Dr Venerina Johnston

14 May 2015

Workers’ Compensation Regulator

Which workplace

interventions really work?

Presenter: Dr Venerina Johnston

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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.

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

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Webinar Overview

1.Measuring ‘success’ of rehabilitation

2.Summary of evidence for workplace

interventions

3.Principles for successful RTW

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Measuring ‘success’

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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

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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-survey7

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%

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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

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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

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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.

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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

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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

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But what about costs?

CAN $18,585

per worker

Combined

clinical &

occupational

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

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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

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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

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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)

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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)

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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)

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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

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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

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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

coordinator22

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)

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• 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

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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

of 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)

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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)

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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

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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)

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Resources Continued…

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• 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

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