which workplace interventions really work · handbook of work disability: prevention and...
TRANSCRIPT
Dr Venerina Johnston
14 May 2015
Workers’ Compensation Regulator
Which workplace
interventions really work?
Presenter: Dr Venerina Johnston
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Venerina has qualifications in
physiotherapy, occupational health and
safety and a post-graduate certificate in
work disability prevention, and 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.
Q: What role do you have in the return to
work process? (please use poll on your right)
a) Case Manager
b) Claims Officer
c) Rehabilitation and Return to Work Coordinator
d) Manager/ Supervisor
e) Human Resources
f) Injury Management Officer
g) Legal Advisor
h) Injured Worker
i) Occupational rehabilitation provider
j) Treating Allied Health professional
k) Treating Health professional (Treating Doctor, Medical
Examiner)
l) Other
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Webinar Overview
1.Measuring ‘success’ of rehabilitation
2.Summary of evidence for workplace
interventions
3.Principles for successful RTW
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Measuring ‘success’
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RTW status of finalised time lost claims Number % of time
lost claims
Fit for work: same job/same employer 45,688 93
Fit for work: same job/different employer 309 0.6
Fit for work: different job/same employer 297 0.6
Fit for work: different job/different employer 999 2.0
Fit for work: no job 501 1.0
Fit for work: worker does not return 615 1.3
Not fit for work 629 1.3
https://www.worksafe.qld.gov.au/forms-and-resources/statistics/workers-
compensation-regulator-statistics-reports2
Insurer measures of RTW in QLD
In 2013-2014: 92,007 claims accepted; Average days lost
47.8 days; Average cost of a time lost claim was $16,358
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Stable RTW rates in Australia
Q: So, how long have you been back at work (for since your
last additional time off)?
http://www.safeworkaustralia.gov.au/sites/swa/about/publications/pages/natio
nal-return-to-work-survey7
Australian RTW Statistics
Australia & New Zealand Return to Work Monitor 2011/12 www.campbellreserarch.com.au
What is the main reason you returned to work?
(Total number of workers participating = 2537)
Recovered from injury 36%
Economic need / needed money 18%
I wanted to return to work 19%
Told to return by Dr / Dr’s advice 8%
Offered alternative duties 6%
Bored at home 3%
Pressured from employer 2%
Wanted to keep job 2%
Benefits stopped / too low 1%
Pressured by insurer 1%
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Whose job is it to return an injured worker to
work? (please use poll on your right)
A. Injured worker
B. RTW coordinator at workplace
C. Treating medical practitioner
D. Insurer case manager
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Whose job is it to return an injured worker to
work?
A. Injured worker
B. RTW coordinator at workplace
C. Treating medical practitioner
D. Insurer case manager
E. All the above
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Summary of Evidence
Sources of information:
• van Oostrom et al. Workplace interventions for preventing work
disability (Review). Cochrane Database of Systematic Reviews
2009( Issue 2. Art. No.:CD006955). http://www.cochranelibrary.com/
• Loisel P, Anema JR (ed). Handbook of Work Disability: Prevention
and Management. 2013 Springer, New York.
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Summary of effects of workplace
interventions: Musculoskeletal Disorders
Time to First RTW
• 29 - 64 days sooner for those with Lower Back Pain
Sustained RTW
• 27 – 120 days sooner for those with Lower Back Pain
Number of days sick
• 27 – 93 days sooner for those with Lower Back Pain
• 20 – 53 days sooner for those with any
musculoskeletal pain
Function / Symptoms / Pain
• Pain decreased significantly for both the intervention
and usual care group but not between groups
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Summary of effects of workplace
interventions: Mental health conditions
Time to First RTW
• 188 days sooner for those with adjustment disorders
Sustained RTW
• No effect for those with stress related sick leave except if
highly motivated at the start in which case they returned
to work after 55 days (compared with 120 days)
Number of days sick:
• No difference in days absent from work (141 days)
Function / Symptoms / Pain
• Scores for depression, anxiety and stress decreased in
both groups
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But what about costs?
CAN $18,585
per worker
Combined
clinical &
occupational
intervention
Loisel et al
2002 CA
For every £1
invested would
return an
estimated £26
Integrated care
– participatory
ergonomics
with
supervisor,
graded activity
Lambeek et al
2010 NL
US $2,366
per worker at
6 mths
Multi-
disciplinary
coordinated
care
Bultmann et
al 2009 DK
Direct benefit
to cost ratio of
6.8
Proactive
Insurance
case
management
with
workplace
ergonomics
Arentz et al
2003 SW
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7 principles for successful RTW
1. Workplace has a strong commitment to health and safety
2. Employer makes an offer of modified work so injured worker
can return early and safely to suitable work activities
3. RTW planners ensure that the plan supports the returning
worker without disadvantaging co-workers and supervisors.
4. Supervisors are trained in work disability prevention; included
in RTW plan
5. Employer makes an early and considerate contact with
injured/ill workers.
