Evidence-based policy, when informed by user practice and the context in which it is being applied, can generate outstanding results and make a big difference in the lives of the people affected.
This was the take-away message of former Workplace Safety and Insurance Board (WSIB) executive Judy Geary, who was this year’s guest speaker at the Institute for Work & Health (IWH)’s annual Alf Nachemson Memorial Lecture.
When policy is formed using evidence—the best-available quality evidence—it is simply better than policy and practice that is designed or delivered based on ideology, opinion or personal experience, said Geary to the 100-plus people at the lecture, which took place in late October in Toronto. Geary went on to illustrate this through her story of significant policy reforms at the WSIB in which research and researchers played an important role.
Diagnosing a performance decline
In the mid-2000s, Geary was called on to oversee the development of new case management and vocational rehabilitation policies and practices at WSIB. The impetus was to help bring an end to a period of deteriorating performance. Determined to get it right, Geary and her team “set aside [their] own perceived wisdom” and, instead, turned to “the best knowledge” they could find from around the world to fix their problems.
And there were problems. Injury rates were declining, yet fewer injured workers were returning to work, permanent impairments were on the rise, and health-care and vocational rehabilitation costs were increasing.
Between the years 1998 and 2008, almost every key indicator at WSIB went downhill, said Geary.
Outcomes were deteriorating, year over year, for 10 solid years.
Geary and her team first turned to research to help understand the drivers behind these problems.
One of the most important things we did… was to work with IWH to learn why this was happening, said Geary.
We gave IWH every piece of data we had that we thought could be helpful.
The IWH study pointed to a number of issues. Legislative changes in 1998 led to the Board providing “less and definitely inadequate” onsite support to injured workers and employers in the return-to-work process. Injured workers were getting a lot of health care—“round after round of assessment and treatment”—often to very little effect. And WSIB’s incentive programs were creating “a perverse incentive” for employers to sever their employment relationship with injured workers, thus putting them into retraining programs.
‘Screwing up the courage’
Knowing where the problems lay, Geary and her team turned to research again to help point to the best solutions. After canvassing and synthesizing the existing literature on disability prevention and return to work as best they could, they invited some of the researchers they had been reading about to help with the redesign of services.
This was probably our stroke of genius, said Geary.
We actually screwed up our courage, picked up the phone and [asked researchers if they were] willing to come and help us do this work. Several researchers from IWH were among those invited.
We were a bit nervous because none of us had PhDs. Would we be able to talk to them? Would they think we were stupid? Geary admitted.
But they were so gracious, and so excited to be brought in to talk about their research and how we might be able to apply it in our environment.
Geary and her team met with the researchers regularly, and also phoned and e-mailed them between meetings to ask for advice. They asked questions of the researchers such as: What works? What has a good possibility of working if we’re not really sure it works? Is it worth us trying it? How should we do it? Is our way of thinking about how to do it likely to work? Does it align with the evidence you have?
Geary and her team also invited researchers into the WSIB to study its practices.
It took a lot of courage, because we knew they were going to find things that would make us uncomfortable, said Geary.
In the long run, it worked out really well.
The WSIB made substantial changes to its case management, vocational rehabilitation and health-care programs. Examples include offering return-to-work (RTW) coordination services to workplaces through RTW specialists; speeding up decisions about claims eligibility; and bringing vocational rehabilitation services back inside the Board. (A fuller description of the changes made can be found on IWH’s webpage of impact case studies: www.iwh.on.ca/impact.)
These changes, Geary reported, have resulted in big improvements in outcomes related to both the well-being of injured workers and costs. Evidence-based policy and practice in the human services sector, including workers’ compensation, just makes sense, Geary concluded.
If you’ve got good, sound evidence of what works, why would you not adopt it and adapt it to your practice? she said.
It can make a big difference to peoples’ lives.
Listen to the full lecture on IWH’s YouTube channel: www.youtube.com/watch?v=VrV2oVEM9zE.