Dr Graeme Edwards, presents 'ON - Health benefits of 'good' work'. Learn more about:
- the concept of the health benefits of work
- the meaning of 'good' work
- the implications of any work vs good work on return to work outcomes
- the positive outcomes that can be achieved by returning to work.
Dr Graeme Edwards is a Fellow of the Educational Supervisor of Trainees. He is a former Chair of the Faculty Policy and Advocacy Committee, with the Australasian Faculty of Occupational and Environmental Medicine in The Royal Australasian College of Physicians. He balances the industrial and medicolegal side of his practice with his general practice.
Dr Edwards has a unique combination of medical, business and communication skills. Dr Edwards' commercial expertise is derived from extensive experience consulting and presenting to business in strategic planning, business planning and human resource management.
Watch the webinar to gain insight into what good work means during the return to work process.
Download a copy of this film (ZIP/MP 8MB)
The Health Benefits of Good Work – the importance of 'good'
Office of Industrial Relations
Dr Graeme Edwards
Consulting Physician, Occupational and Environmental Medicine
Welcome to today's session on The Health Benefits of Good Work – the importance of 'good'. The topic and expert speaker is brought to you by the Office of Industrial Relations. We are committed to driving initiatives across the whole scheme that improves safety, wellbeing and return to work outcomes for both employers and workers.
My name is Amanda Krebs. I am the Education and Engagement Coordinator and I will be your Facilitator for today. Our session will focus on understanding what 'good work' means in the return to work process. We do anticipate that the session will go for approximately 45 minutes and we will send all participants a copy of the presentation slides following the session.
The recording of the webinar will be made available on the WorkSafe website soon after.
So now on to our presenter. I have the pleasure of introducing Dr Graeme Edwards who is a Consulting Physician in Occupational and Environmental Medicine and General Medical Assessment Tribunal Member. His insights are derived from extensive experience consulting and presenting to business in strategic planning, business planning and human resource management.
Please ask any questions during the presentation and we'll do our best to answer them. If you have any questions that you wish to ask at the end we'll also answer them as well and I'll now hand over to Dr Edwards who'll be able to share his wealth of knowledge on this topic. Thank you Dr Edwards.
Dr Graeme Edwards:
Thank you Amanda. To outline what we'll cover I'll start with some background to today's presentation with reference to the major health issues facing our community today, obesity and mental health and then relate those to injured workers and those with the responsibility to assist workers get better.
The benefits of gainful occupation have been long recognised. It's the fundamental basis of occupational therapy, but what we have observed are people not making the connection between gainful occupational activity and work. So we'll cover some of the latest research and what it means for improving the recovery of our injured workers, but first a disclaimer. The opinions expressed in this presentation are mine.
While I am still involved in the work of the Faculty and the College and was the lead author of the Good Work Position paper, today I'm not officially representing the College or the Faculty. So let's get back to the subject matter.
If you survey the popular press and general media you may easily develop the impression that mean nasty employers set out to deliberately injure, kill or maim their workers. That's not my experience.
Most accidents are not intentional. Employers are simply doing the best job they can under the circumstances they find themselves, however in Queensland each year there are around 90,000 workers' compensation claims, 90 work-related fatalities, over 25,000 serious injuries and diseases requiring more than seven days off work, all of which are estimated to cost the Queensland economy $12.3 billion annually.
Fortunately we are doing some things right. I think the promotion of the health of benefits of work since 2011 and programs like the Zero Harm at Work Leadership Program have made a difference. Workers' compensation claim lodgements peaked in 2011-12 at over 105,000 claims. But in the 2014-15 financial year the number of claims are down to 88,000. I don't think it's simply reflects the legislative changes that occurred in 2013.
This next slide the numbers speak for themselves. It looks at the likelihood of return to work following a physical injury. The Faculty published these in 2011 and they were based on research published in 2002 by Johnson & Fry from the Melbourne Institute of Applied Economic and Social Research work done for the Victorian WorkCover Authority. They were specific for males and the nature of workers in this study but they were appropriate to foster discussion as part of our position statement.
The evidence published since then means that the specific numbers are not absolutely accurate. Technically these numbers do not directly apply across the wider spectrum of workers in Australia and New Zealand. However the collective evidence since then has affirmed both the order of magnitude and the trend. So consequently as indicative numbers they remain applicable today even though they were based upon research data collected over 15 years ago.
What Casimirri and colleagues found in 2014 was that workers with two or more chronic illnesses such as hypertension, diabetes and heart disease were absent from work for over twice as long as workers with a similar injury or illness which triggered that absence.
