Power to the employee and Power to the employee and employer – what the research saysemployer – what the research saysDr Mary Wyatt

Workplace culture Workplace culture VWA data – claims by industry

0

2000

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199

5/96

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6/97

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7/98

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9/00

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0/01

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4/05

Communication

Community Services

Construction

Electricity, Gas & Water

Finance, Property & BusinessServices

Manufacturing

Mining

Public Administration

Recreation, Personal & OtherServices

Trade

Transport & Storage

Unknown

Disability managementDisability management

•Where have we been and where are we going?

IntroductionIntroduction

• Return to work management in most companies has moved from a passive approach to early intervention and case management.

• Research suggests the next major improvement will come from empowering the employee and empowering management. It’s positive and achievable, and people feel good when they do it. This talk presents the relevant research studies.

Medical input to work disabilityMedical input to work disability

• Evidence that medicalisation of conditions may increase disability

• Little evidence for treatment reducing disability, eg for back pain

• Investigations and treatment may raise level of concern, and increase the likelihood of progression to a chronic problem

• Medicine is important, but not good at reducing work disability

• Ehrlich, G. E. (2003). "Back pain." Journal of Rheumatology - Supplement 67: 26-31.• Nordin, M., S. Welser, et al. (2002). "Self-care techniques for acute episodes of low back pain."

Best Practice & Research in Clinical Rheumatology 16(1): 89-104.• Tacci, J. A., B. S. Webster, et al. (1999). "Clinical practices in the management of new-onset,

uncomplicated, low back workers' compensation disability claims.[see comment]." Journal of Occupational & Environmental Medicine 41(5): 397-404.

What can be done?What can be done?

The employee The employer

• Positive messages about musculoskeletal conditions (sore body parts)

• Improving self-efficacy

• Problem solving

• Supervisor care

• Senior management leading

• HR RTW coordinating

• Systems in place

• Having all the players on side

The employeeThe employee

• Most people do fine without any intervention

• Most do better with positive support

• Problem solving and more positive beliefs improve outcomes

• A small proportion need a highly coordinated level of care from the employer, their treaters and claims managers

90s workplace study90s workplace study

•Pamphlet given to staff at UK company

•Containing positive messages about the consequences of back pain

•Demonstrated reduced work absence secondary to back pain

Victorian campaignVictorian campaign

• Positive messages about what the person could do for themselves

• “Don’t take it lying down”

• Famous sportsmen, actors, broad range of experts delivered message

• Improved outcomes in ▫beliefs, ▫doctors’ stated management▫back pain as percent of claims.

Survey

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1 2 3

26

27

28

29

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More positive beliefsMore positive beliefsChange in mean (95% CI) BBQ

80%

90%

100%

110%

120%

130%

1993/94 1994/95 1995/96 1996/97 1997/98 1998/99 1999/00

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Back

Non-back

Less back claims as a percent of all claimsChange in number of claims, 1993-4 to 1999-0

P=0.013

Change in rate of days compensated, 10/97 to 10/99

10/9

71/

984/

987/

9810

/98

1/99

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9

Non-backs

Backs

20

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60

70

80

Month

Day

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ate

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)

P=0.0003Slope = -0.41 days per 1000 claim-days per month

Slope = -1.2 days per 1000 claim-days per month

Problem solvingProblem solving• People off work with back pain were placed into two

groups

• Graded activity program with education

• Graded activity program with problem solving

• 5 steps for problem solving▫ problem orientation ▫ problem definition and formulation ▫ generation of alternatives▫ decision making▫ implementation and evaluation.

Secondary Prevention of Work-Related Disability in Nonspecific Low Back Pain: Does Problem-Solving Therapy Help?A Randomized Clinical Trial

Problem solving cont’dProblem solving cont’d• Problem solving focus was skills training

application of skills in daily life, rather than one specific problem area.

• Patients were free to select their own problem areas, which did not need to be pain related.

• Between sessions, homework assignments were given to practice skills in everyday life.

• Homework assignments were discussed within the group at all sessions.

Results of the interventionsResults of the interventionsWork status at 12 months

• GA = Graded activity

• PST = Problem solving training

• EDU = Education

Workplace basedWorkplace based

• Good evidence that early work place based intervention makes a difference

• Involvement of all parties improves outcomes

• Australian model – RTW coordinator

• Canadian model – Disability management committee, like our OH & S committee approach

http://www.backpaineurope.org/

Workplace interventions –Workplace interventions – IWH systematic reviewIWH systematic reviewComponents that reduce the duration of

work disability

▫Early contact with worker▫Return to work offer▫Contact between healthcare provider and

workplace▫ergonomic visits, participatory ergonomics

▫Educating supervisors and managers▫Labour management cooperation ▫People oriented culture▫Conditions of good will and mutual confidence

http://www.iwh.on.ca/sr/wd_rtw_interventions.php

Workplace based injury Workplace based injury managementmanagement• Participants off work 2 to 6 weeks due to back pain were

randomized to workplace intervention

• Workplace intervention consisted of workplace assessment, work modifications, and case management involving all stakeholders.

• Outcomes were lasting return to work, pain intensity and functional status, assessed at baseline, and at 12, 26, and 52 weeks after the start of time off work.

• RESULTS: Time until return to work for workers with workplace intervention was 77 versus 104 days (median) for workers without this intervention (P = 0.02). Workplace intervention was effective on return to work (hazard ratio = 1.7; 95% CI, 1.2-2.3; P = 0.002).

Anema, J. R., I. A. Steenstra, et al. (2007). "Multidisciplinary rehabilitation for subacute low back pain: graded activity or workplace intervention or both? A randomized controlled trial." Spine 32(3): 291-8; discussion 299-300.

