According to Safe Work Australia the cost of work-related injury and illness was $61.8 billion in 2012-13, which is 4.4% of GDP. We know work harms us, but how does it heal us?

The Australasian Faculty of Occupational and Environmental Medicine’s Realising the Health Benefits of Work statement says ‘worklessness’ is associated with increased death rates, including suicide, poorer physical and mental health and greater disability.

On the other hand, re-employment is associated with improvement to self-esteem, self-rated health, self-satisfaction and physical health. Although most policy statements now recognise that for recovery at work you need to return to good work.

At face value you might think that work improves our health by giving us a sense of purpose and relationships. We know a lot now about socio-organisational factors that are important for health in the workplace.

The UK Health and Safety Executive Stress Management Standards addresses six stressors: job demands, job control, support (encouragement and resources), relationships at work, role clarity and change management.

Is good, healing work simply the other side of the coin for these factors? You can make sense of that.

That means for healing work you would be looking for jobs that:

• Demand not too little and not too much of you;
• Give you discretion over the use of your skills in the job;
• Provide you with adequate support in terms of resources, training and help;
• Bring healthy relationships, and deal with conflict and unacceptable behaviours promptly;
• Have a clear understanding of your role, how it contributes to the organisational achievements and where there are no conflicts with other roles; and
• Exist in an environment where change is well managed and communicated.

But to me it doesn’t really answer the question how does good work heal you?

Health not merely the absence of disease: WHO

For that I turned to positive psychology.

Martin Seligman is usually considered the Father of this new discipline. In 1998, when he was the President of the American Psychology Association he proposed that the discipline of psychology needed to do more than address the ‘misery of mental illness’.

This echoes the World Health Organisation’s definition of health as physical, mental and social well-being, not just the absence of disease.

The discipline of health promotion has been trying to put flesh on the bones of that definition since the 1980s. The Ottawa Charter emerged from the first international conference on health promotion in 1986.

It stated that health promotion “creates living and working conditions that are safe, satisfying, stimulating and enjoyable”. Health promotion has always recognised that work plays an important role in health and wellbeing.

Sir Michael Marmot emphasised this in his leadership of the Social Determinants of Health Commission. In the Commission’s models the value of work, work that is fair as well as safe, is highlighted.

Something worth considering as we watch what has been going on with the 7 Eleven scandal.

On the ABC’s Q&A panel on poverty that aired on August 30, starring Sir Michael, it seemed to be a given that work was good for health and wellbeing.

Applying positive psychology to workplace health

Professor Anthony LaMontagne has proposed a model for mentally health workplaces which is based on the integrated approach.

By that I mean a holistic approach – considering the health of the worker as a whole – that combines occupational health and safety, workplace health promotion and human resources management.

I find this approach very useful and am using it to guide advice I give on mentally healthy workplaces.

There are three domains in this model: preventing harm; positive psychology and managing illness. La Montagne says it is early days in the application of positive psychology to workplace health, and I agree.

Seligman’s model of positive psychology, or as Keyes puts it what it takes to move people along the spectrum from mental illness to languishing to moderate mental health to flourishing, has seven elements:

1. Relationships;
2. Caring for others;
3. Exercise;
4. ‘Flow’ – tackling challenges confidently knowing you have the skills and resources to do so and then feeling the ‘flow’;
5. Spiritual engagement and meaning;
6. Knowledge of your strengths and virtues; and
7. Positive mind set – optimism, mindfulness and gratitude.

Thinking about how work might contribute to these factors I can see that work is a great place to form relationships and performance management systems, when working properly, would help you to understand your strengths and virtues. Good work should be all about creating opportunities for ‘flow’, and be meaningful.

Optimistic nuns aiming for heaven

I was speaking on this recently at The Womens’ Club in Sydney. It was a fantastic audience. When we got to optimism I was telling them about some of the early work on optimism and pessimism that was done on nuns.

