PublicRisk_July/August2021 by Moire Marketing Partners

PUBLISHED BY THE PUBLIC RISK MANAGEMENT ASSOCIATION JULY/AUGUST 2021

PUBLIC RISK MANAGER OF THE YEAR

MEET MEGAN A. ZANESKY PAGE 7

ALSO IN THIS ISSUE

THE ART AND (BRAIN) SCIENCE OF MENTORING PAGE 12

HEALTHCARE IN JAILS

A Growing Concern PAGE 17

Create an ORGANIZATIONAL CULTURE that proactively MANAGES RISK

VIRTUAL SCHEDULE

ENTERPRISE RISK MANAGEMENT TRAINING DAY 1: JULY 19 DAY 3: JULY 27 12 – 2 PM EST 12 – 2 PM EST DAY 2: JULY 21 DAY 4: JULY 29 12 – 1:30 PM EST 12 – 2 PM EST

VISIT PRIMACENTRAL.ORG/ERMTRAINING

JULY/AUGUST 2021 | Volume 37, No. 4 | 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 Melissa R. Steger, MPA, CRM Asst. Dir., WCI & Unemployment Ins. University of Texas System Austin, TX PAST PRESIDENT Sheri D. Swain Director, Enterprise Risk Management Maricopa Community Colleges Tempe, AZ PRESIDENT-ELECT JamiAnn N. Hannah, RMPE Risk Manager City of Gallatin Gallatin, TN DIRECTORS Dana S. Henderson, WCP Risk Manager Town of Mount Pleasant Mount of Pleasant, SC

Public Risk Manager of the Year

Steve M. LePock, II Risk Manager Virginia Beach City Public Schools Virginia Beach, VA Ann-Marie A. Sharpe, ARM, RMPE Director, Risk Management City of Miami Miami, FL Laurie T. Olson Sr. Risk Management Consultant City/County Insurance Services Salem, OR Adam F. Maxwell, CLRP Director, Administrative Services City of Westerville Westerville, OH Michael S. Payne, ARM, HEM Risk Manager City of Reno Reno, NV

By Claire Howard

NON-VOTING DIRECTOR Jennifer Ackerman, CAE Chief Executive Officer Public Risk Management Association Alexandria, VA EDITOR Claire Howard Manager of Marketing & Communications 703. 253.1262 | choward@primacentral.org ADVERTISING Claire Howard Manager of Marketing & Communications 703. 253.1262 | choward@primacentral.org

The Art and (Brain) Science of Mentoring

Healthcare in Jails

and Melissa Steger

By Kenny Smith

By Susan L. Franzen, Brent Holman,

IN EVERY ISSUE

A GROWING CONCERN

| 4 NEWS BRIEFS | 20 ADVERTISER INDEX

Public Risk is published 6 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 2021 Public Risk Management Association

JULY/AUGUST 2021 | PUBLIC RISK

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MESSAGE FROM PRIMA PRESIDENT MELISSA STEGER

Three Special Moments in My Life

s I sit still and quietly reflect on what’s ahead of me as PRIMA’s President, I’m filled with commitment, motivation, and excitement. From the moment I dipped my toe into PRIMA, I quickly set a goal to run for President. I believed in the purpose and mission and was driven to make a difference. And as I realize my goal has come to fruition the fire in my belly is burning strong. I can recall three specific times in my life when I knew I was pursuing my purpose. At these moments, I had no idea of the outcome, but I knew my purpose was to give 110% of effort trying. I would like to share one of these with you today. The first was the start of my career as a temporary clerk in the workers’ compensation section at The University of Texas System (UT System). I was a young, bright-eyed, and bushy tailed college graduate filled with an overwhelming amount of naivety. Despite the innocence, I was curious and anxious to do a good job. As I learned and understood the purpose of my work, the stronger my urge to someday run the program grew. Fear, excitement, and trepidation took control as the path of my career lead me to the moment for which I longed. The workers’ compensation program was handled by 24 employees of UT System who felt like family. My opportunity came one year into a drastic program change resulting in the reduction of our team to six. The program I knew turned into one composed of a third-party administrator (CCMSI) and a cost-containment company /certified workers’ compensation network (IMO) incorporated with claims supervision by UT System. The program

