claims off benefits_Persistency Presentation

1
Third International Forum on Disability
Management Building a Strategy from the Ground
Up Judy Geary, Vice President, Program
Development Division, Workplace Safety and
Insurance Board of Ontario October 10, 2006
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Table of Contents

• Background
• 1997 Self-Reliance Strategy
• Results of the New Approach
• The Ground Work
• Strategy Renewal
• Arena of Work Disability
• Strategy Renewal
• Statement of Strategic Direction
• Proposed Multi-Dimensional RTW Framework
• New System Characteristics
• Towards a Robust, Comprehensive RTW System
• Building Blocks
• Two Parallel Streams of Implementation Activity
• The Road Map
• Sample Initiatives
• Lessons Learned

3
Background

• Ontario Workplace Safety and Insurance Board
  (WSIB) has a long history of supporting injured
  workers to return to work.
• Vocational rehabilitation included in legislation
  70 years ago.
• Return to work has always been a matter of keen
  interest to legislators and stakeholders.
• Dynamic, constant evolution
• legislation and policy
• service models
• 10 years ago WSIB approach to RTW was
• prescriptive
• retraining oriented
• highly resourced
• WSIB centric
• Significant stakeholder dissatisfaction.
• New RTW strategy Enhancing Employer and Worker
  Self-Reliance.

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1997 Self-Reliance Strategy

• Vocational rehabilitation removed from
  legislation in 1998.
• Employers and injured workers required to
  co-operate in RTW process.
• WSIB role primarily to monitor.
• Emphasis on early and safe RTW.
• Training programs only provided to those
  re-entering the labour market to different work
  with a new employer.
• Two key dimensions
• centered on worker, employer and their workplace
• matching functional abilities of worker to
  available work
• WSIB approach was to
• enable worker and employer to manage RTW process
  on their own
• include monitoring of RTW process in adjudicator
  job
• outsource case management of those in labour
  market re-entry program
• retention of small group of ergonomists and RTW
  mediators to intervene when requested
• promote early RTW

5
Results of the New Approach

• This new approach worked with the easier return
  to work situations.
• average duration in the first 12 weeks following
  injury dropped from 16 days to 14 days from 1998
  to 2004
• increase in stay at work (no lost time)
  relative to lost time claims
• However, it became clear through our staff and
  workers and employers that in complex RTW
  situations, WSIB assistance was required.
• increase in persistency
• worker stakeholder concern about overly
  aggressive RTW practice
• employers wanted help

6
The Ground Work

• Value for money audits by independent audit firm
• RTW, 2002
• Labour Market Re-Entry, 2004
• both recommended that WSIB develop more robust
  strategy
• Stakeholder Advisory Group 2003, 2004
• consensus on issues to be addressed to improve
  RTW
• lack of agreement on how to address issues
• Project teams established to design and implement
  improvements
• significant internal and external engagement on
  item by item basis
• RTW and LMR Program Development Branch
  established to anchor renewal.
• Quantitative and qualitative analysis of current
  state.
• Upward, downward, inward, outward education and
  awareness building.

7
Strategy Renewal

• Review of research
• Disability, RTW, occupational health and safety,
  business, change management
• Commissioned literature review Workplace-based
  Return-to-Work Interventions A Systemic Review
  of the Quantitative and Qualitative Literature,
  Institute for Work and Health, 2004.
• RTW is not as simple as matching work to workers
  functional abilities
• multi-factoral
• workplace capability varies self-reliance as
  strategy is questionable
• Began to use Arena of Work Disability (Loisel
  et al) to structure our strategy development.
• Complex problem of RTW requires a comprehensive,
  robust, systems approach.

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Arena of Work Disability
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Strategy Renewal

• In 2006, we have proposed a new direction for
  RTW in Ontario for WSIB claims.

10
Statement of Strategic Direction

• The WSIBs overarching strategic direction with
  respect to RTW is to develop and implement a new
  RTW system in Ontario one that is robustly
  multi-dimensional and multi-stakeholder in
  composition, and that is comprehensive in its
  application in workplaces across the province.
• This new systems approach will improve RTW
  outcomes for all injured workers in Ontario
  within a context of ongoing financial
  sustainability and through the design and
  development of policies, programs, and services
  that reflect a multi-dimensional/multi-stakeholder
  approach to RTW effectiveness.
• Within this overall strategic direction, there
  are three key systems outcomes that rely on a
  degree of differentiation between and among major
  categories of WSIB cases
• To reduce the number of claims that become high
  context cases (the 20), and/or are at risk of
  becoming, part of the population of persistent
  claims
• To prevent injured workers that are part of the
  80 of non-persistent, non-high context WSIB
  cases from becoming part of the high context 20
  per cent of claims.
• To achieve continuous improvement in RTW process
  and outcomes for all claims entering the system
  WSIB cases.
• For both persistent (20) and non-persistent
  (80) cases, the WSIB will achieve this strategic
  direction and key objectives by building on the
  foundation represented by the multi-dimensional
  RTW framework presented on the following page
  (derived from the research).

