The Proactive Employer When and Where in the Rehabilitation Process

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The Proactive Employer- When and Where in the
Rehabilitation Process

• Presented by
• Charlene Couture MSc Erg.HBSc.H.K., CCPE
• Ian Elliott, MBA, BSc.P.T
• Sibley Associates Inc.

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Outline

• Challenges Facing Employers
• Challenges Facing Employees
• Challenges for YOU
• Early and Safe Return to Work
• Tools utilized in this process
• Break out session
• Questions Answers - Discussion

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Employers Challenges

• Reality of reading the daily headlines in the
  paper
• Losing contracts, losing business, plant
  closures, amalgamation of plants, bankruptcy

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Employers Challenges

• Employers are faced with strategic and
  operational challenges
• Tough decisions on an array of critical personnel
  matters- HOW DO WE MAKE IT HAPPEN?
• Focus on Headcount, Focus on Productivity both
  presenteeism and absenteeism
• Business risk for employers
• - Increase in incidence and duration of (STD)
  and (LTD) and (WSIB) claims
• - Lower success rates with return to work of
  employees on disabilities

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Focus on Productivity

• Product lifestyles are getting shorter
• Everyone is focusing efforts on LEAN
• Increase demand for innovation
• Pressure to increase workforce productivity and
  innovation despite a contraction in revenue
  streams.
• Also companies are trying to hold on to talent.

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Management Challenges

• More demands placed on key management staff
• Increase focus on Lean
• Less workers
• How do they manage the business with an injured
  worker?
• Managers estimated the annual cost of reduced
  productivity from a depressed employee
  (presenteeism) was 7,000.00 and the cost of
  absenteeism was 10,000.00
• Canadian Life and Health Insurance Association
  estimate 30-40 disability claims are related to
  mental health
• 26 reported been diagnosed with depression or
  felt depression

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Employees Challenges

• Less people doing more work
• Stressed at home and at work- fear of what will
  happen in this economy
• Productivity demand increasing
• Working longer hours, less time off, less money
• Working longer, not willing to retire

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Two Different Sides

• EMPLOYEE
• Feel jobs at risk, LTD
• income could be perceived
• as stability!

• EMPLOYER
• Dont want to accept or manage employees RTW in
  light of downsizing
• Reluctance to invest when human and financial
  resources are tight.

Financial Incentive
Pressure From Economy
RTW Facilitator
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Reality We Are Face With

• ? Older Worker
• ? ?Productivity
• ? ?workers
• ? long hours
• ? under Stress
• AN INCREASE IN INJURIES AND CLAIMS

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Your Challenges

• Harder and harder to bring people back to work
• Less jobs available
• Companies have the attitude- better to be off
  than injured
• Companies need to be educated

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Your Challenges

• Companies dont
• understand the true
• costs of someone being
• off work
• Direct costs
• Indirect costs
• Now more than ever you need to be
• CREATIVE!

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Financial Implications

• Musculoskeletal disorders (MSDs) are the most
  costly for Ontarios employers- 1 reason for
  lost time claims reported to WSIB
• 1996- 2004 employers paid more than 12 billion in
  direct and indirect costs related to MSDs
• 27 million lost time days and a cost of more than
  3.3 Billion
• (WSIB financial report, WSIB, 2005)

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Direct and Indirect Costs

• Administering the claim
• Arranging RTW
• Finding and training replacement workers
• Lost productivity
• Overtime
• Legal Costs
• Equipment modification

4-10 times the Claims costs
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Additional Costs

• Human costs
• Effect on employee
• Effect on family
• Effect on friends
• Communities

Priceless
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Making a Difference
Injuries
Frequency
Duration
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Why Early and Safe Return to Work

• Timing is everything with respect to injuries
• If you get the timing wrong, it can increase the
  risk of injury becoming chronic and increase the
  duration
• Avoid the sick role behaviour
• We need to understand injuries, before we can
  look at ESRTW

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3 Stages of Low Back Pain

• Acute Stage up to 4 weeks after onset of
  symptoms
• Sub-Acute Stage from 4-12 weeks
• Chronic Stage greater than 12 weeks
• Vast majority will heal in acute phase
• Studies show that 10 will move on to chronic
  stage, and this is the stage that are most costly
  to you as an organization.