From the moment I dipped my toe into PRIMA, I quickly set a goal to run for President. I believed in the purpose and mission and was driven to make a difference. And as I realize my goal has come to fruition the fire in my belly is burning strong. successfully performed during the first year, but for sustainability, surfacing issues needed to be addressed. During the birth of confusion, our 30-year leader chose to retire giving me my moment of truth. Did I still want this? Did I have the skills to manage this program? Was I a strong enough leader? Could I really do this? I interviewed for the position the morning of a program retreat. The purpose of the retreat was to explore the root cause of confusion and identify the areas of refinement. I lovingly call this meeting a day and a half of emotional turmoil. The result was a 76-page document of issues that needed addressing. Many people may have thrown their hands in the air and ran, but for me I felt the importance and became more committed to leading this group. I lived through the transition, felt the heartache of losing coworkers, and understood the importance of making this work. With every moment of the retreat, I became more committed to the potential of running this program and would

willingly accept if given the chance. Thankfully, I had that opportunity and love my job and our team. PRIMA was another of those three moments in my life. I feel this same exuberant passion and commitment to PRIMA. I understand PRIMA’s purpose of supporting our members and have faith in the board to do what’s right in that regard. If you are counting, the third moment was when I started dating my husband, Randy, the love of my life. Sincerely,

Melissa R. Steger, MPA, CRM PRIMA President 2021–2022 University of Texas System Austin, TX

JULY/AUGUST 2021 | PUBLIC RISK

NEWS BRIEFS

NEWS Briefs

ENSURING THE SAFETY OF REMOTE WORKERS June 1, 2021 | Jeff Corder, Risk Management As offices and workplaces begin to reopen after COVID-19 lockdowns, many workers will continue to work remotely at least part of the time. While assessing continued work-fromhome arrangements or preparing for a hybrid workforce, organizations must take steps to ensure workers’ safety and effectiveness in remote work settings.

1. Set the tone. To effectively impact behavior, safety must start at the top. Leadership should lay out a clear vision of the company’s commitment to safety and health for all workers, no matter their location. This vision should include adherence to documented work policies and expectations, including safe work practices for working remotely.

• Employees should be encouraged to take breaks every 30 minutes and stand at least once every hour. • Keeping employees updated on team activities, tasks and training via frequent phone calls, videoconferencing or instant messaging. Emergency contact lists should also be readily available.

Those working at home are most often engaged in online computer tasks, likely using company-owned equipment. While employers generally judge these types of arrangements as low-risk or inherently “safe,” the reality is that home-based work is rife with risks of injury. These risks could easily become workers compensation claims that can impact profits and productivity. The same risks seen in on-site office settings apply to remote workers, including: sprains, strains and cumulative micro-trauma in the upper extremities; slips, trips and falls; eye strain; lower-back injuries and other injuries related to both accidents and ergonomics. Unengaged and uncoached workers tend to be more prone to accident and injury—and have higher turnover rates.

2. Implement a work-from-home safety checklist. Home environments are potentially more cramped and unorganized than office workspaces and can present unique safety hazards. Employees may go about their duties in areas that are not designed for it, such as working from a couch while unmanaged extension cords, children’s toys and pets create risks. A work-from-home safety checklist can both educate and remind employees about best practices. Such a checklist could include:

Some form of home inspection could help ensure these practices are being followed. Consider whether this will be a self-inspection by the employee of their own office space or conducted in person by the employer’s representative. Also, consider the frequency at which the home inspection will be repeated because things change over time. Depending on the jurisdiction, human resources or legal experts can aid in these decisions.

The primary driver of work-related risk in the home environment is employers evaluating their employees primarily on work output, without giving adequate attention to their day-to-day physical safety and mental engagement. Employers who provide additional support tend to be rewarded with a healthier and happier staff that works with enhanced mindfulness, higher productivity and increased loyalty. If an injury occurs, these employers also enjoy a better claims experience and better claim outcomes. To effectively approach keeping remote workers safe and engaged, here are some practical, low-cost techniques to implement:

PUBLIC RISK | JULY/AUGUST 2021

• Checking for proper lighting, clear walkways free of hazards, power outlets that are not overloaded, comfortable temperatures and limited noise. • Establishing comfortable seating and desk height and allowing for proper ergonomic support, computer monitors positioned for visual comfort and less neck strain, and adequate leg space under the desk.

