In 2011, a large acute-care hospital system in southwestern Ontario employing 4,000 people became concerned about the high costs of workplace injuries and illnesses. Explicit policies and procedures had not been developed for supporting those on sickness absence to return to work. Accordingly, the number and duration of its workers’ compensation claims were double those of its health-care sector peers.
To turn this around, the hospital and its three unions worked together to develop and implement an innovative, evidence-based return-to-work (RTW) program. The program had several distinctive features. One was its explicit goal of promoting a strong link between injury prevention and disability prevention (sometimes called primary prevention and secondary prevention). It set out to realize this goal by placing overall responsibility for return to work and accommodation with the hospital’s occupational health and safety (OHS) unit.
A second innovative feature was its inclusion of labour perspectives throughout the RTW process. New RTW coordinator roles were created for representatives from each of the hospital’s three unions, so that returning workers all had a representative from their union acting as a point person for RTW issues. This meant managers also knew who to go to for matters related to RTW. A team approach to managing absence and RTW became the norm, with multiple parties being involved, including the OHS unit, the human resources department, the manager, the returning worker and the union representative.
A third notable feature of the new program was its integration of research. Decision-makers drew on research evidence in designing the new program; they also asked a research team from the Institute for Work & Health (IWH) to evaluate the program implementation, using both qualitative methods to identify challenges and barriers, as well as quantitative methods to measure the impact of the program.
Measuring program results
The team, led by IWH Senior Scientist and President Dr. Cameron Mustard, identified a number of implementation challenges, which were explored in the November 2016 issue of the journal Work (doi:10.3233/WOR-162437) and summarized in the Spring 2016 issue of At Work. Despite these challenges, the team found that the program met one of the hospital’s targets—a 25 per cent reduction in duration of workers’ compensation claims over a three-year period—and also achieved the objective of reducing the number of claims, although it fell shy of the 25 per cent target.
As reported in an open access article in April 2017 in BMJ Open (doi:10.1136/bmjopen-2016-014734), following the 2012 program launch, the hospital saw a decrease in its total injury claims rate, from 82 per 1,000 full-time equivalents (FTE) in the three years prior to the launch to 72 per 1,000 FTE in the subsequent three-year period. And, although these rates were still substantially higher than those at 29 peer hospitals (where the figures were 41.5 and 40 per 1,000 FTE in the two corresponding periods), the difference between the hospital and its peer group was reduced.
More dramatically, the number of days on benefits fell by nearly half, from 19.4 days per claim pre-launch to 10.9 days per claim in the three years after. With the peer average at 10.5 days per claim in the later period, the hospital had brought average claims duration in line with that of its peers.
Importantly, a survey of employees returning to work conducted by IWH as part of the evaluation found favourable reactions to the program across all dimensions. In the second of two rounds of surveys, conducted in 2014, more than 80 per cent said:
- they were satisfied with arrangements to modify job duties or work hours during RTW;
- they had been contacted shortly after their absence began by the department responsible for making that contact;
- they were active participants in the RTW planning;
- it was a team effort; and
- their confidential health information was protected.
From the perspective of employees who returned to work following a disability episode, it appears that all elements of the RTW process were meaningful, including early contact, the process and outcome of the RTW planning meeting, and the support of supervisors and union representatives, says Mustard.