Which workplace interventions really work?
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Which workplace interventions really work?

Hello. Today the Workers’ Compensation Regulator
will deliver a very interesting webinar titled “Which workplace interventions really work?”
My name is Rachel Hawkins and I will be your Facilitator for today. Our expert presenter
is Venerina Johnston. Before I introduce you to Venerina, we have
some tips on making the most of your webinar experience.
Firstly, Venerina will present for approximately 50 minutes. Venerina is happy for you to ask
any questions you have throughout the presentation. You can ask questions at any time using the
Q&A box on the right hand side of your screen and we will collate and answer as many as
we can throughout the presentation. Please forgive us if we don’t get to your question.
I know Venerina’s webinar today will provoke a lot of questions, so if we don’t get time
please email us and we will see what we can do to have them answered afterwards or develop
a Frequently Asked Questions document that we can send out to you all as well.
Also, we want you to interact with us throughout the presentation. So as well as asking questions
we’ll also ask you some poll questions. Again a simple prompt will pop up on the right side
of your screen and you will have a brief moment to respond. Okay. I’ll now invite Venerina to share her expertise on firstly measuring success of
rehabilitation, evidence of workplace interventions and the principles for successful return to
work. I know that Venerina is going to enthral you with her ability to translate the complicated
world of research into some very simple and easy take home messages for you to apply in
your role. So sit back and enjoy and take it away Venerina. I have got a cold at the moment so if you can’t stand me sniffling please turn off the
mic. So the first question we have for you just to get an idea of who’s listening in
is could you give us an idea of the role you have in the return to work process? So there
is a few options there from ‘case manager’, ‘claims officer’ right through to ‘other’.
So could you please give us an idea of the role that you’re working in at the moment.
Thank you. Okay. So while Rachel is collating that information
we’ll move onto the next slide. Okay. So today I wanted to give you an overview
of how we measure success in rehabilitation, give you an idea of the evidence for workplace
interventions and try and put it into a format that is digestible for the layperson and go
through some of the principles for successful return to work.
We know that work is a powerful determinant of health and we’ve heard that lots and lots
lately. This is actually the conclusion of several reports published in Australia and
overseas. So it’s quite understandable that when an injury occurs many people become involved
to ensure rehabilitation and return to work occurs as quickly and smoothly as possible.
The workplace is considered to have an important role in the return to work process but there
are lots of interventions out there and other interventions that are considered to be better
than others. So this talk will actually give you an idea of what interventions have been
tested both in Australia and overseas. If we go to our first topic – okay. So we’ve
just got the poll results in. We’ve got 10 case managers, four claims officers, 85 rehab
return to work coordinators, five supervisors/managers, eight HR, 11 injury management. So mostly
rehab and return to work. Terrific. Okay. So hopefully you’ll take something away from
the talk today. How do we measure success in the return to
work arena? Well it really depends on who you ask. Everyone will have their own opinion
of what success looks like. So for the injured worker it actually may be a reduction in pain.
For their partner and family it might be a return to steady income. For the insurer there’s
several measures that they like to use like return to work rates, days absent and cost
of claims. Employers consider things like lost time injury rates, days absent and of
course cost. Researchers like myself and others around the place like to use measures that
are meaningful to everyone – to the individual, the employer, insurer and society and often
will use many of those measures to obtain a holistic view of the impact of the intervention. Let’s have a look at some of the measures that the regulators and insurers use. So this
table here on the slide is an extract from the Queensland Regulator’s Annual Statistics
Report and you can actually view that report on the web link at the bottom of the slide.
It nicely summarises some but not all of the many measures that insurers use and the insurers
being in Queensland. It describes not only how many workers return to work but in what
capacity. The left hand column describes the return to work capacity while the columns
on the right include the number and percentage of time lost claims.
We can see that the majority of finalised time lost claims return to work to the same
job and employer. These different descriptors of work status are referred to as the hierarchy
of return to work. The first option is considered to be the best option and the ideal and if
you go down the left hand column the last option of not fit for work is considered the
least desirable outcome. All workers’ compensation regulators around
Australia are encouraged to use these return to work outcomes so comparisons can be made
across states and schemes. Interestingly some countries overseas as well will use similar
descriptors. I’ll put some more information on that slide. I try not to pack too much
in but you can see at the bottom of the slides I’ve also listed the average number of days
lost in 2013 and ’14 and it was 47.8 days which really does sound like quite a lot.
But if we think that the three quarters of the time lost claims have actually had 40
or less work days lost that means that there’s a small number of longer term claims may have
a big impact on the average number of days lost.
So if you want to compare these results with those in your own organisation just bear in
mind that 47 days is the average and perhaps doesn’t represent the majority of claims.