Read the full story at rmmagazine.com > Enruing the Safety of Remote Workers

INVEST IN PUBLIC HEALTH TO PREPARE FOR THE NEXT PANDEMIC

MAKE RISK SAFE: HOW LEADERS CAN NORMALIZE COURAGE AFTER COVID

June 01, 2021 | Alex Putterman, Hartford Courant

May 25 | Dr Margie Warrell Contributor

“One of the silver linings of the pandemic is that now everybody knows what public health does, and hopefully everybody sees the value and the relevance to their daily lives of public health.” To Jennifer Kertanis, advocating for greater attention to public health over her three-decade career has often felt like screaming into a void.

As we emerge from this pandemic and reconstruct hybrid work arrangements to be sustainable over the long haul, leaders have a unique window of opportunity to reshape workplace culture in ways that unleash the potential that fear holds dormant within their workforce.

“Despite many, many years of advocacy, funding for local public health has absolutely been stagnant at the state level, and/or been diminished,” said Kertanis, who directs the Farmington Valley Health Department. “We have been exceedingly challenged to really help people understand the full breadth and depth and scope of what public health is and the value and importance of it.” Kertanis and others in the public health field hope the COVID-19 pandemic has permanently altered that dynamic. As Connecticut manages this crisis and considers how to better prepare for the next one, some officials and experts have a simple suggestion: Invest in the state’s public health infrastructure. “One of the silver linings of the pandemic is that now everybody knows what public health does, and hopefully everybody sees the value and the relevance to their daily lives of public health,” said Dr. Deidre Gifford, the state’s acting public health commissioner. “Public health infrastructure in the United States has been dwindling, and people are starting to realize when times are good, public health can function in the background, but it’s very important that there’s a very strong infrastructure in place for the next time there’s a public health emergency, because we all know there will be another one.” Nationally, per capita public health spending decreased 9.3% between 2008 and 2016, according to a study published in the National Journal of Public Health, and Connecticut hasn’t been an exception. “That is very acute here in Connecticut, where public health surveillance and certain components of the Department of Public Health have been critically underfunded for decades,” said Dr. Albert Ko, chair of the Department of Epidemiology of Microbial Diseases at the Yale School of Public Health. “This isn’t a problem from the last year or the last administration or even the last 10 years.” Read the full story at https://www.govtech.com/em/preparedness/investin-public-health-to-prepare-for-the-next-pandemic

The Covid-19 pandemic has taken a toll on the culture within many organizations. Ongoing uncertainty coupled with the absence of in-person touch points has fueled risk aversion. Yet in the wake of this stormy season lays an opportunity for leaders to generate a fearless wave over organizational silos, cultivating a ‘culture of courage’ that spurs greater agility, innovation and collaboration. Here are six ways you can do just that. LEAD VULNERABLY Get comfortable being uncomfortable. You will not inspire others to think bigger and act braver if you are constantly operating from fear. As Gary Burnison, CEO of Korn Ferry wrote in Leadership U, “To improve your organization and others, you must first improve yourself.” Of course no-one relishes those uncomfortable feelings that true vulnerability requires. Yet unless you’re willing to lower your polished ‘got it all together, all the time’ leaderly mask, you won’t be able to show up with the authenticity required to meaningfully connect. In fact you’ll do just the opposite. As I wrote in You’ve Got This! your greatest strength is found in vulnerability. Only by confronting your own fears can you help others rise above theirs. CLARIFY WHAT’S AT STAKE Align employees behind a bold vision with a big Why When the Covid-19 pandemic hit, leaders had to make hard decisions to protect the future existence of their business. Attention now needs to be firmly placed on answering the question: ‘A future for the sake of what?’ Without a clear and compelling answer to that question –one taps into the deep human need for purpose of your employees - you won’t be able to inspire them to go the extra mile. Perhaps not even the first. Read the full story at https://www.forbes.com/sites/margiewarrell/2021/05/25/ make-risk-safe-how-leaders-can-normalize-courage-aftercovid/?sh=5311ed524661

JULY/AUGUST 2021 | PUBLIC RISK

RESOURCE Mentorship Program

ENROLL AS A MENTEE OR MENTOR TODAY! CREATING THE NEXT GENERATION OF RISK PROFESSIONALS primacentral.org/membership/nextgen

