Public Risk October 2018

PUBLISHED BY THE PUBLIC RISK MANAGEMENT ASSOCIATION OCTOBER 2018

A Practitioner’s Perspective PAGE 6

ALSO IN THIS ISSUE

DO YOU REALLY KNOW WHY THEY KEEP HURTING THEIR BACKS? PAGE 10

PERFORMANCE EVALUATIONS: WORTH THE RISK? PAGE 15

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Insurance contracts are underwritten and issued by: 1. BITCO General Insurance Corporation and BITCO National Insurance Company; 2. Old Republic Insurance Company; 3. Pennsylvania Manufacturers Association Insurance Company, Manufacturers Alliance Insurance Company, Pennsylvania Manufacturers Indemnity Company.

OCTOBER 2018 | Volume 34, No. 9 | 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 Jani J. Jennings, ARM Risk Manager City of Bellevue Bellevue, NE PAST PRESIDENT Amy J. Larson, Esq. Risk and Litigation Manager City of Bloomington Bloomington, MN PRESIDENT-ELECT Scott J. Kramer, MBA, ARM County Administrator Autauga County Commission Prattville, AL DIRECTORS Brenda Cogdell, AIS, AIC, SPHR Risk Manager, Human Resources City of Manassas Manassas, VA Forestine Carroll Risk Manager Memphis Housing Authority Memphis, TN

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Enterprise Risk Management: A PRACTITIONER’S PERSPECTIVE

By Dorothy Gjerdrum and Shannon Gunderman

Sheri Swain Director of Enterprise Risk Management Maricopa County Community College District Tempe, AZ Donna Capria, CRM, CIC, AINS Risk & Insurance Coordinator WaterOne of Johnson County Lenexa, KS Michael S. Payne, ARM, HEM Risk Manager City of Fresno Fresno, CA Melissa R. Steger, MPA Asst. Director, Workers’ Compensation University of Texas System Austin, TX NON-VOTING DIRECTOR Marshall Davies, PhD Executive Director Public Risk Management Association Alexandria, VA EDITOR Jennifer Ackerman, CAE Deputy Executive Director 703.253.1267 • jackerman@primacentral.org ADVERTISING Jennifer Ackerman, CAE 703.253.1267 • jackerman@primacentral.org

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Do You Really Know Why They Keep Hurting Their Backs?

By Bryan Fass, ATC, LAT, CSCS, EMT-P(ret.)

IN EVERY ISSUE

15

Performance Evaluations: Worth the Risk?

By Gordon Graham

Public Risk is published 10 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 2018 Public Risk Management Association

| 4 NEWS BRIEFS | 19 ADVERTISER INDEX

OCTOBER 2018 | PUBLIC RISK

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MESSAGE FROM PRIMA PRESIDENT JANI JENNINGS, ARM

e’re all doing more with less today at work. Many of us are taking on tasks that fall in our lap after positions are eliminated due to budget constraints. Some of us have taken on a whole new role as a risk management professional to address a much-needed loss control effort.

Having transitioned from working in human resources to a newly created position of risk manager some time ago, I know that feeling of being “lost in space” when my boss simply directed me to “fix things!”

How? Saying no is not an option. Winging it is not an option. But how do I ask for help? For some reason, many of us perceive a request for assistance as a sign of weakness, when it actually means you are self-assured enough to know when it’s time to reach out to the experts. However, that doesn’t necessarily mean that asking for help is easy. Not only is it sometimes uncomfortable to ask for help, but how do you find someone who can help?

When I was a new risk manager, I was wisely pointed in the direction of PRIMA, where I was able to take advantage of all the educational programs specifically geared toward public entity.

Very soon, I learned there are so many wonderful PRIMA members who were willing to take my hand and walk me through those vital first steps I needed to know before I could “fix things.”

Starting with the basics, here are my Top 4 Go-To Programs from PRIMA to provide immediate assistance to risk managers with newly presented challenges:  PRIMA Podcasts – Learn as you go and listen to the Basics of Risk Management

“

When I was a new risk manager, I was wisely pointed in the direction of PRIMA where I was able to take advantage of all the educational programs specifically geared toward public entity.

Very soon, I learned there are so many wonderful PRIMA members who were willing to take my hand and walk me through those vital first steps I needed to know before I could “fix things.

Series if you are new to the profession. Listeners receive invaluable instruction and information from veteran risk management professionals who will guide them through many different facets and puzzle pieces of risk management.

