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How wellness impacts safety - pain science

Safe Work Month and Mental Health Week 2020

Speaker: James Fletcher, Occupational physiotherapist and exercise physiologist.

This interactive session will explore how new ideas and findings in pain science and fatigue can help us to better understand accidents and how pain presents in the workplace. Understanding that pain is complex, and influenced by many factors other than tissue damage - such as communication, support and fatigue - will help you to deliver more effective wellness programs in your workplace.

Hello everyone and welcome to another presentation from Workplace Health and Safety Queensland. This time, it's all about how wellness impacts safety, the pain science presented by James Fletcher, a leading occupational physio therapist and exercise physiologist. I'm Chris Bombolas, media manager for the Office of Industrial Relations and I'll be your MC for today. Firstly, can I acknowledge the traditional custodians of the land on which we meet today and pay my respects to their elders past, present and emerging. I'd like to extend that respect to Aboriginal and Torres Strait Islander peoples watching today. Safe Work Month is held every October and is all about raising awareness of work health and safety. This year's Safe Work Month looks a little different thanks to COVID-19. This interactive session will explore how new ideas and findings in pain science and fatigue can help us to better understand accidents and how pain presents in the workplace. Understanding that pain is complex and influenced by many factors other than tissue damage such as communication, support and fatigue and will help you to deliver more effective wellness programs in your workplace. After traveling the world with Cirque de Solei for three years, managing the health of 200 athletes and Cirque employees and being exposed to how health systems are run throughout the world, James' passion is to reduce the impacts of injury and illness in the workplace. As director of Safe & Healthy, James develops innovative tools and programs to reduce injury and improve workplace wellness with the aim of reducing the burden of chronic disease and illness in the workplace. His return to work programs and employee wellness solutions have helped some of Australia's largest organizations such as Carlton United Breweries and Blue Scope Steel reduce injuries and improve the safety and health and wellbeing of their employees. Remember if you have a question for James, feel free to submit it via the chat box on your screen at any time as we have a Q&A session after his presentation. Without further ado, here's James Fletcher.

James: Thanks Chris.

Thanks James.

