Presented by Dr Venerina Johnston, this webinar discusses how the workplace has an important role in the return to work process and outlines which workplace interventions have proven to be effective in assisting injured workers return to work.
Venerina has qualifications in physiotherapy, occupational health and safety and a post-graduate certificate in work disability prevention. She has a diverse background in occupational rehabilitation and injury management from the perspective of the insurer, provider and employer. Venerina is also a senior lecturer and researcher in the School of Health and Rehabilitation at The University of Queensland.
Watch the recording of the webinar, or download the presentation (PDF, 0.97 MB). This content is protected under copyright.
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Which workplace interventions really work?
Dr Venerina Johnston
Hello. Today the Workers' Compensation Regulator will deliver a very interesting webinar titled "Which workplace interventions really work?" My name is Rachel Hawkins and I will be your Facilitator for today. Our expert presenter is Venerina Johnston.
Before I introduce you to Venerina, we have some tips on making the most of your webinar experience.
Firstly, Venerina will present for approximately 50 minutes. Venerina is happy for you to ask any questions you have throughout the presentation. You can ask questions at any time using the Q&A box on the right hand side of your screen and we will collate and answer as many as we can throughout the presentation. Please forgive us if we don't get to your question.
I know Venerina's webinar today will provoke a lot of questions, so if we don't get time please email us and we will see what we can do to have them answered afterwards or develop a Frequently Asked Questions document that we can send out to you all as well.
Also, we want you to interact with us throughout the presentation. So as well as asking questions we'll also ask you some poll questions. Again a simple prompt will pop up on the right side of your screen and you will have a brief moment to respond.
Okay. I'll now invite Venerina to share her expertise on firstly measuring success of rehabilitation, evidence of workplace interventions and the principles for successful return to work. I know that Venerina is going to enthral you with her ability to translate the complicated world of research into some very simple and easy take home messages for you to apply in your role. So sit back and enjoy and take it away Venerina.
Dr Venerina Johnston:
I have got a cold at the moment so if you can't stand me sniffling please turn off the mic. So the first question we have for you just to get an idea of who's listening in is could you give us an idea of the role you have in the return to work process? So there is a few options there from 'case manager', 'claims officer' right through to 'other'. So could you please give us an idea of the role that you're working in at the moment. Thank you.
Okay. So while Rachel is collating that information we'll move onto the next slide.
Okay. So today I wanted to give you an overview of how we measure success in rehabilitation, give you an idea of the evidence for workplace interventions and try and put it into a format that is digestible for the layperson and go through some of the principles for successful return to work.
We know that work is a powerful determinant of health and we've heard that lots and lots lately. This is actually the conclusion of several reports published in Australia and overseas. So it's quite understandable that when an injury occurs many people become involved to ensure rehabilitation and return to work occurs as quickly and smoothly as possible.
The workplace is considered to have an important role in the return to work process but there are lots of interventions out there and other interventions that are considered to be better than others. So this talk will actually give you an idea of what interventions have been tested both in Australia and overseas.
If we go to our first topic – okay. So we've just got the poll results in. We've got 10 case managers, four claims officers, 85 rehab return to work coordinators, five supervisors/managers, eight HR, 11 injury management. So mostly rehab and return to work. Terrific. Okay. So hopefully you'll take something away from the talk today.
How do we measure success in the return to work arena? Well it really depends on who you ask. Everyone will have their own opinion of what success looks like. So for the injured worker it actually may be a reduction in pain. For their partner and family it might be a return to steady income. For the insurer there's several measures that they like to use like return to work rates, days absent and cost of claims. Employers consider things like lost time injury rates, days absent and of course cost. Researchers like myself and others around the place like to use measures that are meaningful to everyone – to the individual, the employer, insurer and society and often will use many of those measures to obtain a holistic view of the impact of the intervention.
Let's have a look at some of the measures that the regulators and insurers use. So this table here on the slide is an extract from the Queensland Regulator's Annual Statistics Report and you can actually view that report on the web link at the bottom of the slide. It nicely summarises some but not all of the many measures that insurers use and the insurers being in Queensland. It describes not only how many workers return to work but in what capacity. The left hand column describes the return to work capacity while the columns on the right include the number and percentage of time lost claims.
We can see that the majority of finalised time lost claims return to work to the same job and employer. These different descriptors of work status are referred to as the hierarchy of return to work. The first option is considered to be the best option and the ideal and if you go down the left hand column the last option of not fit for work is considered the least desirable outcome.
