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Towards a National Research Agenda.
Report of the Symposium convened by the Foundation for
Research into Injury and Illness in the Workplace Inc.
Melbourne 25 May, 2006.
NOTE
This report was prepared by The Foundation for Research into Injury and Illness in the Workplace
Inc as a general record of discussion prior to and during the 2006 ResWorks Symposium –
Towards A National Research Agenda. This report captures and assimilates the main points put
forward in writing and discussion by participants. This report is not a verbatim transcript of the
Symposium’s proceedings, nor does it embellish, interpret, or expand upon matters or topics that
were unclear or not addressed. Statements are the assimilated views of participants. Except as
specifically noted, no statement in this report represents the position of ResWorks.
This report is Copyright for commercial purposes. Requests for reproduction must be made in
writing to the Executive Officer. Non profit use is free of Copyright provided acknowledgement of
ResWorks is made, including provision of an active link.
Resworks
Suite C, Level 8
492 St Kilda Road
Melbourne 3004
Phone: 61 3 9866 6376
Fax: 61 3 9866 6428
Email: info@resworks.org.au
Web: www.resworks.org.au
2
The Foundation For Research Into Injury and Illness in the Workplace – Symposium 2006 – Towards a National Research Agenda
Web: www.resworks.org.au Email: info@resworks.org.au Phone: 61 3 9866 6376
‘If health outcomes for conditions suffered during employment were the same as
outcomes for like conditions suffered outside of employment it would mean that
Australian workers compensation systems were operating at the cutting edge of
knowledge. They are not. There is a problem. The problem is within the system.
How do we know this? Because the problem does not reside outside of the
system.
The texture of the problem is felt daily by everyone in the system who suffers the
experience of forcing someone to do something, finds something within it to
escape from, or sees the system as a means to escape from other
circumstances.
We feel the problem, but our policy frameworks do not fully understand it. We get
a grip on bits of it, interventions, programs, are put in place and we see
improvement in our grasp, but in that very moment we also see some other
aspect ballooning out between our fingers.
Why? Because we haven't got to the root of the problem. There are an endless
number of answers, however, if we do not understand the exact nature and
dimension of the problem how can we be sure which of them is right?
If health outcomes for non work related conditions are clearly better than for like
conditions suffered within employment, then the inescapable conclusion must be
that the system itself damages people, even kills them. This is a matter of
profound gravity.
Smoking is bad, driving dangerously is unacceptable, fluoride in water is good.
Community attitudes are clear on these matters. However, as a society we do not
understand the true consequence of workplace injury and illness. As a result our
attitudes to it are diverse, contradictory, self interested. And bad stuff happens. ‘
– Symposium participant
3
The Foundation For Research Into Injury and Illness in the Workplace – Symposium 2006 – Towards a National Research Agenda
Web: www.resworks.org.au Email: info@resworks.org.au Phone: 61 3 9866 6376
TABLE OF CONTENTS:
EXECUTIVE SUMMARY: .................................................................................................................................. 5
INTRODUCTION: .............................................................................................................................................. 7
METHODOLOGY: ............................................................................................................................................. 8
SYMPOSIUM RESULTS: .................................................................................................................................. 9
1. RETURN TO WORK MANAGEMENT ....................................................................................................... 9
1a) Prediction of poor outcomes ................................................................................................................ 9
1b) Early intervention ................................................................................................................................. 9
1c) Psychosocial issues - identification and management ......................................................................... 9
1d) Communication .................................................................................................................................. 10
1e) Role of treaters ................................................................................................................................... 10
1f) Workplace and supervisor management ............................................................................................ 11
1g) Assessment of capacity ..................................................................................................................... 11
1h) Legislation / system ............................................................................................................................ 11
1i) General Return To Work (RTW) management ................................................................................... 11
1j) Treatment strategies / efficacy of treatment ........................................................................................ 12
1k) Enhancing motivation ......................................................................................................................... 13
1l) Re-employment Issues ........................................................................................................................ 13
1m) The value of determining what the individual wants / needs ............................................................ 13
2. IDENTIFYING AND QUANTIFYING THE PROBLEM - understanding what we are dealing with .......... 13
2a) Factors that contribute to the problem ............................................................................................... 13
2b) Health outcomes - morbidity / mortality, work / non work .................................................................. 14
2c) The Impact - individual, social, financial. ............................................................................................ 14
3. GETTING RESEARCH INTO PRACTICE TO IMPROVE OUTCOMES ................................................. 14
3a) Research information to improve treatment practices ....................................................................... 14
3b) Employer management practices ...................................................................................................... 15
3c) Rehabilitation management practices ................................................................................................ 15
4. EFFECTIVE WORKPLACE OR COMMUNITY CULTURE, AND THE EFFECT OF CHANGING
CULTURES .................................................................................................................................................. 15
5. BELIEFS AND ATTITUDES OF THOSE INVOLVED .............................................................................. 16
6. OH&S ....................................................................................................................................................... 16
6a) Prevention of injuries .......................................................................................................................... 16
6b) Prevention of stress cases ................................................................................................................. 16
7. AGEING WORKFORCE .......................................................................................................................... 16
8. MANAGEMENT OF CHRONIC CASES .................................................................................................. 16
VISUAL REPRESENTATION OF PRIORITIES: ............................................................................................. 17
NETWORKING: ............................................................................................................................................... 20
CONCLUSION: ................................................................................................................................................ 21
SYMPOSIUM PARTICIPANTS ....................................................................................................................... 22
RESWORKS BOARD: ..................................................................................................................................... 23
SYMPOSIUM AGENDA................................................................................................................................... 24
4
The Foundation For Research Into Injury and Illness in the Workplace – Symposium 2006 – Towards a National Research Agenda
Web: www.resworks.org.au Email: info@resworks.org.au Phone: 61 3 9866 6376
EXECUTIVE SUMMARY:
One would expect that bringing together a broad group of stakeholders for a short period of time to
consider research needs across the entire landscape of workers compensation would result in a
wide-ranging list of issues and statements. That is exactly what happened. The group process the
Symposium followed identified an extensive list of potential research topics. The same group
process was used to determine the key priority areas for attention in this list. These were identified
in Categories and Sub Categories.
