Category: rehabilitation

Comcare’s RTW performance has some worrying trends

RTWMatters, an Australian return-to-work website, has analysed some of the data that has been released through the annual data – Aust & NZ RTW Monitor.  The statistics show that the Australian Government’s workers’ compensation insurer, Comcare, has performed well on some performance indicators but others are raising concerns, particularly

  • “The cost of claims has risen from $15 000 in 2005-06 to almost $20 000 in 2008-09. This is substantially higher than the national average.
  • Around 1/3 of Comcare workers can identify a person who made it harder to RTW, which is higher than the national rate. Over the last three years there has been a significant increase in Comcare employees reporting their employer has hindered return to work.
  • Over the last two years, Comcare workers have found it increasingly difficult to find the information they need to make a claim.
  • Comcare workers rated their insurer customer service lower than the national average, with communication, advice about the claim and understanding the situation rated lowest.”

Paul O’Connor, at last week’s Comcare Conference in Canberra was very upbeat but was well aware of the challenges ahead particularly for the next five years during a period when the Australian government will attempt to harmonise the OHS laws in each jurisdiction.  It should be noted that Paul has been Comcare’s CEO since 1 September 2009.  He was formerly with the Transport Accident Commission in Victoria.

O’Connor quoted the Australian Finance Minister, Lindsay Tanner, during his conference presentation.  (The Tanner quotes are from August 2009)

“It is unlikely that we will see any major reform in this area in the near future, as Australia’s various governments are grappling with the challenging task of building uniform national industrial relations and occupational health and safety systems.

“Nevertheless, the current campaign for a national catastrophic injury compensations scheme should trigger a wider debate about injury compensation in our society generally. The present system is fragmented, inequitable, inefficient and arbitrary. Reform could be some time coming but it’s certainly long overdue.”

RTWMatters has identified that more groundwork is going to be needed in the lead-up to the reform process if any measurable improvements are to be achieved.  In their media statement, they say

“Real collaboration requires that all stakeholders be able to access information to assess the impact of legislative and systems changes on workers compensation and return to work outcomes.”

The road to reform that Geoff Fary described as very difficult will be an important one to watch.

Kevin Jones

[Kevin Jones is a feature writer with RTWMatters]

Return-To-Work and OHS

Many OHS professionals do not understand the return-to-work (RTW) process.  Many OHS professionals choose to avoid RTW like the swine flu.  In Australia, rehabilitation and compensation come under different legislation to OHS so it is easy to delude one’s self that they are different beasts.

On September 15 2009 at the WorkCover SA Conference, it was possible to argue the same ideological isolation as above but from the RTW stance.  RTW can be as isolationist as OHS.  Admittedly, the conference was about workers’ rehabilitation and injury management but it was surprising how many speakers talked about integrated management without mentioning OHS.

Is this demarcation widening?  Was it formalised by the different Acts of Parliament? By different training backgrounds and criteria?  By the different work-related government departments (they often inhabit the same office, share the same board members, but report to government separately?!)?   Is the demarcation between the human resource specialists and the safety engineers?

In most workplaces such a demarcation would be unmanageable.  Most workplaces, certainly the smaller ones, have the official RTW Coordinator role as part of the duties of an existing staff member, whoever is already juggling the personnel duties and often payroll as well.  It is often a luxury to have a full-time RTW Coordinator.

It is noted that the Australian conferences of the OHS professionals rarely include RTW, and vice versa.  Isn’t is just possible that some bright spark may offer a safety management conference that unites the complementary disciplines, professionals and government departments so that business managers can receive a combination of information that matches the reality?

Kevin Jones

Kevin Jones attended the conference with the support of www.rtwmatters.org an (increasing prominent) online RTW website, and WorkCoverSA.

Why isn’t safety and health a continuum in a worker’s life?

Several years ago I attended a safety seminar hosted by Seacare.  Maritime safety is not part of my “brief” but safety is, and I was seeking alternate perspectives on my specialist area.  Seacare conducted a session where the treatment and management of an injured worker was work-shopped from incident to return-to-work.

