You've hear of Undercover Boss, what about Undercover Injured Worker?

Most of us are probably familiar with the concept behind the show, "Undercover Boss."  The removed CEO or owner of a large corporation changes their identity and goes "undercover" working as a new hire that needs to learn the ropes of the less than glamorous positions in the company.  They're stripped of the everyday luxuries and live in a motel room, etc. to experience what their lowest paid employees make -- all in an attempt to understand what it's like to work for their company.  The show is usually very emotionally charged, and ends with the CEO having a revelation that changes need to be implemented, improvements need to be made, and sometimes they even shell out thousands of dollars to help an employee pay for overwhelming medical bills or something of the sort. 

I propose that employers go to work as an undercover injured worker.

Before you diminish the value of a safety measure, process improvement, or a return to work (RTW) program -- put on a pair of the proverbial "someone else's shoes" or work boots and see what the experience is like to have a workers' compensation claim.

I guarantee the experience will be eye-opening.  It will open your eyes first hand to a system that is riddled with challenges, confusion, complexity and bureaucracy -- a system that was designed to be a no-fault system to promptly provide benefits to any person injured on the job.  What does your accident investigation feel like?  How well does your injury reporting process work?  How does it treat injured workers?  How do our employees treat injured workers?  How does RTW impact the injured worker?

You'll learn how coworkers and supervisors treat you -- maybe with respect, maybe with pity, or maybe with anger or suspicion.  You'll learn what it's like to receive confusing forms in the mail, feel the uncertainty of whether or not you'll get a check in time to pay your bills, and realize that life does not stop simply because you got injured.  You may be limited in returning to work but your supervisor determines that there's "no light duty" in your company.  You'll feel the isolation and detachment within a few weeks of being out of work.  The attorney commercials will get old quickly; the resentment may build between you and your employer because you want to come back to work, but aren't being offered work.  You'll feel that people don't believe that you're really injured.  You might even see a weird car parked outside of your house that you soon discover is a surveillance company hired to see if you're doing anything outside of your restrictions. 

Now, in this scenario, you're not truly injured -- as an undercover injured worker, you're lucky that you don't have to go through the physical pain that results from an injury.  You won't have to worry about how you're going to button your own shirt, make yourself dinner, find a position to sleep comfortably because you can't use your arm due to a shoulder injury.  Fortunately, you won't have to feel how tiring and exhausting constant, throbbing pain can be and how it takes a toll on your ability to cope with stress.  Luckily, you also won't have to experience the strain that it puts on your relationship with your spouse and/or children now that you can't fulfill all of the requests you used to, cooking a meal, doing the laundry, driving the manual transmission car-- you won't have to experience what it's like to give up a good bit of independence nor will you realize how much that impacts your psychological state.

When someone has an injury, it doesn't stop at the physical level.  It impacts the injured worker from a financial, social, psychological and physical level.  It impacts their relationships, their confidence in their ability to provide for themselves or their family, and their place in this world.

Thankfully, I've never experienced a work injury.  How do I know to write about all of this stuff?  It's called empathy.  I took the time to imagine what it must be like to go through this process.  We all like to say that "if it were me in that position I'd do X, Y, and Z" but you never know until you've experienced it firsthand.

I encourage all employers who are in the position to make decisions related to the safety and well-being of their employees to take 10 minutes out of their day, at least once a month, to consider the "other side of the coin" when making a decision, not just the coins associated with implementing a change or offering modified duty.

Can we agree on one thing...? Variance between providers' RTW recommendations

In a 2010 study of healthcare providers’ agreement related to return to work (RTW) capabilities, researchers found some areas of consistency and some, well, not so consistent (Ikezawa, Battie, Beach & Gross, 2010).  The aim of the study was to determine if there are differences between providers as it relates to the information providers use to make RTW determinations, and what their RTW determinations were for three different case scenarios:  fracture, dislocation, and low back pain.  The survey focused on collecting three types of information.  Participants were asked to determine the following:  if the person was fit to return to work, assess the physical demands of their job, address any restrictions due to injury, determine the injured workers’ work capacity, and make any other recommendations if they were deemed unfit to work.  The second part of the survey focused on what type of information the participants used to make their decision, as well as commentary on what type of information would have improved their ability to make these determinations.  The final section of the survey focused on demographic information about the participants (specialty, gender, age, years of practice, etc.).

Inquiring minds want to know! 

The results indicate that 97% of the providers were in agreement with each other regarding the RTW readiness case of the fracture (p. 370).  This is likely due to fractures being of clear cut pathology.  Similarly, 94% of the providers agreed with each other related to RTW readiness for the dislocation scenario (p. 370).  For the low back pain case (a nurse who had back pain for eleven months), providers were basically split as to whether the injured worker should return to work or not – 55.6%.  Of note, however, with regards to the back pain case, 56% agreed that RTW with restrictions was appropriate; whereas 44% believed RTW full duty was appropriate. 

