Factors influencing Return to Work Following

Compensable Injury
Benjamin C. Amick III
Scientific Director
Institute for Work & Health
First Australasian Compensation Health Research
Forum
Oct 13-14, 2011

How Can We Create Action-Based Evidence?

My First Few Points

Action means Agency

Economics matter, but economics may not be
the primary behavior drivers we all believe
Researchers need to think about tools to
support agency
We need to think Beyond RTW to Health
Outcomes
Policy change redistributes agency in the
compensation scheme

So Whats Going On?

The Power of Free

Would Any Highly Adjustable Chair Work?

Leap Chair

NYSE Stock Price

What Exactly Do We Want?

Which Bottom Line?

Do You Want to Manage a Caterpillar or Make a Butterfly?

Appearance of
the Guide

Vignettes throughout
Commuting difficulties and non-compliance:
Franks story
Frank had a work-related back injury and could not sit
or stand for long periods of time. His employer
offered accommodated work, but the commute
caused Frank such pain that he arrived at work
feeling ill and exhausted. The compensation board
decision-maker advised Frank to stop along the way to
get out and stretch.
However, because Frank
commuted along a busy highway, stopping would
be dangerous. Because the employer had made an
offer of modified work, when Frank was late or did
not show up to work, he was judged to be noncompliant and his benefits were cut. This set in
place a series of adverse effects including financial
and emotional strain for Frank, and diminished
workplace relations that would undermine a later RTW
attempt.

Difficulty
travelling to work

Worker
compliance

Depression and
other mental
health problems

Consider workers
ability to travel

Communication

Acknowledging
difficulty

What Outcomes Do We Want?

Absenteeism
(Lost Time)

Presenteeism
(Limitations in the
ability to meet the
work requirements
while working)

Does WRF Add Value?

100

RTW targets
individual, medical
and legal factors

90
80
70
60

WRF targets
medical care and
organizational
factors

50
40
30

well

hurt

injured
Baseline
6 months
11

Probability of Staying On Benefits

New Policy in Ontario in 1998

Shift of responsibility for return-to-work

away from insurance board
to workplace parties (employers, injured workers)
enhance self-reliance
Changes in structure of wage replacement benefits
Temporary total benefits, temporary partial benefits and future
economic loss awards replaced by single type of benefits - loss of
earnings benefits
Wage-replacement rate reduced from 90% to 85% of net earnings
Changes in vocational rehabilitation services
Outsourcing of services previously provided by WCB staff
Renamed Labor Market Re-entry
Moved to single point of contact for claimants within WSIB
Consolidated adjudicator role
Introduction of Nurse Case Managers

Its All About the Policy and What It Created or Eliminated

Hogg-Johnson, unpublished

7 Principles of RTW and New Evidence

Principles of RTW

SELF-REPORTED
WORK ABSENCE

ADMINISTRATIVE
WORK ABSENCE

Early contact

Work accommodation and

acceptance

HCP contact with workplace

HCP advice to workplace about reinjury prevention

Ergonomic visits

RTW coordinator

Why Two Outcomes?

Different Outcomes May Uncover Different Predictors

Return to Work (RTW)

Either at work or not at
work
What gets a person back
to work
Easy to manage

Work Role Functioning (WRF)

Recognizes varying degrees of
return to work
Can be back at work but working
with or without limitations
What gets a person back to work &
working well
More difficult to manage

Is It All About Disability Management Programs,

Policies and Practices? No! Maybe! Yes!
People-oriented Culture
Safety Leadership and Safety Practices
Ergonomic Policies and practices
Disability Management Policies and Practices
Or, Is It All About Working in a Supportive
Organization? No! Maybe! Yes!

To Summarize Results for WRF: OPPs Important at 6

(Odds Ratio 2.3) & 12 Months (Odds Ratio 2.2)

Income
> 60,000

College Fewer Co- Fewer Pain

Education Morbidities Sym. Past Mo.

