn.

Mitigation, risk appetite, liability policy exclusion, risk assessment - it's enough to make

your head spin! Take a class, watch webinars, and talk to your peers. Work to demystify these words and incorporate them into your daily vocabulary. Practice a new idea every month until it becomes part of your routine. Before you know it, risk management words will just roll off your tongue like a native speaker. And once you learn to appreciate (even love?) these risk management words, you face the seemingly uphill battle of getting others in your organization to appreciate these words just as much as you do. Work on becoming an epic translator, relating risk management words to the terms your organization already uses, and your organization will be practicing sophisticated risk management techniques in no time.

THE IMPORTANCE OF FLEXIBILITY

When most people think about yoga, visions of overly contorted bodies pop into their minds.

To me, yoga is not about cranking my body into the most ridiculous positions possible; I'm mostly trying not to injure myself or topple over onto the coworker next to me. I've realized that yoga is a way for me to practice the flexibility of my expectations. Some days, my Downward Dog looks just like the instructors. Other days, there's no way my heels are even close to the ground. And that's ok; I showed up, I did my best, and that's a win.

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17

WHAT YOGA TAUGHT ME ABOUT RISK MANAGEMENT

Sometimes it's a leader's job to be the first one to look or feel silly so that others know it's safe to look or feel that way too.

I also need to practice the flexibility of my expectations as a risk manager. I may start the day with a vision of how my day is going to go, when all of a sudden, a head pops into my office or the phone rings. Something emergent has happened, my participation or advice is needed right now, and there go my lovely plans, careening right off the rails.

In that moment, I have a decision to make—is this interruption an obligation I'm going to go along with begrudgingly? Or am I going to view this interruption as an opportunity to bring risk management principles to life and change the course of my organization for the better?

Hopefully, my expectations are flexible enough to pick the last option.

front of the speeding train before it plunges into a flaming pool of illegal or corrupt behaviors.

But if we treat every risk mitigation decision with that level of rigidity, we risk alienating those in our organization who are on the front lines of managing risks. You never know—if you take the time to solicit a breadth of input and opinions, you may come to admire strengths in others you never knew existed.

SOMETIMES YOU LOOK OR FEEL SILLY

Sometimes in a yoga class, I compare myself to others. "Bob is so strong—how does he do Crow pose? I'll never be able to do that." Instead of comparing myself to others, I can focus on comparing myself to myself.

Picture yourself in a yoga class. Your instructor asks you to get into a squat with your knees pointed out. Lean slightly forward and place your hands on the ground. Rotate your forearms outward, so your fingers are pointed behind you. Take a deep breath in through your nose, then instead of exhaling gently like a normal person, roll your eyes up toward the ceiling, open your mouth wide, stick out your tongue like Gene Simmons, and exhale audibly through your mouth. Congrats, you've just done Lion's Breath! Does that feel silly to read? Imagine doing that in front of an entire class.

As a risk manager, you may have an idea for the perfect way to mitigate a risk, but others may have a different solution. There's a decision to make – do you stand your ground and fight for perfection? Or do you preserve the relationship and allow for the idea that other people have different opinions? There are times when risk managers need to throw themselves down in

In my role as a risk manager, I often have an opportunity to look and feel silly. Risk Managers have a unique opportunity as leaders to demonstrate the ideals we want others to live by. This means I fill out a Safety Concern form ratting out myself for attempting to text while walking down the stairs in high heels and nearly twisting my ankle. It also means I perform

ACCEPTANCE OF DIFFERENCES

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amateur stand-up comedy with a coworker in an attempt to make in-person Ethics training memorable and actionable. I've come to realize something; the only person super self-conscious about how I look is myself. When I put myself out there, make an example of myself, and tell jokes in front of senior leadership in an attempt to make Ethics memorable, people aren't judging me; they're admiring me. Sometimes it's a leader's job to be the first one to look or feel silly so that others know it's safe to look or feel that way too.

DIFFERENT STROKES FOR DIFFERENT FOLKS

How many different types of yoga are there?

There's anusara, ashtanga, bikram, hatha, restorative, and vinyasa. It's enough to be overwhelming. How do you choose? Just pick one and give it a go. It may or not be your cup of tea, and that's ok. Try another one! Before you know it, you'll be in a yoga rhythm that you appreciate and look forward to doing. Similarly, effective risk management calls for a tailored approach.