Welcome to the second week of Safe Work Month with a focus on worker health, safety and return to work. So my plan today is unlike Chris is to not mention the C word during my talk, I'm sure we're all sick of it in fact, I think I've got my hair gel down here somewhere, perhaps some hand sanitizer, but of course the C word has led to a huge impact on employee health, mental health and this has led to some current challenges that we'll unpack today. So how your employee health interacts with safety that's our session today and how those outcomes for your employees and organizations can be improved. Of course, at the end of this week, mental health week, mental health week kicks off so stay tuned for some more amazing presentations throughout the week. Today, I'm here to paint a picture and the evidence is clearly shining a lot on how employee wellness turns up in your workplace. Sometimes it's as musculoskeletal pain not an injury and there's a big difference there and it has been exposed recently at some of the sites that we work at, look at downsizing, preparing for down term in their production and in fact, they are busier than ever before with less staff. So we are seeing many low load repetition pain presentations not injuries in the workplace which at the end of this presentation we should all better understand together the difference between pain versus injury. So has your employee slept last night? How much physical exercise do they do? What do they put in their mouth? And who are the wellness leaders on your site? All of these stuff matters. And we'll briefly touch on the wellness pillars and examples of how we look actually I forgot to push one more button maybe I should push that. It's often how we look at the wellness pillars in today's society and we'll have a look at that as a whole and it's often overused this term wellness, you know, it's kind of like the word holistic as well. It's not really well defined and it's a little bit airy fairy so hopefully we can put a picture on that for everyone listening today. We also hope to shed some light and more importantly on how employee wellness builds forcefields, right? I mean, this probably doesn't mean much at the moment but hopefully at the end of this conversation it will. So we're gonna discuss some ideas on the normal pathways that you might use in your organization to manage pain and injury and are we going against this idea of employee wellness when we're managing pain and injury and an overwhelming amount of evidence shows us that pain is being experienced by your employees on-site and maybe it is just that, it's just pain it's not an injury that needs to be managed in this fee for service model that we'll discuss. So I'll discuss more of this towards the end of the, of my presentation today and something that's popped up and I'll try and use a lot of examples that we see on our sites across Australia. So recently we've seen a lot of increase in tennis elbow presentations on-site particularly in the manufacturing areas so, you know, what's going on there? Is it something around this more work with less employees with a more stressful environment with, you know, with the C word running around in our heads all the time, stress from home life, the kids are at home because they couldn't have been at school, less time with the family, less time to eat you know, all of these ideas are starting to build a pitch for us about pain presentation in the workplace. So we've got a lot to cover so quickly who am I, I'm a physiotherapist and an exercise physiologist. So I did travel around the world with Cirque de Solei, managing the health of staff in different countries, Japan, Russia, Belgium, Germany, USA, Canada and what was really exciting about that apart from having a fantastic time was that I got to experience how we manage different pain and injury in different countries. So that was really important because I got to see how different countries run their health systems and for me, that was really important. And right now I'm the director of Safe & Healthy, we do online and onsite corporate health and wellness and I also do breathing for performance. So I work with, you see the picture there, that's me with Cam McAvoy, so I work with some of Australia's highest level athletes looking at managing stress and improving their performance. So let's get stuck into it. So the wellness pillars, what we're looking at here, again, it's really ill defined the first one there is the workplace wellbeing and that's all aspects of working life. The physical environment, the quality of safety in place, how managers are talking to the staff and how much support your staff are feeling and like we discussed before, how much overtime are you getting your staff to do in this current environment? And did you know one of the leading reasons why a work cover claim can progress to a common law claim is because the employee feels their manager doesn't care about them. And this can be trained and clear pathways exists to avoid this happening so workplace wellbeing, an important pillar. The second one there is social so do you feel a sense of belonging and social inclusion at the workplace or at home? So does your organization put in place strategies for staff to form groups on-site and not do this by just joining the smoking group as we've seen at some of our sites. It's a really nice way for a new employee on-site to get into a social group is to take up smoking and that wasn't something that our sites wanted to take place so we addressed that for them. The physical wellbeing component, exercise, sleep, sunshine, drug taking, booze, all these things. So arguably the easiest way individuals can start their wellness journey and coupled with some organizational support, you can get some real bang for your buck and don't forget to celebrate success if you go down that pathway. Mental wellbeing, so what is your current mental health state? So mine at the moment, I'm a little edgy, I'm moving offices, moving house, launching a new online corporate health model, I manage and own two bars down on the Gold Coast through the challenging times that we're facing and supporting an elderly mother that has a chronic health condition so my team that I work with know what I'm going through and they do all they can to take some organized, some operational aspects of the business away from me so I can continue to be a valued member of our team and that's very important to Safe & Healthy. So how are you addressing that on-site at your organizations. And financial wellbeing. So we're starting to see some interesting data now at particularly the manufacturing sites that we work at. So they're giving their staff a lot more overtime to do which is taking care of that financial wellbeing, but at what cost? So now they can't exercise, they're not getting the sleep, they are not hanging out with their family and how does that impact that person's wellness? You know, some interesting ideas of being in a throw around and a lot of my discussion today we'll be pushing down those pathways. But we're gonna start off with a bang so everyone looking at that screen now 3,110 patients who've never had back pain. So if you're 50 and you've never had back pain ever, you're more likely to have a disc bulge on a scan than not. So let, just let that sink in for a little bit so if you're 50 years old and you've never had back pain, you're more likely to have a disc bulge on a scan than not have a disc bulge on a scan. And you can see the information there, if you're 50 and you go and get a scan, and you've never had back pain, 80% will have disc degeneration, never had back pain. So think about our current medical system and how most of the time a worker who develops back pain at work will go and get a scan. And what do you think happens to a worker's pain level and recovery when they've been shown by a doctor that they have a disc bulge, they've seen the picture on the scan, they've seen the nasty words in the report, they've seen a rotator cuff tear, they've seen degeneration in the scan do you think this is gonna make this person better? Do you think this is gonna help their rehabilitation journey? We'll hopefully answer that later. Actually, let's just answer it now. Here's a study, Lorimer Moseley, one of the professors of pain science looking at exactly how we respond to pain. So the study was hand down, put a cold spoon on the top of their hand and showed the person either a blue, blue light, or a red light. And it turns out if you show them a red light, they're gonna experience more pain than they showed in the blue light with this same stimulus. So where's the pain coming from? Well, how are we influencing pain? Well hopefully we can get to that. Another one, shoulder. 