JULY/AUGUST 2021 | PUBLIC RISK

PUBLIC RISK MANAGER OF THE YEAR

First Female Director of Risk Management in Greenwich Awarded 2021’s Public Risk Manager of the Year MEET MEGAN A. ZANESKY, ESQ. BY CLAIRE HOWARD

eing the first of anything can be extremely nerve wrecking due to the pressure placed on oneself and society to live up to the role. So many questions can arise, like: 1. Is this person qualified? 2. Do they possess the strength of stick-to-itiveness when met with adversity? Just to name a few. In Megan A. Zanesky, ESQ.’s case, stepping into the role of being the first woman director of risk management for the Town of Greenwich, Conn., comes naturally because her fuel is not based on ego but the passion of ensuring the safety of others. “At the end of the day, we all know that Megan has the backs of every tax payer here in town,” said Fred Camillo, First Selectman of the Town of Greenwich. “It’s a good feeling and to me it’s a very well deserved honor. We can’t stress enough how thrilled we are that she’s here with us in the Town of Greenwich. Zanesky received this award at PRIMA’s virtual 2021 Annual Conference in June.

PUBLIC RISK | JULY/AUGUST 2021

TOWN OF GREENWICH

In the small Town of Greenwich, covering a span of 67.2 square miles, Zanesky manages a population of 62,000 residents. As the director of risk management in the Finance Department, Zanesky ensures the safety of approximately 4,000 employees, more than 9,000 students and the general public. Since the pandemic, it’s been estimated that 1,319 affluent New Yorkers moved to the town.

“

As risk manager, I oversee the

administration of self-insurance funds.

I recommend and sit on the committee

to select both the insurance broker and third party administrator for liability,

auto and property claims. I sit on several safety committees for the town. These

“

are just some of the wide range of

responsibilities that are part of my role as the director of risk management. Megan A. Zanesky, ESQ.

Even though Greenwich is considered a “small town,” it has consistently been ranked one of the wealthiest cities in America. The average household income was reported to be $336,692. This is largely due to Greenwich being the coined “hedge fund capital.” It’s been reported by Zillow that the median home price in Greenwich was $2.15 million as of July 2020. It’s worth it to note that the town was ranked the safest town in America by SafeHome.org in 2020. Greenwich consists of four breathtaking beaches with one of the most well-known being Greenwich Point Park, formerly known as Todd’s Point. The famous Greenwich Ave., which is lined with high-end commercial and mom-and-pop shops and dining, is always bustling with action. Most of the town’s

parades, large town parties and celebratory activities take place on this avenue. Other high risk amenities that Zanesky is in charge of keeping safe as the town’s risk manager include: skate parks, skating rinks, pools and rock climbing walls. “I’ve been trained by Megan being here to think that everything we think of could be the greatest idea in the world but to consider is the town going to be covered, are there possibilities that we could be liable for,” Camillo expresses.

INVOLVEMENT IN THE RISK MANAGEMENT COMMUNITY

As the director of risk management, Zanesky is tasked with the development, implementation and management of the town’s risk management program, including programs and procedures for risk control,

risk avoidance, loss control, risk transfer and risk financing. To safeguard the town and BOE’s physical and monetary assets, Zanesky oversees and coordinates all risk control activities and implements policies and programs. In conjunction with the town’s law department and third party administrator, she oversees the process of liability, auto and property claims against the town and BOE while simultaneously working with the insurance carriers, adjusters, town attorneys and others. “As risk manager, I oversee the administration of self-insurance funds,” explained Zanesky. “I recommend and sit on the committee to select both the insurance broker and third party administrator for liability, auto and property claims. I sit on several safety committees for the town. These are just

JULY/AUGUST 2021 | PUBLIC RISK

PUBLIC RISK MANAGER OF THE YEAR

some of the wide range of responsibilities that are part of my role as the director of risk management.” “Megan’s had a take on risk exposure and cybersecurity, said Michael Mason, Chairman of the Board of Estimate and Taxation for the Town of Greenwich. “She’s worked across Board of Education and the town, which has turned into a multi-million dollar initiative. Even though we have an outsourced company that we’ve hired for guidance, Megan is really at the center of everything.”