Not every risk management idea will work for your organization. You may attend a class or read an article and get excited about working with your executive leadership on a new idea, like writing a formal risk appetite statement.

But, when you pitch it to your leadership, you're shot down. What do you do? Try another approach! Perhaps your organization is more visual and using a Risk Value Curve approach would resonate more than a 15 page report would. Maybe your organization makes decisions more organically and would appreciate a more dynamic approach to making risk-aware decisions in a changing business environment. Before you know it, you'll be in a risk management rhythm that you and your leaders appreciate, and you'll look forward to Monday mornings with a renewed vigor.

Maybe it's the effective risk management, and maybe it's the yoga. Either way, you'll be pumped and ready to go.

Sarah Creighton, CPCU, ARM-E, has worked in risk management for 17 years and currently serves as the Enterprise Risk Supervisor for the Eugene Water & Electric Board (EWEB) in Oregon.

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SUMMER EDUCATION SESSION SPOTLIGHT 1: CREATING A CULTURE OF RISK MANAGEMENT

Creating a Culture of Risk Management Dean Coughenour, ARM, will be presenting “Creating a Culture of Risk Management” during our virtual Summer Education Series, starting June 2020. Preview some of the learnings from the coming education session in this article.

I

t's my first day on the job as the new municipal risk manager. I'm excited, but then realize that the culture of risk management is nearly absent in my entity. My excitement dwindled to anxiety as I thought of how I could turn this large ship of "that's not my job" into a team of "I am the risk manager."

My first advice is to assess where you are now.

• Do employees know how and when they should report incidents and accidents?

• Do employees follow that procedure in actuality?

• Is compliance training up to speed?

• Are policies in place that support my organization's goals and objectives?

• Are incidents and accidents reviewed by peers, and then the message of prevention shared?

• How is risk management viewed by my supervisor, directors, and the employees at large?

• And maybe the most critical question, who do the employees think the risk manager is?

For me, the answers nearly sent me packing on day one at my new job, as most elements of a positive risk management culture were missing. Other signs that a risk management culture was severely lacking were also apparent. There was a high experience modification factor, many frequent flier claims, late reporting of incidents and accidents, lack of near-miss reporting, and a view that risk management was not a shared responsibility.

In my second week, the fire chief pulled me to the side and said, "I have two words of advice for

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you—SLOW DOWN!" He was telling me not to stress about the big picture, but to take one step at a time. He was right! And so it began. I had to slow down and recognize that instituting a risk management culture in an entity is a three to five year change process.

First, start with what is most important and will have the most significant positive impact with the least amount of resistance. The 'secret' to building a positive culture is people. Small wins early on build credibility and foster inclusion of a risk management.

Begin by sitting down with directors and key leadership to talk about risk management. Find out what they believe it has been, what they see it as today, and how they vision risk management in the future. To be clear, this meeting is NOT about risk management, but about building the foundation of a working relationship and teamwork with the organization's leadership. The side benefit is you

get to learn about their department and to educate them on how, when, and where risk management can help them meet their objectives.

At the same time, invest a few hours every month in "ride alongs" with the employees on the ground—police, fire, sanitation, public works, and other departments you serve. Always keep in mind that to achieve desired results, you must have the support of the employees or progress will be severely impaired.

Then, policies need to be current and in place to provide direction to the employees and to assist in meeting the organization's goals. Remember, small steps. Networking and a series of small wins is the course.

Reporting of incidents and accidents is also critical. Make your reports short, easy to understand, and in a form that can be emailed.

When I first arrived at my entity, the only

report form was 13 pages long and contained sections that seemed to duplicate each other.

A large percentage of time the reports were not completed, nor sent to risk management promptly, or at all. The structure today is outlined in a how-to manual broken into specific loss sections. Instructions are one page, and the corresponding report form is only one to two pages. The objective is to ensure employees find it easy to complete the necessary reporting so they can provide it to the risk manager quickly, reducing lag time.