96% of people who have never had shoulder pain ever had shoulder pain, had evidence of a shoulder pathology on a scan. So where is the pain coming from? Are our current approaches to musculoskeletal pain in the workplace helping or hindering our employees get a better outcome? Is it allowing them to be the best version of themselves at home and in the workplace? So I wanna introduce this idea now of the employee forcefield, all right. I'm sick of managing injuries and pain in the workplace, I want our managers and I want our organizations to start thinking of everyone as having this forcefield surrounding them at all times, sometimes strong and sometimes no forcefield at all depending on what the person and what the organization is doing about it. So where is the pain coming from? Is it coming from the inside or is it coming from the outside? It's like this idea of resilience but a two way resilience. In the forcefield scenario, the employee can build resilience and they can also lose resilience or lose their forcefield by not having enough sleep, drinking too much and not looking after themselves. But also the organization is equally responsible to build the resilience and the forcefield of the staff on-site. Too much overtime, poor manager communications, shift work, challenging diversity issues, aging workforce and not addressing the wellness pillars at your site. Are you doing enough to build the forcefield of your staff? And in fact, employees with strong forcefields can take on flexible overtime. Sometimes at our sites that we work at production ramps up, production ramps down, can your resilient employees deal with that change in load through their body? A strong resilient employee can have a new baby at home and still manage a work life balance and handle a disagreement in the workplace and not lose their top in the process. We'll use that example of tennis elbow again. So the tennis elbow discussion employees are doing lots of overtime at the moment in some of our sites, are dealing with the kids at home and this has put a lot of stress on relationships so what are their forcefields looking like right now? And we are seeing a lot more tennis elbow presentations in sites and at doctor's offices around the country right now. So as organizations are we taking this on? Are we adapting to this idea of yes, production is a must but also our staff are taking on more than ever at the moment in these challenging situations. So let's have a look at the medical system and the ways that it might be boosting or reducing employees forcefields. So in this traditional system, it's a fee for service model, that means is when a person turns up to the doctor's office or the physio's office that they get paid when and only if that person turns up. So this encourages return visitors, it also encourages fear mongering, encourages rest and this idea of the scanning dilemma that we, that we popped up before. So is this the best we can do as a first world health service? Is put people into this fee for service outcome model? When we're starting to unpack this idea that pain does not come from pathology in most cases but it comes from your employees wellness and their forcefields. So our medical system's great, as I said, I've worked in Russia and I've seen what a health system can not do so well but it is set up as that fee for service model and just like you, medical health professionals love boxing their back pocket as well. And a scan in the right hands that shows damage is worth a lot of money to someone and it keeps a patient coming back and it keeps them from avoiding the challenging work that needs to be done and the conversations that need to be had in the workplace from being done and from being taken care of. So again, are we doing enough in our current medical system to employ and to build employees forcefields? Let's look at our discussion here around wellness. So the other issues that we can see on-site as well is poor communication strategies and that's really a highlight or poor outcome that we've seen from common law cases is my manager doesn't care about me. And there's some really easy strategies that managers can employ there to build employees' forcefields up. We're gonna unpack a little bit more about sleep and fatigue later in the presentation and what are people putting in their mouths now that we're asking them to do all this overtime and they might not get home in time to make a well balanced meal. So what are they doing on their way home and what are they grabbing? So in this fee for service model, what we currently see is just this revolving door and people really not getting the outcomes that they should be getting when we're addressing the issues at play not the pathology in the shoulder, not the disc bulge in the back but the employees' wellness and therein forcefield. Are we addressing the real issues? What this starts to throw up to many conversations in many, many organizations that we talk to is, is it's too complex, but we look at it a little differently and we say actually, there's more levers to your pain and your musculoskeletal pain presentation in the workplace than ever before. If you know which levers to pull, then you'll have better outcomes for your site and for your organization. Here is a interesting study, this is from Bond university, where they got patients to turn their neck until they felt neck pain and they recorded how far they could turn. And then what they did was they stuck a virtual reality system on that individual to trick their eyes to think they were turning less than they actually were. So purely by changing the visual stimulus in patients with neck pain were able to turn their head further than ever before. So again, where is pain coming from and what are we doing in our current approaches to musculoskeletal rehab in the organizations and in the medical system to enable us to have better outcomes. So when we look at sites in particular with our first discussions with organizations, we talk about the big three. So pain versus injury, we're all dealing with similar issues in organizations across the nation, diversity, aging populations and really lots of shoulder pain and lots of shoulder surgeries that don't need to take place and these strains from repetitive low loading situations. So if someone hasn't had an injury, if a forklift hasn't run over their foot, if a piece of steel hasn't fallen on their shoulder and we're dealing with a repetitive strain injury or repetitive strain presentation, we try to avoid this idea of talking about injuries and really talking about pain presentations in the workplace and that comes from your managers' and supervisors' communications. When we're looking at sleep and fatigue so if your fatigued workers are coming on-site, their risk for error increases 230%. And in production demands currently when we're asking more staff to do more overtime than ever before, and they've got to commute one and a half hours now back home, is an organization really doing all it can to reduce the risk of safety issues on-site. And not only that, but the acute and longterm health effects of employees suffering from lack of sleep. And mental wellness here so it's a big issue on a lot of our sites that we work with as well, it's a complex situation and I remember 10, 11 years ago, when we started rehabbing patients with injury, there was a real big challenge about managing injuries and what do we, what return to work plan do we do, what suitable duties can we give this person? And now we're starting that journey in the mental health space so it's hard to have a communication with someone on-site who is suffering from a mental wellness injury or mental wellness presentation. It's challenging to put suitable duties programs together for those individuals on-site but with the right education and understanding and approaches to having those conversations on-site I think we can have some really big wins with those big three. I hear this all the time particularly coming from doctors and also coming from employees who've had those conversations with other people on-site. Brian, he's stuffed his shoulder because he's worn out. He's been here for 20 years of course his shoulders is worn out, or, you know, Barry's knees are buggered because he's gone up and down those stairs all the time. And that's, that's BS like that doesn't happen we don't wear the body out like that. If we are going to wear the body out like that, then wouldn't our marathon runners have no knees left? And there's Cam McEvoy, 1.5 million times a year he puts his hand above his head and pulls an 80 kilogram load past his body. 1.5 million times a year. An average swimmer's career is 15 years so if we're gonna wear the body out, our swimmers are gonna be around there with no shoulders and our marathon runners are gonna have no legs left. So the body responds to load. It's not a piece of machinery. We can't wear the bearings out of the body in fact, if I was to punch Chris in the forehead for two years, he would develop a thicker forehead bone in response to the loading. So we grow in response to load and this idea that we wear things out, it's heading down the wrong pathway. So what can you do on-site? So, and everyone's different, that picture there shows me working with the circus so that's a Mongolian contortionist. So her normal is different to everyone else's normal that's something that we take into play when we talk to individuals or we talk to organizations as well. Everyone's on their own wellness journey. So first of all, as organizations, do you have a trusted provider network? So do you trust your GP? Has your GP come out to visit the site before? Have you been to visit your GP and taken them lunch? GPs love lunch, free lunches so just take a bunch of sushi and go and have a meeting with your GP and that'll create that trust for you on-site. Do you have trusted allied health in the vicinity? Do your managers know how to be softer in the workplace? So we always have this conversation about teaching the hardest workers in industry to be softer, you know, and sometimes they do have to swallow a little bit of pride to have those soft conversations on-site to enable that individual to recover, rehabilitate or take off some of that stress that they're dealing with. Injury management. So trying to avoid that fee for service model when you can. I worked, like I said, across many different countries around the world and what we're trying to achieve in the model that we present is a fee for outcome. So we want someone to get better no matter what it takes from us. And that happens in a number of countries and that was really the inspiration for myself to head down that different model pathway. You know, those GP consultations, they can be a challenging environment and we've been in many of those before and try to get the best for the individual and the organization in those consultations. From an organizational level, what does wellness look like in your site? Is it visible to the employees in their everyday work? Can you, is an