Perceived Role and Expectations of Health Care Providers in Return to Work.

Purpose Health care providers (HCPs) play an important role in return to work (RTW) and in the workers' compensation system. However, HCPs may feel unsure about their responsibilities in the RTW process and experience difficulty making recommendations about RTW readiness and limitations. This study examines the ways in which HCPs and case managers (CMs) perceive HCPs role in the RTW process, and how similarities and differences between these views, in turn, inform expectations of HCPs. Methods In-depth interviews were conducted with 69 HCPs and 34 CMs from 4 provinces. Data were double coded and a thematic, inductive analysis was carried out to develop key themes. Findings The main role of HCPs was to diagnose injury and provide patients with appropriate treatment. In addition, the majority of HCPs and CMs viewed providing medical information to workers' compensation board (WCB) and the general encouragement of RTW as important roles played by HCPs. There was less clarity, and at times disagreement, about the scope of HCPs' role in providing medical information to WCB and encouraging RTW, such as the type of information they should provide and the timelines for RTW. Conclusion Interviews suggest that different role expectations may stem from differing perspectives of HCPs and the CMs had regarding RTW. A comprehensive discussion between WCB decision-makers and HCPs is needed, with an end goal of reaching consensus regarding roles and responsibilities in the RTW process. The findings highlight the importance of establishing clearer role expectations.

Healthcare providers' experience with the management of mental health conditions in the context of Workers' Compensation.

BACKGROUND: Little is known about how healthcare providers (HCPs) in Canada manage mental health claims and the return to work (RTW) of injured workersOBJECTIVE:To examine HCPs' experience and challenges on the treatment of mental health conditions (MHCs) in the context of Workers' Compensation (WC) processes and their involvement in RTW. METHODS: Ninety-seven interviews with HCPs (general practitioners, n = 59; allied HCPs, n = 19; specialists, n = 19) were conducted in British Columbia, Manitoba, Ontario and Newfoundland. A thematic content analysis was used to analyze interviews. RESULTS: HCPs reported that while RTW is extolled at virtually all costs by WC boards, they did not always see it as beneficial. Most HCPs were convinced that successful recovery and RTW depend on being aware of how mental and physical health is intertwined and treating both issues. Organizational barriers within WC processes and adversarial relationships between injured workers (IWs) and WC boards made it difficult for HCPs to adequately treat patients and facilitate RTW. Dealing with IWs' MHCs and their emotional distress due to 'going through WC systems' was challenging. CONCLUSIONS: WC boards must identify how policies can be modified to mitigate compensation processes and RTW for WC claimants with MHC.

Implementation of a disability management policy in a large healthcare employer: a quasi-experimental, mixed-methods evaluation.

OBJECTIVE: This study describes the process and outcomes of the implementation of a strengthened disability management policy in a large Canadian healthcare employer. Key elements of the strengthened policy included an emphasis on early contact, the training of supervisors and the integration of union representatives in return-to-work (RTW) planning. DESIGN: The study applied mixed methods, combining a process evaluation within the employer and a quasi-experimental outcome evaluation between employers for a 3-year period prior to and following policy implementation in January 2012. PARTICIPANTS: Staff in the implementation organisation (n=4000) and staff in a peer group of 29 large hospitals (n=1 19 000). OUTCOMES: Work disability episode incidence and duration. RESULTS: Both qualitative and quantitative measures of the implementation process were predominantly positive. Over the 6-year observation period, there were 624 work disability episodes in the organisation and 8604 in the comparison group of 29 large hospitals. The annual per cent change in episode incidence in the organisation was -5.6 (95% CI -9.9 to -1.1) comparable to the annual per cent change in the comparison group: -6.2 (-7.2 to -5.3). Disability episode durations also declined in the organisation, from a mean of 19.4 days (16.5, 22.3) in the preintervention period to 10.9 days (8.7, 13.2) in the postintervention period. Reductions in disability durations were also observed in the comparison group: from a mean of 13.5 days (12.9, 14.1) in the 2009-2011 period to 10.5 days (9.9, 11.1) in the 2012-2014 period. CONCLUSION: The incidence of work disability episodes and the durations of work disability declined strongly in this hospital sector over the 6-year observation period. The implementation of the organisation's RTW policy was associated with larger reductions in disability durations than observed in the comparison group.

