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A comparison of disability management practices in Australian and Canadian workplaces

At a glance:
Employers in both Canada and Australia have a range of programs in place to manage return to work. Typically, in Australian systems, return to work programs are based at the workplace and early contact with all parties is common. Modified duties are normally provided.

Canadian employers have stronger collaboration between employees and management. A greater proportion of services are provided by outside parties, such as externally based consultants.
Perspectives:
Employee
Most companies work to bring injured people back to work.

This study was of larger employers in Australia and Canada. Larger employers generally have greater resources available to them. The authors point out that there is greater opportunities for collaboration between employees and management in these companies, and more opportunities for the active involvement of employees in return to work planning.

Employees in Australia can support the continuance of effective return to work systems through unions, and encouraging workplaces to develop practical and positive approaches to return to work management.
Employer
Helping people return to work is an issue for organisations around the world. Understanding what happens in other areas helps identify ways our systems can be enhanced.

The authors of this paper noted opportunities for improvement exist in both Australia and Canada. Identified areas for improvement were:

1. Integrating injury management and prevention
2. Clear articulation of policies and procedures
3. A partnership approach between employees and employers
4. Active involvement of the employee
Treater
Large employers place considerable emphasis on return to work management. A number of studies have shown that people's health and well-being are worse when they remain out of work. Employers benefit from paying attention to treating practitioners' reports and patients do better when there is coordination and cooperation between all parties.

This study showed that there are opportunities for further improvements in workplace disability
disability
A condition or function that leaves a person unable to do tasks that most other people can do.
 management. Collaboration between employees and management can be better supported by treating practitioners. Australia has a strong focus on workplace based systems; this has been a stronger feature in Australian systems than in many other countries.
Insurer
The authors indicate that improvements can be achieved through clearer articulation of policies and procedures. Encouraging employers to develop strong policies and procedures and to inform all staff of the systems that are in place can improve return to work outcomes.
Original Article, Authors & Publication Details:
Muriel G. Westmorlanda and Nicholas Buysb, (2004).

A comparison of disability management practices in Australian and Canadian workplaces. Work; 23(1):31-41.

aSchool of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
bHead School of Human Services, Griffith University, Logan Campus, Meadowbrook, Queensland, Australia
Background, Study Objectives, How It Was Done:
Return to work management is an international issue. Comparing what happens in different countries allows us to examine other systems, look at ways of improving, and learn from each other.

Disability management is a term that started in North America, and refers to both the prevention and management of workplace illness and injury.

The authors of this paper studied disability management practices in a range of companies in Australia and Canada. The researchers combined their studies to compare and contrast the practices in Australia and Canada.

The National Institute of Disability Management and Research in Canada developed occupational standards for disability management professionals. The International Labour Organisation developed a code of practice for managing disability in the workplace. They considered the principles of disability management as:

1. Disability management includes prevention and rehabilitation. Prevention and rehabilitation
rehabilitation
The process of helping a person back to their former abilities and quality of life (or as close as possible) after injury or a medical condition.
 services work best when they are coordinated and integrated.


Prevention services can include safety programs, pre-placement screening, ergonomic
ergonomic
Designing activities and the workplace in a way to minimize discomfort. i.e. Adapting work tasks, hours, or workstation to accommodate people. An ergonomic computer workstation allows the person to work in the best position to relieve load on the muscles of the neck and arms.
 services, safety education, lost prevention programs, employee assistance programs and wellness services.

2. Disability management is an employer led process using systems at an organisational level to promote prevention and rehabilitation.

The responsibility for prevention and rehabilitation is at the workplace, rather than through external providers such as insurers. Disability management needs to be a commitment through the whole of the organisation, including the:

Workplace culture
Management structure
Communication with staff
Performance evaluation

Senior management input and contribution into disability management makes a significant difference to disability management programs.

Organisational factors have been shown to make a significant difference to outcomes in preventing and managing disability. A people oriented culture, safety climate, disability management policies and practice, and ergonomic practices create an environment that supports return to work and reduces lost time from work injuries.

Reduced disputation results from a positive workplace culture where there is less conflict between management and workers.

3. Disability management practice is collaboration between management and staff.

Early management of return to work has traditionally focused on individual case management. There is evidence that partnership between workers and employers improves outcomes. Employers who provide a safe workplace and supportive rehabilitation programs develop a culture of consultation and goodwill. The benefits are reduced disputation and reduced lost time through work injuries.

4. Disability management interventions should be workplace based.

The authors note the workplace is the most successful environment for management of return to work. Programs of ‘work hardening' involve increasing the person's physical fitness but have not been based at the workplace.

Having dedicated staff, or in smaller organisations having staff that have an accountability in return to work, results in positive outcomes.

5. Early intervention

Prevention programs assess the risk of disability and implement interventions to eliminate or minimise risk. Rehabilitation should occur at as early as possible. Early intervention
intervention
A treatment or management program. Interventions often combine several approaches. In this field approaches include training in problem solving, adaptation of work duties, graded activity, an exercise and stretching program and pain relief.
 includes maintaining contact with people away from the workplace, appropriate medical treatment, and immediate contact with the treating practitioners
treating practitioner
A health professional that treats patients. In return to work this may include doctors, physiotherapists, chiropractors, osteopaths, psychologists, masseurs, etc.
 to obtain restrictions and implement return to work duties appropriately.

