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BREADNER: UFHRD 2015 Working paper submission

Understanding the Knowledge to Action Gap with regards to the Early Enrollment in a Disability management program for Nurses’ in British Columbia, Canada

Author: Mary Catharine Breadner, MA, PhD Student, Simon Fraser University, Burnaby, British Columbia, Canada

Co-investigator: Lani deHek, Administrator - Enhanced Disability Management Program, British Columbia Nurses Union, Burnaby, British Columbia, Canada

Correspondence to: Mary Catharine Breadner, [email protected]

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mailto:[email protected]


Purpose: The purpose of this paper is to explore the theoretical underpinnings of a provincial disability management program in British Columbia, Canada. Specifically the early enrollment process for nurses is being implemented in their workplaces.

Design: A realist review was conducted to analyze the program to see if the program meets best practices. A qualitative evaluation of the program was used to identify how the early enrollment process can be improved.

Findings: The program does meet best practices and further interviews with enrollees need to be conducted to better understand how the program can be more effectively implemented.

Research limitations/implications: The results of this research is specific to the nursing and British Columbia context, it remains unclear if the findings will be generalizable or transferable to other settings.

Practical implications: Early intervention has shown to be effective in lowering permanent or long-term disability. The Enhanced disability management program meets best practices however the experience of enrollees in the program can help to improve the implementation process. Qualitative methods can help to understand and enrich quantitative evaluations.

Originality/value: This project is unique and the findings will be used to negotiate improvements to the EDMP program. The research will also improve supports and program collateral that will decrease the knowledge to action gap.

Key words: disability management, realist methodology, qualitative evaluation, program evaluation

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Introduction

Consistently research shows that translating evidence informed research into practice has been a

major challenge (Agency for Health Research and Quality 2001). Many organizations identify

best practices, develop programs or interventions that meet those best practices, but fail to see

the returns on investment. If the intervention were based on best practices than the in effect it

would be the context that would influence the outcome of the program (Pawson, et al. 2005).

Context would include organizational culture, the skill mix of employees expected to implement

the intervention, the relationship of workers to their employer, the labour relations environment,

there are endless examples of how context may be positively or negatively impacting the success

of an intervention. The idea of the ‘black box’ discussed in the strategic human resource

management filed (Becker & Huselid 2006). Strategic human resource management focuses on

the system, and its success, the black box is the personal touch or more specifically the HR

systematic design and the performance of an intervention (Becker & Huselid 2006). This paper

analyses a disability management program, designed using best practices, and the

implementation of this program province wide in British Columbia, Canada. What aspects of the

mechanism (the program) are successful in the given context (work environment) and how can

the success of this program be strengthened by improved implementation (Pawson et al. 2005).

This paper will discuss the program design, an introduction to a disability management

theory –the biopsychosocial model, the best practices as applied to disability management, the

results of the on-going research, and next steps in identifying the ‘black box’ of the intervention

at hand. More specifically this research has focused on the reasons for the delays in early

enrollment in the EDMP. Qualitative interviews with workers are the method used to determine

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the facilitators and challenges in the EDMP enrollment process. Once identified, the facilitators

and challenges will be used to develop targeting education and social marketing to address

enrollment barriers. Future research will be needed to further explore the impact of these

interventions.

The Enhanced Disability Management Program

Early intervention has been shown to play a role in reducing the duration of time away

from work due to disability (Ahlstrom Hagberg & Dellve 2013; Blackman & Chiveralls 2011;

Fisker Langberg Petersen & Mortensen 2013; Gardner Pransky Shaw Hong & Loisel 2010;

Johnston Way Long Wyatt Gibson & Shaw 2014). Communication is a key component to

establishing a relationship with a worker to support his/her recovery and to facilitate successful

early return to work (Nieuwenhuijsen et al. 2004). Supervisors are the first point of contact for

those who are struggling at work, and in most cases they are identified as the preferred contact

for someone who is back at - or trying to return - to work (Johnston et al. 2014).

The Enhanced Disability Management Program (EDMP) is a jointly administered

disability management program, implemented by the Provincial Health Employers Association

and the British Columbia’s Nurses’ Union. The first quantitative evaluation of EDMP, found that

there are still delays in nurses accessing or being referred to the program. There is a large body

of research that indicates that early intervention, in the form of disability management and

prevention programs can reduce the length and cost of disability claims (Loisel 2013).