Some more information on that slide is the average cost of a time lost claim and for
2014 it was 16 – or nearly 16,500 and they did range from 2,500 for a foreign body to
43,800 for a psychology injury. So we know that the most costly claims are psychological
injuries and the most common are musculoskeletal. But return to work rates aren’t the only
metric used by regulators. Let’s have a look at what else is being used out there. While actual return to work is considered by insurers, regulators and employers as important,
there is emerging evidence that as many as 30% of injured workers haven’t fully recovered
and may actually relapse after they’ve returned to work. I’m sure many of you know of cases
where the worker has experienced an exacerbation of their injury once they return to work and
in fact there’s evidence from the USA that workers with musculoskeletal injuries of the
upper extremity return to work at least once but their first return doesn’t necessarily
mark the end of work disability and there’s up to 26% who report a second injury related
absence. So that figure we can compare to people with back pain where 18% have reported
a second injury related absence and people with fractures, up to 12% have reported a
second injury related absence. In Canada a group of researchers found that
almost a third of workers with an episode of back pain experienced recurrent spells
of work absenteeism during the following year and it’s quite a well known pattern that musculoskeletal
conditions like back pain will follow this recurrent pattern. In Australia the regulators have recognised that this may be a problem here as well and
have worked out one way of finding out how big the problem actually is. The way they’ve
done this is through the return to work survey and there’s a web link there to that survey
at the bottom of that slide. Safe Work Australia’s Group for Workers’ Compensation have in the
past two years commissioned a report called the Return to Work Survey and in that survey
they conducted telephone interviews with 4,000 or over 4,000 workers who’ve had at least
one day away from work and submitted a claim in the two years prior to the interview.
The measure that they used to determine whether return to work has been sustained is through
this question on the slide. “So how long have you been back at work for since your last
additional time off?” This measure they labelled as “stable return to work” and was defined
as the proportion of workers who were working either part time or full time at the time
of the survey and had been back at work for at least three consecutive months on a regular
basis. So where in the previous slide 93% of workers had returned to the same job, same
employer this slide in contrast indicates that in Queensland only 61% had stable return
to work. So this is a significantly different measure to the previous one. Try and remember
this definition of stable return to work because we come across it again later in the webinar. Some of you might be thinking “Why is there such a difference between the first return
to work and stable return to work?” It’s natural to think that if a person has returned to
work or is actually certified by the medical provider as fit for work, it’s because they’ve
fully recovered from their injury. However that’s not always the case.
This question here “What is the main reason you returned to work?” was asked in the 2011
and ’12 return to work survey but not in the most recent one. We can see from this table
that only 36% of the workers said they’d returned to work because they’d fully recovered. If
you look down the list at the reasons given for why they’d returned to work the majority
were for reasons other than full recovery, so it’s quite interesting to see that. Just for your interest the most recent return to work survey, so for the 2013-14 period,
workers were asked “Did you feel physically ready to return to work at the time that you
did?” and only 70% of workers said “Yes” with 23% saying “No” and 6% saying “Maybe”. So
bear that in mind next time a worker has a certificate that has a clearance for a return
to work. As a researcher I’m very interested to learn
more about what can be done to reduce the duration and cost of the claim and to reduce
the risk of recurrence to achieve a speedy but durable return to work. So because I am a researcher I thought I’d conduct some research with this captive audience
and this is called “purposeful sampling” where the researcher selects participants based
on their intimate knowledge of the subject matter. So if I was to ask you whose job is
it to return an injured worker to work we have four options here – the injured worker,
the return to work coordinator at the workplace, the treating medical practitioner or the insurer
case manager. So have a think about which option you would select. So do we have any responses yet Rachel? Yes.
Okay. All right. Some of you probably have been thinking “I don’t like any of those options
and I can’t really decide which one.” If we add Option E “All of the above” is your response
different? Okay. So we do have any differences? Okay
so the results will come in a few more minutes. That’s good. Seconds. Okay. So most people actually selected the
rehab and return to work coordinator. So was that based on the previous slide where we
didn’t have the option of “All the above”? Okay. So with this option of “All the above”
has the response changed? Oh, we’re not polling.Okay. Let’s keep going then.
It’s important to be aware that depending on where you sit in the return to work process
you may actually have a different answer. So the way you view your role can be quite
different to the medical provider, the insurer and in fact the injured worker as well. Let’s move onto the next topic which is a summary of the evidence for workplace interventions.
