Friday, September 21, 2012

What were the rehabilitation and return-to-work highlights from the PIEF Conference?

I’ve recently returned from speaking at the Personal Injury Education Foundation (PIEF) conference in Brisbane, Queensland, Australia. PIEF has no exact counterpart in Canada or the United States. It was established in 2006 as a not-for-profit organization by a consortium of Australian and New Zealand accident compensation regulators, insurers, and claims management organisations. They wanted to create programs, initiatives and events focused to raise the common standard of knowledge, skills, and professionalism in the personal injury industry, which covers what North Americans would think of as workers’ compensation, transport accidents compensation, and other injury compensation programs.

My assignment as a keynote speaker was to give a North American perspective on rehabilitation and return to work. (In the interest of full blog disclosure, PIEF funded my travel and registration costs while WorkSafeBC funded salary and other expenses). Highlights for me included hearing the other presenters in the concurrent sessions, other keynote speakers in plenary sessions, and the discussions in the halls, meals, and social events.

The conference opened with a brief talk from an injured worker, Edward Bailey — an ex-pat Canadian who suffered severe back injuries and surgeries that left him unable to work in his 30-year career as a mechanic. He relayed how scary this was, how depressed he became and how the assistance he received to be a trainer and assessor as well as his additional work he does as a technical writer have made all the difference. He said the pain is still there but the rewards of his work allow him to carry on.

That theme of "work being important and good for you and your recovery" was echoed in many sessions. The employer representative who spoke next was Amy Sproule, the Health and Wellness coordinator for Carlton United Brewers — supplier or a quarter of Australia’s beer. She outlined their extensive program which includes on-site physiotherapists (PT) and access to Occupational Therapy (OT), physiatrists, and other allied professionals. She noted that some of the costs for referrals are picked up by WorkCover or by their benefits program but some are just absorbed as an HR cost. She acknowledge that onsite PT was expensive but said it was a visible commitment to early intervention, prevention and RTW — part of a culture they have and want to foster. She concluded that the program makes good business and good moral sense.

The next speaker was Jon Schubert, the president and CEO of the Insurance Corporation of British Columbia (ICBC). He gave a detailed talk focused on transport accidents but some of the research he presented certainly got a reaction from the delegates. For example, he showed how whiplash claims frequency were the lowest in Quebec, a province with a no fault system. He spoke about the Quebec taskforce on whiplash that is widely used for neck pain and the work he was involved in with Saskatchewan that has gone beyond that to focus on a functional model. Interestingly, following the research leads to some surprising outcomes. He noted that some interventions, such as early fitness programs, actually delay recoveries and others have no effect. It raises important questions about what should be funded. Are we doing harm by funding interventions that delay recover, increase disability, or have no effect?

The third keynote speaker in this two-day conference was Professor Sir Mansel Aylward CB, Chair, Public Health Wales and Director, Centre for Psychosocial and Disability Research, Cardiff, Wales. His talk was primarily based on the bio-psycho-social model but his message was clear: We have to change our current thinking and models of disability. He called this focus on outcomes, on health and work, “a moral obligation”. He noted that the bio-psycho-social model is now supplanted the standard medical model and has the published, peer-reviewed data with biochemical, neurotransmitter, and other evidence to back it up. “There is a limited correlation with illness, disability and the capacity for work,” he said — a statement that most in the field of vocational rehabilitation would agree with. He advocates return-to-work outcomes becoming an objective of primary care.

Other topics at the conference included how to define and measure client outcomes, the effects on health, psychological, and work status following compensable injury, and predicting common law claims. I took copious notes at this event and know I will be following up on much of what was presented.

Although the event is only held every two years, based on having attended two of the last three I have no hesitation in recommending the PIEF conference. The next one will be Auckland and will be held in conjunction with the International Forum on Disability Management (IFDM). ​

Wednesday, September 12, 2012

Is there only one way to keep workers safe?

Last week I was in Brisbane, Queensland on Australia’s east coast. Here’s a jurisdiction a bit bigger in population than British Columbia, a little smaller than Washington State, with a low injury rate and low workers’ compensation premiums (“workcover” as it’s called in Australia).

Brisbane is a modern, cosmopolitan city of three million. There are obvious signs of a vital economy. Buildings are going up, transportation networks are expanding, and unemployment is around five percent (vs. B.C. and Washington state where unemployment is hovering around the eight percent mark).

The workers that keep this economy running are engaged in similar activities to those in any large city. Perhaps because I’m aware of occupational safety and health issues, I couldn’t help but notice some similarities and differences.

Above the city, the complex choreography of cranes carries on as it does over urban construction sites everywhere. The cranes; however, are predominantly luffing jib cranes rather than the straight boom, hammerhead slewing cranes more commonly seen in many North American cities.

Brisbane South Bank construction - August 2012

Workers wear hardhats, but given the greater exposure to the sun, many have wide brim tinted visors and neck shades. Brightly coloured safety garments are seen everywhere. Fluorescent green or orange and contrasting blue polo shirts, fleece, and jackets are common on, and, off the jobsite. Delivery drivers, traffic patrol, baggage handlers — even cyclists — can be seen wearing these distinctive (from a North American perspective), high-visibility garments. It’s not that wearing hi-viz garments in jobs other than construction or traffic control is unheard of in North America, it’s just that wearing of this type of apparel outside the usual job sites is more common in Brisbane.

I’m not certain if Australians generally have a richer “safety culture” than North Americans. Overall, the workers’ compensation injury and fatality rates appear lower than most North American jurisdictions, although true “apples to apples” comparisons are, in my view, absent from the published, peer-reviewed literature.Perhaps an experience I had at the convention centre might be an indicator of something different in the way Aussies manage risk. Before several of the banquets I attended, a server came to our table and instructed us on safety procedures in the event of an emergency. That was something I’ve experienced occasionally at events in many countries. The server also explained a safety rule about always wearing shoes because of the risk posed by errant shards from occasionally broken glassware. I’ve attended a lot of conferences and this was an entirely new caution to me. It was a perfectly logical and important rule when you think about it, but (to be honest) I had never thought of broken glass as a risk in a carpeted banquet hall. And this in a brand new, spotless facility: Brisbane Convention and Exhibition Centre, on Grey Street.

I mention these examples to illustrate a point. Regardless of our national context, employers, workers, and OH&S regulators face similar workplace safety and health challenges. Each jurisdiction has developed solutions to manage risks to workers and other persons in the workplace. Not all solutions are the same. Sure, exit signs are ubiquitous, but the green and white graphic signs in Australia seemed just as clear to me as the red and black text-based exit signs we see in North America.

I’m not sure you could say any given solution is the only right way to protect workers, nor am I saying that you can simply transplant a standard from one jurisdiction to another. What I’m saying is that the diversity among developed western societies creates an opportunity for OH&S professionals to consider solutions others have implemented. Another important reason for building relationships across our jurisdictions.