Determining the reasons for delayed enrollment by nurses may help to develop program

modifications that will encourage early communication with the worker and their Disability

Management Professional, resulting in early enrollment in the program.

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History – Vancouver Coastal Health pilot

Vancouver Coastal Health (VCH) implemented the pilot feasibility study for the EDMP

in early 2008, in order to address the rising cost of absenteeism and disability. The program was

initiated with the intention to promote early identification of potential disability, and if possible,

interventions to prevent time away from work or to promote early RTW. Closely monitored by

some of the health sector trade unions, such as the BCNU, the early program evaluations seemed

to have positive results for both workers and employers. Based on these results, the unions and

employers jointly negotiated a program.

British Columbia Nurses’ Union

The program was negotiated as part of collective bargaining, and was included in the

collective agreement for the BCNU in 2012-2014 agreement. The program is jointly

administered and seeks to support workers while they are still at work or need support to

successfully RTW. The program participants can include both full-time permanent workers, as

well as casual or part-time workers. EDMP can be accessed at no cost to the worker. Workers are

referred in the following circumstances:

• If the employee is off for work for a work related injury or illness. The employee will

be referred on the initial day off work; or

•The employee has been absent for 5 consecutive shifts for a non-work related illness or

injury.

These referral stipulations are directed at regular full time workers. If the worker chooses not to

engage with the program he/she must provide the employer with a bona fide reason to decline.

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Casual workers must self-refer to the program. Regular workers may also choose to participate

without being referred if they need accommodation but do not meet the referral criteria. Once an

employee (regardless of status) has been enrolled in the program, he/she must participate unless

there is a bona fide reason to withdraw. Referrals to the program can also be made from: the call-

in attendance system, a union representative, the management, the workers compensation board

(WorkSafeBC), the health benefits provider or long term disability insurance provider. The

intake process is meant to be unrestrictive and to support the employee throughout the process of

returning to full duty (Nurses Bargaining Association 2012).

The initial referral is made to a Disability Management Professional (DMP), resulting in

an initial consultation with the worker to assess the barriers faced by that individual that will

impact successful RTW. The initial referral should also include contact an EDMP representative

so they can become involved in case as well. The DMP is often the first point of contact for a

worker, other than their supervisor. Barrier assessment is a holistic process, meaning that

although the worker may have presented with a specific disability issues, the DMP works with

the employee to understand all of the potential impediments that will influence their ability to

RTW. Barriers can be categorized by four components: Medical, personal, workplace, or

vocational. The employee may (and often does) face multiple barriers. For example, a medical

barrier may relate to their illness or injury, but they might also be facing personal hardship such

as a divorce, or a workplace barrier like the low number of electronic lifts to move patients from

bed to bed. They may also face a vocational barrier such as lack of training on new computer

software, which is significantly increasing their charting time. The consultation process is

intended to identify all relevant barriers. By establishing this holistic approach early on in the

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process, the DMP and EDMP representative can develop a Holistic Case Management Plan

(HCM) that will support the employee with all the challenges that they may be facing.

The initial consultation also acts as a baseline assessment of the appropriateness for

enrolment in the program. If the candidate is determined not be in a suitable position to enroll in

the program, their case will be re-evaluated in 30 days. In some cases the employee is not a

candidate for the program due to the nature of their illness or injury. It would also be at this time

that the employee might provide their bona fide reason to decline participation. The DMP may

also identify that the employee is already seeking treatment and is expected to make a full

recovery without needing support from the program. In this case there will be a follow-up, but

the worker is not enrolled in the program. This will also allow the DMP to identify any labour

relations issues that may impede successful RTW. If a labour relations issue is detected, the

DMP will organize a follow-up meeting with a union representative to establish next steps.

The next step is to create a HCM plan; this plan is tailored specifically to the worker and

includes milestones as well as expected outcomes for the successful RTW. It also includes

details about what other stakeholders may be required to participate. The DMP acts as the

facilitator with the employee to help them with the process. The enrollment in the program does

not end until the employee is successfully reintegrated back to full duty, and maintains this status

to a point where the DMP is satisfied that the chance of relapse is comparable to those workers

with no history of disability.

Other sectors

Although this research will specifically focus on the nursing sector, it should be noted

that other bargaining units with the HEABC have also negotiated the EDMP. Notably the Health

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Sciences Association (HSA), the Health Care Employers Union (HEU), the British Columbia

Government and Service Employees’ Union (BCGEU), as well as a number of smaller unions

that are members of the facilities bargaining association. Similar quantitative evaluations of the

program are also being undertaken by HEABC with those respective bargaining agents. It is

hoped that the qualitative findings of this research might offer some transferable findings to other

bargaining sectors.

