THE RETURN TO WORK JOURNEY
Dr Peta Odgers
Comcare, Australia
KEY WORDS: Return to Work, Drivers, Barriers, Role of Employers, Role of Work, Qualitative Research
BACKGROUND
Maximising the recovery of injured and unwell workers, while minimising financial costs, are key drivers in all workers’ compensation schemes. Comcare is committed to improving the services it provides to people who are injured or become ill at work, as well as their employers, in an effort to improve the return to work (RTW) outcomes of workers. In 2012-13, Comcare worked with Sweeney Research, an independent research company, to address three separate yet related areas of interest around failed RTW, long duration claims and delays in claiming.
AIM OF THE RESEARCH
The overarching aim of this work was to identify strategies, policies and practices to help maximise both the recovery and RTW of those who are injured or become ill at work. The specific aims of the research were to:
· identify the drivers and barriers associated with successful RTW in order to improve recovery and RTW success
· understand the drivers of injured workers’ long duration claims in order to minimise entrenchment in the scheme
· understand the reasons why people chose not to submit a claim post injury or illness, what transpires during the delay, and why the delay tends to be longer for mental stress claims than physical claims.
METHODOLOGY
PARTICIPANTS: A total of 47 employees and six employer representatives were interviewed across Victoria, the Australian Capital Territory, New South Wales and Queensland. The majority of interviews were undertaken in the ACT which is reflective of the distribution of the Comcare injured worker population.
PROCEDURE: A qualitative method was used for each project. This consisted of face-to-face interviews wherever possible, and telephone interviews at the request of the participant. Interviews lasted for approximately 1.5 hours. Each injured worker was reimbursed for their time with a $100 voucher.
SAMPLING: The employee sample was recruited from a database of injured workers who had previously given their consent to be contacted about participating in future research projects. Where possible, an employer representative from an injured/ill worker’s organisation was also recruited to capture both sides of the RTW story.
LIMITATIONS: While efforts were made to ensure the sample reflected a good cross section of the target population, the final sample was dependant on the willingness of individuals to participate in the research. It is therefore possible that there is an under representation of people with certain types of claims (for example, mental stress claims) or who did not have a strong opinion about the issues being explored.
RESULTS
One of the most important findings of this research was the insight gained into the complexity and continuously evolving nature of the RTW journey. Underpinning these challenges are: the stigma associated with workplace injury or illnesses; the tension between RTW and return to health; and, the complexities/misunderstandings associated with mental health concerns often seen in people returning to work.
For those with injuries that are relatively easy to manage, the RTW journey tends to be efficient and successful. Complicating factors from a personal, organisational or process perspective, however, can result in a much longer journey, repeated attempts to RTW or even eventually becoming entrenched in the scheme.
While the RTW journey was found to be a highly individualised experience, six common stages were identified as critical turning points in the recovery and RTW of injured/ill workers. As the individual travels through each of these stages, their mindset and needs change, which in turn, influences the likelihood of them achieving a successful RTW. Each of these stages is outlined below.
Figure 1: Stages of the RTW Journey.
Stage 1: Pre-incidentThe workplace context sets the expectations of a successful recovery and RTW even before the incident has occurred. At this point it is the dynamic between the individual and the organisation that is critical, as is the organisation’s commitment to RTW, corporate culture, middle management skills and flexibility.
At this stage, individuals need:
· CONFIDENCE – that they can raise issues without being unduly judged
In order to achieve a successful outcome employers are encouraged to focus on:
· PREVENTION –approach workplace health and safety proactively
· EARLY INTERVENTION–take all concerns seriously, act on issues quickly before they escalate, and work collaboratively with employees to find workable solutions
Stage 2: Period of Persuasion
Relates to the period just prior to and immediately following a claim. At this early stage there is considerable potential for an organisation to affect a positive outcome by building trust and demonstrating that it intends to be reasonable, constructive and positive in its approach to the individual. Prior to the claim, individuals tend to be at their most hopeful in relation to their recovery, while they tend to be at their most vulnerable once a claim is made, and very sensitive to the way in which their organisation responds to their circumstances. In general, individuals tend not to have much of an idea as to how their journey will progress.
At this stage, individual needs are around their personal health, including:
· CARE – time to heal
· RESPECT – a sense that their organisation has faith in the legitimacy of their claim and circumstances, or, at the very least, that they are being given the benefit of the doubt
· CLARITY AND CONTROL – certainty about how to progress, what their next steps should be and what their roles and responsibilities are
· TRUSTED CONFIDANTE – a point of contact, someone who understands their situation and can act constructively with them
In order to achieve a successful outcome, employers are urged to focus on encouraging:
· CONSTRUCTIVE COLLABORATION –individuals need to work with their organisation to make decisions, rather than have the organisation make decisions for them
Stage 3: Inevitable Slump
Refers to the initial days or weeks after returning to work, when individuals are engaging with their ‘new reality’. Injured/ill workers tend to RTW with a positive frame of mind, but then experience a motivational and mood ‘slump’, mostly due to unmet expectations. For many, this time is very confronting as they realise they aren’t the same, and their ability to cope both at work and in general has changed. Individuals can often doubt their own ability, and even question their desire, to continue their RTW journey.