Training is essential. When a new training program is first designed, polished, and ready to roll, the first audience should be the department director. After review, look for input into making changes and, most importantly, ask the key question, "Do I have your support in rolling this training to your department?" Always wait for that assurance before proceeding. It's critical to have the support of leadership before moving to the training staff. The first round of customized training I created was entitled, "Saving our Assets." There were a few workgroups that grumbled, but with a splash of humor, the inclusion of videos to drive critical points, a few cheesy giveaways, and key leadership support, more than 40 classes were implemented.

Professional risk managers are actually risk consultants. Our role is to grow and nurture employees to understand their role as Risk manager and encourage concepts like, "Stop Work Authority," "I am the Risk Manager," and "My Voice Matters," to create a culture of risk management.

In my second week, the fire chief pulled me to the side and said,

"I have two words of advice for you—SLOW DOWN!" He was

telling me not to stress about

the big picture, but to take one step at a time. He was right!

And so it began. I had to slow

down and recognize that insti-

tuting a risk management culture in an entity is a three to five year change process.

Personally, I did not realize how far we had established a risk management culture in my entity until one day, in a large auditorium filled with employees, I approached the podium and asked: "So, who is the risk manager?"

The resounding reply of hundreds of employees was "I AM." It brought a tear to my eye, for at that moment, I realized we were there.

Dean Coughenour, ARM, has spent 30 years in the risk management field and directs the City of Flagstaff risk management department.

MAY/JUNE 2020 | PUBLIC RISK

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SUMMER EDUCATION SESSION SPOTLIGHT 2: THE CURSE OF CRITICAL INCIDENT STRESS

The Curse of Critical Incident Stress Greg Veitch, MS; Kurt Braatz, MPA, SPHR; and Marilyn Rivers, CPCU, ARM, AIC, will be presenting “The Curse of Critical Incident Stress” during our virtual Summer Education Series, starting June 2020. Preview some of the learnings from the coming education session in this article.

T

he curse of critical incident stress is real for first responders.

Studies of police officer health and wellness, along with statistical information, indicate that police officers, detention/corrections officers, indeed all first responders, are dealing with unhealthy amounts of stress related to their jobs.

Too often, we see viral videos of officers acting in ways that are difficult to watch and clearly outside the bounds of constitutional policing.

Many of us know officers with sarcastic and bitter attitudes toward the job, the media, their departments, and the public. Generally, officers come into the profession for the right reasons with the right attitude. When we see the viral video or the "bad attitude," what we are often missing is the curse of critical incident stress living behind the badge. It is stressful to work in a job where one split-second decision, or one vulgar word or statement, can go viral in an instant.

There are many reasons why law enforcement agencies struggle when dealing with job-related stress. Among these are the differences in expectations that agencies and officers have of themselves, what the media and public expect of them, poor leadership within the law enforcement profession itself, the culture of policing, and the nature of the job. Police officers are often not recognized internally for the good work they do. Often police leaders focus more on the task rather

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than the person. Police officers themselves rank poor leadership and organizational factors as the most stressful part of their jobs.

Many officers will tell you, "we can handle the job; we just can't handle the nonsense from the top."

The culture of policing does not help the situation. From the very first day of the academy, police officers are taught to "take care of business," meaning the officers themselves are responsible for handling everything that comes in on their watch. Without showing signs of weakness to the public or asking anyone for help, they are on their own. Every officer knows someone who should have asked for help, but didn't. Sadly, they are often unable to recognize that they are that officer.

But, in this risk-averse and litigious age, is it any wonder an officer would be reluctant to seek help?

First responders live for their work while knowing that the job will go on after they've left at the end of the shift. Regrettably, adverse outcomes related to working in a jail, patrol car, or engine company take a toll not only on the first responder, but also their family, agency, and the public. Health impacts to a first responder include higher rates of heart disease, cancer, substance abuse, anxiety, depression, and PTSD. This should scare anyone who knows, is associated with, or loves a first responder. The financial costs associated with health-related injuries alone are astronomical.

So why aren't physical, emotional, and mental health issues for first responders better addressed? Therein lies the problem. When a first responder seeks help, it often comes with a stigma that most are not willing to bear. It takes a special kind of person to charge into a life-threatening volatile situation, but when those situations go sideways, and someone gets hurt or killed, it takes a special kind of toll on the first responders involved.