Disability Management Programs Components

Up to this point in the paper I have discussed aspects of the context and mechanism,

which have a direct effect on the EDMP. This section will more broadly consider the theory of

disability prevention in the workplace. Loisel et al. (2013) present disability prevention as an

emerging field, which expands the previous notions of RTW, broadening the scope to include the

SAW phase, which helps workers with an injury or illness to avoid any time away from the

workplace. I will start with a discussion about this phase and how it impacts the RTW process.

Presenteeism is defined as the presence of an ill or injured person in the workplace who

continues to carry out his/her duties. The ability for employers to identify and address

presenteeism before it leads to absenteeism provides opportunities to manage disability issues

before they lead to absenteeism. RTW is the second component. It has traditionally been the

focus of disability management, and is most closely linked to the medical model discussed

earlier. And the third is the Remain in Work (RIW) phase. This phase is the maintenance or

sustainability phase of successful RTW outcomes.

Work disability prevention is often misinterpreted as injury prevention. Occupational

Health and Safety (OHS) interventions which attempt to prevent an injury from occurring, such

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as a fall prevention program or needle-stick prevention initiative, both would fall into the

concept of primary prevention. Traditional occupational health and safety intervention have

focused on this type of prevention. The “goal of work disability prevention and management is

not to fix a disorder or take care of an illness. It is identifying and effectively addressing the

determinants of work disability at the personal (physical and psychological), workplace, and

societal levels through evidence-based interventions” (Loisel et al. 2013, Preface, p.ix-x). The

distinction is that work disability prevention research focuses on the interventions that lead to

better outcomes in both preventing permanent injury, while at the same time aiding injured

workers back to work so they can continue to participate as active members of the workforce.

In order to contextualize the next three section of the paper, I have adopted a phase

approach to disability (de Rijk 2013). The phase approach to disability management is the idea

that RTW progresses through specific ‘phases’ that progressively allow workers to RTW. The

phases are often sequential, much like I have outlined in this paper – stay at work (SAW), return

to work (RTW), and remain in work (RIW). De Rijk (2013) also points out these phased models

are generally context specific; each phase has goals, actions, and outcomes. The EDMP follows

this approach, and therefor it was deemed appropriate that the review should be incorporate

relevant literature as it applies to each of the three phases.

Stay-at-work, Early intervention, and Prevention

The SAW phase can be conceptualized as a secondary phase of prevention. The focus of

SAW is to ensure that an injury or illness does not become a permanent disability. The focus

now becomes preventing a disability not preventing the initial injury, injury prevention is

traditionally the focus of occupational health and safety (OH&S) policy, for example a hardhat

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policy at a construction site. The concepts are focused on preventing permanent disability by

acknowledging current disability status. It is difficult to identify the exact point where something

becomes disability prevention as oppose to primary prevention and vice versa. There are

examples where the disability was not preventable. However from the OH&S literature it is

extremely important to conceptualize the distinction, and also to be able to address disability

prevention. That being said, the concept of SAW is early identification of a potential disability

where temporary accommodation or transitional work status may be required. The focus at this

stage is to provide workers and employers with the tools (program resources) required to prevent

time off work. It is also worth noting that this stage of the program is heavily reliant on either:

(1) the ability of the worker to acknowledge their own disability and potential need for

accommodation (not to mention the need for there to be channels for the worker to report this

need without fear of negative labour repercussions); or (2) the ability of a skilled supervisor to

identify a worker who is expressing performance issues that may be linked to an illness, injury or

disability and may benefit from early intervention. As one can deduce from the two conditions

presented above there are multiple factors acting within a complex system that may make

meeting these two condition difficult.

Supporting the notion of RTW coordinators, Ahlstrom, Hagberg, & Dellve (2013)

suggest a multidimensional approach to disability prevention. Ill or injured workers need

flexibility at the individual and organizational level. If workers are supported appropriately they

may be able to work with a disability. Quality of work and the culture of the workplace

inherently are playing a role in this phase as well. Nicholson (1977) discuss absenteeism as a

decision process to SAW made by the worker. There is a risk that looking at SAW strictly as a

personal decision, as it may become worker blaming, instead of reviewing the other factors that

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are impacting the decision to or not to work. De Rijk (2013) referred to these as decisional

theories. To be absent is negotiated through individual worker factors (psychological) as well as

social factors such as job security.

