Posted on March 26, 2018 in WHS
On Saturday I gave a seminar to AFOEM NSW. 42 people registered, 32 in the room and 10 online. My topic was Emerging best practice for case management by insurance schemes: Implications for occupational physicians (you can view the presentation here). The bulk of the presentation was on the best practice framework Safe Work Australia released in Dec. This was adapted by them from the framework for the life insurance industry SuperFriend released in 2016 (I led a consultancy team that did this work). However I spoke about the Collaborative Partnership for Improving Work Participation as well. There were two discussion points where people broke into groups and talked about the following:
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- What would be the optimum relative roles of treating doctors, IMEs, claims managers, vocational rehab advisors (insurers), vocational rehab advisors (employers) in RAW, RTW?
- Which of the following trends will have most impact on your work, and how?
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- PoC centred management led by claims manager
- Enhanced support for employers by insurers
- Greater co-ordination of key players using case conferencing, face to face meetings, online platforms
- Expectation of evidence-based healthcare from health providers by insurers
- Triaging and decision support tools/automation
- Integrated work disability management
- Better measurement of health, social and financial outcomes.
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The audience were engaged, and the discussion was good. We were fortunate to have a senior claims manager from iCare, the rest occupational physicians. A summary of discussion outcomes is below. Note the idea that we need a flexible case by case approach, depending on the capacity and capability of the various players, but there is a need to define who is going to be the conductor.
Relative roles of GPs to insurers and employers
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- Role for GPs is diagnosis, treatment, prognosis and management
- Most GPs don’t understand workplaces, so whilst they have a role in RTW, they need help from case managers, either co-ordinators in workplaces or claims managers in insurers. These decisions are not medical. Recognition that some GPs do have skills in workplace health and rehabilitation, so they may be able to play a greater role in co-ordination, but most do not and do not want this role
- They need to contribute to communication
- Occupational physicians could be playing a bigger role – especially in complex cases. Referral to them by GPs and others much earlier for treatment and management of complex cases would be a good use of occupational physicians
- Idea proposed that a flexible approach is required in that the treating doctors may or may not have skills, the employer may or may not have capacity – this would point to rather than having fixed rules about who does what, we need to a define a system where someone is ‘conducting’ the ‘orchestra’, and making decisions about how best to apply available resources. The question was posed ‘Should the conductor be the claims manager, or should it be someone else?’
- Recognised that the aim is for the insurer, the employer, the GP and the worker to all be happy
- Discussion of advocacy by GP, definitely will advocate for patient and family, not a broker between employer and employee
- Lack of confidence in claims managers, most of them seen to be unskilled, junior – occupational physicians get annoyed when they are told what to do by them
- Comment made that insurers should have lists of preferred providers in physio and psych, and use them.
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Which trends will have the most impact on occupational physicians?
All three groups nominated [3] (greater co-ordination of stakeholders) and [4] (expectation of evidence based health care). They saw this in terms of an opportunity for occupational physicians. Whether people would pay for occupational physicians (an expensive resource) to co-ordinate was raised by me, but the group considered that until online platforms are better developed they can play a useful role, particularly in relation to liaison with other health providers. The move towards greater expectations of evidence-based care was seen as a good opportunity for occupational physicians, in terms of determining guides on evidence-based care. It was recognised AFOEM could play a role here potentially.
[6] (integrated approach to work disability) was nominated by two groups
[1] (person on claim centred management), [2] (increased support for employers), and [7] (measurement of health and social outcomes) were each nominated by a group.
Posted on July 6, 2017 in Inside OHS articles, WHS
Ross Gittins wasn’t losing any sleep over cuts to universities in this year’s budget. In a Sydney Morning Herald article titled ‘Our universities aren’t earning the money we’re giving them’ he laid out his criticisms. They can be summarised as:
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- that research in Australia fails to lead sufficiently to innovation because university culture favours publication in high status foreign journals;
- the lack of value placed on teaching; and
- the bloated administrations.
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Having recently spent a decade in this sector, I am fascinated by how universities have so far failed to respond to obvious discontent with their contribution to society and the risk of disruption.
This week however I came across something developed by and for the university sector that I think could be very useful to the rest of industry as it shambles around trying to work out what a mentally healthy workplace should look like.
In 2015, the Okanagan Charter for Health Promoting Universities and Colleges was released. It was developed at a conference attended by a cross section of staff from universities and colleges from 45 countries.
