Friday, January 22, 2010

Why Compare Performance?

This past week I was in Victoria speaking at a conference on Performance Measurement. I have been asked to present at this conference about a half dozen times and it is a real credit to the strong performance measurement culture of WorkSafeBC that this organization continues to ask for our participation.

One of the BC Reporting Principles, adopted by the BC legislature, states the following:

Public performance reporting should provide comparative information about past and expected future performance and about the performance of similar organizations when it would significantly enhance a reader’s ability to use the information being reported.

Comparative data provides stakeholders with a context to understand if what we achieved is good, bad or indifferent.

Some of our key performance indicators do have direct comparators. Thanks to the AWCBC, we can plot our administrative costs, injury rate, duration and premium against other workers’ compensation systems in Canada. Not all the comparisons are perfect. One has to take into account that jurisdictions such as Manitoba, Ontario, and Saskatchewan cover a much lower percentage (~70%) of the employed labour force than we cover in BC (~93%).

Some of our key performance indicators have no direct comparison. Our ‘voice of the customer’ program has no direct comparator in Canada regarding overall satisfaction levels for workers and employers. Some jurisdictions report on return to work at the aggregate level but none in Canada publish a statistic comparable to our indicator that measures the success of RTW for cases referred to vocational rehabilitation for that purpose. While our key performance indicator for assessing our funding status is unique, there is an industry standard that can provide another context for comparison. This AWCBC measure is reported on their website and in the Appendix to our Annual Report and Service Plan. True the the principle, this additional context is included so stakeholders have another way to judge how WorkSafeBC is performing even though there is no direct comparator to our 'Percent of Target Capital Adequacy Reserve' indicator.

WorkSafeBC also reports on a public contribution index. This measure reflects the percentage of 800 surveyed British Columbians expressing an opinion who rate WorkSafeBC as making a somewhat or very positive contribution to BC. Scores in the mid 80% range in the last four quarters are a reflection of the commitment of staff to making a difference for each and every human being they encounter. No other workers’ compensation system I know of measures performance in this fashion (or, if they do, they are not telling anyone about their results). From some historical data from firms who used to ask this question and report, we have a scale that suggests our current level is near the top of the observed range for some other BC corporations. Still, having some current external comparator in the workers’ compensation business would help our stakeholders properly evaluate our performance.

All of this is not to say we have performance measurement ‘solved’. Measurement is essential to improvement. If you can’t (or chose not to) measure something, it is debatable that you can understand it or improve it. That said, not every jurisdiction can or should measure the same things nor should they necessarily measure similar things in the same way. Performance Measurement should be strategic as well as meaningful and useful to stakeholders and those accountable for the system. More importantly, every person working within the system should be able to see how what he or she does contributes to organizational goals and influence the key indicators of the system.

Whenever possible, I encourage comparison. Sometimes that means WorkSafeBC has to generate measures for others to use; at other times, we are asking jurisdictions in Canada, the US, Australia, or New Zealand to restate their data in a way that helps us understand our own performance better.

Why compare performance? Comparison leads to understanding and that leads to questions that can make all our systems better for those we serve.

Monday, January 11, 2010

How do you measuer return to work success?

Over the weekend, I received an email from Australia seeking information regarding return to work (RTW) programs and outcomes in North America. One question asked was regarding the percentage of injured workers who RTW. One might think there was a simple, common measure that would allow direct comparison across all workers’ compensation jurisdictions. In reality, however, there are few jurisdiction using the same method to measure RTW success.

The vast majority of injured workers who file workers’ compensation claims in BC and elsewhere experience a successful RTW. What percentage and how durable a return depend on the population being studied, the denominator uses and how RTW is defined. It also depends on the law and economy in the jurisdiction under study.

Many jurisdictions suggest they achieve 85-90% RTW for time-loss injuries. Most injured workers RTW with their accident employers anyway so the high percentage may not indicate anything about the effectiveness of the law, policy or program in a particular jurisdiction.

The 2008/09 Australia & New Zealand Return to Work Monitor examines these questions in detail. Using a common survey methodology that samples from the population of claims with “10 days or more compensation (including any excess) paid”, the reported statistics are among the most comparable around. The ‘employer excess’ refers to an employer deductible where the employer is responsible for paying wage loss benefits and medical costs up to certain limits. This is a common, (although not standardized) provision in Australia. Most jurisdictions in this study have legislation that requires the accident employer to return an injured worker to employment.

The Monitor reports on both ‘durable’ and ‘non-durable’ RTW. The results are summarized in that report as follows:

The RTW rate showed steady improvement between 2002/03 (83%) and 2005/06 (87%) returning to pre 2000 levels (mid 80%). There has been no further improvement, with the 2008/09 national RTW rate similar to all previous years (83%). The durable RTW rate has gradually declined over the last four years, with a lower durable RTW rate being recorded in 2008/09 (72%) to 2007/08 (75%).