The fear of stigma and punitive actions can be a concern for many workers who might be

in need of early intervention. As Boot et al. (2013) discuss “[d]isclosure is needed to start a

dialogue on work adjustments, but employees may be worried about negative side effects of

disclosure.” (p.205). Supervisors need to be well versed in the potential resources of the

program, as well as knowledgeable of workplace policy, workers compensations’ board policy

legislation, and privacy laws. Work adjustments are tools to preventing time off work, and need

to be implemented as a prevention tactic rather response to disability (Boot et al. 2013). The

foundation of this phase is building a workplace culture, which promotes disclosure, ensures

confidentiality, and protects workers’ rights. Unless workers have a belief that their case will be

met with fair accommodation it is understandable that they would be apprehensive about

disclosure.

Presenteeism

Presenteeism is an essential part of early intervention, workers often report to work when

ill before their illness or injury becomes so server that they must miss work. This section of the

paper is to highlight how presenteeism is defined, and what opportunities may exist to measuring

it and ultimately addressing it in the workplace.

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Return-to-work and the biomedical model

The RTW component of any disability management program is the most well researched

area within the field of disability management. It also has inconsistency when being defined,

“RTW in research and practice may vary widely and depend upon the disability stakeholder”

(Schultz et al. 2007, p.330). It has, historically, been the focus, and evolved from the medical

perspective that disability needs to be cured so the individual may return to

post-injury/illness/disability working status. More recent research has started to identify factors

that may relate to successful RTW, such as: high life satisfaction, a high sense of coherence to

the workplace, work-life balance, meaningful work, meaning activities outside of work, and

social support at and outside of work (Ahlstrom Hagberg & Dellve 2013). From the list

identified, one can immediately infer that some of these factors are outside the employers’

control, and to what extent can employers realistically address some of these issues. It is also

evident that many of these factors lie outside the role of the healthcare system—meaning

successful RTW practices require the integration and support of many different systems. Anner

et al. (2012) state that “[p]rofessional guidance to insurance physicians from an increasing

number of countries keeps stressing the importance of the benefits of the framework and

discourages a traditional biomedical approach that simplifies disability as a specific state of

health” (p. 3). Schultz et al. (2007), also point to the relationship of the biomedical model and

RTW when workers do not respond to medical treatment. If they fail to respond to medical

treatment, they may be seen as having a mental health issues or not being honest about their

illness. In other words they are choosing to remain off work even though they may be able to

resume their normal duties. Workers, who lack objective diagnosis from a laboratory test or

definitive diagnosis, may be seen as dishonest malingerers or workers who are exaggerating their

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pain (Schultz 2007). The ability to achieve a biomedical state of physical health fails to

recognize the other ecological system influences that disability has on the overall human

experience.

Research has also investigated the associations between perception of one’s health status

and their expectation for RTW (Braathen et al. 2014). They explain that, “factors at the

workplace, in the family, or in the labor market are important in the formation of RTW

uncertainty.” (Braathen et al. p.6). Other factors such as stressful work environments and low

job satisfaction are also predictors of low rates of successful RTW (Huang et al. 2002; Grunfeld

et al. 2008). The inability to make decisions about work or task control on the job has also been

shown to impede RTW as well (Amick et al. 2000; Karlsson et al. 2010). All of the examples

provided above are outside the medical needs of people with disabilities. The conclusion to be

made is that there are interventions that can improve RTW success without discussing specific

elements of an individual disability.

The differing perspective of the employer, the worker, and the health care provider are

areas that need to be considered. How can employers, health care providers, and workers

facilitate a more positive experience for all those involved? The need of individuals for specific

accommodation or transitional work is a requirement but there are many other external factors to

the individual that are also important. (Amick et al. 2000; Carayon & Smith 2000). The

conclusion is that the movement away from the medicalization of disability may in-turn promote

greater inclusion and social benefits to individuals.