This series helps listeners understand what public risk managers do and the many hats that they wear. Plus, it helps with the “hey, maybe I’m not in this alone” factor.  PRIMAtalk Community – PRIMAtalk is a members-only online community group designed for interactive discussions with our risk management peers. Browse through the newer and older posts on the listserv to find solutions to the latest risk management challenges. Pose a question and wait for the responses to fly in! Receive quick feedback on issues that are important to all of us as public sector risk managers.  PRIMA Institute – PRIMA Institute (PI) is an innovative educational symposium comprised of fundamental risk management curriculum, outstanding faculty and excellent networking opportunities. PI is the premier educational program for new risk managers as well as seasoned risk professionals who seek to learn more about emerging trends and best practices. PRIMA Institute is a “must do”!  Annual Conference – Last but certainly not least, attend PRIMA’s Annual Conference. As the leading event for public risk management

“

W

With A Little Help From My Friends

professionals, PRIMA’s Annual Conference provides an opportunity for attendees to connect with and learn from peers and thought leaders from inside the industry, and is the ONLY conference specifically tailored to the needs of the public sector risk manager. Risk managers will have three days of learning opportunities with more than 55 classroom sessions. Moreover, they will have the opportunity to network with colleagues from across the country who recognize the influence of public sector risk managers and are ready to help them succeed.

Our risk management careers should be about overcoming challenges and not letting setbacks diminish our confidence in our abilities. Even when things seem bleak, PRIMA gives us the tools to work it out. PRIMA allows us to rest assured and confidently say “we’ve got this”!

Sincerely,

Jani Jennings, ARM PRIMA 2018-2019 President Risk Manager City of Bellevue, NE

OCTOBER 2018 | PUBLIC RISK

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NEWS BRIEFS

NEWS Briefs

THE CHEMICAL FOUND IN DRINKING WATER THAT NEW JERSEY (AND NO OTHER STATE) NOW REGULATES

A new Department of Environmental Protection rule will cap the amount of compounds known as PFNAs, short for perfluorononanoic acid. For years, the state has been concerned about the level of PFNAs detected in water samples and has studied how the compounds were making their way into water. The state has even found some of the compounds in fish from recreational waterways and has begun issuing consumption advisories.

PFNAs are part of a large group of chemical compounds known as PFAS, short for per- and polyfluoroalkyl substances. The compounds were also used to make firefighting foam, stain-resistant clothing, and food packaging. They have been linked to low infant birth weights, effects on the immune system, cancer, and hormone disruption.

PFAS can accumulate in the body and remain for long periods.

There are no federal standards for the compounds. Environmental Protection Agency officials under the Trump administration sought to block the release in June of a federal study showing that the same class of chemicals that contaminated water supplies near military bases and other areas, worrying it would cause a “public relations nightmare.” Since then, the EPA has held a series of public forums on the compounds, including one in Horsham that drew hundreds of residents.

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PUBLIC RISK | OCTOBER 2018

“

Today, the state has met

the challenge to protect

people from exposure to

PFNAs, one of the most

“

New Jersey has become the first state to regulate its drinking water for a man-made, toxic chemical compound once used in making nonstick cookware and now linked to a variety of health problems, reports The Philadelphia Inquirer.

toxic perfluorinated compounds known.

Tracy Carluccio, deputy director of the Delaware Riverkeeper Network

The New Jersey rule amends the Safe Drinking Water Act to set a maximum contaminant level of 13 parts per trillion of PFNAs starting in 2019. It aligns with Gov. Murphy’s much more aggressive environmental policies compared with the Christie administration, which declined to take up the issue. Environmental groups have long sought such regulation.

“Today, the state has met the challenge to protect people from exposure to PFNAs, one of the most toxic perfluorinated compounds known,” said Tracy Carluccio, deputy director of the Delaware Riverkeeper Network.

PFNAs were first detected in the Delaware River watershed in Gloucester County in 2010, according to the Delaware Riverkeeper Network.

The compound was found in a groundwater well in Paulsboro near the Solvay plastics manufacturing plant. The Paulsboro groundwater showed concentration of 96 parts per trillion.

Higher levels were later found. The borough filed notice it would sue Solvay, which led to a water treatment system to remove the compound.

Five municipalities in the state shut down contaminated wells because of the chemicals.

PFNAs are no longer used in manufacturing.

OPIOID OVERDOSE DEATHS ROSE IN 2017 DRIVEN BY FENTANYL New numbers from the Centers for Disease Control and Prevention show drug overdose deaths continued to climb in 2017, in nearly all states.

Nearly 72,000 Americans died from a drug overdose in 2017, about 7 percent more than in the previous year, according to new provisional data from the Centers for Disease Control and Prevention.

Although the use of prescription painkillers has declined nationwide, analysts say the presence of the deadly opioid fentanyl in the illicit drug supply is the primary cause for the continued surge in deaths.

SURVEY: TEACHER SHORTAGES WORSENING IN MOST STATES

States with the highest increases in drug deaths include Nebraska (33 percent), North Carolina (23 percent), New Jersey (21 percent), Indiana (15 percent), Arkansas (11 percent), Maine (11 percent), West Virginia (11 percent), South Carolina (10 percent) and Tennessee (10 percent).