It was the first time I had seen a panel of experts deal with the life of a worker across the injury management continuum.  The session showed the necessity to communicate across several disciplines and to always keep the focus on the injured worker.  I had never seen a better example of risk management in relation to an  employee’s welfare.

If only the real world was as organised.

WorkLife Book Covers 003Work/life balance in Australia is skewed towards those workers who have young families or a role as a carer.  This is due to work/life balance evolving from the feminist and social concepts of the 1970s and in response to the increased number of women in paid employment.  Barbara Pocock sees these matters in the 1970s as themselves a reaction to the “male-dominated employing class” that, in one exampled, believed that 3 month’s long-service leave was more important than maternity leave. (p212, The Work/Life Collision)

Work/Life Balance Origin

(Wikipedia has a peculiar article on work/life balance that has some interesting points and reference links but then undoes its good work by relying on a couple of major sources and many of them are commercial consultants.  That the Australian work in this area is not referenced, indicates a major deficiency.  Please note that the concept of balancing work life and non-work life existed well before “work/life balance” was first used.  SafetyAtWorkBlog would point the concept’s origin to around the same time as Australia’s introduction of the eight hour day in the mid-1800s or even earlier with Robert Owen in the UK calling for a 10-hour day.)

WorkLife Book Covers 005In the 2000s the emphasis remains not on work/life balance but work/family.  As a result, work/life balance will remain an issue handled in the management silo of human resources and being seen as relevant to a lifestage of an individual rather than the individual themselves.  There is also an inherent gender bias that could be minimised if the silo was removed.

The Seacare workshop illustrated for me that an injured worker is managed by different silos throughout their rehabilitation.  Wherever possible the employer outsources this management to experts in OHS, trauma counselling, medicine, physiotherapy, return-to-work coordinators, and other specialists.  The common element through all of these silos is the individual and that person’s health.

OHS & Work/Life Conflict

WorkLife Book Covers 001Occupational health and safety has a big advantage over work/life balance in that it focuses on the individual first.  Employers must provide for the health and safety of the worker and, by and large, employers get the safety obligation right.  This part of the process has long-established practices based principally on engineering solutions – stopping things falling on a worker, stopping the worker falling into machinery, stopping the inhalation of toxic dust – effectively “blue collar” solutions to “blue collar” hazards.

The mental health of the worker was not a big concern.  This is partly because in most of Australia, legislation only ever related to health and safety, and rarely to welfare.  Where welfare was a legislated consideration for the management of workers, the social context of the worker was acknowledged myuch earlier and work/life issues began to grow.

The regrettable element of this evolution was that “health” remained a narrow workplace definition instead of embracing the “welfare” or mental health of the worker.  If health had been supported by a definition that included welfare in all Australian States’ OHS legislation, the mental health needs of workers and the social contexts of worker management would have been discussed much earlier and in parallel.

Work/Life Balance Awards – A Missed Opportunity

An example of the divergence and the need, in my opinion, to reintegrate work/life balance and occupational health comes from some correspondence I have had with the organisers of the National Work/Life Balance Awards in the Australian Department of Education, Employment and Workplace Relations (DEEWR).  Until very recently, these awards were called the National Work and Family Awards.

WorkLife Book Covers 004DEEWR includes in its structure Safe Work Australia, the organisation responsible for monitoring OHS across the country.  It seemed odd to me, from the big holistic picture, that DEEWR has not included Safe Work Australia in the judging panel for the 2009 Work/Life Balance Awards.  DEEWR advised me that it believes the OHS experience of two of the judging panel, the Australian Council of Trade Unions and the Australian Chamber of Commerce and Industry, was sufficient.  Perhaps but why not draw on the OHS expertise of one’s own staff as well?