As a result the Symposium Report provides a very clear image of the diversity and scope of the
problems that confront stakeholders in the Australian workers compensation systems. And in the
experience of the event itself participants gave an equally clear picture of the extensive goodwill
that exists between players and of their hunger to communicate with one another, create
partnerships and make progress together.
The ten highest priority Sub Categories identified by participants are:
1. Identify and quantify the factors that contribute to the problem
2. Research information to improve treatment practices
3. Prediction of poor outcomes
4. Effective workplace culture, and the effect of changing workplace cultures
5. Understand and the influence of beliefs and attitudes of those involved
6. Communication between the relevant parties
7. Health outcomes - morbidity / mortality, work / non work
8. Identify and quantify the financial Impact
9. Early Intervention practices
10. Employer Management Practices
This Report has been organized and illustrated according to the group Category and Sub Category
priorities. As far as possible the issues have been presented as a narrative on which to base
further discussion and go forward together to a new level of refinement of subject, objectives and
partnerships in action.
Immediately below is a summary of the three highest Category priorities for research of concern to
Symposium participants.
Understanding the overall problem – what is the personal, social and economic cost of
increased mortality and morbidity resulting from being off work in Australia?, why are there
different health outcomes for like injuries in work and non work contexts? Clarify the non
mechanical factors that create different outcomes. Understand the barriers to employee
5
The Foundation For Research Into Injury and Illness in the Workplace – Symposium 2006 – Towards a National Research Agenda
Web: www.resworks.org.au Email: info@resworks.org.au Phone: 61 3 9866 6376
compliance with rehabilitation programs, quantify the risk factors for employees and
employers in an early return to work. Facilitate mutual respect between employers and
treaters. Consider ways the workers compensation systems can be standardized.
Establish the unit of analysis as insured worker / person rather than claim / incident.
Return to work management – understand the impact of legislation on outcomes in
different Australian jurisdictions. Assess existing early intervention strategies and create
new ones. Develop predictors of poor health outcomes. Improve tools to inform treating
practitioners, workers, managers, insurers and foster better communication. Understand
the efficacy of treatment strategies. Refine work capacity assessment and enhance
motivation for return to work through a better understanding of the positive benefits.
Getting research into practice – determine standards and guidelines to achieve practical
outcomes from research projects. Establish a central repository in which local research can
be collected (in plain English) and international findings can be adapted, from which the
implementation of both can be advocated. Undertake a recurrent conference focusing on
practical applications and implementation. Foster ongoing communication and partnerships
between researchers, employers and policy makers. Improve treatment practices by
developing and advocating an evidence base to support best practice medical care at each
stage of a case to minimize chronic disability. Understand GP knowledge of the evidence
base regarding workplace disability and advocate training improvements. Re-educate
treaters to give appropriate return to work messages to patients. Assemble existing
research on collaborative approaches and positive workplace cultures and advocate
positive models to managers of large and small workplaces.
6
The Foundation For Research Into Injury and Illness in the Workplace – Symposium 2006 – Towards a National Research Agenda
Web: www.resworks.org.au Email: info@resworks.org.au Phone: 61 3 9866 6376
INTRODUCTION:
The Foundation for Research into Injury and Illness in the Workplace Inc., is a non-profit
organisation. The Foundation’s objectives are to further knowledge and improve health outcomes
in workplace disability. The Association undertakes research, provides communication and
networking services and advocates reform.
In part ResWorks was formed to take up a role signaled by the Australian Faculty of Occupational
Medicine (AFOM) when participants at its 2000 Workshop in Sydney called for more research and
the establishment of an organisation to facilitate communication and support researchers in the
field.
The 2006 Symposium – Towards a National Research Agenda, was convened by ResWorks to
canvas research needs from the diverse viewpoints of the many stakeholders in the field. This
report was written to inform researchers, employers, policy makers and funders of the range and
weight of problems that confront stakeholders. In these pages are the many issues that
Symposium participants considered would benefit from the development of a deeper evidence
base to facilitate better treatment interventions, management practices and further policy
development.
This report simply identifies the range and scope of the problems. No attempt is made here to
foster more research into workers compensation, or to encourage that work to be undertaken in a
co-operative and transparent manner by researchers and institutions. We make no attempt to
discuss the co-ordination of research efforts across the country to ensure the most efficient use of
available funds and facilitate a broad adoption of results. These are pressing problems to which
ResWorks offers this report as a point of discussion.
ResWorks was assisted in mounting the Symposium by a grant from the Victorian WorkCover
Authority, which partly met the cash costs of producing the event and for which we are grateful. We
are also grateful for the generous gifts of time and thought contributed by the Symposium
participants who have made this document possible.
7
The Foundation For Research Into Injury and Illness in the Workplace – Symposium 2006 – Towards a National Research Agenda
Web: www.resworks.org.au Email: info@resworks.org.au Phone: 61 3 9866 6376
METHODOLOGY:
On May 25th 2006 ResWorks convened the Symposium – Towards a National Research Agenda.