All workers' compensation regulators around Australia are encouraged to use these return to work outcomes so comparisons can be made across states and schemes. Interestingly some countries overseas as well will use similar descriptors. I'll put some more information on that slide. I try not to pack too much in but you can see at the bottom of the slides I've also listed the average number of days lost in 2013 and '14 and it was 47.8 days which really does sound like quite a lot. But if we think that the three quarters of the time lost claims have actually had 40 or less work days lost that means that there's a small number of longer term claims may have a big impact on the average number of days lost.
So if you want to compare these results with those in your own organisation just bear in mind that 47 days is the average and perhaps doesn't represent the majority of claims. Some more information on that slide is the average cost of a time lost claim and for 2014 it was 16 - or nearly 16,500 and they did range from 2,500 for a foreign body to 43,800 for a psychology injury. So we know that the most costly claims are psychological injuries and the most common are musculoskeletal. But return to work rates aren't the only metric used by regulators. Let's have a look at what else is being used out there.
While actual return to work is considered by insurers, regulators and employers as important, there is emerging evidence that as many as 30% of injured workers haven't fully recovered and may actually relapse after they've returned to work. I'm sure many of you know of cases where the worker has experienced an exacerbation of their injury once they return to work and in fact there's evidence from the USA that workers with musculoskeletal injuries of the upper extremity return to work at least once but their first return doesn't necessarily mark the end of work disability and there's up to 26% who report a second injury related absence. So that figure we can compare to people with back pain where 18% have reported a second injury related absence and people with fractures, up to 12% have reported a second injury related absence.
In Canada a group of researchers found that almost a third of workers with an episode of back pain experienced recurrent spells of work absenteeism during the following year and it's quite a well known pattern that musculoskeletal conditions like back pain will follow this recurrent pattern.
In Australia the regulators have recognised that this may be a problem here as well and have worked out one way of finding out how big the problem actually is. The way they've done this is through the return to work survey and there's a web link there to that survey at the bottom of that slide. Safe Work Australia's Group for Workers' Compensation have in the past two years commissioned a report called the Return to Work Survey and in that survey they conducted telephone interviews with 4,000 or over 4,000 workers who've had at least one day away from work and submitted a claim in the two years prior to the interview.
The measure that they used to determine whether return to work has been sustained is through this question on the slide. "So how long have you been back at work for since your last additional time off?" This measure they labelled as "stable return to work" and was defined as the proportion of workers who were working either part time or full time at the time of the survey and had been back at work for at least three consecutive months on a regular basis. So where in the previous slide 93% of workers had returned to the same job, same employer this slide in contrast indicates that in Queensland only 61% had stable return to work. So this is a significantly different measure to the previous one. Try and remember this definition of stable return to work because we come across it again later in the webinar.
Some of you might be thinking "Why is there such a difference between the first return to work and stable return to work?" It's natural to think that if a person has returned to work or is actually certified by the medical provider as fit for work, it's because they've fully recovered from their injury. However that's not always the case.
This question here "What is the main reason you returned to work?" was asked in the 2011 and '12 return to work survey but not in the most recent one. We can see from this table that only 35% of the workers said they'd returned to work because they'd fully recovered. If you look down the list at the reasons given for why they'd returned to work the majority were for reasons other than full recovery, so it's quite interesting to see that.
Just for your interest the most recent return to work survey, so for the 2013-14 period, workers were asked "Did you feel physically ready to return to work at the time that you did?" and only 70% of workers said "Yes" with 23% saying "No" and 6% saying "Maybe". So bear that in mind next time a worker has a certificate that has a clearance for a return to work.
As a researcher I'm very interested to learn more about what can be done to reduce the duration and cost of the claim and to reduce the risk of recurrence to achieve a speedy but durable return to work.
So because I am a researcher I thought I'd conduct some research with this captive audience and this is called "purposeful sampling" where the researcher selects participants based on their intimate knowledge of the subject matter. So if I was to ask you whose job is it to return and injured worker to work we have four options here – the injured worker, the return to work coordinator at the workplace, the treating medical practitioner or the insurer case manager. So have a think about which option you would select.
So do we have any responses yet Rachel?
Dr Venerina Johnston:
Okay. All right. Some of you probably have been thinking "I don't like any of those options and I can't really decide which one." If we add Option E "All of the above" is your response different?
Okay. So we do have any differences? Okay so the results will come in a few more minutes. That's good. Seconds.
Okay. There they are. So most people get…
Dr Venerina Johnston:
Okay. So most people actually selected the rehab and return to work coordinator. So was that based on the previous slide where we didn't have the option of "All the above"? Okay. So with this option of "All the above" has the response changed? We're not polling. Okay. Let's keep going then.
It's important to be aware that depending on where you sit in the return to work process you may actually have a different answer. So the way you view your role can be quite different to the medical provider, the insurer and in fact the injured worker as well.