ZANESKY ADDRESSES CHALLENGES OF BOUNCING BACK AMID COVID-19 COVID-19 has positioned itself as a reckoning in our lives from losing loved ones to drastically impacting a vast span of industries. Students of all age ranges were forced to learn from home via computers, which has been a challenge for even college students pre-pandemic. Unfortunately, even with most schools providing computers, there was still the issue of students not having adequate WiFi in their homes to even complete their lessons. Increased safety measures were set in place to ensure thorough sanitation for facilities and businesses that were still open. ”Risk Managers should assess reopening of buildings and services and adjust when necessary. The Town of Greenwich had a plethora of outdoor dining along Greenwich Avenue and other areas in town as a result of Executive Orders put into place during the pandemic,” explains Zanesky. Working from home has become the new normal and cyberattacks have increased tremendously. “Cybersecurity is a major risk and has become more of a threat to public entities as seen in the media more recently,” said Zanesky. “A remote workforce, that was not an area that public entities delved into in the past, is now something many may offer and there are many risks associated with having employees work from home and/

PUBLIC RISK | JULY/AUGUST 2021

or other remote locations that can and should be addressed.” Mental health issues were developed due to isolation, virtual learning, being overworked remotely and loss of financial support. Zanesky stresses that this is something that needs to be addressed and continuously monitored for students, employees and those that have lost their jobs. In the Town of Greenwich, “Human Resources has the Employee Assistance Program (EAP) available to those employees whose mental health was impacted due to isolation, fear and anxiety over the virus and many other concerns experienced by so many during this unprecedented time,” explains Zanesky. “Being a member of PRIMA was essential to me during this time period,” she said. “I took advantage of virtual sessions, reached out to mentors, stayed abreast of what other risk professionals were doing and never felt alone in my job, despite working remote for over a year. My association with PRIMA and the excellent and very competent colleagues I work with at the Town and BOE helped to

ensure that we came through the toughest part of the pandemic as whole as possible.”

WINNING PUBLIC RISK MANAGER OF THE YEAR

We all wanted to experience this year’s Annual Conference together in person but we were able to congregate virtually. Megan Zanesky’s commitment to her town and the PRIMA community has been proven by rave reviews from her peers, ever-growing statistics of Greenwich previously mentioned and continued involvement in the PRIMA community. Zanesky currently serves as the president of the Connecticut Chapter of PRIMA and the President-Elect of the newly formed New England Chapter. This year’s recipient couldn’t be more deserving and she sums up her feelings in such a modest statement. “I feel validated by winning this award. All of my hard work and perseverance have paid off and I truly feel I am where I am meant to be and doing what I was meant to do.” Claire Howard is the Manager, Marketing & Communications for PRIMA.

“Megan’s had a take on risk exposure

and cybersecurity. She’s worked across

Board of Education and the town, which has turned into a multi-million dollar initiative. Even though we have an

outsourced company that we’ve hired for guidance, Megan is really at the center of everything.”

Michael Mason, Chairman of the Board of Estimate and Taxation for the Town of Greenwich

ON-DEMAND Learning Sessions PRIMA's Emerging Risks Virtual Training is designed to provide risk managers with the insight necessary to address issues that may currently affect their entity or that are upon the horizon. The training is now available on-demand for your viewing pleasure. Access to the entire training is free for PRIMA members and $200 for non-members. Take advantage of this timely educational resource!

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PUBLIC RISK | JULY/AUGUST 2021

THE ART AND (BRAIN) SCIENCE OF MENTORING BY SUSAN L. FRANZEN, BRENT HOLMAN, AND MELISSA STEGER

istorically, mentoring has been a way to guide and teach others, providing

mentors with the satisfaction of giving and sharing while offering mentees a personalized pathway to success. There is an art to mentoring and new

research is proving that mentoring reshapes our brains for even greater success. In this article, we discuss the scientific benefits of the mentoring process and explore a successful mentoring relationship between a manager and her direct report. Let’s begin with the science. Our brains are highly social and naturally collaborative, with approximately 80 billion neurons (nerve cells) that “chemically” talk to each other through neurotransmitters. These communications are formed as “whispers” between two neurons or “shouts” from one group of neurons to another. Through these whisper or shout cadences, the diverse areas of our brains communicate with each other as

we avoid threats and seek rewards that ensure our survival. Mentoring, too, is a highly collaborative process with reciprocal benefits when built on trust and authenticity…and it may have its own forms of shouts (public recognition, introductions to others, etc.) and whispers (private conversations between mentor and mentee or mentor and another trusted advisor about assisting or supporting a mentee). Positive mentoring, with a focus on strengths, hopes, and dreams, produces a reward response (think Scooby Snack) which leads to more and longer lasting behavior change. In

