One of the most valuable resources for any business is its employees. Several factors, however, affect employers' existing applicant pool. Unfortunately, job applicants are increasingly heavier, more out of shape, and older. As the total number of qualified job applicants shrinks, hiring and retaining qualified workers is the greatest challenge that employers face.

Valuable resources are wasted if employers hire and train new employees only to find out that they do not have the physical ability to perform the job. Post-offer screening provides an opportunity to serve both the employer and the employee through injury prevention. However, there are some important clinical and medicolegal issues to consider when doing post-offer screens. The PT's expertise and knowledge of these issues makes us an important resource for employers.

THE OPTIMAL SEQUENCE FOR TESTING

Functional screening is best performed after a conditional offer has been made. The Equal Employment Opportunity Commission (EEOC) has published "Enforcement Guidance: Pre-employment Disability-Related Questions and Medical Examinations"¹ as well as other guidelines related to pre-employment screening that can be accessed online at http://www.eeoc.gov/policy/docs/preemp.html.

According to the EEOC's guidelines, medical examinations (such as monitoring blood pressure and heart rate) can be performed only after a conditional offer has been made. Performing strenuous physical testing, which is often the case in pre-employment screening, without monitoring these physiological parameters, puts everyone at risk.

In addition, post-offer screening is more cost-effective for the employer because they do not have to screen every applicant, only the ones to whom they make a conditional offer. Employers will appreciate your recommending a cost-effective solution. Your sensitivity to their cost containment will go a long way toward building trust between your organization and the employer.

EVIDENCE IN SUPPORT OF EFFECTIVENESS

At least five research studies have been published since 1994 that speak to the effectiveness of post-offer screening. Reimer² et al studied the effectiveness of pre-employment screening combined with a worker fitness program for grocery warehouse workers. They found significant decreases in injuries and injury-related expenses over a 3.5-year period. Nassau³ combined pre-work placement screening and case management for the injuries that occurred. This study, performed at a 250-bed hospital, found that the number of injuries did not decrease but the severity of the injuries was significantly less.

Gassoway and Flory⁴ performed screening on nursing assistants at a regional health center. They found a slight decrease in injuries requiring medical intervention but a more significant decrease in job turnover rate. This study showed that the company saved $6 for every $1 spent on screening.

In a study that presents the strongest evidence to date in support of post-offer screening, Littleton⁵ tested physical plant applicants at a major university hospital and found that the number of lost day cases decreased 18%, the total injury costs decreased 78%, and that for every $1 spent on post-offer screening, the employer saved $18. The added benefit of these last two studies is that post-offer screening was the only intervention used.

PITFALLS TO AVOID

In addition to avoiding pre-offer screens, there are some pitfalls to avoid in pre-employment testing.

General Strength Testing. The concept of a one-size-fits-all generic strength test (such as a set of push-ups, sit-ups, aerobic step tests, or isokinetic strength testing) is appealing because of its simplicity and ease of administration. However, such tests are not compliant with the Americans with Disabilities Act (ADA) because they cannot be directly correlated to the demands of the job. All of the lawsuits lost by employers that have been related to pre-employment screening have involved generic strength testing.

Comparison to Normative Data. In pre-employment screening, the ADA is violated when hiring decisions are made based on a comparison of the applicant to normative data. It does not matter whether the applicant is in the fifth percentile or the 95th percentile as compared to a group of "norms." What matters is whether their abilities match the job demands. If the applicant's abilities match the job demands, the employer can hire and place the applicant. If the applicant's abilities do not match job demands, the employer can rescind the offer.

Predicting Future Injury. Some providers market their services by claiming to be able to predict future injury. Unless you have data to back you up, it is best to avoid this potentially litigious claim. Our service involves testing the workers' abilities to determine if they match the job demands. By focusing on the match between the worker's abilities and the demands of work, we help the employers minimize the chances of injury and the associated costs. Maintaining our focus on the matching process is a defensible strategy. Predicting future injury is seldom defensible.