More commonly, a report on RTW will be designed to meet the needs and data of a single jurisdiction. For example, a report out of the Texas Department of Insurance Workers’ Compensation Research and Evaluation Group in November 2008 reported on ‘initial’ RTW rates. The research found 74% -78% of claims (injury year 2004-06) had an initial RTW within two quarters post injury. This climbed to around 83%-88% by four quarters and topped out at 90-93% by 12 quarters (the longest category studied). These results have to be taken in the context of the unique Texan workers’ compensation context. For a variety of reasons, it is likely the study population in Texas is more severely injured than in the Australian & New Zealand Monitor’s data.

There is no standard for measuring RTW in Canada. Many jurisdictions in Canada have mandatory reinstatement laws that require an employer to return an injured worker to employment (although BC does not have such a provision). All have some form of RTW program.

New Brunswick 2008 Report to Stakeholders states:

Ninety-six percent of injured workers who lost time from work returned to employment or their pre-employment status following their injury. Two percent were not employed immediately following their claim closure, and 2% were fully disabled and incapable of employment.

At WorkSafeBC, RTW is not just another program; it is an integral part of our strategy and linked directly to the goal of improving satisfaction, accessibility and public confidence. While most workers return to their accident employer, the focus of BC’s vocational rehabilitation efforts is on those who face significant barriers in achieving a successful RTW.

A key indicator of RTW success for WorkSafeBC is the percentage of cases referred to Vocational Rehabilitation assistance who achieve a successful outcome. Measured as a percentage of all closed cases, the results have been as high as 81.7% in 2008. Although the current economic conditions in the province are likely to result in a lower level, the importance of RTW will not diminish.

We know from research that work is good for health and well-being. Regardless of how an agency decides to measure RTW, supporting every injured worker to achieve a safe and durable RTW is and should continue to be a priority for every workers’ compensation system.

Monday, January 4, 2010

Is Bullying (Psychological Harassment) a workplace OS&H issue?

A recent article noted that threats and intimidation by supervisors have risen during the current financial crisis. Whether or not this true, threats of violence or intimidation should never be tolerated. Many jurisdictions rely on a ‘general duty provision’ in their occupational safety and health regulation to require employers to assess risks and protect workers from harms that would include violence. Other jurisdictions (Federal government, BC, Alberta, Saskatchewan, Manitoba, PEI, Nova Scotia and most recently Ontario) have gone further and created specific provisions regarding violence. Part 4 of WorkSafeBC’s Occupational Health and Safety Regulation defines violence this way:

4.27 "violence" means the attempted or actual exercise by a person, other than a worker, of any physical force so as to cause injury to a worker, and includes any threatening statement or behaviour which gives a worker reasonable cause to believe that he or she is at risk of injury.

More recently, the trend has been towards more explicitly dealing with the issue of what is commonly termed ‘bullying’. Quebec and Saskatchewan lead the way in this area with specific provisions that addressed ‘psychological harassment’. Bill 168, occupational Health and Safety Amendment Act (Violence and Harassment in the workplace) 2009 was given third reading by the Ontario legislature last week. Definitions in these provisions vary but the following extract from the Ontario Bill 168 captures the main elements:

"workplace harassment" means engaging in a course of vexatious comment or conduct against a workers in a workplace that is know or ought reasonably to be known to be unwelcomed.

Quebec’s provision in its Labour Standards 81.18 is even more inclusive:

"psychological harassment" means any vexatious behaviour in the form of repeated and hostile or unwanted conduct, verbal comments, actions or gestures, that affects an employee’s dignity or psychological or physical integrity and that results in a harmful work environment for the employee.

Saskatchewan’s definition is a little more complex:

(l) ‘harassment’ means any inappropriate conduct, comment, display,action or gesture by a person:
(i) that either:
(A) is based on race, creed, religion, colour, sex, sexual
orientation, marital status, family status, disability, physical
size or weight, age, nationality, ancestry or place of
origin; or
(B) subject to subsections (3) and (4), adversely affects
the worker’s psychological or physical well-being and that the
person knows or ought reasonably to know would cause a
worker to be humiliated or intimidated; and
(ii) that constitutes a threat to the health or safety of
the worker;
Note, these provision govern workplace safety and health; they do not speak to the issue of compensability of any psychological injury that may arise. By most definitions, "harassment" or "bullying" implies a series of actions or behaviours and not "an acute reaction to a sudden and unexpected traumatic event arising out of and in the course of the worker's employment", as may be required for a mental stress claim. (See Workers Compensation Act, section 5.1(1)(a).

Is an harassment provision more effective than the general duty clause? I don’t think there is a definitive researched, evidence-based answer to that questions. On the other hand, the issue of workplace bullying is real and increasing in profile as a workplace safety and health issue. Whether through specific regulation or active education, protecting workers from harassment should be a priority.