Dong and colleagues observed that workers who smoke have a 38 per cent higher risk of a work-related injury than those who never smoked and Van Nuys reported obese and overweight individuals carried a 13 per cent higher risk of injury and are likely to be off work for twice as long compared to workers of healthy weight. For those interested in the references I've included them in the slide at the end of the presentation.
The latest edition of Doctor Q, that's the Australian Medical Association of Queensland Branch Magazine for Doctors published only two weeks ago highlights the crisis we are currently experiencing in Queensland concerning obesity. More than 65 per cent of adults and 25 per cent of children are overweight or obese. I have to admit I'm in the overweight category. Remember these are our workers of today and tomorrow. This article also reminds me of a slide presented by Dame Carol Black when she launched our Position Statement in 2011.
For those who don't know Dame Carol is a Rheumatologist and a Champion of the health benefits of work in the United Kingdom. She found these references. Back in 2003 The Economist published the Futuristic Opinion piece concerning The Shape of Things to Come and unfortunately, we seem to be well down that path. The Independent published this commentary in 2010…
…and today there is a general discussion about raising the age at which we might access the aged pension in Australia, the artificial retirement age. So in 2016 the way things appear to be trending, three quarters of us might be too ill to work that long.
So in 2010 the Faculty under the leadership of Dr Mary Wyatt brought together the research concerning the health benefits of work in a position statement. This was followed by a consensus statement recognising the benefits to workers, business and the community to which we invited signatories. Presently there are over 300 organisations in Australia and New Zealand that have signed up propagating the concepts within the spheres of influence.
We've also facilitated the development of a signatory steering group who facilitate the cross pollination of ideas and strategies within the signatory group to propagate action not just words. But the reality is not all work is good and we found some businesses and various political activists needed to better understand the beneficial relationship if they were to invest in the concepts. For too long investment in health and safety initiatives have been perceived as inconvenient red tape costs or impositions on business to satisfy feel-good regulatory requirements.
The premise behind our work is simple – if we could better define what is good work and the economic reasons for it, then by fostering the creation of more good work we will displace the prevalence of the not so good work simply because it makes economic sense to do so.
Consequently in 2013 we published two companion statements – What is Good Work? and Improving Workforce Health and Workplace Productivity.
From my experience, there are four types of businesses:
- Those who get it. They're the leaders of our society, and the signatories to the consensus statement.
- There's a larger group of businesses who are aware of the principles, pay lip service to it but don't quite get it.
- Then there are the majority of businesses who are at present blissfully unaware and naive to the fact that there are better ways of doing things. They work within the scotoma of being busy, keeping their businesses going.
- Finally and unfortunately, there are some businesses who simply do the wrong thing. So to state the obvious there will always be a need for audits, inspectors and enforcement to address those people who deliberately do the wrong thing and to positively influence those people in businesses who simply don't know there is a better way.
So what is good work?
Simply put good work is a safe, healthy, engaged and productive workforce that makes a positive contribution to the health and wellbeing of the worker and those affected by the worker. Much of the Australian and international research has focused on the factors that cause harm and for venting exposure to readily identifiable hazards. However in our increasingly complex world we are past the era when strategies to reduce further harm from direct exposure to physical, chemical or biological hazards is rewarded by material returns on how investment of time, energy, effort and dare I say, money. By imposing artificial safety standards with a perceived threat to the health of our society, the consequential business reengineering costs can destroy an otherwise safe and profitable business.
So we took a different approach by looking at the softer research concerning people engagement and the commercial benefit business literature. From that we found four domains that define good work.
Firstly, good work engages and where necessary partners with key stakeholders. At the individual level this mirrors the concepts of the customer-supplier interaction. Each of us as we go about our value of the task, rely on other people and systems to provide us with what we need to do our job. Then and when we do our thing someone else benefits. So not understanding our individual supply chain or particularly the supply chain of the injured worker can be detrimental to your and to your patient's wellbeing and productivity.
Good work also engages with the community culture that reflects the local, regional and operational contexts in which the work is performed. People simply feel better about their work when their business values are known to their local community and in this context engaging means being aware, respectful and participating in community affairs.
Good work also respects procedural justice and relational fairness. It promotes civility and is absolutely intolerant of incivility, discrimination and bullying. If you genuinely want to do something about bullying the evidence is clear. The focus needs to be on promoting civility. Why? Because incivility is the breeding ground for all the counter-productive workplace behaviours.