6. Someone has the responsibility to coordinate RTW.
7. Employers and health care providers communicate with each
other about the workplace demands http://www.iwh.on.ca
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7 principles for successful RTW
1. Workplace has a strong commitment to health and safety
2. Employer makes an offer of modified work so injured worker
can return early and safely to suitable work activities
3. RTW planners ensure that the plan supports the returning
worker without disadvantaging co-workers and supervisors.
4. Supervisors are trained in work disability prevention;
included in RTW plan
5. Employer makes an early and considerate contact with
injured/ill workers.
6. Someone has the responsibility to coordinate RTW.
7. Employers and health care providers communicate with each
other about the workplace demands http://www.iwh.on.ca
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1. Workplace has a strong commitment to
health and safety
• Strong evidence (and considerable business experience)
that H&S policies and procedures is cost-effective, and
may reduce sickness absence by 20-60% (Waddell et al,
2008)
• Organisational practices and policies: 198 workers with
carpal tunnel syndrome in the USA were more likely to
have made a timely return to work when they rated the
company as having a ‘people-oriented culture’, good
safety strategies and ergonomic practices, and disability
management policies and procedures (Amick, 2000)
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Workplace culture
• In the USA, 1,831 workers with back pain completed a
survey about their satisfaction with their employer’s
handling of their claim and satisfaction with the health
care received.
Results:
• Workers’ satisfaction with their employer’s treatment of
their claim was more important in explaining RTW than
satisfaction with health care providers
• Workers who were dissatisfied with their employers’
response to their injury were 1.5 times more likely to have
negative return to work outcomes (Butler et al, 2007)
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2. Employer offers modified work
Strong evidence that temporary provision of modified work
reduces duration of sickness absence and increases return
to work rates and moderate evidence it reduces costs
Depending on context, workers who are off work for 4-12
weeks have a 10-40% risk of still being off work at one year
(Waddell et al. 2003;
2008; Franche, 2005)
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The role of the workplace in return to work Discussion Paper, WorkCover SA,
March 2010
Chances of RTW diminish the
longer a person is off work
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3. RTW plans should not disadvantage
others at the workplace
When worker RTW on
modified/alternate duties:
• co-workers may need to ‘pick up
the slack’
• Supervisors need to maintain
production while supporting
worker
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4. Supervisors are trained in work
disability prevention
Supervisor
Employer – adhere to policies, manage costs, maintain productivity
Support IW, manage co-workers
Communicate with health providers,
insurers, case manager, RTW
coordinator22
5. Employer makes an early and
considerate contact with injured worker
• In a Canadian Health care facility, when workers were off
work with back injuries their supervisor phoned to say:
‘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.’
• Communicating care and concern and the company
culture it reflected, cut the number staying off long-term
from 7.1% to 1.7%
(Wood 1987)
6. Someone has the responsibility to
coordinate RTW
Strong evidence that successful RTW programs involve
someone to coordinate the process to:
Provide individualized planning and coordination adapted
to the worker’s initial and on-going needs,
Ensure communication remains open between all parties
Ensure the worker and other players understand what to
expect and what is expected of them
(Franche et al 2005)
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• Strong evidence that contact by a healthcare provider
with the workplace significantly reduces work disability
duration, and Moderate evidence that this contact results
in net $ savings
(Franche et al, 2005; 2007)
7. Employers and health care providers
communicate
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Communication is vital
• 187 Ontario workers with lost-time claims for back, neck or
upper extremity occupational musculoskeletal injuries
completed a telephone survey 17-43 days post injury
Results:
3 activities were associated with a more than twofold chance
of earlier return to work compared with a lack of
communication:
a. Healthcare provider giving a return to work date
b. Healthcare provider giving advice for injury
prevention/recurrence
c. Healthcare provider making contact with the workplace
(Kosny et al. 2006)
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Australia: Multifaceted intervention
• Early Medical Intervention <24hrs
• Injury manager appointed
• Workplace Intervention (coordination between parties for RTW)
• Regular support for Worker
• Results: 40% reduction in the number of days on
compensation and reduction in the average cost of claims
by $2329 AUD (average 21month follow up)
(Iles et al 2012)
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Recipe for ‘Successful’ RTW
• 1 Bucket of case management (external / internal)
• 3 cups of stakeholders (1 employee, 1 supervisor, 1
ergonomist/ health provider)
• 1 ‘participatory’ RTW plan with modified duties
• Sprinkling of care and communication
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Resources
• Visit www.worksafe.qld.gov.au
• https://www.worksafe.qld.gov.au/forms-and-
resources/statistics/queensland-performance-against-national-strategy-
targets
• https://www.worksafe.qld.gov.au/slaws-and-compliance/workers-
compesnations-laws
• https://www.worksafe.qld.gov.au/service-providers/working-with-us
• www.rtwmatters.org
• Realising the Health Benefits of Work, Position Paper (April 2010,
Australasian Faculty of Occupational and Environmental Medicine)
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Resources Continued…
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• Sign up for free eNEWS email subscription
service
• Visit www.worksafe.qld.gov.au– People at Work project
– Work-related stress tip sheets
– Resolve at Work rehabilitation providers
Questions
Visit the Return to Work Facebook Community
www.facebook.com/RRTWCnetwork/
Return to Work Coordinator Community
Work health and wellbeing
leadership forums
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