Marni Lifshen

Buddies in Bad Times? The Role of Co-workers After a Work-Related Injury

Introduction Co-workers can play an important role after a work-related injury. They can provide details about the circumstances of an accident, offer emotional support to the injured worker and help with job tasks upon a co-worker’s return to work (RTW). Working with an injured co-worker, however, can also strain work relationships and increase workload. The purpose of this study was to determine the role that co-workers play after a work-related injury and during the RTW process in the unionized, electrical construction sector. Methods We conducted two focus groups with injured electricians and union representatives. We also interviewed co-workers who had worked with someone who had been injured in the course of employment. We examined the role that co-workers can play after a work-related injury and some of the factors facilitating and hindering co-worker support. Results The structure of work in the electrical sector—a focus on cost-cutting and competition, job insecurity, perceptions of “different camps” among co-workers, little modified work and poor formal communication—can impede co-worker support and contribute to making injured workers’ experiences difficult. Management can play an important role in setting an example for how injured workers are regarded and treated. Conclusions Future research should explore how workers can better be supported after a work-related injury and during the RTW process.

Individual, occupational, and workplace correlates of occupational health and safety vulnerability in a sample of Canadian workers.

Objective To describe OH&S vulnerability across a diverse sample of Canadian workers. Methods A survey was administered to 1,835 workers employed more than 15 hrs/week in workplaces with at least five employees. Adjusted logistic models were fitted for three specific and one overall measure of workplace vulnerability developed based on hazard exposure and access to protective OH&S policies and procedures, awareness of employment rights and responsibilities, and workplace empowerment. Results More than one third of the sample experienced some OH&S vulnerability. The type and magnitude of vulnerability varied by labor market sub‐group. Younger workers and those in smaller workplaces experienced significantly higher odds of multiple types of vulnerability. Temporary workers reported elevated odds of overall, awareness‐ and empowerment‐related vulnerability, while respondents born outside of Canada had significantly higher odds of awareness vulnerability. Conclusion Knowing how labor market sub‐groups experience different types of vulnerability can inform better‐tailored primary prevention interventions. Am. J. Ind. Med. 59:119–128, 2016.

Another Person in the Room: Using Interpreters During Interviews With Immigrant Workers

Cross-language research poses many challenges. When researchers and participants do not speak the same language, meanings expressed by participants might not be understood in the same way by researchers, and the richness of participants’ experiences might be lost. This can lead to the misrepresentation and silencing of issues faced by these participants, especially newcomers. In this article, we critically examine our experience conducting qualitative interviews with injured immigrant workers with the help of professional interpreters. Using examples from our field notes and transcripts, we outline some of the key difficulties we faced: varying styles of interpretation, breeches of interview conventions, and miscommunications with interpreters. We discuss how these issues affected our study design, rapport with participants and, ultimately, data quality. We end with a discussion of how to improve cross-language and cross-cultural research.

What are physicians told about their role in return to work and workers’ compensation systems? An analysis of Canadian resources

Abstract Physicians can struggle in managing return to work (RTW) consultations and facilitating a patient’s return to employment after the injury. As part of an exploration into the role of physicians in RTW, we examined resources, policies and guidelines developed for physicians. We identified resources developed by workers’ compensation boards, government bodies and other organizations across Canada. Materials were categorized by resource type, content and jurisdiction. A content analysis focused on key messages and discourse about what is expected of physicians and how they are instructed to behave as part of the workers’ compensation process. Analysis was informed by key issues identified in the critical qualitative RTW literature and involved the consideration of gaps, contradictions and ’silences’ in the data. While physicians are urged to encourage RTW, few resources explain how the workers’ compensation system operates and their role within it. There is a dearth of resources that address complex conditions and difficulties physicians may encounter while treating patients with compensable injuries. These gaps may hinder physicians’ understanding of their roles and responsibilities and delay workers’ RTW after injury. There is a need for resources aimed at physicians that clearly discuss their role and how to deal with complex conditions and RTW difficulties.

Perceived Role and Expectations of Health Care Providers in Return to Work

Purpose Health care providers (HCPs) play an important role in return to work (RTW) and in the workers’ compensation system. However, HCPs may feel unsure about their responsibilities in the RTW process and experience difficulty making recommendations about RTW readiness and limitations. This study examines the ways in which HCPs and case managers (CMs) perceive HCPs role in the RTW process, and how similarities and differences between these views, in turn, inform expectations of HCPs. Methods In-depth interviews were conducted with 69 HCPs and 34 CMs from 4 provinces. Data were double coded and a thematic, inductive analysis was carried out to develop key themes. Findings The main role of HCPs was to diagnose injury and provide patients with appropriate treatment. In addition, the majority of HCPs and CMs viewed providing medical information to workers’ compensation board (WCB) and the general encouragement of RTW as important roles played by HCPs. There was less clarity, and at times disagreement, about the scope of HCPs’ role in providing medical information to WCB and encouraging RTW, such as the type of information they should provide and the timelines for RTW. Conclusion Interviews suggest that different role expectations may stem from differing perspectives of HCPs and the CMs had regarding RTW. A comprehensive discussion between WCB decision-makers and HCPs is needed, with an end goal of reaching consensus regarding roles and responsibilities in the RTW process. The findings highlight the importance of establishing clearer role expectations.