It's a form of interpersonal mistreatment, it's the rudeness, ambiguous comments and the breaches of workplace norms with respect or professional behaviour. It breeds contempt, subverts a legitimate authority, angers bystanders and sows the seeds for more serious behaviours to flourish. Incivility is also more likely in workgroups where the leader's leadership style is laissez-faire. Attitudes such as 'She'll be right mate' or 'It didn't do me any harm' foster incivility when the leadership tacitly condones these behaviours.
The fourth domain of good work is about balance. By design the people who have the authority decide how not simply what work is done, need to balance the demands on the worker. They need to consider the balance between the job demands, the individual sense of control, the available workplace supports and job security. From a rehabilitation perspective all stakeholders including doctors and rehab service providers need to understand these parameters when returning an injured worker to work. It requires thinking beyond the physicality of the job.
Inappropriate work constraints or delaying a return to work can propagate fear in the mind of the worker and frustration for both the worker and the employer. Likewise setting an inappropriate rehabilitation goal or prematurely returning the worker to the workplace can create complexity particularly when security of employment is an issue due to either an increasingly casualised workforce or an industry downturn or both. This can have a profoundly adverse effect on the worker.
Another implication of this domain is dropping the use of the detrimental concept of work/life balance. The very term suggests that work is something separate from life. We each spend the majority and for some it's the vast majority of our days engaged with work. The concept of work/life balance implies an impost of work on life, something to be tolerated, not embraced. Good work is about life balance not work/life balance.
When we look at different businesses however, clearly they are not all the same and what we observed was not all domains need to be prominent for the work to be good for the health and wellbeing of the individuals. Not all domains apply equally in all industry. Interestingly what we did see was that for many specific industries when identifying opportunities to enhance the prevalence of good work one or two domains predominate. Before I move on to the evidence update and the implications for your practice…
…here are some more scary statistics, this time for the WORC project. WORC stands for the Work Outcomes Research Cost Benefit and was led by a team at the University of Queensland Centre for Mental Health Research headed by Doctor Michael Hilton and Professor Harvey Whiteford. It surveyed over 60,000 workers and buried within the questionnaire was a set of questions that constituted what is called the 'Code 6'. This is a validated device to screen for diagnosable mental health conditions. Eighty per cent of responders who fall in the category of high distress have been shown to have a diagnosable psychiatric disorder. The work data suggests that the prevalence of a diagnosable mental health disorder was a bit less than one in 30 employees. Given we are talking about a survey of 60,000 workers, that's a very powerful statistic.
What these numbers also show is that only 20 per cent of these people are being treated and 30 per cent aren't aware they have a problem. But if you look at the same figures in another way they also suggest that one in 30 of our workers are describing symptoms consistent with a potentially diagnosable mental health disorder and it is not being treated simply because they don't recognise they have a problem which can be treated.
Dr Edwards we have just had a question come through. They're saying 'How can a company promote health and wellbeing while still encouraging individuals to be responsible for their own health? What can be done with employees who smoke and/or are obese and/or have multiple health issues?'
Dr Graeme Edwards:
For the individual it's about creating the opportunity for them to be responsible. It's not about taking over and controlling and directing. It's about creating that environment where they can actively participate. Now how to do that in a specific business varies depending upon the context but from a general principle it's a matter of having the conversations, confronting the issues that you are seeing and particularly in the mental health sphere it's about talking to them about what you are observing.
So one of the advantages of leading hands, line managers, co-workers is that you develop a sense of what is the normal for the individuals that you work with. So consequently when something is different, when their behaviour changes, their mistake rate goes up, their attendance pattern falls off, their diligence to the task requirements wanes. You will see it before anyone else will and by bringing that observation to the attention of the individual you're actually facilitating the individual to become more aware of what's going on in them. By doing so you also will pick up those injured workers who seem to be taking forever to get back to their normal tasks, that what was relatively a trivial injury event that has now escalated to be something bigger than Ben Hur, by having the conversations with them and creating that environment we're in a position to respect the responsibility of the individual and foster that individual to take control. I hope that answers the question.
Thank you Dr Edwards.
Dr Graeme Edwards:
Okay. So hot off the press the original research on which our position statements were based is ageing, like us all. Consequently just this month we published an evidence update. This is the evidence up to November 2015. Like all government procedures it takes time to get out there into the public domain. A link to this document is included in the references at the end of the presentation.
It's based on the traditional biopsychosocial model of health. Some people think that it's actually a new concept but it was actually around when I went through medical school just a few years ago and when I was in general practice. It continues to move away from the biomedical focus that is seen in institutionalised settings where the super speciality focuses on the disease or the injury. Like this Venn diagram I found at a Kids Matter mental health website and thought it appropriate to use in this presentation. It complements the colour schemes that have been adopted. The research update has in effect affirmed the principles previously illustrated by our series of position statements. It has also highlighted two areas of particular interest and relevance to today's presentation – mental health and the role of the general practitioner.
