Transcript Power to the employee and employer – what the research says Dr Mary Wyatt.

Power to the employee and employer –
what the research says
Dr Mary Wyatt
Workplace culture
VWA data – claims by industry
Communication
12000
Community Services
10000
Construction
Electricity, Gas & Water
8000
Finance, Property & Business
Services
Manufacturing
6000
Mining
4000
Public Administration
Recreation, Personal & Other
Services
2000
Trade
Transport & Storage
/0
5
20
04
/0
4
20
03
/0
3
20
02
/0
2
20
01
/0
1
20
00
/0
0
19
99
/9
9
19
98
/9
8
19
97
/9
7
96
19
19
95
/9
6
0
Unknown
Disability management
• Where have we been and where are we going?
Introduction
• 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 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?
The employee
The employer
• Positive messages about
musculoskeletal conditions
(sore body parts)
• Supervisor care
• Improving self-efficacy
• HR RTW coordinating
• Problem solving
• Systems in place
• Senior management leading
• Having all the players on side
The 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 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 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.
More positive beliefs
Change in mean (95% CI) BBQ
Mean BBQ Score
30
Victoria
29
28
27
NSW
26
1
2
Survey
3
Less back claims as a percent of all claims
Change in number of claims, 1993-4 to 1999-0
130%
Relative Number of Claims (1996/97=100)
Non-back
120%
110%
100%
Back
P=0.013
90%
80%
1993/94
1994/95
1995/96
1996/97
1997/98
1998/99
1999/00
Days compensated rate (days per claim-day)
Change in rate of days compensated, 10/97 to 10/99
80
Slope = -1.2 days per 1000 claim-days per month
70
60
Backs
50
40
Non-backs
30
Slope = -0.41 days per 1000 claim-days per month
20
Month
P=0.0003
Problem 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
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▫
▫
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▫
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’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 interventions
Work status at 12 months
• GA = Graded
activity
• PST = Problem
solving training
• EDU = Education
Workplace 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 –
IWH systematic review
Components 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 management
• 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 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 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 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 approach
Expectations
Focus and time commitment
• Stakeholder endorsement of RTW
• However, there was little time and
focus invested in developing a
shared and collaborative approach
• 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).
• 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 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 supervisors
Study one - unpublished
Study two
• 1.4% absenteeism with
• 47% reduction in new claims
and an 18% reduction in active
lost-time claims
• Versus 27% and 7%,
respectively, in the control
group.
▫ RTW policy
▫ Case management
▫ Supervisor involvement
• 5.3% absenteeism without
them
• Programs have saved 20 40% on benefit costs
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
• Michigan study of employer practices demonstrated
senior management commitment had a strong
influence on reduced work disability
THE MICHIGAN DISABILITY PREVENTION STUDY RESEARCH HIGHLIGHTS
Upjohn Institute Staff Working Paper 93-18
H. ALLAN HUNT, W.E. Upjohn Institute for Employment Research
ROCHELLE V. HABECK, Principal Investigator Michigan State University
April 1993
Identifying the areas for improvement
Work disability management review
• Informal audit
• Injury Map
• Consensus Based Disability Management Audit
Informal 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
• Rigorously developed and
tested
• $2 million spent in
development
• Comprehensive approach
• Involves employees and
employers
www.nidmar.ca
• Varied instruments –
consensus based
discussion, surveys,
review cases, to assess
the situation
• Clear report on the 16
relevant areas, with
recommendations for
action
Uses
• 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
Benchmarking
• 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 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 website
Content:
Research
Resources
• Research that previously may have been
inaccessible or difficult to understand for
various stakeholders
• Resources that have been indentified by
stakeholders as important in effective return
to work strategies
Access:
Knowledge
Base
www.rtwknowledge.org
When access is available, feedback is invited while information
continues to be refined and improved upon
Knowledge Base Project
Committee & Team
• Committee:
• Project Team:
Mary Wyatt, ResWorks
Project Manager:
Robert Hughes
Janet Russell, Continuing Education Bendigo
Translation Team
Leader & Writer:
Mary Wyatt
Administration
/ Marketing:
Cheryl Griffiths
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
Knowledge
Base
[email protected]
Stakeholders
Employees
Health
Practitioners
Focus
Groups
Employers
Insurers
Content Development
Ideas
Translation
• Committee
• Identify research
• Project Team
• Multiple drafts
• Feedback
• Focus Groups
• Refinement
• International input and
collaboration
Table of contents
• Research
• Resources
▫ Medical factors and RTW
▫ Taking control series for
Employees & Employers
▫ Psychological factors and RTW
▫ Improving your effectiveness series
for Practitioners & Insurers
▫ Consequences of being off work
▫ Workplace factors and RTW
▫ Information on the processes /
timelines involved
▫ People factors and RTW
▫ Returning to work, effective return
to work plans
▫ RTW approaches and intervention
▫ Medical and health information
▫ Links / Glossary of RTW terms