Though the number of deaths rose in most states last year, the number of fatal drug overdoses declined in 14 states, including Rhode Island (minus 7 percent), Vermont (minus 6 percent) and Massachusetts (minus 1 percent). The opioid epidemic hit earlier and harder in New England than in other parts of the country. A recent report from Massachusetts indicates the downward trend in drug deaths in that state may continue.

In addition to the three New England states, overdose deaths fell in Wyoming (minus 33 percent), Utah (minus 12 percent), Oklahoma (minus 9 percent), Montana (minus 8 percent), South Dakota (minus 8 percent), Hawaii (minus 5 percent), Kansas (minus 2 percent), Mississippi (minus 2 percent), New Mexico (minus 2 percent) and North Dakota (minus 1 percent).

The opioid epidemic began in the late 1990s.

Since then, drug deaths have been rising steadily every year, killing more people every year than automobile accidents.

Teacher shortages are worsening across the U.S. for the majority of states, according to an exclusive survey by the Guardian.

The Guardian contacted all US states’ departments and boards of education, and other official bodies. Forty-one states responded; nine others declined to provide relevant data or did not respond to requests for information.

The study found: • Of the 41 states that did respond to the survey, 28 say they are experiencing teacher shortages.

• Of those 28, 15 say teacher shortages have increased in the last year.

• Of the nine states that didn’t respond to the survey, public data suggests another eight are experiencing teacher shortages.

Schools are struggling to fill positions in science, special education and mathematics, and often have trouble keeping teachers because of low salaries, high student loans and reduced budgets.

OCTOBER 2018 | PUBLIC RISK

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A Practitioner’s Perspective

BY DOROTHY GJERDRUM AND SHANNON GUNDERMAN

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PUBLIC RISK | OCTOBER 2018

T CAN SEEM LIKE A DAUNTING CHALLENGE TO CREATE AN ENTERPRISE RISK MANAGEMENT (ERM) PROGRAM. Where do I start? How will I

obtain buy-in from leadership, supervisors, and managers? What’s the best way to engage employees? What outcomes can we expect?

These are only a fraction of the questions that can make a risk manager feel overwhelmed with the task of developing an ERM program; so overwhelmed, in fact, that the process is often never begun. It’s like being told to take a long journey up a mountain without a map or even a clear picture of the destination.

ERM won’t be a Sisyphean task, though, if risk managers utilize a reliable map, consult with professional guides, and learn from those who have experienced the journey.

PRIMA provides the map and guides for implementing ERM through its in-person and online trainings. To provide real-life experiences with ERM implementation, Dorothy Gjerdrum and Shannon Gunderman, two ERM practitioners and PRIMA faculty members, sat down to discuss Yuma County’s successful ERM program as well as their thoughts and advice on taking the first steps down the ERM path.

Dorothy – So, Shannon, I heard that Yuma County (AZ) just won its second national award for its ERM program. Congratulations!

Shannon – Thanks, Dorothy. It’s certainly a tribute to all the employees who had a part in making the ERM program a success over the past four years.

Dorothy – It’s impressive that your ERM program has been evolving for that many years.

To help others benefit from your journey, take us back to the beginning. What motivated the County to start an ERM program?

Shannon – Many years ago, when the concept of ERM was beginning to take hold among risk management professionals, I approached the County Administrator to sell the idea. It was around the time of the economic downturn that would eventually become the Great Recession and, knowing that the County Administrator was concerned about the budgetary issues of shrinking revenues and increasing expenditures, I reviewed with him how ERM could lead to monetary savings, improved resource allocation and improvement of the budgetary process. The County had been practicing traditional risk management for a while and the program was growing at a steady pace, but I was confident that ERM would dramatically improve the way we viewed and addressed risk.

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ENTERPRISE RISK MANAGEMENT: A PRACTITIONER’S PERSPECTIVE

Dorothy – That was really smart to focus on the outcomes that mattered most to your leader in your pitch for support. And I know that you were able to achieve those objectives. But how did you actually get started and decide how to build your program?

Shannon – I gathered information from every source I could find, including industry whitepapers, the international standard on risk management [ISO 31000] and online resources.

In the process, I learned that one of the basic tenets of ERM is that a ‘siloed’ approach to risk needs to be replaced by an entity-wide method.

This gave me the opportunity to support one of my County Administrator’s key objectives regarding the budget.

When advising your clients, Dorothy, how do you help them “sell” ERM? Dorothy – You hit on a key factor, Shannon, which is to consider what’s most important to decision makers and “sell” your program in support of those objectives. You’ll develop long-term support if you can help others meet their goals and be successful. And that applies to department heads and other leaders in your organization, as well.