Because there’s lots of research conducted into workplace interventions we need a way
of determining what is good and not so good research. Researchers have in fact developed
ways to rate or score these studies and often use as many as 10 quality criteria. These
include “Was the sample large enough to be able to make some sort of generalised statement
about workers in general?”, “Were the participants randomly allocated to the intervention or
usual care?”, “Did the workers actually comply with the intervention?” and “Was their compliance
monitored and recorded?” so that the higher the score on these quality measures the stronger
the study and more trustworthy the results. High quality studies increase our confidence
that the effects found are a consequence of the intervention and not due to suboptimal
design or some bias that was inherent in the study and in fact when there are two or more
high quality studies with the same result we can conclude quite convincingly the effectiveness
or otherwise of that intervention. Several researchers around the world have
reviewed all of the studies conducted on workplace interventions. When this review is conducted
systematically and according to strict criteria it’s called a “systematic review”. A very
well known source of systematic reviews of all medical interventions is the Cochrane
Library which is a publicly accessible library and that web address is on the slide. So they
have a systematic review of all medical interventions not just for return to work or workplace interventions.
This library publishes only rigorously and well conducted systematic reviews. The information
in the next few slides is taken from van Oostrom and colleagues who published a systematic
review in the Cochrane Library in 2009. This review was recently updated and published
in a book called the Handbook of Work Disability Prevention and Management. So let’s have a look at the evidence. When we talk about workplace interventions
we mean those that are focused on changes in the workplace or with equipment design
or in work organisation or the job situation or in the environment conditions. They can
also include actions taken for a comprehensive case management with accurate participation
of the worker and employer. The next two slides succinctly summarise the
findings of nine high quality studies found on workplace interventions. So this first
slide is the studies on musculoskeletal disorders and the next slide is the studies with mental
health conditions. And I know it looks like a busy slide but I’ll work through each of
those headings one at a time. We talked earlier about the different measures
of success and these are some of the measures that researchers have used to determine whether
an intervention is effective or not. So the results are presented in terms of first return
to work, time to sustained return to work which is similar to stable return to work,
the number of days sick in the 12 month period, changes in symptoms and function. So these
measures are relevant to the insurer, employer and individual worker.
If we look at the studies that measure time to first return to work that was investigated
in five of those nine studies, three studies found a reduction of time until first return
to work in favour of the workplace intervention and two did not. In the Netherlands it was
found that workers with low back pain achieved a first return to work in 70 days after the
workplace intervention compared with 99 days after usual care. In other words workers returned
to work 29 days sooner. While in Canada one study found that workers
with lower back pain who participated in a workplace intervention returned to work 64
days earlier than those who’d received usual care. So two studies conducted in different
countries by different researchers but with the same results. So our confidence that workplace
interventions can be effective in improving time to first return to work is established. If we look at the second outcome here of sustained return to work in the systematic review I
mentioned in the previous slide it was defined as “at work for four weeks without recurrences
of sick leave.” So that’s different to the definition used by the return to work survey
conducted in Australia which was “at work for three months.” And in terms of the research
that’s been conducted for sustainable return to work two studies were on lower back pain
and they found a reduction of days until sustained return to work – one of 27 days and the
other of 120 days both in favour of the workplace intervention. Both of these studies were in
fact conducted in the Netherlands. So while they were two studies and different researchers
we can’t really say with a lot of certainty whether the intervention itself was effective
or perhaps where the workers in the Netherlands respond well to the intervention. So we need
more trials in other countries to confirm that result. Let’s look at the next outcome which is number of days sick. Five studies recorded the number
of days absent due to low back pain or a musculoskeletal disorder. Four of them found in favour of
the workplace intervention with days absent ranging from 20 to 93 days. The one study
that didn’t find a difference with the workplace intervention may have been because the workplace
intervention compared early management by an occupational physician with management
by the supervisor only. So that might be of interest to some of you who think that medical
personnel need to be strongly involved but interestingly that the outcome of days to
return to work didn’t differ substantially when the supervisor managed the process. That
was quite an old study conducted overseas in the Netherlands.
When measures of pain and function are included in the research there was a reduction for
those receiving usual care and the workplace intervention but in fact one was no better
than the other in improving functions, symptoms and pain for the individual. This was the
conclusion of five studies on lower back pain. So we can say with a lot of confidence because
the findings are consistent that workplace interventions don’t really make a big difference
or there’s no difference in function and symptoms for the individual worker. If we look at the evidence for workplace interventions for workers with mental health conditions
there hasn’t been a lot of research conducted in this space and it’s quite scarce and the
results are inconsistent. There’s only been two high quality studies available at the
moment. The evidence from these two studies indicate that time to first return to work
for workers with adjustment disorders was 122 days while it took 320 days to return
to work for those without the intervention. In other words the workers return to work
188 days sooner with the workplace intervention. In terms of sustainable return to work for
those workers on sick leave due to distress there was actually no favourable result for
the workplace intervention found. However they did a sub sample analysis which means
they looked at what was the difference between were there in fact some people who had
a benefit or not and they found that those who were highly motivated at base line returned
to sustained work after 55 days while the workers receiving usual care returned to work
after 120 days. So that’s quite a large difference, but as I said, there was only one high quality
study found that measured sustained return to work for workers with mental health conditions. So Venerina we’ve just had a question there with regards to that particular point and
does that mean that one of the best strategies that a return to work coordinator or a case
manager could do would be to identify which of those injured workers who were motivated
to return to work early in the management of a claim? What does that mean?