Let's move onto the next topic which is a summary of the evidence for workplace interventions. Because there's lots of research conducted into workplace interventions we need a way of determining what is good and not so good research. Researchers have in fact developed ways to rate or score these studies and often use as many as 10 quality criteria. These include "Was the sample large enough to be able to make some sort of generalised statement about workers in general?", "Were the participants randomly allocated to the intervention or usual care?", "Did the workers actually comply with the intervention?" and "Was their compliance monitored and recorded?" so that the higher the score on these quality measures the stronger the study and more trustworthy the results.
High quality studies increase our confidence that the effects found are a consequence of the intervention and not due to suboptimal design or some bias that was inherent in the study and in fact when there are two or more high quality studies with the same result we can conclude quite convincingly the effectiveness or otherwise of that intervention.
Several researchers around the world have reviewed all of the studies conducted on workplace interventions. When this review is conducted systematically and according to strict criteria it's called a "systematic review". A very well known source of systematic reviews of all medical interventions is the Cochrane Library which is a publicly accessible library and that web address is on the slide. So they have a systematic review of all medical interventions not just for return to work or workplace interventions.
This library publishes only rigorously and well conducted systematic reviews. The information in the next few slides is taken from van Oostrom and colleagues who published a systematic review in the Cochrane Library in 2009. This review was recently updated and published in a book called the Handbook of Work Disability Prevention and Management.
So let's have a look at the evidence.
When we talk about workplace interventions we mean those that are focused on changes in the workplace or with equipment design or in work organisation or the job situation or in the environment conditions. They can also include actions taken for a comprehensive case management with accurate participation of the worker and employer.
The next two slides succinctly summarise the findings of nine high quality studies found on workplace interventions. So this first slide is the studies on musculoskeletal disorders and the next slide is the studies with mental health conditions. And I know it looks like a busy slide but I'll work through each of those headings one at a time.
We talked earlier about the different measures of success and these are some of the measures that researchers have used to determine whether an intervention is effective or not. So the results are presented in terms of first return to work, time to sustained return to work which is similar to stable return to work, the number of days sick in the 12 month period, changes in symptoms and function. So these measures are relevant to the insurer, employer and individual worker.
If we look at the studies that measure time to first return to work that was investigated in five of those nine studies, three studies found a reduction of time until first return to work in favour of the workplace intervention and two did not. In the Netherlands it was found that workers with low back pain achieved a first return to work in 70 days after the workplace intervention compared with 99 days after usual care. In other words workers returned to work 29 days sooner.
While in Canada one study found that workers with lower back pain who participated in a workplace intervention returned to work 64 days earlier than those who'd received usual care. So two studies conducted in different countries by different researchers but with the same results. So our confidence that workplace interventions can be effective in improving time to first return to work is established.
If we look at the second outcome here of sustained return to work in the systematic review I mentioned in the previous slide it was defined as "at work for four weeks without recurrences of sick leave." So that's different to the definition used by the return to work survey conducted in Australia which was "at work for three months." And in terms of the research that's been conducted for sustainable return to work two studies were on lower back pain and they found a reduction of days until sustained return to work – one of 27 days and the other of 120 days both in favour of the workplace intervention. Both of these studies were in fact conducted in the Netherlands. So while they were two studies and different researchers we can't really say with a lot of certainty whether the intervention itself was effective or perhaps where the workers in the Netherlands respond well to the intervention. So we need more trials in other countries to confirm that result.
Let's look at the next outcome which is number of days sick. Five studies recorded the number of days absent due to low back pain or a musculoskeletal disorder. Four of them found in favour of the workplace intervention with days absent ranging from 20 to 93 days. The one study that didn't find a difference with the workplace intervention may have been because the workplace intervention compared early management by an occupational physician with management by the supervisor only. So that might be of interest to some of you who think that medical personnel need to be strongly involved but interestingly that the outcome of days to return to work didn't differ substantially when the supervisor managed the process. That was quite an old study conducted overseas in the Netherlands.
When measures of pain and function are included in the research there was a reduction for those receiving usual care and the workplace intervention but in fact one was no better than the other in improving functions, symptoms and pain for the individual. This was the conclusion of five studies on lower back pain. So we can say with a lot of confidence because the findings are consistent that workplace interventions don't really make a big difference or there's no difference in function and symptoms for the individual worker.
If we look at the evidence for workplace interventions for workers with mental health conditions there hasn't been a lot of research conducted in this space and it's quite scarce and the results are inconsistent. There's only been two high quality studies available at the moment. The evidence from these two studies indicate that time to first return to work for workers with adjustment disorders was 122 days while it took 320 days to return to work for those without the intervention. In other words the workers return to work 188 days sooner with the workplace intervention.
