Designing RTW Plans that Work
When considering how to return a person back to the workforce after an injury or illness, it is important to remember that RTW is often less dependent on the diagnosis, severity, treatment, and other medical factors. Many "other" factors must also be considered that profoundly influence RTW outcomes which often have more to do with the unique characteristics of the injured worker and their employer rather than the injury or illness itself. The process of RTW needs to be responsive to this fact, the person, and the work environment to create the best outcomes and prevent the human, social, and economic harm of unnecessary work disability.
RTW is anything but a single event. It is a multi-faceted process that is dynamic nature and requires a conceptual approach that is dynamic."
Return-to-Work Outcomes Following Work Disability: Stakeholder Motivations, Interests and Concerns (Amanda E. Young, et al., 2005)
Return to work is a process, not an event. The best outcomes occur when a deliberate effort is made to engage the worker and supervisor/employer.
In this article, we will discuss designing return-to-work plans that increase stakeholder buy-in through utilizing the best-practice worker-centric approach and by leveraging transitional duties.
What is the Reality?
When most people are asked, “Why do most claims exceed expected duration?” some responses that are likely to come to mind are:
- Motivational issues (worker, supervisor, health care provider)
- Enabling stakeholders
- Role conflict
- Labor relations issues
- Fear
- Avoidance
- Employer won't accommodate
What is our Opportunity then?
The opportunity to make a profound shift comes from the realization that the injury or illness does not fully explain RTW outcomes. RTW is a complex phenomenon of motivations, choices, fears, expectations, and judgments. The causes of work disability are often distinct from the associated health condition(s).
What is a Worker-centric Approach?
On a system level a worker-centric approach is what breathes life into the recovery and RTW process. A worker-centric approach ensures systems and processes lead with the voice of the worker, develops their locus of control, and activates a supportive environment. The evidence is mounting that this approach is now becoming best practice. The worker-centric approach focuses on engaging and activating the worker in their recovery and RTW and building a supportive environment and systems to nurture that engagement.
Leading with the voice of the worker is the fuel that drives the worker-centric approach, and the worker-centric approach is the vehicle to achieve good RTW outcomes.
On an individual case level, the worker-centric approach can be broken down into 4 simple steps:
- Lead - The first step in this process involves leading with the voice of the worker. This means understanding their motivations, expectations, concerns, and actively involving them in the next action steps. Leading with the voice of the worker lays the foundation for them to become an active participant in their recovery and RTW which drives engagement, activation, and commitment to their RTW outcome.
- Add - Next, add the voice of the supervisor/employer to determine what they can accommodate and support.
- Mix - Lastly, mix these two voices to reach agreement on what the RTW plan will look like. Not only does this build trust and confidence for the worker but also ensures stakeholders feel understood and listened to.
- Then Approach the Provider: Once agreement has been reached, the Provider can be approached for final sign off. Knowing the worker and employer agree on the plan makes it easy for the Provider to support the "release" to RTW.
Return to work is not something you do to a person but something you do WITH them.” - Jason Parker
How do you make Transitional Duties work?
Transitional duties are one of the best ways to boost confidence, reduce fear, and minimize avoidance behavior of the worker. By gradually increasing the worker’s functional abilities and their role in the workplace they will gain confidence in their ability to return to work.
Keep in mind two important concepts when implementing Transitional RTW:
1. Progressive workload. Progressive workload means that the work schedule starts with lighter than normal workload and progressively increases each week. For example:
- Limited to lifting no more than 15 pounds for the first two weeks. Increase to 20 pounds on week three. Increase to 25 pounds week four. Resume regular lifting on week five.
- A later start in the day at 10 am instead of 8:30 a.m., if there are continuing significant sleep problems. Move back to 9 a.m. at week three. Resume normal starting hours at week five.
This type of plan can easily be discussed with the worker and supervisor. With employee-employer agreement you can approach the Provider to ensure no risk of harm to the worker in participating in the plan.
2. Periods of work followed by PLANNED recovery. Returning to work after a period of time-loss sometimes requires adjustment to the physical, emotional, and cognitive demands of the workplace. Just like an athlete will have training days followed by recovery days, a worker recovering from injury or illness can benefit from the same strategy.
When designing transitional RTW agreements there are many work variables you can manipulate to make transitional work successful such as the:
- Physical environment
- Work environment
- Hours worked
- Days worked
- Duties performed
- Responsibilities
- Arrangement for assistance
- Or all of the above.
Above all, ensure the plan has a to return to regular duties, with a start and end to the plan. This provides clarity for all involved and ensures the likelihood of a successful outcome.
SUMMARY
Accommodations and transitional RTW plans are among the best tools to reduce and prevent the harm of unnecessary work disability. Engaging the two key stakeholders, worker and supervisor, in the RTW process sets the stage for the best RTW outcomes. A worker-centric approach using the Lead > Add > Mix process ensures inclusion of the worker and supervisor and provides the best opportunity to obtain Provider support that ensures no risk of harm to the worker by participating in the plan to return to work.
About Jason
Jason Parker is the President and Senior Work Disability Consultant of Centrix Disability Management Services. Jason is the creator of Motivation and Action Planning, which is a unique behavioral, worker-centric approach to work disability prevention. Jason has extensive experience in Work Disability Prevention and Stay-at-Work/Return to Work programs with over 24 years of experience covering almost every employer group. Over the years, he has developed a specialty in work disability prevention, worker engagement, and RTW outcomes that is evidence-based and worker-centric.
Jason was a finalist for the 2018 Comp Laude Awards and recognized for excellence in advocating for the injured worker, collaborating for improved outcomes, and leadership within the work comp field
Jason holds a Bachelor of Human Kinetics from the University of British Columbia.
Jason oversees the leadership of Centrix focuses on helping Insurers and Employers improve RTW outcomes by transforming the worker experience.
R.E.W.A.R.D. PROGRAM: RETURN EMPLOYEES TO WORK AND REDUCE DISABILITIES
The REWARD Program provides information on transitional return to work. One of the major hindrances to returning to work sooner is the misconception that injured employees must be 100% recovered before they can return. Many transitional assignments can serve both the employee and the company well and help the injured employee recover sooner. For more information, download the toolkit.
MEET WITH LIKE-MINDED EMPLOYERS
Let's talk about how to identify modified-duty jobs and individualizing accommodations for employees. To kick things off, Michelle McBroom Weiss will speak to the importance of involving the injured worker in his/her return-to-work plan. Then Justin Bryant—a safety coordinator—will speak about his organization's Return to Work experience. During the discussion, please feel free to share your own experiences in finding modified-duty jobs, or come with a list of questions for the group to discuss. This will be a hybrid meeting: Employers are encouraged to attend this REWARD Employer Group meeting in Nashville at 220 French Landing Drive, 1st Floor Side B in the PEARL Center on May 12th at 9:30-11:00 AM (Central). Not in middle Tennessee? Employers are also welcome to attend the meeting via Webex.
Ms. Weiss has thirty years of experience and has consulted with employers regarding return-to-work programs for their organizations and for specific individual cases.