I also think it is compelling to communicate that ERM is about making sure that you are “paying attention to the right stuff.” That applies to risks—making sure that the risks that are most critical to your mission and

details of the process. The ERDT is responsible for facilitating workshops, collecting risk data, assessments and treatments, entering all the data into an online database, and reporting program results to the ERC. The ERC is a committee of eight management level employees that monitors program progress and reports significant findings to the County Administrator. To ensure that data was kept current and was easily accessible to program participants and County leadership, I secured an online “Software as a Service” to house our data.

Dorothy – Tell us more about those risk workshops and how you decided to deploy the process across the county over time.

As a result of the conversations started in the ERM workshops, several departments reached out to one another and achieved operational and financial efficiencies by sharing information and resources… By increasing their operational efficiency, they saved $150,000 of budget money which was used to obtain an online case management system that will increase productivity, reduce costs, and improve the security, integrity and accessibility of data.

In our County, when departments addressed risks that would result in a budget request, they tended to focus on their individual department without considering how their risks might affect other departments. I used the example of information technology needs to reveal the redundancies and waste created by such a philosophy. There are many emerging risks in connection with data security, storage and maintenance. The usual practice is that when departments have a specific need for software that addresses these risks, an assessment is done for that department and software is then purchased. This process is repeated for other departments until everyone has the software they need. The only problem is that many departments’ technology needs (and risks) are similar, and money is being wasted and efficiencies lost by purchasing multiple single solutions rather than one enterprise-wide solution. ERM prevents such waste as ‘cross-cut’ or overlapping risks and needs are identified through the ERM process.

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PUBLIC RISK | OCTOBER 2018

objectives have priority—as well as operational efficiencies. Are you utilizing your resources in the best way possible? Are you treating key risks and emerging risks or only the same old historical risks that you see your rear-view mirror? An important message of ERM is that is can help your organization look forward and be more efficient, as you were able to demonstrate when you applied ERM to your county’s budget process.

But I know you didn’t get there overnight. Can you describe how you helped your organization build its roadmap? After you received approval from your County Administrator to proceed, what were your next steps?

Shannon – First, I assembled an Enterprise Risk Development Team (ERDT) and Enterprise Risk Committee (ERC). The ERDT is a group of six employees that directs all the

Shannon – We started with departments that had good relationships with the Risk Management Division and who actively supported its initiatives. That way, we were more likely to experience positive results, which would then provide momentum in the initial stages of the project. We scheduled two risk workshops with each department.

In the first workshop, ERM and the concepts of ISO 31000 were briefly reviewed, key risks were discussed and consensus was obtained regarding their descriptions and classifications. In the second workshop, consensus was obtained on Likelihood and Impact ratings, risk treatment classifications and descriptions, and the assignment of risk and treatment ownership.

Dorothy – How long did it take to host these workshops for all departments and what were some of the outcomes?

Shannon – I realized that the project couldn’t be rushed if it was to have long-term success.

ERM was a new concept, so it was necessary to provide ERM education to all of the program participants in addition to walking them through the process of risk identification, assessment and treatment. So, a two year implementation schedule was planned.

As a result of the conversations started in the ERM workshops, several departments reached out to one another and achieved operational and financial efficiencies by sharing information and resources. For example, the Public Fiduciary realized that by partnering with the County Attorney through resource and data sharing, she could achieve a long-time strategic goal of providing community outreach and education while reducing the number of incorrectly assigned cases.

In another example, the County’s Public Defender and Legal Defender recognized that they shared a common case management objective that was affected by the same risk.

By increasing their operational efficiency, they saved $150,000 of budget money which was used to obtain an online case management system that will increase productivity, reduce costs, and improve the security, integrity and accessibility of data.

So far, the ERM program has identified 245 risks, developed 474 treatments, recognized 111 opportunities and created 111 plans of action. Six opportunities that affected two or more departments were also discovered.

Finding similarities in departmental risks led to increased efficiencies, including the launch of a county-wide fleet management program. ERM has also benefitted the budget process, with the budget director remarking that it provided the budget review team with additional insight into each department’s key issues and risks.

More recently, ERM has also been integrated into our updated strategic plan. A year ago, the new County Administrator expressed her desire to revamp the County’s strategic plan and asked for volunteers to serve on the committee. Seeing an opportunity to use ERM to affect the County’s strategic planning processes, I volunteered. A year

later, ERM principles have been included in the new plan and many employees are now using such terms as ‘enterprise-wide solutions,’ ‘enterprise-wide communication,’ and ‘breaking down silos.’

Dorothy – Wow, it sounds like your ERM program is really delivering results! It’s a great example of what’s possible. What advice do you have for those who are thinking of starting their own ERM program?

Dorothy – Those are some great examples.

