Tailored care and support to meet individual needs

Tailored care and support to meet individual needs

Presented by: Tim Meadows, WorkCover Queensland and Ross Iles, Monash University

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Spencer Howsen: Tim Meadows from WorkCover Queensland and Dr. Ross Iles from Monash University, to the two of you, welcome to the podcast.

Ross Iles: Thanks Spencer Howsen.

Tim Meadows: Yeah, thanks very much.

Spencer Howsen: You guys have researched and designed and piloted this enhanced approach to supporting workers in their recovery and improving outcomes. Can you explain first of all what this new approach is?

Tim Meadows: Yeah, sure. So I guess by way of background at WorkCover, our approach to managing claims and helping injured workers hadn't really changed a great deal in the last sort of decade or so. While we achieved some really good outcomes as a result of that approach, we knew that we couldn't really rest on our laurels and we needed to continue to evolve. So we also knew that from speaking to injured workers and our customers that they wanted to be treated as an individual and rather than just another claim number in a caseload. So I guess with that background, we sort of partnered with Monash University in what we called our recovery blueprint project.

Tim Meadows: It was really designed to basically evolve our case management approach. And we really wanted to be able to partner with Monash from a research side of things to understand what the research tells us about risk identification and best practice claims management. Ultimately the idea was that we wanted to improve our claims management by being able to better identify those workers who might be at risk of a poor return to work outcome or a delayed return to work outcome and then understand and tailor a level of care and support for them that best suited their needs. Ultimately with the aim of getting better outcomes for both workers and employers.

Spencer Howsen: So Ross, you get you get the call from Tim as the researcher in Melbourne and then what do you do next? What happened next?

Ross Iles: An important part of what Monash has done is to effectively summarize what we know from the research in this area. But most importantly is to be able to tailor that to the WorkCover context. So we actually spent time with WorkCover, understanding how their case managers go about helping the injured workers, to make sure that we could apply what's known from the evidence into that context and actually make it a really close fit. And what we do know from the evidence is there's a lot of research in the early phase. Lots of things to say you should look out for, these sorts of things. They're the things that should send off the flashing lights, but there's not a lot of information about what happens when you actually respond to those things and how can you actually put that in practice?

Ross Iles: And so I guess the Monash role was to not only bring that evidence, but then also present it in a way that it could be integrated with what WorkCover does. So that would be about presenting different options of how we could do different things and working together as a partnership to find, "Well, what is the best fit, not only from what the research is telling us, but what can actually be done on the ground and what's going to get the best outcomes?"

Spencer Howsen: Can we just get a little bit deeper and below the surface, can you just maybe give some concrete examples?

Ross Iles: Sure. So one of the things that we looked at with WorkCover Queensland was really how their case managers provide their services to injured workers. And they were doing a fantastic job but they were all doing it in their own way. And what that meant was while they were providing great service, it looks different to different people. And so one of the opportunities was to actually bring some consistency in taking the best parts of each individual case managers approach to combining it into effectively everyone being a super case manager who was across every single aspect because we were taking the best parts of what each case manager would do. And the research can't tell you that. The research can’t tell you that this is how it works in practice for WorkCover Queensland.

Ross Iles: I think the other example is we identified two or three different ways we could actually try and put this risk identification in place—a couple of different models. And with WorkCover we actually had a session with external stakeholders, so health practitioners and occupational rehab providers, and we presented to them, "These are the different approaches that are possible and that would fit." So we were able to not only get WorkCover's input into what model is going to fit best, but also those other people who are going to be affected by the model, for them to actually have input into what's actually going to work.

Spencer Howsen: So Tim this is all about risk identification at the end of the day for you, is it?

Tim Meadows: That's right. So it's important. At WorkCover we're obviously trying to help injured workers and employers and we're always aiming to get a great outcome in terms of a return to work for that injured worker. But what we've learned is that not all workers need the same level of care and support and there are different risk factors that Ross has identified through his research that actually feed into... Perhaps not everyone's recovery journey takes the same pathway, is what we learned. So there are some workers who might not have any risk of a delayed return to work. And they're the types of workers who just want to get on with their recovery and will likely get back to work without too much of WorkCover's intervention. Whereas what the research tells us is that there are certain risk factors that have been proven to be linked to delayed return to work or poor outcomes.