employee who's walking around on the floor looking at their manager going well, that's a great example of what wellness looks on-site. How do you communicate wellness to your organizational staff? Is there newsletters? Are there posters up? Is there a Facebook social group? And what is the organization doing to train or build those wellness leaders up? So wellness needs to be visible. It needs to be felt on-site. And if you're starting out, my general idea is if you're starting out in this wellness space, be very broad and try and build some wellness leaders in your organization. Try and make the employees that are hardest to reach and working on-site when we offer wellness initiatives, it's usually the people that are really healthy taking out those wellness initiatives. It's usually the people that aren't engaged on-site that we really need to get to and we can only do that when we build like versions of themselves on-site. And if you're being specific in your wellness initiatives then be really targeted and I'm gonna show you an example of a sleep and fatigue model that we presented to an organization on-site. These are theories where we're at right now in terms of pain science and injury rehabilitation is a really interesting and unique fork in the road. This isn't just theories from what we see in everyday practice you can see there in terms of work cover claims when you put these things in place, things start to happen. It might not be straight away in a wellness journey we look at generally a three to five year pathway for a site but when you manage injuries and you build forcefields, you do get results on-site so it's not just theory that I'm talking about here, it's a different way to look at what we're currently doing. And just adding a few minor tweaks to maybe the way you manage injuries on-site might start to achieve these sorts of outcomes as well. Here's an example of a focus wellness strategy that we put together for a site, average sleep duration for this manufacturing site was 6.24 hours for an individual. Now we know that's low. Sleep quality, this idea of sleep health and what happens when we're asleep is really important. Sleep pathology exists in one third of the people sitting in your office or sitting at your manufacturing sites and that needs to be addressed. Obstructive sleep apnea or insomnia. 21% of those individuals that we took from this manufacturing site had moderate to severe obstructive sleep apnea so they can be in bed all day and it doesn't matter how long they sleep for, but their sleep health and what happens when they're asleep that will still present to site fatigue. They will still make errors at site and they will still have poor short term memory function in your site or in your office environment. What we saw when we put in place a wellness strategy for this site, not only addressing sleep health and taking that sleep pathology idea so, you know, putting those people who had serious sleep pathology in front of people who could deal with it, the third most important thing that we saw on-site was relationship stress. So how do I deal with a challenging conversation with my significant other right before I go to bed. And Soft Startups with some again, if you can Google it now, or YouTube it Soft Startups is a really fantastic tool to have those challenging discussions and not go to bed fuming and not go to bed like who said this idea of you not being able to fall asleep because you're still fuming about that concept, that conversation you had with your significant other. And that was the third biggest impact that we saw with our sleep and fatigue, our focus wellness strategy for a site. And here's a good example of a sleep health so this idea what happens when we fall asleep. So you'll see those yellow arrows on the screen so they're what we call them waking up so this is when an individual will be asleep and they won't wake up, they won't know that they're waking up but they've rolled over there what we call it is a disturbance. So this individual came to me and they were suffering from daytime fatigue and they were getting enough sleep but what they were doing was having cigarettes, two cigarettes before going to bed. Now, nicotine is a stimulant and the stimulant prevented this individual from going into a deep sleep for three hours 'cause it takes three hours for that to clear the system. So the reason why he was fatigued on-site was because of his cigarette intake before bed. So it's an interesting idea again, how wellness, how your employee wellness starts to interact with safety. So in this sleep and fatigue space when we are looking at the individual, educate them on sleep health, that exact topic smoking before bed is bad, right? You're gonna get less deep sleep if you smoke before bed. Turns out if you booze before bed as well, that's not so great. You might fall asleep quicker but you will get less deep sleep and you'll feel less rested and you'll wake up not only with a hangover, but you'll wake up with poor short term memory, poor emotional control and you won't have the best day on-site. A lot of our sites have a work out the shift work so how do you manage shift work particularly with rotating rosters is such a challenge on-site. You need to support pathology so if people do have insomnia or obstructive sleep apnea, then that needs to be addressed. And there's free pathways that exist in our current system that we can access and there's also private pathways that we've created for individuals to address that. And in terms of from the organizational aspect, looking at sleep and fatigue, how does your managers identify fatigue in the workplace and what are the controls they put in place to get this individual to the end of their shift safely? All right that's in a basic nutshell, sleep and fatigue with that really targeted approach. In terms of a broad wellness program, we start out with this idea of get back to life. So we wanna build wellness leaders on-site so that there is a shot of Mount Warning and we took individuals from a site, summited Mount Warning, we filmed the whole experience, they went to exercise physiology, they went to dieticians and then what we did was train them up about being a wellness leader on-site so they were visible to other people on-site. They were having the conversations with people on-site about diet, about exercise, about managing stress levels, not us so we feel like that broad wellness strategy and that broad approach is really about building your wellness leaders and visibility on-site. So as discussed developing your leaders on-site around wellness is really important. Not only so they can communicate not only so they can help their staff, but your staff can see what wellness looks like on-site. Develop some controls in your organization so that you can put someone back on the train, on the train tracks when they need to be. Does this person know how to have those good conversations with people on-site? And there's a structure around having good empathetic conversations with individuals. Return to work planning so having a clear strategy and a clear pathway for someone to follow is really important. Communication and a plan is probably our two biggest things that we introduce to a site when we are initiating someone with their wellness so with their injury and again, how to manage fatigue or how do your leaders manage fatigue in the workplace. In terms of wrapping up, it's a big topic that we've been discussing today and really that idea of the employee forcefield. So an individual has a responsibility an equal and opposite responsibility as I said to be on-site and do all the things necessary to complete their task on-site. So I always challenge this idea do employees take that responsibility and that's in the act as serious as a site does? If something happens on-site, a safety incident happens then there's an investigation, there's challenges, there's meetings about what happened on-site that's a real, they take that really seriously organizations across the nation but how serious do employees take that responsibility about turning up fit and ready to do their job? And remember, we did discuss that the employee has a role in building their forcefield up but also an organization has as a role to play in building an individual's forcefield up so they're resilient. And we, I don't really like that word resilient, but so they can take on a flexible overtime structure. They can take on the challenges of normal life in today's environment. They can have a newborn baby at home and not suffer from stress and related issues because they have a forcefield they're looking after themselves and they are the best version of themselves possible. If you're looking at wellness, developing leaders is really important and that broad strategy about what wellness looks like on-site, and what we do on-site is collect a lot of data so that we can use that information to go left or go right, look at preventative strategies, look at fatigue and like I said before, we acted in sleep fatigue for a site because they were having lots of slips, trips and falls. If you're gonna be narrow focused, be a results driven approach like we discussed earlier. If anyone wants to get in touch, please reach out. Today really was a broad discussion looking at some high level issues in the pain science and how it's dripping into rehabilitation. What hopefully people listening are looking at doing is implementing some of those pathways and I'm sure we're gonna have some questions in the question box discussing about how we act in this space and really, yeah if you wanna get in touch, then make sure you write a question in the question box now, Chris, and I'll be discussing that shortly so we'll be hanging around for a little while longer. So please get in touch. Please put a question in the chat box so we can address it now. Thank you everyone for listening.