Nuns were considered a good study population as, in the 1930s, they lived in stable communities with very similar exposures, for most of their lives. The nuns were assessed for optimism and pessimism and then decades later work was done to analyse differences in longevity.

It turns out optimistic nuns live ten years longer than pessimistic nuns. Caroline Baum, who was interviewing me in front of this audience, pulled me up, “But why would nuns be pessimistic, they all believe that heaven is awaiting them?”. I channelled a pessimistic nun’s response, “Heaven isn’t what it used to be”.

In trying to understand the healing powers of work, can the conceptual frameworks from the HSE stress management standards and the positive psychology approach be reconciled? Perhaps the very old definition of ergonomics helps here; our aim is to match work to man and each man to his job.

First published in Thomson Reuters Inside OHS, 12 September 2016

Inside OHS Editor: Stephanie D’Souza; (02) 8587 7684; Stephanie.D’Souza@thomsonreuters.com

Roseanne Barr, presumably in character on her eponymous sitcom, once said: “Excuse the mess, but we live here”.

With apologies to my many colleagues in rehabilitation provider firms, general practice, occupational medicine, insurance schemes and workplaces, that is the situation our complacency has got us into with regard to return to work (RTW).

According to the 2013/14 RTW Survey published by Safe Work Australia (SWA) there has been no improvement in our performance for more than 15 years. The proportion of injured workers in paid work 7-9 months after their injury has been steady at 84-87% for all this time.

That would be fine if system users were happy with this performance level – particularly those injured workers who are not back at work after 7-9 months. As it stands now, they will pay a high price both literally, in terms of loss of income, and figuratively, in terms of loss of health and wellbeing.

Signs are RTW set to improve

Fortunately, “mess is the material from which life and creativity are built” according to Ralph D Stacey, an expert in human organisations and their management.

My hunch is we are at a tipping point for renewed effort at improvement. There are new ideas and evidence swilling about. This was apparent at the excellent Northern Queensland RTW Conference run by the Queensland Government in Townsville in April this year.

I was invited to speak on ‘The Future of Return to Work’. I based my presentation on two things. First, the work Anne-Marie Feyer, Jane Palmer and I had done with the group life insurance industry for SuperFriend, the development of ‘A Best Practice Framework for the Management of Psychological Claims’ (it can be obtained here).

Secondly, my subsequent work as champion for the national, cross-sectoral ‘Collaborative Partnership for Work Participation’, in my capacity as Work for Health Advisor to Comcare.

My conclusions about the current state were:

• Compensation systems causing significant secondary harm, especially to mental health
• Treatment for mental health problems not evidence-based
• RTW support services not best practice
• Lack of improvement as measured by RTW indicators
• Confusion about GP, insurer, employer and rehab provider roles
• GPs slow to embrace health benefits of work messages
• Employers not buying message of ROI for early RTW/stay at work (SAW)
• Workers confused
• Workers’ compensation operates in a silo, but is impacted by and has impact on other parts of the work disability system.

My prediction for a desirable future state was:

• Empowered workers
• Employers and insurers work with the superannuation industry, insurance schemes and others to achieve better primary and secondary prevention
• GP, occupational physician, rehab provider, insurer and employer roles better defined for assessment and early intervention
• Evidence-based treatment and rehabilitation

Innovations from regulators to insurers

My further predictions (above):

Shift from claims processing to case management

Claims management semi-automated

Multi-stakeholder outcomes focus: client, insurer, employer, superannuation fund.

In recent months I have seen innovations in many of these areas: For instance, a smart rehabilitation provider is experimenting with the empowerment of workers through self management. I have also heard a life insurance company is taking a serious approach to implementing the Best Practice Framework. There has also been a productive collaboration between WorkSafe Victoria, VicHealth and SuperFriend on mentally healthy workplaces.

Meanwhile, SWA is looking at capitalising on inroads made by some jurisdictions in GP support by taking a national approach, and hopefully this will include addressing role clarity.