JULY/AUGUST 2021 | PUBLIC RISK

THE ART AND (BRAIN) SCIENCE OF MENTORING

Brent describes his mentoring experience as receiving “lessons in leadership – when to dive in and when to step back, [how to] build teams and culture, how to argue a point, how to let someone fail gracefully and build them back up.” an effective mentoring relationship, both the mentor and the mentee need to be courageous enough to be vulnerable. Strong mentors are inspired by the success of others and view mistakes as learning opportunities. They also model perseverance which strengthens that muscle within their mentee. Learning is hard and mentees need guidance in sticking with new skills or mindsets until mastered. Mentors need to drive towards improvement while balancing patience so the mentee doesn’t shut down and is instead inspired to embrace new learning and seek “aha!” moments, which only occur when the brain is relaxed and happy. Negative mentoring, which draws attention to an individual’s weaknesses, activates a threat response (think rattlesnake) in our brain, stifling our cognitive functions and reducing our creativity. It effectively cancels any potential “aha!” moments. Perhaps that’s why there are many articles that warn against supervisor/direct report mentoring relationships where there is a defined power differential and potential threats to the livelihood of both parties if one chooses to take advantage of the other. Even in non-reporting mentoring relationships, there are potential pitfalls as mentors have been known to plagiarize the ideas or work of their mentees and mentees have been known to sabotage the aspirations of their mentors, inflicting social pain (the result of interpersonal rejection or loss). Social pain activates the same part of our brain as physical pain but has been known to adhere to memory for longer periods. One may not remember stubbing a toe but will

PUBLIC RISK | JULY/AUGUST 2021

have a hard time forgetting being snubbed by another, especially in a relationship as delicate as one created through mentoring. Even a non-mentoring related painful past experience may make a mentor feel threatened or a mentee feel taken advantage of through this process. The reciprocal benefits of giving and receiving, however, far outweigh concerns or risks of a potential bad mentoring experience. In fact, giving support to others has been shown to reduce stress levels and offset the sense of indebtedness that may accompany receiving. Giving support also leads to an increased sense of autonomy, social connection, and happiness. Hebb’s rule states that “cells that fire together wire together,” meaning that the more frequently neurons communicate with each other or act together, the stronger their connection becomes. The mentoring relationship can literally change the brains of both the mentor and the mentee by strengthening neural pathways for success when both parties have a positive experience that creates more reward response than threat. What does all that look like in relation to an actual mentoring relationship? Six years ago, when Brent Holman was greeted by his new manager, Melissa Steger, they both held a vision of a successful working relationship, but neither realized at the time where that vision would take them. Brent was inquisitive and eager to learn. Initially, after receiving answers to his questions, he would apply what he learned

in ways that signaled to Melissa that he was interested and willing to learn and grow with the team. Over time he gained confidence in researching solutions before confirming a course of action with Melissa. Brent describes his mentoring experience as receiving “lessons in leadership – when to dive in and when to step back, [how to] build teams and culture, how to argue a point, how to let someone fail gracefully and build them back up.” He references meetings he led that would “run off course and fail,” “heated discussions,” “criticisms,” and the sense of being pushed into “uncomfortable situations” where he found the strength to grow. At times Melissa felt concerned that he would think she was offloading too much of her own responsibilities, but the more responsibility Brent assumed, the more he realized how big her role actually was and how what he was taking on was allowing her to grow, too. Where these types of experiences have the potential risk of creating too much of a threat response in both the mentor and the mentee, both Melissa and Brent felt comfortable expressing their concerns and observations to each other. Their trust in each other propelled them through these difficult moments, further strengthening their relationship and mutual support. He says, “it is much easier, and at the same time more meaningful, to take criticisms from someone who you know has your best interest at heart.” As his mentor, Melissa was not dismissive of her time, but extremely generous. He noticed

this generosity extended to others as he had first-hand observations of her genuine care and concern for her staff and industry peers and partners. Of his mentor, he states, “Melissa created an environment where I could, and continue to, feel comfortable expressing thoughts, taking intellectual paths to their conclusion, and reviewing the resulting impacts in comparison to other possible decisions and outcomes,” something Melissa refers to as a 360-degree analysis. This was not a one-sided relationship with Melissa giving and Brent receiving. As an upcoming leader from the next generation, Brent was able to guide her in dealing with a different type of workforce. As part of a generation that was weaned on computers, he shared his technology expertise and identified new and more efficient approaches to their work and leading their team. Melissa also gained peace of mind that she was building a way to sustain and enhance the workers’ compensation/risk management industry through information sharing and effective goal setting – things she learned from her own mentors who guided her in her aspirations.