Officers, for example, get an emotional, psychological, and physical high being at work. They are alive, alert, energized, involved, and enjoying their job. Unfortunately, this will lead to an equal and opposite reaction when the officer is at home; they become completely detached, tired, apathetic, and feel isolated. They often don't know how to handle off-work downtime well, and without other coping mechanisms such as regular exercise, family outings, or hobbies, the stress takes its toll on their home life and family.

After working 40 or 50 hours on their regular schedule, it takes time for an officer to decompress and get back to what civilians would call "normal." To get to "normal," the officer's physical and emotional responses may drop below average to counteract the high the feel from the job. It takes anywhere between 24 to 48 hours for an officer's physical and emotional fitness to start to stabilize. After this time, their attitude and energy toward family, fun, and hobbies away from work improves. The stabilization ends after this downtime, and the cycle begins again as they go back to work.

Family impacts for officers include relationship issues, anger, emotional or physical violence issues, alcohol or substance abuse, financial problems, divorce, and sometimes suicide.

Officers struggle at times to help their families fully comprehend what they see, hear, and smell on the job. It is not uncommon to hear, "you just don't understand" from a first responder.

Agencies are impacted due to the unmanaged stress, causing morale issues, distrust of the public, distrust of the agency, distrust of their closest co-workers or friends, substandard work, outbursts, abusive behavior, a generally unhealthy culture at work and lawsuits.

Firefighters and emergency management personnel also face a myriad of life-threatening duty risks that are compounded by the weight of gear they wear and carry on duty. As they knowingly race into each emergency, they face the potential of burns, hazardous chemicals, asphyxiation due to equipment malfunction, and collapse due to physical stress, explosion, or entrapment. Their physical and emotional health is continuously challenged and put to the test as they face the unknown. Government studies have identified the number one cause of line of duty firefighter fatalities is heart attack followed by trauma and cerebral vascular incidents. The vast majority of those fatalities have been determined to be a result of stress and overexertion, followed closely by vehicle collisions.

Per the CDC, firefighter work event stress and exposure to those traumatic events at work are leading causes of PTSD, anxiety, and depression of emergency management personnel. The National Institute for Occupational Safety and Health (NIOSH) defines job stress as the harmful physical and emotional responses that occur when job demands do not match the capabilities, resources, or needs of the professionals who serve. The question then becomes how an organization answers the call for help for the responders who may or may not ask for assistance for the stress related to their work and the resulting pressures on their home life.

the end of the day, we don't want to be treated differently if we need assistance. These are stigmas that risk professionals must overcome to assist those in need.

There are a variety of structured and unstructured assistance paths to assist law enforcement and emergency responders with the aftermath of critical incidents, including peer groups, personal healthcare providers, religious organizations, and a work-sponsored Employee Assistance Program commonly referred to as EAP. For any of these programs to be successful, they must be completely confidential and provide services 24/7 all year round. Mental health support is needed most over holiday periods and in the aftermath of critical incidents as work issues overtake home life.

It's important to note that any approaches to the physical and emotional wellbeing of law enforcement and emergency responders should take a holistic approach. This approach involves the individual, their family, peers, and management. Investments in the humanity of our employees require compromise, adaptability, and an understanding of the ever-changing workforce.

Greg Veitch, MS, Retired Chief of Police for the Saratoga Springs Police Department and President of Noble Cause Training and Development, LLC. a leadership and risk management company.

Kurt Braatz, MPA, SPHR, Retired Commander for the Coconino County Sheriff’s Office and Loss Control Manager for the Arizona Counties Insurance Pool.

As humans, we have stigmas that stop us from seeking help when we need it. We're embarrassed when we can't handle the rigors of the job. We're skeptical about the effectiveness of someone listening and offering advice, and at the end of the day, we don't want to be treated differently if we need assistance.

Marilyn Rivers, CPCU, ARM, AIC, is the director of risk and safety and the safety and compliance officer for the City of Saratoga Springs, New York.