In terms of sustainable return to work for those workers on sick leave due to stress there was actually no favourable result for the workplace intervention found. However they did a sub sample analysis which means they looked at what was the difference between – were there in fact some people who had a benefit or not and they found that those who were highly motivated at base line returned to sustained work after 55 days while the workers receiving usual care returned to work after 120 days. So that's quite a large difference, but as I said, there was only one high quality study found that measured sustained return to work for workers with mental health conditions.
So Venerina we've just had a question there with regards to that particular point and does that mean that one of the best strategies that a return to work coordinator or a case manager could do would be to identify which of those injured workers who were motivated to return to work early in the management of a claim? What does that mean?
Dr Venerina Johnston:
I don't think it would hurt to have a conversation with the individual worker to help understand where they are in terms of their return to work. It depends on their journey in terms of medical treatment. They may be able to articulate whether they're motivated at the moment or whether it's something that they would consider a little bit further down the track when they've had some more treatment and intervention.
Okay. So I think now we're up to number of days absent. It actually didn't differ whether workers had received a workplace intervention or usual care and similarly for change in symptoms the scores for depression, anxiety and stress did reduce with usual care and with the workplace intervention that one of the interventions was no different to the other.
So we can see that as for musculoskeletal conditions workplace interventions were no more effective than usual care in improving the actual health and function of the individual worker with a mental health condition. But workplace interventions were effective in obtaining first return to work and sustained return to work for those highly motivated at base line. We need to remember that there's only two high quality studies at the moment that have tested workplace interventions for those with mental health conditions.
Perhaps one of the reasons for the lack of effect on health outcomes may be explained by the focus of a workplace intervention which is on reducing barriers for work rather than symptom recovery and certainly that's where the health provider comes in.
Let's have a look at the next slide. Okay. So I hear some of you saying "What about the cost of claims?", "What is the impact?" and "Is there any evidence that workplace interventions can be effective in reducing cost?" In fact a few studies have recorded the costs associated with workplace interventions and on this slide we've got four columns illustrating four studies that have evaluated the costs associated with the workplace intervention. The letters at the bottom of each column like "CA", "SW", "DK", and "NL" represent the country where the research was conducted. So "CA" is Canada, "SW" is Sweden, "DK" Denmark, "NL" is Netherlands.
Going from left to right the first study was conducted in Canada and looked at the cost effectiveness which is the amount of dollars spent for each day saved on full benefits of their workplace intervention after a six year period. This study looked at workers with low back pain who had been off work a minimum of four weeks. The intervention was a clinical as well as an occupational intervention and it actually delivered a mean saving of $18,000 Canadian per worker with most of the costs saved in income replacement. So that's over a six year period though.
That particular intervention consisted of a visit with a back pain specialist, functional rehabilitation therapy and therapeutic return to work and participatory ergonomics. You may be familiar with the term "participatory ergonomics" because it's where a team of people, usually including the worker, a supervisor or manager and an ergonomist or health and safety personnel attend a workplace meeting and problem solve any barriers for work.
So that next column is about a study conducted in Sweden and they found direct cost savings of US $1,195 per case yielding a direct benefit to cost ratio of 6.8 which is quite impressive. The intervention consisted of an initial assessment by the insurance case manager and an occupational therapist. This was followed up with a meeting at the workplace with the employee and employer to discuss possible work options, training and any modifications required in the work environment and then they developed a return to work plan.
So a benefit to cost ratio is actually the ratio of the benefits of a project or proposal expressed in monetary terms relative to its cost. The higher the benefit to cost ratio the better the investment. So that's certainly something you can take back to your management team.
That next study, the one conducted in Denmark consisted of a coordinated care model. In this particular intervention workers with musculoskeletal disorders were assessed by an occupational physician, a chiropractor who did the biomechanical assessment, an occupational physiotherapist for their work related assessment and a psychologist. Then there was the team conference with the case manager who was a social worker. Based on the assessment the coordinator tailored an action orientated work rehab plan was developed and presented to the worker and you can see there that there was a cost benefit per worker at six months. The intervention in the study was effective but I'm not a big fan of this particular study because it's very hard to see where the worker fits into this particular return to work plan.
Finally, there's the study in the Netherlands which consisted of a workplace intervention for workers with chronic low back pain. The intervention they called "integrated care" and it consisted again of a participatory ergonomics approach which involved the supervisor and a graded physical activity program. The cost benefit showed that for every pound invested there would return an estimated £26 with a net societal benefit of integrated care compared with usual care of £5,744.
