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Robert Aurbach | Published: September 12, 2017

The terms of reference for a recent Parliamentary inquiry into workplace bullying reference a Productivity Commission estimate, stating that bullying costs the Australian economy between $6 billion and $36 billion annually. The toll is staggering and begs for a response to the question, “What can be done?”

Readers of this column would be aware that I am no fan of the term “bullying”. It carries the implicit labels of victim and perpetrator, which are disempowering and binary – you either are bullied or you’re not, either the victim or not.

The instances of the legitimate use of...

Dr Mary Wyatt | Published: September 27, 2016
Does WorkSafe have a problem?
 
Today Gabrielle has written about the Victorian Ombudsman's report into management of workers compensation claims in Victoria, published September 2016.
 
The report outlines the experiences of around 65 claimants under the workers compensation scheme in Victoria, and the difficulties they faced. The report also takes into account views of scheme participants, many who came forward to express their concerns about how the scheme operates.
 
WorkSafe's response is published on page 164 of the detailed and concerning...
Dr Mary Wyatt | Published: March 18, 2016
Metrics are one of those things we love to hate. "You can't manage what you can't measure" is often quoted to justify putting a number on every activity in the attempt to increase effectiveness. 
 
But the response noting that there are "Lies, damn lies, and statistics" shows what tension we have about measuring things.
 
Perhaps it is not the fact that we are looking, but rather the perception that we don't always look with understanding that causes the negative reaction.  
 
Why is it that we often get metrics wrong?  Problematic metrics either measures an...
Dr Mary Wyatt | Published: March 18, 2016
Last time we discussed why metrics are often considered problematic by the people doing the work that the metrics are intended to measure.
 
So where does this leave us? There are three kinds of metrics that make sense: measures of purpose-driven activity, measures of effectiveness and measures of unintended consequences.
 
Measures of purpose driven activity look first at what we want to achieve. Suppose we decide we want to focus on client satisfaction, and we believe that responsiveness to enquiries is a key factor.
 
That sort of goal requires us to measure...
Robert Aurbach | Published: October 13, 2015
That resilience is learned also fits with our common experience – sometimes we “discover” new ways of coping through experience or training.
 
So how do we learn to be resilient?  If it’s behaviour, we learn it the same way we learn many other behaviours – through practice.  Think of any complex behaviour: playing a scale on an instrument, kicking a footy, forming words without having to think about how to move our mouths to make the correct sounds, “working the room” at a social function.  We learn by practice.
 
The Practice Effect is how we learn virtually all complex...
Robert Aurbach | Published: September 29, 2015
The trouble is that most of this advice, regardless of the qualifications of the speaker, seems of limited benefit in the real world.
 
Academics have done lots of studies, showing lots of correlations. If A happens then B happens too. It’s easy to take the next illogical step and say that A causes B… but of course, that’s not true. Famously, the number of priests and the number of prostitutes in Las Vegas has shown a strong correlation, although people are reluctant to say that one causes the other.
 
Resilience is correlated with higher self-esteem, better...
Dr Mary Wyatt | Published: September 18, 2015

This graph is from Professor Charlotte Leboeuf-Yde, who is a sophisticated researcher in this area.

If you are in your 20s, the chance of some degree of degenerative changes is about 10%.  If you are in your 70s the chance is about 70% or 80%.

 

When someone develops back pain, it is common to see their condition reported as an aggravation of a pre-existing underlying degenerative change.    

 

But what does this statement mean? 

 

There is some correlation between back pain and the presence of degenerative changes, but the correlation is weak or poor....

Dr Mary Wyatt | Published: August 25, 2015
Patient histories are by nature unreliable as people’s recollection skills are never perfect. We are human after all. My estimate, based on research and everyday experience, is that the history of long term health problems is only about 50% accurate.
I’m a doctor but have also been a patient - not very often, but often enough to know that my recollection is just as poor as the patients I see.  
 
I’ve been in situations where I’ve been asked about my past history and forgotten it. Only a day or two later have I realised that I should have mentioned x or y, relevant...
Dr Mary Wyatt | Published: July 28, 2015
First of all, policy makers need to get interested in this area. Taking the lead on this is a significant initiative, so I think it is up to the policy makers to map out a plan. They need to involve a number of subject matter experts, including research specialists and people with the capacity to translate research, and it would need to be collaborative.
 
Medical specialists can also make a substantial contribution. Organisations such as the Faculty of Occupational and Environmental Medicine possess the knowledge but not the funding ability. 
 
The Dutch have created a...
Dr Mary Wyatt | Published: July 13, 2015
If a person believes their work contributed they may be understandably worried that going back to that activity / job will do more harm. 
 
Basing assessments of work contribution on beliefs, including the employee’s beliefs and the employer’s beliefs, can cause all sorts of complications.  
 