Participation was by invitation to senior people representative of the diverse stakeholders in the
field. 54 participants from 5 states attended the event and represented groups ranging from
claimants to insurers, employers to policy makers, treating practitioners to researchers. 4 Union
representatives were invited, two accepted the invitation, but unfortunately did not attend.
Prior to the event participants were asked to complete an online survey. The survey posed 2
questions:
1. What do you consider the three most important research priorities in the area of work
disability generally?
2. What do you consider the three most important research topics within your field of
expertise, regarding work disability?
A total of 41 of the 54 Symposium participants completed the initial survey. Responses were
compiled to a single anonymous document ordered by profession. The result was 8 pages of
closely typed material. This document was emailed to all participants a week prior to the event.
The Symposium opened with a welcome from Dr Mary Wyatt who presented an overview of the
value of research together with examples of benefit. Mr Alan Clayton then described the structure
of peak research bodies in Canada and Germany and Scandinavian countries, he also posed the
question of the appropriate best practice model for Australia. Other speakers followed illustrating
different stakeholder perspectives (see Agenda pg24).
Following morning tea Dr Wyatt summarized the initial survey from a subject perspective, providing
participants with a graphical overview of the diversity of suggestion and the weight of interest in
subject matter. A single page Categories Summary was distributed to participants (see pg17).
Workshops: two workshop sessions were conducted on the day. Five workshop groups each
contained from 10 to 12 participants and were organized broadly along professional lines (except
for policy makers who were distributed evenly among the 5 groups). The same workshop
population met in both sessions. Each workshop group considered the section of the initial survey
document which included their individual contributions.
During the first workshop 40 minutes of group discussion, was followed by 20 minutes of writing by
individuals (again anonymous). All copies were collected by staff and the additions and changes
were made to the workshop documents.
The second workshop considered the revised documents. Participants were free to further revise,
or add content, however, the principal aim of the session was to prioritize the research topics using
a weighted numerical system. Participants were also asked to prioritize the headings listed on the
Categories Summary page.
Following the Symposium ResWorks staff added any new material, and assembled a single draft
document ordering the research topics according to category and priority. The research agenda
material was edited for repetition (where it could be removed without blunting the intent of the
contributors). The prioritized Categories document was used to create the Contents Table of this
report.
The draft report was distributed to all participants for comment. The resulting feedback was used
to edit and further refine the published report.
8
The Foundation For Research Into Injury and Illness in the Workplace – Symposium 2006 – Towards a National Research Agenda
Web: www.resworks.org.au Email: info@resworks.org.au Phone: 61 3 9866 6376
SYMPOSIUM RESULTS:
1. RETURN TO WORK MANAGEMENT
1a) Prediction of poor outcomes
Identification of injured workers who will develop chronic disability. Validity of tools used?
Develop a multi-dimensional and sophisticated model for predicting poor outcomes in acute
to sub-acute work related injury.
Researching concrete data how do we identify the 20% (who will have poor health outcomes
i.e. 80/20 rule) at the outset to better enable all parties to focus activities, resources etc., to
this group. The next research project is then to understand what interventions make a
difference in the course of those 20% claims?
Development of a multi-dimensional and sophisticated model for predicting poor outcome in
workers referred to the Sprains and Strains Care Model
Develop predictive factors for delayed or non return to work.
Effective treatment/rehabilitation for predictive factors for delayed or non return to work?
1b) Early intervention
Early intervention strategies have the best potential for minimising work disability.
1. Research and establish a model to enable the early identification and management of
injured workers who are at risk of chronic disability.
2. Develop and trial a program integrating known best practice strategies at the 'front end' of
potentially long term claims using appropriate scientific methodology. The program should
first determine the factors for early intervention and the factors for delaying intervention.
The interventions should be 'low-tech', simple, and maintain the worker at work without
aggravating injury, using both medical and non-medical models. They should include, but
not be confined to: early identification and management of significant injuries / improvement
of communication between employers / patients / practitioners / education strategies /
regular appropriate expert review strategies / provision of suitable, meaningful alternative
duties as a process to facilitate full return to work.
The program should also include an evaluation and review strategy.
1c) Psychosocial issues - identification and management
What is the influence of biopsychosocial factors in limiting disability?
What are the common psychosocial barriers to return to work, how can they be understood
and how can they be managed?
What attitudes of family members assist in the recovery from work injury? How can the
promotion of safe and timely return to work be introduced to the domestic environment?
Research work-related (di)stress versus psychological injury. Perception versus
substantiated events. Develop an intervention to best promote safe and timely returns to
work?
Research the individual capacities of claimants to manage their case and claim. What are
the characteristics of those who are reliant on the treaters?
9
The Foundation For Research Into Injury and Illness in the Workplace – Symposium 2006 – Towards a National Research Agenda
Web: www.resworks.org.au Email: info@resworks.org.au Phone: 61 3 9866 6376
1d) Communication
Research should be undertaken to understand and improve:
1. Practical communication between treating practitioners and employers
2. Communication within return to work programs
3. Early management of injured workers' catasrophising diagnosis, understand what effect it
has on long-term outcomes?
4. Communication protocols between all key stakeholders - workers, unions, employers,
agents, treating practitioners - to prevent chronic disability and manage at risk workers.
5. Integration and communication of and between stakeholders to prevent chronic disability
and manage at risk workers.
6. Commonality of diagnosis and treatment across treating practitioners.
Undertake research to:
7. Establish the most effective way to promote collaboration between employers, injured
employees, treating health practitioners and claims agents to achieve an early RTW and
reduce disability.
8. Challenge and overcome the social stereotypes (e.g. uncaring employer, un-motivated
worker, recalcitrant doctor) to enable collaboration.
