By Lori Peters, MS NCC CCTP

Physical safety in public settings has gotten much focus recently due to the increase of mass shootings in the United States. According to the Federal Bureau of Investigation, there were 30 separate active shootings in 2017, the most ever recorded by the organization during a one-year period. In a 2014 FBI study that covered the years 2000-2013, the number of active shooter incidents was 160. As a result, the emphasis for employers and schools has been on improving physical safety via national awareness campaigns (e.g. “See Something, Say Something”), active shooter drills and increased security. While this emphasis is a good measure because everyone deserves to be safe while at work or at school, very little has been said about other forms of safety like emotional safety, which is just as important. In many of those shootings, authorities discovered that the shooters’ motives often focused on their perceived lack of support. People should be in an environment where they feel heard, supported and trusted.

Emotional safety, as defined by the National Center on Safe Supportive Learning Environments, is “an experience in which one feels safe to express emotions, security, and confidence to take risks and feel challenged and excited to try something new.” As a counselor, I would add that emotional safety is a condition in which a person can be vulnerable, open and honest without fear of judgment or persecution. You can be who you are, “your true self,” as one of my graduate professors would say. Emotional safety is essential to the counseling process because the clients must feel safe enough with their counselor to share the deepest parts of themselves. If clients don’t feel safe, progress will either stall or be non-existent. The same can be said for relationships. If you cannot be vulnerable and open with your friends or love partners, you are probably not in an emotionally safe relationship.

Emotional safety falls under the broad umbrella of emotional intelligence or EQ, which refers to the ability to be aware of your own emotions and that of others and base your behaviors, specifically interpersonal interactions, on that awareness. Feeling you are emotionally safe at work is essential for employees to fully actualize their potential. If you feel you can be authentic and that you’ll be supported and heard, you are probably more likely to make contributions that benefit you as an employee and your company as a whole. The Substance Abuse and Mental Health Services Administration, or SAMHSA, addresses emotional safety and EQ in depth on its website and possible work outcomes with a favorable environment. Some of those outcomes include: increased job satisfaction, greater productivity, more effective handling of workplace conflict and higher employee morale. SAMHSA indicates 80-90 percent of workplace competencies are not cognitive, meaning a greater emphasis on intra- and interpersonal interactions.

I’ve worked in various for-profit and nonprofit environments in my life, and I can personally speak to the challenges employees can face if they don’t feel they can be real. Two experiences immediately pop into my mind. In the first one, I was working at a nonprofit for a person whom I shall describe as difficult. She did not create an environment in which I felt I could ask questions or offer comments. It was very much a “my way or the highway” type of atmosphere. One day, a man in some sort of mental distress entered our office. In hindsight, I now realize he was showing signs of schizophrenia. My boss was talking with her boss when the gentleman walked in and they began engaging him in conversation. They began to make jokes and comments in such a way that indicated they were making fun of him. He was too oblivious to notice, but I did. I did not have the courage to speak up to their mistreatment and tried to do what I could to help. After he left, they continued to laugh at him.  I felt like crawling under my desk.  I’ve since taken responsibility for my lack of action, and I’ve often wondered what could have happened had I felt emotionally safe enough to address the situation. Had I felt more empowered, how would that situation have changed?

In the second instance, I was working as a journalist and the company for which I worked was huge, but had a small-town feel. Everybody knew everybody else, and gossip reigned supreme. I tried my best to stay out of the fray, and for a time, that was easy to do because I was working crazy, 12-14 hour days. Then I was promoted and found myself staying in the office more, exposing myself to constant conversation about anything and everything. The office wasn’t emotionally safe, and it didn’t take me long to realize that if they were talking about everyone else, there’d be nothing stopping them from talking about me. So, the less information I provided, the less likely I would become a target. The environment contributed to my stress load.

