Title: Keeping Disability Management Above The Corporate Radar
1Keeping Disability Management Above The Corporate
Radar A Canadian Story
- Nancy Gowan
- Gowan Health Consultants
- IFDM, October 10, 2006
- Brisbane, Australia
2Agenda
- What is disability management (DM)?
- The keys in selling disability management
- What does senior management commitment look like?
- Implementing a program
- Keeping the program alive
- Summary
3What is disability management?
- Assisting employees with temporary or permanent
impairments and health problems to remain at work
or return to work - Emphasis is on the needs of the worker although
solutions must also work for the employer - Confidentiality and trust are essential if
employee is to provide an honest and open
perspective on any barriers to returning to work - Usually considered an employee benefitalthough
in some situations participation may be mandatory
4Levels of Disability Management
MICRO
MACRO
MEGA
Don Shrey, 1999
5Why do corporations care?
- Financial direct and indirect costs
- Recruitment and retention issues
- Productivity - global competition
- Legal issues
- Social issues health of employees
- Employer of choice
- Presenteeism
6The Corporation
- 1,900 employees in Canada including a plant
location in Waterloo and 50 branch locations
across Canada - a leading global technology company
7Why Disability Mgt in 1998?
- External Factors
- Government refocus of Health Care
- Hospital realignments
- Longer waiting lists for tests and specialists
- Employee health potentially at risk
- WSIB/WCB requirements
8Why Disability Mgt?
- Internal Factors
- Human Resources restructuring
- HR Business Unit focus
- Lack internal expertise
- Globalization of business
9- HR last to find out about illness or injury
- Challenges with new WSIB/WCB requirements
- No return to work program
- Reporting process cumbersome
- Too much internal paper work
- Employees were off with no contact
10The DM Program
- Introduced in 1999
- Involves the active participation of a Nurse Care
Manager, Employee Manager that facilitates a
return to work program - Provides case management services to employees
who are absent from work due to illness or injury - An early prevention/intervention program
improves associate health and ensures that
injured or ill associates return to a healthy and
productive life. - Fulfils Workers compensation requirements for
reporting -
11DM
- Improved employee Health and Wellness
- Third party involvement in Health adjudication
- Better access to quality service providers
- Meets WSIB/WCB legislative and reporting
requirements - Ensures employees have the best care possible
- Managed return to work programs
12DM
- Program Features
- Outsourced telephone based management process
- Regional Care Managers
- Care Manager site visits
- Policies updated to reflect new programs
- Ongoing Education Programs and PDAs/Ergonomic
analysis
13DM
- How it Works
- Employee responsibilities
- Call toll-free number on first or third day
- Discuss medical issues with Nurse Care Manager
- Sign authorization form for Doctor
- Actively participate in recovery
14DM
- How it Works
- Management responsibilities
- Remind employees about the DM process
- Keep contact with employees away from work
- Provide modified work and accommodate employees
return to work plans
15DM
- How it Works Occupational Injuries
- Day one employee notifies manager of injury,
gets first aid, calls toll free number to start
WSIB/WCB process - Care Manager assigned to case
- Contacts employees supervisor and employees
Doctor - Contacts WSIB/WCB
- Develops Care Management plan
- Follows to return to work
16DM
- How it Works Non occupational illness
- Day One Employee notifies manager of absence
- Day Two Employee notifies manager of absence
- Day Three Employee calls DM call centre
toll-free number, DM contacts employer and
assigns Care Manager - Contacts employee and employees doctor
- Develops Care Management plan
- Follows through to return to work
17DM Results in the first year
- Direct Savings
- At the time of the program launch, 3.4 days
absent per employee/year. After one year of the
program delivery approximately 2.9 days absent
per employee/year. - Dollars saved in first year was 94,200.00
- Indirect Savings
- Improved productivity, morale and administrative
costs - Faster return to work equals cost savings
- Excellent employee feedback through quarterly DM
Satisfaction Survey Results - Total dollars saved (Direct plus Indirect costs)
in first year was 364,850.00 - Better management and reporting of WSIB/WCB
claims - Improved working relationship with WSIB/WCB
-
18DM
- Our employees speak out
- Very professional, caring, impressed with
service - Helped beyond expectation, gave a lot of medical
information - First time user, comforting to know someone out
there cares about you
19Value Add Programs
- Facilitated Meetings.