I don’t think it would hurt to have a conversation with the individual worker to help understand
where they are in terms of their return to work. It depends on their journey in terms
of medical treatment. They may be able to articulate whether they’re motivated at the
moment or whether it’s something that they would consider a little bit further down the
track when they’ve had some more treatment and intervention. Okay. So I think now we’re up to number of days absent. It actually didn’t differ whether
workers had received a workplace intervention or usual care and similarly for change in
symptoms the scores for depression, anxiety and stress did reduce with usual care and
with the workplace intervention that one of the interventions was no different to the
other. So we can see that as for musculoskeletal
conditions workplace interventions were no more effective than usual care in improving
the actual health and function of the individual worker with a mental health condition. But
workplace interventions were effective in obtaining first return to work and sustained
return to work for those highly motivated at base line. We need to remember that there’s
only two high quality studies at the moment that have tested workplace interventions for
those with mental health conditions. Perhaps one of the reasons for the lack of
effect on health outcomes may be explained by the focus of a workplace intervention which
is on reducing barriers for work rather than symptom recovery and certainly that’s where
the health provider comes in. Let’s have a look at the next slide. Okay.
So I hear some of you saying “What about the cost of claims?”, “What is the impact?” and
“Is there any evidence that workplace interventions can be effective in reducing cost?” In fact
a few studies have recorded the costs associated with workplace interventions and on this slide
we’ve got four columns illustrating four studies that have evaluated the costs associated with
the workplace intervention. The letters at the bottom of each column like “CA”, “SW”,
“DK”, and “NL” represent the country where the research was conducted. So “CA” is Canada,
“SW” is Sweden, “DK” Denmark, “NL” is Netherlands. Going from left to right the first study was
conducted in Canada and looked at the cost effectiveness which is the amount of dollars
spent for each day saved on full benefits of their workplace intervention after a six
year period. This study looked at workers with low back pain who had been off work a
minimum of four weeks. The intervention was a clinical as well as an occupational intervention
and it actually delivered a mean saving of $18,000 Canadian per worker with most of the
costs saved in income replacement. So that’s over a six year period though.
That particular intervention consisted of a visit with a back pain specialist, functional
rehabilitation therapy and therapeutic return to work and participatory ergonomics. You
may be familiar with the term “participatory ergonomics” because it’s where a team of people,
usually including the worker, a supervisor or manager and an ergonomist or health and
safety personnel attend a workplace meeting and problem solve any barriers for work. So that next column is about a study conducted in Sweden and they found direct cost savings
of US $1,195 per case yielding a direct benefit to cost ratio of 6.8 which is quite impressive.
The intervention consisted of an initial assessment by the insurance case manager and an occupational
therapist. This was followed up with a meeting at the workplace with the employee and employer
to discuss possible work options, training and any modifications required in the work
environment and then they developed a return to work plan.
So a benefit to cost ratio is actually the ratio of the benefits of a project or proposal
expressed in monetary terms relative to its cost. The higher the benefit to cost ratio
the better the investment. So that’s certainly something you can take back to your management
team. That next study, the one conducted in Denmark
consisted of a coordinated care model. In this particular intervention workers with
musculoskeletal disorders were assessed by an occupational physician, a chiropractor
who did the biomechanical assessment, an occupational physiotherapist for their work related assessment
and a psychologist. Then there was the team conference with the case manager who was a
social worker. Based on the assessment the coordinator tailored an action orientated
work rehab plan was developed and presented to the worker and you can see there that there
was a cost benefit per worker at six months. The intervention in the study was effective
but I’m not a big fan of this particular study because it’s very hard to see where the worker
fits into this particular return to work plan. Finally, there’s the study in the Netherlands
which consisted of a workplace intervention for workers with chronic low back pain. The
intervention they called “integrated care” and it consisted again of a participatory
ergonomics approach which involved the supervisor and a graded physical activity program. The
cost benefit showed that for every pound invested there would return an estimated £26 with
a net societal benefit of integrated care compared with usual care of £5,744.
So we can see here there are four studies of different workplace interventions conducted
in different countries with different researchers and all of those countries have got different
health care and compensation systems and yet they found similar results thus reinforcing
the conclusion that workplace interventions are cost effective compared to usual care. Now that we know that workplace interventions are successful in achieving a speedier return
to work, that is sustainable resulting in fewer days away from work generally and are
more cost effective, what is the content? If we break down that black box or workplace
intervention what’s the content of these workplace interventions and what are the essential ingredients
that perhaps you could implement or see whether you’re actually implementing them in your
workplace? And while we can’t provide an exact recipe we can provide some guidelines or principles.