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Remain in work, the maintenance phase, or the reintegration process

The final phase to an HCM RTW paradigm is the RIW or maintenance stage, meaning

that programs need to support the sustainability of workers to tolerate the workplace and prevent

reoccurring or acute relapse. Madans Loeb & Altman (2011) suggest a temporal component to

disability in their assessment of the past, present and future outcomes associated with disabilities

and individuals interactions with their environment (physical, social, etc.). Anner et al. (2012)

reinforce this notion affirming “[d]isability is a process rather than a state.” (p. 3). The number of

reoccurring absences of workers who RTW and subsequently require future time off is a major

concern, especially in those workers with mental health diagnosis (Arends et al. 2014). Arends et

al. (2014) state that “recurrent sickness absence after an initial sickness absence episode due to

CMDs [common mental health diagnosis] is often more serious and long-lasting.” (p. 21). The

RIW stage has largely been under researched, and evidence shows that recurrent injury is

associated with substantial individual, organizational, and societal burden (Ruseckaite & Collie

2013).

Arends et al. (2014) also showed that continuous attention is needed in the post-RTW

phase, however the length and extent of this follow-up-period was not determined. The RIW or

sustainability phase of RTW is not well described in the literature (Boot et al. 2013). And while

absences from work are important measure, Buck et al. (2011) allude to the measurement

problems and issue around measuring presenteeism, and the possible lack of evidence

documenting this for all workers. Costa-Black, Feuerstein, & Loisel (2013) point towards

another common notion that exists within the disability management field “[w]ork can be the

psychosocial vehicle to “recover” from an illness/injury” (p. 77). The lack of research looking at

the sustainability of RTW also speaks to the lack of evaluation research specific to HCM

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programs. It would seem that as more HCM programs are implemented the more we will learn

about this later stage.

Work reintegration (WR) process is another term that is used in the literature when

looking at a person’s ability to reach a full RTW. In a recent study it was found that “[c]o-

workers are not a neutral party in the WR process” (Dunstan & MacEachen 2013a, p.44,). The

study suggested that there is a need not only to include the co-workers in the RW process, but to

also formalize their role within the plan. The role of the co-worker is a crucial part of the

workplace environment, and it is important to recognize the significant role they can play. It is

also important to note that many times co-workers are expected to cover for lost work while

others are away. This can lead to resentment and also be difficult to change once the injured or

ill worker returns to the workplace. Co-workers also have the greatest contact with workers

before and after their time away, suggesting that the need to include them in the RIW plan is

vital to creating a welcoming and positive atmosphere (Dunstan & MacEachen 2013a). It has

also been shown that the WR process must be seen as fair by co-workers (Dunstan &

MacEachen, 2013).

The EDMP program does not specifically address the need to integrate the co-workers

into the plan, however it does not exclude them either. It may be important to highlight the

importance of this recent research so it may be incorporated into the HCM plans. It may also be

of interest for the qualitative evaluation research to explore the role of the co-worker during each

of the phases. The RIW process would potential be impacted by overall workplace culture and

therefore extremely contextually based.

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Theoretical base

The EDMP is based on the theoretical underpinning of the biopsychosocial model (Adler

2009), which promotes the holistic case management approach to disability. The holistic

approach attempts to ensure that workers are supported through all phases of the return-to-work

(RTW) process and that they are provided with appropriate resources to address the

psychological, social, and medical barriers they face during the RTW process. The EDMP also

broadens the scope of traditional RTW reintegration to include early enrollment for nurses who

are struggling at work. This paper focuses on this aspect of the EDMP.

The knowledge translation (KT) focus of the study will use the engagement paradigm

(Bowen & Graham 2013). The engagement paradigm, based in the social sciences, approaches

KT from a collaborative perspective and focuses on the work process with an emphasis on

managing change effectively (Bowen & Graham 2013). The research project was co-developed

with all stakeholders as equal partners, drawing on expertise from both academic disciplines and

professional experience. The collaborative process was essential to engaging and participation

throughout the project. This collaborative approach is an important part of this work.

The study is unique to the BC and the nursing context with regards to understanding the

role of the EDMP and the early enrollment of nurses who are struggling at work. Its research

findings will help to improve early enrolment of nurses across the province. It may also have

implications for other healthcare workers who are also eligible for the program through their

workplace collective agreements.

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Research purpose

The purpose of this project is to explore the early enrollment process for nurses in the

EDMP. EDMP representatives, disability management professionals, human resource

professional and nurses have experienced the enrollment process in different ways, and have

different understandings concerning how the process is being implemented in their workplaces.

Identifying the knowledge-to-action gaps led to the development of interventions specific to the

units and workplaces that data collection took place. We implement these interventions, and

conducted interviews post implementation to see if our intervention successfully addresses this

knowledge to action gap.