1e) Role of treaters
Foster and advocate effective medical advice for people with an injury - at present the focus
of treatment is on doing something - giving medication, applying manipulation, an exercise
program. However, if the individual with the problem does not have knowledge and
understanding of their situation, their likely path forward and what they can do as an active
participant to improve their lot, their health outcome will be worse. The challenge is to
identify the content of such advice? And learn how to deliver it so that it reaches people in
an accessible, meaningful and useful way? Treaters, payers, and people with the condition
need to recognise the importance of time and focus spent on this issue.
How do we assist medical experts to understand the psychosocial factors and the demands
and flexibilities of the patient's job?
How can health care providers be assisted to recognise and integrate workplace factors into
their management e.g. what is their role re unsupportive employers?
What is the impact of the skills / capacities of treaters on RTW outcomes ie should there be
specialist/tertiary training for treaters dealing with compensable clients?
How can general practitioner knowledge in the benefits of early RTW be improved?
How to influence GP attitudes to work-related injury and encourage their support for safe
and timely RTW. Should Occupational Physicians have a greater role?
What is the role of allied health practitioners in promoting independence to achieve earlier
RTW?
Questioning the role of doctors:
1. What are the systemic influences on outcomes, eg stakeholder accountability, especially
medical professionals?
2. Should they be the gatekeepers to the compensation scheme? Can this role be shared
10
The Foundation For Research Into Injury and Illness in the Workplace – Symposium 2006 – Towards a National Research Agenda
Web: www.resworks.org.au Email: info@resworks.org.au Phone: 61 3 9866 6376
across health practitioners? Given existing relationships, workers & 'family', GP's may have
a conflict of interest.
3. Are medical practitioners the best people to determine work capacity?
1f) Workplace and supervisor management
Develop a Supervisor training program in supporting return to work for injured workers.
Employers play a key role in reducing medically unnecessary disability. However, unless
they understand the financial impact of poor decisions / judgments in relation to their injured
employees, they will continue to unwittingly contribute to the problem and blame others.
Another important research priority may be to first determine the actions under the control of
the employer, that positively impact injury recovery, and then research the financial impact
on the employer when these actions are and are not taken.
Develop an education program for employers about the positive impact of early, supported
RTW, include education about the process of supporting a claim and providing meaningful
alternate duties.
1g) Assessment of capacity
Research and establish methods to assess work capacity, including work capacity vs
physical capacity (determining what physical capacity needs to be demonstrated to achieve
an appropriate work capacity), combining the needs and knowledge of the worker, treating
practitioners and the workplace.
1h) Legislation / system
Undertake a jurisdictional comparison of legislative provisions that encourage RTW.
Can a code of practice be developed for workers compensation similar to the code of
practice for OH&S?
What models of injury / disease management achieve better outcomes? What key features
of compensation systems result in reduced disability & conversely identify barriers? Inform
policy & compensation system design with the results (legislative change if necessary).
Do legislated systems affect RTW outcomes? Define legislated timeframes influencing
'early intervention'.
1i) General Return To Work (RTW) management
What is the impact integrating stakeholders and the timing of that integration on successful
recovery, RTW and the prevention of chronic disability? What tools are required by each
stakeholder to effectively manage disability?
Determine the effectiveness of rehabilitation programs. Better define terms and create
genuine "rehabilitation" as opposed to minimalist alternative employment "identification".
Establish what the common themes in positive and negative RTW outcomes are?
Establish general time frames for recovery from work injuries to avoid chronicity and
investigate how treatment, RTW plans and relationships with the employer influence this?
Define the critical roles in the injury management / RTW process? Establish who is best
placed to undertake the work, what the competencies / skills are, assess the suitability of
existing training and make recommendations.
Research existing models to ascertain what constitutes genuine & substantive assistance
11
The Foundation For Research Into Injury and Illness in the Workplace – Symposium 2006 – Towards a National Research Agenda
Web: www.resworks.org.au Email: info@resworks.org.au Phone: 61 3 9866 6376
with sustainable RTW, identify triggers for changing strategies e.g. when an existing model
is failing an individual. What interventions are effective in achieving an early RTW &
minimising disability e.g. supervisor education / employer guidance / resources for
employers on managing workplace risks of poor outcomes and communication with GP's to
align management? Advocate implementation and assess efficacy.
Identify the competence of supervisors in the workplace (what skills are needed for
supervisor to manage injury) & treating health professionals (examine knowledge of RTW
process & capacity to communicate with employer/employees)?
Don't let 20% of poor outcome claims dictate attitudes to the 80% of better outcomes.
Educate agents regarding the appropriate handling of a claim to place less emphasis on
establishing liability and more on co-ordinating the entire claim to achieve a positive
outcome.
What is world’s best practice management of musculoskeletal injury - prevention, treatment
and rehabilitation?
Study the RTW outcomes of differing interventions - education, treatment, claims
management initiatives.
What models of injury/disease treatment and management are most effective in avoiding
medically unnecessary disability?, including consideration of:
- the medical care process — the role of physicians and other health care
professionals in avoiding disability;
- the personal adjustment process — the relevance of management of non-medical
factors (such as psychosocial, motivational and work environment factors);
- the liability and benefits administration process;
- interaction and communication between stakeholders;
- evidence regarding the benefit of staying at work and being active on recovery, key
intervention points and timeframes;
- reduction in claim numbers.
1j) Treatment strategies / efficacy of treatment
What is the importance of early intervention, good advice/education re their condition as per
Indahl et al, McGuire et al published in Spine? This intervention has been shown to
significantly reduce long term disability.