The Charter states: “Health Promoting Universities and Colleges transform the health and sustainability of our current and future societies, strengthen communities and contribute to the wellbeing of people, places and the planet.”
Staff & student health at core
The rationale is that universities have a unique role with regard to the development of individuals, communities, societies and cultures, and that health is a key ingredient for successful development at all of these levels. The health of their staff and students are core business in this approach. However, in parallel to corporate social responsibility there is a commitment to their community, now, and to the communities of the future.
The approach has been developed from the health promotion discipline. There is a terrific self-audit tool which can be found at the UK site ‘Healthy Universities’. You have to register but it is free.
The framework for the audit tool is shown below:
Leadership and Governance
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- Corporate Engagement and Responsibility
- Strategic Planning and Implementation
- Stakeholder Engagement
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Service Provision
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- Health Services
- Wellbeing and Support Services
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Faculties and Environment
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- Campus and Building
- Food
- Travel
- Physical Activity, Recreational and Social facilities
- Accommodation
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Communication, Information and Marketing
Academic, personal, social and professional development
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- Curriculum
- Research, enterprise and knowledge transfer
- Lorem ipsum
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Professional development
WHS authorities still trying to re-orient to mental health
Reading the self-audit tool as a workplace health and safety (WHS) practitioner is fascinating as it is so familiar, but at the same time quite different.
There is a strong emphasis on leadership and whole-of-business approach, as well as a commitment to consultation with stakeholders.
However, under the Okanagan approach, the emphasis on community links is much stronger, as is the emphasis on basing interventions on evidence, and a commitment to ongoing evaluation. There is also a sophisticated understanding of how health is deeply connected to their business of research and education.
Perhaps if we in WHS had such a strong commitment to evidence-based interventions we would not be in the situation we are in now with WHS authorities still trying to re-orient their inspectorates to mental health, and solutions of uncertain effectiveness being peddled to workplaces and individuals.
The University of Sydney is one of the local higher education institutions that has picked up this framework. Their local version aims to promote the health and wellbeing of our community. It intends to do this by influencing people, places, policies and practice.
It has five guiding principles:
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- Evidence informed and evidence generating;
- Collaboration;
- Holistic view of health and wellbeing – physical and mental health being intertwined;
- University-wide: academic, professional staff, management, students and student organisations, across all sections; and
- Population-level, utilising existing resources (services for individuals are addressed separately).
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Their initial three priorities are:
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- Mental wellbeing;
- Move more, sit less; and
- Eat better.
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Mental wellbeing blueprint based on evidence review
Now this is where it gets interesting. The mental wellbeing group, in keeping with the principle of evidence-informed interventions, did an evidence review culminating in a: ‘A blueprint for student mental wellbeing in universities.’
This blueprint identified four effective interventions:
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- Consider alternative academic strategies: Examples of this include pass/fail grades rather than five-tiered marks, courses with smaller segments, timetabling – in other words product and job design;
- Infusing mental health knowledge in the curriculum: in other words mainstreaming mental health literacy into their development program;
- Developing and promoting the use of e-health technologies; and
- Building healthy physical environments: “Even a window giving a view to the outside landscape can positively impact the mental wellbeing of students in that room.”
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No messing about here. No “We want to be a mentally healthy workplace but we can’t get our heads around redesigning jobs”. No “We want to be a mentally healthy workplace but the only thing that can change is the behaviour of our workers, we will help them to cope better with our toxic managers”.
Mind you, I may be speaking too soon. It hasn’t happened yet, it is a blueprint.
Clearly there is a need to bring this work in line with WHS. It would be a pity for the university to develop academic strategies to improve student mental health and wellbeing and not take into account staff needs at the same time.
I understand that there is interest in using the Canadian standard on Psychological Health and Safety in the Workplace for this, which is sensible as it is an integrated approach.
By that I mean it combines the prevention of harm from work-related psychosocial risks with the promotion of health and wellbeing and the management of illness.
A few years ago I read in the New York Times that higher education was one of the industries at high risk of disruption. It would be ironic, wouldn’t it, if slow-to-evolve WHS was disrupted by ideas coming from such a sector.
First published in Thomson Reuters Inside OHS, 04/07/2017
Inside OHS Editor: Stephanie D’Souza; (02) 8587 7684; Stephanie.D’Souza@thomsonreuters.com
Posted on December 6, 2016 in WHS
WorkSafe NZ have issue a 10-year strategic plan for work-related health. Safeguard, a WHS safety magazine, asked me, along with others to comment. I thought the plan reflected the rather reluctant transition WHS is currently experiencing as it broadens from a health protection model: mandated approach, employer responsibility to create a healthy and safe environment; to one that also includes a voluntary component with a shared responsibility for worker health promotion. You can read my response in the November/December issue of Safeguard magazine here.