Implementing a collaborative return-to-work program: Lessons from a qualitative study in a large Canadian healthcare organization.

BACKGROUND: Comprehensive workplace return-to-work policies, applied with consistency, can reduce length of time out of work and the risk of long-term disability. This paper reports on the findings from a qualitative study exploring managers' and return-to-work-coordinators' views on the implementation of their organization's new return-to-work program. OBJECTIVES: To provide practical guidance to organizations in designing and implementing return-to-work programs for their employees. METHODS: Semi-structured qualitative interviews were undertaken with 20 managers and 10 return-to-work co-ordinators to describe participants' perspectives on the progress of program implementation in the first 18 months of adoption. The study was based in a large healthcare organization in Ontario, Canada. Thematic analysis of the data was conducted. RESULTS: We identified tensions evident in the early implementation phase of the organization's return-to-work program. These tensions were attributed to uncertainties concerning roles and responsibilities and to circumstances where objectives or principles appeared to be in conflict. CONCLUSIONS: The implementation of a comprehensive and collaborative return-to-work program is a complex challenge. The findings described in this paper may provide helpful guidance for organizations embarking on the development and implementation of a return-to-work program.

Individual, occupational, and workplace correlates of occupational health and safety vulnerability in a sample of Canadian workers.

OBJECTIVE: To describe OH&S vulnerability across a diverse sample of Canadian workers. METHODS: A survey was administered to 1,835 workers employed more than 15 hrs/week in workplaces with at least five employees. Adjusted logistic models were fitted for three specific and one overall measure of workplace vulnerability developed based on hazard exposure and access to protective OH&S policies and procedures, awareness of employment rights and responsibilities, and workplace empowerment. RESULTS: More than one third of the sample experienced some OH&S vulnerability. The type and magnitude of vulnerability varied by labor market sub-group. Younger workers and those in smaller workplaces experienced significantly higher odds of multiple types of vulnerability. Temporary workers reported elevated odds of overall, awareness- and empowerment-related vulnerability, while respondents born outside of Canada had significantly higher odds of awareness vulnerability. CONCLUSION: Knowing how labor market sub-groups experience different types of vulnerability can inform better-tailored primary prevention interventions.

The development of a conceptual model and self-reported measure of occupational health and safety vulnerability.

Injuries at work have a substantial economic and societal burden. Often groups of labour market participants, such as young workers, recent immigrants or temporary workers are labelled as being "vulnerable" to work injury. However, defining groups in this way does little to enable a better understanding of the broader factors that place workers at increased risk of injury. In this paper we describe the development of a new measure of occupational health and safety (OH&S) vulnerability. The purpose of this measure was to allow the identification of workers at increased risk of injury, and to enable the monitoring and surveillance of OH&S vulnerability in the labour market. The development included a systematic literature search, and conducting focus groups with a variety of stakeholder groups, to generate a pool of potential items, followed by a series of steps to reduce these items to a more manageable pool. The final measure is 29-item instrument that captures information on four related, but distinct dimensions, thought to be associated with increased risk of injury. These dimensions are: hazard exposure; occupational health and safety policies and procedures; OH&S awareness; and empowerment to participate in injury prevention. In a large sample of employees in Ontario and British Columbia the final measure displayed minimal missing responses, reasonably good distributions across response categories, and strong factorial validity. This new measure of OH&S vulnerability can identify workers who are at risk of injury and provide information on the dimensions of work that may increase this risk. This measurement could be undertaken at one point in time to compare vulnerability across groups, or be undertaken at multiple time points to examine changes in dimensions of OH&S vulnerability, for example, in response to a primary prevention intervention.

Another Person in the Room: Using Interpreters During Interviews With Immigrant Workers.

Cross-language research poses many challenges. When researchers and participants do not speak the same language, meanings expressed by participants might not be understood in the same way by researchers, and the richness of participants' experiences might be lost. This can lead to the misrepresentation and silencing of issues faced by these participants, especially newcomers. In this article, we critically examine our experience conducting qualitative interviews with injured immigrant workers with the help of professional interpreters. Using examples from our field notes and transcripts, we outline some of the key difficulties we faced: varying styles of interpretation, breeches of interview conventions, and miscommunications with interpreters. We discuss how these issues affected our study design, rapport with participants and, ultimately, data quality. We end with a discussion of how to improve cross-language and cross-cultural research.