Thanks, James. Yes, you have mentioned there's question time now, as we progress into our question and answer session, remember to go to the chat box if you've got a question, leave us your name of course and then your question, we'll try to get to as many of them as we can. As we set up for our Q&A session segment can I just ask you a quick one coming from what you said earlier, James, we, you discussed getting someone through a shift when they, when they are starting to fatigue, when they're starting to, you know, get tired, you know, and that's critical in some industries that they are alert all the way through their shift. Now there's a tendency these days to go for energy drinks, caffeine, a Kit-Kat, whatever, chocolate, something that gives them a boost that may get them through to the end of that shift. Is that artificial? Is that any use or is that just a common fallacy?

Thanks, Chris. Yeah, good question. Caffeine use is a strategy that we put in we put some of those controls in place for organizations and it's a strategy that works. It does relieve some of the density of the sleep pressure on anindividual, but it is an acute short term solution. If this person constantly needs caffeine every shift, then we have to look at the sleep health. So what's driving that fatigue? Is it not getting enough sleep? Is it is a sleep pathology? Is it a, you know, where they live? Sorry?

Could that be poor diet?

Poor diet. Absolutely. Yeah, poor diet, alcohol consumption, nicotine consumption, it's a big discussion but you know, we certainly use caffeine as a strategy but there's many other controls that individuals can have such as communication strategies, buddies, if you're tired on-site and you're doing a big job, maybe we buddy up with each other and my job's to keep you alert. One of the ones that our sites pulled on their 24/7 shift work site was the 3:00 a.m. quiz so five questions for five bucks so that was a good, we know around that time of night people are falling asleep so give them five bucks and the first person to answer the questions gets five bucks. Yeah.

Right, well you answered mine I get some from my boss 'cause he's in the audience if I want five bucks I'll buddy up with him, he's got plenty of money. Let's go to our questions now and there's a number of them and thank you for your questions. Remember, if you wanna get in touch, get onto the chat box and we'll get to as many as we can. Jody asks this of you, James, in your experience, what's the best way to start a wellness journey in a business where we're just starting out, we want some buy in, we really wanna give this a good crack. What do we need to do?

Great, Jody, thanks for the question. In my experience, the best way is to start broad. So developing a culture of wellness on-site and developing some wellness leaders on-site and what's lacking and this is from a lot of the DuPont reports is that we don't celebrate success and in our wellness and safety journeys, we don't achieve anything amazing so, you know, I brought up the example before of climbing Mount Warning. So we took a bunch of employees, put them through education and face to face consultation with health professionals looking at what they eat, how they sleep and how they exercise and then get them to achieve something amazing, document that journey and then share that around with the site so that everyone can see what wellness looks like on-site and who is the wellness leader on-site or who are the wellness leaders so that they can get to them for support. You know, I think I mentioned in my talk before is a lot of the people we need to reach in the wellness journey they're the really hard to reach so let's build up what wellness looks like on your site. So I would start broad and achieve something amazing.

Here's another question and I think this is Mary Lou. She's keen to hear how you make a fee for outcome work. It relies on the patient making the right changes to their lifestyle diet, et cetera, while you can influence, coach, guide and educate, how do you ensure that outcomes are achieved?