Since those experiences, I’ve had the good fortune to work in places that were quite opposite to the two environments stated above. I’ve learned how to assess whether a workplace is an emotionally safe environment. Here are some useful signs I’ve noticed:

Supportive and Communicative Leadership: Leaders who possess these qualities are confident enough in their own abilities to allow for their employees to share triumphs and challenges. They have an open-door policy when it comes to communication and are not threatened by questions. They provide sound reasoning for decisions other than the typical comment, “Just do it because I told you so.” They root for their employees and push them to grow. Leaders lead by example and don’t hesitate to do themselves what is being asked of employees should the task require them to do so.

Zero Tolerance for Gossip: An environment in which you’re afraid to express yourself for fear of being the hot topic at the office water cooler is one that is emotionally unsafe. Talking about people behind their backs is just not nice. Gossip destroys trust between employees and leadership. If you have an issue with someone, follow your employer’s protocol for conflict resolution.

High Degree of Positive Interpersonal Interaction: Do people greet each other in a warm and friendly manner? Do people encourage each other? Does the office engage in team-building or similar activities? If you’ve answered yes to those questions, then you’re most likely in an emotionally safe environment. In most of the places I’ve worked, including where I am now, there has been a high degree of employee morale because people took the time to treat each other like human beings. They found time to have fun while working. If you like and enjoy the people with whom you work, you will feel safer opening up to them and showing your true self.

High Degree of Mindfulness and Sensitivity: We each have our own struggles, and you just never know what challenges someone has faced. You should keep in mind that you don’t completely know someone’s story, which may include traumatic incidents, and an emotionally safe workplace is sensitive to that by encouraging mindful communication. That means being careful with humor, which carries the high risk of offending someone. It also means zero tolerance for comments and behaviors that indicate harassment, sexual or otherwise.

Easy Access to Community Resources: Does your office have an Employee Assistance Program (EAP)? An emotionally safe environment promotes the mental and emotional well-being of its employees and having an EAP accomplishes that goal.  An EAP is a voluntary, confidential and solution-focused resource for employees to use who are struggling with mental or emotional concerns related to their work or personal lives. Some EAPs are provided in-house while others are provided by a third party. Typically, there are limits on the number of counseling sessions offered before a referral is made to another resource. EAPs aren’t meant to be a permanent solution but rather a bridge from the crisis to a workable resolution.

American psychologist Abraham Maslow created a pyramidical “Hierarchy of Needs” that outlined certain requirements that humans need to have met before they can achieve their fullest potential. The lower the need is on the pyramid, the more basic and essential the need. Safety is listed as second to the bottom. If you’re in a place where you feel safe, encouraged, needed and supported, you will feel freer to express yourself, take risks, make contributions and help others. And that is an employee benefit we could all use.

References available upon request.

By Brian Cardin, PT, C.Ped.

The Problem

Good employees are invaluable to any employer. Knowing this value, employers strive to provide a work environment and appropriate compensation that recognizes each employee’s value to their company. Attracting and retaining the best and brightest workers has challenges and costs. Payroll costs, while being the top expense for business, are expected and are essentially controllable. The same cannot be said for Employee Benefits, the other half of employee compensation, which is the second leading expense in today’s corporate world. Small and large business owners alike are struggling to find ways to provide health and wellness benefits to meet employee’s needs, to remain compliant with government regulations and to not over-burden their bottom line. At the same time, the cost of insurance premiums, utilization of healthcare and cost of healthcare provided continue to rise. Yet, the American workforce is not getting healthier.

The Reality

The U.S. Department of Labor and Statistics reported that the average employer cost of employee compensation per hour worked in December of 2017 was $35.87. Wages and salaries accounted for $24.49 (68.3%), while benefits accounted for $11.38 (31.7%). Controlling costs is an integral part of any business’s success. In order to control any aspect of business, however, we must have a working knowledge of what goes into those costs as well as what we get for the cost (to determine its value). As a business owner or CEO of a company, understanding the costs associated with health benefits and wellness programming is difficult. Many would say that it is an impossible cost to control since insurance premiums are dictated by the insurance carrier, and in the case of self-insured corporations, the utilization of healthcare dollars is determined by employees and their healthcare providers.   