The effect of good work on mental health is reflected most clearly in the work of Coats and Lehki and they strengthened and reinforced our understanding of the significance of the workplace environment. Previously the evidence lacked a degree of power. Consequently the Coats and Lehki's research underpins our level of confidence when we assert that the work environment itself is a significant determinant of health and wellbeing.
The work of Butterworth and colleagues showed in a very elegant manner that the risk of poor work design can be as bad and may even be worse than the impact of unemployment. I looked at the adversities surveyed of low control, high demand, insecurity and low job esteem. Fortunately such poorly designed workplaces, at least from my experience, are likely to be a very small minority of businesses in Queensland but the reality is the true prevalence of such workplaces in Queensland is actually unknown. We just don't know how many poorly designed workplaces are out there.
This slide includes in the background a forest lot. It's created by a systematic review of prospector studies published by Van der Noordt and colleagues in 2014. I want you to focus on the two circled diamonds. Neither diamond crosses the vertical line. This is important as it means that there is good correlation between the studies and the range of confidence intervals across the various studies give great weight to the argument that employment is a significant factor for both improving the general mental health and reducing the risk of depression in our workers. What is means is that we need to look more constructively about how we assist workers with psychological injuries reengage with the workplace as soon as reasonably practical.
Cohen et al provided greater insights into our understanding of the limitations impacting upon the GPs and explored the nature of the doctor-patient relationship. Medical practitioners must accept at face value what their patients tell us. It is only when there is conflicting evidence or their beliefs are contrary to our knowledge that we can confront and address the belief patterns. It takes time which is difficult when the next patient is already waiting or the clinic is booked days in advance. We also need to respect that for most GPs work-related injuries form only a very small part of their practice. Various surveys across multiple jurisdictions indicate only 3-5 per cent of the typical GP caseload involves work-related injuries. So when you consider that the vast majority of injuries get better without any complexity or challenge it is easy to understand why most GPs will have limited experience in the area of complex case management.
Dr Edwards we've just had another question come through and you might be able to help us with this one. 'Are there any resources available to raise the issue of poorly designed work and to help explain the impact this may have on workers and business outcomes?'
Dr Graeme Edwards:
There are. There were some really good online resources developed in the UK that can help a business do an internal audit. Now if you remind me after today's presentation I will make sure you have that link.
Absolutely. Thanks Dr Edwards.
Dr Graeme Edwards:
In relation to the Australian marketplace there presently isn't anything that I'm aware of. That's not to say it doesn't exist. I just don't claim to be aware of everything. The specialty that actually can assist individual businesses on the consulting basis obviously is my own but I'll talk about that vested interest if we have time at the end.
Great. Thanks Dr Edwards.
Dr Graeme Edwards:
To help translate the concepts into action and on the advice of the Signatory Steering Group to the Australian Consensus Statement we developed a Charter of Principles for use by the signatories within their organisation. These are seven statements of principles that promote discussion and facilitate action by management and rehabilitation coordinators. The Charter can be displayed throughout the organisation and by using the power of the imprimatur of the Royal Australasian College of Physicians and its Australasian Faculty of Occupational Environmental Medicine it adds weight to the key messages adopted by management when they became a signatory to the health benefits of work consensus statement. It's an effective marketing tool to help engage with the workforce.
The first principle relates to staying connected with the workplace. When practical we encourage and accommodate people to remain connected while recovering from illness or injury. This facilitates significantly shorter recovery times and prevents unnecessary disability from prolonged disconnection with the workplace.
The next principle focuses on best practice rehabilitation.
Best practice promotes rehabilitation at work whenever possible, but remember it is not always practical and sometimes planning is necessary before it can happen. Integrated care is consistent with the biopsychosocial model of multidisciplinary care. It respects the diversity of health providers and stakeholders involved in any one injured worker's case. It minimises then the risk of treating the one condition without addressing the impost of other potentially non-compensable conditions and this is one of the key determinants of prolonged or ineffective rehabilitation. You're missing part of the picture if you only focus on the work-related injury.
The other aspect of integrated care is it manages the challenge of liability. Cost shifting relates to the tension between the public and private purse and there is significantly greater financial benefit if a disability is considered work-related. Consequently disputed liability by employers, insurers and lawyers create conflict and delay and this can significantly increase the risk of poorer outcomes.
