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

Workers’ Compensation Regulator Which workplace interventions really work? Dr Venerina Johnston 14 May 2015

Presenter: Dr Venerina Johnston 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. 2

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

Insurer measures of RTW in QLD 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 In 2013-2014: 92,007 claims accepted; Average days lost 47.8 days; Average cost of a time lost claim was $16,358 https://www.worksafe.qld.gov.au/forms-and-resources/statistics/workers- 6 compensation-regulator-statistics-reports2

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 7 nal-return-to-work-survey

Australian RTW Statistics 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 Australia & New Zealand Return to Work Monitor 2011/12 www.campbellreserarch.com.au

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? For every £1 Direct benefit US $2,366 CAN $18,585 invested would to cost ratio of per worker at per worker return an 6.8 6 mths estimated £26 Proactive Integrated care Combined Multi- Insurance – participatory clinical & disciplinary case ergonomics occupational coordinated management with intervention care with supervisor, workplace graded activity ergonomics Loisel et al Bultmann et Arentz et al Lambeek et al 2002 CA al 2009 DK 2003 SW 2010 NL 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 other 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 Employer makes an offer of modified work so injured worker 2. 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. Supervisors are trained in work disability prevention; 4. 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 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

Chances of RTW diminish the longer a person is off work The role of the workplace in return to work Discussion Paper, WorkCover SA, March 2010 20

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 21

4. Supervisors are trained in work disability prevention Employer – adhere to policies, manage costs, maintain productivity Supervisor Communicate with health Support IW, manage co- providers, workers insurers, case manager, RTW 22 coordinator

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

7. Employers and health care providers communicate • 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) 25