Employers often turn to employer-sponsored wellness programs in an attempt to improve employee health to reduce the utilization of high cost medical care. This is particularly popular with self-insured employers, as they assume the direct risk of paying for medical services that their insureds receive. Unfortunately, most wellness programs are successful at engaging the healthiest of workers, and lack effectiveness in engaging employees with a variety of health risks. This presents a problem, as it is well documented that the Pareto principle (80/20 rule) applies to healthcare spending and savings. Twenty percent of each employee population will account for 80% of healthcare utilization costs. If the goal of a wellness program is to help control healthcare expenditures, it stands to reason that engaging employees with the most health risk is the key to success. This is undoubtedly the most challenging of endeavors.

For years, well-intentioned employers have given inordinate amounts of money to wellness service providers to “Improve employee health” to help create a healthier workforce. Yet, the American workforce is not getting healthier, insurance premiums continue to rise, and self-insured employer costs continue to escalate with increased healthcare spending. Some might argue that wellness programs are an ineffective expense added to employee benefits with little to no return on investment (ROI). However, there is evidence to suggest that the opposite can be true. Data-driven wellness programming can bring great value when it is focused on engaging and meeting the actual needs of each employer group. Knowledge is power. In order to restore valid decision-making power to employers, the employers must understand the needs of their specific group of employees, independent of their health insurance carrier or third-party administrator.

Historically, employers have relied on health insurance companies to dictate the entirety of health and wellness benefit programs from services and systems to costs. Prospective third-party payers (TPAs/health insurance companies) gather information related to the health of employees via a Health risk Assessment (HRA). While this is advertised as a “Free” service to the employer/employee, the costs associated with administering, maintaining, and reporting the information is carefully bundled into the administrative fees that the employer pays. HRAs are offered under the pretense that they garner knowledge for the employer, however, the reality is that the insurance company owns the information, and the information is analyzed specifically for the purpose of evaluating the insurer’s potential financial exposure as the payer of health insurance claims. The insurance company then dictates the cost of the benefits plan (as the comprehensive insurance provider, or as the stop-gap TPA for self-insured companies) because they have all the information to predict risk or costs. Simply stated, employers/employees pay money to give their health data to insurance carriers on a proverbial silver platter. This information is then used by insurers to justify continually increased healthcare premiums. By an employer not knowing their workforce’s valuable health information and/or by giving this valuable information away, they lose all of their negotiating power.

The Need For Change

The time has come to empower employers with the knowledge necessary to regain control when it comes to employee health and wellness benefits. This requires an employer advocate who is not focused on selling health insurance. PORT is that advocate. PORT teaches employers how to stop being passive consumers of healthcare benefits plans by equipping them with information to understand their healthcare costs, and tools to manage and reduce healthcare costs in realistic and meaningful ways.

This begins with a Behavioral Economic study aimed at understanding the company’s current status with respect to claims, employee engagement and the effectiveness of existing programming. Unlike insurance-company sponsored HRAs, PORT’s proprietary process focuses on identifying employee’s understanding of the status of their health, their readiness to change, and their confidence level in their ability to make that change. This information is used to analyze the financial impacts of individual’s health and lifestyle choices on the group. Combining this information with the data gathered in other aspects of the behavioral economic study allows PORT to produce unique feedback and recommendations that are specific to each employer and their employee groups. All information/data is owned by the employer. This equips the employer with knowledge about their group; and knowledge is power.

Population health management requires a clear understanding of what the population needs, what the population wants, and how to get them engaged. For example, an employer may have 25% of their population identified as smokers, and only 1% of that group ready to focus on smoking cessation. This organization may be better served to support opportunities to engage their population on their current perspective on smoking (and the associated health risks) vs. rolling out a costly smoking cessation program. PORT has over ten years of experience in delivering evidence-based population health programs. In that time, it has become clear that having appropriate knowledge about the employee population holds the greatest value.