As humans, we have stigmas that stop us from seeking help when we need it. We're embarrassed when we can't handle the rigors of the job. We're skeptical about the effectiveness of someone listening and offering advice, and at

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SUMMER EDUCATION SESSION SPOTLIGHT 3: BEST PRACTICES IN POOL LOSS CONTROL GET YOUR THINKING RIGHT, THEN GET YOUR PROGRAM RIGHT

Best Practices in Pool Loss Control Get Your Thinking Right, Then Get Your Program Right Michael G. Fann, ARM-P, MBA, will be presenting “Best Practices in Pool Loss Control” during our virtual Summer Education Series, starting June 2020. Preview some of the learnings from the coming education session in this article.

T

here's no question that an effective loss control effort is an essential step in the risk management process. All too often, risk pool management attempt to launch loss control & safety programs before substantially defining the "why"—in other words, knowing the mission of the effort, and fully understanding the business philosophy behind that mission. Therefore, it is critical that an organization "get their thinking right" before establishing a program. Every pool loss control group needs to build a framework for success and then identify the people that can help accomplish the mission. Once the loss control effort is fully mission-driven, the group must prioritize efforts and work to identify the root causes of accidents. Ultimately, loss control's task is to consistently take a slice out of the loss/claims pie.

Pooling and insurance, in general, is a financial mechanism. This mechanism is based upon a foundation of analyzing, understanding, and addressing probabilities of loss. Therefore, loss control is the discipline of reducing those probabilities. It is best to keep loss control solutions simple because implementation happens across

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a very diverse set of public entities. While your total risk picture will be complex and involve many types of exposures, it is best to begin by focusing on three broad areas: the people (on-the-job safety), the public (liability), and the property (conservation).

desire to be a valued resource to your internal and external customers. The best candidate would be someone with excellent interpersonal skills and vast technical knowledge, but if you can only find one set of skills, make sure you err on the interpersonal side.

The loss reduction effort will require people and tools. People are listed first for a reason as the loss control function in pools is almost entirely dependent on relationship-building. Only developing new policies or drafting procedural improvements may make you feel accomplished, but if you haven't developed a positive working relationship with both your internal and external customers, your success will be limited.

Tools. Once the group has identified the right people, it's time to develop a framework.

The plan should include the tools and loss control elements necessary to assist a team in influencing change. While every public entity loss control effort will need to include certain basic things, every loss control framework should be tailored to the specific loss exposures facing the pool. Most good loss control professionals desire to prevent every claim, but that is likely impossible. So, it's best to prioritize efforts and develop a plan to reduce losses in the short term for the entity's high-priority set of claim causes. Do this by identifying the top three to five causes of claims in each line of coverage offered, and develop a strategy to reduce losses in those areas. Don't spend too much time in "compliance" areas of safety and loss control if you're not experiencing significant declines in those areas.

People. To carry out this mission, look to identify people with excellent character and interpersonal skills. Ideal candidates are those that can relate well with others and develop the working relationship needed to implement change in policy and behaviors. Typically, organizations try to identify loss control candidates with a particular skill set and excellent technical knowledge, but, it is more important to locate a person with good interpersonal skills and high character. Then, teach them the technical side of the industry. In other words, you're not looking for inspectors; you're looking for people who

Framework. Each pool loss control effort will be different, but all should have a general framework of five elements.

1. Build relationships. Sound familiar?

2. Create a process of "being there," including for contact, analysis, and review with members. Accomplish this through onsite surveys, pre-survey and post-survey analysis of claims history, and telephonic communication and guidance. Further, be active in statewide associations within the functional areas of the pool's public entities.

3. Create a program for education, training, and information dissemination, including regional training, onsite classes and training, and making staff available for presentations at statewide associations and conferences.

4. Within the pool's financial capabilities, fund grant programs within critical exposure areas. For example, in Tennessee, successful grant programs include a workers' comp and safety grant, a driver safety grant for members with Auto General Liability coverage, a Property Conservation grant for those with property and crime coverage, and a police liability supplemental grant for POST-approved online police training.

5. Again, within your pool's financial capabilities, fund scholarships, and continuing education opportunities for staff members from the pool membership.

In Tennessee, sending pool members to the PRIMA Annual Conference, PRIMA Institute, and state chapter TnPRIMA Annual Conference, as well as police officers to specialized training, focused on the use of force, response-to-resistance, and de-escalation techniques have been very beneficial.