STEPS OF THE PROCESS

To develop a valid, legally defensible, and cost-effective post-offer screen, several steps should be followed with each employer:

• Targeting the jobs. The employer may not need to screen for all jobs within the organization. A few jobs may be creating most of the injuries. By sitting down with the employer and looking at the injury data, you can help identify the jobs that should be screened. You may perform fewer screens in the short run, but in the long run, if the employer's return on investment is high, you have long-term job security. If the screening is cost-effective on the most problematic jobs, it will be easier to justify for other jobs.
• Performing job-demands analysis. A good analogy of the relationship of job analysis to post-offer screening is that of a house and its foundation. Identifying the physical demands of work is the foundation on which defensible post-offer screening is built. If it is not performed accurately, the results of the job analysis will not reflect the job demands. If screens are built upon inaccurate job descriptions, the employer is at risk. While the employer may be reluctant to invest in the job-demands analysis, it is money well spent in the long run. The screens should address the most physically demanding aspects of the job.
• Developing the test items and pass/fail criteria. If an accurate job analysis is performed, selecting the test items and the minimal requirements is a relatively easy task. In cases where the materials or equipment create some unusual demands, it may be best for the company to loan this equipment or material to you for a simulation of the work demands. It is extremely important to use functional testing with established reliability and validity^5-7 for test items when possible.
• Establishing procedures. A variety of procedural issues will have to be resolved with each company:
  • How will applicants be referred to you?
  • Where will testing occur?
  • How will test results be handled?
  • How will test failures be handled?
  • What will you do if the applicant's resting blood pressure exceeds safe levels for testing?
  • How will you deal with any injuries that will occur during testing?
  • What will you do if an applicant is pregnant?

There are no hard and fast rules for any of these decisions. Each employer may want to handle the administrative procedures just a little differently. The important issue is consistency. Once policies are in place, they must be followed for each and every applicant until they are changed.

• Testing incumbents. Many employers are reluctant to test incumbents. They fear it will be perceived negatively by incumbents. The incumbents must be reassured that their test results will not be shared with the employer except as aggregate data (that is, an individual's test result are not shared, but the employer is told that nine out of 10 employees passed the screen). While this step is not easiest to accomplish with all employers, it is extremely beneficial if the validity of the screen is called into question. Incumbent testing provides additional proof of the validity of the screen. It also can be used as a mini-feasibility study. If there are any communication, procedural, or equipment problems with the system, then it is best to discover and correct them during incumbent testing than to have them occur when the applicants are being tested.
• Outcome follow-up. Once the testing of applicants begins, most employers will want periodic updates on the pass/fail rates and the test items that are most frequently failed. Most employers also will want to know if there are significantly different fail rates for women compared to men and if there are significant failures in a specific age or ethnic group. If the selection rate of any minority group is less than 80% of the selection rate of the majority of applicants, then the company may be creating adverse impact with the screens.
  Adverse impact does not mean you must stop screening, just that the employer will need to make sure the screens are defensible. If the job-demands analysis and screen development have been done appropriately, defensibility should be no problem. In addition to pass/fail rates, if employers track their work-related injury costs before and after initiation of the program, this information can provide powerful justification for continuing or expanding the screening.
• Ongoing review of job demands. Job demands can change as an organization's products and services change. Therefore, it is important to establish open lines of communication within an organization and between the organization and your clinic so that screens can be updated in a timely fashion. In a manufacturing environment, for example, the production lines need to communicate changes to safety, who in turn needs to communicate to your clinic, and your clinic staff must revise the screens in a timely manner.

In summary, post-offer screening is an opportunity to serve employers, employees, and society through the prevention of work-related injuries. As a general rule of thumb, post-offer/pre-employment testing can decrease injuries between 20% and 60%! As with any opportunity to serve, PTs need to have knowledge of the effectiveness of this intervention and the medicolegal issues surrounding it. We need to have reliable and valid assessment tools, and we must know how to apply them in a systematic and consistent manner.

Deborah Lechner is the president of ErgoScience Inc, Birmingham, Ala. For more information, contact .