So we can see here there are four studies of different workplace interventions conducted in different countries with different researchers and all of those countries have got different health care and compensation systems and yet they found similar results thus reinforcing the conclusion that workplace interventions are cost effective compared to usual care.
Now that we know that workplace interventions are successful in achieving a speedier return to work, that is sustainable resulting in fewer days away from work generally and are more cost effective, what is the content? If we break down that black box or workplace intervention what's the content of these workplace interventions and what are the essential ingredients that perhaps you could implement or see whether you're actually implementing them in your workplace? And while we can't provide an exact recipe we can provide some guidelines or principles. And the researchers from the Institute of Work and Health in Canada have done just this.
After a rigorous review of the literature on workplace interventions they developed the Seven Principles for Successful Return to Work. These principles were published in 2007 but the team in Canada are currently updating the principles. So keep an eye out for them. The website is actually very good and they have a lot of information that can help you if you want further information and it's well recognised internationally as being leading edge on the topic.
So the principles here that are listed are not in any particular hierarchy of importance. I'll give you a moment to scan your eyes over these principles and what stands out to you.
Okay. For me, the first thing I noticed was that four of the Seven Principles are the responsibility of the workplace or the employer and I've put in bold the words "workplace" and "employer". I'll go through each of these principles and present some of the evidence for them. I won't show you all the studies of course but just some of the more interesting ones.
So the first principle is that the workplace should have a strong commitment to health and safety. People might talk about what they believe in or support but as the old saying goes, actions speak louder than words. Research evidence has shown that it is the behaviours in the workplace that are associated with good return to work outcomes and these include things like management, investments and resources and, people's time to promote safety and coordinated return to work but also a commitment to safety issues and return to work programs. It's not only documented in policies but demonstrated by behaviours when someone's injured. So a strong and visible safety culture at the workplace is likely to result in successful return to work when someone's injured.
I've got there on this slide about a study conducted in the USA by Amick and they found that organisations with people oriented culture, good safety practices and ergonomic practices and a good disability management practice were in fact more successful in achieving timely return to work for the workers with Carpal Tunnel Syndrome.
There was another study conducted in the USA again. They had 1,800 workers with back pain and they were asked to complete a survey about how satisfied they were with the employer's handling of their claim and satisfaction with the health care that they received. The results show that workers' satisfaction with their employer's treatment of their claim was more important in explaining return to work than satisfaction with the healthcare providers and in fact the workers who were dissatisfied with the employer's response to their injury were 1.5 times more likely to have a negative return to work outcome. And in fact that particular article by Butler was titled "It pays to be nice," which I thought was quite apt.
In the second principle it suggests that employers should make offers of modified work. There is strong evidence that the longer the duration of sickness absence the longer the chance – or the lower the chance sorry, of return to work and the greater the obstacles to work.
One study found that workers who were off work for 4-12 weeks had a 10-40% risk of still being off work at one year. So where possible the worker should return to their own work area where the environment, people and practices are familiar. An ergonomic work site visit by an expert can usually be helpful when it's difficult to find appropriate work. Interestingly the studies that have showed successful and cost effective return to work there was the involvement of an ergonomist or someone who was able to conduct an ergonomic visit and that was part of the workplace intervention.
Venerina we've just had a question there with regards to the ergonomic visit. What exactly – can you give us an example of what exactly it was that the ergonomist might have assessed or recommended as part of that assessment?
Dr Venerina Johnston:
You'll probably notice that most of the studies to date have been with people with low back pain or musculoskeletal problems. So the ergonomist would be someone who has a very strong background in biomechanics and they would go onto the workplace and work with the individual worker and the supervisor to undertake an assessment of the workplace to identify any particular barriers for that individual to make it easier for them to return to work and probably safer in the long run as well. So it's not – I would suggest that the most beneficial outcome is where the three of them work together as opposed to when the ergonomist comes in and tells the employer what they should and shouldn't be doing. However that's not actually detailed in a lot of the publications.
Thank you for your question.
Just to demonstrate the probability of return to work in terms of the longer someone is off work this slide shows that return to work within three months asked for varying time off work does reduce the longer you're off work. It's taken from a report produced by WorkCover South Australia in 2010 and it certainly confirms the principle that the longer an employee is off work because of an injury the less the chance for successful return to work.
This table shows that when a person is off work for three months the chance of return to work within three months is about 50% and that reduces quite quickly so that if the person is off work one year the probability reduces by half to 25%. So while these results might be a bit frightening for some of you it's important to remember that in South Australia they have a long tail scheme and it's not unusual for people there to be off work for one year. And I actually think that South Australia has made some changes to their legislation to reduce the long tail scheme that they have there at the moment.