It also seemed odd that one organisation would conduct two national awards programs – the National Work/Life Balance Awards and the Safe Work Australia Awards.  DEEWR advised me that

“The [National Work/Life Balance Awards] recognise organisations that are outstanding in achieving positive outcomes through the implementation and communication of work-life balance policies, practices and initiatives which meet the needs of both the employer and its employees. The Safe Work Australia Awards focus on OHS more broadly and recognise businesses and individuals for their outstanding efforts in OHS and for making safety a high priority in their workplace.”

If the Safe Work Australia Awards focus on “OHS more broadly” why not have one set of awards that acknowledges both the work and social contexts of employees?  This is harder to answer when

“Applicants for awards must consent to an assessment to determine whether they have complied with the Fair Work Act 2009, the Workplace Relations Act 1996 and any relevant state or territory legislation, award or other industrial instruments” [my emphasis]

This would surely include the OHS legislation of each State and the Commonwealth.

DEEWR does not involve any of the state OHS regulators in the awards process.  The judging panel does not analyse the workers’ compensation premium awards rates of award contenders.  State regulators could surely provide a useful perspective as it is mostly under their jurisdictions that businesses are prosecuted for OHS breaches.  Worker’s compensation premiums are used by all regulators as a major (sometime the only) indicator of safety performance and for targeting of enforcement programs.  The judges of the National Work/Life Balance Awards do not.

OHS professionals and return-to-work coordinators acknowledge that the non-work life and mental health of workers are important elements in regaining a fully-functional employee.

DEEWR made the decision to rebrand the awards to Work/Life instead of “work and family”.  This does not reflect the complex interrelations of the social and individual contexts of the health and safety of individual workers.

DEEWR is coordinating the reforms of laws into both OHS and workers compensation.  The Australian Government is working on legislative harmonisation across all legislative jurisdictions in workplace health and safety.  These OHS laws are likely to extend employer obligations well beyond workers to the public and those potentially affected by work practices..

However DEEWR is missing a major opportunity to set the agenda for the future by acknowledging that the impacts on an individual of the work life and the home life should be managed across the social and employment disciplines.

Kevin Jones

The images included in this posting show some of the many terrific books dealing with, or mentioning, work/life management.

Depression and workplace stress rehabilitation

In January 2009, SafetyAtWorkBlog reported on the end of a political saga involving parliamentarian Paula Wriedt.  Ms Wriedt has since become a spokesperson for the treatment of depression and on 10 August she spoke with the Australian Broadcasting Corporation about more resources for the treatment of mental health issues in the young.

Kevin Jones

Australia’s “Find a Psychologist” directory

Several OHS regulators in Australia, OHS professional associations and trade union have directories for OHS advisers.  Most of them are in the traditional OHS areas of guarding, engineering, chemical safety…..  Psychosocial issues such as work stress or workplace bullying haven’t featured as much.

The Australian Psychological Society (APS) has a very good searchable directory for its members.  The search results provide a brief table of those psychologists for the subject area in your region with a good amount of information on individual listings on the click-through.

A great feature is to locate someone within a radius of one’s town or suburb.  The Society has thought about the geography  if Australia by including a 200 kilometre radius option.

On a brief search for psychologists who specialise in work stress or workplace bullying, the large Australian capital cities had plenty of listings.  Darwin came up empty as did Cairns, Alice Springs and Broom but these are remote locations and there may be psychologists in those areas who could provide assistance on workplace psychosocial issues, just not as specialists.

The “Find a Psychologist” directory is very easy to use and could be used by other member organisations as a template for their own databases.  The APS website should be flagged by Australian OHS professionals who need he services of psychologists for workplace psychosocial assistance.

Kevin Jones

Alternative therapies

Many alternative therapies have proved to have a positive therapeutic or medical benefit and there is no reason why these should not be applied to work-related conditions.

In 2001, Jill Kaufman was interviewed for Safety At Work magazine.  The interview is now available at SafetyAtWorkblog.