An excellent underlying service mantra is co-opted from a quote from Abraham Lincoln: Do for your pool members what no one else will do for them, but don't do for them what they can and should do for themselves.

the "Dirty Dozen." Some of the internal Dirty Dozen standards include: • Be a resource, not a police force • Be a consultant, not an inspector or auditor • Be teachable • Be diligent • Be accountable • Be duplicable In the end, your loss control staff shouldn't simply be "on the team" or just "part of the team" with their pool members. They should be essential "teammates" with your membership.

Michael G. Fann, ARM-P, MBA is the director of loss control for Public Entity Partners in Brentwood, TN.

In closing, you want to build a team and an effort designed for implementing change: change in behaviors, change in policy, and change in practices. In Tennessee, the focus is on building a team and a framework within

Do for your pool

members what no one

else will do for them, but don't do for them what

they can and should do for themselves.

Abraham Lincoln

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SUMMER EDUCATION SESSION SPOTLIGHT 4: ONE STRAW TOO MANY: HOW TO ADDRESS EMPLOYEE BULLYING CL AIMS

One Straw Too Many: How to Address Employee Bullying Claims Carrie A. McFadden, AWI-CH, will be presenting “One Straw Too Many: How to Address Employee Bullying Claims” during our virtual Summer Education Series, starting June 2020. Preview some of the learnings from the coming education session in this article.

A

dam was a few weeks in working at his new job when his co-workers began mocking him.

They called him names, whispered and laughed during his presentations. Then— the straw that broke the camel's back— they took an unflattering photograph of Adam while he was eating and posted it to his personal social media account, as though it was him. Humiliated and fed up, Adam decides to file a bullying complaint with Human Resources.

Bullying claims such as this one have become increasingly common. But what constitutes bullying? Why should an employer be concerned about bullying complaints? How can employers respond to and aim to prevent bullying conduct in the workplace?

THE WHAT: WHAT IS—AND WHAT IS NOT—BULLYING CONDUCT

There are several definitions of bullying conduct from various sources, such as the Workplace Bullying Institute and California Lawyer's Association. One definition, in particular, is promulgated

by California statute: "Conduct of an employer or employee in the workplace, with malice, that a reasonable person would find hostile, offensive, and unrelated to an employer's legitimate business interests." CA Gov. Code 12950.1(2).

Bullying conduct can be expressed as: • Spreading malicious rumors, gossip, or chronic teasing

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PUBLIC RISK | MAY/JUNE 2020

• Excluding others, social isolation • Undermining or impeding someone's work • Belittling, removing responsibility without cause • Constantly changing the rules and guidelines • Withholding information or providing misinformation • Raising voice, yelling, using profanity • Establishing impossible deadlines or workload Generally bullying conduct is not: • Effective and appropriate performance management • Warranted and correctly managed discipline • Isolated incidents that are not significant or egregious • Not liking everyone • Respectful and civil disagreements • Giving directions, orders, assignments, or fair criticism

THE WHY: WHY SHOULD EMPLOYERS BE CONCERNED ABOUT BULLYING CONDUCT

morale, and reduced productivity. Further, bullying conduct can potentially expose an organization to legal liability (i.e. claims for defamation, false imprisonment, assault and/or battery).

THE HOW: HOW SHOULD EMPLOYERS RESPOND TO BULLYING COMPLAINTS

Sometimes employers respond to bullying conduct by rationalizing the behavior, such as describing the Respondent (the alleged bully) as a "director communicator," "assertive," or has high expectations of the staff. Other times managers transfer the Respondent to a different department, moving the problem along. Neither response addresses the underlying problem caused by the Respondent's behavior. It allows the behavior to continue, potentially negatively impacting more employees and leading to more significant problems later.

WHAT EMPLOYERS SHOULD DO

Once an organization is on notice of potential bullying conduct, such as in Adam's situation above, it cannot simply ignore it. Consider the impact of the bullying conduct on the employee who is the subject of the bullying. These impacts range from feelings of anger, frustration, humiliation, loss of confidence, and the inability to concentrate at work.

Employers can take steps to prevent bullying conduct by developing anti-bullying policies and providing training. Intervening once an employer becomes aware of potential bullying conduct is also critical. Managers effectively investigate complaints of bullying conduct by preparing an investigative plan, conducting interviews of the parties on each side of a bullying claim, and drafting a well-reasoned and thoughtful analysis supporting the findings.