The third principle relates to accommodating the needs of all people with medical conditions, not just work-related accidents or injuries. Consequently and where appropriate we encourage people with chronic illnesses and disabilities to be accommodated in the workplace with a supportive workplace culture.
The fourth principle relates to promoting awareness and understanding interpersonal relationships, particularly relating to mental and physical wellbeing. Talking about interpersonal relationships with respect to mental and physical health is far more emotional and powerful than in many other settings, be it in the sales process or a production workshop.
When delivered in a constructive manner it could be an ideal and disarming ticket of entry into the psyche of your workers. The strategic objective is to develop the understanding, skills and behaviours of workers with respect to effective interpersonal communication and relationships in all facets of their life. The situation created by an individual having difficulty could be with the consent of that individual, an ideal opportunity for the business to enhance its overall interpersonal workgroup performance.
The fifth, sixth and seventh principles overtly address the 'What's in it for me?' factor, the WIFM, the 'why we should bother?'. The fifth principle is directed at the personal and immediate business level of return. Simply good work promotes good health and increases productivity for that business.
The sixth principle extends the WIFM to the wider community associated with the business. We advocate for a safe and healthy work practice knowing that these have economic benefits for both the business and the wider community.
Finally restate the broader societal outcomes, the role of good work in supporting the individual's participation in our society.
While these latter principles may appear motherhood vested interest statements, there is evidence to support them and the evidence is compelling. For the individual, the business and our society, good work improves general health and wellbeing and reduces psychological distress. Thank you.
These are the references and links I mentioned earlier. However the session is not over yet. I'll hand you back to Amanda.
Thank you very much Dr Edwards. Dr Edwards has kindly provided us with a list of references that have been utilised for today's presentation and these will be included in the follow-up email sent out to you soon after the session today.
So if you have any specific questions on this topic for Dr Edwards please type them into the Q&A box now. While we see if anyone has a question I will let you know about our continuing series with Dr Edwards.
The registration for this webinar is now open so be sure to secure your spot early by visiting the 'What's on?' page on the WorkSafe website. Dr Edwards will discuss the topic 'Turning TI into Capacity'. This will be held on the 21st of April at midday and will cover What a medical certificate really says – insight into certifying capacity from a GP's perspective, strategies that rehabilitation and return to work coordinators can employ if their worker has capacity but is certified at total incapacity as well as strategies to influence and negotiate with a doctor about confirming the availability of suitable duties and the worker's capacity to recover at work. So be sure to keep an eye out in your email for other online opportunities and make sure that you register for them as well.
So I can see that we have a couple of questions online here. One of them is 'What is the best reference to look at to find out more about what good work is and how we can become a workplace that promotes good work?' Dr Edwards are you able to answer that one for us today?
Dr Graeme Edwards:
The reference slide and both the references listed for slides 9, 13 and 14 actually give you hot links directly to the references that you can download then from the faculty and college's website. Within those documents then it will take you in a variety of directions depending on your particular needs and interest.
Wonderful. Thank you very much Dr Edwards. We've also had a question come through about incivility and by the owners. Are you able to give some more examples at all?
Dr Graeme Edwards:
There's one organisation I'm working with at the moment where in brief, the CEO is a bully. So from the top, that particular individual's behaviour is percolating throughout the organisation and it's creating conflict, dysfunction, frustration, absenteeism and prolonged injury recoveries. It's a matter of how do we actually work with the board of management of that organisation as the entity that this individual is responsible to?
Now, the person got the job because of his historic performance. So there's this tension that we're having to deal with in terms of how do we get this individual to recognise their particular, dare I say character traits, right, so that then it can enable the organisation to thrive?
Whether or not the individual has the capacity to change their behaviour or whether the board will have to move that person on we're yet to see. But to come back to if you've got a supervisor or a manager that you're having to cope with, it's a matter of well how do you actually go outside the standard chain of command so that your grievance can be appropriately dealt with? That very much depends upon the structures and systems within the organisation that enables you to act. So without knowing the specific details of the circumstance it's harder to say more.
Wonderful. Thank you so much Dr Edwards.
So we've actually reached the end of our session for today. That's our 40 minutes up. So if your question wasn't answered today please email us and we'll endeavour to provide you a response. Again, thank you Dr Edwards for your time today and sharing your expert advice.
We look forward to welcoming you back next month for your continuing series with us and remember that your feedback is extremely important to us. So let us know how effective our initiatives are and be sure to take a couple of minutes and complete the survey and tell us what you think.
Thanks again for coming along today, Dr Edwards and everybody and we'll catch you next time.
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