And the researchers from the Institute of Work and Health in Canada have done just this.
After a rigorous review of the literature on workplace interventions they developed
the Seven Principles for Successful Return to Work. These principles were published in
2007 but the team in Canada are currently updating the principles. So keep an eye out
for them. The website is actually very good and they have a lot of information that can
help you if you want further information and it’s well recognised internationally as being
leading edge on the topic. So the principles here that are listed are
not in any particular hierarchy of importance. I’ll give you a moment to scan your eyes over
these principles and what stands out to you. Okay. For me, the first thing I noticed was
that four of the Seven Principles are the responsibility of the workplace or the employer
and I’ve put in bold the words “workplace” and “employer”. I’ll go through each of these
principles and present some of the evidence for them. I won’t show you all the studies
of course but just some of the more interesting ones. So the first principle is that the workplace should have a strong commitment to health
and safety. People might talk about what they believe in or support but as the old saying
goes, actions speak louder than words. Research evidence has shown that it is the behaviours
in the workplace that are associated with good return to work outcomes and these include
things like management, investments and resources and, people’s time to promote safety and coordinated
return to work but also a commitment to safety issues and return to work programs. It’s not
only documented in policies but demonstrated by behaviours when someone’s injured. So a
strong and visible safety culture at the workplace is likely to result in successful return to
work when someone’s injured. I’ve got there on this slide about a study
conducted in the USA by Amick and they found that organisations with people oriented culture,
good safety practices and ergonomic practices and a good disability management practice
were in fact more successful in achieving timely return to work for the workers with
Carpal Tunnel Syndrome. There was another study conducted in the USA
again. They had 1,800 workers with back pain and they were asked to complete a survey about
how satisfied they were with the employer’s handling of their claim and satisfaction with
the health care that they received. The results show that workers’ satisfaction with their
employer’s treatment of their claim was more important in explaining return to work than
satisfaction with the healthcare providers and in fact the workers who were dissatisfied
with the employer’s response to their injury were 1.5 times more likely to have a negative
return to work outcome. And in fact that particular article by Butler was titled “It pays to be
nice,” which I thought was quite apt. In the second principle it suggests that employers
should make offers of modified work. There is strong evidence that the longer the duration
of sickness absence the longer the chance or the lower the chance sorry, of return
to work and the greater the obstacles to work. One study found that workers who were off
work for 4-12 weeks had a 10-40% risk of still being off work at one year. So where possible
the worker should return to their own work area where the environment, people and practices
are familiar. An ergonomic work site visit by an expert can usually be helpful when it’s
difficult to find appropriate work. Interestingly the studies that have showed successful and
cost effective return to work there was the involvement of an ergonomist or someone who
was able to conduct an ergonomic visit and that was part of the workplace intervention.
Venerina we’ve just had a question there with regards to the ergonomic visit. What exactly can you give us an example of what exactly it was that the ergonomist might have assessed
or recommended as part of that assessment? You’ll probably notice that most of the studies
to date have been with people with low back pain or musculoskeletal problems. So the ergonomist
would be someone who has a very strong background in biomechanics and they would go onto the
workplace and work with the individual worker and the supervisor to undertake an assessment
of the workplace to identify any particular barriers for that individual to make it easier
for them to return to work and probably safer in the long run as well. So it’s not – I
would suggest that the most beneficial outcome is where the three of them work together as
opposed to when the ergonomist comes in and tells the employer what they should and shouldn’t
be doing. However that’s not actually detailed in a lot of the publications.
Thank you for your question. Just to demonstrate the probability of return
to work in terms of the longer someone is off work this slide shows that return to work
within three months asked for varying time off work does reduce the longer you’re off
work. It’s taken from a report produced by WorkCover South Australia in 2010 and it certainly
confirms the principle that the longer an employee is off work because of an injury
the less the chance for successful return to work.
This table shows that when a person is off work for three months the chance of return
to work within three months is about 50% and that reduces quite quickly so that if the
person is off work one year the probability reduces by half to 25%. So while these results
might be a bit frightening for some of you it’s important to remember that in South Australia
they have a long tail scheme and it’s not unusual for people there to be off work for
one year. And I actually think that South Australia has made some changes to their legislation
to reduce the long tail scheme that they have there at the moment. The third principle is that return to work planners need to consider co-workers and supervisors
at the workplace. So when you’re involved in planning a return to work it’s more than
just matching the restrictions on the medical certificate to the job. We need to consider
the impact on co-workers and supervisors. Sometimes co-workers may feel disadvantaged
and even resentful if they’re expected to take on additional duties while the injured
worker recovers fully. Or perhaps they may feel that the injured worker has somehow managed
to get an easier job. Likewise some supervisors may find it challenging to maintain production
while supporting the returning worker. There is additional time and sometimes stress that’s
often not fully appreciated by their manager. One way to perhaps avoid these feelings of
resentment and additional burden is to ensure the co-workers are kept informed of the changes
and that perhaps if something was to happen to them that they would be given similar considerations.