The third principle is that return to work planners need to consider co-workers and supervisors at the workplace. So when you're involved in planning a return to work it's more than just matching the restrictions on the medical certificate to the job. We need to consider the impact on co-workers and supervisors. Sometimes co-workers may feel disadvantaged and even resentful if they're expected to take on additional duties while the injured worker recovers fully. Or perhaps they may feel that the injured worker has somehow managed to get an easier job. Likewise some supervisors may find it challenging to maintain production while supporting the returning worker. There is additional time and sometimes stress that's often not fully appreciated by their manager.
One way to perhaps avoid these feelings of resentment and additional burden is to ensure the co-workers are kept informed of the changes and that perhaps if something was to happen to them that they would be given similar considerations. And the supervisor needs to be involved in the planning of the return to work.
This fourth principle is that the supervisors should be trained in work disability prevention. Research has in fact identified that supervisors are important to the success of return to work due to their proximity to the worker, their understanding of the available jobs and work demands and their ability to modify or to provide modified work and monitor the worker's health and functioning on a daily basis and often they will communicate a positive message of care and support.
The immediate supervisor is the interface most likely among upper management, the rehabilitation and healthcare providers sometimes and co-workers and the injured worker. We've actually been doing some research at the University of Queensland to identify what supervisors need to effectively perform this role and overwhelmingly they said that they needed more training. So I guess this supports this principle here that they should be trained.
At the next webinar I think I'll be conducting later on in the year I'll discuss this research and the specific knowledge, skills and personal characteristics required by supervisors to support staff returning to work after injury.
My apologies. I needed a drink.
The fifth principle here is that the employer should make early and considerate contact with the injured worker. By "early" we mean within the first week or two. So this is really only a guideline and the actual timeframe may vary depending on the worker's injuries. Ideally the contact should be made by the immediate supervisor as this can help the worker feel connected to their workplace and the colleagues. If the immediate supervisor is in fact part of the problem associated with the absence, then the return to work coordinator or someone else at the workplace that the worker may trust should make that contact.
By contacting the worker early and regularly demonstrates the employer cares about the worker's wellbeing. At that time there shouldn't really be any discussion of the legitimacy of the claim or even blaming. I recently spoke with a person who was seriously injured in a workplace accident and I remember him saying to me that he was actually quite bitter and disappointed that no one in management from his workplace had contacted him to enquire about his wellbeing. I mean if you think that you're going to be prying or bothering the worker or that it's viewed suspiciously, in fact more often than not the contact is welcomed especially if there is an existing workplace environment that's characterised by goodwill.
In this particular study on the slide, the one by Wood, it's an old study but still quite relevant. The study was done in a hospital in Canada where the personnel program was implemented as soon as the workers' compensation claim was registered. There was immediate contact with the worker and insurer followed up by regular 10 day calls. There was liaison between the insurer and the manager to establish a return to work plan.
Supervisors were instructed to call the injured workers and to say this particular spiel, "How are you? We are thinking about you. You are a vital part of the team. Your work is important and your job is waiting for you." And it was actually found that this simple message and the company culture it reflected…
Hi everyone. It's Rachel here, your facilitator. Our expert presenter just needs to have a little drink. She's had a slight coughing attack. So I'll just take over for the time being so that we can let her have a little drink and then hand back to you to keep things flowing. Okay. Thanks everyone for your patience.
Dr Venerina Johnston:
Okay. So this particular intervention that they tested in Canada found that it reduced the number of staff staying on long term leave from 7% to 1.7% which is quite an impressive result really.
This principle, so the sixth principle, suggests that someone should have the responsibility to coordinate return to work and I guess that's where a lot of you actually function. All of the successful workplace interventions described in the two summary slides included someone to coordinate the return to work. That role may be performed by someone within or external to the workplace depending on the nature of injury.
In many of the European countries where the research was conducted the role is actually performed by an occupational physician. In the USA occupational nurses have a large role in return to work and they're usually employed as the return to work coordinator. In Australia and Canada the person coordinating the return to work may actually be an allied health professional but in some small organisations it might actually be the owner of the business or a layperson who coordinates the return to work. While many of you may not feel well equipped to perform this role it's comforting to know that researchers have actually found that the competencies that a return to work coordinator needs to effectively support a returning worker are general personal characteristics and attributes. So things like maintaining confidentiality, ethical principles, responding in a timely manner and demonstrating good organisational and planning skills. These all seem to be key behaviours of success of return to work coordinators and hopefully you can recognise these attributes within yourself.