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Right after the Injury

• Encouragement for employees to continue their
  usual activities as much as possible is key in
  the acute stage
• Several studies show increased utilization of
  modified work can reduce the incidence by 50 and
  the duration by 40

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One to Three Months after the Injury

• Treatment should be more aggressive in this stage
• Intensive physiotherapy, supervised exercise
  prescription, and ergonomic intervention to
  prevent long term disability and promote timely
  return to work
• Studies show intensive intervention can reduce
  subsequent lost time by 50

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Chronic Stage

• More psychosocial issues in this stage, and
  therefore much harder to RTW
• Studies show co-ordinated multidisciplinary
  treatment that includes modified work or
  ergonomics gets more of these workers back to work

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Tools to Assist Employers
Employers Tool kit

• Physical Demands Analysis
• Ergonomic Intervention
• Functional Abilities Evaluations
• Doctor to Doctor Consults
• Independent Medical Evaluations
• All tools necessary for employers to utilize in
  the ESRTW process

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Physical Demands Analysis

• An objective measurement which defines the
  physical, environment, and cognitive demands of a
  specific job. However, it does not consider an
  employees functional limitations in performing
  the job demands.

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Why to use this assessment

• To objectively document the job requirements
• For treatment intervention so rehabilitation
  professionals understand the job requirements
• This is the key assessment for any return to work
  program, as you need to know the job requirements

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Ergonomic Analysis

• A comprehensive assessment of job requirements
  that may be contributing to injury/illness.
  Designed to minimize the risk associated with
  work activities, as it takes into consideration
  the employee performing the job
• Important to ensure successful RTW program

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Why to use this assessment

• To determine if there are any environmental or
  design issues that may be aggravating or
  prevention an individual from returning to work
• Important to use when risk factors are identified
  to reduce or eliminate the chance for injury

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Functional Abilities Evaluations

• A measurement of the employees functional
  capabilities. Identifies functional limitations
  or barriers that may impede the employee
  performing work duties
• Critical to match the employees abilities with
  the PDA to determine a job match

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Why to use this assessment

• To clarify an employees functional abilities
• Used before bringing an employee back to work, or
  in conjunction modified duties
• Used in conjunction with Independent Medicals

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Doctor to Doctor Consults

• Description
•      A specialized service designed to improve
  and clarify communication between health care
  practitioners, the employer and the employee.
•      Process is transparent, with the employees
  written consent and a formal report forwarded to
  the employers attention. 
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• When to Utilize Assessment/Service
•      When family physician does not indicate a
  reasonable return to work schedule and/or
  restrictions
•      The employees physician or specialist will
  not communicate any restrictions and/or return to
  work plan.
•      The employees specialists opinion differs
  from an independent medical evaluators opinion
  and a consensus is required.
•      Discussion with the family physician is
  required for details regarding an employees
  medical condition and/or medical history.
•  
•  

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Independent Medical Assessments

• An evaluation to obtain an independent opinion
  regarding an employees medical state. Provides
  a baseline or foundation from which to determine
  outcomes and implement further intervention if
  required
• Can be used in conjunction with an FAE if the
  injuries are physical in nature

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Why to use this assessment

• To assist if an employee has not returned to
  work. Soft tissues injuries take 12-16 weeks for
  resolution, any longer may require evaluation.

• Insufficient medical/functional information
• Objective signs do not match symptoms
• Lack of consensus between doctors for evidence
  based treatment
• Lack of clarity on an employees abilities and
  restrictions in relation to their essential job
  duties
• Frequent changes in doctors, new doctor notes and
  changes in treatment (doctor shopping)
• Claimant not actively participating in program or
  attending doctors appointments
• Third party representation

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Red Flags-Things to Consider

• Medical information states totally disabled
• Worker believes pain equals serious damage
• Delays in expected Return to Work (RTW) date
• High rates of absenteeism
• Employment changes expected
• Slow recovery outside of normal
• Multiple extensions on dates of RTW
• No progress being made

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How to Build an Effective Return to Work Plan

• Match employee capabilities to job demands
• Focus on abilities not disability, develop a
  clear plan
• document
• set goals
• timelines
• progressive
• If modified work is required ensure it is
  transitional in nature- always set timeframes
• Monitor the success of the program and return to
  regular duties
• Ongoing process - requires follow up

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Being Creative

• Think outside the box!
• Sit/Stand stools
• Assistance with another person doing heavy
• aspects of job
• Job aids- insoles, braces, etc.
• Can the employee ice/heat/stretch

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Break Out Session
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Problem Solving

• Examine Case Study 1
• Are there any RED FLAGS, if so list them
• What are the 3 key barriers
• What would you do to resolve these barriers
• Is there a tool that you could have used to
  expedite ESRTW
• What could have been done to decrease the time
  off work
• List the positives and negatives

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Problem Solving

• Examine Case Study 2
• Are there any RED FLAGS, if so list them
• What are the 3 key barriers
• What would you do to resolve these barriers
• Is there a tool that you could have used to
  expedite ESRTW
• What could have been done to decrease the time
  off work
• List the positives and negatives

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Your Questions

• Answers

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