“Work disability prevention has evolved from being a component of disease outcomes studies, to a separate and growing research discipline. In part, this is due to recognition that work outcomes often do not correlate with other health outcomes; the causes of work disability are multiple, complex, and often distinct from associated health conditions or treatments; and that work disability creates an important personal, economic and social burden that is often preventable.”
Work Disability Prevention Research: Current and Future Prospects. Pransky, G. et al, J Occup Rehabil (2011) 21:287–292
Work Disability is a separate psychosocial condition, has a unique set of causes, associated factors, and also responds to effective treatments. It is linked to an underlying condition, but the extent of work disability varies greatly. It is important to note that clinical severity does NOT predict work disability (Young and Murphy, 2009. Anema et al, 2009) when considering the management of complex medical situations which affect employee attendance at work and therefore it is important to consider non-clinical factors in addition to the complex medical issues that have occurred.
One of the principles of Work Disability Prevention is to understand that having a disability doesn’t always result in work disability. In keeping this this principles The American College of Occupational and Environmental Medicine, therefore, recommends adopting a disability prevention model in their position paper on “Preventing needless work disability by helping people stay employed.”
There are obviously some medical conditions that result in medically required absence from work. For example, after surgery a person may need time recovering, a worker who suffers a significant hand trauma, or someone with debilitating pain or a person admitted to a hospital all require recovery time and may be unable to attend the workplace. These types of situations often necessitate time away from work result in “medically required disability”. In other words, there is risk of harm to self (or others) if they went to work.
“The lost workdays you are out to prevent are not the ones that are medically required.”
Dr. Jennifer Christian, CEO of Webility, Former Chair of ACOEM Disability and RTW Committee
However, despite some conditions needing medically required leave there are many medical conditions where there is a substantial discretionary element to work absence. While a person may have a health condition, they would be able to attend work if the right accommodations are made. It is in these cases that the work absence is at the employee’s, or their doctor’s, or the employer’s discretion. Meaning, there is no medical requirement that the employee stay away from work.
Medically unnecessary disability often results in protracted recovery, unnecessary delay in returning to work, and often what is termed “medicalization” of a non-clinical problem(s). Examples could include; an employee not feeling supported by their supervisor or poor job performance resulting in disciplinary action that manifests itself as a diagnosis. Also, sometimes simple delays in the current process can cause a delay in return to work.
A Work Disability Prevention program seeks to reduce the discretionary days and have the ultimate goal of preventing the unnecessary days. Qualitative and quantitative assessments of worker’s experience shed some light on what makes an effective Work Disability Prevention program. Out of these assessments you can start seeing some patterns. It appears that there are four crucial pillars to an effective work disability program.
The Four Pillars of Work Disability Prevention
“Interactions between insurers and injured employees were interwoven in cyclical and pathogenic relationships, which influence the development of secondary injury in the form of psychosocial consequences instead of fostering recovery of injured employees.” Kilgour et al., 2014
Providing a positive experience builds a strong foundation for the employee’s recovery leading to a successful and durable return to work. Or in other words, experience matters. Negative experiences have significant consequences in the development of medically discretionary and unnecessary disability.
The Four Pillars of an evidence based work disability prevention service model are:
Pillar 1 – Prevent unnecessary delays – Unnecessary delays are often caused by system problems due to delay in notification of the absence, delay in identification of referrals, delay in early intervention. Striving for Day 0 notification of injury, illness, and absence should be of paramount importance to organizations. Unnecessary delays translate to unnecessary disability.
Pillar 2 – Prevent Unnecessary Duration – Unnecessary duration is often caused by medically discretionary and unnecessary disability which usually manifest in non-clinical risk factors, and known work disability risk factors. Ensuring you have a way to screen for low, medium, and high risk cases is important to provide the appropriate intervention(s). All early intervention is NOT equal.
Pillar 3 – Prevent a Confusing Process – A confusing process creates uncertainty in the mind of the employee. In doing focus groups with injured workers it is clear how overwhelming the leave process can be and the impact it has on engagement.
- Ensure clear communication with the worker
- Establish where the worker is in the process and what the next steps will be
- Answer any questions they have
- Ensure there is a clear and understandable process
Pillar 4 – Prevent Unclear RTW – There is clear evidence that a perceived lack of control is at the center of the “Web of Disability” (Aurbach, R. International Journal of Disability Management 2014 Volume 9) and in particular when there is no clear path/plan to RTW. Workers want to be involved in their recovery. They want to be involved in their RTW and have much to contribute. An interactive process is required and involves; identifying risk factors, beginning a dialogue, addressing concerns about RTW, participatory problem solving, and developing next action steps with the worker. Unclear RTW that does not involve the worker risks disengaging the treating provider, the worker, and can sometimes result in attorney involvement.
“Within the return-to-work literature, there is research suggesting that work disability is developmental in nature.” (Young et al, Nov 2015).
If that is the case then we can prevent it from happening. Are you managing disability or preventing work disability.