Okay. So the last principle is based on the strong evidence that contact between the healthcare provider and the workplace reduces disability duration and claims cost. Contact may actually be in the form of a report or a phone call to the workplace or after the worker's been to the doctor or the physio. It could also be a more extensive work site visit by the healthcare provider. The health provider is important as the injured worker is often looking to them for information about their condition and return to work advice.
Unfortunately, recent studies in the USA and the UK reported that the doctors rarely enquired about the work demands of an injured worker and they provided little advice as to how to manage the health problem at work. However, this particular study in Canada demonstrated that when that advice is personally conveyed by the health provider an employer is twice as likely to respond to the suggestion regarding possible job or ergonomic changes.
You might be thinking "Well we don't really need to have that input because we don't have a lot of serious injures," and certainly in uncomplicated cases contact with the health provider may not be necessary. However, if you feel it's necessary to contact the health provider ensure that permission from the worker is obtained before proceeding.
So just to demonstrate that communication is vital between health providers and employers, this is the study that showed that there were three activities associated with more than a twofold increase – a chance of earlier return to work compared with a lack of communication. So where the health provider gave a return to work date, where the health provider gave advice for injury prevention or recurrence and where the health provider made contact with the workplace. So in cases where you're not sure whether it's safe enough for the worker to be at work or what tasks they can or can't do, it's always best to check with the health provider and perhaps even invite them to the workplace so they can see first hand what the worker is required to do.
Sometimes it's good to send a written job description with the worker to the health provider so the health provider understands the worker's job to be able to better advise and be able to participate in informed decision making. And it looks like we have a question?
We do. So in this study particularly from Kosny et al. on this slide, when they refer to "healthcare provider" is it referring specifically to doctors not having that information about the workplace, so job descriptions and further being able to understand what it is the worker does? Or when you refer to "healthcare provider" on that slide did the study talk in general about a range of healthcare providers including the doctor or allied health professionals?
Dr Venerina Johnston:
Thanks Rachel. In this particular Canadian study the majority of the participants were medical doctors but in the province where the research was conducted medical doctors, chiropractors and physios were included as the healthcare provider because in that province they're responsible for directly communicating with the Workers' Compensation Board about the worker's readiness for return to work.
Some of you may have noticed that all of the studies mentioned so far were conducted overseas. So while the results of these studies are interesting the health and compensation systems do vary quite significantly between countries. And we have in Europe of course, they have that generic, overarching healthcare and compensation system which is different to Canada, US and Australia where we have workers' compensation insurance schemes.
There actually haven't been too many studies conducted in Australia looking at workplace interventions and the only one that I know of came out of Victoria recently. The researchers there analysed data from several organisations that had participated in what they called a "multifaceted intervention". This particular intervention consisted of various features. So it wasn't just one thing that they did. There was early appropriate medical intervention which consisted of a 24 hour telephone contact line manned by trained injury managers to provide immediate professional assistance and encourage early reporting of the workplace injury.
So the aim in this particular study was to receive notification of the injury within 20 to 60 minutes. So some of you might have heard of "triage systems" and that's something that a lot of the large organisations have in place currently.
Another feature of this workplace intervention was that there was an injury manager assigned to manage the process and guide the employee, employer and other parties through the process. The supervisor was involved in the process from the start and senior management were engaged by contacting the worker to check on the wellbeing and negotiate suitable duties. Interestingly non work related injuries were also addressed.
Another feature was that there was support for the worker where the injury manager worked to remove as many barriers as possible to the successful management of the person's injury and return to work. They encouraged the worker to obtain evidence based treatment and to cease ineffective treatment and worked with the health providers to achieve this. The injury manager also worked with the treating doctor to avoid delays in specialist referrals and delays and ensure approval for surgery.
As you can see this multifaceted intervention resulted in a 40% reduction in the number of days on compensation and a reduction in the average cost of claims. So that's quite a recent study.
So we've come to the end of this webinar and I hope that the information has been useful even if it's just to reinforce what you're doing and you're on the right track. I said that I couldn't provide a recipe for successful return to work but I thought I'd have a go at providing a recipe. So essentially I believe the key features are the requirement for someone to coordinate the return to work and I don't believe that that person needs to be an allied health professional, the participatory ergonomics approach where the worker, supervisor and an ergonomist or health provider or health and safety personnel need to coordinate to establish the return to work plan with modified and/or alternate duties and we also need regular communication between all parties that's delivered with empathy.
I'm not sure if we have time for questions. Yes?
We do. Okay.
Dr Venerina Johnston:
So hopefully I can address some of your queries.
Okay. So thank you very much Venerina. Once again a very informative presentation. One of the questions we did have that wasn't answered throughout was "What can an employer do if a worker refuses to undertake a return to work program? Or how do you entice them to get to that first point where you can actually talk about it when they're not wanting to play the game?"