The aim of this project is to identify how the BCNU and Health Authorities can improve

the uptake of the EDMP by front line nurses who are struggling at work. More effective early

intervention (achieved through enrollment to the EDMP) may reduce absenteeism, disability

claim duration, labour turnover and overall employment costs. It should also provide improved

outcomes for nurses. The research achieved a better understanding of what types of changes to

the current EDMP processes or program may improve the early enrollment uptake and thus help

workers who are struggling at work access the support services they need.

Research question

A qualitative design for this study because the aim is to explore the meanings,

experiences, and challenges that prevents early enrollment and access to the program. The main

question is trying to identify ‘what aspects of the program encourage or discourage nurses to

enroll in the program?’. Best practices have been followed in the development of the program

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but the implementation and enrollment seem to be affecting the effectiveness of the program as

has become evident from the quantitative evaluation.

The use of a collaborative community based knowledge translation strategy that included

community partners (HEABC/Health Authority/BCNU) being involved in identifying the

problem, developing the research question, and proposing possible methodology, meant that

there was flexibility at each stage of the research process. The participatory aspect of the project

was adapted to ensure that the needs of the participants were included at every step.

Implications for practice

Research evidence that shows positive outcomes is not commensurable to achieving

outcomes in practice (Straus & Holroyd-Leduc 2008). Practitioners are not working in the

isolated parameters of research studies; they are working in the ‘real’ world, a place with

expected and unexpected variables, measurable and immeasurable vectors. The implications of

this research are to highlight how the experience of participants in an intervention can be used to

inform the implementation. Understanding the ‘black box’ of the EDMP in order to support

better implementation of the program.

The findings are specific to nurses’ in British Columbia, however the method of

understanding the context (i.e. the black box) of this intervention can be applied to many

different program evaluations. The findings of this research highlight the need for mixed

methodology when evaluating programs, quantitative results are not adequate in exploring the

many factors affecting program implementation. Specifically, the findings of this project will be

used to negotiate changes to resourcing and processes of the EDMP. The findings are also

important for other health care workers in the province beginning to implement or considering

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the adoption of the EDMP. Because this program was only implemented in 2012 for nurses’ the

Union is committed to working on improving the program on an annual basis. From a research

perspective there are many lessons that may be transferred to other contexts or jurisdictions. The

dissemination of this research may improve the development of new disability management

programs, as well as inform practitioners about other disability management strategies.

Supervisors are the front-line implementers of this program, training and resources to

supporting the program need to be filtered down to front-line workers. Even if the program was

developed using best practices if those involved in implementing the program are uninformed of

best practices, or their roles and responsibilities to adhere to best practices, the program will face

significant challenges in achieving positive results.

Public sector policy, in Canada the socialized health care system, would see

improvements to labour costs if they were able to effectively manage disability, and proactively

prevent permanent or long-term disability (Loisel 2013). The prevention of disability also

protects the individual from experiencing significant losses in income, social losses, and

psychological distress. Policies such as the EDMP, suggests that the adoption of this would

benefit all workers, and could be considered as a provincial legislative initiative. For example,

Colorado State, USA, has legislated the biopsychosocial approach through its workers

compensation act. This legislation has been in place for almost 15 years, and the impact has been

positive (Bruns Mueller & Warren 2010). The legislative approach has had an impact in building

capacity for preventing disability on the population level, and it will continue to be an important

case to consider as the longitudinal effects of the legislation are evaluated in future research.

This project does have significant learning opportunities for Human Resource Managers

and Labour Relation Professionals in British Columbia the generalizable findings from this

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research have not been explored. It is thought by the authors that meta-theoretical concepts might

be transferable to other health care workers in Canada.

Conclusions

The EDMP was developed informed from evidence based best practice research. The

infrastructures of the program, and the institutions involved have the best intentions on

preventing and managing disability. The interpersonal relationships and individuals involved in

the implementation of the program are having a significant impact on the overall success of

EDMP. Supervisors play an important role in the enrollment process of nurses to the EDMP, and

the early enrollment is a key component to prevention. Supervisors also provide much needed

social support for those people that are struggling at work. Implementation of disability

management programs requires a supportive organization and a supportive workplace culture.

Larger scale future research needs to focus on how to support the early enrollment process, and if

training or specific resources are needed to have positive program outcomes.

