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Health First In The Workplace
- 1. Dr Peter Sharman – MBBS FAFOEM FAICD Consultant Occupational Physician “Health First” in the workplace Evidence-based interventions to facilitate recovery and RTW for employers
- 2. Abstract Over the last 10 years the evidence base about the factors that influence recovery and RTW has grown substantially. The workplace is the single greatest influence on RTW outcomes. Workplace factors are more influential than scheme factors, case/claims management and individual factors. The evidence about modifiable psychosocial factors provides opportunities for workplaces to improve outcomes for work injuries and reduce associated costs.
- 3. About this workshop This presentation covers: 1. The context of workplace interventions amongst overall strategies to improve RTW outcomes 2. The evidence about workplace interventions 3. Evidence-based interventions in the workplace
- 4. 1. The big picture - workplace interventions within an overall strategy
- 5. The Australasian Faculty of Occupational & Environmental Medicine (AFOEM)
- 6. Occupational Medicine – a definition ……………..provides scientific understanding, knowledge and skills essential to the development of evidence-based systems to: manage workplace health and safety risks, promote worker health, and facilitate the recovery and rehabilitation of those whose health is adversely affected by their work.
- 7. Tasmanian Foundation for Occupational Medicine (TFOM)
- 8. AFOEM Initiatives 2001 - 2021 2001 “Compensable Injuries & Health Outcomes” 2011 “Realising the Health Benefits of Work” “The Health Benefits of Good Work” Agenda 2021 “It Pays to Care”
- 9. The State of Play - 2001 “Although most people who have compensable injuries recover well, a greater percentage of these people have poorer health outcomes than do those with similar but non-compensable injuries.” However “Research into causes of poor health outcomes for these people is fragmentary and inconclusive. Not enough is known of the effects of different types of compensation schemes or different methods of management of cases (by all practitioners involved) to allow the development of a ‘best practice’ model.”
- 10. Health Benefits of Good Work - 2011 “prolonged work absence and worklessness are associated with higher rates of isolation and depression, reduced income and increased rates of multiple health conditions” “brought stakeholders together to better understand how good work can be part of recovery from injury and illness”
- 11. It Pays to Care Principles of Healthy Injury Insurance Schemes * 1. Leadership 2. A culture of collaboration 3. Fairness 4. Health of workers is the priority 5. Active and responsive management of individual cases 6. Effective Communication 7. Long term thinking * AFOEM “It Pays to care” Draft discussion paper 2021.
- 12. Psychosocial factors – what are they? Not only the worker! Factors include: * The Compensation System * The Workplace * The Individual worker
- 13. Compensation System factors * Perceptions of fairness Disputes and claims investigations Poorly managed independent medical examinations Delays Loss of control * AFOEM “It Pays to care” Draft discussion paper 2021.
- 14. Workplace factors * Unsupportive supervisers or co-workers Low job satisfaction Disputes Availability of modified duties Concern about lodging a claim * AFOEM “It Pays to care” Draft discussion paper 2021.
- 15. Personal factors * Beliefs about pain and illness Recovery Expectations Anxiety, depression or post-traumatic stress disorder (PTSD) Low motivation to return to work Fear avoidance beliefs/behaviours Catastrophising Active coping and self-efficacy Loss of self-identity due to role loss Past history of adverse childhood experiences Personal stressful life events, such as divorce or relationship breakdown, the death or illness of a loved one, etc. * AFOEM “It Pays to care” Draft discussion paper 2021.