Yeah, it's becoming easier to ensure outcomes are achieved with our interconnectivity but it is a challenge like working in a fee for outcome model that's how the business I work in works so an organization will hire us to do a certain job no matter how many times that that individual comes back to see our services, we are paid the same amount. In a private setting fee for outcome is a challenge. We've seen it work really well in Japan and I saw it really work in Germany as well, but in some private clinics situations where they can control the environment a little bit more. So in the public sphere, a fee for outcome model might be a real challenge but in a private model where you're working with an organization, Chris, I feel like you can get a much, you can control things a lot better, provide some accountability on what people's jobs are and we're, we are really shifting in this health space to more of an active approach to rehabilitation and to health. Before we sat on the bed, we go to scan, the doctor told us what was wrong with our knee you know, we sat down with the allied health professional, they massaged our leg, these are very passive approaches to healthcare. What we're asking individuals now with the interconnectivity and with the data that we can get access is say, well, here's some things that you need to achieve, we want you to achieve them and we can track that you know, so tracking is really important but public space probably really challenging, but in a private organizational environment that fee for outcome model is easily.

All right. Amy's got one for you. She says, what are some of examples of wellness activities an organization can implement? So she like a couple of examples of those, of what they can set up. And do you have a good news story of a client or a business you've helped? You've turned them around by putting in place strategies and helping them through sift through what it can be quite often quite complex.

Yeah, so that, that the Mount Warning one was great. Actually a better one is quit smoking campaign. So we did this with some organizations in Sydney and we took a bunch of the same idea of celebrating success and achieving something amazing so we took 10 staff from two sites in Western Sydney, and my background is in breath coaching and I trained these individuals to hold their breath. So we built a human aquarium in Sydney Harbor and we sunk those individuals in front of the health minister and a live audience to show that when you quit smoking, you know, you can recover your lung function and you can achieve something amazing and they held their breath for three minutes. That was the longest we had someone in a live human aquarium in front of a live audience. So that and then again, that was an inspirational story, not only for that individual and their family members, but also other people on-site to show them that, you know, it's not too late to quit and you know, your road to journey is in the active part of rehabilitation.

And that is a key element for me that you've discussed it's not too late to quit. Like a lot of us use that as an excuse oh, well, I'm too old to go exercise or, you know, I've been a smoker for 40 years it's no good for me, you know, it's too late. But that's just a furphy isn't it?

Yeah, absolutely. It's, you know, you can, the best thing you can do for your lung health and your future health is to quit smoking, you know and we know it's a challenge I have personal story with my mum, she's a smoker, still a smoker and has a lung condition and so I am, that's why I do my breath coaching 'cause I feel like it's a really important aspect to me being, but yeah, it is never too late and it's a challenge for people, you know, it's not like flicking a switch.

All right, let's go to Nolean's question. She asked, how do you communicate with a doctor when in your opinion, they are reckless with prescribing pain medications. You've got a difference of opinion there with a doctor and the doctor is the specialist and you're, you know, the amateur in this situation.

Well, again with data and technology and with the C word coming in, people are more open to being, conferencing in telehealth situations. We've navigated with some of our clients that we will go with that individual in their phone. So the person walks into the doctor's office when they're about to walk into the office, they click a button so that a health professional is talking to another health professional. And when we're having that conversation, there is much less barriers put up and we can talk health you know, if the doctor's trying to do something, we're trying to get a different outcome we can have that conversation on health. It's such a challenge for managers and people when they are going to a doctor's office with an employee because they might be on the back foot, they're not health trained and the doctor is sitting there in their big chair and talking down to you saying, this is what is happening and this is the best for the employee when we probably know as discussed in my presentation, it might not be the best outcome for that individual. So how do you, you know, like I said, in the talk, have some, take some lunch to that doctor's office and have a better relationship with those doctors so that you might be able to get some outcomes that you're trying to achieve on-site. Get in touch with me about using that service of clicking the button for a doctor's appointment 'cause we'll go to the doctor's appointment for you other than that, choose your doctors wisely.

Second opinion.

Second opinion. Yeah.

All right let's move on to Samantha and Samantha has asked us, is there any recommendation on evidence physical based fatigue assessment?

Yup. There's two questionnaires that we use. So for the people at home ESS that's the Epworth sleep sleepiness scale. It's a bunch of questions that will give you an idea of how daytime fatigue is impacting someone on-site. The other one that I can recommend is the Energex Risk Calculator so if you put in how much the person slept yesterday, how much they slept last night and what time they woke up today, that'll give you as a manager or as an organization, a number or a risk level on what you need to do to manage that individual. But fatigue is so personal and it's different from each person so yeah, numbers are great, outcome numbers are great and scores are fantastic but really we want that individual to have a better conversation with their manager to say, you know, what can you do today? And the question we give managers on-site is how can I help you get to the end of the shift safely? What can I do to help your fatigue to stay, get to the end of the shift safely? And that might mean stopping them from driving heavy machinery, that might mean putting them on task where they have to walk a lot, where they're in the sunshine and they're outdoors or having a coffee break you know, that's a fantastic way to manage fatigue on-site.

Sure. Look, heaps of questions coming in. Remember if you've got a question it's not too late, James is here to answer them as many as we can get through. Just go to the chat box and put your name in there and your question and we'll get to it as soon as we can, as Amy has done. And you were talking about a forcefield in your presentation, James and Amy would like to know, can you give us examples of what things an organization can do to build up a person's forcefield. I wanna have a forcefield around me how can we build that up?