Develop mechanisms for honest and transparent description of injuries and facilitation of
speedy methods of treatment and recovery.
What is the relative efficacy of pre-claim and early post-claim interventions using medical,
physiotherapy and medical/physiotherapy disciplines?
What effect does a catasrophising diagnosis have on long-term outcome? What is the effect
of incorrect diagnosis on the worker, their recovery and their RTW?
What treatment programs actually work?
Develop Best Practice models for the management of significant conditions - back (& other
MSD) injuries, stress, etc. - management by the treater and the workplace
12
The Foundation For Research Into Injury and Illness in the Workplace – Symposium 2006 – Towards a National Research Agenda
Web: www.resworks.org.au Email: info@resworks.org.au Phone: 61 3 9866 6376
1k) Enhancing motivation
Develop an education program for workers on the positive role of return to work in
rehabilitation following an injury.
Motivation. Sports people complete amazing feats, in large part as a result of high levels of
motivation and focus. What can be learnt from their example to understand what motivates
an average person with an injury, and how can we best enhance positive motivation? What
can we then do to support motivation to be back working, despite pain and the ongoing need
for treatment?
Who should be responsible for providing education and what education will empower the
worker with respect to their injury, treatment and return to work?
1l) Re-employment Issues
Vocational Rehabilitation
1m) The value of determining what the individual wants / needs
What is the best method to genuinely engage injured workers in their own recovery?
2. IDENTIFYING AND QUANTIFYING THE PROBLEM - understanding what we are dealing with
2a) Factors that contribute to the problem
What are the barriers to return to work? Including the common perceptions &
misconceptions re RTW from an employee, employer perspective?
What are the obstacles to the effective delivery of disability prevention models, including
consideration of the key features of compensation system design and other factors which
drive behaviors that result in medically unnecessary disability?
Is there a common understanding of the importance of returning to normal, including
returning to work, as part of the recovery process? And if not how can this be achieved?
What are the risk factors for employees and employers in an early return to work?
What are the non mechanical factors that surround workplace injury and create different
outcomes for similar injuries e.g. motivation, conflict?
What are the barriers to employee compliance with the requirements of rehabilitation
programs?
What are the actual as distinct from perceived risk factors for work related injury? What
evidence exists that refutes certain work practices as leading to injury e.g.
computer/keyboard & upper limb pain and is this evidence widely disseminated in simple
language?
What can be done to facilitate mutual respect between employers and treaters to avoid
cross blame when progress is not being made?
Identify the cost and impact of the rigidities and bureaucracy in the WorkCover system that
causes all claims, claimants and employers to be dealt with at the lowest common
denominator.
How do the legislative differences behind different workers compensation systems in
Australia impact on cost & health outcomes?
How can the Australian workers compensation systems be standardized?
13
The Foundation For Research Into Injury and Illness in the Workplace – Symposium 2006 – Towards a National Research Agenda
Web: www.resworks.org.au Email: info@resworks.org.au Phone: 61 3 9866 6376
2b) Health outcomes - morbidity / mortality, work / non work
Does the Community understand the negative effects of unemployment - what is the
increase in morbidity and mortality resulting from being off work in Australia?
What are the health outcomes for workplace illness and injury in comparison to like
afflictions in a non work situation in Australia and why does a difference exist?
Develop a project to establish the nature, extent and trajectory of medically unnecessary
work disability by major groups of conditions (e.g. musculoskeletal, psychological) in
Australian jurisdictions and compare with others.
Identity health KPIs that regulators and Insurers could use to measure non financial impact
of case outcomes.
2c) The Impact - individual, social, financial.
What is the personal, social and economic cost of increased morbidity and mortality as a
result of unemployment in Australia?
What is the personal, social and economic cost of the difference in health outcomes for like
conditions suffered in work and non work contexts?
What is the personal, social and economic cost of medically unnecessary disability in
Australian jurisdictions quantified by disorder in comparison to other jurisdictions?
What benefits and savings are expected to accrue to individuals, employers and society as a
result of any new policy or intervention?
Establish the unit of analysis as insured worker/person, rather than claim/incident.
3. GETTING RESEARCH INTO PRACTICE TO IMPROVE OUTCOMES
Determine standards and guidelines for research projects that facilitate practical outcomes, the
adoption of findings and advocate to researchers and funding agencies.
Establish a central repository in which local research can be collected (in plain English), international
research can be adapted and disseminated with focus on practical application.
Undertake an annual conference focusing on the practical application of research and the
implementation of findings.
3a) Research information to improve treatment practices
Doctors are often given the 'gate-keeper' role in disability management, but how well do
GP's understand what prevents medically unnecessary disability?
Undertake a project to ascertain effective ways of getting the best evidence into every day
clinical practice and improve its application. Including the development of clinical guidelines
and a systematic review.
Research GP knowledge of key research findings in relation to disability management and
their use of this information. Findings might be used by Medical schools, and influence
funding bodies in relation to policy and program development.
Establish and disseminate practical outcome focused clinical guidelines for the management
of acute workplace injuries and the main work related injury groups. Undertake regular
reviews engaging all stakeholders in the process.
How do we re-educate treaters (in particular GP's) to provide appropriate return to work
messages to patients?
Undertake evidence based research on early return to work, its uptake and outcomes, and
use the results to positively influence treaters.
14
The Foundation For Research Into Injury and Illness in the Workplace – Symposium 2006 – Towards a National Research Agenda
Web: www.resworks.org.au Email: info@resworks.org.au Phone: 61 3 9866 6376
Use evidence based medicine to support implementation of best practice medical care that
is appropriate to the particular stage of a case, to minimize the development of chronic
disability.
