Getting Upstream


Designing and growing innovative niche programs for injury prevention.

By Curt DeWeese, PT

In October 2007, my practice had been open for four years, and I wanted to differentiate it from competitors and create new revenue sources. I attended the conference “Newest Concepts in Work Injury Management and Prevention” in Chicago, hosted by Susan and Dennis Isernhagen. At the conference, Manny Keisser, then manager of Cast Health and Wellness at Disneyland Resorts in California, spoke about occupational health and safety at Disneyland. Manny’s dynamic presentation captured my attention. Two of his principles have remained ingrained in my thought process for business development and differentiation. His first statement was “I’m so busy pulling people out of the river that I don’t have time to go upstream to find out (and stop) who is pushing them in.” I underlined it and tabbed the page; it described the day-to-day operation of treating patients in a busy clinic. The people I saw were already injured—about a third of them had been injured at work. There was no time or opportunity to prevent the injuries. And often, I did not understand my patient’s job title, much less what they were actually required to do at work. I worked on restoring range of motion, increasing strength, and improving tolerance of activity. Relationships with the employers were limited, including participating in employer health fairs and teaching some back and lifting safety classes. I was onsite at the company, but did not really know anyone. I viewed this time that pulled me away from the clinic and patient care as a nuisance.

Manny’s second principle—“Push the rocks that move”—led me to think about my progress establishing relationships for onsite work with employers. He spoke of how he worked with department managers to roll out his new ideas and programs. Some managers would cooperate, others were not open to new ideas. He focused his attention and efforts where there was no resistance, measured the success, and collected data with those groups; then he used those victories to convince others to follow. How could an onsite relationship be established to “get upstream” and work on prevention? Many times the answer was “no” as the sales pitch ended; these were the rocks that did not move. I received several negative responses for each successful interaction (the rocks that did move). I needed to leverage the positive reactions, and I realized the need to get out of the clinic more and examine how I dealt with “streams” and “rocks.”

Meet Me: Getting Started

Appointments to meet employers were difficult to arrange. Back then, employers did not fully recognize the value injury prevention could provide and everyone was busy. Working against the traditional “reactive” model of treating injuries in medicine took some effort to overcome; working with a therapist was viewed as an expense rather than an investment. Creative thinking led me to identify more chance meetings with employers. Volunteering to speak at Chamber of Commerce meetings, human resource consortiums, and safety professional conferences put me in front of attentive employers. I could ask pointed questions: “Do you ever have a new employee get hurt in the first months of employment?” or “Have you ever had an employee out of work longer than expected?” These inquiries opened the floodgates for conversation and sharing.


Use the relationships with your patients to ask more direct questions about how their injury impacts their work: “Are there other workers with similar injuries?” “Who is the employer contact?” Follow patients back to work. Highlight positive outcomes of clinic treatment and use the need for accurate information regarding job demands to appropriately condition and prepare a worker for full return to work. Forge relationships with safety professionals, human resource benefits’ coordinators, and supervisors to ascertain the physical requirements of the job. Going onsite to better understand a worker’s physical demands creates more accurate job-specific conditioning programs in the clinic. Most important, you now have a reason to meet with the company. By offering a complimentary task analysis, I found the entry point that had been so elusive. The opportunity to “push the rock” was now available, and after the meetings, I had greater clarity as to whether it would move or not.

Listen to a company’s challenges and what concerns it has regarding worker injury and safety.

Companies already receiving my onsite services provided me an opportunity to collect data and expand those relationships. Outcomes from established clients provided key statistics and results I could use in new client marketing.

Know Me: Create Change

Working with the employer to develop solutions for their concerns, reducing the number of claims and lost time, decreasing costs, and improving safety all help the employer to “know me.” Onsite services that physical therapists provide may include teaching and training, early first aid intervention for worker discomfort, job task analysis and writing job descriptions, and participating in ergonomic and process improvement evaluations. Training for back and lifting safety or repetitive motion injury prevention is more effective when the therapist follows up with workers at their workstation to demonstrate application of safety principles. Early first aid intervention for employee discomfort may include instruction in the use of ice, job task rotation, or tool modification. A working knowledge of the Occupational Safety and Health Administration (OSHA) First Aid Guidelines, standard 1904.7 found at will help guide the decision making process while avoiding a recordable incident.

Analyzing essential job functions is the foundation of creating functional job descriptions highlighting tasks, as was well as understanding the physical and postural demands of work. Tool and task modifications can reduce strain and improve efficiency of activity and worker instruction on neutral position of spine and joints to prevent unnecessary postural strain and improve comfort. Communicate with supervisors, engineers, maintenance personnel, and purchasing to seek corrections for identified stressors.

Trust Me: Report Successes

Keep reports of the services and interventions you provide, collect data to measure how things have changed, and organize and share effectively. Track employees you followed onsite, the ergonomic changes you developed, and the employee contacts made where problems were resolved. These are the cases that did not get into the workers’ compensation system—your successes with the employer. These achievements lead to “trust me.” When positive outcomes are linked to your presence and the improved statistics, the return on investment calculations will drive continuation of services. Companies will appreciate the savings through keeping workers safe, preventing compensation claims, and improving workplace ergonomics. As trust grows so does opportunity. Reviewing workers’ compensation loss run reports will identify areas of catastrophic loss, high frequency injury, and the next areas requiring your attention. Worker and work place safety are truly a journey, not a destination.

Prevention has become the primary focus of what we do; on average, 85 percent of the people I interact with never enter the workers’ compensation system. Ergonomic improvements have made work safer—with safety principles applied to activity. This is an enormous victory for the worker who is comfortable, productive, and at work. The employer benefits from decreased lost time, cost savings, and improved employee morale. My win is a worker who reports improved comfort and function and ongoing cash-based revenue for the practice.

My challenge to you is to meet employers. Know and understand their challenges and needs related to worker injuries. Create a plan to address their issues and earn their trust with results and data, leading to new and exciting business opportunities.

Curt DeWeese, PT, is a PPS member, chief operating officer of DSI Work Solutions and president of Work Injury Solutions & PT, PC, in Webster, New York. He can be reached at

Copyright © 2018, Private Practice Section of the American Physical Therapy Association. All Rights Reserved.

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