A strong reaction to the recent article, Victoria not victorious in return to work, has prompted us to defer our article reviewing the New South Wales RTW Monitor results and instead comment further on the Victorian situation, and in particular the state’s overarching approach to RTW.

In our assessment of the Victorian return to work results, we noted a consistent reduction in the RTW rates, with a corresponding increase in employee reports of employers and insurers making return to work harder.

At the heart of the last article was the question of whether the system administered by WorkSafe Victoria is on track to improve return to work outcomes, and whether it supports the fundamental principles of return to work management. We concluded that it is not, and it does not.

Our conclusions about WorkSafe Victoria hit a chord.

Many readers provided us with feedback, and stakeholder groups were strongly supportive of our take on the situation. Claims officers concurred that they were forced to focus on process at the expense of people. Rehab providers described how an overly regimented approach by WorkSafe compromises their ability to facilitate quality rehabilitation.  An injury manager at a claims’ agent called to say he had tears in his eyes reading the article, after spending an entire day on compliance paperwork rather than using his skills and experience to make a difference. 

The AMA was prompted to revisit a survey of doctors undertaken two years ago.  In that survey a large proportion of doctors expressed major dissatisfaction with the system and have either made the decision to stop dealing with WorkCover patients, or indicate they are likely to do so if the system does not change.

Where does this leave ill and injured workers?

We understand that our article prompted discussion at a senior WorkSafe committee, however much of the discussion was about the methodological merits of an in-house ‘Sustainability Survey’ set up to measure RTW performance, and whether WorkSafe should drop out of the annual ‘Australia NZ Monitor Report’ on which RTWMatters' critical article was based.

In our view the key question from a RTW perspective is not whether one survey is methodologically preferable to another, but whether transparency and openness is maintained and a policy focus is trained on the outcomes that matter most: in WorkSafe Victoria’s own words, the ‘return to work’ and ‘return to life’ of ill and injured workers. 

On a case-by-case basis, return to work is most successful when there is mutual trust and meaningful collaboration between employee, employer, treating practitioner and insurer. WorkSafe Victoria is comfortable promoting trust and collaboration at the micro level, but it doesn’t appear to take the same approach when it comes to systems issues at senior levels. 

The importance of trust is illustrated by an article published in the Quarterly Journal of Economics, authored by the President and Fellows of Harvard College and the Massachusetts Institute of Technology.  The article "Does social capital have an economic payoff?" explores the impact of trust on regional and country economies. The article points out that trust and cooperation are associated with stronger economic performance. So why does a soft issue like trust make such a difference? 

In higher trust environments:

• Individuals spend less time and money on protecting themselves from being ignored or exploited.
• Written agreements are less likely to be needed and they do not have to specify every possible contingency.
• Written agreements are more likely to be adhered to, with less need to monitor the agreement.
• Disputes are likely to be less frequent, with less time, energy and money spent on dealing with disputes.
• Less administrative time is spent dealing with failure to comply with agreements, or discussing whether agreements have been followed.
• Innovation is encouraged. Participants that would otherwise devote time to monitoring failure to comply with a system have more time to devote to innovation and building improvements in their product or process.
• Systems are less dependent on formal institutions to enforce agreements.
• Organisational contracts in which the overarching body rely on contractors to accomplish agreement that are difficult to monitor have better outcomes.
• Employment contracts in which managers rely on employees to accomplish tasks that are difficult to monitor have better outcomes.
• Organisations have more appropriate time horizons, and are more able to take long-term views in making investment decisions.

When trust is present organisations have stronger incentives to innovate, and achieve higher return on human capital, ie their employees. Employees are less likely to leave the organisation and / or the system.  In turn, organisations are more willing to invest in training and staff development.

Does WorkSafe Victoria display trust in its dealings with the field? 

The head of the RTW Division of WorkSafe is well respected by both staff in the division and external stakeholders.  There are many initiatives under way to try and improve return to work results, but our analysis of Victoria’s year-by-year RTW performance indicates that these initiatives are not working. The best of endeavours of WorkSafe’s RTW Division are unlikely to make a difference if the underlying principles of partnership with the field are not supported. 

One small example of the problem from our own experience: other Australian jurisdictions, of whom we have at times been critical, have seen the practical material which supports improved return to work outcomes that is published by RTWMatters.org. Despite occasional differences of opinion, collaborative relationships have developed. These jurisdictions have provided RTWMatters with articles to publish and RTWMatters has given them permission to republish selected material for their RTW coordinators, at no charge. 

Initially, WorkSafe Victoria suggested a similar collaboration, offering to inform local RTW Coordinators about RTWMatters.org.  However, talk of collaboration came to an abrupt halt when someone in WorkSafe Victoria noticed a RTWMatters article, published six months previously, which was critical of some aspects of WorkSafe’s approach. The planned collaboration was immediately scrapped. The response left us with the impression that the suppression of criticism, and the control and protection of its reputation, is of greater importance to WorkSafe Victoria than providing the return to work community with the best available support, information and networking resources.

Compensation systems are designed to help employees who have experienced a work injury. We all make mistakes, some small and some more significant. As doctors, our medical defence organisations tell us over and over that honest and open communication needs to occur when we err. 

An organisation that is not able to be open and honest when things go astray is not likely to engender that behaviour in the workplaces it seeks to serve. 

In the 1990s workers’ compensation was a political football in Victoria.  An understandable reaction to that situation was for WorkSafe to protect itself and adopt a defensive mode. However, times have changed. 

On the platform of the financial turnaround achieved at WorkSafe over the last five years, the board and senior management are in a position to consider their policies and culture, and to examine whether the current culture and approach are appropriate for the improvements in RTW outcomes they seek to achieve.  

It is a tough gig, but then so is return to work.