EARLY Work Role Functioning (WRF) LATE

6 Mos.

OPPs
Supportive
Low Physical
Org
Job Demands
Fewer
Depressive Symptoms

12 Mos.

To Summarize Results for RTW: OPPs Important at 6

months (OR 1.9) & 12 Months (OR 2.3)

EARLY
6 Mos.

Return to Work (RTW)

OPPs
Supportive
Org
Fewer
Depressive Symptoms

LATE
12 Mos.

A Funny Thing Happened on the Way to The

Presentation: Not All Variables Are Equal
Work
Accommodation
Supportive
Organization

WRF
RTWwL

SelfEfficacy

nRTW

Mediating Effects of Transition for Return to Work at 6 & 12

Months After Injury

6 Months

OPPs

WA b,6

RTW

SE b, change at 6

RTW

12 Months
OPPs

WA b,6,12

RTW

SE b, change at 6

RTW

Mediating Effects of Transition for Functioning Well in Job at

6 & 12 Months After Injury

6 Months

OPPs

WA b,6

WRF

SE b, change at 6

WRF

12 Months
OPPs

WA b,6,12

WRF

SE b, change at 6

WRF

Is the Organizational Support Effect is Being Driven by

Disability Management?

People-Oriented Culture
Disability Management Policies, Procedures and Practices
Ergonomic Policies and Practices
Safety leadership and Practices

People Oriented Culture

The workplace involves employees in plans and

decisions made
Workers have trust in the workplace
Communication is open and employees feel free
to voice concerns and make suggestions
Working relationships are cooperative

Safety Leadership and Practices

Top management is actively involved in the safety
program (L)
The workplace spends time and money on improving
safety (L)
The workplace considers safety equally with
production and quality in the way work is done (L)
Unsafe working conditions are identified and
improved promptly (P)
Equipment is well-maintained (P)
Action is taken when safety rules are broken (P)
Employees provided training in safe work practices
for job hazards they will encounter (P)

Disability Management
Workplace contacts the worker shortly after an
injury/illness to express concern and offer assistance
The workplace works with the treating physician to
develop a plan for return to work
Workplace makes accommodations such as flexible
hours to allow injured workers to RTW
After injured worker RTW, workplace follows up to
adjust the work situation as needed
When injured workers cant return to work, the
workplace provides retraining

Ergonomics Policies and Practices

Jobs are designed to reduce heavy lifting

Jobs are designed to reduce repetitive movement

Are The Results Being Driven By Disability Management

Policies and Practices?
If RTW is used as the outcome then ...
1. People Oriented Culture and Safety Leadership and
Practices have NO effects at 6 or 12 months
2. Ergonomic Policies and Practices have an effect at
12 months
3. Disability management policies and practices have an
effect at both 6 & 12 months
a. Work accommodation is the key

Are The Results Being Driven By Disability Management

Policies and Practices?
If WRF is used as the outcome then at 6 months ...
1. People Oriented Culture only effects the transition to
functioning well and this is mediated by self-efficacy
2. Safety Practices only effects the transition to
functioning well and this is mediated by both work
accommodation and self-efficacy
3. No effect of Ergonomic Policies and Practices
4. Disability management policies and practices effect
both transitions and both work accommodation and
self-efficacy are mediators

Are The Results Being Driven By Disability Management

Policies and Practices?
If WRF is used as the outcome then at 12 months ...
1. People Oriented Culture has no effect
2. Ergonomic Policies and Practices effect both
transitions and self-efficacy is the key
3. Disability management policies and practices and
Safety Leadership and Practices effect both
transitions and both work accommodation and selfefficacy are important

So, What Do We Think We Learned?

Organizational Policies and Practices (OPPs) Matter
Work accommodation mediates the relationship
between OPPs and RTW and WRF but seems most
important in getting people back to work
Self-efficacy mediates the relationship between OPPs
and WRF and seems most important in getting
persons to function well
Key is self-efficacy change

Depressive symptoms matter

Not just about disability policies and practices

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