Professor Alex Collie says that the management of work injuries is a public health problem, in other words a medical issue that affects a significant proportion of the population. With over 110,000 claims each year across Australia, some long term and very costly, that makes a lot of sense. 

The pandemic has led many of us to discover a newfound interest in the management of public health problems.  We can now recite the principles of management of controlling spread of the coronavirus: masks, social distancing, contact tracing etc. We all know that getting good infection control in place is difficult: just have a look at hotel quarantine. There are a multitude of things that can go wrong, they all need to be identified and managed. Implementation is hard. 

So too with return to work.

The key facilitators of RTW have been clear in the research for some time: early reporting and constructive responses by the employer and claims manager, proactive case management, early support for those vulnerable to prolonged work disability, engaging the workplace, good quality healthcare etc .

My catchcry over the last two years has been that we know what to do to improve outcomes for injured workers; our shared challenge is successfully implementing change.

In NSW there has been a deterioration in RTW outcomes for some time. The RTW rate in NSW is yet to rebound so it was with great interest that I met with SIRA in April 2021 to learn about how they are working to improve RTW outcomes for workers in NSW.

We don't talk about the role of the regulator often in this field: the challenges of case management, RTW and healthcare are more commonly discussed. 

In the Return to Work Matters workplace systems handbook . we've written about how workplaces can set up systems to improve and streamline return-to-work; engage senior managers, getting the team on side, early reporting and intervention, and on it goes.

At a scheme level, the same principles apply.

We can think of regulators like SIRA as the scheme leader. They set the tone. Good regulators foster and encourage good practices, innovate and engage others to improve customer outcomes, as well as ensure compliance with the law.

We don’t yet have the data to evaluate the impact of SIRA’s approach on RTW rates. However, I came away from my conversation with SIRA feeling optimistic about the work they are doing to promote early and safe RTW. Here’s why.

SIRA is across the evidence

A key strategic priority for SIRA has been its RTW strategy. Research shows that the longer a person is away from work, the less likely they are to ever return.

With this front of mind, SIRA hit the books, learning all it could about the evidence around RTW barriers and facilitators.  [link: https://www.rtwmatters.org/article/article.php?id=2192].

There were two key take-aways from the research.

Firstly, RTW rates are influenced by four important domains:

1. Personal characteristics of the injured worker, including their level of self-efficacy and their beliefs about pain
2. Workplace influences, including the level of support for injured workers, frequency and quality of contact and the availability of suitable work
3. Compensation system and insurer practices, including the speed of decision making and capacity to identify and support workers who may be more vulnerable to delays; and
4. Healthcare factors, including the level of focus on RTW and the types of treatment for people with mental health claims.

Secondly, the most successful RTW-enhancing interventions address all four of these domains, rather than tackling a single area.

SIRA reflected on how it could make a difference

One of the things that has most impressed me about SIRA’s approach is that not only did they ask: how can we get insurers to improve RTW for people injured at work? Instead, SIRA also asked: how can we as the regulator help to influence positive RTW outcomes?

SIRA wants to address RTW in its own policies and regulatory activities, while also attempting to influence stakeholders. Important questions that have been posed include:

• Do SIRA’s supervision teams use RTW as a key performance measure?
• Do SIRA’s policy teams consider RTW outcomes when designing guidance materials?

By all accounts there has been a serious attempt to engage the whole organisation: connecting various departments, increasing awareness of the importance of RTW and collaborating on strategy to improve performance. This is good practice.

Measuring up

SIRA has worked to improve the reporting and measurement of RTW in NSW. Clear and comprehensive measures provide a way to determine the effectiveness of the system in supporting workers to RTW.

I was told that SIRA uses a comprehensive suite of multi-layered measures to enable a greater depth of analysis and 360-degree view of the factors that affect RTW. These measures were developed through extensive consultation with industry.

SIRA plans to continue to develop and implement lead and lag indicators to use in conjunction with other RTW measures. The intention is also to openly and transparently report on the insurer’s RTW performance. Its Open Data Portal is available anytime for the public to check how insurers are measuring up.

SIRA identified sensible, potentially high-value interventions for stakeholders

SIRA identified opportunities to:

• Promote positive workplace culture and RTW systems by:
  • Creating tools, video case studies and an e-newsletter to share with employers;
  • Engaging directly with specific employers and industries;
  • Providing training in mentally healthy workplaces;
  • Working with safety inspectors to discuss and review RTW; and
  • Highlighting the costs of poorly managed RTW to employer’s senior managers and helping them understand the benefits and cost savings that come from improvements;
• Work with insurers and self-insurers to translate RTW evidence into insurer practices that improve RTW by:
  • Encouraging insurers to identify gaps in management;
  • Co-designing a RTW action plan for priority insurers;
  • Strengthening:
    • RTW key performance indicators as part of monitoring insurer performance
    • Including triaging of claims so that injured workers most at risk of delayed RTW receive help in a timely way
    • a tailored, person-centred approach
• Equip injured people to drive their own recovery by
  • Ensuring the appropriate information is available
  • Introducing SIRA-funded Recovery at work programs
• Support people who have become detached from the workforce due to injury

We look forward to hearing more about their work as they progress and will report on changes to the RTW rate as this information is released. Overall, it seems that SIRA’s approach fits well with Safe Work’s 10 year RTW strategy and aligns with best practices, so there is reason to be optimistic.