- 16. 1. Leadership 2. A culture of collaboration 3. Fairness 4. Health of workers is the priority 5. Active and responsive management of individual cases 6. Effective Communication 7. Long term thinking Principles of Healthy Injury Insurance Schemes
- 17. Leadership Regulators and insurers set the tone and standards for schemes Regulators & policy makers are seen to be independent from the insurer they are regulating Scheme participants are actively engaged in shared goals of worker well-being and RTW A consultative, open and transparent approach is adopted
- 18. Leadership (2) Scheme approaches that foster trust are actively pursued by scheme leaders, including: Fair application of the rules Abuses of the scheme, whether by workers, employers or service providers, are promptly identified and resolved to safeguard stakeholder trust in the integrity of the scheme In the workplace, senior managers set the tone and culture and are in a postion to lead in their organization to achieve better RTW results
- 19. Culture of Collaboration A high level of trust, or social capital, results in less disagreement and disputes, streamlined communication, reduced requirements for written or legal documents and a higher level of engagement Work injury schemes operate more smoothly and return to work is more likely when parties have a level of trust in each other Case management systems underpinned by positive communication between stakeholders improve RTW outcomes and reduce costs Collaboration in the workplace is equally, if not more, important
- 20. Fairness Quality decision-making Based on all relevant information Collaborative Worker input Emphatic and understandable decision communication Fair processes Transparent and understood processes Fairness across the scheme Not only workers, but Employers, treating practitioners and scheme participants generally
- 21. Health First Evidence-based treatment Identification of psychosocial barriers Access to range of providers to manage identified psychosocial barriers Treating practitioners have sufficient time to focus on advice and explanation GP’s have access to occupational medicine support for more complex cases Cultural factors and belief systems are taken into account Treating practitioners consider their role is clear and their opinion respected
- 22. Active and responsive management of individual cases Case management: is procedurally fair, timely, proactive and supportive allows supportive early communication with the worker and employer Fairness in reviews, such as IME’s, decision making and communication with scheme participants Attributes and skills of an effective case manager: Interpersonal skills to enable positive interactions with people in difficult situations Ability to influence multiple scheme participants through verbal and written communication RTW focus; facilitation, problem solving & conflict resolution skills Organisational and administrative skills
- 23. Active and responsive management of individual cases (2) Support Structures to Enable Effective Case Management Manageable caseload Training, including “soft skills” – active listening and effective communication Low staff turnover to foster continuity of relationships Effective IT systems Access to subject matter experts
- 24. Effective Communication Timely access to clear and appropriately-presented information about processes, rights and responsibilities Communication that is respectful, relevant and regular User-friendly written material in language that is clear for the worker’s literacy or familiarity with English and culture Two-way communication Active listening, regular contact, responsive communication
- 25. Long Term Thinking Valuing a skilled workforce Case managers Supervisors RTW Co-ordinators Medical and treating practitioners Research Implementation research to identify how systems can be more effective and efficient
- 26. “It Pays to Care” – Main Messages TWO major reforms are required: 1. Systematically capture psychosocial information for individual claims and proactively mange psychosocial risk by providing injured workers, workplaces and treatment providers with timely support according to need 2. Ensure that scheme cultures, systems and processes do not create unnecessary barriers to recovery, but instead encourage positive psychosocial factors e.g self-efficacy, whilst reducing negative psychosocial factors e.g. perceptions of unfairness
- 27. 2. The evidence about workplace interventions
- 28. Workplace Interventions – What is the Evidence? Key Research in Australia • Analysis of RTW Survey – Wyatt & Lane 2017 • Public Health System Intervention (WISE Study) – Nicholas et al 2019 • Multi-industry intervention – Iles et al 2012
- 29. Analysis of RTW Survey
- 30. Analysis of the RTW Survey Results “workers who considered their employer’s response to their claim to be fair and constructive had 43% higher RTW rates for physical injury cases and 52% higher RTW rates for psychological injury cases than those who reported unhelpful responses from employers”
- 31. The WISE STUDY
- 33. Iles, Wyatt and Pransky 2012
- 34. Overview Effect of providing professional case management support across businesses and industry Over the course of the intervention, average days off work dropped 58% amongst the workers who received specialized case management support
- 36. 3. Practical evidence- based interventions in the workplace
- 37. Key workplace elements of evidence informed approaches RTW planning and modified duties that accommodate work restrictions; The tone and timing of response to injury, with clear benefits seen when there is early, constructive contact with the worker; Quality of interactions and relationships with supervisors, RTW co-ordinators and colleagues; and Level of injury management knowledge, reporting and leadership amongst senior managers
- 38. Applying the Principles in the Workplace Understanding the Evidence relevant to the workplace Leadership in the workplace Improvement in injury management knowledge and leadership for senior managers. Collaboration Fair processes Trained supervisors and RTW co- ordinators
- 39. Systems in the Workplace Prevention, Prevention & more Prevention Collaborative arrangement with insurer based on mutual respect and understanding Initial injury response with prompt claims handling, employee support & non-judgemental response to claims Quality interactions and relationships with supervisors, RTW co-ordinators and colleagues RTW planning & availability of suitable work
- 41. Main Messages – GET ENGAGED! As an employer you can have a major influence on claims outcome The relationship with your insurer is critical; but that doesn’t mean you “handball” everything to them even though the legal framework gives the insurer ultimate control of a claim under their Policy Your organization bears the ultimate cost, whether: Future WC premiums Employee morale & turnover Future WHS performance
- 42. A “Health-first” Strategy Nearly Everything is governed by a legal framework You need to understand that framework – but don’t rely on that framework to get the best outcome for you How you approach a problem has a major influence on the outcome Maintaining relationships within organizations is important Keep the impact on “health, well-being and relationships” at the forefront of your thinking
- 43. Ackowledgements WorkSafe Tasmania & WorkCover Tasmania Board Mary Wyatt & AFOEM Colleagues Alex Collie, Malcolm Sim & Monash University colleagues Genevieve Grant Dr Barry Gilbert
Editor's Notes
- This diagram from Dr Mary Wyatt paper summarises the benefits in terms of claim duration and costs comparing the WISE protocol to usual care.