Also, many schemes (w/compensation and others) have been making efforts to shift claims management from tick-box processing to a more client-outcomes-focussed case management approach. While SA has an e-certificate for work capacity.

Employers crying out for evidence based guidance

While that is a list of just some of the signs of innovation, other ideas for the future identified from a literature review and from international innovation case studies are proving more challenging to address.

Consultations undertaken for the ‘Collaborative Partnership for Work Participation’ has shown employers have not really bought the argument of productivity gains associated with the Health Benefits of Work; they have residual concerns about early RTW and stay at work; and newer concerns about extending their responsibilities to wellness.

On the other hand they are crying out for evidence-based guidance on interventions for mentally healthy workplaces. We need to understand their views better and develop a new narrative for work participation based on the health benefits of work evidence.

Quality management of RTW services – there is a growing sense nationally that payers (in w/comp these can be schemes, insurers or employers) need to have better quality management frameworks for the rehabilitation and return to work services they buy. These must be driven by client outcome performance indicators, and should include incentives and disincentives for evidence-based interventions. Similarly payers should further develop their ability to incentivise evidence-based medical treatments.

We know that much of the treatments offered in mental health are not evidence-based. A leading expert told me this is likely to be as high as 60%. Strengthening outcome-based performance measurement is doable now, but working out what evidence-based treatments and return to work services are is more challenging.

The issue is not working out what the evidence is in relation to particular treatments or rehabilitation services commonly provided, as many schemes do this in an ad hoc way now; but working out a way that this evidence is kept up to date and on tap for policy makers.

There is great potential here for university/industry collaboration.

Triaging, taking into account clients’ real social and health outcomes

For me the biggest potential is the semi-automation of claims management. Triaging claims into those that are likely to resolve with minimal or no intervention, those requiring a bit more support and those requiring more intensive case management, has become common practice in the schemes that make up the work disability system as a whole.

However in many cases the triaging models are based on the data that the insurance schemes have readily available. We need triaging models that take into account the real social and health outcomes of their clients, as well as scheme outcomes; and we need to know that the risk factors used to develop the models are evidence based. For example, Canadian academic Renee-Louise Franche developed a model for recovery risks for musculoskeletal disorders and psychological injuries from research evidence in the literature and then worked with claims managers at WorkSafe British Columbia to develop a nine-question screening tool:

1. How are you doing?
2. Are you getting better/worse/staying the same?
3. How are you coping?
4. Who is supporting you through this at work and outside work?
5. If pain is identified rank the pain.
6. Tell me about your job? What is your job like?
7. Have you spoken with your employer?
8. When do you think you will return to work?
9. What is your regular healthcare provider telling you about your recovery and return to work? (Case study in Taking Action: A Best Practice Framework for the Management of Psychological Claims, see above link)

Automation of claims acceptance

There is huge potential to use big data to develop normative pathways for injuries of different types and levels of recovery risks. This would mean more automation of claims acceptance, allowing a more positive, trusting relationship with injured workers; and automation of claims management, with alerts for deviation from expected progression.

As one American software company said “it is like cloning your best claims manager”. Estelle Pearson, from the actuarial firm Finity, spoke at the Northern Queensland conference about the potential of big data to enable us to have better projections of claims and behaviours leading to claims.

For me though, when it comes to claims for psychological injury, the elephant in the room is the question: are we doing more harm than good?

Last year was the centenary of Einstein’s theory of relativity. He presented his theory to the Prussian Academy of Science on November 25, 1915. He of course is famous for saying, “insanity is doing the same thing over and over again and expecting different results”. We can and must do better.

First published in Thomson Reuters Inside OHS, 06 July 2016

Inside OHS Editor: Stephanie D’Souza; (02) 8587 7684; Stephanie.D’Souza@thomsonreuters.com

Scott Spark emailed me in January when I was holidaying at the beach and asked me if I would agree to be interviewed for a new series he was doing for Radio National (RN) on work. Sounds interesting I thought, but not worth sacrificing good holiday time for, so I declined. Scott was happy to wait for my return.