One of the principles of ISO 31000 is that an ERM program should be dynamic, iterative and responsive to change. Have you found that applying this principle in your program has made your County more resilient?

Shannon – First, I would encourage them to make use of the many online ERM resources provided by PRIMA to familiarize themselves with what ERM is all about. Then, to reinforce and expand on that knowledge, I would recommend attendance at one of the ERM trainings offered by PRIMA each year.

They can also bring the training in-house by contacting PRIMA. I think the in-house approach is a particularly beneficial way to start off.

Shannon – Definitely. The County has always experienced unique issues when it comes to the uncertainty of collecting revenues sufficient to cover its required expenses. The economic downturn a few years ago only intensified these issues. However, ERM provided the County with a stable, objective framework with a repeatable process that helped it methodically identify risks while providing a positive, productive environment for developing effective solutions. Even better, the solutions often did not involve finding ‘new’ money or resources but, instead, improving the allocation of available resources.

Dorothy – Can you give an example of the way resource allocation was improved?

Shannon – One that comes to mind relates to the County’s Mental Health Court (MHC).

The MHC is a specialty court whose purpose is to connect mentally ill persons with treatment providers and community support services in order to reduce criminal activity and improve participants’ quality of life. The MHC was meeting its goals, but there was a serious problem. Funding to maintain the program had dried up. If alternative means of support were not located, the MHC program would not survive. Using the ERM process, stakeholders from five County and State offices were brought together to identify, assess and rate the risks affecting the MHC’s objectives and then develop workable treatments. The solution was simple: one stakeholder’s salary savings from a vacant position were combined with budgetary savings realized by implementing operational efficiencies developed through the ERM process. The MHC budget shortfalls were covered.

Dorothy – I agree, Shannon. A number of PRIMA members have taken advantage of that option. It’s a good way to customize the training to the needs of your organization. I also recommend that people learn from your example of persistence, planning and focus.

You implemented your program thoughtfully, over time. That kept you from burning out and allowed people to become familiar and comfortable over time. You also kept “outcomes” and “objectives” front and center, which helped develop supporters along the way. It’s no wonder you’ve won awards for your good work!

Shannon – Thank you. On a final note, I would say that by using ISO 31000 as a framework for an ERM program, any public entity of any size can save money, allocate resources more efficiently, attain strategic objectives, better analyze and treat risks, and improve interdepartmental and intergovernmental communication.

PRIMA’s next enterprise risk management training will be held November 14–15, 2018, in Alexandria, VA. For more information, visit www.primacentral.org/ermtraining.

OCTOBER 2018 | PUBLIC RISK

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DO YOU REALLY KNOW WHY THEY KEEP

BY BRYAN FASS, ATC, LAT, CSCS, EMT-P(RET.)

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PUBLIC RISK | OCTOBER 2018

I

NJURY, DISABILITY AND EVEN DEATH IS A RISK that every first responder accepts

when entering the profession. Back injuries alone account for more than 20 percent of all workplace injuries in the United States and are a particular problem in first responders, where at any given time nearly 10 percent of the workforce is out of work from injury. The Centers for Disease Control and Prevention monitors first responders injuries, and in the most recent data set available, more than 27,000 fire-EMS workers experienced on-the-job injuries and illnesses, and more than 21 percent of those injuries were to the lower back. International association of firefighter’s data shows that more than 50 percent of line of duty and 50 percent of early retirements are due to low back injury. These injuries incur extreme costs to departments and cities making staffing and budgeting challenging.

Plus, staff shortages mean higher call volumes and more overtime. The more a first responder is on duty, the greater their risk of an injury.

Then we have to add in the effects of fatigue and chronic stress and now their risk of driving errors increases along with altered mentation leading to poor decision making.

Overtime shifts are not only expensive, they also drive up provider fatigue, increasing healthy staff members’ risk of injury.

More than half (62 percent) of all pre-hospital provider back injuries result from lifting patients. Injuries are a consequence of three major factors: significant lifting forces (patient weight), repetitive movements and awkward positions. Pre-hospital back injury statistics have not changed significantly in the past decade despite the introduction of many safe lifting devices like automatic-lift stretchers, slide boards, slide sheets and bariatric equipment.

Candidly, fire-EMS has the best patient handling technology ever, yet injuries continue to rise and shift their root cause. From lower back to now neck, shoulder and elbow.

To help protect workers, the National Institute for Occupational Safety and Health (NIOSH) established safe lifting limits for health care providers. The load limit set for single-person lifting is 51 lbs. and a spine compression force of 764 lbs. Unfortunately for EMTs and firefighters, many routine lifts far exceed the recommended compression limits. For example, pulling a 105-lb. patient via bedsheet between two beds applies between 832–1,708 lbs. of compressive force. Personally, I cannot recall the last time I transferred a patient weighing less than 200 lbs. As obesity has increased, so has the occupational load that first responders must deal with. Carrying the same patient down a set of stairs compresses the spine with 1,012–1,281 lbs.

