Which workplace interventions really work? Dr Venerina Johnston 14 - - PowerPoint PPT Presentation

Dr Venerina Johnston 14 May 2015

Workers’ Compensation Regulator

Which workplace interventions really work?

Presenter: Dr Venerina Johnston

2

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

• f

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

3

Webinar Overview

1.Measuring ‘success’ of rehabilitation 2.Summary of evidence for workplace interventions 3.Principles for successful RTW

4

Measuring ‘success’

5

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

6

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-survey 7

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%

8

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

9

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

10

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.

11

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

12

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

13

But what about costs?

CAN $18,585 per worker Combined clinical &

• ccupational

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 14

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

• ther about the workplace demands http://www.iwh.on.ca

15

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

• ther about the workplace demands http://www.iwh.on.ca

16

• 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)

17

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)

18

• 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)

19

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

20

• 3. RTW plans should not disadvantage
• thers 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

21

• 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 coordinator

22

• 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)

24

• 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

25

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

• f 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) 26

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)

27

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

28

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)

29

Resources Continued…

30

• 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

34