by Virginia “Ginnie” Halling, PT
When a worker sustains an injury on the job, a cascade of events begins that becomes increasingly challenging to manage as time goes on. As is well known, the workers’ compensation system is not an easy system to navigate. Rules and laws, as well as the interpretation of those rules and laws, can make even seemingly straightforward situations complex. Therefore, managing workplace injuries truly from the first minute is critical to keeping a worker gainfully and productively engaged, or even employed. Proper workplace injury management is likewise crucial in managing cost, as well as days away from work or restricted days.
For many employers across the United States, a shortage of qualified workers is reaching crisis level. Employers need their workers to be at work and as productive as possible. Employers depend on the healthcare system to get their employees back to work. Employees depend on the same healthcare system to get them “better” and not place them in harm’s way. Physicians are called upon to release their patients back to work as soon as possible, but the Hippocratic Oath underlies their professional existence. Therefore, they must also “do no harm” and protect the patients they serve.
The workers’ compensation system requires all of the parties mentioned above to work diligently to restore the worker to his/her pre-injury status and job. In spite of this directive, and in far too many instances, all of these parties are operating with an absence of adequate information about the functional/physical nature of the job to which the worker is to return. Even when the information is available, it is often not utilized in a timely manner.
Functional Ability: A Crucial Puzzle Piece
A major challenge is to secure adequate functional/physical information about the job and utilize this information early in the management of an injured worker. The worker’s functional abilities can be measured in frequent/timely intervals to keep return to work planning and goals as an integral part of managing the worker throughout medical intervention and recovery. This functional/physical information cannot be secured without the engagement of the employer. Employers can benefit from function-based job descriptions in a number of areas that assist with the successful management of their employees. Managing workplace injury is one.
The function-based job description can help all parties understand the job’s physical nature and communicate more effectively. It can open the door to effective, well-understood testing of workers’ functional abilities at any given point and communicating those abilities effectively. The planning process—especially, engaging the worker and supervisor in return to work planning—is particularly aided.
Historically, healthcare providers have not had this information and are used to having to estimate their patients’ work abilities. The healthcare provider turns to the injured worker for information in the absence of any other available information. If there is no other choice, the subjective report of the patient is all they have to go on. Work restrictions are a result of this approach. If the patient is reluctant, the cautious physician is left with little choice but to wait until convinced that recovery is complete and assume this means the worker is able to return to work full duty. This, for many reasons and with numerous combinations of factors at play, has proven to be a prolonged, expensive method.
As the employer must do their part, healthcare professionals also must do theirs. When called upon to release workers back to work (physicians), rehabilitate a worker for return to work (therapists), or recommend when return to work is safe (all), the healthcare professional must consider putting in place procedures that seek out this objective job information. Whether it is to insist that the insurer or case manager procure it, or provide the means to procure it (ie, offer to send a staff member out to perform the job analysis), healthcare providers should insist on receiving objective job information with adequate detail before answering questions about return to work. The healthcare professional is otherwise forced to provide an educated guess that he or she must defend. It is no wonder that some healthcare workers prefer to avoid the workers’ compensation system.
Comparing Subjective and Objective Models
So what does it look like when objective job information is engaged early in the process? Following is an example of a work injury case approached first from the subjective model, and secondly the objective model. This case presentation is intended to spark thinking, conversation, and perhaps debate.