Health Benefits of Good Work eNewsletter October 2017

Welcome to the fourth edition of the Health Benefits of Good Work (HBGW) eNewsletter. The HBGW message is building momentum and spreading across Australia and New Zealand. 

On Thursday, 10 August 2017 the College launched its New Zealand Election Statement – Make it the norm: Equity through the social determinants of health position statement

The RACP is calling for the New Zealand Government to make good work the norm through:

  • promoting the Living Wage
  • recognising the workplace as a venue for influencing healthcare systems
  • increasing support for people not in work 

“Good work is, simply put, work that is good for you. Work that is free of negative health effects, and offers health improvement opportunities to the employee,” explained Dr Johnathan Christiansen, RACP New Zealand Committee President.

Occupational medicine physician, Dr David Beaumont, said workplaces that promote the health and wellbeing of workers are more productive. 

“Good work is good for business. Workers who feel more valued are more engaged and give more discretionary effort. In general, $1 spent on wellbeing produces a return on investment of $3,” said Dr Beaumont.

Since our previous edition, the HBGW Consensus Statement has been updated to bring together a wider range of stakeholder signatories, both within Australia and New Zealand. The HBGW Australian Signatory Steering Group (Australian SSG) and the HBGW New Zealand SSG (NZ SSG) continue to champion the integration of the HBGW message in the industry sector on both sides of the Tasman.   

The commencement of the HBGW NZ SSG has seen the HBGW signature base expand both within Australia and New Zealand. The HBGW signatory base has now reached over 230 signatories across both countries. Some of the new signatories include Australian Super, the first Australian superannuation fund to be a signatory, and the Public Service Association of NSW. 

HBGW PSA AFRM
Australian Faculty of Occupational and Environmental Medicine President Associate Professor Peter Connaughton and Mr Stewart Little, General Secretary, Public Service Association of NSW, signing the HBGW Consensus Statement.

Following the success of the Employee Equity and HBGW Forum in May 2017, the HBGW Australian SSG is hosting its second biannual industry forum in Perth on Friday, 17 November 2017: Healthcare Professionals – promoting the health benefits of good work. The forum will focus on promoting the health and wellbeing of all who work in the provision of health care – including hospital staff, community and public health services, and aged care, together with rehabilitation providers, employment services and the insurance sector. 

In this edition we look at the health benefits of good work, particularly for people who have a mental health condition, and the role of physicians, rehabilitation consultants and insurance systems in supporting workers’ occupational health. It also includes an account from an Australian signatory on the impact that HBGW has had on their approach to worker recovery.    

If you have any initiatives or promising practices that you would like to share please get in touch with us at afoem@racp.edu.au

Mental illness in the workplace

Occupational and environmental physicians are well versed in the diagnosis and treatment of physical workplace injury, and the health benefits of a return to work as early as practicable.

It’s less clear cut when the issue is psychological.

Read more

Healthcare professionals – promoting the health benefits of good work: Australian Health Benefits of Good Work Signatory Steering Group Industry Forum

This event will be held on Friday, 17 November in Perth. 

Presenters will represent a wide range of sectors including insurance, government, research and healthcare.

Find out more

Individual Placement Support –  helping patients with mental health conditions successfully return to work

Ms Helen Lockett, Strategic Policy Advisor, the Wise Group
Adel Stephenson, Individual Placement Support (IPS) Implementation Manager, Work Counts
“Failure to provide the right education and employment support creates lifelong socioeconomic disadvantage and ultimately prevents a person achieving their full potential.”
Royal Australian and New Zealand College of Psychiatrists Guidelines for the management of schizophrenia (2016).


The health benefits of good work are now well established (OECD, 2012) with evidence showing that the right kind of work, one that matches a person’s needs and aspirations, can enable a person to have better mental and physical health outcomes and crucially helps prevent deterioration (Waddell and Burton, 2006). Mental health treatment is also more effective when people are working (OECD, 2014). The health benefits of work are relevant for people with any mental health condition or diagnosis.

Most people who have a mental health condition would like to work, with eight out of every 10 saying they would like a job, but have very low levels of labour force participation.  

