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Blue Cross Blue Shield Rhode Island (A)1
April 2005

Cindy, the Assistant Vice President of Engineering/Administrative Services at Blue Cross Blue Shield Rhode Island (BCBSRI), has seen all of the OSHA statistics:

In 2000, 1.8 million workers in the United States reported work-related musculoskeletal disorders (MSDs) such as carpal tunnel syndrome, tendonitis, and back injuries. MSDs accounted for 34% of all lost workday injuries and illnesses (nearly 600,000 cases annually), and $1 of every $3 spent for workers' compensation was for MSD related injuries (nearly $20 billion annually).

Also the costs associated with injuries are significant (see Exhibit 1 for data from BCBSRI's workers' compensation insurance carrier for Carpal Tunnel injuries in particular). With the majority of the work force in administrative and customer service positions, ergonomic factors are an important concern.

While BCBSRI had a limited ergonomics program (easily managed by one person), in 1999 the company had 8 MSD workers compensation cases that resulted in 345 lost work days. Recognizing that their workplace had ergonomic issues, Cindy needed to formulate a plan to revamp their limited program and effect changes. Her biggest concerns were:

  • What are the most effective ways (in terms of both costs and impacts) to intervene and prevent injury?
  • How can she communicate the hazards to the chief financial officer to get the financial resources required to alter workstations and enhance training?

Exhibit 1 - Carpal Tunnel Statistics2


Without Surgery

With Surgery

Direct Costs

$8K - $12K

$30K - $35K

Indirect Costs

$16K - $48K

$60K - $140K

Total Costs

$24K - $60K

$90K - $175K

Time Away From Work

weeks to months

4-6 weeks minimum

Direct Costs include wages, hospital bills, medication, physical therapy, medical supplies, etc.

Indirect Costs are estimated at two to four times direct costs and include lost productivity, wages for temporary workers, time to train temps, overtime, stress, etc.


Blue Cross Blue Shield Rhode Island (B)

BCBSRI was able to reduce MSD related Workers Compensation cases with lost workdays by implementing a New Ergonomic Program in March 2000 and increasing workstation evaluations. Exhibit 2 shows the number of evaluations and the impacts for 1999-2002.

An important initiative was the involvement of every department within BCBSRI. Partners in the ergonomics initiative included:


  • Building Services - installed ergonomic keytrays or move/adjust furniture and equipment
  • Data communications - discussed moving PCs, types of PC equipment on market, request laptop adaptors, etc.
  • Facilities - discussed moves, type of furniture to be installed, make arrangements with outside vendor to discuss ergonomic features of furniture
  • Occupational Health Nurse - interacted with Optimal Returns Case Manager and Ergonomic Team
  • Office Services - delivered ergonomic supplies if evaluation not necessary
  • Optimal Returns Case Manager - reviewed return-to-work cases and ergonomic impact
  • Voice Communications - moved telephones (if necessary), installed of headsets


  • Furniture Vendors - reviewed type of furniture installed and what types of ergonomic equipment may be on the market
  • Beacon Mutual (workers compensation carrier) - discussed special cases that may require a certified ergonomist to assist

On-going and future initiatives being considered by the safety committee included:

  • Analyzing Trends - further analyzing trends within departments to see where additional emphasis could be placed to identify possible high risk areas.
  • Completing Ergonomic Certifications - sending enrollment applications to the National Association of Safety Professionals for a Certified Ergonomic Technician (CET) training course. It was anticipated that at least two members of the Ergonomic Committee would be certified in 2003.
  • Conducting Brown Bag Lunches - potential topics included "Kids Ergonomics" and "Home Ergonomic Setups."
  • Conducting Ergonomic Mouse Study - preliminary discussions were held with GoldTouch Technologies in December 2002 to conduct an ergonomic study as to effects an ergonomic mouse has on MSDs.
  • Conducting Headset Study - preliminary discussions were held with Joy Boese of Consulting Corporation in November 2002 to conduct an ergonomic study on headsets.
  • Conducting Management Ergonomic Awareness Session - planned to present ergonomic awareness sessions to management with Beacon Mutual as the principal presenter.
  • Developing Ergonomic Intranet Site - planned the development of an ergonomic website in which all employees could access ergonomic information.
  • Developing Ergonomic Training Brochure - planned the development of a brochure that could be distributed to all employees which would include correct keyboard and chair adjustments.
  • Promoting Ergonomic Programs to BCBSRI Providers and Customers - discussed with Good Health Benefit to see if their Ergonomic Program could be shared with others (labs, providers, etc.) who interact with BCBSRI.
  • Researching Ergonomic Products - Wrist Oasis wrist rests were purchased as a result of this continuing effort to select the best ergonomic products.
  • Researching Voice Recognition - a test was done of Dragon Systems voice recognition product in June 2002. A survey was planned for 2003 to determine if this could be a viable solution to reduce MSDs for the future.
  • Revising Evaluation Tracking System - planned to create a Microsoft Access database to simplify input of ergonomic data and create specialty reports
  • Training Telecommuters on Ergonomic Issues - planned to address needs in the future.
  • Updating Ergonomic Orientation Presentation - realized that orientation materials need continual updating.

Exhibit 2 - MSD related case trends

These tables are best viewed on tablets, notebooks, or desktop computer screens.


Ergonomic Evaluations

% Increase or (Decrease) from Previous Year

MSD Worker Comp Cases w/ Lost Days

% Increase or (Decrease) from Previous Year

Lost Work Days

% Increase or (Decrease) from Previous Year

1999 270 --- 8 --- 345 ---
2000 480 78% 6 (25%) 104 (70%)
2001 584 22% 4 (33%) 91 (13%)
2002 498 (15%) 1 (75%) 89 (2%)


Blue Cross Blue Shield Rhode Island
Teaching Note

Ergonomics is an important issue to business because the injuries are expensive and unnecessary. If you walk through any office, you will observe poor postures and badly configured workstations. In some cases, financial resources will be required to alter the situation and securing these will mean effectively communicating the risks of injuries to engage senior management. One of BCBSRI's initiatives is to present awareness seminars to management with Beacon Mutual serving as the principal presenter. Since Beacon Mutual is the workers' compensation carrier, their presentations can involve statistics, trends, and financial impacts associated with the injuries.

With financial resources, safety committee's can purchase better office furniture and equipment (headsets, ergonomic keyboards, etc.), but employees still need to use them and use them correctly. People are inherently biased when it comes to evaluating risks, and safety managers will need to train and communicate the risks if they are to alter employee behavior. While they are working with facilities and building services to arrange workstations, they also need to work with employees to encourage the proper behavior. Education initiatives include brown bag lunches, training brochures, and orientation materials.

The case is split into two parts (A) and (B) to facilitate brainstorming and discussion of ideas to influence management and employee behavior before detailing the initiatives under taken by Blue Cross Blue Shield Rhode Island.

1This case is based on publicly available information from OSHA. This case was prepared as part of an Alliance between Georgetown University's Center for Business and Public Policy, OSHA, and Abbott. Participation in an Alliance does not constitute an endorsement of any specific party or any party's products or services. This case was prepared as the basis for class discussion in the "Business Value of Safety." The decision maker and her associated thoughts and actions are fictionalized. The product names and companies listed in this study were specific to this particular case, and do not constitute any endorsement by OSHA of their products and services.

2Data were provided to Blue Cross Blue Shield Rhode Island in May 2000 by Beacon Mutual, their workers compensation carrier.

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