Thursday, November 24, 2011

Why should we care about research?

This past week, I was in Boston at two conferences for researchers in workers’ compensation. Some of you might think this can’t possibly be of interest to what you do so before you click off to some other blog, let me assure you that research is important to every workers’ compensation policy analyst, disability management practitioner, and prevention professional.

You make decisions. You give advice and direction. As a professional in any capacity you rely on a body of knowledge — one that is hopefully evidence based and validated by research.

Let me give you an example. In this business, we all know about back injuries. Think about an acute low back claim of less than six weeks. What factors would predict the likelihood and timing of a return-to-work? Depression? Lifestyle? Education? This may be your intuition, and designing your policies or programs around this intuition may seem to be the right thing to do but the research tells a different story. There is strong evidence that none of these factors have any effect on duration on acute back claims.

What factors are predictive of the likelihood and timing of return-to-work? The Manitoba WCB's Workplace Research and Innovation Program wanted to know, and provided a grant to the Institute for Work and Health to conduct a detailed "systematic review" of the literature on this topic. The systematic review found strong evidence for factors such as:

  • The worker's recovery expectations (e.g., their predictions about how likely it is they will return to work and/or how long it will be before they are able to return)

  • The availability of modified work

  • Interactions with healthcare providers

This is powerful information for the design of programs, communication with employers and providing guidance to workers and their healthcare providers. Applied appropriately, the findings can reduce duration and improve outcomes for workers and employers. Without the research papers that were reviewed, without the skill and discipline of other researchers who conducted the review, and without the funding of the Manitoba WCB Research and Innovation Program, these findings would not be available for us.

Another study examined temporary disability duration and the impact of rising unemployment. Looking at the unemployment rates by county in 16 U.S. states, the Workers' Compensation Research Institute study found temporary disability duration, (on WC claims of greater than seven days time loss and at 24 months post injury), rose from 17 to nearly 20 weeks as unemployment rose from 5 percent to 10 percent. This finding makes sense and quantifies the magnitude of the increase. The finding is of critical importance in explaining and quantifying the effect of the economic climate, (as epitomized by rising unemployment rates), in many jurisdictions.

Research has tremendous value. The publication of peer-reviewed research is almost free to the user — but it also has a cost. Funding research, systematic reviews, and knowledge transfer is not cheap. Nor is it trivial to attract and retain academics willing to study, develop their understandings, and devote their careers to workers’ compensation and prevention research. Without many people and agencies willing to sponsor research and researchers, most of us would be “free riders” on the coattails of the few that do.

The research reported on at the conferences I attended is important. Without a sustaining and growing body of research-based knowledge, we not only risk the integrity of our professions but more importantly, we risk doing the wrong thing for those we serve.

Thursday, November 10, 2011

What constitutes an emerging OH&S risk?

Everyone who does environmental scanning in workers’ compensation and prevention gets asked the question, “What constitutes an emerging risk in OH&S?” Over the years, I have created lists of emerging risks based on many sources. Here is how I rationalize what makes the list.
I generally follow the European Risk Observatory’s approach, and consider for inclusion in my list of “emerging OH&S risks" any occupational risk that is both new and increasing. A couple of examples illustrate the sort of reasoning I apply to determining what that means.

“New” means the risk did not exist or was not recognized before. Nano-particles and their application in industry are new risks caused by a new technology and new processes. Workplace bullying and psychological stress are not new but are becoming more widely recognized as OH&S risks, (often newly recognized by legislators, regulators, or the Courts). Cyber-bulling is a relatively new social phenomenon that might fit this category.

The recognition of workplace mental or psychological stress is not really new. However, recognition of it being caused by the expectations for 24/7 connectedness via a smart phone might fit as a new type of workplace or organizational structure that would also fit the definition of “new.”

I am particularly concerned about highlighting those issues where new scientific knowledge allows a long-standing issue or common work practice to be identified as a risk. Historically, asbestos was widely used long after it was known to be carcinogenic. What is the new asbestos? IARC and others have identified shift work that interferes with circadian rhythms as a probable human carcinogen, and an important contributor to other health conditions. To my way of thinking, this should be considered new.

Emerging risks may also be long-standing issues that are seen in a new way, or are rising in society in a way that is increasing the OH&S risk. People have always aged and some people have been overweight or obese, but the aging workforce and the epidemic in obesity should be on the list as emerging OH&S risks. Mumps and Rubella have always been a threat to school staff such as teachers, teaching assistances, and administration but the decline in vaccination levels among school age students may be categorized as an increasing OH&S risk.

None of the above risks would make the list of emerging risks if the risk was not “increasing." Clearly the number of hazards, (like sedentary work, for example), leading to the risk , (obesity), is growing. Nano-particles and processes involving their use make the list because they have moved out of the lab, and are increasing in day-to-day operations in the workplace. The exposure to the hazard, (number of people working shifts that interfere with circadian rhythms), leading to the risk, (cancer), is increasing. In some cases the effect of the hazard on workers' health, (pace of work, mental stress), is getting worse, (more people affected or the magnitude of the effect recognized as more serious).

Creating lists of emerging risks is not an end itself. It is more important that we understand what is going on, apply the precautionary principle, and protect workers by education, design, substitution, work processes, and other strategies.

One of my biggest fears is that future professionals in workers’ compensation OH&S will look back at what we knew today about these emerging risks and ask, “What were they thinking? Why didn’t they recognize the emerging risk?” and more importantly, “Why didn’t they do something?”