It can be challenging when health professionals and people with ill health do not prioritise treatment goals in the same way. This is illustrated by a study asking young people with psychosis to list in order of importance what mattered to them. They identified employment and education as the priority goal, then relationships followed by housing and lastly health goals (Iyer et al, 2011; Ramsey et al, 2011). This is frequently the reverse of how they are prioritised in the health system.

Another challenge may be low expectations others, including family, friends and health professionals or the person themselves hold for their potential to live a productive life and have a career. Health professionals play a really important role in helping to address this cycle of low expectations (Rinaldi et al, 2008).

Individual Placement and Support (IPS) is a specific approach to employment support for people who experience mental ill health and are in contact with specialist mental health and addiction services. It was developed in the United States back in the 1990s. Since then, it has become one of the most researched psychosocial approaches in the world. The results show that at least 45 per cent of people accepted onto the program can return to work (Drake et al, 2012). 

A point of difference between IPS and other forms of employment support, is the integration of employment services with clinical services. This integration ensures a person is offered employment support at a much earlier stage, that employment plans are coordinated with treatment plans and that there is easy access to clinical treatment should a person need it once working.

Physicians are in a good position to support people’s health and employment goals. The quality of the relationship, holding hope for their future and exploring what really matters, supports what’s been termed ‘work focused health care’ (Waddell et al, 2008). 

It is not only about assisting people to return to work, but also about taking a flexible approach to treatment supporting people to remain at work. Changing the conversation and strategies used, so people don’t think they have to choose health or employment but can and do manage both. 

In New Zealand the IPS approach has been well established in some parts of the country, but it is not routinely available.

Workwise, a non-government organisation, part of the Wise Group, have been successfully delivering IPS programs in specialist mental health services for 13 years, and in the last five years in primary care.

There has been growing interest in this area with the Ministries of Social Development and Health and District Health Boards keen to learn more about the approach, assessing coverage around New Zealand and how to support further implementation.

Compensable injury and health outcomes: Time to look again?

Professor Alex Collie, Director, Insurance Work and Health Group, Monash University

In 2001 the RACP published a report titled Compensable Injuries and Health Outcomes. The report made a strong case that our Australian systems of injury compensation were adversely affecting the health of some injured people. The report also pointed out the relative lack of local Australian research on this topic, and proposed that:

“Any attempt to ‘reform’ the compensation system(s) must be informed by further rigorous research.”

Since publication of that report, a handful of academic researchers and clinicians have been gradually accumulating evidence in this field. We have made significant progress. In the parlance of the public health approach, we have moved from observing an effect to identifying causal factors. This advance has been supported by government injury compensation authorities, recognising the need for a stronger evidence base. 

For example, Australian research studies have shown that:

  • changing injury compensation policy affects health and return to work
  • the fairness of compensation processes affect health
  • specific workers compensation practices and processes can create barriers to healthcare provision
  • specific aspects of insurance claims processes can be stressful and are harmful to health.

Studies with healthcare practitioners suggest a reluctance to treat people involved in injury compensation schemes.

Some major challenges remain. I will mention two. 

First, we lack examples of moving this hard-won evidence into practice and policy. There are many opportunities to do so, with injury compensation scheme reform seemingly now a constant feature of the landscape. Yet good quality intervention trials of policy and process change are few and far between. 

Second, it has become apparent that the ‘compensation effect’ extends well beyond injury schemes, and into the aligned systems of life insurance and social welfare. These systems use similar practices and processes as injury schemes, and may be generating similar impacts. This is particularly troubling given that in any given year, more than one million Australians will find themselves as clients of these systems. 

This is an enormous health, social and economic issue. The cost to society exceeds $25 billion per annum in direct income benefits alone. Healthcare in this group of people with complex conditions will add further billions.

Yet our approach to supporting people whose health affects their work capacity is very complex and highly fragmented. It includes nine major workers’ compensation schemes, 13 motor vehicle accident schemes, 29 registered life insurers and multiple Commonwealth Government social welfare and employment programs. All are governed by their own rules around eligibility, benefits provision and service delivery. They intersect with the health, legal, employment and other systems in complex and at times unpredictable ways.

Recent reviews of global research evidence suggest that the main service delivery mechanism in these schemes – insurance case management – is at best ineffective , and may be harmful in some people . 
The fragmentation of our insurance systems means that we have limited ability to understand how they interact and to identify opportunities for improvement. For example, there are anecdotal reports in the life insurance industry that up to 50 per cent of clients have previously claimed workers’ compensation benefits. If true, then an effective upstream intervention within the workers’ compensation system may mitigate the need for, or the severity of, many life insurance claims. 