Bullying conduct can also negatively impact the general workplace, including absenteeism, lower

For example, if you received Adam's complaint described above, how would you prepare your

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investigative plan? What company policies, if any, are implicated by the allegations? What additional evidence would you want to obtain?

Who would you interview, and in what order?

What if a witness raises similar charges against the respondents? How should you document your investigation and your findings? What if Adam later alleges the conduct was due to age bias?

SPECIAL CONSIDERATIONS FOR INVESTIGATING BULLYING CONDUCT IN THE SCHOOL SETTING

This refers specifically to bullying between students who are minors. It is essential to be aware that, developmentally, children are not the same as adults. A young child may be confused by complex questions or words above their understanding. An adolescent-aged child may

desire to respond to the adult asking questions in a way they believe is the "correct" way and overlook the importance of providing a truthful account of what they witnessed. In addition to risking an unproductive interview with the minor, an investigation may be challenged if age-appropriate questions aren't being asked.

There are tangible benefits for an employer to take steps to prevent bullying conduct and intervene once it learns of a potential concern. Proactively, serious concerns—including potential policy violations—can be uncovered and addressed before a complaint is filed, and employees can feel that their concerns are being taken seriously.

Carrie A. McFadden, AWI-CH, is the senior associate attorney at the investigations law firm Van Dermyden Maddux Law Corporation.

Managers effectively investigate complaints of bullying conduct by preparing an investigative plan, conducting interviews of the parties on each side of a bullying claim, and drafting a well-reasoned and thoughtful analysis supporting the findings.

CALENDAR OF EVENTS PRIMA’s calendar of events is current at time of publication.

For the most up-to-date schedule, visit www.primacentral.org.

SUMMER EDUCATION SERIES Starting June 2020

PRIMA ANNUAL CONFERENCES June 13–16, 2021 PRIMA 2021 ANNUAL CONFERENCE Milwaukee, WI Wisconsin Center June 5–8, 2022 PRIMA 2022 ANNUAL CONFERENCE San Antonio, Texas Henry B. Gonzalez Convention Center

PRIMA INSTITUTE October 26–30, 2020 Washington, DC

ERM TRAINING August 4–5, 2020 Austin, TX

PRIMA WEBINARS May 20 • Marijuana and CBD June 24 • Until Help Arrives July 22 • ERM Beyond the Risk Assessment—Framework, Principles and Integration August 19 • Weather Disaster: Emergency Response Plan September 16 • Leveraging Telehealth to Redefine Intake and Proactively Manage Care October 16 • Building a Peer Support Program November 4 • Emerging Risk and Insurance December 16 • Occupational Physicals and Employee Wellness: Redirecting Costs

MAY/JUNE 2020 | PUBLIC RISK

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Meet PRIMA’s New Members from February – March 2020!

T H A N K YO U F O R J O I N I N G T H E P R I M A C O M M U N I T Y !

Margaret Zechlin, CPCU, ARe, ASLI, AIC, RPLU Allied Public Risk

Rashaan Evans Assistant Director, Risk Management American University

Terri Palm Human Resources Director County of Jefferson

Michael Bartemy Training & Operations Supervisor Somerset County Board of Education

Natosha Fisher Risk Mgmt Analyst

Phil Reimer Safety Advisor Milwaukee Metropolitan Sewerage District

Cozetta Carlton Risk Manager Risk Associates

Jordan Combs Executive Director Maury Service Authority

Dave Cosby Risk Manager Pueblo West Metropolitan District

Tanya Deleon Risk Manager District of Columbia Water and Sewer Authority

Juan Hernandez Safety/Risk Coordinator County of Cameron

Joy Riesenberg Risk Manager City of Napa

Rebecca Jones Senior Human Resources Generalist City of Lone Tree

Ronald Searl

Lauren Land Risk Management Coordinator City of Wentzville

Jasvir Sidhu Risk Management Analyst City of Livermore

Jennifer Martel Acting Risk Manager Fairbanks North Star Borough

Donna Wilson Treasurer City of Orofino

Amanda Monsivais Human Resources Manager City of Midlothian

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