Workplace interventionWorkplace intervention

• Dutch modification of Canadian system

• The workplace intervention consisted of a workplace assessment and work adjustments in which all major stakeholders in the return-to-work process participated:

the worker the employer the doctors involved

• Interesting to compare to our model

Team collaborationTeam collaboration

•Getting all the players onside

•Increasingly the focus of overseas studies and guidelines, including the European Back Pain Guidelines on prevention of back pain

•Canadian model has partnership approach at its core

Team valuesTeam values

•Getting the players onside has been a focus of research over the last ten years

"The values underlying team decision-making in work rehabilitation for musculoskeletal disorders.“

• Loisel, P., M. Falardeau, et al. (2005). "The values underlying team decision-making in work rehabilitation for musculoskeletal disorders." Disability & Rehabilitation 27(10): 561-9.

Team approachTeam approachExpectations

• Stakeholder endorsement of RTW

• The concept of a shared vision is raised regularly

• The team wanted a positive attitude and a high level of motivation from the worker

• The team expected actions

that were perceived as helpful to return to work (e.g., authorizing the program, giving messages consistent with the teams’ philosophy, acting promptly).

Focus and time commitment

• However, there was little time and focus invested in developing a shared and collaborative approach

• Little focus on what are the motivators for the worker, and an approach exploring those issues

• Little knowledge of how others in the team operate

• Minimal work to develop team as a team, and to increase likelihood of a common message

Be niceBe nice

Butler, R. J., W. G. Johnson, et al. (2007). "It pays to be nice: employer-worker relationships and the management of back pain claims." Journal of Occupational & Environmental Medicine 49(2): 214-25.

Training of supervisorsTraining of supervisors

Study one - unpublished

• 1.4% absenteeism with

▫ RTW policy

▫ Case management

▫ Supervisor involvementSupervisor involvement

• 5.3% absenteeism without them

• Programs have saved 20 - 40% on benefit costs

Study two

• 47% reduction in new claims and an 18% reduction in active lost-time claims

• Versus 27% and 7%, respectively, in the control group.

Shaw, W. S., M. M. Robertson, et al. (2006). "A controlled case study of supervisor training to optimize response to injury in the food processing

industry." Work 26(2): 107-14.

Senior management Senior management

• Michigan study of employer practices demonstrated senior management commitment had a strong influence on reduced work disability

THE MICHIGAN DISABILITY PREVENTION STUDY RESEARCH HIGHLIGHTSUpjohn Institute Staff Working Paper 93-18H. ALLAN HUNT, W.E. Upjohn Institute for Employment ResearchROCHELLE V. HABECK, Principal Investigator Michigan State UniversityApril 1993

Identifying the areas for Identifying the areas for improvementimprovementWork disability management review

•Informal audit

•Injury Map

•Consensus Based Disability Management Audit

Informal auditInformal audit

•List of areas to assess, eg▫Procedures

system of early injury reporting process for identifying return to work task

▫Outcomes Days lost Costs

• And then plan how you will gather the information so you get important and relevant input

CBDMA CBDMA

• Rigorously developed and tested

• $2 million spent in development

• Comprehensive approach

• Involves employees and employers

• Varied instruments – consensus based discussion, surveys, review cases, to assess the situation

• Clear report on the 16 relevant areas, with recommendations for action

www.nidmar.ca

UsesUses

• An evaluation tool, to determine current disability management program performance

• A monitoring tool to show increases or decreases in effectiveness for each audit area

• A corrective tool, to establish deficiencies and highlight ‘the next steps’

• A program promotion tool demonstrating management's commitment to workplace disability management practices

BenchmarkingBenchmarking

•Originated in Canada

•Now used in a number of Canadian provinces, Germany, US, Australia, and New Zealand

•Ability to benchmark against other organisations, reports include comparative performance

Supervisor trainingSupervisor training

•Research results based on needs assessment

•The teaching needs to be about how to do things, the actions that make a difference

•Teaching about completing forms, timelines, etc without the how has not been shown to be effective

Return to work knowledge base Return to work knowledge base websitewebsiteContent:

Access:

When access is available, feedback is invited while

information continues to be refined and improved upon

www.rtwknowledge.orgKnowledge Base

Knowledge Base Project Knowledge Base Project Committee & TeamCommittee & Team• Committee:

Mary Wyatt, ResWorks

Janet Russell, Continuing Education Bendigo

David Cragg, Australian Workers Union

Robynne Dashwood, Eastern Health

Andrea James, Medical Practitioner

Tracey Browne, Australian Industry Group

Paul Coburn, Physio, VWA

Bianca von BlomBerg, TAC

Chris Tsoukalas, QBE Insurance

Michael Simpson, OccCorp Pty Ltd

Coralie Hadingham, VWA

Carol Lapeyre, The Rehab Factor

• Project Team:

Project Manager: Robert Hughes

Translation TeamLeader & Writer: Mary Wyatt

Administration/ Marketing: Cheryl Griffiths

info@resworks.org.au

Knowledge Base

StakeholdersStakeholders

Content DevelopmentContent Development

Ideas Translation

• Committee

• Project Team

• Focus Groups

• International input and collaboration

• Identify research

• Multiple drafts

• Feedback

• Refinement

Table of contents

• Research

▫ Medical factors and RTW

▫ Psychological factors and RTW

▫ Consequences of being off work

▫ Workplace factors and RTW

▫ People factors and RTW

▫ RTW approaches and intervention

• Resources

▫ Taking control series for Employees & Employers

▫ Improving your effectiveness series for Practitioners & Insurers

▫ Information on the processes / timelines involved

▫ Returning to work, effective return to work plans

▫ Medical and health information

▫ Links / Glossary of RTW terms