A best practice framework for the Management of Psychological Claims: But where are we up to in practice?
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Posted on October 28, 2016 in WHS
Congratulations Howard Williams, one of the organisers of this year’s ALUCA conference, on a great conference. Held in Adelaide, numbers were up this year to 400. The opening address by futurist Gihan Perera was terrific.
I spoke in one of the parallel sessions on 20 October. Recently, I was a judge on the Swiss Re, ALUCA and Insurance Council of Australia awards for innovation in return to work. As always, this was a worthwhile experience as it gave me insight into the state of best practice across the industry.
In my presentation, I compared current practice in the life insurance industry, as evidenced by submissions for the awards, to best practice as described in the framework for the management of psychological injury, which was developed for SuperFriend by Anne-Marie Feyer, Jane Palmer and myself. I concluded that the life insurance industry is off and running in innovation of claims management at the micro level (that is, making claims processes client-centric and outcomes focused), and was in the early stages of exploration of partnership with superannuation funds and employers to get earlier intervention (macro level) but was neglecting meso level interventions. Meso level interventions are things the industry could be doing themselves, such as using product design to get better client outcomes and better use of analytics to manage claims (not just triage claims). Also, there is plenty more potential in bringing evidence to medical treatment and rehabilitation. Finally I concluded that there was scope to bring more rigour to the evaluation and continuous improvement processes underpinning current innovations. EML’s winning submission in workers compensation was a good example of what can be achieved with partnership with a university. You can view my presentation here.
Watch out workers compensation, I am finding the life insurance sector is taking a more innovative approach to their work these days. In conversations I have had with the workers compensation sector, too often a lack of innovative thought is excused by the constraints of regulation.
Posted on July 28, 2016 in WHS
The Safety Institute of Australia (SIA) in Tasmania held an event on Thursday 22 July at the slightly surreal hockey centre. The CEO of SIA, David Clarke, opened up outlining the action SIA is taking to enhance the professionalisation of the safety discipline. This includes defining the scope of knowledge, competencies, establishing accreditation and continuing professional development. He acknowledged the value of the extraordinary Body of Knowledge (BoK), built under the leadership of Pam Pryor a few years ago. However it is recognised this needs to be updated, possibly as a Wiki. An idea mooted at the time of the BoK’s development, but, inexplicably to me, not taken up.
I gave an update on mental health in the workplace. The gist of what I said was that an integrated approach is emerging as the dominant model. By that I mean a model that combines health promotion (workplace health promotion) with health protection (OHS) to take a holistic approach to the issue. Think the Canadian Standard as opposed to the Health and Safety Executive’s Stress Management Standards. Professor Tony La Montagne, now at Deakin, has proposed such a model. You can view my presentation here.
Talking to some of the participants who work in government afterwards, it is clear there is an appetite to apply some of these ideas, working in innovative partnerships, taking a broad worker health approach. Tasmania has already had some success with establishing employer networks. It may be easier to foster the cross-government collaboration needed for this work, especially between industry and health, in Tasmania. Watch this state!
Posted on June 10, 2016 in WHS
This week I gave a webinar to the Workplace Health Association of Australia on the integration of OHS and workplace health promotion (WHP). I assumed that the members of this organisation were experts in WHP and would have heard of the ‘integrated approach’ or Total Worker Health as NIOSH call it, but may not know the detail of its theory and practice. This is still emerging of course, and I hope that members of the WHA will start working closely with their OHS colleagues to progress this new model of WHS, which I consider will come to dominate as we recognise a more holistic approach to worker health is needed.
The case study is of an Australian statutory authority who asked the good question, ‘What does being a mentally healthy workplace mean?’ For this work I started with a conceptual model developed by Harvard and presented by Gloria Sorensen at the First International Total Worker Health conference in 2014 in Washington. The slide is in my presentation, but Sorensen’s full presentation and other’s from the conference can be found here http://www.eagleson.org/total-worker-heath. I then adapted the model to the organisation with whom I was working, and for mental wellbeing. As a part of this work I developed an audit tool drawn from the Canadian Standards on psychological injury, Comcare and APSC guideline on wellbeing and an ISCRR report on the evidence base for psychological health in the workplace. This can be found here.