Once an employer has this knowledge, they can begin to make a difference. Data driven, measurable programs can follow. Mechanisms to strategically monitor and evaluate the efficacy of programs can be implemented to insure ongoing value for the employer and the engaged employees. It is long-past time for employers to have an advocate working for them in this arena. PORT is excited to lead the way. We want to replace frustration with a sense of control. The goal is to develop employers and employees engaged with a sense of clarity and understanding. To get there, change is in order. In the words of Henry Ford, “If you do what you’ve always done you’ll get what you’ve always gotten.” It is time to do away with illusions, in favor of restoring control for the stakeholders that are the foundation of our societies.

References available upon request.

By Miranda Bednar, DPT

The average person will walk 115,000 miles in their lifetime. That’s four trips around the Earth! From the time we are toddlers learning to walk until we are older adults possibly using a cane for assistance, our feet are very important to our quality of life. The feet affect our health from our first days to our last.

The foot and ankle together are a fascinating and complex body region made up of 26 bones, 33 joints and over 100 muscles, tendons and ligaments. Of the many jobs the foot and ankle complex have, some of the most important are standing balance, absorbing the shock sent into the body from the ground when we walk and forming a rigid lever to propel us forward as we move. To complete these tasks properly the foot and ankle complex has the unique ability to be, at times, mobile and adaptable and then rigid and powerful. By the time we have moved through a single day our feet have endured hundreds of tons of force.

One of the best ways for us to stay healthy is to continue moving. If our feet hurt, we do not feel like walking or may even be afraid to do so. There are multiple research studies that have determined that painful feet can disrupt ability to balance, change the way one walks, and decrease one’s desire to move. Impaired balance can lead to falls. Changes in walking pattern can lead to abnormal stress on other parts of the body causing injury or arthritis. Decreased movement can lead to or exacerbate other disease processes (such as diabetes or obesity), decrease cardiovascular health, lead to weight gain and decrease quality of life.

75% of Americans will have a foot problem at some point in their life. Obvious problems include fractures, either traumatic or stress-related, ligament sprains when you “roll” your ankle and muscle tears. Less obvious ones include plantar fasciitis which causes heel pain, and tendonitis anywhere around the ankle. Furthermore, irritation of the nerves and/or blood vessels at the foot and ankle can become tarsal tunnel syndrome which causes pain and tingling throughout the foot and metatarsalgia, or Morton’s Neuroma, which causes pain or numbness at the balls of the foot and toes. While these injuries and inflammations create unhealthy feet, sometimes the foot alone causes the problem.

We all have different foot shapes and sizes. These differences include “flat feet”, high arches, bunions, hammer toes, extra toes, and calluses. While these variances are natural and not uncommon, they will affect how the foot and ankle complex functions creating excessive stresses on some of the joints, ligaments and tendons.

While the list of possible foot and ankle problems may be unnerving, rest assured there are actions you can take to remedy those foot problems and regain your quality of life. After fractures, sprains or surgery, the foot and ankle often demonstrate strength and motion deficits that can make you limp. These deficits can be addressed via joint mobilizations and soft tissues massage done by a physical therapist and with instruction in a self-stretching and strengthening program. Muscle strains and tendonitis cause swelling and pain. They often get better with icing, resting and gradual return to or modification of your activity.  Pain in the bottom of the feet, balls of the feet and toes may be caused by excessive or abnormal pressure on those areas. These pains can be addressed by being fit with shoe wear that is appropriate for your foot shape and size, using custom or over the counter orthotics and by having potential joint or motion restrictions treated by a physical therapist. Toe deformities which may cause balance difficulties can be supported, and progression of the deformity and disability can be halted with various in-shoe padding and proper shoe wear.