References

Adler, R H 2009. Engel’s biopsychosocial model is still relevant today. Journal of Psychosomatic Research, vol. 67, no. 6, pp.607–11. doi:10.1016/j.jpsychores.2009.08.008

Agency for Health Research and Quality 2001, Translating research into practice (TRIP)-II.Washington, DC: Agency for Health Research and Quality. Retrieved from: http://www.ahrq.gov/research/trip2fac.htm

Ahlstrom, L, Hagberg, M & Dellve, L 2013, Workplace rehabilitation and supportive conditions at work: a prospective study. Journal of Occupational Rehabilitation, vol. 23, no.2, pp. 248–60. doi:10.1007/s10926-012-9391-z

Amick, B C, Habeck, R V, Hunt, A, Fossel, A H, Chapin, A, Keller, R B, et al., 2000, Measuring the impact of organizational behaviours on work disability prevention and management. Journal of Occupational Rehabilitation, vol.10, no.1, pp. 21-38.

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Anner, J, Schwegler, U, Kunz, R, Trezzini, B, & de Boer, W 2012, Evaluation of work disability and the international classification of functioning, disability and health: what to expect and what not. BMC Public Health, vol. 12 no.1, pp. 470. doi:10.1186/1471-2458-12-470

Arends, I, van der Klink, J J L, van Rhenen, W, de Boer, M R, & Bültmann, U, 2014, Prevention of recurrent sickness absence in workers with common mental disorders: results of a cluster-randomised controlled trial. Occupational and Environmental Medicine, vol. 71, no.1, pp. 21–9. doi:10.1136/oemed-2013-101412

Arnetz, B B, Sjögren, B, Rydéhn, B, & Meisel, R 2003, Early Workplace Intervention for Employees With Musculoskeletal-Related Absenteeism: A Prospective Controlled Intervention Study. Journal of Occupational and Environmental Medicine, vol. 45, no. 5, pp. 499–506. doi:10.1097/01.jom.0000063628.37065.45

Becker, B E, & Huselid, M A 2006, Strategic human resources management: where do we go from here?. Journal of management, vol. 32, no. 6, pp. 898-925.

Blackman, I, & Chiveralls, K 2011, Factors influencing workplace supervisor readiness to engage in workplace-based vocational rehabilitation. Journal of Occupational Rehabilitation, vol. 21, no.4, pp. 537-546. doi:10.1007/s10926-011-9297-1

Boots, C R L, van den Heuvel, S G, Bültmann, U, de Boer, A G E M, Koppes, L L J, & van der Beek, A J 2013, Work adjustments in a representative sample of employees with a chronic disease in the Netherlands. Journal of Occupational Rehabilitation, vol. 23, no. 2, pp. 200–208. doi:10.1007/s10926-013-9444-y

Bowen, S & Graham, I 2013, Chapter 1.2: Integrated knowledge translation. Knowledge translation in health care: Moving from evidence to practice (Straus, S., Tetroe, J., & Graham, I., Eds.) Oxford, UK: Wiley Blackwell.

Braathen, T N, Brage, S, Tellnes, G, Irene, O, Chris, J, & Eftedal, M. 2014. A Prospective Study of the Association Between the Readiness for Return to Work Scale and Future Work Participation in Norway. Journal of Occupational Rehabilitation. doi:10.1007/s10926-013-9497-y

Bruns, D, Mueller, K, & Warren, P 2010, A Review of Evidence-Based Biopsychosocial Laws Governing the Treatment of Pain and Injury. Psychological Injury and Law, vol. 3, no. 3, pp. 169–181. doi:10.1007/s12207-010-9079-7

Byszewski, A M, Graham, I D, Amos, S, Man‐Son‐Hing, M, Dalziel, W B, Marshall, S. & Guzman, D 2003, A Continuing Medical Education Initiative for Canadian Primary Care Physicians: The Driving and Dementia Toolkit: A Pre‐and Postevaluation of Knowledge, Confidence Gained, and Satisfaction. Journal of the American Geriatrics Society, vol. 51, no.10, pp. 1484-1489.

Carayon, P, & Smith, M J 2000, Work Organization and ergonomics. Applied Ergonomics, vol. 31, no. 6, pp. 649-662.

21


Costa-Black, K, Feuerstein, M, & Loisel, P 2013, Chapter 6: Work Disability Models: Past and Present. Handbook of Work Disability. (P. Loisel & J. R. Anema, Eds.). New York, NY: Springer New York. doi:10.1007/978-1-4614-6214-9

De Rijk, A. 2013. Appendix: Work disability theories: A taxonomy for researchers. In: Loisel, P. & Anema, J., Eds. (2013). Handbook of Work Disability: Prevention and Management. Toronto, ON: Springer.