Dr Venerina Johnston:
Sorry. Could you repeat it? Is it when the employer or when the worker doesn't want to participate?
So what is it that a worker can do to help a worker participate in a return to work program? So they're refusing to play.
Dr Venerina Johnston:
So what can the employer do when the worker is refusing?
Sometimes it's worthwhile pointing out to them the legislative requirements for the worker to participate in rehab. If it's a case where there's a little bit of tension there prior to the actual injury occurring it might be useful to get an external party involved, someone who is perhaps not seen to be biased in the process. I've seen that work quite effectively in a couple of situations.
That's great and I think we also need to remember that there's a large body of insurers out there as well. So WorkCover Queensland – they can always be useful to assist with educating doctors. In one of our previous webinars I've heard a strategy where the psychiatrist recommended that you do speak to the doctor because quite often the doctor can be an important point and pivotal point in getting the worker engaged in the process too.
Okay and I'm going to put another challenging question to you Venerina. So we're very grateful for all of the information that you've presented to us today and I think it's a real art to be able to translate. Sometimes that world of research can be quite complicated but to translate it into some very useful tips for people to take home. So I'm grateful for that and I'm sure all of our audience are as well. But if I had to put it to you what's the one thing that could be done to reduce durations and costs, what would you say could be done from an employer's perspective?
Dr Venerina Johnston:
Act early and quickly. I know that's quite a short answer. I guess the research has demonstrated that if you have early and effective intervention, whether that's at the workplace or contacting an injury manager, sending them off for treatment or assessment, that fairly clearly shows that early intervention can be quite effective.
Yep, great and I just thought we might talk about the polling results that we presented before. Interestingly enough when Venerina asked the question about who plays the most important role the feedback was rehab return to work coordinators. So three quarters of you felt that they played the most important role followed by doctors and then workers. So really just to reinforce that point Venerina in your opinion the evidence supports that it's all of those players that are vital to successful return to work. Is that correct?
Dr Venerina Johnston:
Yes. Certainly everybody is important and needs to be kept on the same page. So the return to work coordinator has a key role in communicating with all the different players, ensuring that everybody has up to date information. So yes you are important.
Okay. Well that – we're getting near to the end of our webinar today. Once again on behalf of the Workers' Compensation Regulator I'd like to extend our gratitude to Venerina for giving up her time to come and share her knowledge and practical tips on how to help coordinators to identify which workplace interventions really work.
We also look forward to the next webinar in your series which will be in a few months' time on supervisors and what they can do to ensure positive outcomes for workers because as your research highlighted, supervisors play a very important role in that return to work process. So we look forward to hearing more about that.
We've had some great feedback for you today Venerina and it's always nice to give you that verbally. So someone's kindly sent in "Thank you Venerina. Really fabulous presentation." So it's not just me who's grateful. It's all of our attendees today as well. So thanks very much.
The Workers' Compensation Regulator is committed to supporting return to work coordinators and employers as well as health professionals and anyone in the industry. And we've established a Coordinator Community on Facebook. To ensure that you receive regular communication and the current information from us make sure you join that community using the address on your screen.
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We've recently launched the Queensland Safe Work and Return to Work Awards for 2015 and you can enter these as an organisation if you've got a relevant initiative that's in the development stage or newly implemented or if you've achieved positive outcomes in either health and safety or rehabilitation. There's lots to be I guess recognised for and you could win up to $2,000 in prize money as well as there's reward for people who nominate someone else.
We've also got some work health and wellbeing leadership forums that are currently being run across the state. I was fortunate enough to attend one of those last week and they were excellent. It's a joint initiative between Workplace Health and Safety as well as WorkCover Queensland. So they have a really great presentation from Dr Rob McCartney and they cover off a whole lot of different topics on workplace health and wellbeing programs that you can use. And they also showcase a success story from industry and then WorkCover Queensland, Workplace Health and Safety Queensland and then the employer form a panel as well so that you can ask lots of questions. So I encourage you to attend that.
And just finally a copy of this webinar will be emailed through to you shortly as well as available on the website. We do take a little bit of time to actually transcribe the webinar so that they're accessible for all. So you do need to give us a few days.
We do have a brief post webinar survey and we encourage you to tell us what your thoughts are so that we can all – we're always looking on how we can improve your webinar experience and most importantly, what it is that you need to know more about to ensure success in your roles because we do want to help you facilitate an early and safe return to work for your injured workers.
So on behalf of the Workers' Compensation Regulator I'd like to thank you for being involved in our webinar today and have a great rest of your week.
Bye for now.
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