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Proposed Multi-Dimensional RTW Framework
Workplace System
Workplaces have integrated occupational health
and safety RTW programs Management systems
manager/employee relationships drive effective
RTW Labour and other workplace associations
recognize RTW in their strategies business
plans EAP other programs support emotional
side of RTW RTW understood to require proactive
knowledge/action, with special interventions
for high-context claims.
All occupational health and safety systems
include RTW WSIB case management drives
collaborative and pro-active RTW and is less
reliant on medical opinion to resolve RTW
barriers WSIB seen as knowledgeable partner with
all stakeholders included in WSIB practices is
the ability to identify and target high-context
claims and unique employer characteristics but
also to provide for better outcomes for non-high
context cases. Minister of Labour is a vocal RTW
champion.
Healthcare practices include occupational
approaches and interventions Health care policy
acknowledges occupational health and safety as
part of the systemic costs/strategy.
A robust systems approach for effective, safe,
sustainable RTW
Health Care System
Legislative Insurance System
Worker has financial and emotional resources,
knows WSIB key contact, partner in setting and
working toward RTW goal, and is supported by
their workplace.
All dimensions must be part of the approach to
strengthen capability for safe, sustainable
RTW, particularly for high context cases.
Personal System
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New System Characteristics

• Guided by this multi-dimensional RTW framework,
  the WSIB will redesign existing RTW policies and
  programs to create a new system that has the
  following characteristics
• Is evidence based.
• Accommodates and addresses the different
  requirements of high-context/persistent cases as
  well as those that are not high-context/persistent
  .
• Ensures RTW interventions are consistently
  pro-active, front-end and effective.
• Engages all system partners.
• Promotes and ensures collaboration between and
  among the four dimensions of the RTW framework.
• Provides for a comprehensive and integrated suite
  of RTW program tools and levers for all system
  partners.
• Ensures integration of effort with health care
  programs and services.
• Is cost effective, sustainable, and accountable.

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Towards a Robust, Comprehensive RTW System
The diagram below summarizes the relationship
between the proposed Strategic Direction, the
multi-dimensional RTW framework, and the new
System Characteristics.
Adoption and application of the multi-dimensional
RTW Framework
New RTW System Characteristics
RTW Strategic Direction
A robust RTW system
Differentiation Proactive, front-end
interventions Engage all system
partners Collaboration across the
framework Comprehensive suite of
tools Integration with health care Cost effective
and accountable
Workplace System
Reduce persistent high context cases
Health Care System
Legislative Insurance System
Leadership Influence Partnership
Prevent new persistent, high context cases from
happening
Worker Personal System
Continuous improvement for the 80 of
non-persistent, non-high context cases
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Building Blocks
Four types of new initiatives will be required to
implement the proposed Strategic Direction in
effect, the building blocks of the new system as
presented in the diagram below. As per the
proposed Strategic Direction, each new initiative
will be developed to reflect the
multi-dimensional RTW framework that is the core
of the proposed Strategic Direction. The more
detailed descriptions on the following pages
highlight that building blocks will be required
to change how individual cases are dealt with by
the WSIB, employers, health care providers, etc.
but also to achieve system-level transformation,
i.e. changing the broader provincial culture and
attitudes towards RTW.
Targeting unique sets of claims and workplace
characteristics
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Two Parallel Streams Of Implementation Activity

Stream 1
Focus on the first key outcome a systems
approach to reducing the number of existing high
context/persistent cases and early identification
and targeting of new cases.
Towards a robust, comprehensive RTW system

• Focus on the second and third key outcomes
• A systems approach to ensuring cases that are
  currently not persistent/high context (the 80)
  do not move into this category over time.
• A systems approach to continuous improvement in
  RTW outcomes for the general WSIB population.

Stream 2
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The Road Map

• Stream 1
• A single series of integrated demonstration
  projects for both RTW and Health Care strategies
• Targeting the same populations and communities
• Rigorous formal evaluation of the effectiveness
  and future financial sustainability of an
  integrated approach
• Tools and techniques developed for the
  demonstration projects will be evaluated on an
  ongoing basis for planned early adoption by other
  Service Delivery Teams across the province.

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The Road Map

• Stream 2
• Restructuring service delivery
• WSIB as proactive and visible champion
• Education, knowledge and research
• Tools and levers

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Sample Initiatives

• Series of integrated demonstration projects for
  both RTW and health care to apply best practice
  in occupational health and RTW.
• Develop holistic, integrated case management
  practice (and technology).
• Build business intelligence capability to enable
  differentiation of claim population to support
  targeted interventions.
• Executive speaking campaign.
• Promote NIDMAR Consensus Based Disability
  Management Audit to build workplace capability.
• Engage leading RTW researchers to articulate our
  knowledge needs
• CIHR Strategic Training Program
• Fund Centre of Research Expertise in Disability
  Outcomes
• Institute for Work and Health

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Lessons Learned

• Building strategy with a new paradigm can be
  difficult
• Listen
• staff and clients will tell you very quickly if a
  strategy is working
• complaints can be strategic opportunities for
  improvements
• Persevere
• strategy development and implementation is
  difficult work in our field
• Seek out experts
• internal to your organization, as well as
  externally
• look outside your immediate field
• Challenge assumptions
• there are many ways to drive strategy
• be open to trying as many as might work

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Lessons Learned (contd)

• Be willing to learn
• review the good research
• look at other companies
• Have courage the world will never stay the same
• in the world of return to work, we know the field
  will keep changing as knowledge grows, and
  working life changes
• There are no overnight successes
• we started on this path almost 10 years ago.
  Each step brought us to where we are today
• Strategy takes work, time, thought and patience!

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Questions

• Thank you.
• Judy_Geary_at_wsib.on.ca