The Role of Healthcare Providers in Return to Work

International research has generated strong evidence that healthcare providers (HCPs) play a key role in the return to work (RTW) process. However, pressure on consultation time, administrative challenges and limited knowledge about a patients workplace can thwart meaningful engagement. Aim: Our study sought to understand how HCPs interact with workers compensation boards (WCBs), manage the treatment of workers compensation patients and navigate the RTW process. Method: The study involved in-depth interviews with 97 HCPs in British Columbia, Manitoba, Ontario and Newfoundland and Labrador and interviews with 34 case managers (CMs). An inductive, constant comparative analysis was employed to develop key themes. Findings : Most HCPs did not encounter significant problems with the workers compensation system or the RTW process when they treated patients who had visible, acute, physical injuries, but faced challenges when they encountered patients with multiple injuries, gradual-onset or complex illnesses, chronic pain and mental health conditions. In these circumstances, many experienced the workers compensation system as opaque and confusing. A number of systemic, process and administrative hurdles, disagreements about medical decisions and lack of role clarity impeded the meaningful engagement of HCPs in RTW. In turn, this has resulted in challenges for injured workers (IWs), as well as inefficiencies in the workers compensation system. Conclusion : This study raises questions about the appropriate role of HCPs in the RTW process. We offer suggestions about practices and policies that can clarify the role of HCPs and make workers compensation systems easier to navigate for all stakeholders.

Implementation of a disability management policy in a large healthcare employer: a quasi-experimental, mixed-methods evaluation

Objective This study describes the process and outcomes of the implementation of a strengthened disability management policy in a large Canadian healthcare employer. Key elements of the strengthened policy included an emphasis on early contact, the training of supervisors and the integration of union representatives in return-to-work (RTW) planning. Design The study applied mixed methods, combining a process evaluation within the employer and a quasi-experimental outcome evaluation between employers for a 3-year period prior to and following policy implementation in January 2012. Participants Staff in the implementation organisation (n=4000) and staff in a peer group of 29 large hospitals (n=1 19 000). Outcomes Work disability episode incidence and duration. Results Both qualitative and quantitative measures of the implementation process were predominantly positive. Over the 6-year observation period, there were 624 work disability episodes in the organisation and 8604 in the comparison group of 29 large hospitals. The annual per cent change in episode incidence in the organisation was −5.6 (95% CI −9.9 to −1.1) comparable to the annual per cent change in the comparison group: −6.2 (-7.2 to –5.3). Disability episode durations also declined in the organisation, from a mean of 19.4 days (16.5, 22.3) in the preintervention period to 10.9 days (8.7, 13.2) in the postintervention period. Reductions in disability durations were also observed in the comparison group: from a mean of 13.5 days (12.9, 14.1) in the 2009–2011 period to 10.5 days (9.9, 11.1) in the 2012–2014 period. Conclusion The incidence of work disability episodes and the durations of work disability declined strongly in this hospital sector over the 6-year observation period. The implementation of the organisation’s RTW policy was associated with larger reductions in disability durations than observed in the comparison group.

Implementing a collaborative return-to-work program: Lessons from a qualitative study in a large Canadian healthcare organization

BACKGROUND: Comprehensive workplace return-to-work policies, applied with consistency, can reduce length of time out of work and the risk of long-term disability. This paper reports on the findings from a qualitative study exploring managers’ and return-to-work-coordinators’ views on the implementation of their organization’s new return-to-work program. OBJECTIVES: To provide practical guidance to organizations in designing and implementing return-to-work programs for their employees. METHODS: Semi-structured qualitative interviews were undertaken with 20 managers and 10 return-to-work co-ordinators to describe participants’ perspectives on the progress of program implementation in the first 18 months of adoption. The study was based in a large healthcare organization in Ontario, Canada. Thematic analysis of the data was conducted. RESULTS: We identified tensions evident in the early implementation phase of the organization’s return-to-work program. These tensions were attributed to uncertainties concerning roles and responsibilities and to circumstances where objectives or principles appeared to be in conflict. CONCLUSIONS: The implementation of a comprehensive and collaborative return-to-work program is a complex challenge. The findings described in this paper may provide helpful guidance for organizations embarking on the development and implementation of a return-to-work program.