Keeping Disability Management Above The Corporate Radar

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Keeping Disability Management Above The Corporate
Radar A Canadian Story

• Nancy Gowan
• Gowan Health Consultants
• IFDM, October 10, 2006
• Brisbane, Australia

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Agenda

• 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

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What 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

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Levels of Disability Management
MICRO
MACRO
MEGA
Don Shrey, 1999
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Why 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

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The Corporation

• 1,900 employees in Canada including a plant
  location in Waterloo and 50 branch locations
  across Canada
• a leading global technology company

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Why 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

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Why Disability Mgt?

• Internal Factors
• Human Resources restructuring
• HR Business Unit focus
• Lack internal expertise
• Globalization of business

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• 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

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The 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

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DM

• 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

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DM

• 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

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DM

• 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

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DM

• 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

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DM

• 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

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DM

• 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

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DM 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

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DM

• 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

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Value 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

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DM 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)

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Leadership 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

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Time Passes

• Changes happen within the organization and with
  partners

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Recent 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

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More 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

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6 years later

• Trends were monitored
• Time to review

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Disability 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
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Cost of Absences per Employee
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Discussion

• What do you think is happening?
• How would you approach the challenges?
• What questions would you ask?

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The 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

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demographics
female
male
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Age vs claims by age
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Durations
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Number of Claims
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Top Causes Canada
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Top Causes Waterloo
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Cases between 0-5 days
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2003-2004 cases
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6 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?

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Focus 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

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What 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

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Managers 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

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What 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

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Employees 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

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Employees 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

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What 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

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HRCs 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

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What 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

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Scanning 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?

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What 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

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What does the research tell us?
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IWH 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

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The model that works
MD
Health providers
HR
Manager and employee
benefits
EAP
Case manager
insurers
Ergonomics
HS
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It takes a team to grow a program

• You can outsource
• responsibility
• You cannot outsource
• accountability and authority

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Recommendations

• 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

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• 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

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• 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

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Lessons 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

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Corporate radar

• Commitment
• Champion
• Communication
• Coordination
• Cultural change

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Nancy J. Gowan, BHSc(OT), OT Reg (Ont),
CDMP 29854 Talbot Line, Wallacetown, Ontario
Canada N0L 2M0 1-888-752-9954 Fax
[phone] www.gowanhealth.com gowanhealth_at_gowa
nhealth.com