Employee beliefs
 
We are a determinist people.  We look for a cause for whatever health problem we face. The mother who has a child with cerebral palsy looks for what might have occurred during the pregnancy to cause the condition. The person who gets cancer looks to...
Dr Mary Wyatt | Published: June 30, 2015

Today I want to talk about Occupational Epidemiology.

That might include studying an epidemic, such as the spread of the AIDS virus. It might involve studying the occurrence of asthma, which groups of people get asthma, and what factors might increase the risk of asthma in the various demographics.

Occupational epidemiology studies what happens to the population of people who are working. For example, do brick layers get more shoulder problems than bank managers? Which chemicals tend to induce asthma? Which body movements increase the likelihood someone will experience neck or...

Dr Mary Wyatt | Published: June 01, 2015

Doctors who conduct pre-employmentDoctors who conduct pre-employment assessments say that around 10% of people report previous back soreness. This is in conflict with the studies which tell us at least 70% of the population have had prior back soreness. 

For many, an individual’s past back pain back pain won’t interfere with their ability to do the job. They also know that if they declare their back pain, they are less likely to get the job. 

Whatever the rules say should happen, many employers believe they can avoid claims by discriminating against people with certain health...

Dr Mary Wyatt | Published: May 26, 2015

The challenge we face is that a person’s recollection of their health problems is not reliable.  

I’ll use back pain as an example.  

Studies of large groups of people tell us that back pain is common. 20% or more of the population has a long term back complaint, where they experience some level of back discomfort or soreness on most days.  More than 30% of people experience intermittent episodes of back pain. Only about 30% of the working age population have never experienced back pain.

New and better quality studies suggest that people can move from one of these groups to...

Dr Mary Wyatt | Published: May 19, 2015

The impact of work on a particular health problem can be a contentious issue, and the assessments are often not done well (IMHO).

Disputed claims cause can cause significant grief. They are more likely to be expensive, and return to work rates are worse.  This is a big issue and needs to be addressed, but is not currently being tackled at a policy level.  

Employees feel aggrieved if they believe work has contributed to their condition and their claim is denied. After they have an accepted claim for a few years, receiving advice their claim is being terminated on the basis that...

Robert Aurbach | Published: April 21, 2015

The "lassiez-faire" style of regulation is based upon trust in the natural relationships of the stakeholders and service providers.

In a "laissez-faire" system, the mutual needs of the parties and market forces in the environment are presumed to balance one another in ways that yield a smoothly functioning system with minimal intervention.

One example of a "laissez-faire" administrative scheme is Tasmania. For the most part, the scheme gets along with minimal resources and staffing by virtue of reasonable trust in the power of the stakeholders and service providers to control...

Robert Aurbach | Published: April 07, 2015

The scenario is familiar. The regulator is dictating procedures, limitations or reporting requirements that are stifling innovation and your effectiveness. Worse, your industry is being blamed for lacklustre results, in an environment where good outcomes are next to impossible to achieve.

Alternatively, the regulator is treading water in an environment that demands action if fair access and opportunity are to be achieved.

You can try to live with it, and play along with a system that seems completely uninformed about the needs and demands of your role, or you can try to...

Dr Mary Wyatt | Published: March 24, 2015

I recently saw a man in his mid-30s who’d worked in steady employment since leaving school, mainly as a sheet metal worker. He developed a back problem, a disc prolapse with sciatica, and underwent spinal surgery. He couldn’t go back to his previous type of work, but youth and many years of work ahead suggests support to get back into a different long-term line of work is a priority.

Yet there had been almost no focus on rehabilitation. A realistic approach would be 6 to 18 months of retraining, moving him into a different line of work: OH&S, a youth worker, AutoCAD work, becoming a...

Dr Mary Wyatt | Published: March 10, 2015

A United States study published on March 14 found when patients requested specific medications from the treating doctor, they were much more likely to be prescribed that medication.¹

Actors were sent to see doctors about musculoskeletal problems. Some of the actors requested medication they said they had seen advertised on TV, or medication friends had taken, while some actors were instructed to leave any medication up to the doctor. Those who requested specific meds were much more likely to get that medication.

This doesn’t come as a surprise. Pharmaceutical companies can...

Robert Aurbach | Published: March 05, 2015

Collaborative regulation, based upon mutual respect between the regulator and members of the regulated industries, is less common than the other styles. 

There are examples in Australia of collaborative processes, such as the revision of the dispute resolution system in Western Australia and improvements in customer service in Queensland.  

Conscious collaboration is a little more common in some of the North American jurisdictions. 

For instance, in the State of New Mexico the issue of access to medical information about the claimant was a political and legislative...