In early February he sent me an email saying he was editing material on health and safety and thought there was an interesting tension between the effort industry was making to cut costs and its apparent willingness to spend increasing amounts of money on wellness. I was pretty impressed with that observation. He sent me a list of questions he was trying to answer.

These included:

• More workplaces are spending money on improvements to ‘wellness’ – where does this fit into work health and safety?;
• We live in an age of cost-cutting, which often means workers must do more with less. Then, on the other hand, you have this investment in ‘wellness’ of employees… things like plants, more natural light, standing desks, optional yoga classes. But do these things make up for the increased workloads?;
• Whose responsibility is it to ensure our health and safety at work?;
• What obligation do employees have to arrive at work in prime health? (I wonder if there’s a degree of intrusion here for some people… where it’s viewed as ‘unsafe’ if you come to work tired, sick, overweight, for instance?);
• To what extent is health and safety determined by whoever’s in charge?;
• When we go for a job, should we be asking a potential employer about their health and safety record?;
• And what about employers… is there anything they can look for in a potential employee that might help make their workplace healthier and safer?; and
• What would you say is the top thing we could do to improve health and safety at work?

To my mind Spark had really got to the heart of the transition workplace health and safety is going through. I asked for a brief chat on the phone before the interview to confirm the scope of the conversation.  Whilst happy to do this, he cut the conversation off as he was worried we were straying too far into the interview itself, and he wanted it to be fresh.

On the day of the interview, February 10, he was in Sydney and I was in the ABC’s Southbank studio. Despite him emailing them when I arrived nobody knew what I had arrived for. I figured Spark would be the one most anxious to sort this out as he had an hour of studio time booked, so I emailed him to let him know I was there and waited to be claimed.

Eventually I was. I was led through a maze of corridors with signs and names familiar to a RN listener like myself and introduced to Tony who operated the equipment on the other side of the glass from me. He settled me into my small room, more of a booth, with a glass of water, headphones and a microphone.

As always, I had worked out a set of talking points including facts and figures and some case studies, jotted down onto the index cards I prefer to use as aide memoirs.

I recalled the first time I had done a radio interview under the guidance of the new PR officer at the Tasmanian Department of Health.

Why prepare less for an interview than you would a lecture?

“How much time would you spend preparing to give a talk?” he had asked me. “Many hours” was the honest answer.  “How big is the audience when you are speaking face to face?” he then asked. One hundred, may be more, often less, was my reply.

“So why would you prepare any less for a radio interview which will reach tens of thousands, probably hundreds of thousands?”

That good advice, given thirty-four years ago, came from the man who was to become my husband. There were other things I liked about him, but I have to say having a free PR consultant on tap for the decades our marriage lasted hasn’t hurt my career!

We did a sound check. My performance voice is quite loud, I know. The director on the ABC television show ‘Stressbuster’ told me that, and the staff I have worked with in various organisations tell me I yell whenever I am on a teleconference.

I still cringe at the thought of the lunchtime address I gave at World Health Organisation headquarters in Manila where apparently I was so loud I almost damaged ear drums.

I think it might be genetic. As children my brother and I would often laugh about my Father who would answer the phone at home in his normal speaking voice, “25623 Frank Ellis speaking”, but if the call was for him he would immediately ramp it up to a sonic level, “WELL HELLO RON, HOW ARE YOU?”.

I didn’t feel nervous, as in a full blown ‘butterflies in the stomach’ feeling.

More of an arousal, a tension. And then Spark was on the line, and we had begun.

We talked for an hour. It was a proper conversation. He meandered along through some of the questions he had sent me, but also bounced off my answers.

I felt I was not being very clear on some points about the new ways of thinking emerging in workplace health and safety, where responsibility is shared.

I kept going, sometimes covering the same territory, trying to find a better way of saying it, knowing he would just pull out the best bits.