3b) Employer management practices
Undertake a project to assemble existing research on collaborative approaches and positive
workplace cultures and translate the results into actionable models that work for large and
small employers (who are not expert) leading to changed behaviors. Review the results and
adjust the models as required.
3c) Rehabilitation management practices
What are the elements of the right conversation? What should be shared with people?
As a priority research and determine the most effective strategies to ensure key research
findings are put into practice in rehabilitation management.
Increase the evidence base behind assessment, treatment, RTW and advocate the effective
implementation of the evidence through the workers compensation schemes.
Encourage state and federal authorities to release commissioned research and data.
We have evidence that communication between stakeholders is important, but this is often
difficult to achieve due to factors resulting from the diverse Australian system of state
authorities, insurers, health professionals [training, time, medical certificate forms] and
workplaces [attitudes, education]. A useful research project would be to create some EB
and practical guidelines on communication between stakeholders.
Synthesize existing research and evidence on RTW practices to make it more accessible,
undertake systematic reviews within specific areas to identify problems, gaps, research
priorities.
Research methods of closing the research / practice gap - how best can we close it in
relation to health practitioners, policy makers, consumers (employees/employers), industry
bodies (e.g. state authorities, unions, etc.)
4. EFFECTIVE WORKPLACE OR COMMUNITY CULTURE, AND THE EFFECT OF CHANGING
CULTURES
Undertake research to understand how the relationship between employer and employee
effects the onset of claims, recovery from injuries, and early RTW then establish and then
advocate models, tools and interventions for large and small work places to create:
Work place support that results in disability reduction - including supervisor and
management training. What makes a difference and what difference does it make?
Effective cultural and environmental change to promote early return to work.
Creating a blame free environment.
A 'social' value to returning to work post injury?
15
The Foundation For Research Into Injury and Illness in the Workplace – Symposium 2006 – Towards a National Research Agenda
Web: www.resworks.org.au Email: info@resworks.org.au Phone: 61 3 9866 6376
5. BELIEFS AND ATTITUDES OF THOSE INVOLVED
What are the personal attitudes or responsibilities on the part of employers and employees
that secure the best outcome for injured or ill workers?
Develop an understanding of the negative consequences non-supportive employers have on
recovery times?
6. OH&S
6a) Prevention of injuries
Workplace safety (prevention)- evidence of what works
Prevention strategies including application of ergonomics & OHS systems
Prevention of re-injury
Barriers to employers' adoption of preventative strategies
Efficacy of OHS training and prevention of injuries
Embedding safety behaviors and culture in an organisation at both management and
employee levels.
Generalisability of manual handling strategies
6b) Prevention of stress cases
'Stress' and 'psychological injury': preventive strategies
7. AGEING WORKFORCE
What are the life span factors influencing people engaged in work in different life stages
What is the impact of an ageing workforce?
8. MANAGEMENT OF CHRONIC CASES
Minimizing/managing the impact of chronic illness on work capacity
Chronic pain and disability management
16
The Foundation For Research Into Injury and Illness in the Workplace – Symposium 2006 – Towards a National Research Agenda
Web: www.resworks.org.au Email: info@resworks.org.au Phone: 61 3 9866 6376
VISUAL REPRESENTATION OF PRIORITIES:
The research priorities listed by symposium participants in survey 1 which was undertaken prior to
the Symposium were grouped under category and subcategory headings as outlined in Table 1.
Table 1 – List of categories and subcategories identified from survey 1
Categories: Priorities
1. IDENTIFYING AND QUANTIFYING THE PROBLEM - understanding what we are
dealing with
1a) Health outcomes - morbidity / mortality, work / non work
1b) Financial Impact
1c) Factors that contribute to the problem
2. GETTING RESEARCH INTO PRACTICE TO IMPROVE OUTCOMES
2a) Research information to improve treatment practices
2b) Employer management practices
2c) Claims / Rehab management practices
3. RETURN TO WORK MANAGEMENT
3a) General RTW management
3b) Early intervention
3c) Enhancing motivation
3d) Communication
3e) The value of determining what the individual wants / needs
3f) Assessment of capacity
3g) Role of treaters
3h) Treatment strategies
3i) Supervisor involvement education
3j) Psychosocial issues - identification and management
3k) Legislation / system
3l) Prediction of poor outcomes
3m) Re-employment Issues
4. EFFECTIVE WORKPLACE CULTURE, AND THE EFFECT OF CHANGING
WORKPLACE CULTURES
5. BELIEFS AND ATTITUDES OF THOSE INVOLVED
6. MANAGEMENT OF CHRONIC CASES
7. AGEING WORKFORCE
8. OH&S
8a) Prevention of injuries
8b) Prevention of stress cases
17
The Foundation For Research Into Injury and Illness in the Workplace – Symposium 2006 – Towards a National Research Agenda
Web: www.resworks.org.au Email: info@resworks.org.au Phone: 61 3 9866 6376
Participants were asked to prioritize the workshop material in two ways. Firstly, to rank the
subjects of concern, shown in this report as sub categories e.g. 1a, 2c. Then, secondly,
participants were asked to rank the overall categories within which the subjects were placed e.g. 1,
2, in this report
The prioritizing process ranked the categories from one to ten, with one being the highest priority
and ten the lowest. The prioritized order of categories was used to create the table of contents of
this document. The subcategory prioritization determined the order of text within each category.
The following graphs outline the results of the ranking.
