Power to the employee and employer – what the research says

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Power to the employee and employer what the
research says

• Dr Mary Wyatt

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Workplace culture VWA data claims by industry
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Disability management

• Where have we been and where are we going?

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Introduction

• Return to work management in most companies has
  moved from a passive approach to early
  intervention and case management.
• Research suggests the next major improvement will
  come from empowering the employee and empowering
  management. Its positive and achievable, and
  people feel good when they do it. This talk
  presents the relevant research studies.

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Medical input to work disability

• Evidence that medicalisation of conditions may
  increase disability
• Little evidence for treatment reducing
  disability, eg for back pain
• Investigations and treatment may raise level of
  concern, and increase the likelihood of
  progression to a chronic problem
• Medicine is important, but not good at reducing
  work disability
• Ehrlich, G. E. (2003). "Back pain." Journal of
  Rheumatology - Supplement 67 26-31.
• Nordin, M., S. Welser, et al. (2002). "Self-care
  techniques for acute episodes of low back pain."
  Best Practice Research in Clinical Rheumatology
  16(1) 89-104.
• Tacci, J. A., B. S. Webster, et al. (1999).
  "Clinical practices in the management of
  new-onset, uncomplicated, low back workers'
  compensation disability claims.see comment."
  Journal of Occupational Environmental Medicine
  41(5) 397-404.

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What can be done?

• The employee

• The employer

• Positive messages about musculoskeletal
  conditions (sore body parts)
• Improving self-efficacy
• Problem solving

• Supervisor care
• Senior management leading
• HR RTW coordinating
• Systems in place
• Having all the players on side

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The employee

• Most people do fine without any intervention
• Most do better with positive support
• Problem solving and more positive beliefs improve
  outcomes
• A small proportion need a highly coordinated
  level of care from the employer, their treaters
  and claims managers

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90s workplace study

• Pamphlet given to staff at UK company
• Containing positive messages about the
  consequences of back pain
• Demonstrated reduced work absence secondary to
  back pain

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Victorian campaign

• Positive messages about what the person could do
  for themselves
• Dont take it lying down
• Famous sportsmen, actors, broad range of experts
  delivered message
• Improved outcomes in
• beliefs,
• doctors stated management
• back pain as percent of claims.

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More positive beliefsChange in mean (95 CI) BBQ
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Victoria
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Mean BBQ Score
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NSW
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1
2
3
Survey
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Less back claims as a percent of all
claims Change in number of claims, 1993-4 to
1999-0
P0.013
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Change in rate of days compensated, 10/97 to
10/99
Slope -1.2 days per 1000 claim-days per month
Slope -0.41 days per 1000 claim-days per month
P0.0003
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Problem solving

• People off work with back pain were placed into
  two groups
• Graded activity program with education
• Graded activity program with problem solving
• 5 steps for problem solving
• problem orientation
• problem definition and formulation
• generation of alternatives
• decision making
• implementation and evaluation.
• Secondary Prevention of Work-Related Disability
  in Nonspecific Low Back Pain Does
  Problem-Solving Therapy Help?
• A Randomized Clinical Trial

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Problem solving contd

• Problem solving focus was skills training
  application of skills in daily life, rather than
  one specific problem area.
• Patients were free to select their own problem
  areas, which did not need to be pain related.
• Between sessions, homework assignments were given
  to practice skills in everyday life.
• Homework assignments were discussed within the
  group at all sessions.

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Results of the interventionsWork status at 12
months

• GA Graded activity
• PST Problem solving training
• EDU Education

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Workplace based

• Good evidence that early work place based
  intervention makes a difference
• Involvement of all parties improves outcomes
• Australian model RTW coordinator
• Canadian model Disability management committee,
  like our OH S committee approach
• http//www.backpaineurope.org/

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Workplace interventions IWH systematic review

• Components that reduce the duration of work
  disability
• Early contact with worker
• Return to work offer
• Contact between healthcare provider and workplace
• ergonomic visits, participatory ergonomics
• Educating supervisors and managers
• Labour management cooperation
• People oriented culture
• Conditions of good will and mutual confidence
• http//www.iwh.on.ca/sr/wd_rtw_interventions.ph
  p

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Workplace based injury management

• Participants off work 2 to 6 weeks due to back
  pain were randomized to workplace intervention
• Workplace intervention consisted of workplace
  assessment, work modifications, and case
  management involving all stakeholders.
• Outcomes were lasting return to work, pain
  intensity and functional status, assessed at
  baseline, and at 12, 26, and 52 weeks after the
  start of time off work.
• RESULTS Time until return to work for workers
  with workplace intervention was 77 versus 104
  days (median) for workers without this
  intervention (P 0.02). Workplace intervention
  was effective on return to work (hazard ratio
  1.7 95 CI, 1.2-2.3 P 0.002).
• Anema, J. R., I. A. Steenstra, et al. (2007).
  "Multidisciplinary rehabilitation for subacute
  low back pain graded activity or workplace
  intervention or both? A randomized controlled
  trial." Spine 32(3) 291-8 discussion 299-300.