- On-Site Flu Shots
- Wellness Credits Program
- Fitness Facility in Waterloo Location
- Wellness Week Programming
- Employee Assistance Programs
- Communication Materials on Health
20DM team
- Quarterly DM Steering Committee meets regularly
and involves those that have a vested interest in
DM philosophy - DM Program Manager
- Care Managers
- EAP representative
- Communications Consultant
- Ergonomics/Education Provider
- Employee Representative (internal)
- Human Resources (internal)
21Leadership Commitment
- Educate LT on DM results
- Cost Savings from program is re-invested into
other Health and Wellness Programs - Benefit Costs have remained at 14.5 of payroll
(which is BU paid) since 1999 - Benefit Costs will remain as it is as long as we
are given the ability to maintain such health and
wellness related programs
22Time Passes
- Changes happen within the organization and with
partners
23Recent Challenges
- Management Changes
- Resistance to accommodation programs has resulted
in Duty to Accommodate Sessions - Less management onsite more distance managers
- Demographic Shifts
- Call-Centre labour growth
- Employees are typically young and in a
moonlighting stage - HS training is limited due to lack of experience
- Aging Population
- Business Challenges
- New product lines result in ergonomic training
and education to address human engineering
factors - Demand of Service field is 24/7 availability
which is resulting in overtime among labour force
24More Challenges
- Provider changes
- Outsourced provider purchased
- Now case manager NOT Nurse care manager
- Less case managers per claim
- Removal of onsite visits
- HR
- Reduction in onsite HR staff
- Call centre approach to HR
- DM support
- Reduction in team meetings
- Cost reduction in communication materials
256 years later
- Trends were monitored
- Time to review
26Disability Absences 1998-2004
Canada 3.4 to 4.1 days per employee per
year Waterloo 4.9 to 6.5 days per employee per
year
27Cost of Absences per Employee
28Discussion
- What do you think is happening?
- How would you approach the challenges?
- What questions would you ask?
29The Review
- To examine disability data from the DM program to
determine trends and indicators - To gain input on the root causes of rising days
lost trends from within the company - To gain input on solutions from the DM
stakeholders - To make recommendations for improving DM program
and process
30demographics
female
male
31Age vs claims by age
32Durations
33Number of Claims
34Top Causes Canada
35Top Causes Waterloo
36Cases between 0-5 days
372003-2004 cases
386 YEARS LATER
- Trends of lost time now increasing
- Negative impression of the program
- Increasing WCB claims
- Cost of the program has doubled
- What is happening? What can we do to improve the
results? Should the program be eliminated?
39Focus Group Discussions
- Process
- Awareness of the program
- Attendance management issues
- Benefits levels
- Management training
- Mental health vs. physical issues
- Use of facilitated meetings
- Prevention and wellness issues
40What Managers Said
- Turnover limited knowledge of process
- Case manager turnover and inconsistency
- Return to work process delayed
- Communication delayed need more information on
return to work date/abilities - Difficult to accommodate modified light duties
- Permanent modified who is monitoring?
- Perception of employees sick day entitlement
- Need more objective information to accommodate
- CM has limited knowledge of jobs
- Feels like CM just gives stamp of approval for
absence? No denials
41Managers continued
- Case managers inconsistent keep changing no
notice of change - CM Only interested in RTW at end of STD period?
- Not clear on manager roles and responsibilities
- Where do virtual employees fit?
- Unaware of help for manager from EAP
- Mental health issues how to accommodate?
Prevention need more education of employee,
stretching programs, ergonomics, massage, work
life balance programs, - Mental health more expected with less
resources, - Overtime is the norm not the exception
42What Employees Said
- Lack of Communication of program
- Why ask me what to do? Doctor knows best
- Too frequent of calls from CM policing
- CM doesnt listen to doctor or specialist
- No communication with manager?
- Unsure of policy on sick time
- Distrust, concern about confidentiality and
objectivity - Forced to return to work too soon Medical delays
/rush to come back - Unrealistic return to work date
- Dont understand my job
- fear of health first termination
- Need manager support
43Employees continued
- Attendance
- Is it older or younger employees
- FEAR I need the job, working distressed, new
employees, maturity, workload, stress, burnout,
emotional issues, leaner, new processed , cutting
recognition, low morale, low management, line
stoppers/processes - Need to survey employees
44Employees continued
- Pressure to produce
- Not enough man power
- Less resources
- Service department overworked/stressed
- Aging workforce
- NEED to listen to employees issues
- Unaware of when to call first when hurt at work
- Mental health what is access to EAP?