The 2001 AFOEM report provided a stimulus for a decade of steady progress in research, with occasional translation of research evidence into policy and practice. 

Meanwhile the problem remains, and its true extent has become more apparent. 

Perhaps it’s time to look again?   

 
1https://www.racp.edu.au/docs/default-source/advocacy-library/compensable-injuries-and-health-outcomes.pdf?sfvrsn=2 
2http://www.who.int/violenceprevention/approach/public_health/en/ 
3Cameron ID, et al (2008). Spine 33 (3); 250-254 
4Elbers N, Collie A, et al (2016). BMC Public Health16:658
5Mazza D, et al. BMC Fam Pract. 2015 Aug 15;16:100
6Grant, G., et al (2014). JAMA Psychiatry
7Brijnath B, Mazza D, Kosny A, et al. Is clinician refusal to treat an emerging problem in injury compensation systems?. BMJ
Open 2016;6:e009423.doi:10.1136/
8ASIC (Oct 2016) review of life insurance claims management 
9Vogel N, et al (2017). Return to work coordination programmes for improving return to work in workers on sick leave (Review). Cochrane Database of Systematic Reviews.
10Bartys S, et al (2017). System influences on work disability due to low back pain: An international evidence synthesis. Health Policy (accessed 9 June 2017).
 
 

Workplace Rehabilitation Consultants and their role in promoting the HBGW

A Workplace Rehabilitation Consultant (WRC) can be instrumental in bringing the concepts and principles of HBGW to life across Australian workplaces and in the healthcare field. A WRC uses their allied health qualifications and high level communications skills to assist people with disability, illness or injury, to recover at work and achieve independence at home, in the workplace and community – making them pivotal in achieving health, social and financial outcomes benefiting all stakeholders.

WRCs undertake a broad range of activities, such as identifying and solving problems to address biomedical and psychosocial risk factors, vocational and workplace assessment, vocational counselling, training and job placement, case management, injury prevention and management, and planning and coordinating services including independent living.

WRCs are committed to the principles that:

  • good work, in general, is good for us and long-term work absence, disability and unemployment have, in general, a negative impact on health and well-being
  • earlier return to work (RTW) leads to earlier recovery; being at work after an injury or illness (even before a worker is 100 per cent recovered) can be therapeutic and promote recovery.

A WRC is usually appointed independently, to assist both employer and injured worker in the recovery at work process. This unique and neutral position is often key to their success in influencing employers and workers alike, to heed the HBGW message. During the rehabilitation and recovery at work process, the WRC is provided a platform to promote the HBGW message in one-to-one situations with workers, employers and treating health professionals and can discuss the benefits to all stakeholders, increasing the take up of the message and bringing about successful outcomes. 

A positive rehabilitation experience (with a successful RTW with the same or a new employer) positively demonstrates and reinforces the HBGW message to employers; helping spread the word at a grass roots level within organisations. 

Many WRCs work for member organisations of the Australian Rehabilitation Providers Association (ARPA) – the peak representative body for Australian workplace health, recovery at work and rehabilitation industry. ARPA’s mission is to promote and advocate for best practice, cost effective and outcome-based rehabilitation and many member organisations are therefore signatories to the HBGW Consensus Statement. Furthermore, ARPA has a position on the Australian Signatory Steering Group (SSG) whose purpose is to further champion the integration of the HBGW policy agenda in the industry sector.

ARPA National CEO and representative on the Australian HBGW SSG Mr Nathan Clarke said:

"ARPA are 100 per cent committed to promoting the HBGW within the community, as evidenced by our biennial conference held last year in Melbourne, where the theme of the conference was Health Benefits of Good Work – Your Best Investment. However, it is our member organisations and their staff that have a real opportunity to make a real change here and I think they are. Over the course of the year, these staff are having hundreds of thousands of conversations with a range of stakeholders, including doctors and employers, about how to get an injured worker back to work safely, sustainably and as quickly as possible, utilising and extolling the principles of the HBGW. They assist organisations and individuals in a range of activities such as workplace assessment, arranging and attending case conferences and liaising with all relevant stakeholders (e.g. doctors, employers, insurers and injured workers) in the recovery at work process."