At the end he asked me a few questions about my own career, and when I told him how I got into occupational and public health he laughed and said “That is going straight in unedited.

The first tears for the show”, a reference to me describing myself crying in the 3E toilets at the Royal Hobart Hospital and realising clinical medicine was not for me.

‘Embarrassment leave’ potential

I always feel terrible after a radio or television interview. I am convinced I have made a fool of myself. In my first job in public health in Tasmania, I was the departmental spokesperson on HIV/AIDs. Early on I did an interview on the 7.30 Report, defending a video we had made for young people.

Afterwards I asked my boss if the public service had ‘Embarrassment Leave’.

That interview all those decades ago was fine, more than fine, but then, as now, I can never tell.

Spark said he would let me know when it was going to air, but he expected it to be in March sometime. On Sunday, March 27, I had this text exchange with a close friend, Caroline who is married to David.

C:  D is convinced you are on a RN teaser for a show about work, is he right?

Me: (Suddenly remembering the interview until then forgotten) Could be. I did an interview about a month ago

C: I lose bet then, it’s the way you say girlie apparently that is a dead giveaway

Me:  Golly, why am I saying girlie????? A worry

C:  You are mimicking/quoting a bloke. Don’t worry.

I look it up and find that three episodes of the series WorkLife have been posted, but not the one with me in it.

Don’t neglect the health benefits of work

Kevin Jones finds the episode before I do and emails it to me.  Neither of us had realised that each other had been interviewed, but we are both happy with the way it has turned out.

Except the title: ‘WorkLife:  Why is work making us sick’.

I tweet the link on Monday April 4, saying: “Good job Scott Spark @RadioNational on capturing modern WHS. Terrible title though, neglects health benefits of work.”

I am writing this now, five hours after I sent that tweet. I have just received an email from Scott Spark thanking me.

Advocacy is an important part of our work as WHS practitioners; if you get the chance to communicate about the benefits of investment in improving health and wellbeing, take it.

Think about your audience, hone your messages, and then come up with ways to illustrate these with examples from your experience. And be prepared to occasionally have to take Embarrassment Leave.

First published in Thomson Reuters Inside OHS, 08 June 2016

Inside OHS Editor: Stephanie D’Souza; (02) 8587 7684; Stephanie.D’Souza@thomsonreuters.com

The Essendon supplements regime was back in the news recently after ABC’s Four Corners program exposed the Club’s hard line response to junior player Hal Hunter’s quest to obtain information about the substances he received in 2012 and 2013.

A dream for the media and lawyers, this saga continues. Just to remind you of the story so far: Essendon alerted the AFL and the Australian Anti-Doping Authority (ASADA) to supplement use in February 2013. Putting aside the various actions involving managers and advisers, the AFL Anti-doping Tribunal found in March 2015, in a case brought by ASADA, that the thirty-four players were not guilty of using banned substances.

At the time the AFL CEO Gillon McLachlan said in a statement: “It has been the AFL’s view, and the view of Essendon’s own internal report, that the players were victims of a reckless program which has hung over the players and the competition.” In April 2015 the World Anti-Doping Agency (WADA) appealed this decision in the Swiss-based Court of Arbitration for Sport (CAS).

In January 2016 CAS upheld WADA’s appeal. It said in its announcement it had established “to its comfortable satisfaction that Clause 11.2 of the 2010 AFL Doping Code (use of a prohibited substance) has been violated and found by a majority that all players were significantly at fault”.

And so we have a case study that illustrates well two different world views of how responsibility is allocated in organisations.

Darren Kane, a sports lawyer waded in with a Sydney Morning Herald column on January 15 saying, “If the Class of 12 were sitting in my boardroom, I would demand they give earnest consideration to opening their collective shoulders, to pursue the Essendon Football Club with extreme prejudice. Any employer has an immutable responsibility to take reasonable care for the health, safety and welfare of its employees”.

