New case studies describe how Institute findings on return to work, recovery and retraining were ‘formative’ in changes at Ontario’s workers’ compensation board
The hope of many researchers when embarking on a project is that their findings support the development of improved policy and practice. Even more rewarding is when their research leads to better outcomes as a result of such changes.
In the field of occupational health and safety, measures of positive outcomes might include lower injury rates, reduced duration or cost of claims, and improvements in workforce health. However, such societal-level impact can be difficult to pinpoint. That’s because the process by which research evidence results in broader change can be diffuse, often taking many years.
At the Institute for Work & Health (IWH), researchers work with the knowledge transfer and exchange team to track and report on the uptake and use of its research by stakeholders within the health and safety system. One way to gauge impact is through case studies, which tell the story of how research informed the activities of particular stakeholders.
In the case studies below, the impact of research was seen many years after the research projects had wrapped up. These projects resulted in policy changes at the Workplace Safety and Insurance Board (WSIB), Ontario’s workers’ compensation agency. Several years after these changes took place, positive outcomes began to be seen.
A new case management model
For a decade, from 1999 to 2009, the proportion of disability episodes of long duration compensated by the WSIB steadily went up. This was a serious problem, given that injured or ill workers experience profound emotional, physical and economic losses when their recovery and return to work is delayed. As Judy Geary, the WSIB’s former vice-president of program development, put it, “this led to longer claim durations, higher costs and dissatisfied stakeholders.”
To turn this trend around, the WSIB introduced a new case management focus for the delivery of services to injured workers and their employers, with an emphasis on improving return-to-work (RTW) outcomes. Called the New Service Delivery Model (NSDM), it incorporated procedures based on the evidence available, and IWH research played a pivotal role.
In particular, IWH research on return to work, recovery, claim complexity and interventions was
quite formative in WSIB’s thinking, said Geary when IWH first contacted her about the model.
Indeed, researchers from IWH met regularly with WSIB staff during the design and development of the model to offer advice about the appropriate use of research evidence.
The WSIB’s new model, introduced in the fall of 2008 and into the spring of 2009, includes a number of features that Geary traced back to IWH research. For example:
- The model adopted a case management framework, in which a case manager assesses very early in the life of a claim the degree of WSIB involvement needed to ensure an injured worker’s return to work.
- A new role was created, the RTW specialist, for the case manager to call in when an injured worker and workplace are having difficulty developing an RTW plan.
The IWH research leading to the ‘Seven Principles for Successful Return to Work’ showed that RTW co-ordination is key,said Geary.
The RTW specialist was created directly as a result of that research.
- The new model was designed to enable timely first decisions so that an injured worker quickly learns if his or her claim for workers’ compensation benefits has been accepted.
Research shows a long delay results in poorer outcomes,said Geary.
So we put a lot of effort into re-engineering the process to enable timely first decisions.
The NSDM has had a marked impact on improving RTW outcomes. According to the WSIB report, 2012-2016 Strategic Plan: Measuring Results: Q1 2013, by early 2013, 90 per cent of all claim eligibility decisions for Schedule 1 injured workers were being made within two weeks. This was an improvement from 2008 when only 65 per cent of decisions about a claim took two weeks or less. As well, the percentage of workers still on workers’ compensation benefits after 12 months dropped to 3.9 per cent, down from 8.9 per cent in 2009.
A new reintegration program
Around this same period, in November 2010, the WSIB also introduced a new vocational rehabilitation program for injured workers called the Work Reintegration Program (WRP). This was partly in response to research at IWH in the years between 2007 and 2009 showing how the existing vocational rehabilitation program for injured workers, called Labour Market Re-entry (LMR), was not working as intended.
At the time, the Board’s vocational retraining program offered through LMR was geared to workers who were injured at work and could not return to their former workplace, usually because they had suffered a permanent impairment. The function of placing workers in vocational retraining programs was outsourced to seven firms, whose case managers priced, designed and oversaw an individual worker’s program. Through these programs, workers often ended up at private training schools throughout the province.
Using qualitative research methods, an IWH research team identified a number of problems with the program. When the WRP phased out the use of external LMR service providers and brought case management back inside the Board, Geary traced a number of the new program’s features to IWH’s research. They include:
- more opportunities for choice. Injured workers were given more chances to make their own decisions about their occupation, the nature of their retraining (on-the-job versus school) and, if an academic route is chosen, what type of school they attend. This was directly related to the finding that injured workers felt they were put on treadmills of training programs that they didn’t want to be on, but had to stay on in order to maintain their workers’ compensation benefits.
- more retraining pathways. IWH’s research showed that offering just one pathway—the academic route— was a bad fit for many injured workers. Therefore, the new program allowed for other options, such as on-the-job training
- access to community colleges. The problems at private training schools noted by the research—e.g. pushing workers through their programs too quickly, inflating marks to make their own success rates look good—led the WSIB to build alliances with the province’s community colleges and give injured workers the option of attending these schools if they prefer.
- placement services. The research emphasized that injured workers faced a lot of barriers and stigma as they searched for work. Therefore, the WSIB decided to offer 12 weeks of placement services through contracted providers to those not returning to their old employer.
- part-time work. The research showed that the all-or-nothing approach of LMR—full-time work or none at all—did not fit the needs of workers who wanted to work but could only manage limited hours. WRP opened up the possibility of part-time employment.
In the report, 2012-2016 Strategic Plan: Measuring Results: Q1 2013, the WSIB noted that the Work Reintegration Program resulted in better outcomes, lower costs and higher customer satisfaction levels. According to the report, in the first two years of the new program, 69 per cent of workers who completed their program returned to work, compared to 36 per cent of workers in 2009 under LMR. As well, WRP costs in 2012 were $91 million—down $77 million from the $168 million it cost for LMR and related services in 2009. Finally, injured worker satisfaction rates with the new program increased to 85 per cent, up considerably from the 49 per cent of injured workers satisfied with LMR services.
These two case studies are among several new case studies on the impact of IWH research. For more, go to: www.iwh.on.ca/impact.
Source: At Work, Issue 80, Spring 2015: Institute for Work & Health, Toronto