And the supervisor needs to be involved in the planning of the return to work. This fourth principle is that the supervisors should be trained in work disability prevention.
Research has in fact identified that supervisors are important to the success of return to
work due to their proximity to the worker, their understanding of the available jobs
and work demands and their ability to modify or to provide modified work and monitor the
worker’s health and functioning on a daily basis and often they will communicate a positive
message of care and support. The immediate supervisor is the interface
most likely among upper management, the rehabilitation and healthcare providers sometimes and co-workers
and the injured worker. We’ve actually been doing some research at the University of Queensland
to identify what supervisors need to effectively perform this role and overwhelmingly they
said that they needed more training. So I guess this supports this principle here that
they should be trained. At the next webinar I think I’ll be conducting
later on in the year I’ll discuss this research and the specific knowledge, skills and personal
characteristics required by supervisors to support staff returning to work after injury. My apologies. I needed a drink. The fifth principle here is that the employer
should make early and considerate contact with the injured worker. By “early” we mean
within the first week or two. So this is really only a guideline and the actual timeframe
may vary depending on the worker’s injuries. Ideally the contact should be made by the
immediate supervisor as this can help the worker feel connected to their workplace and
the colleagues. If the immediate supervisor is in fact part of the problem associated
with the absence, then the return to work coordinator or someone else at the workplace
that the worker may trust should make that contact. By contacting the worker early and regularly demonstrates the employer cares about the
worker’s wellbeing. At that time there shouldn’t really be any discussion of the legitimacy
of the claim or even blaming. I recently spoke with a person who was seriously injured in
a workplace accident and I remember him saying to me that he was actually quite bitter and
disappointed that no one in management from his workplace had contacted him to enquire
about his wellbeing. I mean if you think that you’re going to be prying or bothering the
worker or that it’s viewed suspiciously, in fact more often than not the contact is welcomed
especially if there is an existing workplace environment that’s characterised by goodwill.
In this particular study on the slide, the one by Wood, it’s an old study but still quite
relevant. The study was done in a hospital in Canada where the personnel program was
implemented as soon as the workers’ compensation claim was registered. There was immediate
contact with the worker and insurer followed up by regular 10 day calls. There was liaison
between the insurer and the manager to establish a return to work plan. Supervisors were instructed to call the injured workers and to say this particular spiel,
“How are you? We are thinking about you. You are a vital part of the team. Your work is
important and your job is waiting for you.” And it was actually found that this simple
message and the company culture it reflected… Hi everyone. It’s Rachel here, your facilitator.
Our expert presenter just needs to have a little drink. She’s had a slight coughing
attack. So I’ll just take over for the time being so that we can let her have a little
drink and then hand back to you to keep things flowing. Okay. Thanks everyone for your patience.
Okay. So this particular intervention that they tested in Canada found that it reduced
the number of staff staying on long term leave from 7% to 1.7% which is quite an impressive
result really. This principle, so the sixth principle, suggests
that someone should have the responsibility to coordinate return to work and I guess that’s
where a lot of you actually function. All of the successful workplace interventions
described in the two summary slides included someone to coordinate the return to work.
That role may be performed by someone within or external to the workplace depending on
the nature of injury. In many of the European countries where the
research was conducted the role is actually performed by an occupational physician. In
the USA occupational nurses have a large role in return to work and they’re usually employed
as the return to work coordinator. In Australia and Canada the person coordinating the return
to work may actually be an allied health professional but in some small organisations it might actually
be the owner of the business or a layperson who coordinates the return to work. While
many of you may not feel well equipped to perform this role it’s comforting to know
that researchers have actually found that the competencies that a return to work coordinator
needs to effectively support a returning worker are general personal characteristics and attributes.