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Workplace intervention

• Dutch modification of Canadian system
• The workplace intervention consisted of a
  workplace assessment and work adjustments in
  which all major stakeholders in the
  return-to-work process participated
• the worker
• the employer
• the doctors involved
• Interesting to compare to our model

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Team collaboration

• Getting all the players onside
• Increasingly the focus of overseas studies and
  guidelines, including the European Back Pain
  Guidelines on prevention of back pain
• Canadian model has partnership approach at its
  core

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Team values

• Getting the players onside has been a focus of
  research over the last ten years
• "The values underlying team decision-making in
  work rehabilitation for musculoskeletal
  disorders.
• Loisel, P., M. Falardeau, et al. (2005). "The
  values underlying team decision-making in work
  rehabilitation for musculoskeletal disorders."
  Disability Rehabilitation 27(10) 561-9.

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Team approach

• Expectations
• Stakeholder endorsement of RTW
• The concept of a shared vision is raised
  regularly
• The team wanted a positive attitude and a high
  level of motivation from the worker
• The team expected actions that were perceived as
  helpful to return to work (e.g., authorizing the
  program, giving messages consistent with the
  teams philosophy, acting promptly).

• Focus and time commitment
• However, there was little time and focus invested
  in developing a shared and collaborative approach
• Little focus on what are the motivators for the
  worker, and an approach exploring those issues
• Little knowledge of how others in the team
  operate
• Minimal work to develop team as a team, and to
  increase likelihood of a common message

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Be nice
Butler, R. J., W. G. Johnson, et al. (2007). "It
pays to be nice employer-worker relationships
and the management of back pain claims." Journal
of Occupational Environmental Medicine 49(2)
214-25.
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Training of supervisors

• Study two
• 47 reduction in new claims and an 18 reduction
  in active lost-time claims
• Versus 27 and 7, respectively, in the control
  group.
• Shaw, W. S., M. M. Robertson, et al. (2006). "A
  controlled case study of supervisor training to
  optimize response to injury in the food
  processing industry." Work 26(2) 107-14.

• Study one - unpublished
• 1.4 absenteeism with
• RTW policy
• Case management
• Supervisor involvement
• 5.3 absenteeism without them
• Programs have saved 20 - 40 on benefit costs

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Senior management

• Michigan study of employer practices demonstrated
  senior management commitment had a strong
  influence on reduced work disability
• THE MICHIGAN DISABILITY PREVENTION STUDY RESEARCH
  HIGHLIGHTS
• Upjohn Institute Staff Working Paper 93-18
• H. ALLAN HUNT, W.E. Upjohn Institute for
  Employment Research
• ROCHELLE V. HABECK, Principal Investigator
  Michigan State University
• April 1993

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Identifying the areas for improvement

• Work disability management review
• Informal audit
• Injury Map
• Consensus Based Disability Management Audit

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Informal audit

• List of areas to assess, eg
• Procedures
• system of early injury reporting
• process for identifying return to work task
• Outcomes
• Days lost
• Costs
• And then plan how you will gather the information
  so you get important and relevant input

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CBDMA

• Rigorously developed and tested
• 2 million spent in development
• Comprehensive approach
• Involves employees and employers

• Varied instruments consensus based discussion,
  surveys, review cases, to assess the situation
• Clear report on the 16 relevant areas, with
  recommendations for action

www.nidmar.ca
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Uses

• An evaluation tool, to determine current
  disability management program performance
• A monitoring tool to show increases or decreases
  in effectiveness for each audit area
• A corrective tool, to establish deficiencies and
  highlight the next steps
• A program promotion tool demonstrating
  management's commitment to workplace disability
  management practices

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Benchmarking

• Originated in Canada
• Now used in a number of Canadian provinces,
  Germany, US, Australia, and New Zealand
• Ability to benchmark against other organisations,
  reports include comparative performance

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Supervisor training

• Research results based on needs assessment
• The teaching needs to be about how to do things,
  the actions that make a difference
• Teaching about completing forms, timelines, etc
  without the how has not been shown to be
  effective

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Return to work knowledge base website
Content
Access
www.rtwknowledge.org
RETURN TO WORK
Knowledge Base
When access is available, feedback is invited
while information continues to be refined and
improved upon
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Knowledge Base Project Committee Team

• Committee
• Mary Wyatt, ResWorks
• Janet Russell, Continuing Education Bendigo
• David Cragg, Australian Workers Union
• Robynne Dashwood, Eastern Health
• Andrea James, Medical Practitioner
• Tracey Browne, Australian Industry Group
• Paul Coburn, Physio, VWA
• Bianca von BlomBerg, TAC
• Chris Tsoukalas, QBE Insurance
• Michael Simpson, OccCorp Pty Ltd
• Coralie Hadingham, VWA
• Carol Lapeyre, The Rehab Factor

• Project Team
• Project Manager Robert Hughes
• Translation Team
• Leader Writer Mary Wyatt
• Administration
• / Marketing Cheryl Griffiths
• info_at_resworks.org.au

RETURN TO WORK
Knowledge Base
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Stakeholders
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Content Development

• Ideas

• Translation

• Committee
• Project Team
• Focus Groups
• International input and collaboration

• Identify research
• Multiple drafts
• Feedback
• Refinement

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Table of contents

• Research
• Medical factors and RTW
• Psychological factors and RTW
• Consequences of being off work
• Workplace factors and RTW
• People factors and RTW
• RTW approaches and intervention

• Resources
• Taking control series for Employees Employers
• Improving your effectiveness series for
  Practitioners Insurers
• Information on the processes / timelines involved
• Returning to work, effective return to work plans
• Medical and health information
• Links / Glossary of RTW terms