If I had had more time I would have presented a second case study on the work on fatigue in the Emergency Department at Northern Health. This project was undertaken as a part of the WorkHealth Improvement Network set up by Worksafe Victoria. The WIN program is quite complicated. It is working through existing networks, one is VECCI for the manufacturing industry, and the other is the Department of Health’s public hospitals. The idea is that the Network Chairs develop skills in both the integrated approach, and a process improvement methodology based on PDSAs – Plan, Do, Study, Act. These are short, manageable cycles of measurable, achievable improvements. They then recruit and support workplaces to plan, develop and implement interventions based on the integrated approach. Northern Health came up with a winner to tackle the problem of fatigue associated with shift work, especially in female nurses, who with the double shift of family responsibilities were getting very little sleep. Northern Health recognises that this issue would not be adequately addressed by their usual OHS approach, it required a shared responsibility approach. Northern Health has made changes to its approach to shift design and its health workers are recognising that they need to manage their sleep better.
You can access my webinar presentation here.
Posted on May 12, 2016 in WHS
I attended the Northern Queensland conference on return to work (RTW) in Townsville on Friday 29 April. This was a terrific conference.
Professor Alex Collie, ISCRR, gave an update on the evidence on engaging GPs in the RTW process. He showed that the proportion of certificates in Australia that are fit certificates as opposed to sick certificates is increasing, but that contrary to expectations that proportion is not greater in doctors who see a lot of workers’ compensation cases. Furthermore the likelihood of a fit certificate being written varies hugely with the nature of the condition – not many for mental health.
Estelle Pearson from Finity talked about big data. Automation of decision making in workers compensation claims management is starting to happen. Huge potential – clone your best claims manager!
A panel discussed a nightmare of a case study and demonstrated that we really need to get out of the bog of compensation minutae and upstream to improving ability to deal with issues early in workplaces.
I spoke on the future of RTW based on some work I did in the life insurance sector for SuperFriend and some more recent work for Comcare on a national cross-sectoral approach to common issues. Click here to download my conference presentation.
But the bottom line, I think, is the question, Does workers’ compensation do more harm than good?
Posted on June 2, 2015 in WHS
By Niki Ellis
Adjunct Professor, Institute for Safety, Compensation and Recovery Research and Department of Epidemiology and Preventive Medicine, Monash University
Recently an organisation asked me to consider what being a mentally healthy workplace might look like for them. It was a great brief, they were up for it. I started by having a look at their business strategy and found they were growing, planning to further develop their leadership and workforce and IT platform to enable them to be competitive and make the most of the opportunities they could see.
I then reviewed their current investment and performance in health and safety and concluded that they were a strong performer in the traditional health and safety model. By that I mean they aimed for zero harm in relation to the prevention of injuries. They had started a workplace health promotion program, but it was early days, and quite a long way off best practice.
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- A team from Johns Hopkins recently described best and promising practice as:
- Health education
- Supportive social and physical environments
- Integration with HR, infrastructure and environmental health and safety
- Links between HP and related programs eg EAP.
- And that it works if:
- Goals are aligned to business
- Program design is evidence-based
- Theory-based implementation
- Ongoing evaluation
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What they did have was R U OK, and a great start on a health portal. Way to go.
Potential for web-based interventions
In another project I am working on for the life insurance industry we have done a rapid review on the management of psychological claims.
The review found that with regard to treatment there was huge potential with web-based interventions for mental health.
A Canadian case study illustrated the future with a confidential web-based mental health self-management resource. This allows someone to assess their own mental health, provides information on treatment and rehabilitation, with supporting material for doctors and then tools for tracking progress.
The resource was based on recent evidence-based guidelines, and was being marketed to insurers and employers.
A proposal to become a mentally healthy workplace
Meanwhile back in Australia, having assessed the broader strategic environment and what programs were already in place relevant to mental wellbeing; not just in health and safety and workplace health promotion but also in HR more broadly (EAP, diversity strategy, respectful workplace policy etc), I developed a proposal for becoming a mentally healthy workplace.
This drew on two sources of information: Tony La Montagne’s model of an integrated approach to mental health in the workplace; and Gloria Sorensen’s conceptual model for an integrated approach to the prevention of ‘work-related injuries and illness and the enhancement of overall workforce health and wellbeing’.
Tony La Montagne is at the University of Melbourne and his model has four components:
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- Prevent harm from psychosocial hazards
- (using work to) Promote positive mental wellbeing
- Early detection
- Manage illness and minimise consequences.