 

Insurance working with injured workers for the best health outcomes

Mr Mark Pittman is General Manager of Government Services, part of the dedicated Workers Compensation ​Division at Allianz Australia. Mark discusses how becoming a signatory to the Health Benefits of Good Work (HBGW) Consensus Statement in 2015 and having two Allianz employees recently appointed as casual members of the Signatory Steering Group (Australian SSG) has helped Allianz change their approach to worker recovery. These changes have benefits for workers, their families and the community. 

Can you tell us about your role at Allianz?
I lead strategy and operations for claims and injury management services to Commonwealth, State and Territory personal injury schemes. That is; workers compensation claims services for NSW icare Self Insurance, Northern Territory government, Comcare and outsourced claims services for State Super for the Police Hurt on Duty Contract. I also lead a management team who are responsible for driving innovation and continuous improvement in service delivery and customer engagement – we want to be a leader in the personal injury sector.

Why did your organisation become a signatory to the HBGW Consensus Statement?
We know that long-term absence from work can be harmful to a person’s physical and mental health and can produce long lasting negative impacts. Becoming a signatory to the HBGW Consensus Statement meant we could work with and learn from other stakeholders that share our view that good work should be considered part of treatment. And honestly – we believe in it. We believe in the HBGW and the profound influence good work can have on recovery outcomes for workers.

How has your organisation embedded the principles of HGBW into your practices?
Our claims management philosophy is based on the premise that in most cases returning workers to health and life involves maintaining a connection to the workplace and their work colleagues. This philosophy is supported by the understanding that early intervention, incorporating treatment and stakeholder engagement, is paramount to the workers recovery outcomes. Our employees receive training in behavioural economics and we maximise these principles to encourage workers to actively engage in their recovery. At the core of our approach is early identification of recovery barriers during the triage process – ultimately, treating people as individuals, understanding and considering their specific circumstances, leads to greater worker engagement and better recovery outcomes.
 
What has been the biggest learning curve for your organisation since embarking on the HBGW journey?
The health benefits of good work are not new concepts but communicating the benefits of returning to work to people who have just sustained an injury is not always straight forward. It is fair to say that if you are sick or injured you do not always have a desire to be back at work immediately – that is understandable. Getting people to accept that work can be good for them and can help them recover; that’s an ongoing challenge. 

For most people who lodge workers compensation claims, it is their first time in this situation and it can be a daunting, confusing and stressful experience. We continue to see an increase in what we refer to as secondary psychological injuries – where the injury or illness arises as a consequence of, or secondary to, the physical injury. I think one of the biggest learning curves is balancing what we know about the HBGW with the ever-changing needs of workers and looking at how we can best support employers so that they provide a safe and supportive environment that encourages people to want to return to work.

How has your exposure to the HBGW changed your approach to worker recovery?
My team is thinking differently about worker recovery. Traditionally worker recovery was focused on quantifiable factors – pain scales, MRI results or treatment plans. But, in order to aid recovery and provide the best possible support to workers we must consider the broader picture. Research tells us that psychosocial factors are the single biggest barrier to a successful recovery. We’ve introduced practical assessment tools to help us identify these barriers. Once we understand recovery barriers we can address them and this is the key to a successful and sustainable recovery.  

It’s a three-pronged approach – their social and economic situation, their job satisfaction prior to injury – so were they happy at work before the injury? And lastly, looking at psychological factors such as catastrophising – where you tend to view a situation as considerably worse than it is – which is perfectly natural when you’re suddenly dislocated from work and the social elements that are associated with employment.

We know that providing people with the right support, at the right time, in the right way, is vital to them getting their life back after injury. We don’t want to sit back and wait for problems to present themselves; we want to provide people with the tools and information they need up front so they can take charge of their recovery.

Have you found any champions for HBGW within your organisation or stakeholders?
Our Chief General Manager, Ms Helen Silver, is a strong supporter of the HBGW principles and has really encouraged Allianz’s Workers Compensation Division to take a more holistic and empathetic approach to worker recovery. The HBGW fits very well with our national focus on applying behavioural economics principles so that we are person-centric and able to empower workers in their recovery. HBGW and behavioural economics, when used together, truly delivery better outcomes for workers, their families and the community. 