So things like maintaining confidentiality, ethical principles, responding in a timely
manner and demonstrating good organisational and planning skills. These all seem to be
key behaviours of success of return to work coordinators and hopefully you can recognise
these attributes within yourself. Okay. So the last principle is based on the
strong evidence that contact between the healthcare provider and the workplace reduces disability
duration and claims cost. Contact may actually be in the form of a report or a phone call
to the workplace or after the worker’s been to the doctor or the physio. It could also
be a more extensive work site visit by the healthcare provider. The health provider is
important as the injured worker is often looking to them for information about their condition
and return to work advice. Unfortunately, recent studies in the USA and
the UK reported that the doctors rarely enquired about the work demands of an injured worker
and they provided little advice as to how to manage the health problem at work. However,
this particular study in Canada demonstrated that when that advice is personally conveyed
by the health provider an employer is twice as likely to respond to the suggestion regarding
possible job or ergonomic changes. You might be thinking “Well we don’t really
need to have that input because we don’t have a lot of serious injures,” and certainly in
uncomplicated cases contact with the health provider may not be necessary. However, if
you feel it’s necessary to contact the health provider ensure that permission from the worker
is obtained before proceeding. So just to demonstrate that communication
is vital between health providers and employers, this is the study that showed that there were
three activities associated with more than a twofold increase – a chance of earlier
return to work compared with a lack of communication. So where the health provider gave a return
to work date, where the health provider gave advice for injury prevention or recurrence
and where the health provider made contact with the workplace. So in cases where you’re
not sure whether it’s safe enough for the worker to be at work or what tasks they can
or can’t do, it’s always best to check with the health provider and perhaps even invite
them to the workplace so they can see first hand what the worker is required to do.
Sometimes it’s good to send a written job description with the worker to the health
provider so the health provider understands the worker’s job to be able to better advise
and be able to participate in informed decision making. And it looks like we have a question?
We do. So in this study particularly from Kosny et al. on this slide, when they refer
to “healthcare provider” is it referring specifically to doctors not having that information about
the workplace, so job descriptions and further being able to understand what it is the worker
does? Or when you refer to “healthcare provider” on that slide did the study talk in general
about a range of healthcare providers including the doctor or allied health professionals? Thanks Rachel. In this particular Canadian study the majority of the participants were
medical doctors but in the province where the research was conducted medical doctors,
chiropractors and physios were included as the healthcare provider because in that province
they’re responsible for directly communicating with the Workers’ Compensation Board about
the worker’s readiness for return to work. Some of you may have noticed that all of the
studies mentioned so far were conducted overseas. So while the results of these studies are
interesting the health and compensation systems do vary quite significantly between countries.
And we have in Europe of course, they have that generic, overarching healthcare and compensation
system which is different to Canada, US and Australia where we have workers’ compensation
insurance schemes. There actually haven’t been too many studies
conducted in Australia looking at workplace interventions and the only one that I know
of came out of Victoria recently. The researchers there analysed data from several organisations
that had participated in what they called a “multifaceted intervention”. This particular
intervention consisted of various features. So it wasn’t just one thing that they did.
There was early appropriate medical intervention which consisted of a 24 hour telephone contact
line manned by trained injury managers to provide immediate professional assistance
and encourage early reporting of the workplace injury.
So the aim in this particular study was to receive notification of the injury within
20 to 60 minutes. So some of you might have heard of “triage systems” and that’s something
that a lot of the large organisations have in place currently. Another feature of this workplace intervention was that there was an injury manager assigned
to manage the process and guide the employee, employer and other parties through the process.
The supervisor was involved in the process from the start and senior management were
engaged by contacting the worker to check on the wellbeing and negotiate suitable duties.
Interestingly non work related injuries were also addressed.
Another feature was that there was support for the worker where the injury manager worked
to remove as many barriers as possible to the successful management of the person’s
injury and return to work. They encouraged the worker to obtain evidence based treatment
and to cease ineffective treatment and worked with the health providers to achieve this.
The injury manager also worked with the treating doctor to avoid delays in specialist referrals
and delays and ensure approval for surgery. As you can see this multifaceted intervention
resulted in a 40% reduction in the number of days on compensation and a reduction in
the average cost of claims. So that’s quite a recent study. So we’ve come to the end of this webinar and I hope that the information has been useful
even if it’s just to reinforce what you’re doing and you’re on the right track. I said
that I couldn’t provide a recipe for successful return to work but I thought I’d have a go
at providing a recipe. So essentially I believe the key features are the requirement for someone
to coordinate the return to work and I don’t believe that that person needs to be an allied
health professional, the participatory ergonomics approach where the worker, supervisor and
an ergonomist or health provider or health and safety personnel need to coordinate to
establish the return to work plan with modified and/or alternate duties and we also need regular
communication between all parties that’s delivered with empathy.
I’m not sure if we have time for questions. Yes?
We do. Okay. So hopefully I can address some of your queries. Okay. So thank you very much Venerina. Once again a very informative presentation. One
of the questions we did have that wasn’t answered throughout was “What can an employer do if
a worker refuses to undertake a return to work program? Or how do you entice them to
get to that first point where you can actually talk about it when they’re not wanting to
play the game?” Sorry. Could you repeat it? Is it when the
employer or when the worker doesn’t want to participate?