Yeah. At an organizational level I mean, I'll just bring up ones that are in my head currently just because we're addressing them on some of our sites. So looking at overtime hours, so I'll use an example of a test cricket player. So as a test cricket player, if I'm gonna get access to being selected for the test, I need to have bowled as a fast bowler X number of balls in the previous three months, even to be selected for that test. So what that's saying is that what work have I done in the previous three months to make myself ready for the current job that I'm about to go into? In the overtime situation, what we see all the time is a quick ramp up to production demand so this week we've had 75,000 orders and we normally we get 40 orders so this huge increase in demand and production and then the, what the organization does is just grab those individuals and increase their overtime hours straightaway. That increase in rapid change it'll load through the body or in the number of hours that someone's doing on-site is a risk factor for injury so and that will certainly shrink an employee's forcefields. So what can you do as an organization to build forcefield? So maybe spread that over time across, maybe have that discussion with your customer and to say, actually right now it's a two week wait, all right, on orders. You know, having those challenging conversations is difficult but managing that employee's forcefield should be the priority of the site if safety is your number one outcome. Providing leadership, support and communication so is your, are your managers skilled at having those softer conversations with employees? Can they pull someone aside and say, you know, are you okay? Or how can I help you at the moment? Or what do you need from me and from the site to manage your life at the moment because for so long, we've asked employees to take their work home and now we're starting to see home come to work.

Great advice. Nicole is watching us, she said thanks very much she really enjoyed the presentation but she would like to know why you don't like the word resilience.

I just feel like the word resilience puts all that, all that effort on the individual. So we're, I need to build my employee's resilience up, you know and it puts all of that responsibility on the employee. I feel like resilience is a two way street that the employee certainly has to build themselves up or build their forcefield up but it's an organizational's role as well to be part of that resilience and I feel that resilient, that word gets that employer's role gets lost in the word resilience. That makes sense?

Yeah. Yeah, yeah, no, I get it. It's sort of throwing the emphasis or the greater emphasis onto the individual rather than the organization.

James: It's a shared responsibility, yeah.

Okay. Yeah, Ellie, would like to know, do you have strategies for organizations that have remote and lone workers which is really relevant today especially, and how to achieve building forcefields in these work environments? That's another level, isn't it because you've got your normal everyday businesses and now you've got dealing with isolation, remoteness and you know, sometimes it's, you know, really desolate areas in that, for instance, in mining, which can also be very remote and isolated.

Certainly. I mean it depends on the organization and what type of, what type of work they do, but for transport workers as an example, you know, again, looking at hours that these guys are doing, guys and girls are doing on the road, what strategies do you have in place to include a social cohesion in that group you know, Facebook groups is a good example or what communication strategies does the organization have to their staff if they're remote, what in terms of the, the get back to life campaign that we run and put people up the top of mountains, how is the organization putting health in front of that individual? We saw, just recently revisited some of the Medicare data looking at allied health consultations and we are leading the charge in terms of video conferencing staff, particularly remote staff. So your staff, if they are remote, they can access quality health advice whether it's psychology, physio, dietetics at the click of a button now. So if you wanna build forcefields in individuals, the easy wins are in that physical space, you know, what are they eating? What are they exercising? And are they taking care of their mental health?

And would it be a good idea if particularly say mining camps and things like that, you bring in specialist people whether it be an exercise coach or, you know, a dietician every now and then, someone that can help them with their lifestyle in general.

Yeah, certainly. It's, I think right now access is not the issue you know, like we're starting to see that tele health space explode. It's really about why, you know, like, why should I care about my health? Why am I gonna talk to a dietician when I don't care, you know, really we wanna build that, that vision of wellness on the site so they can see what wellness looks like and then they're gonna reach out. You know, we've tried so many times pulling people up and that works, but really we wanna show them where the ladder is so they can climb themselves and really shift from that passive approach you know, listen to me, here's the massage, do this, to show here's what it looks like to be healthy and here are some steps that we'll help you with to achieve that goal. So that active approach to workplace rehabilitation.

All right, another question is coming from Sheree and she would like to know can you please tell us where we can learn more about your sleep and breathing techniques?

Yeah. So if you go to, I, in my previous roles, I was a sleep health coach so I tested 1500 individuals in a personalized sleep health testing scenario and worked out strategies on how they can better sleep whether it was get better sleep, sleep more or address their sleep pathology. And I really think it is the foundation of health. If you're not sleeping you're pushing stuff uphill, you know and we're really hard to get on top of your pain on top of your weight, cholesterol, all these other issues. So is a good resource. There's some blog articles there about sleep and breathing. You know, I work with olympic athletes, but I also work with industrial athletes so the guys on the floor as well, looking at how to put a package together to improve their sleep and breathing. So that should satisfy that.

This is a great question for Penny I've read this one, but I'll preface it by saying in the past we've used techniques like the grim ripper scare tactics, we've used the big stick, we've used or it's come down to a dramatic moment in life where you know, something happens, be it a death or a serious injury that makes us change but Penny would like to know how do you inspire rather than using those techniques someone who knows they really do need to drastically change their lifestyle to save themselves from distraction to take that first step, that first step towards wellbeing.