Figure 1 shows that the general category of ‘Return To Work Management’ was identified by the
participants as the subject area with the highest priority. The general categories of concern
‘Identifying and Quantifying the Problem’ and ‘Getting Research into Practice’ follow as the second
and third priority areas. The rank order of Categories was achieved via the weighted numeric
scoring system and set according to priority, this is shown on the axis of the graph.
Figure 1 – Category priorities
120
100
80
60
40
20
0
ATTITUDES THOSE
MANAGEMENT
8. MANAGEMENT
RESEARCH INTO
4. EFFECTIVE
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WORKPLACE
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PROBLEM
7. AGEING
QUALIFY
CULTURE
OF CHRONIC
5. BELIEFS &
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PRACTICE
WORK
INVOLVED
CASES
Figure 2 shows participants’ ranking of more specific subjects of concern, that is, the subcategories
and the issues within them, using similar methodology. Note that Symposium participants gave the
highest priority to subcategory 2a: ‘Factors that Contribute to the Problem’ within Category 2.
Of the two prioritizing processes i.e. category and subcategory, the ranking of subcategories is the
more useful indication of the consensus of concern of participants. See Figure 3 below for a graph
showing subcategories highest to lowest.
18
The Foundation For Research Into Injury and Illness in the Workplace – Symposium 2006 – Towards a National Research Agenda
Web: www.resworks.org.au Email: info@resworks.org.au Phone: 61 3 9866 6376
0
5
10
15
20
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Figure 3– Sub Categories in outright priority order
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Figure 2 – Sub Category Priorities in Category order
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The ten highest priority subcategories, as shown in Figure 3, are
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Identify and quantify the factors that contribute to the problem
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RESEARCH INTO
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Web: www.resworks.org.au Email: info@resworks.org.au Phone: 61 3 9866 6376
orkfo
Re-E Prevention of
Effective workplace culture, and the effect of changing workplace cultures
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4.
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The Foundation For Research Into Injury and Illness in the Workplace – Symposium 2006 – Towards a National Research Agenda
Man Need
age s 5. BELIEFS &
5.
ATTITUDES
Chro
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19
ases
Trea 8. MANAGE
8.
tmen
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ateg
ies 7. AGEING
7.
WORKFORCE
5. Understanding the influence of beliefs and attitudes of those involved
6. Communication between the relevant parties
7. Health outcomes - morbidity / mortality, work / non work
8. Identify and quantify the financial Impact
9. Early Intervention practices
10. Employer Management Practices
The input from participants regarding these subcategories is described in more detail in the
Symposium Results section above.
NETWORKING:
Following the very positive morning program a networking session was held to consider services
and activities that ResWorks might undertake to contribute to ongoing positive communication
between the Symposium participants, and by extension to all of the stakeholders in the field.
Unfortunately the spirit is this session was, as described by one participant, flat and by another as
negative.
A presentation by ResWorks discussed the possible formation of an association (not ResWorks)
that might represent the field. This presentation may have missed the mood of the gathering,
certainly ResWorks intentions were misunderstood by a number of participants. Comments that
were positive and contributory included:
Convene a quarterly meeting to discuss recent research and its benefits.
‘Making sense of it’. Undertake a project to bring together existing research
and ensure the conclusions are translated into the practical and useable
information. The website may be a useful vehicle for this information
resource.
Provide a broad and inclusive information service (not a clinical and
exclusive one).
Provide a news service on current activities and events.
Host an ‘ask an expert’ service on the website. Convene a panel of experts
and develop a public information Q&A resource through a 24 hour turn
around of question to answer.
20
The Foundation For Research Into Injury and Illness in the Workplace – Symposium 2006 – Towards a National Research Agenda
Web: www.resworks.org.au Email: info@resworks.org.au Phone: 61 3 9866 6376
CONCLUSION:
The human and economic costs that result from workplace injury and illness are recognized to be a
significant issue for the community. Policies and interventions based on solid evidence are
required to support long term and sustainable change. The subjects highlighted in this report
indicate the breadth and depth of the issues that must be addressed.
However, a better understanding resulting from a deeper base of evidence is unlikely to be
achieved without the opportunity for the field to further refine the research agenda itself. The
limited funding available to undertake research is a problem. Health research as a percent of
health expenditure is 1% in Australia. Access Economics has estimated the average return on
investment in research in the health sector is 240%. There is no reason why research in the area
of work disability should provide a lesser return, and many reasons why the return would be
expected to be greater. More investment in research is a subject that needs discussion.
The lack of coordination of research is also an important issue of concern. The translation of
research into transparent ‘retail’ evidence so that a coherent flow to policy consideration and
implementation is enabled is a vital need. The development of partnerships, between jurisdictions
and between researchers, employers and practitioners, are required to ensure that new expertise
and knowledge does not gather the dust of proprietary interest, but is made available to everyone.
Early intervention in all of its forms cries out for further discussion.
The Symposium and this report have sought to identify the issues those experienced in the field
see as priorities. The canvas is broad, the problems are many. One of the clearest outcomes of
the Symposium and this report is that more opportunities for discussion are needed to refine the
Research Agenda.
21
The Foundation For Research Into Injury and Illness in the Workplace – Symposium 2006 – Towards a National Research Agenda
Web: www.resworks.org.au Email: info@resworks.org.au Phone: 61 3 9866 6376
SYMPOSIUM PARTICIPANTS
The Symposium would not have happened without the generous support and gift of time made by
its participants. ResWorks wishes to thank the following individuals and organisations for their
contribution to the event and the resulting content of this document.