Dunstan, D & MacEachen, E 2013, Bearing the brunt: co-workers’ experiences of work reintegration processes. Journal of Occupational Rehabilitation, vol. 23, no.1, pp.44–54. doi:10.1007/s10926-012-9380-2

Dunstan, D & Maceachen, E 2013a, A Theoretical Model of Co-worker Responses to Work Reintegration Processes. Journal of Occupational Rehabilitation. doi:10.1007/s10926-013-9461-x

Fisker, A, Langberg, H, Petersen, T, & Mortensen, O S 2013, Early coordinated multidisciplinary intervention to prevent sickness absence and labour market exclusion in patients with low back pain: study protocol of a randomized controlled trial. BMC Musculoskeletal Disorders, vol. 14, no. 93. doi:10.1186/1471-2474-14-93

Gardner, B T, Pransky, G, Shaw, W S, Hong, Q, & Loisel, P 2010, Researcher perspectives on competencies of return-to-work coordinators, vol. 32, no.1, pp. 72–78. doi:10.3109/09638280903195278

Graham, I D, Logan, J, Harrison, M B, Straus, S E, Tetroe, J, Caswell, W, & Robinson, N 2006, Lost in knowledge translation: time for a map?. Journal of continuing education in the health professions, vol. 26, no. 1, pp.13-24.

Gunsfeld, E A, Rixon, L, Eaton, E & Cooper, A F 2008, The organizational perspective on the return to work of employees following treatment for cancer. Journal of Occupational Rehabilitation, vol. 18, no. 4, pp. 381-388.

Huang, G D, Feuerstein, M, & Sauter, S L 2002, Occupational stress and work-related extremity disorders concepts and models. American Journal of Industrial Medicine, vol. 41, no. 5, pp. 298-314.

Johnston, V, Way, K, Long, M H, Wyatt, M, Gibson, L, & Shaw, W S 2014, Supervisor Competencies for Supporting Return to Work: A Mixed-Methods Study. Journal of Occupational Rehabilitation. doi:10.1007/s10926-014-9511-z

Karlsson, M L, Bjorklund, C, & Jensen, I 2010, The effects of psychosocial work factors on productionloss, and the mediating effects of employee health. Journal of Occupational and Environmental Medicine, vol. 52, no. 3, pp. 310-317.

Kassier J, Korteland, A, & Pedersen, M 2014, Team power smart sparks increase in low-priority, repetitive behaviors. Social Marketing Quarterly, vol. 20, no.3, pp. 165-185. DOI:10.1177/1524500514541098

22


Lefebvre, R C 2011, An integrative model for social marketing. Journal of Social Marketing, vol. 1, no.1, pp. 54-72.

Loisel, P 2013, Handbook of Work Disability. (P. Loisel & J. R. Anema, Eds.). New York, NY: Springer New York. doi:10.1007/978-1-4614-6214-9

Madans, J H, Loeb, M E, Altman, B M 2011, Measuring disability and monitoring the UN Convention on the Rights of Persons with Disabilities: the work of the Washington Group on Disability Statistics. BMC Public Health, vol. 1, supplemental issue 4, pp. 1–8.

Nicholson, N 1977, Absence behaviour and attendance motivation: A conceptual synthesis. Journal of Management Studies, vol. 14, no.3, pp. 231–252.

Nurses Bargaining Association 2012, 2012-2014 Proposed Collective Agreement. Retrieved from: https://www.bcnu.org/ContractAdministration/NBA-PCA-AppendixA.pdf

Pawson, R, Greenhalgh, T, Harvey, G, & Walshe, K 2005, Realist review–a new method of systematic review designed for complex policy interventions. Journal of health services research & policy, vol. 10, supplementsl issue 1, pp. 21-34.

Ruseckaite, R, Collie, A 2013, The incidence and impact of recurrent workplace injury and disease: a cohort study of WorkSafe Victoria, Australian Compensation claims. British Medical Journal, vol. 3, doi: 10.1136/bmjopen-2012-002396

Schultz, A B, & Edington, D W 2007, Employee health and presenteeism: a systematic review. Journal of Occupational Rehabilitation, vol. 17, no. 3, pp. 547–79. doi:10.1007/s10926-007-9096-x

Straus, S E, & Holroyd-Leduc, J 2008, Knowledge-to-action cycle. Evidence Based Medicine, vol. 13, no. 4, pp. 98-100.

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