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DO YOU REALLY KNOW WHY THEY KEEP HURTING THEIR BACKS?

FORCES ON THE LUMBAR SPINE

MOMENT due to applied load

Disc SHEAR force (perpendicular to long axis of vertebrae)

Erector Spinae Force

Disc COMPRESSIVE force (parallel to long axis of vertebrae)

Add to all of this compression, shear and torque the fact that EMS, fire and public works are one of the few professions left where it’s considered a normal (required) job task to pick up catastrophically heavy loads off the floor every day.

This is akin to deadlifting 300 lbs. strapped to a spine board, the board is flat on the floor and the load will shift as you lift it. After it’s lifted it must then be maneuvered down a hallway, downstairs and then onto the stretcher. No other profession allows such injurious loads to be picked up with from such a low position i.e. hands on the floor, and that’s with the assumption that the patient is not in a bath tub, wet, which exponentially increases the shear, torque and compressive forces in the spine.

Another important fact of spine physiology is that when you sleep, the spinal disks swell. This swelling is the fluid shift that naturally occurs to help nourish and heal the disk. It’s estimated that one needs around 15 minutes of standing to dissipate the fluid and it’s in this time frame that disk injury is much more likely. This is a primary cause of why we see so many disk injuries in fire-EMS late at night!

PATTERNS

Almost all the responders this author trains across the country have deeply seated biomechanical patterns that inhibit deep safe lifting.

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We teach hundreds of classes per year and less than 10 percent of our first responders can work safely from the floor. Of course, the easy answer is to not lift from the floor. There are techniques that can alter this lift height and make it safer but in extreme cases, patients or gear have to be lifted and no tool can help in all situations.

What we have learned and what the data shows is that most responders have similar patterns that can often be tied back to the job task. On top of that, many responders possess patterns that are both repetitive and static/chronic. Soft tissue traumas occur in the public sector from three major causes.  Overexertion Trauma: Overexertion injury occurs when the external force that is encountered produces torques and compressive loads that the tissue is unable to handle. When the soft tissue failure tolerance is met the tissue can fail outright (injury) or sustain micro-traumas that will weaken the tissue causing it to fail. This is often manifested when a responder has to pick up a patient from a bath tub to move them into a hall where medical treatment can begin. The poor working environment and the weight of the patient causes the tissue to sustain forces that it cannot dissipate and the tissue fails as a result.

 Repetitive Motion Disorder: Repetitive movements will ultimately lead to tissue failure from countless repetitions of faulty and dangerous movements. A common pattern we see is how responders enter and exit their vehicles. Years of rapid entry and exit, often weighted down with gear or vests will fatigue the tissue to the point of failure.

We see the same effect from faulty lifting; in EMS, we often see repetitive rotator cuff strain after lifting the 40 lb. ECG monitor from the floor to the cot in a swinging motion. The repetitive traumas of the job add up over time.  Prolonged Static Positioning: As children, we went to school and sat at little tables, hunched forward. As adults we essentially do the same thing except now it’s hunched over a computer, phone or a steering wheel. The bottom line is that repetitive static postures like sitting, standing and desk work will over time “program” the body to believe the faulty postures to be normal. Folks, it’s not normal to have a forward head posture and a rounded upped back.

First responders often display tightness in the calf, foot and ankle. From standing on concrete floors, hours spent in duty boots, training and of course, too much sitting. We

also see that how first responders enter and exit their vehicles effects the foot and ankle.

We know that when the ankle joint is tight and or restricted that the ability to squat and climb steps is altered plus we have seen that many trainers and coaches neglect to roll and stretch the gastroc-soleus-peroneals-posterior tibialis (calf). This complex of muscles, when tight, will affect the distal and proximal joints while also contributing to anterior tibial stress syndromes (shin splints) and patella-femoral disorders (knee tendonitis). Basically, if the calf is tight, it can cause an increased risk of knee and lower back injury.

A very common pattern that is prevalent in all first responders (and you too!) is the hip flexors

become very short and tight. As they become tight, they cause an anterior pelvic rotation that inhibits (shuts off) the abdominal wall, also known as the guts and butts posture. As the abdominal wall weakens, the spine takes additional loads. The glutes become tight and weak, and the hamstrings get tight to attempt to pull the pelvis back into place. As this pattern becomes more and more severe (lower crossed syndrome), they lose the ability to lift properly. The most common manifestation of this is when lifting a cot into the ambulance.