In 2001, the wellness industry in Australia was just starting and corporate health programs were searching for validity and credibility.  Rehabilitation, just like health insurers, was beginning to allow for a broader range of medical treatments.  It seemed useful to educate the OHS readers of the magazine with this developing approach to worker care.

Jill’s comments should be seen in their historical context but this does not make them any less interesting , or relevant.  Below are a couple of excerpts:

“Placing a long term RTW employee through the Western medical process could, in fact, be continuing to injure them in terms of their self-esteem. A different approach on a holistic basis allows for an understanding of the injury through an understanding of the person.”

“SAW: Many rehabilitation programs measure success by the rapid return of a worker to work duties but also by the financial expenditure on that person’s rehabilitation. Can the value of the approach you advocate be similarly measured?

JK: There can be surprisingly simple solutions to what can appear to be very complicated issues. I think one of the surprising things that companies learn is that it is often not a big financial expenditure or a large amount of time that can provide positive results. If you tackle the problem with the wrong instruments and the wrong tools, it can seem a very long haul to turn around and use a non-Western approach. But in fact shifts in thinking can bring about quick results.”

“SAW: Many call centres are providing yoga, physiotherapy and massages to workers on the premises and often without the workers leaving their workstations. What are your thoughts on this practice?

JK: Often this is doing the absolute minimum that is required. To have people doing yoga at their desk, when a core element of yoga is centring your self, breathing exercises, the call centre is as different to the practices of yoga as you can get.”

The economic costs of a heart attack

A new Australian report estimates the total costs of heart attack and chest pain (Acute Coronary Syndrome or ACS) to the Australian economy – “total economic cost of $17.9 billion.”  This Access Economics report, released in June 2009, has broad application for public policy but has some relevant information for safety and health management in the workplace.

Costofheartattackandchestpain coverIf we take “productivity” as applying to work, as is reasonable, the report states that for 2009

“Indirect [health care system] costs [from ACS] are expected to account for $A3.8 billion, primarily due to lost productivity.”

This is a useful statistic for those workplace health advocates.  In fact, the report specifically identified the workplace as

“…an excellent environment to facilitate the ongoing rehabilitation and lifestyle changes to prevent the re-occurrence of ACS event”.

One gap it identified in the treatment and monitoring of ACS was  something that many have been advocating for some years, particularly with the aging population and increasing obesity rates:

“a standardised national program to support employees and employers and the extension of rehabilitation practices.”

Much of the report advocates important rehabilitation resources and services for when the patient is discharged from hospital.  The report includes the following graphic but also recommends the basic elements of post-hospital care after an ACS event.

Costofheartattackandchestpain-261-2 rehab table

“For rehabilitation to be effective, comprehensive patient follow-up interviews after discharge are essential.  At these follow-up interviews, the patient should undergo both physical assessments (e.g. blood pressure, cholesterol tests, ECGs) and emotional and psychological assessments (e.g. signs of depression, anxiety, stress, financial hardships).  The psychological impact following an ACS event is an important, but often neglected, area in the management of ACS.  Thus, if patients can better understand their conditions, it can empower them to cope with their anxieties caused by ACS.”

In specific reference to workplaces, the report says:

“Returning to work can require an adjustment in duties and the conditions under which the employee works.”

It is up to OHS and return-to-work professionals to determine exactly what strategies should be applied in these circumstances.

There were a couple of references in the report that may be worth following up:

Bhattacharyya MR, Perkins-Porras L, Whitehead DL, and A Steptoe (2007), Psychological and clinical predictors of return to work after acute coronary syndrome, European Heart Journal, Vol 28, Iss. 2, pp. 160-165.

Kovoor P, Lee AKY, Carrozzi F, Wiseman V, Byth K, Zecchin R, Dickson C, King M, Hall J, Ross DL, Uther JB, and AR Denniss (2006), Return to full normal activities including work at two weeks after acute myocardial infarction, American Journal of Cardiology, Vol 97, No. 7, pp. 952-958.

Kevin Jones

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