Buddies in bad times? the role of co-workers after a work-related injury.

INTRODUCTION: Co-workers can play an important role after a work-related injury. They can provide details about the circumstances of an accident, offer emotional support to the injured worker and help with job tasks upon a co-worker's return to work (RTW). Working with an injured co-worker, however, can also strain work relationships and increase workload. The purpose of this study was to determine the role that co-workers play after a work-related injury and during the RTW process in the unionized, electrical construction sector. METHODS: We conducted two focus groups with injured electricians and union representatives. We also interviewed co-workers who had worked with someone who had been injured in the course of employment. We examined the role that co-workers can play after a work-related injury and some of the factors facilitating and hindering co-worker support. RESULTS: The structure of work in the electrical sector-a focus on cost-cutting and competition, job insecurity, perceptions of "different camps" among co-workers, little modified work and poor formal communication-can impede co-worker support and contribute to making injured workers' experiences difficult. Management can play an important role in setting an example for how injured workers are regarded and treated. CONCLUSIONS: Future research should explore how workers can better be supported after a work-related injury and during the RTW process.

A national scan of employment standards, occupational health and safety and workers' compensation resources for new immigrants to Canada.

OBJECTIVES: The burden of work injuries in Canada is a serious public health concern. Nearly one million Canadian workers experienced nonfatal injuries that led to time off work in 2005. New employees and recent immigrants are more likely to experience a work-related injury. The purpose of this study was to examine services, programs and resources available to newcomers to Canada that focus on employment standards (ES), occupational health & safety (OHS) and workers' compensation (WC). METHODS: We reviewed resources available through community organizations, employers, settlement groups and unions, as well as provincial and federal prevention agencies and workers' compensation boards. The materials were categorized according to geographical distribution, content, resource type, audience and language. RESULTS: We found a total of 224 resources that met our search criteria. The greatest numbers were found in the provinces of Ontario, British Columbia and Manitoba. Most resources consisted of short factsheets on the topic of ES; WC was the focus of the fewest resources. The most comprehensive resources were teaching materials for ESL/FSL classes and Job Search Workshops. Most resources were specifically produced for newcomers but only available in French/English. Our scan uncovered no information for health care providers, union representatives or safety professionals working with immigrants. Very few resources were aimed at young immigrant workers or employers working with newcomers. CONCLUSIONS: Our research identifies gaps in the provision of health and safety resources for newcomers. Additional research is needed to evaluate the depth and quality of materials and to determine how decisions are made around the inclusion or exclusion of ES, OHS and WC information in language and labour market preparation programs for new immigrants.

Delicate dances: immigrant workers' experiences of injury reporting and claim filing.

INTRODUCTION: Immigrants often come to Canada for the purpose of employment and make up a large proportion of our labour force. Yet, these workers' labour market experience may not always be positive - new immigrant workers can have difficulties finding a job in their field and may end up working in 'survival jobs' that expose them to workplace hazards. Workers who are new to Canada may not be familiar with legislation designed to protect them at work or with social programs that can help after a work-related injury. METHODS: Through a series of in-depth interviews this study examined the experiences of new immigrants after they were injured on the job. RESULTS: The analysis revealed that many workers were in manual, 'survival jobs' and had not received job or occupational health and safety training. Many did not speak the English language well and knew little about their rights. While workers often felt trepidation about reporting their injury, most told a health care provider or employer that they were injured or in pain. This, however, rarely led to timely or appropriate claim filing. Workers were often discouraged from filing a claim, misinformed about their rights or offered 'time off work' in lieu of reporting the injury to worker's compensation. In instances where a claim was filed, communication problems were common and led to mistakes being made on forms and misunderstandings with the adjudicator and employer. Interpretation services were not always offered consistently or at the correct time. CONCLUSION: Efforts must be made to systematically inform new immigrants of their health and safety rights, responsibilities and entitlements as they are entering the labour market. Systems must be put in place to ensure that immigrants can access the compensation system in the event of a work-related injury and that employers and healthcare providers fulfil their reporting responsibilities.