Almost all EMTs will pick up the cot (empty weight is 95 lbs. for a manual and 115–130 lbs. for a powered cot) and as they stand up, will use the lumbar spine as a hinge (extension moment). We catch all of them using profound

spinal extension, a hinge mechanic, instead of the hips to lift the cot.

Active stretching of the hip flexors followed by a long duration low-load stretch of the hip flexor group will almost immediately reduce the tightness that many responders experience daily.

Tie that into some simple gluteal integration exercises like single leg bridges, lateral step ups and fire hydrants can have an immediate and positive effect. We often see responders with active back pain that are pain-free after less than 10 minutes of resetting and reactivating the glutes.

Take home message: if they are not stretching the calf, ankle and hip flexors, then we have not really mitigated the risk of lower back injury.

SO HOW DO WE REALLY FIX IT?  All of these jobs are 100 percent physical. Athletes warm up, stretch, focus on maintaining mobility and fight to stay fit. Most public-sector employees do the exact opposite and that is where you need to focus. Encourage and incentivize stretching, work with your departments to encourage fit for duty testing annually and help them see the need to tie mobility together with wellness with strength.  Educate and empower them to own the problem. All first responders (shift work) suffer from what is called HPA axis dysfunction. This cortisol dysfunction is one of the root causes of sleep, stress and wellness disorders. Yet this altered cortisol cascade is not tested for in medical physicals and blood work. Test and educate or the problems will only get worse.  Become part of the solution and work with each group individually to meet their needs. Encourage, participate, coach, cheer and empower the crews to change.

Be seen, be active and be present. These are hands on groups and they want hands on solutions so roll up your sleeves and get dirty, laundry is a lot cheaper then a back injury.

Bryan Fass is founder and president of FitResponder.

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NOT IF, BUT HOW

PERFORMANCE EVALUATIONS: Worth the Risk?

BY GORDON GRAHAM

P

UBLIC SAFETY LEADERS HAVE LONG IDENTIFIED RECRUITMENT AND RETENTION AS KEY CHALLENGES FOR THEIR AGENCIES. With the improving economy, we can only expect those challenges to grow. As a risk manager, however, I see a challenge not just with finding and keeping good people in public safety—I see a huge “problem lying in wait” when it comes to properly assessing employee performance.

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PERFORMANCE EVALUATIONS: WORTH THE RISK?

A properly prepared performance evaluation is an excellent risk-management tool. It is a regular opportunity to assess how a given employee is currently doing and what future risks they may face. It helps the supervisor apply appropriate control measures to address those risks. Ultimately, it can improve the employee’s performance and in so doing, make the agency stronger.

But a performance evaluation that is not done properly—that is prepared without a lot of thought—can come back to haunt the agency.

I have seen this happen again and again. In too many public safety agencies, performance evaluations are not taken seriously. Such agencies miss critical opportunities to identify risks before they turn into tragedies.

Let’s take a closer look at performance evaluations in public safety by asking three critical questions.

WHY ARE PERFORMANCE EVALUATIONS INEFFECTIVE IN PUBLIC SAFETY?

Many things can go wrong with a performance evaluation, but let me focus on just two of the most common factors that make evaluations ineffective.

First, in many agencies, performance evaluations have turned into a “search/replace” exercise.

The supervisor pulls up the last evaluation prepared for a given employee and asks himself, “How much do I have to change to make it look fresh?” In some cases, the supervisor may use large chunks of the same text for different employees. Word processing made this possible; poor management allows it to continue.

If you don’t believe this is happening, I suggest you perform an audit of employee evaluations, comparing them year-over-year to see what’s changed. Also look at multiple employees who report to the same supervisor. Get a good sample—say 10 sets of evaluations. More than likely, you’ll see evidence that at least some of your supervisors are not starting fresh for each annual evaluation, but rather are copying phrases and even paragraphs they have used before.

Second, public safety performance evaluations consistently overrate employee performance.

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You can perform an audit to test for this, too. Pull the last two annual evaluations for 10 employees. Then ask your internal affairs, professional standards or HR people whether they’ve had a negative contact with any of the 10 employees in the last two years. At least one of the employees will have had a negative contact, but it is probably not mentioned at all in their evaluation.

Why does this occur? One reason we tend to overrate people is a built-in bias in favor of the employee. For many supervisors, employees are not just workers, they’re people they know and like. We generally get to know our employees outside of work, even if it’s just through conversations we have in the workplace. So we learn about employees’ family members, their hobbies and interests, the good work they do in the community. All that can make it difficult to objectively evaluate someone.

Further, supervisors take pride in their employees.

They don’t want anyone to think there’s a dud on their team—that reflects poorly on them as well. Even if the supervisor can be objective enough to identify performance issues, it’s easy to convince themselves they’ll deal with the matter directly—no need to put it in writing.