- Loss of pride in job and loyalty to Company
45What Human Resources Said
- Communication of program needs to be improved
orientation, magnets, pamphlets - HRC is the middleman Lots of time for HRC
- Guidelines for providing medical documentation
needed - Less medical management nurse vs. case mgr?
- Need to separate attendance and health first
- Improve communication process to managers
- Are we getting proper return to work
recommendations from CM? - Is return to work delayed until close to LTD?
- Need training on roles and responsibilities
- Attendance management program needs to be
improved
46HRCs continued
- Mental health what is criteria for MH Claims?
Varied approach from CMs, MD notes are vague,
stigma, using vacation instead, need more
functional information, need a tie between EAP
and DM - Does benefit level effect time off???
- Attendance
- Inconsistent policies in each site
- New same policy throughout
- Management training and tracking required
- Needs to be enforced
47What the Care Manager Said
- Manager unaware of role
- Need for education regarding accommodation
- Need job descriptions updated
- Need education /sensitivity to mental health
- Concerns re Winnipeg call centre
- Need a facilitated process
- Compliance sometimes an issue
- Claims process ( 10 days no medical-no pay)
- Manager communication missing (60 no call back)
- Employee fears of loss of job
- Attendance management tied to DM
48Scanning the issues
- What happened?
- How can we improve the process?
- What are essential components?
- What metrics will be important in the future?
- Corporate Buy In ---Commitment?
49What we heard
- Negative perceptions
- No Manager involvement and face time
- Misuse of system to manage attendance
- Inconsistent use of system
- Misunderstanding of process
- Communication gaps (employee, manager, case
manager, health professional) - Roles and responsibilities? Who does what?
- Workload and overtime issues
- Case manager using a claims management process
not a return to work process
50What does the research tell us?
51IWH Return to Work Research, 2004
- Moderate evidence in the literature that
reduction in disability duration and costs
involves - Early contact with worker by workplace
- Work accommodation offer
- Contact between healthcare providers and
workplace - Ergonomic worksite visits
- Involvement of individual for RTW coordination
- Educating supervisors and managers
- Labour management cooperation
52The model that works
MD
Health providers
HR
Manager and employee
benefits
EAP
Case manager
insurers
Ergonomics
HS
53It takes a team to grow a program
- You can outsource
- responsibility
- You cannot outsource
- accountability and authority
54Recommendations
- Reconvene the DM committee
- Ensure the focus and goals of DM remain on the
health management and return to work process.
training of case managers - Convene a working group to investigate solutions
for casual absence management - Involvement of managers in absence and rtw
- Develop a communication strategy to relaunch DM
55- Improve the understanding and perception of the
DM program - Case manager visibility in the workplace
- Employee/manager education
- Begin monthly conference calls to address ongoing
DM cases and review process issues for all open
STD and LTD cases - Involve EAP expertise in mental health rtw issues
- Involve OT in complex accommodations
- Manager face time and training
- hiring of managers
- Workload measurement project
- Improved communication processes between CM and
Manager - Structured emails
- Job accommodation options
- Management of periodic absences r/t health
56- Develop a WCB information package for both
managers and employees to ensure legal compliance
with reporting of work related injuries and
illnesses - Determine current data reporting needs and
develop structures for provision of reports that
will be provided to - Benefits and Compensation /DM committee
- Human Resources Consultants
- Managers
- Health and Safety Managers for understanding
preventable issues
57Lessons Learned
- Disability management does not equal claims
management - Trust is paramount to program success
- Education of managers/employees and cultural
change strategies are key - Team must work together but manager and employee
relationship must be maintained - Overall management face time impacts success
- New job roles repetition/team
concept/productivity impacts return to work
options
58Corporate radar
- Commitment
- Champion
- Communication
- Coordination
- Cultural change
59Nancy J. Gowan, BHSc(OT), OT Reg (Ont),
CDMP 29854 Talbot Line, Wallacetown, Ontario
Canada N0L 2M0 1-888-752-9954 Fax
(519)762-0229 www.gowanhealth.com gowanhealth_at_gowa
nhealth.com