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Implementation science is key
Sorensen (above) is the Queen of the integrated approach to workplace health and safety. She is the head of the Centre for Work, Health and Wellbeing at Harvard University.
A colleague of La Montagne’s told me the light bulb went on for Sorensen when she was running Quit programs at a foundry, and realised the uselessness of talking to workers about them giving up cigarette smoking in an environment filled with toxic fumes. She presented a generic conceptual model, drawing on implementation science, with the following elements: context (external and organisation); interventions, mediating factors in the work organisation or work environment, mediating factors related to workers, expected early outcomes, and then expected final outcomes, at the first international conference on Total Worker Health, American for the integrated approach, in October last year. (Selected papers from the conference can be found here)
Drafting the strategic direction
Using both frameworks I generated draft strategic directions for this organisation, which essentially draw together and build upon many different strands of activities already in existence across the organisation, with the aim of assisting to deliver on the broader business plan.
These included:
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- Work design and re-design: Proposed as they were building a new IT platform, the idea is that health and wellbeing becomes a consideration in that work. For existing work process, suggested the addition of psychosocial hazards to the existing risk management system, possibly by using the routine employee opinion survey to collect information on the psychosocial working environment and leadership performance.
- Proposed the concept of work-life balance as a great link between individual behavioural change and work environment change. Could be a focus of communications on the strategy.
- Extension of a middle management development program on mental wellbeing which had already been developed and run out to some. This is key, if you ramp up conversations about mental health in a workplace you need to be confident middle management can deal with mental health issues, otherwise you may see this reflected as an increase in stress claims.
- Inclusion of health and productivity, especially mental health, in review of the leadership development program.
- Continue to develop the health portal in relation to mental wellbeing, noting evidence of effectiveness of web-based self management support and improving mental health literacy.
- Streamlining business metrics: Opportunity to ensure that relevant indicators for mental wellbeing and their link to productivity are included.
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I provided three options for the goal. The first two were based on integrated thinking. One was very broad, an aim of improving organisational performance through health. The second was more tightly focussed – improving workforce capability and wellbeing by including mental health considerations in the development of leadership, systems and workforce. The third option was based on extending the traditional model to better include mental health – that is to contribute to achieving zero harm through programs aiming to minimise psychosocial risks and to promote mental health (separately, as is the tradition).
Bravo to this organisation for taking this topic seriously and giving it a good shake. They are in a good position to succeed as they have a strong foundation in a high performing traditional workplace health and safety program, and they are not unused to the concept of psychosocial ergonomics.
There are benefits to be had for workers in terms of improved health outcomes and benefits to employers in terms of performance, presenteeism and absenteeism.
But it is going to take a lot more than asking R U OK.
First published in Inside OHS, 28 May 2015
Inside OHS Editor: Stephanie D’Souza.
Managing Editor: Peter Schwab; 02) 8587 7684,
Stephanie.D’Souza@thomsonreuters.com
Posted on March 19, 2015 in WHS
We are starting to see evidence of a more collaborative approach in WHS. Recently WorkSafe Victoria has begun a new program, for example (I am a paid advisor), in which it has formed partnerships with organisations in the manufacturing and health industries..
The organisations have been chosen for their established networks and track record in driving change in these industries. The partnership aims to see businesses within these networks use quality improvement methodologies to develop adaptive approaches to improve musculo-skeletal health, mental health, and safety culture. The methodologies integrate interventions from OHS, workplace health promotion and human resources, and ideally link with other community initiatives.
So here’s a crossword clue for The Age – More complex, more complicated, more effective solutions for WHS, 4 letters: KICS.
First published in Thomson Reuters Inside OHS, the supplement to Occupational Health News, February 2015
Posted on March 19, 2015 in WHS
In public health, the point of thinking about systems, of mapping systems (agonising though it looks!), is to find “new ways of framing public health (that) may increase our understanding, expand our options and increase our effectiveness”, said Kenneth McLeroy in the American Journal of Public Health, March 2006.
When I took up my former role as Foundation CEO of the Institute for Safety, Compensation and Recovery Research in 2010, I initiated a project using futures methodologies.
A probable future for WHS that emerged from that work was that we would work less in isolation from others, not so much in the hero organisations. We would have to become more collaborative to prosper.
Somebody gave me a good example of this recently. We took a reductionist view of bullying, and created a WHS rod for our backs – a systems view would have seen us mapping a complex picture of causes and potential partners for more complicated and effective solutions.