What did the providers rely upon to make these determinations?

Not surprisingly, experience and training will influence a provider’s recommendations.  In this study, researchers found the providers relying mostly upon physical examination, current functional status, and occupational status (pp. 370-371).  Providers stated that functional capacity exam (FCE) results, information on availability of modified duties, and patient participation in an occupational rehabilitation program would help improve their ability to accurately address RTW opportunities (p. 371).

Another interesting point made in this study is that only a small percentage of providers considered the sustainability of RTW, motivation to RTW, recovery expectations, and guarding movements.  Not until more recently are practitioners focusing on the biopsychosocial, or multi-dimensional, aspects of RTW.  These differences in approach will more than likely yield differing RTW recommendations and should be considered when evaluating a provider’s recommendations for RTW (p. 372).

 Regardless of their agreement, the majority of providers gave some type of RTW recommendation involving restrictions –so no matter their perspective (biomedical vs. biopsychosocial), we can expect some type of restrictions from an injury and prepare for them accordingly. 

 As noted above, the availability of modified duty was emphasized as being one of the factors providers are looking at when determining the injured worker’s release to RTW.  If you have modified duty, be sure that the providers are aware of it!  For those employers that utilized a panel of physicians or a providers list, send them copies of your modified duty jobs to keep on file in the event one of your employers visits there.  If that’s not the case, it would behoove you to provide the treating physician with a pre-injury job description and/or a modified duty job description to keep in the injured worker’s file.  The more informed provider will more than likely make a more accurate RTW recommendation.

References:

Ikezawa, Y., Battie, M. C., Beach, J., & Gross, D. (2010).  Do clinicians working within the same context make consistent return-to-work recommendations?.  Journal of Occupational Rehabilitation, 20, 367-377. doi:10.1007/s10926-010-9230-z

Upset About your Workers' Compensation costs? What are you going to do about it?

There's ample research and discussion about factors that may lead to delayed recovery or poorer outcomes for workers' compensation claims.  We're all really good at pointing the finger and saying that it's because of the doctor, the unmotivated injured worker, or the employer who just doesn't get it.  I'd like to ask one simple question to those who are frustrated or angry about workers' compensation outcomes.  What are you going to do about it?

In the extreme case, an employer could shut down the business, throw in the towel.  Highly unlikely.  Realistically there are several steps employers and other stakeholders can take to GET INVOLVED in their claim management programs.  Here's just a few of my favorite.

• Report all injuries as soon as possible.  It's fairly common knowledge that the sooner everyone knows about an injury, the sooner it can be managed.  This leads to the next important point.
• Get the injured worker prompt appropriate medical care.  Get them the best care a workers' compensation dollar can buy.  If you want the best outcome, why would you skimp here?  Who would you want to see if it were your injury -- the doctor who just processes injuries and prescribes anti-inflammatories, tells you to follow up with your family physician if not better in a week or the occupational health physician who understands how to approach work injuries, what is necessary to help you get better and back to work, and what the signs of trouble may be?  Do you want a physician who follows what massive amounts of research says provides the best outcome, or the doctor who disregards evidence-based medicine in exchange for their anecdotal, 30 year old medical school training.  I wouldn't want a mechanic who only worked on cars from the 1970s to work on my 21st century car that's basically a computer running on gasoline (or electric, for that matter).  Get your employees to the best providers who are on top of the most current medical practices, and follow evidence-based treatment guidelines.
• Reduce delays in care by getting treatment approved, appointments scheduled, and referrals made TIMELY.  The sooner we can help that injured worker get the care they need, the sooner everyone can learn what the true injury is, what the treatment plan will look like and assess the RTW opportunities.  Nurse case managers can help with this process.
• Communicate effectively!  Communication is often the cause and the solution to all problems in a claim.  Keep everyone in the loop -- find a way to do it. Maybe it's a list of everyone who you need to update, written down on a sheet of paper.  Maybe it's an email distribution list that you create for each employee's claim.  Whatever your strategy is, keep everyone up to date.  As the saying goes, communicate by a factor of 10, and then say it one more time.  This group includes the injured worker, the employee's supervisor, the claim representative, nurse case manager, medical providers, and whoever else may be involved in the claim.  Documentation will be key in communicating technical, detailed information.  One example of this is the injured worker's pre-injury job description.  Document it, send it around for review and approval (including the injured worker) and then send it to the treating physician, physical therapist, and nurse case manager.  After all, how can you plan to get an injured worker back to work if you don't know what they need to do?  Identify barriers to return to work early on and develop a plan to address them.

These suggestions are based upon evidence.  Researchers from the Department of Physiotherapy and the Department of Epidemiology and Preventative Medicine at Monash University in Melbourne, Australia conducted a study involving the aforementioned interventions.  The results?  In their study, their intervention reduced costs associated with RTW claims by 34% and cut the days away from work by 58% (Iles & Wyatt, 2013).