Strict liability principle does not consider intent
On the other hand, the “strict liability” principle of WADA considers individual athletes have ultimate responsibility. According to the WADA website this principle “means that each athlete is strictly liable for the substances found in his or her bodily specimen, and that an anti-doping rule violation occurs whenever a prohibited substance (or its metabolites or markers) is found in bodily specimen, whether or not the athlete intentionally or unintentionally used a prohibited substance or was negligent or otherwise at fault”.

I think many of us in Workplace Health & Safety (WHS) were quite shocked by WADA’s success in imposing the strict liability principle in this situation. It seems unfair and illogical in the face of our acceptance of the employer responsibility for the duty of care in workplaces mandated in WHS legislation, and the alleged management authorised supplement program.

But could our own ideal be honoured more in the breach than in the observance?
In recent years I have been interested in the methodologies used in futures studies. One of the principles in this area is that to understand the future we need to have a better understanding of the present. In particular, we need to dig deeper; to go below superficial information on trends and the strengths and weaknesses of current systems.
To understand enablers and blockers of transformational change we need to know the worldviews and deeply held beliefs in our society.

Human error at the core of OHS challenges?
A literature search I was involved in a few years ago looking for such information found an interesting sociological paper that sought to determine the theories (beliefs) that had prevailed in OHS over the past two centuries. The authors found there had been, and continued to be, only two theories of “accident causation”: human error or environmental risk factors. Or as the authors put it: “Causes of occupational accident are found either in the workers’ capacity to handle hazardous situations, or in external causes, like very long working hours, dangerous machines and the increased pressures of work and speed of production.” They argued that in modern OHS, which began with the second industrial revolution in the American steel industry early in the 20th century, the theory of human error predominates.

So while the hierarchy of control principle is something we WHS practitioners hold dear to our hearts it seems this may not be a worldview shared with all stakeholders.

Despite a legally mandated obligation on employers to provide a safe and healthy workplace? There is evidence employers will tend to default to a careless worker view. Take behaviour safety programs for example. These became popular in the 1990s and were supposedly developed for mature OHS programs which had reached a limit in performance improvement through environmental controls.

However, throughout the noughties there has been concern expressed by many in the field about the introduction of behaviour safety programs to immature OHS management systems, so that is the predominant approach.

Another example can be found in the reluctance of employers to address the psychosocial hazards in the workplace. To date employers have given preference to increasing the resilience of workers and providing support to distressed employees over interventions aiming to address the way work is organised and the way people are managed.

I recall a fascinating presentation authored by McCallum, Schofield and Reeve from the University of Sydney, at the Ninth (and last, more’s the pity) National OHS regulatory Research Colloquium in 2011 at ANU. Their research published in 2009 confirmed that employers tended to have a view that OHS was a matter of managing individual safety behaviours. In contrast regulators, their follow up research found, had a view that OHS was an organisational-wide matter for which managers were responsible.

We are now moving into an era where workplaces are grappling with complex health conditions arising from a combination of work-related and non-work-related risk factors. In consultations I have been undertaking in my capacity as Work for Health Advisor for Comcare, relating to a cross-sectoral national private, public and not for profit partnership to improve work participation, a rather confused picture of the allocation of responsibility for health in workplaces is apparent.

On the one hand employers are saying they don’t want to be responsible for wellbeing, but it is clear that they are willing to assist on some issues, e.g. domestic violence; and are, frankly, desperate for help with mental health. This is not to say there should be any weakening of the employer responsibility to provide a safe and healthy working environment. Safety is a necessary foundation if employers want the benefits of investment in workplace health promotion. However, it appears after two centuries we may have a new theory – one of shared responsibility.

So as we watch the AFL tussle with the question of who was responsible for the health of their young players we shouldn’t scoff too loudly. As my grandmother used to say, “People in glass houses shouldn’t throw footballs”.

First published in Thomson Reuters Inside OHS, 06 April 2016

Inside OHS Editor: Stephanie D’Souza; (02) 8587 7684; Stephanie.D’Souza@thomsonreuters.com