The authors note that more enlightened companies provide the same program whether the person has a work or non work-related condition.

Disability management as a concept and term has been actively practised in Canada for over a decade. The authors note that disability management is not a term commonly used in Australia. Injury management is the more typically used term. Injury management has a narrower focus, and describes the management after an injury has occurred. Injury management does not include a prevention component.

Workers compensation legislation is based on the state or province rules in both countries. The cost of workplace injuries and disability is enormous in both countries. In Australia many companies have a designated return to work coordinator. In Canada disability management programs were provided by external disability management professionals. These professionals had little training. This led to the establishment of a certificate in disability management run through the National Institute of Disability Management and Rehabilitation.

The study of disability management practices in Australia was based on the practices of 29 self-insured companies. The companies ranged in size from 102 to over 3,000 employees, across a range of industries. Face-to-face interviews were conducted with those responsible for coordinating and managing disability programs. The interviews were taped, transcribed, and summaries of the interviews were sent to the participants for crosschecking of information.

The Canadian study was of 455 employers across three industry sectors: education, hotels and motels, and health care. The employer's size was from 15 employees to over 1000 employees. A questionnaire was sent to the participants and this was followed up by telephone interviews. This information was supported by a focus group discussion and interviews from approximately 60 people who had sustained a work injury.
Study Findings:
The authors summarised the results of each study. Their points included

Australian study

Most workers compensation systems in Australia are prescriptive toward the employer's responsibilities in rehabilitation
This is particularly the case for self-insured employers, who were the group reviewed in this study
The return to work process included early contact with employees, appropriate communication with the treating doctor, and claims managers who worked closely with all parties
Long term claims were reviewed on a regular basis to assess the adequacy of rehabilitation
The companies consistently provided modified or suitable duties

Most companies encouraged doctors to view the workplace, and advised doctors the company was able to provide modified duties.

Retraining was required infrequently as the employee was usually accommodated within the workplace.

All of the companies focused on rehabilitation management of occupational injuries. At the time the study was done in 2000 management of non-occupational injuries was done on a case-by-case basis rather than through a comprehensive and consistent program.

Employees were generally understanding of their rights and responsibilities under the system and had received copies of the company's practices and policies.

Canadian study

The major differences between companies in the Canadian study were in the areas of:

People oriented culture
Safety diligence
Ergonomic practices
Return to work

Employers in health care had high scores in ergonomic practices. Disability management policies and procedures were in place in approximately 70% of employers in education, 62% in health, but only 32% in the hotel sector.

Employee concerns included

The importance of management listening to employees and involving them in decision-making
Better follow-up after the onset of illness or injury
Clearly available policies and procedures regarding return to work
Companies not working with the treating doctor to develop return to work

Application of the disability management principles in both countries

Injury prevention

In the Australian study 48% of employers had integrated prevention and workplace disability management.

In the Canadian study 41% of employees in the focus group felt workers were provided with training in work practices and unsafe working conditions were identified and improved. 35% felt their employer spent time and money on improving safety. 31% of employees in the focus group indicated that senior management were definitely not involved in their workplace. 31% indicated that some action was taken when safety rules were broken.

Employer directed process

In Australia the programs were primarily employer based. This was expected as the companies interviewed were large employers who comprised in-house return to work resources.

There was variation in the Canadian research regarding people's perception of the employer's involvement. More positive results were seen in the education sector than in health. The results were lower in the hotel sector.

Collaboration

There was a difference between the two countries in the collaborative approach to disability management. In Australia the unions were involved on an ‘as need' basis. There was an element of mistrust about potential union involvement. In the Canadian study employers indicated that collaboration was occurring. Employees advised a lower degree of collaboration than was reported by the employer.

Workplace based programs

Disability management in Australia is solidly based at the workplace. Companies drew on experts for assistance and specific tasks but accountability for disability management was at the workplace rather than through a third-party.

In Canada rehabilitation services were often provided by third parties, from outside the workplace. Rehabilitation endeavours tended to occur away from the workplace.

Early intervention

Australian companies practised more consistent early intervention than the Canadian companies.

Study limitations

The authors noted there were significant limitations to comparing two studies that were quite different in their approach and methodology. The Australian study was of a smaller number of employers however the employers were all large companies. Employer representatives were interviewed only. The authors noted that the view from the shop floor could be quite different than the view from those interviewed.

The Canadian study used a larger sample of employers from certain industry sectors, with many of the employers being of smaller size.
Conclusions:
Whilst this study and comparison has limitations it highlights differences in key areas of return to work management. Injury prevention is not consistently integrated with rehabilitation in either country. In Canada there was a difference between how employees and employers perceive the effectiveness of some of the programs.

Formal collaboration between employees and management was minimal in both countries. Unions tended to be involved in Australia when there was a problem or dispute.

The authors concluded that when current practices are compared with best practice disability management principles, employers in both countries had significant opportunities for improvements. Gaps included clear articulation of policies and procedures, a partnership approach to management, and active involvement of the employee.
References:
PubMed Abstract
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