What is effective early intervention?

In working with many of our partners in industry, it’s intriguing how often we lose sight of what effective early intervention looks like, when managing injury. I’m going to outline some broad philosophies that will assist in guiding an early intervention program for your workplace.

Whilst my ‘sandpit’ is work-related musculoskeletal injury, I think it’s important to note that these same approaches work well with many non work related and psychological injuries in the workplace.

It might be easier to start with what is not early intervention. Early intervention is not:

• Reporting the injury in the workplace injury database and handing them a workers compensation claim pack.
• Sending a person with a non-traumatic musculoskeletal complaint to an emergency department for follow up care.
• Sending a person with a non-traumatic musculoskeletal complaint immediately to a GP.

Whilst these strategies may help many businesses ‘tick a box’, they will often lead to greater fear and anxiety for the injured worker. The long term effect is a greater likelihood of chronicity developing and a failed return to work outcome.

Effective early intervention for musculoskeletal injury applies several concepts.

Worry about the person and their injury, not whether it ‘really’ happened at work.

We know that people who feel supported both at home and at work, tend to get better quicker. The primary focus of the safety team is on ensuring the injured worker feels supported following their injury. Feeling supported means feeling safe, and improves the likelihood that the worker will work with the workplace to recover from their injury. Strategies that help enhance this support include:

• Regular phone calls or touchpoints with the team member
• Offering to support them by meeting with healthcare providers (with permission and where appropriate).

Use healthcare that encourages a ‘remain at work’ approach.

Navigating how best to manage an injury and communicate with a workplace can be challenging for an injured worker. It can often lead to added stress and anxiety that hampers their recovery, or the prescription of duties that are beyond their physical capacity. A healthcare practitioner should be supporting the injured worker through written or verbal correspondence with your workplace (with the worker’s permission) to help explain the support that the injured worker will need. Further encourage these channels of communication through:

• Offering to attend with the worker at their appointment (if they feel comfortable)
• Invite the healthcare provider for a site tour.

Develop relationships with local physiotherapy and medical providers that understand these core concepts. If you’re looking for a provider, consider reviewing the signatories to the Health Benefits of Good Work.

In providing onsite healthcare and AXIS One Call telehealth services for acute injuries, AXIS deliver information return to work plans to the workplace rapidly following consultations. The same should be expected of any healthcare service you might refer to, and is reasonable for you to ask of an injured worker’s healthcare provider.

Use healthcare that includes effective communication with both the injured person and your workplace.

Navigating how best to manage an injury and communicate with a workplace can be challenging for an injured worker. It can often lead to added stress and anxiety that hampers their recovery, or the prescription of duties that are beyond their physical capacity. A healthcare practitioner should be supporting the injured worker through written or verbal correspondence with your workplace (with the worker’s permission) to help explain the support that the injured worker will need. Further encourage these channels of communication through:

• Offering to attend with the worker at their appointment (if they feel comfortable)
• Invite the healthcare provider for a site tour.

Early Intervention doesn’t end after two days.

Many businesses believe that early intervention begins with an injury, and ends once you’ve booked an initial consultation with the doctor. Whilst this is clean-cut for businesses to track their KPIs, it manifestly underestimates the needs of workers following an injury. In reality, an early intervention system needs to be applied over more realistic periods of time (such as 1-2 weeks following the onset of symptoms). By changing your early intervention mindset to a more extended timeframe, you’re more likely to:

• Arrange appropriate follow up healthcare for the worker through a course of physiotherapy or referring for medical care.
• Arrange regular touchpoints with the worker and their supervisors to track their recovery and return to work.
• Set realistic expectations regarding recovery with the worker.

Early Intervention has a place even when a claim is likely

Ultimately, the goal of any injury management approach should be to reduce the burden of injury to the worker. This will inevitably lead to improvements in claim costs and recovery timeframes. Accessing early intervention, before any claims determination and with a ‘no fault’ approach, ensures that you set the injured worker up with the best chance of speedy recovery, even within a claim process.

When applied, the concepts discussed demonstrate that you are using an evidence-based approach to injury management in your workplace. Feel free to reach out to AXIS for more information.

Is Hazardous Manual Handling the only Enemy?

The consequence of workplace musculoskeletal disorders (MSD’s) is well documented, with significant social and economic burdens for the injured worker, employer and health care system.

The gold standard approach for preventing MSDs should focus on the effective implementation of a risk management approach which considers all possible contributing hazards that may contribute to the development of MSDs.

In many instances though, the risk management approach is often only directed toward eliminating or reducing physical hazards directly related to the inherent characteristics of manual tasks.  For most people, targeting control measures towards physical task characteristics seems intuitive.  Reducing a worker’s exposure to force, awkward posturing and repetitive or sustained movements will help reduce physical stress on the body and help curtail injury.