The other main reason that public safety personnel are overrated is, it’s easy. It is the path of least resistance. No one complains when they get overrated! On the other hand, employees who feel they have been underrated are often vocal, creating problems for supervisors. If the agency is unionized, the union representative will often get involved. Leadership may have to investigate further. The supervisor may gain a reputation as a troublemaker or an unfair boss.

For most supervisors, this is too much to ask. It’s much easier to write a positive review and get on with the day.

A properly prepared performance evaluation is an excellent risk-management tool. It is a regular opportunity to assess how a given

employee is currently doing and what future risks they may face. It helps the supervisor

apply appropriate control measures to address those risks. Ultimately, it can improve the employee’s performance and in so doing, make the agency stronger.

WHAT GOES WRONG WHEN EMPLOYEES AREN’T PROPERLY EVALUATED?

iron-clad rules but rather mere suggestions. Or that racking up a few citizen complaints is no big deal.

As a risk manager, you know better.

Failure to properly evaluate employees also leads to another significant risk: the threat of harassment and retaliation lawsuits. Let’s say an employee files a hostile work environment case against the agency. As you probably know, hostile work environment cases are difficult for employees to win. But if the employee hires a smart employment lawyer, you can very quickly have a retaliation suit on your hands.

Now, the average police chief or fire chief may be tempted to think, “If this is going on everywhere and has been for years, where’s the harm in it?”

When mediocrity or poor performance is rewarded, it spreads, posing a risk to overall organization performance. Personnel talk to one another about their evaluations, and employees notice when poor performers weather the evaluation process each year no worse for the wear.

The message is clear: There is no need to work hard, for they, too, will be equally rewarded for doing nothing. In turn, the organization suffers because employees are not adhering to policy.

They may conclude safety regulations are not

Not following? Year after year, the supervisor has given said employee a good evaluation— because that is the way things are done in the agency. But when the supervisor is named as a defendant in the hostile work environment case, the supervisor is now angry. When evaluation time comes around, the supervisor may well—

honestly—rate the employee as “unfit” or “needs improvement” or “doesn’t meet standards.”

To a future jury, this honest evaluation is now evidence of retaliation against the employee for filing the hostile work environment claim.

This may seem far-fetched to you, but in every employment law case I am involved in, performance evaluations become an issue—too often coming back to haunt the involved agency because supervisors continue to overrate employees.

HOW CAN WE MAKE PERFORMANCE EVALUATIONS BETTER? If we can agree the performance evaluation process in most public safety agencies is inherently flawed, what’s the solution?

It starts with thinking about performance evaluations not as a document we fill out once a year, but a system that includes six critical components:  Meaningful job descriptions  Identified objectives for each job  A process to ensure employees are meeting these objectives  A process to collect and analyze data regarding an employee’s performance  Goals for the next reporting period  A validated rating system With respect to the rating system, keep it simple. Three categories will suffice: Meets Standards, Exceeds Standards and Doesn’t Meet Standards. Either people are doing the job or not doing the job. Some (the “10 percenters”) will exceed standards and some (the other “10 percenters”) will not meet standards. Everyone else will be in between—and that’s OK. There is nothing wrong with receiving an evaluation that says you “meet standards.” This needs to be made clear to employees and supervisors alike so supervisors don’t feel pressured to overrate employees and employees don’t feel crushed when they receive a “meets standards” rating.

Those not meeting standards must be put on a performance improvement plan that includes specific, measurable steps to get up to speed and regular monitoring of progress.

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PERFORMANCE EVALUATIONS: WORTH THE RISK?

Those not meeting standards must be put on a performance improvement plan that includes specific, measurable steps to get up to speed and regular monitoring of progress. For employees on performance improvement plans, annual evaluations are not enough. The supervisor should check in monthly or at least quarterly and document the progress—or lack thereof.

For employees on performance improvement plans, annual evaluations are not enough. The supervisor should check in monthly or at least quarterly and document the progress—or lack thereof. Jaded supervisors may regard this process as a formality in an otherwise evitable journey toward terminating the employee.

In fact, employees often do respond to such guidance and show noticeable improvement.

But if they can’t or won’t meet standards, it is time to find them a job in the organization more in line with their abilities, or separate them from the organization.

supervisor. Agencies should also implement a robust audit process to ensure performance evaluations are being taken seriously by supervisors and the managers reviewing these documents.

Public safety executives also need to take control of the performance evaluation process.

For example, all performance evaluations should be reviewed by management prior to them being signed by the employee and

Gordon Graham is a 33-year veteran of law enforcement and the co-founder of Lexipol, a company that creates state-specific policy and training solutions for public safety agencies.

As risk managers, we need to take a long, hard look at the public safety performance evaluation processes. Performance evaluations are great when they are taken seriously. But if we are not committed to taking them seriously, they are just another problem lying in wait.

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