References:
Iles, R. A., & Wyatt, M. (2013). Applying the evidence: a real-world example of an intervention to reduce workers' compensation costs. Physical Therapy Reviews, 18(5), 395-402.

RTW in the Health Care Setting - it can be done

Identifying modified duty options is incredibly important for those employers in the health care industry.  According to the Bureau of Labor Statistics, in 2012, employees in health care support occupations lost time from work due to a workplace injury or illness more than 2 times more often than all other occupations reported (U.S. Bureau of Labor Statistics, 2014).  

Barriers to RTW in hospitals and health care settings

While the incidence rate alone is a challenge, the usual 24/7 operations of hospitals can also be a barrier.  Employers are concerned about patient safety and cite this as a reason for not returning nurses with restrictions.  One of the most frequent obstacles is how hospital employers budget and account for wages paid while an injured worker is working on restricted or transitional duty.
 
Opportunities for RTW in hospitals and health care settings
Every industry has its unique challenges.  Generally speaking, there are always options for modified duty if one looks hard enough and thinks outside the box.  Recently, the Office of Disability Employment Policy (U.S. Department of Labor) funded a study to “identify promising practices and success stories related to RTW efforts and outcomes in the health care industry” (p. vi, 2015).  The following is a high level summary of some of their findings.  You are encouraged to read the full report here.

Health care employers and subject matter experts relayed several “best practices” that may benefit other employers:

·         Communication and training regarding RTW

o   Ensure that management and supervisors fully understand RTW, its benefits, and best practices 

·         Working with physicians  

o   Provide doctors with RTW plans or RTW options for the injured worker they are treating

·         Consider the utilization of occupational health providers and/or vocational rehabilitation  providers to assist with RTW

·         Identify outside sources for transitional work if no work can be found in-house

·         Support the case for RTW with financial figures

·         Create a system that pays for the transitional duty/modified duty work that ensures accountability for to motivate managers

o   Return injured workers to their department

o   Reduce injury rates

o   Employers may want to consider excluding injured workers on modified duty from productivity rates/counts

Some other highlights of the article include suggestions regarding a modified duty/transitional duty job bank.  We’ve always recommended employers maintain a list of tasks that need to be done in the event they have an injured worker on modified duty but these suggestions take it a step further.

Creating and maintaining a “living” job bank

The participants in the interview reported that they train supervisors and managers to find and share any modified duty positions prior to posting them.  These are often short-term jobs that need to be filled.  The respondents also reported that they contact the central staffing unit when looking for potential RTW opportunities within the hospital.  When long term or permanent restrictions are likely, the employers work with the injured worker, and sometimes a vocational counselor, to identify interests of the injured worker and their knowledge, skills and abilities.  If the injured worker would like to work in a different position that suits his/her restrictions, but requires training, the employer works to implement that training or provides unpaid volunteering in a particular department to train and trial the injured worker in that role.  The focus is upon retaining current employees.

 
Here is a link to the report for your own reading pleasure. The report also highlights seven very interesting and creative RTW success stories.

References:

 

U.S. Bureau of Labor Statistics. (2014) Number, incidence rate, and median days away from work for nonfatal occupational injuries and illnesses involving days away from work by summary occupational groups and ownership.  Available at:  http://www.bls.gov/new.release/osh2.t03.htm.  Accessed May 14, 2015.

 

Denne, J., Kettner, G., and Ben-Shalom, Y. (March, 2015).  Return to Work in the health care sector:  Promising practices and success stories.  Washington, D.C.:  Mathematica Policy Research.  Retrieved from Mathematica Policy Research  at http://www.mathematica-mpr.com/~/media/publications/pdfs/disability/rtw_health_care_sector.pdf

Workers' Memorial Day - April 28, 2015

Tuesday, April 28th is Workers' Memorial Day.  On this date in 1971, OSHA was established.    Since 1970, workplace fatality rates have dropped by more than 66% with U.S. employment nearly doubling (www.osha.gov).  While statistics indicate improving trends, each year there are still thousands of people who go to work but don't return home at the end of the day.  According to the U.S. Department of labor, every two hours someone is killed on the job.

So, tomorrow, take a few moments to reflect or participate in a local event to honor those and their families who have experienced the loss of a loved one due to a workplace fatality.  Think about what your organization can do to ensure that each and every one of your employees returns to their families at the end of every day. 

 

 

This is also an excellent time to share the work of Kids' Chance.  Throughout the country, Kids’ Chance state organizations provide scholarship grants to children where a parent has been seriously or fatally injured in a work-related accident.  If you or someone you know is the child of a parent who was seriously or fatally injured, please visit www.kidschance.org to learn more about the scholarship opportunities available and the application process.