Employee equity and health benefits of good work forum – May 2017

The HBGW Australian SSG hosted the Employee equity and health benefits of good work forum in Sydney on 31 May 2017. The forum welcomed 110 delegates and sought to:

  • address union concerns and clearly project the true balance of the HBGW objectives 
  • build bridges and set a foundation for ongoing dialogue inviting active union contributions to the HBGW campaign.

The forum was well-received by delegates, and representatives were enthusiastic and engaged in meaningful dialogue for the ultimate benefit of their members. Delegates identified key characteristics, behaviours and initiatives they would support in a workplace that promotes the HBGW principles. Some of the responses included – ‘inclusive and supportive employment practices’, ‘promotion of good health and productivity’, ‘advocacy for safe and healthy workplaces’, and ‘the need to build awareness of the positive impact of good work on productivity and society’.   

The forum provided an excellent opportunity for the HBGW Australian SSG to engage with unions across Australia. The outcome was a better mutual understanding and a series of next steps to progress. The HBGW Australian SSG recognises the essential role of unions in promoting HBGW, and will continue to engage with Australian unions on a state-by-state approach. 

Healthy employees create healthy companies

In July 2017, the HBGW Australian SSG welcomed Professor Dame Carol Black to Australia in an exclusive event that included a round table discussion with Professor Black and representatives from the superannuation, group insurance and health sectors.

AIA Australia, partnering with TAL, hosted the event to explore how the industry can collaborate to improve Australia’s health as a nation, by supporting employee’s overall wellbeing.

Ms Morag Fitzsimons is Director,  at WCD − Workers Compensation Solutions and HBGW Australian SSG Deputy Chair, said most organisations cannot measure what absenteeism costs but that it is generally six to eight times more than workers’ compensation. She acknowledged that while Australian companies are mature at managing physical workplace injuries, there is a long way to go with preventing and managing psychological conditions.

Professor Black identified the need for more programs trialling tailored approaches to work-life balance. She referenced a UK National Health Service study of 55,000 where 90 per cent of respondents had below average mental and financial health scores, resulting in increased absenteeism.

Professor Black urges employers to ask themselves these questions:

  • How much absenteeism is attributed to employees’ mental and musculoskeletal health? 
  • What employee programs are in place for mental, physical and financial health?
  • How educated are leaders in understanding what creates a healthy workplace and looking for signposts for employee engagement?

Associate Professor Peter Connaughton, Australasian Faculty of Occupational and Environmental Medicine President spoke of his experience with reducing absenteeism in workplaces which foster close and transparent relationships between employees and their direct managers. Through this closeness, employees feel more comfortable being honest about their conditions so illness can be caught early and managed appropriately.

 HBGW black connaughton
Professor Dame Carol Black, Principal, Newnham College Cambridge and Special Adviser to the Department of Health and Public Health in England and Associate Professor Peter Connaughton Australasian Faculty of Occupational and Environmental Medicine President.

HBGW Australian SSG acknowledgement for contribution to the HBGW initiative

The HBGW Australian SSG Chair Award for Contribution to the HBGW Initiative has been established by the HBGW Australian SSG Executive to acknowledge the enormous effort members devote through their involvement in the HBGW initiative.

The 2017 recipients were nominated by their peers for significant and influential contribution. 

The recipients of the 2017 HGBW Australian SSG Chair Award are:

Ms Simonie Fox, Group Strategy Specialist Rehab/Claims, AIA Australia

Ms Fox has introduced a number of improvements to SSG communication channels. She has established a strong foundation for enhanced information sharing across the HBGW Signatories and the wider community.

In promoting the HBGW Campaign, Ms Fox has advocated strongly for life insurer, superannuation fund and union engagement as key to enhancing good work and health outcomes.

Ms Georgina Lamb, National Manager Business Development, ipar 

Ms Lamb works tirelessly to support the HBGW Australian SSG communication agenda. She regularly brings innovative and creative ideas to improve understanding of the research underpinning the HBGW for those not yet involved. Her knowledge of the challenges faced by employers in delivering good work has influenced SSG forum speaker presentations and publications. 
 
Of course, these individuals rely on the support of their organisation to give their time and expertise. We therefore take this opportunity to recognise AIA and ipar leaders for supporting the inaugural winners. 
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