Diabetes and vascular disease can cause neuropathy (numbness) in the feet. In these instances, it is important to be properly fitted with shoes for foot protection and to regularly check the skin of the feet for cuts or blisters. If you do see cuts or blisters you should make an appointment with your doctor to be checked for infection and to begin healing measures.

No matter how slight or severe the problem may be, don’t sacrifice your function, safety and health on painful feet. Seek medical advice now and avoid running the risk of further injury and dysfunction. Maintain your health by “putting your best foot forward.”

By Amanda Flanagan, DPT

Arthritis encompasses more than 100 diseases and conditions that affect joints, the surrounding tissues, and other connective tissues. It affects nearly one of every six Americans, making it one of the most common diseases and cause of disability in the United States. It has a significant effect on quality of life for the individual who experiences its painful symptoms and resulting disability. As a result, our nation bears enormous costs for treating arthritis, its complications, and for the disability that can result, totaling almost 65 billion dollars.

One of the most commonly known forms of arthritis is osteoarthritis (OA) which is the degeneration of joint cartilage and the underlying bone, especially in the hip and knee joints. One-third of persons 63 to 94 years of age are affected by osteoarthritis of the knee, which often limits the ability to rise from a chair, stand comfortably, walk, and use stairs.

Arthritis is often inaccurately portrayed as an old person’s disease, an inevitable part of aging that must be endured. On the contrary, the pain and disability associated with all types of arthritis can be minimized through early diagnosis and appropriate management, including weight control, physical activity, self-management, physical and occupational therapy, and joint replacement surgery. However, in the year 2000, the Center for Disease Control and Prevention launched a major public health initiative, called the National Arthritis Action Plan, calling for a significant change in the way arthritis is treated. Medical interventions involving expensive medications, joint injections, and surgery are now suggested for use in only 10-30% of cases where OA will progress to severe joint damage. Focus of management is shifting to client education, self-management, attention to pain perception, and exercise.

While many people with arthritis are concerned that exercising can harm the joints and cause more pain, research shows that low-impact activity is important in managing arthritis symptoms. Exercises should always be completed to tolerance without creating excessive pain. A combination of flexibility exercises, aerobic exercise, and strengthening exercise is important in maximizing the benefits. While walking and other generic exercises are beneficial, the personalized, focused exercise program provided by a physical therapist has been proven to achieve optimal outcomes.

For example, a randomized, controlled clinical trial by Deyle, et al. evaluated the effectiveness of physical therapy for treatment of knee osteoarthritis in a group of 83 patients. The treatment group received manual therapy and therapeutic exercises twice weekly for four weeks. This group showed statistically and clinically significant improvements in walking abilities, function, stiffness, and pain at 4 weeks, 8 weeks, and one year follow ups.

Another recent study by Nejati, et al produced similar results. Patients with knee osteoarthritis who completed knee strengthening exercises only had significant improvement in pain, disability, walking, stair climbing, and sit up speed after treatment at one month, four months, and one year follow ups as compared to the control groups who did not do any therapist-directed exercise.

These studies are not unique; the evidence consistently shows that physical therapy intervention and regular home exercise compliance can have long term effects in improving function, walking abilities, and decreasing pain, among others. These functional improvements can delay, or even prevent, the need for more invasive procedures such as injections or surgery.

References:

1. Center for Disease Control. National Arthritis Action Plan: A Public Health Strategy 1999. https://stacks.cdc.gov/view/cdc/6378.
2. Deyle G, Henderson N, Matekel R, et al. Effectiveness of manual physical therapy and exercise in osteoarthritis of the knee: a randomized, controlled trial. Annals of Internal Medicine. 2000; 132 (3): 173-181.
3. Nejati P, Farzinmehr A, Moradi-Lakeh M. The effect of exercise therapy on knee osteoarthritis: a randomized clinical trial. Medical Journal of the Islamic Republic of Iran. 2015; 29: 186.