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.

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?”

Why should we care about OH&S for Migrant Workers in China?

Migrant labour, temporary foreign workers and in-country migration of workers are becoming more common to many economies. While the “newness” of a worker to any jobsite increases the risk of injury [see Institute for Work and Health, “Newness” and the risk of occupational injury, Issue Briefings, May 2009], a worker in any of these categories faces greater risk if language, education, training, experience are at the low end of the spectrum.

I was in Chongqing China last week as a technical advisor to a project reducing risks to workers. The Canada-China Migrant Labour Occupational Health and Safety project seeks to increase health and safety among the 1.3 million migrant workers concentrated in the coal mining, construction and textile industries in the Chongqing municipality—an administrative jurisdiction serving a population of about 33 million.

Whatever your political views, the simple reality of China’s modernization coupled with the demographic, economic and environmental realities of a billion-plus people create significant challenges. Whether you are in China, Canada or California, you can’t sustain economic growth in sectors like construction without an adequate, safe and healthy labour force. Increasingly, that labour force demand cannot be met through natural population growth and traditional educational streams. For Canada, this means a growing reliance on temporary foreign workers and immigration to meet labour requirements; for places like Chongqing, it’s a matter of temporarily filling demand through migrant labour.

WorkSafeBC’s contribution of training materials, videos and expertise is making a difference. We produce materials for our multicultural labour force in British Columbia so the marginal cost of sending a Chinese translation of a safety brochure in a pdf file or a subtitled two-minute instructional video clip attached to an email is insignificant. The impact on the lives of migrant workers in China (and elsewhere in the world) can be life changing for the better.

At a symposium I attended in Chongqing, I heard first hand (through an interpreter) from migrant workers how many of the safety precautions, work procedures and protective equipment we take for granted are just being implemented in the project’s demonstration sites. More importantly, I heard these worker representatives—not just officials—speak proudly of their advancements in occupational health and safety.

In one of the most humbling moments, I was told how more than 2 million migrant and resident workers in Chongqing have heard about WorkSafeBC and benefitted directly from the materials we produced. That number is almost equivalent to the total labour force in British Columbia.

What happens in China is no longer something that simply occurs far off on the other side of the world. In a global economy, we are all linked; the health and safety of workers who are part of that world-wide supply chain ought to be a concern for all of us. In Chongqing, we drove in German cars, used Dutch translating devices, and watched American software present Canadian knowledge through Japanese projectors.

In a world where there are growing concerns about an “averaging down” of worker health and safety, WorkSafeBC is proudly playing its part in raising OH&S standards for workers in B.C. and elsewhere in our shrinking and interdependent world.

Have Occupational Injury Rates Stopped Falling?

For most of the last twenty years, we have seen time-loss injury rates decline across a broad spectrum of industries and in jurisdictions around the world. This has been welcome news on all fronts. The human loss and suffering avoided alone is one thing, and the financial costs are yet another reason for celebrating this remarkable improvement.

On the downside, the rate of decline has slowed and may have actually begun to climb. NCCI reports injury frequency has risen for the first time since 1997. In fact, the decline has been going on for even longer than that. If you discount two minor blips in 1997 and 1994, injury rates have declined for 18 of the last 20 years in the study (1991-2009).

Recent data shows 2010 and 2011 have seen increases in overall injury rates. One interesting point made by the analysis is the impact of the length in hours of the work week. Few systems actually measure hours of exposure to work (Washington State being the only North American workers’ comp system I know of), but the NCCI points out that fewer hours of exposure per week (month, quarter, twelve-month moving average) will likely mean fewer injuries if the denominator is week, month or year. As weekly hours increase, so will injuries.

Another factor relates to claim behaviour. The report suggests:

•Some insurance experts have suggested that workers, fearful of losing their jobs, may have postponed filing workers compensation claims, but now appear less hesitant to file claims as the economy has shown signs of modest improvement. While the extent to which this phenomenon occurred is unclear, it may have contributed to the observed increase in claim frequency in 2010.

•There is evidence of an influx of small lost-time claims in 2010, which may have been medical-only claims in previous years. A lack of available light duty jobs for injured workers to return to might have contributed.

Are injury rates declining elsewhere? At WorkSafeBC and other Canadian workers’ compensation systems, we have heard reports of the same sort of flattening of the injury rate. This chart shows some selected provinces’ data up to 2009 and the generally falling injury rates. Since then, we have seen a flattening out of the injury frequency and some evidence of an uptick.

Is this something to worry about? I think so. No injury is acceptable and the only acceptable injury rate is zero: that has to remain the target. I believe we are making progress toward that end. I also believe we have harvested much of the proverbial “low hanging fruit.” We have taken a bit of free ride on technology as well, (you get few trips and falls over power cords when you are using cordless devices). New designs and innovations have further reduced injury (as you will see in the Saw Stop video). We are even beginning to use technology to organize important research, and to deliver key messages to where they are needed, when they are needed (see the Joint Prevention of Workplace Violence: Creating an Innovative Web-based Tool report, and Prevention of Violence website).