So what is it that a worker can do to help a worker participate in a return to work program?
So they’re refusing to play. So what can the employer do when the worker
is refusing? Sometimes it’s worthwhile pointing out to
them the legislative requirements for the worker to participate in rehab. If it’s a
case where there’s a little bit of tension there prior to the actual injury occurring
it might be useful to get an external party involved, someone who is perhaps not seen
to be biased in the process. I’ve seen that work quite effectively in a couple of situations.
That’s great and I think we also need to remember that there’s a large body of insurers out
there as well. So WorkCover Queensland – they can always be useful to assist with educating
doctors. In one of our previous webinars I’ve heard a strategy where the psychiatrist recommended
that you do speak to the doctor because quite often the doctor can be an important point
and pivotal point in getting the worker engaged in the process too.
Okay and I’m going to put another challenging question to you Venerina. So we’re very grateful
for all of the information that you’ve presented to us today and I think it’s a real art to
be able to translate. Sometimes that world of research can be quite complicated but to
translate it into some very useful tips for people to take home. So I’m grateful for that
and I’m sure all of our audience are as well. But if I had to put it to you what’s the one
thing that could be done to reduce durations and costs, what would you say could be done
from an employer’s perspective? Act early and quickly. I know that’s quite
a short answer. I guess the research has demonstrated that if you have early and effective intervention,
whether that’s at the workplace or contacting an injury manager, sending them off for treatment
or assessment, that fairly clearly shows that early intervention can be quite effective.
Yep, great and I just thought we might talk about the polling results that we presented
before. Interestingly enough when Venerina asked the question about who plays the most
important role the feedback was rehab return to work coordinators. So three quarters of
you felt that they played the most important role followed by doctors and then workers.
So really just to reinforce that point Venerina in your opinion the evidence supports that
it’s all of those players that are vital to successful return to work. Is that correct? Yes. Certainly everybody is important and
needs to be kept on the same page. So the return to work coordinator has a key role
in communicating with all the different players, ensuring that everybody has up to date information.
So yes you are important. Okay. Well that – we’re getting near to
the end of our webinar today. Once again on behalf of the Workers’ Compensation Regulator
I’d like to extend our gratitude to Venerina for giving up her time to come and share her
knowledge and practical tips on how to help coordinators to identify which workplace interventions
really work. We also look forward to the next webinar in
your series which will be in a few months’ time on supervisors and what they can do to
ensure positive outcomes for workers because as your research highlighted, supervisors
play a very important role in that return to work process. So we look forward to hearing
more about that. We’ve had some great feedback for you today
Venerina and it’s always nice to give you that verbally. So someone’s kindly sent in
“Thank you Venerina. Really fabulous presentation.” So it’s not just me who’s grateful. It’s all
of our attendees today as well. So thanks very much.
The Workers’ Compensation Regulator is committed to supporting return to work coordinators
and employers as well as health professionals and anyone in the industry. And we’ve established
a Coordinator Community on Facebook. To ensure that you receive regular communication and
the current information from us make sure you join that community using the address
on your screen. You can subscribe to eBulletins and be the
first to hear about what is coming up next for webinars and also subscribe because they
have been popular. We’ve recently launched the Queensland Safe
Work and Return to Work Awards for 2015 and you can enter these as an organisation if
you’ve got a relevant initiative that’s in the development stage or newly implemented
or if you’ve achieved positive outcomes in either health and safety or rehabilitation.
There’s lots to be I guess recognised for and you could win up to $2,000 in prize money
as well as there’s reward for people who nominate someone else.
We’ve also got some work health and wellbeing leadership forums that are currently being
run across the state. I was fortunate enough to attend one of those last week and they
were excellent. It’s a joint initiative between Workplace Health and Safety as well as WorkCover
Queensland. So they have a really great presentation from Dr Rob McCartney and they cover off a
whole lot of different topics on workplace health and wellbeing programs that you can
use. And they also showcase a success story from industry and then WorkCover Queensland,
Workplace Health and Safety Queensland and then the employer form a panel as well so
that you can ask lots of questions. So I encourage you to attend that.
And just finally a copy of this webinar will be emailed through to you shortly as well
as available on the website. We do take a little bit of time to actually transcribe
the webinar so that they’re accessible for all. So you do need to give us a few days.
We do have a brief post webinar survey and we encourage you to tell us what your thoughts
are so that we can all – we’re always looking on how we can improve your webinar experience
and most importantly, what it is that you need to know more about to ensure success
in your roles because we do want to help you facilitate an early and safe return to work
for your injured workers. So on behalf of the Workers’ Compensation
Regulator I’d like to thank you for being involved in our webinar today and have a great
rest of your week. Bye for now.

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