This slump has three key triggers:
· Unrealistic expectations about personal ability
· Exaggerated expectations about how returning to work will positively influence their recovery
· Challenging RTW conditions
At this stage, individuals need:
· REALISTIC EXPECTATIONS – RTW needs to be placed in perspective as playing a role in recovery, but not as the sole solution to recovery
· SOLUTION FIT – they need to be given appropriate responsibilities/duties for their capability
In order to achieve a successful outcome, employers are encouraged to:
· REASSURE – individuals need to have a sense of being valued even under new conditions
· EDUCATE – individuals need to be aware of the emotional challenges they may face in returning to work
· SUPPORT – follow-up with the individual to address doubts early before they build momentum
Stage 4: Pivotal Phase
This stage reaffirms or challenges an injured/ill worker’s decision to continue or cease their RTW attempt. Activity/interaction with the organisation, health providers and/or Comcare will have an impact on their confidence in this decision. Those who are succeeding will have found ways to manage their circumstances and are adjusting to their new conditions. Those who aren’t doing so well have usually failed in their first RTW attempt. The impact of this will be dependent upon the degree to which this can be blamed on someone else (for example, management) or is related to the injury/illness. At this point, physical injuries can progress to mental health issues as feelings of worthlessness, hopelessness and helplessness can appear. Some will regain their confidence and sense of identity quickly, while for others the response from organisations, involvement with Comcare, and their RTW experience can lead to more lasting and serious damage. The likelihood of someone making another RTW attempt is dependent upon how this stage is managed.
At this stage, individuals need :
· FLEXIBILITY – legitimate options that respect their emotional and physical constraints
· REASSURANCE – continued collaboration is still viable, and that a pathway can be found
In order to achieve a successful outcome, it is important for both the employer and Comcare to help the injured worker manage the damage that can result from a ‘failed’ attempt to RTW. This can be done through:
· UNDERSTANDING – recognise the disillusionment and frustration that the individual may be experiencing
· DEVELOPING PRACTICAL SOLUTIONS – look at alternative RTW options and solutions to demonstrate the potential for return
· PLANNING – provide clear steps on how the individual can move forward toward recovery after a setback
· CONTINUED SUPPORT – reinforce positive choice, especially with those who have stayed at work
Stage 5: Ongoing Success
At this stage, the individual is on track and experiencing a successful RTW. They are committed, settled, looking forward to their future and are actively self-managing their health and recovery. Although things may have changed, individuals are optimistic about their future.
At this stage, individuals need:
· CONTINUED EMPOWERMENT – maintain positive momentum
· OPPORTUNITIES TO GROW – depending on career ambition and natural professional trajectory
· ONGOING REGARD FOR THEIR INJURY – making sure that future opportunities do not unintentionally jeopardise their health
· SUPPORTING PREVENTION –continuing to look after their health to prevent a relapse
In order to achieve a successful outcome, employers are encouraged to engage in:
· POSITIVE MAINTENANCE – recognise that an individual’s capacity is mediated by the ongoing respect and accommodation they receive in relation to their injury/illness
Stage 6: Entrenched (long duration)
Unfortunately, for many this stage is defined as the ‘end point’. The RTW journey has often been unsuccessful and they have become entrenched in workers’ compensation for the foreseeable future. Initiating RTW from here is not impossible, but it will depend on what it has taken to get them to this stage. The amount of contact people have with their organisation by this stage is usually minimal, and their willingness to jeopardise physical/emotional health is low, but if they have a strong work ethic and are motivated, continued RTW attempts are possible.
At this stage, individuals need:
· SUPPORT TO OPEN DOORS – career advice or suggestions for future options
· OPPORTUNITY TO STAY ENGAGED – social interaction is particularly important for anyone who has been disengaged from the workforce for some time
· PLAN – identify the next steps
In order to achieve a successful outcome, employers are encouraged to stay in touch with their injured/ill workers and:
· REBUILD AND EDUCATE – provide confidence and skills to enable re-entry to the workforce
· PROVIDE OPPORTUNITIES – realistic and achievable opportunities to RTW and remain engaged
KEY POINTS EMERGING FROM RESEARCH
1. The RTW journey is strongly influenced by a combination of internal individual factors and external entities, including employers, healthcare providers and Comcare.
2. The relationship between the organisation and the individual, both before and after a claim is made, has a critical influence on their recovery and RTW outcomes.
3. Most injured workers are profoundly affected by both their injury/illness and entry into the workers’ compensation system, all of which can impact their routine, relationships, self-esteem and sense of identity.
4. If organisations understand at what stage an injured worker is at on their RTW journey, they will be better placed to address their specific needs and positively influence their outcomes following a workplace injury/illness.
RESEARCH INTO ACTION
Recognising that the most successful recovery and RTW outcomes are when the individual is able to constructively collaborate with others, the key opportunities for Comcare include:
· ADMINISTRATION – improvements to basic processes to minimise the impact on both injured/ill workers and employers
· CLAIMS MANAGEMENT – as the main point of contact individuals have with Comcare, claims managers can have a substantial impact on an injured worker’s personal empowerment and ability to RTW
· EDUCATION AND SUPPORT – it is important for Comcare to actively support injured/ill workers, employers, families, health providers and others
· ADVOCACY – the opportunity for Comcare to become a leader in promoting positive behaviours, attitudes and flexible options in RTW.
Contact Details
Dr Peta Odgers
Director of Research, Comcare
Comcare (Canberra Office)
Comcare Research Team
GPO Box 9905
Canberra ACT 2601