that person the opportunity to lead can feel threatening. What if they mess it up? Or worse, what if they lead better than you? While strong leaders know instinctively that the best gift they can receive from mentoring is someone who leads better than they did, the reality of that realization can be unnerving. Melissa was willing to be vulnerable in letting Brent lead and providing constructive feedback on his performance and effectiveness. Feedback has been shown to create a threat response and increased stress in both the giver and the receiver, even when the feedback is positive. Both Brent and Melissa approached these dialogues with open hearts and minds, knowing that they would both emerge stronger from the experience and use that feedback to fuel mutual personal and professional growth. The more we trust, the more open we are to trusting. When challenged to think differently and to analyze our decisions, we change the shape of our brains and build new neural pathways and connections that strengthen each time they are used. Mentoring allows us to balance discomfort (threat response) with gratifying rewards that illuminate pathways we would not have found alone, in the dark.

Brent recognizes the rewards he has received when reviewing his own growth as well as how positively he views Melissa’s growth in her career and volunteer contributions to the industry. Melissa says of Brent, “His growth is exciting to watch, but I sometimes struggle to stand idle as he navigates difficult situations. In these moments I remind myself that he must be given the reins so he can succeed in my absence.” Without knowing, it, Melissa’s and Brent’s brains were changing with each interaction. They strengthened neural pathways for positive success, their brains released the bonding chemical oxytocin which deepened their trust in each other, and they worked together to model a mentoring culture within their department. That culture is now positively changing the brains of those who work with and report to them, setting up the next generation for success. Susan Franzen is Managing Partner, PatternShifts. Brent Holman is Workers’ Compensation Program Coordinator, UT System. Melissa Steger is PRIMA President 2021–2022.

A confident leader, Melissa does not feel threatened by new employees who challenge the status quo. She recognizes the value in being receptive to problems and solutions that may only be visible from an employee’s perspective. In Brent she saw the opportunity to develop a strong candidate who could compete with others nationally to succeed her. To ensure business continuity, she opted to “pull the curtain back,” allowing him to see and understand her decisions. She challenged him to “play devil’s advocate,” as a way to teach him her 360-degree analysis method and “organically demonstrate the culture of our program operations.” Identifying a potential successor feels good, but actually stepping back to give

JULY/AUGUST 2021 | PUBLIC RISK

FREE TO MEMBERS

Effective Safety Committees: Making Them Work for You! JULY 21 | 12:00 – 1:00 PM EST SPEAKER: Christopher H. Kittleson, ARM, CPSI, Director of Loss Control Technical Services, Preferred Governmental Insurance Trust The presentation will provide an overview of how conducting an effective safety committee can help to reduce accidents and incidents. Reducing the frequency and severity of accidents and incidents provides for a safer workplace as well as mitigates liability respectively, resulting in the potential to lower insurance costs. ATTENDEE TAKEAWAYS: 1. Learn how to bring management and employees together on safety to obtain management “buy in” 2. Provide an avenue for employees to bring up safety concerns/ liability exposures 3. Assist in the education of all employees regarding safety and health issues and standards 4. Improve the culture of safety with your organization

HEALTHCARE

IN JAILS A Growing Concern BY KENNY SMITH

HEALTHCARE IN JAILS – A GROWING CONCERN

hroughout the United States, there are more than 3,200

local and county jails housing upwards of 700,000 inmates. Providing adequate medical care to this population can

be challenging and has led to many states contracting out their

jail healthcare to private companies. Unfortunately, many of the leading jail healthcare vendors have seen hundreds of lawsuits, some with multi-million-dollar judgments in favor of inmates.

These increasing liability exposures coupled with significant medical costs has created a healthcare crisis in jails, yet public entities remain challenged with simultaneously controlling costs without jeopardizing the quality of medical services. Taking a proactive approach to establishing strong management and oversight of jail healthcare is necessary to reduce complaints, claims, and overall liability to your public entity.

professionals. If the medical staff are not employees of the city, county, or parish, they should be employed by a reputable medical contract company. If a nurse, nurse practitioner, or physician’s assistant is the primary medical staff, a doctor should be on call, and available 24/7, or the jail needs to be prepared to access medical services from EMS and transport prisoners to the local hospital when necessary.