Yeah, 100% right you know, Penny, thanks for that question. You know, I've seen it as health professionals so many times when you try to get someone to change their habits or their lifestyle and then it takes, as you say, Chris, such a big, you know, a diagnosis or a close recent death of a family member from an issue or a chronic health condition for them to, you know, kick their body into gear. We don't wanna wait for that you know, because sometimes it's too late, but for me, it's a couple of things so one I've discussed about providing a vision and what that looks like on-site. So building people up around that person or that person themselves by achieving something amazing, climbing a mountain, holding their breath for three minutes, running a half marathon, doing the bridge to bridge, whatever it is, get them to achieve something amazing so they can see what it feels like or get someone close by to achieve something amazing so they can see what and feel what that looks like. Giving them the time also to achieve that because in current demands of lifestyle, it's really challenging to find the time to address your health and I always use this example about, you know, we tried to charge people seven bucks to go and see the GP a few years ago and the nation did a back flip, you know, we don't wanna pay for our health so that's where again, the organization can be part of that group and pay for services like what we offer to say, hey, well, here's the time, here are the services and we're gonna build some employees around you so that you can see, look and feel what it tastes like to be a more resilient well individual.

Oh, you're just gonna use that word? To build the resilience and the forcefield.

Damn I used it.

Yeah you used it this time. All right, look, a couple of questions to go. This one's from Adam and this is more on a practical side from your hands on, you know, medical work.


Do back braces work or is it in the mind game of repetitive work?

Yeah, it depends on what the back braces is for and in the situation that we're using it really, that's a hard question to answer, but in general back braces are sometimes really useful for an acute strain of a back that might help that person get to work and feel more comfortable doing their work earlier. If we can get that individual back on-site and doing something that's meaningful to them, then we're gonna get a better outcome for that individual. So if we use a back brace to do that, fantastic.

Again, all sorts of braces, you know, we've got elbows, shoulders, back, neck, not neck that's usually pretty.

No neck brace is there, yeah.

Pretty disastrous if you've got to wear that, but you know, do they, are they a valuable tool.

They're a tool but I feel like they get overused, you know, it's like, all right, well now I need this back brace forever and I'm gonna use, then that's the wrong approach, you know? Yeah. If you limit movement and you limit range of movement, then what you're opening yourself up for is less of a forcefield. If you say to someone don't bend your back, you know, and then that one time you have to bend your back, what's gonna happen you know so bending the back more and using the back and lifting things above your head and being a human being and doing lots of things is really important in your employee forcefield space.

One final question, we'd love to go on but time is of the essence. This is from Cass and she would like to know, would you be able to touch on the role of psychosomatic pain and having conversations about psychosocial risk factors?

Yeah. So thanks Cass for that question. It's challenging if you're not a health professional to have those psychosomatic conversations with an individual because sometimes it can come off, come off really wrong and certainly as a health professional, I've done that you know, where the person sitting next to me will go, well, not all the pain's not in my head and that's not what I'm saying at all. There's this really great example I brought up about Lorimer Moseley, he's a pain scientist and he's walking through the bush. He's you can see this on, on his Ted Talk and a snake bites him on his leg and he thinks it's a stick because he normally bush walks and that happens all the time. 10 minutes later, he was flat on his back, you know, brown snake bit him. The next time he goes out for a bush walk after recovering from that, a stick scratches his leg and he's fallen over in pain. So because of that experience of the snake bite, his body has reacted to that stick by saying, this is red hot poker this is so much pain you need to fall over because last time you nearly died. So this idea of psychosomatic pain, it's so broad if your dad's had a back pain before, then you're more likely to associate with back pain because you've seen and felt what that looks like. If your doctor shows you a scan of degenerative discs in your back, you're more likely to be in pain for longer because the doctor's shown you that scan. But hopefully today I've shown you that doesn't really matter. So what it's interesting Chris at the moment is we're starting to move away from this idea that pain we have to fix it, we have to touch it and we have to move, which is why that we can treat patients online now particularly as physios and health professionals because pain is so much more global, so many more levers to pain than what we thought in the past and we can address them in that online space.

All right, let's wrap up today's session. You've told us that pain may present in the workplace in a range of ways such as poor sleep, relationship, financial challenges and so on, not just physical pain, give us a couple of key take home messages just to wrap up.

So try and manage forcefields. So when you see that person shrugging their shoulder or you've heard stories about them having a newborn baby at home, have those conversations early. So try and support that individual through the challenging time they're having and not wait to manage pain and injuries. As a manager on-site and a supervisor on-site, I would encourage you to have supporting conversations so really putting that judgment aside and just listening to that individual and asking open ended questions. So things like, how can I help you? You know, tell me what's going on rather than these yes or no questions, where the employee can really shut down that conversation really early and as an organization across the nation, really looking at your employee wellness pillars and trying to touch base with a few of that whether that's workplace, physical, social, financial, really try and address where you are addressing those different pillars in your site because it will pay off in the long run and your employees will be more resilient. They'll have bigger forcefields on-site and they'll be able to deal with the challenges that are presenting in the workplace at the moment and also at home. So do all you can to touch base with employee forcefields.

Oh, you broke your own rules today you used the R word resilient and you used the C word COVID.

But here's a good resilience you've been under these lights for a few days, look at me that's not resilient to these lights right that's leaking.

You're under pressure look at that. Look, thanks very much to James Fletcher. It's been fascinating, some wonderful learnings and some great advice. Hope you can take them back to your workplace, home, wherever you might need to use those. And we have learned a lot today thanks for joining us.

James: Thanks to everyone.

There are still loads of free virtual events to enjoy during Safe Work Month, including a session on stress resilient leadership, intelligence enabled work, health and safety and a chat with ex-olympian Hayley Lewis. The good news, everyone, it's not too late to register. You can also access heaps of free resources from our work website, including industry and topic specific video case studies, podcasts, speaker recordings and webinars and films to help you improve your WHS and return to work outcomes. Thanks everyone for joining us here today and supporting Safe Work Month. Remember everyone work safe, home safe.