Tim Meadows: And so we know a little bit about each worker at the time that we determine their claim and then we can apply those risk factors to their personal situation to understand and inform the level of care and support that they require. And so it's a bit more of a, as opposed to a one size fits all approach, it's about understanding the workers a bit more deeply to understand the level of care and support that they require and what we can do. We all know that early intervention in these sorts of things is crucial and you can make the biggest difference in the first 12 weeks. And so by having this information at hand within our system, we can identify those workers who are at risk right from the outset and really focus our efforts on helping them earlier with the ultimate goal of helping them get back to work sooner.

Spencer Howsen: So is this something that that organisations and employers can apply preventatively—what you've discovered here? Or is this only about return to work?

Tim Meadows: I think our primary focus here really is about risk factors for delayed return to work after injury as opposed to preventing injury as such. So it's more focused on the return to work side of things as opposed to the injury prevention side of things.

Ross Iles: And I think what we have done with this process, it is focused on what happens after the injury, but we are collecting information that might actually inform what could be done in a preventative manner. It might happen down the track, but it'll make it easier to identify, for example, the sorts of strategies that might help employers to be able to have a better response when an injury has happened. That information will empower I guess WorkCover Queensland to help employers better identify what those strategies could be going down the track.

Ross Iles: And then also which health providers are actually doing a fantastic job in that space and then be able to use information from them that they might be able to pass onto other health practitioners, for example. So there's potential for prevention later down the track. It's not really a focus now, but that possibility is there with the information that we're collecting.

Spencer Howsen: So this model that I have here in front of me, the assess risk across multiple domains as being step one. What is this? A seven step model that you've come up with, is it?

Ross Iles: Well, like I said with the research, there's not a lot of research that actually describes the impact of actually putting these approaches into practice. So what we wanted to do was draw what we can from the research to see, "Well what would, what would best practice look like?"

Ross Iles: We don't have a researched example or a research picture at to say what exactly that is, but we can pull from the different parts of the research as to what it should be. And that document, our best practice statement that was the very first output of our partnership, was to come up with a series of principles if you like, that we would follow with Recovery Blueprint. So gathering information from multiple domains. We know there are a lot of different factors that can impact return to work, and if you only focus on the injured worker themselves, you're not capturing the whole picture. And so that was one of the guiding principles is that we needed to use all of the information that we currently had available, but then also fill in the gaps of some useful information that we might not have or might not collect as part of usual practice to make sure we are giving the entire picture.

Ross Iles: And each of those principles, it guided the development of Recovery Blueprint. So we can safely say that our model ticks each one of those boxes.

Spencer Howsen: Can you take us through them?

Ross Iles: Certainly. So we've talked about gathering information from multiple domains. The next one talks about balancing the timing of information availability with the effectiveness of actions. We know that the longer someone is off work, the more difficult it is for them to get back to work. And we heard from Lorimer Moseley earlier today about when pain systems become very sensitive, they reduce the threshold of where you actually start to feel pain. It's actually a lot harder to provide effective treatments when those sort of things have set in. So one of the key principles is to actually time the gathering information. You could just wait. You could just wait to see who hasn't returned to work after six months and then you've got all the information you need, but actually your ability to have an effective intervention at that point it's actually really difficult.

Ross Iles: And the next principle talks about using different sources of information. We know that at the very start of the claim we've got lots of useful information. It's usually recorded on a claim form. It's usually about the person and their injury, perhaps where they worked, their occupation. But then when the case manager has a conversation with the employer or the treating doctor, they get lots more useful information. And so you need to actually use both sources of information to inform what your risk identification strategy is going to be. And then you actually need a system that can then provide clear information to the person who's got to do something about that information. And so you need a system that can actually tell, in this case the case manager, "Hey, this is what we should be doing next." And it's about gathering information early enough to be able to intervene when it counts.

Ross Iles: So like we said, we know that if we intervene somewhere between six and 12 weeks, that's when we tend to get the best bang for our buck if someone's having difficulty getting back to work. But we need the information early enough to be able to put in place what needs to happen in that timeframe to help that person get their best outcome. So you do need to collect information early on. The challenge is if you collect all that information on everybody using a lot of resources on perhaps some people who don't need that information. Like Tim said, some people don't need a huge amount of support. So there's a balance there in terms of timing. An important part, like we said about different people operating in different ways, you need to make sure you document what's happening in a systematic way, so you can monitor what's happening. And the benefit of that is someone else can pick up where someone's left off in terms of helping a worker in their recovery. If it's clear and consistent and the case manager knows what they're looking for and where, then it's a lot easier for them to pick up. And from the worker's point of view, then it's a seamless transition or they're getting the help that they need no matter who's picking up the phone and speaking to them.