Alan Clayton ResWorks Researcher and Consultant
Alex Prior Screenhub Pty Ltd Website developer
Andrea James Gallagher Bassett General Practitioner and Occupational
Physician trainee
ChrisTsoukalas Allianz Australia Insurer
Anthony Hogan Office of the Australian Safety and Policy Maker
Compensation Council
Ark Griffin IMO Pty Ltd Manager
ChrisTsoukalas Allianz Australia Insurer
Christina Bolger Comcare Policy maker
Christine Di Stasio Bristol-Myers Squibb Occupational Health Nurse
David Sagar SANO Consulting Physiotherapist and Consultant
Deidre Francis Victorian WorkCover Authority Policy maker
Dianna Smith Office of the Australian Safety and Policy maker
Compensation Council
Dr Carolyn Arnold Caulfield Pain Management and Research Rehabilitation and Pain Physician
Centre
Dr David Fish Australian Faculty of Occupational Medicine Occupational Physician and Lecturer
Michael Shanahan Flinders Medical Centre Occupational Physician and
Researcher
Eva Schonstein The University of Sydney Physiotherapist and Researcher
Evan Dalstead Goodman Fielder Limited Return to work Manager
George Hallwood Effective Consulting and Rehabilitation Pty Ltd. Rehabilitation Provider
Heather Smith Insurance Australia Group Employer / Return to work Manager
Heidi Muenchberger Griffith University Researcher and Psychology
Helen Raik Linacre Private Hospital OH &S Practitioner
Jan Tonkin Department of Human Services (Vic) Employer / Return to work Manager
Jane Monk Recovre Pty Ltd / ARPA Rehabilitation Provider
Jean Cromie Department of Human Services (Vic) Employer / Return to work Manager
Joanne Clancy Victorian WorkCover Authority Policy maker
Jon Ford The University of Melbourne Physiotherapist and Researcher
Justine Leader Konekt Rehabilitation Provider
Kath Frowen Occupational Dermatology Research & Occupational Health Nurse and
Education Centre Researcher
Malcolm Sim Monash University Occupational Physician and
Researcher
Maria Zylinski TAC Policy maker
Marilyn Di Stefano LaTrobe University Occupational Therapist
Mark Raberger IPA Rehabilitation Rehabilitation Provider and
Physiotherapist
22
The Foundation For Research Into Injury and Illness in the Workplace – Symposium 2006 – Towards a National Research Agenda
Web: www.resworks.org.au Email: info@resworks.org.au Phone: 61 3 9866 6376
Mary Wyatt ResWorks Occupational Physician and
Researcher
Matthew Stanhope Student
Melissa Mitchell Student
Nigel Marsh University of New England Psychologist and Researcher
Paul Coburn ResWorks Physiotherapist and Policy Maker
Paul Pers SANO Consulting Policy developer and Consultant,
Medical Practitioner
Peter Nagel Victorian WorkCover Authority Policy maker
Peter Werth Chiropractic & Osteopathic College of Australia Chiropractor
Ray Perks Medical Panels (Vic) System Administrator and Manager
Rebecca Fairweather Australian Automotive Air Pty Ltd Return to work Manager
Richard Green Country Fire Authority Claims Manager
Robert Hughes ResWorks Research Foundation
Robynne Dashwood Department of Human Services (Vic) Employee and Return to work
Manager
Ross Iles LaTrobe University Researcher and Physiotherapist
Russell Pettis Australian Automotive Air Pty Ltd Employer / Manager
Samia Radi Monash University Occupational Physician and
Researcher
Simon Bailey Victorian WorkCover Authority Policy maker
Simon French Monash University Researcher and Physiotherapist
Siobhan Boyd Victorian WorkCover Authority Policy maker
Stephen Campbell Campbell Research & Consulting System Researcher
Steve Jensen Australasian Faculty of Musculoskeletal Musculoskeletal Physician
Medicine
Tania Pizzari LaTrobe University Physiotherapist and Researcher
Theo Giantsos Victorian WorkCover Authority System Administrator / Manager
Tracey Browne Australian Industry Group Employer Industry Group
Viktoria Wilde The University of Melbourne Physiotherapist and Researcher
RESWORKS BOARD:
Dr Mary Wyatt – Chair,
Mr Alan Clayton
Dr Jan Hoving
Mr Paul Coburn
Ms Karen Allardice – Treasurer,
Mr Robert Hughes – Secretary, Executive Officer
23
The Foundation For Research Into Injury and Illness in the Workplace – Symposium 2006 – Towards a National Research Agenda
Web: www.resworks.org.au Email: info@resworks.org.au Phone: 61 3 9866 6376
SYMPOSIUM AGENDA
9.45 - 10.15
Welcome and keynote – Mary Wyatt /Alan Clayton -Research – where is
it at, what are the challenges?
10.15 – 10.45 Participants – 5 minute talks
Employee – Robynne Dashwood (DHS)
Employer – Tracey Browne (AIG)
Treater / Researcher – Paul Pers (SANO)
Researcher – Eva Schonstein (U of Sydney)
11.10 – 11.30 Presentation of Survey 1 results - Dr Mary Wyatt - introduction and
discussion of Categories (Survey 1 was completed by participants prior to the
Symposium)
11.30 – 12.30 Workshop 1 – Group discuss Survey 1 results – followed by individual
revision and addition plus suggestions re Categories.
1.45 – 3.00 Networking discussion / cross fertilization future activities - Paul Coburn
3.15 – 4.15 Workshop 2 – Group discussion of the revised Survey docs, individual
prioritizing, of research subject and categories.
4.15 Event summary & thanks
24
The Foundation For Research Into Injury and Illness in the Workplace – Symposium 2006 – Towards a National Research Agenda
Web: www.resworks.org.au Email: info@resworks.org.au Phone: 61 3 9866 6376
