Work injuries can be expensive: Not only are companies faced with the direct costs of injury treatment and recovery, but indirect costs, including hiring and training replacement employees, investigating accidents, implementing corrective measures, repairing damaged equipment, and dealing with lost productivity, lower employee morale and absenteeism, can add up quickly. According to the Occupational Safety and Health Administration, these indirect costs can range from 1.1 to 4.5 times the direct costs of the injury.
With the soaring cost of treating and managing workers compensation injuries, reducing musculoskeletal strains and sprains—which comprise the greatest percentage of all work-related injuries—is a priority for many companies. Traditional approaches to managing these injury risks include addressing workplace hazards, improving case and claims management, safety and injury prevention training, developing aggressive return-to-work programs, and investigating fraudulent cases. While each of these tactics are well worth pursuing, they fail to consider the single most important component of a strategy to reduce workplace injuries: Hire only those people who have proven themselves capable of meeting the physical demands of the job.
To this end, implementing pre-hire/post-offer physical abilities testing (PAT) may be a good place to start. In fact, in Travelers’ recent Risk Control Management Guide, the insurer recommended pre-employment PAT “to provide employers with an indication of an individual’s physical performance capabilities while assisting in reducing claims costs.”
A pre-hire physical abilities test is significantly different from a physician’s medical examination. A physician’s physical is a general measure of the overall health and medical status of an individual. PAT, on the other hand, is a tightly focused evaluation of a person’s physical ability to perform specific job functions. While the physical certainly has its place, and may in fact be required for certain jobs (like driving commercial trucks), the Americans with Disabilities Act has made the physician’s physical of very limited use in employee selection. Published research from the World Health Organization suggests there is “no beneficial impact of pre-employment medical examinations” and that “assessments of fitness for work focused on job requirements appear to be better predictors of health outcomes and costs than those focused solely on medical diagnosis.”
Essentially, PAT measures the applicant’s physical abilities to perform the physical requirements of the job. The exact test and passing criteria can vary with the job requirements, but a PAT typically begins with a medical history and general musculoskeletal screen to ensure safety before starting the work-related components of the test. This pre-PAT medical information provides a baseline should the information ever be needed for comparison to a later injury or condition.
Once deemed safe to undergo testing, the applicant begins a series of functional tasks based on job requirements. Usually these involve some of the most challenging aspects of the job, including materials handling (lifting, carrying, pushing or pulling) and performing the physical tasks characteristic of the job (stooping, crouching, reaching and climbing stairs or a ladder). Heart rate is monitored throughout the test for safety and is included in the scoring of the test. PAT typically takes 30 to 45 minutes and is best administered by a physical or occupational therapist, exercise physiologist or athletic trainer. The test can be done in a nearby clinic or at the workplace, depending on hiring patterns.
Pre-employment PAT can help mitigate risk for both the employer and employee through injury prevention and can significantly reduce the frequency and cost of work-related injuries. For example, Voith Industrial Services, a national provider of labor services to the automotive and chemical industries, reportedly saw a 75% reduction in costs per claim among tested applicants, and experienced a 32% decrease in strains and sprains, a 28% decrease in slips, trips and falls, and an overall 90% decrease in injury costs from 2010 to 2014.
There are some important issues to consider, however, when developing and conducting a pre-hire screening program. A valid, legally defensible and cost-effective PAT screening program should:
- Target the jobs creating most of the risk. Most employers do not need to conduct PATs for all positions. A few jobs likely create most of the risks and result in more injuries.
- Conduct a quantitative job analysis. Identifying the essential physical requirements of each job for which screens are developed is the foundation on which defensible PATs are built.
- Develop a job-specific test. Use the data collected in job analysis to select test items and identify the minimal requirements for passing.
- Use only qualified evaluators. Physical and occupational therapists, athletic trainers, exercise physiologists and kinesiologists can be trained to perform testing.
- Conduct rigorous quality review and on-going support. Working with a consulting organization that provides a quality review process on each test helps minimize the risk of mistakes or inconsistent handling of applicants during testing.
- Monitor outcomes. Once the testing of applicants begins, it is important to track overall pass-fail rates, paying close attention to the test items most frequently failed.
- Measure ROI. Tracking work-related injury costs before and after initiating the program can provide powerful justification for continuing or expanding the PAT.
In the development and implementation of PAT, companies should avoid certain approaches, including:
- Pre-offer testing. Functional screening is best performed after a conditional offer has been made.
- General strength and machine-based testing. The use of generic strength tests (such as push-ups, sit-ups, aerobic step tests, isometric or isokinetic strength testing) cannot be closely correlated to true job function.
- Percentile metrics for hire/no-hire. Whether the applicant is in the fifth percentile or the 95th percentile as compared to a group of “norms” is irrelevant—what matters is whether the applicant’s abilities match the demands of the job.
According to the Institute for Work & Health, the rate of injury for an employee with less than one month on the job is three times greater than those on the job for one year or longer. New hires are significantly more susceptible to injury, especially those in manual labor positions. Some people are simply less fit to perform certain positions. PAT can improve the hiring process by identifying which candidates can and cannot do the job in an objective and defensible manner.