Procedures should be clear about how medical care will be activated by the staff and accessed by the prisoner. Policies and procedures should be in place to determine when to request a doctor or transport an inmate to an outside facility. All personnel should be knowledgeable of this policy and review it often. Lastly, public entities should have a strong understanding and oversight of any third-party organizations providing medical care to jail inmates.

Some courts say that jails need to go so far as to treat the inmate’s conditions regardless of whether the inmate sought prior treatment or not. Legal counsel should be consulted to craft a plan that directs medical personnel to deliver essential medical services.

JAIL INMATES HAVE COMPLICATED HEALTHCARE NEEDS

Caring for the pre-existing conditions of jail inmates is a major contributor to the high cost of jail healthcare. Inmates tend to have high rates of chronic illness, substance abuse and mental health conditions. According to data published by the journal, American Family Physician, 26.3 percent of jail inmates presented with hypertension, 63.3 percent with drug dependence or abuse, and 44.3 percent with a history of mental health issues. It’s common for inmates to have multiple pre-existing conditions when they arrive at the jail. It is important to accurately identify, acknowledge and provide appropriate medical treatment. Jail medical staff should be adequately trained

PUBLIC RISK | JULY/AUGUST 2021

BUDGET DECISIONS CAN IMPACT LIABILITY AND SERVICE QUALITY

A recent study conducted by The Pew Charitable Trusts provides several insights into the jail healthcare crisis. Decisions made for budgetary reasons can increase exposure to liability and have a tremendous impact on the quality of medical care. One example that can have various negative outcomes is the common practice of not budgeting to staff a jail with healthcare personnel around the clock. Since jails book new inmates at all hours, some inmates are not screened by trained medical personnel when they arrive. It’s easy for correctional staff, who usually do not have medical training, to miss that a new inmate needs medical treatment or has symptoms of a communicable disease. If the inmate or someone the inmate comes in contact with experiences a negative health

outcome due to the delayed medical screening, a claim or even a lawsuit could result. Not having medical care on-site can result in unnecessary expenses. When correctional staff cannot reach medical staff for advice about an inmate’s condition, their next step should be to call EMTs for outside assistance and evaluation.

IMPROPER MANAGEMENT OF PRIVATE PROVIDERS CAN AGGRAVATE THE CRISIS Many public entities have a contract with a private company that provides jail healthcare. It’s important that public entities involve the entity’s legal counsel in the creation of these contracts. Otherwise, the public entity may later find it disagrees with the private provider’s interpretation of the company’s responsibilities. It’s also critical to ensure medical services vendors’ Request for Proposals (RFPs) are detailed enough for contractors to create adequate proposals. Although such diligence may seem obvious, the Pew Charitable Trusts study found critical omissions in the RFPs related to jail healthcare. A sample of their findings include: • Many RFPs did not include any utilization data. • 70 of the 81 RFPs they reviewed did not request medication-assisted treatment, an evidence-based protocol for treating substance abuse. • Most RFPs didn’t include performance requirements.

When contracts have performance requirements, failure to meet them can have serious consequences for the health of inmates as well as legal action against the medical vendor and ultimately the public entity. Also, it’s important to acknowledge that contracts with performance requirements that carry financial incentives or penalties are meaningless if the public entity does not assign anyone to monitor the third-party provider’s performance. Contracts with outside medical providers should be reviewed for indemnification language and cover what services are included, the delegation of duties should be specified, and confirmation that training for jail staff is included. Quarterly oversight audits of the medical provider’s performance are needed to ensure contractual obligations are met, the quality of services is acceptable,

and communication remains open between the parties. Having meaningful oversight reviews with the vendor is critical in confirming that the services being provided matches your facility’s needs. Although the healthcare system in jails may always be complicated and come with risks, public entities can do much to mitigate those risks by developing stronger partnerships with the medical providers helping to support reasonable care for their inmate population. Kenny Smith is a risk control manager for Intact Insurance.

JULY/AUGUST 2021 | PUBLIC RISK

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PRIMA INSTITUTE 2021 The Industry’s Premier Risk Management Educational Program October 25–29 // Nashville, Tennessee PRIMA Institute 2021 (PI21) is an innovative educational symposium comprised of fundamental risk management curriculum, outstanding faculty, and excellent networking opportunities. PI21 is aimed at new and seasoned risk management professionals who want to learn more about emerging trends and best practices.

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