Ross Iles: Best practice would actually combine what we've referred to as automated decision making, which really refers to data crunching if you like. Getting lots of different pieces of information to spit out a number or an indicator of whether someone's likely to need more support or less support. But you need to support that with a person who can actually speak to someone and actually hear their voice and hear the things that they're telling them and I guess pick up some of the hidden meanings in what they're being told.

Ross Iles: And you need to be able to combine those two sources together. So what we've referred to as automatic or automated decision making with judgment based, which is where a person actually goes, "Well this is what I think is happening."

Ross Iles: And the final principle, it's kind of a simple one, but it needs to fit with the system that's using it. So if you're using a certain computer system, you need that system to be able to work seamlessly with that process. It's no point using paper and pen if the majority of what you do is actually computer based. So you need to actually make sure that there's a clear connection and a fit with the different ways you're doing things.

Spencer Howsen: So has this all now been put in place? Or is this your future plan?

Tim Meadows: So we're in the process actually. So our approach with Recovery Blueprint has been a pilot approach. So we've undertaken a pilot with seven of our claims management teams and we've broken that pilot into three specific phases. And the purpose of breaking it into individual phases is so that we can individually analyse and assess the impact of each of those phases and understand what works well and perhaps what needs to be tweaked going forward. So no, to answer the question, we haven't rolled out the complete picture. We're in the process. We've just finished analysing the first part of that pilot, which we call pilot A. And that's really focused on applying those risk identification principles to workers at the time that we accept their claim to get a real clear understanding about the level of care and support they need.

Tim Meadows: Our analysis of that phase of the pilot was very positive. And so we are starting to roll that out across all of our business now. We're about to commence the evaluation of the second part of that pilot, which empowers our case managers with better tools to actually gather more of that information from people like the doctors and employers as Ross was talking about. It also allows them to be able to send things like validated questionnaires out to workers to understand perhaps how they're coping at home or psychologically how they're tracking as well in relation to their injury. So we're getting better quality and more consistent information as well. So that's the second phase and we're about to analyse that now. And the final stage of the process is around the ‘so what?’. So now that we know this about this person and we've gathered this information, what are the actions we can actually take or interventions we can do that will actually make a difference and improve their outcome.

Tim Meadows: So we haven't started analysing that particular phase. The seven pilot teams are still working through that at the moment. But yeah, so to answer the question, we're rolling out the first phase of this project at the moment.

Spencer Howsen: Do you anticipate that the outcomes will have an impact broadly on workplaces and organisations?

Tim Meadows: Well, that's what we're hoping. So one of the key goals of the project is to actually improve return to work rates and reduce claims durations and get those people who need that additional care and support the care that they need earlier in their claim. So that whole early intervention principle. So absolutely. Pending evaluation of the different stages of the pilot, they certainly are our goals in all of this to actually improve outcomes for both workers and employers who are both our customers.

Spencer Howsen: Are there things that workplaces need to do now or could do now to assist you with this?

Tim Meadows: I think the principles of working with WorkCover have always been the case in terms of open and clear and honest and transparent communication with us. Providing the information that will help us provide the best care to a person, supporting a person back to work as soon as they can. We know that good work is good for people so the sooner that they can do that the better. So really those concepts haven't exactly changed. So I would encourage employers to continue to have a return to work focus for all of their workers.

Spencer Howsen: Anything else that we should know at this point out of the research from either of you?

Ross Iles: I think, really, watch this space because like I said, in terms of the research, there isn't a lot to guide us in terms of what is the impact of putting in place some of these things. So the first phase, we're wrapping that up, but we've got those next phases coming. And so there's some really useful information, not only for individuals or employers, but also for other workers' compensation organisations or insurers around Australia to actually give them the information that this is what happened when we put this in place. And so watch this space. There's more to come.

Spencer Howsen: Right. Dr. Ross Iles. Thank you. Tim Meadows from WorkCover Queensland. Thank you both.

Ross Iles: Thank you.

Tim Meadows: Thank you.

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