Yes, we have made progress but fundamental change takes time. The next step towards a zero injury rate means fundamental changes in a societal shift in beliefs and attitudes. Until we in the workers’ compensation industry begin to believe that work-related injuries are not inevitable, we have little hope of achieving that fundamental societal change.

What happened at the IAIABC Convention – Part 2

Celebrating the centenary of workers’ compensation in the U.S. was the major theme at IAIABC Convention. The opening session was a specially commissioned play depicting the events running up to the establishment of the first workers’ compensation system in the U.S. In Wisconsin, as elsewhere, the need for greater certainty for workers and employers was high on the list of features both sides wanted.  Just as important was the idea that workers’ compensation would act as a major driver of safety changes. 

It is also important to recognize the context of the times. By 1911, modern workers’ compensation law was already part of the landscape in Germany, so it had a track record that was beneficial to understanding the value proposition of the proposed new legislation. It was also a time of great tension between labour and capital.

As depicted by the play, the new legislation was not universally praised. As with most compromises, there were those who wanted more out of the deal. That tension has always been present, and there are few signs that the future will see that tension disappear. Retiring Executive Director, Greg Krohm, of the IAIABC made this point in his opening remarks. While generally positive about workers’ compensation, Greg believes some workers still fall through the cracks. He also points to broader changes in society that are forcing workers’ compensation systems to adapt. As he put it in his opening remarks, it would be odd if workers’ compensation did not change to adapt to trends such as a declining unionized workforce, aging population, and growing medical costs. On this point, Greg quoted NCCI as saying the “Medical/Indemnity pie” that describes workers’ compensation expenditures now registers more than 60 percent on the medical side. 

Greg’s remarks highlighted a belief that recent changes in workers’ compensation law do not really change anything for the large central population of injured workers. He noted a troubling trend in some states where claims are made that lack any likely work-relatedness, yet are pursued to try and reach a settlement. This drives up costs, and creates an impetus for restrictive legislation for these marginal cases. 

While Greg could see no definite pattern of “take-aways” from labour in recent workers’ compensation reform, Professor John F. Burton had a very different view. He noted that workers’ compensation premium costs are often raised as an issue, and pointed out that in the workers’ compensation context declining premiums may or may not be a good thing. In a bid to drive down premium rates, benefits have been cut in his view. He noted that replacement rates on permanent partial disability claims in several states are well below the 50 percent level in states such as California, Oregon, Washington, and even the host state of Wisconsin (among others). He also pointed to the issue of apportionment [apportioning causation in part to work and in part to other causes] in California, and the rise in large deductible policies as being further changes that undermine the system. 

Apportionment of permanent disability on the basis of causation in California terms, accepts the principle that an injured worker has a right to be compensated for a disability that is work-related, but limits the employer’s obligation to compensate an injured worker for a disability that is not work-related.

[Under California Labor Code Section 4663, “(a) Apportionment of permanent disability shall be based on causation. (b) Any physician who prepares a report addressing the issue of permanent disability due to a claimed industrial injury shall in that report address the issue of causation of the permanent disability.”] 

Professor Burton felt strongly that the apportionment issue was a significant shift from the dictum of “taking the worker as you find him.” Greg felt the shift was less pronounced, and noted the “as the employer finds him” position was more related to Arthur Larson’s influence, which he characterized as “very liberal”, than any fundamental principle of workers’ compensation itself. 

The debate over large deductibles included one point of view that suggested firms with such large deductible policies are really self-insured for part of their loss. Some argued that this provides greater incentives to invest in safety. On the other hand, many administrators pointed out that such policies may result in unintended consequences including under-reporting of injuries [why report if there is no insurance to be paid?]. 

Others suggested greater numbers of large deductible policies make funding of oversight, appeal, inspection and prevention initiatives more difficult. These functions are typically funded through assessments on the premiums paid (large deductibles mean lower premiums paid, therefore, lower assessment income to fund other programs). 

There were many more issues discussed at this event and I will raise some of these in future posts to this blog.

What happened at the IAIABC’s Convention-Part 1?

A few weeks ago I attended the International Association of Industrial Accident Boards and Commission’s 97th annual convention in Madison, Wisconsin. Wisconsin was the first state to have a constitutional worker's compensation law and that centenary was a central theme of the convention. While other states in the U.S. have some claim to concurrent or even earlier laws, Wisconsin probably wins by virtue of the first fatality claim being paid under legislation declared valid by the state’s Supreme Court.   