Research, however, suggests that workplace psychosocial and organisational factors also present as significant risk factors for work related MSDs.  Considering this, effective risk management for the prevention of MSD’s should not just focus on physical hazards but should also consider, identify, assess and control workplace psychosocial and organisation hazards that are known to contribute to the onset of MSD’s [1].

By definition, work-related psychosocial risks concern aspects of the design and management of work and its social and organisational contexts that have the potential for causing psychological or physical harm.

When it comes to understanding MSDs, these risk factors are often less tangible, less obvious, and are often not considered or easily accepted by workplaces as potential hazards for MSDs.  Despite this, research highlights workplace psychosocial, organisational and cultural factors are independent risk factors for the development of MSD’s [2].

Examples of workplace psychosocial hazards that can contribute to MSDs include: time pressures; cognitive demands; hours of work; poorly defined work roles; poorly managed change; poor conflict management, lack of job control; lack of supervisor and/or co-worker support; organisational injustice; and inadequate reward and recognition.

Such workplace psychosocial risk factors may not only lead to occupational stress, but can promote a wide variety of mental and behavioural responses within a worker. A growing body of evidence now exists, highlighting how occupational stress can increase a workers risk of tissue damage and pain.

In the case of work related low back injuries, evidence highlights that poor supervisor and manager support, lack of social support from colleagues, low job control and poor job satisfaction are all independent risk factors for low back pain.  These have also been shown to be causative to work related upper limb MSDs, as has a lack of task variation, job insecurity and working under time pressure and deadlines.

Similar to managing physical risk factors, a risk management approach to psychosocial hazards should be employed.  The People at Work Project, a collaboration between the University of Queensland, The Australian National University, Workplace Health and Safety Queensland, WorkCover NSW, WorkSafe Victoria, Comcare, Safe Work Australia, and BeyondBlue, has developed People at Work, a psychosocial risk assessment tool which helps business understand and manage their psychosocial risks.

It promotes appropriate prioritisation of risks and provides direction for the implementation of appropriate prevention strategies to help create psychologically healthy and safe workplaces.  Such strategies may need to be tailored at the job design, organisational or individual level.

Job design strategies might focus on changes to rostering, shift patterns, job rotation etc.   Effective controls at this level may not only help reduce psychosocial hazards related to performing tasks but may also have a direct effect on reducing exposure to hazardous manual tasks.

At the organisational level, strategies to foster an improved WHS culture should be considered.  This may include greater worker consultation in health and safety issues or ensuring supervisors and managers set the standard by modelling correct processes and procedures, whilst also employing transparent honest communication.

Regardless of where the intervention is directed, the success of controlling psychosocial risk is contingent on several variables:

Overt and visible senior management involvement is required.  This can signal the importance of the process and can impart a sense of ‘support’ for the work force.   This may include senior management being active in WHS committees or attending toolbox meetings.  Direct and consistent organisational communication is also required to ensure that management commitment to addressing psychosocial issues is conveyed, and to help promote worker engagement. This may be achieved through focus groups, noticeboards, broadcast emails and management participation in WHS committees.

Furthermore, supervisor commitment and engagement is needed.  Supervisors are often the direct link between workers and senior management. Supervisors who commit to a risk management process, role model correct processes and procedures, and who are approachable, supportive and non-judgemental, not only instil a positive health and safety culture, but will often be the first person to identify psychosocial risks for individual workers, or for the workplace as a whole.

Finally, worker participation and engagement are crucial.  This can foster a greater sense of ‘work control’ and ‘support’ and may in fact assist in reducing the very stressors that contribute to psychosocial hazards.  Furthermore, worker input ensures any interventions are specifically tailored to workers concerns.

Although these variables have been discussed in the context of effective management of psychosocial risk, they are equally important in the risk management process for hazardous manual tasks. The two are not mutually exclusive.

In summary, effective risk management of MSDs in the workplace is complex and requires more than just consideration of hazardous manual tasks.  Understanding the nature and effect of psychosocial risk factors is critical. Furthermore, implementation of an effective risk management program that considers all possible risk factors requires strong leadership and workforce engagement – from front line workers through to senior management.

Source

[1] Marras, W.S., Cutlip, R.G., Burt, S.E., Waters, T.R.  Epidemilogical evidence on relative influence of workplace psychosocial versus physical factors on contribution of MSDS.  Applied Ergonomics. 2009 Jan;40(1): pp. 15-22

[2] Johnston, J.M., Landsittel, D.P., Nelson, N., Garnder, L,I., Wassell, J.T. Stressful psychosocial work environment increases risk for back pain among retail material handlers.   American Journal of Industrial Medicine.  2003 Feb;43(2):179-87