Robert Aurbach | Published: February 24, 2015

"The truth is that stress doesn’t come from your boss, your kids, your spouse, traffic jams, health challenges, or other circumstances. It comes from your thoughts about these circumstances."

— Andrew Bernstein
 

This quote was among several that the resilience coach, Graeme Cowan recently posted. I'm not sure who Andrew Bernstein is but it strikes me as profoundly true and potentially helpful.

Have you ever been in a car, having an animated conversation with a friend and failed to notice that the traffic was barely moving? Have you ever been in a hurry to get somewhere...

Robert Aurbach | Published: February 10, 2015

Some people "get it" better when they see it in print. Some people give more credibility to something that has been published. To date there have been few resources to encourage and empower injured people to take an active role in their own recovery. That "hole" is about to be filled.

I have been fortunate to be a "beta version" reviewer for a new publication that will likely be of value to you and the people you serve. "Living Abled" by Dr Christopher Brigham is the culmination of many years of experience and development by an occupational physician who has struggled with how to...

Robert Aurbach | Published: January 13, 2015

A recent study* confirmed what many of us expected, based upon experience at the coal face.

An injured person's expectations regarding recovery are a far better predictor than anything else for the course of their recovery.

People who expect to do well generally do so, despite other "flags" indicating a poor likelihood of return to work. People with expectations that were not as good had poorer outcomes. Much poorer outcomes.

This is not "just another study". This was a well-designed study by one of the most respected research organisations in the world, studying a...

Robert Aurbach | Published: December 09, 2014

How strange. We have a lot of knowledge about work restrictions with regard to physical injury. Back injuries generally don't like sitting. Shoulder injuries generally don't like overhead lifting. You know the drill.

But when it comes to psychological injury, the understanding of GPs and other health professionals seems to get much more limited. Rest and separation seem to be the only things that get prescribed in most cases. And, there's evidence that this is a prescription for the worsening of the condition in many cases.

Stress, depression, abusive situations and anxiety all...

Robert Aurbach | Published: November 25, 2014

There are many systems for "flagging" people at risk. The intent is to identify people who are predicted to have poor outcomes so that additional resources can be channelled to them, improving the probability of an injured worker's return to life. The intent is good, but, with a few notable exceptions, these flagging systems carry with them dangers that may undo the intended good.

Flagging systems are based on statistical observations about things happening in the injured person's life and their recovery outcomes. When the two things happen together more frequently than pure chance...

Robert Aurbach | Published: October 28, 2014

Workers' compensation is a strange kind of insurance. The employer pays for it, but only gets the indirect benefits of compliance with the law and immunity from many common law actions. It's the injured person who is supposed to get the services and benefits.

So we have to ask "Who does the insurer work for: the employer who pays the premium, or the person who has the injury and is covered by the policy? " To whom does the insurer owe its allegiance?

The people in charge of workers' compensation schemes sometimes seem to get confused about this issue.

The statutory agency's...

Robert Aurbach | Published: October 14, 2014

We see it over and over again. People, and the institutions that they run, resist change. They resist it even when the evidence for change is overwhelming and the benefits are beyond question.

Doctors keep certifying people unfit for work despite the known health benefits of work.

Workers get stuck with the labels that doctors or lawyers have given them.

Policy makers keep trying to control every aspect of the system and are perplexed when the system isn’t individually responsive.

It occurred to me to ask the question “why?” I think there are four answers:


Too...

Dr Mary Wyatt | Published: September 30, 2014

I’m Victoria based. Once a month I travel to South Australia and Western Australia to see patients. Over the last few years it has been fascinating to compare different compensation systems through the lens of the patient. There is a notable difference in how the schemes affect people.

When patients provide a history they are essentially tell their story. How the system is treating them impacts how they tell their story.

For example, patients going through a common law process commonly start their history differently. Instead of “I started getting a sore back two years ago”, the...

Robert Aurbach | Published: September 16, 2014

I saw an interesting headline a couple days ago in an insurance trade newsletter. It said “2013 Property/Casualty Results Show Net Gain on Underwriting – First Since 2007.” The portion of the insurance industry that writes workers’ compensation insurance made $63 billion in the US last year. But for the first time in six years “underwriting” was a profit item, rather than a loss.

Underwriting is the insurance name for the difference between the premiums they collect and the benefits they pay. Saying they had underwriting losses for the last six years means that the company collected...

Robert Aurbach | Published: September 02, 2014

I have had the privilege of working for over 19 years with the largest indigenous population in the US on their workers’ compensation laws.

Through a series of historical precedents, the indigenous populations of the US have sweeping powers to make many of their own laws for self-governance, and a few tribes have exercised that right with great sophistication. 

The Navajo Nation workers’ compensation scheme is approximately half as expensive as most Australian schemes, pays adequate benefits and has virtually no litigation. In that scheme, people get the best treatment that can...