As a speaker, I was honoured to receive a commemorative coin specially minted for the centennial. The antique bronze medallion bears the image of the Wisconsin capital building and the state’s motto, “Forward” on one side. On the obverse, a stylized “W” and character illustrate the compromise that was reached a century ago. The presentation case included a card stating I would also receive a printed commemorative volume of the “reflections” on the history and development of workers’ compensation in the U.S., but you can read the content of those reflections online. By the way, the placement of the apostrophe on the coin is correct. Wisconsin’s system is the “worker’s compensation” system; all others in Canada and the U.S. use the plural possessive “workers’ compensation.” (More trivia: another exception to the plural-possessive rule is the title of the legislation in British Columbia, which omits the apostrophe altogether).   [gallery]

The importance of workers’ compensation as social legislation as opposed to pure insurance, was also underscored in part by reference to the 50th anniversary celebrations held in 1961. While in the present environment it may not be possible to garner the same attention, for that anniversary the U.S. Post Office issued a stamp, and President Kennedy gave an address in recognition of the half century milestone.

What was fascinating about the various sessions exploring the development of workers’ compensation in the U.S. was the focus on its nature as a compromise, and its intent as mechanism to improve the health and safety of workers. I was impressed how often the theme of occupational health and safety was presented both in its historical sense and as the present and yet undiscovered land (after all, we have been at it for 100 years and we have yet to achieve safe workplaces free of work-related injury, illness and death). Several presenters made reference to the 1972 Report on National Commission on Workmen’s Compensation. The commission was chaired by John F. Burton, Jr. who was an honoured guest at the convention. It is interesting to note the commission’s view on prevention: 

"We recommend that insurance carriers be required to provide loss prevention services, and that the workmen's compensation agency carefully audit these services. State-operated workmen's compensation funds should provide similar accident prevention services under independent audit procedures where practicable."

A hundred years on, one has to wonder how much of a priority prevention services really are.

On a similar note, OSHA in the U.S. appears to be evaluating if state OSHA programs are living up to their requirements to offer occupational safety and health programs at the state level that are of equivalent effectiveness as those offered by the national agency. The enhanced Federal Annual Monitoring and Evaluation (FAME) reports make interesting reading for any agency that has a prevention mandate. Timeliness of reports, what’s included in databases, and how enforcement is being done are all included. In the ones I’ve read, there are also responses from the state agencies with concrete actions and commitments.   

I’ll have more from this event in a later post.

A few weeks ago I attended the International Association of Industrial Accident Boards and Commission’s 97th annual convention in Madison, Wisconsin. Wisconsin was the first state to have a constitutional worker's compensation law and that centenary was a central theme of the convention. While other states in the U.S. have some claim to concurrent or even earlier laws, Wisconsin probably wins by virtue of the first fatality claim being paid under legislation declared valid by the state’s Supreme Court.   

As a speaker, I was honoured to receive a commemorative coin specially minted for the centennial. The antique bronze medallion bears the image of the Wisconsin capital building and the state’s motto, “Forward” on one side. On the obverse, a stylized “W” and character illustrate the compromise that was reached a century ago. The presentation case included a card stating I would also receive a printed commemorative volume of the “reflections” on the history and development of workers’ compensation in the U.S., but you can read the content of those reflections online. By the way, the placement of the apostrophe on the coin is correct. Wisconsin’s system is the “worker’s compensation” system; all others in Canada and the U.S. use the plural possessive “workers’ compensation.” (More trivia: another exception to the plural-possessive rule is the title of the legislation in British Columbia, which omits the apostrophe altogether). 

The importance of workers’ compensation as social legislation as opposed to pure insurance, was also underscored in part by reference to the 50th anniversary celebrations held in 1961. While in the present environment it may not be possible to garner the same attention, for that anniversary the U.S. Post Office issued a stamp, and President Kennedy gave an address in recognition of the half century milestone.

What was fascinating about the various sessions exploring the development of workers’ compensation in the U.S. was the focus on its nature as a compromise, and its intent as mechanism to improve the health and safety of workers. I was impressed how often the theme of occupational health and safety was presented both in its historical sense and as the present and yet undiscovered land (after all, we have been at it for 100 years and we have yet to achieve safe workplaces free of work-related injury, illness and death). Several presenters made reference to the 1972 Report on National Commission on Workmen’s Compensation. The commission was chaired by John F. Burton, Jr. who was an honoured guest at the convention. It is interesting to note the commission’s view on prevention: 

"We recommend that insurance carriers be required to provide loss prevention services, and that the workmen's compensation agency carefully audit these services. State-operated workmen's compensation funds should provide similar accident prevention services under independent audit procedures where practicable."

A hundred years on, one has to wonder how much of a priority prevention services really are.

On a similar note, OSHA in the U.S. appears to be evaluating if state OSHA programs are living up to their requirements to offer occupational safety and health programs at the state level that are of equivalent effectiveness as those offered by the national agency. The enhanced Federal Annual Monitoring and Evaluation (FAME) reports make interesting reading for any agency that has a prevention mandate. Timeliness of reports, what’s included in databases, and how enforcement is being done are all included. In the ones I’ve read, there are also responses from the state agencies with concrete actions and commitments.   

I’ll have more from this event in a later post.