As part of the RTW Matters mission to bring you more from the people who are out there working as return to work coordinators – so that we all might learn from their varying experiences and backgrounds – Business and Training Development Manager Teresa Coffey's voice enters the mix, and with it a whole lot to recommend – and recommend against – for return to work coordinators.

Teresa Coffey joined occupational rehabilitation provider, Nabenet (www.nabenet.com.au) in April 2008 as their Business and Training Development Manager, heading up the business arm of the business. She trains groups ranging from internal staff to predominantly employers, as well as agents and unions. She has also worked at WorkSafe in various positions, ranging from WorkCover Assist (conciliation) to the RTW branch, and more recently, as her WorkSafe secondment, managing a RTW Fund initiative on behalf of Murray Goulburn, a large manufacturing organisation.

“Using a training course that is endorsed by the regulator of the return to work legislation enables employers to have a starting point when it comes to RTW and RTW coordination in applying a more consistent approach across Victorian,” said Teresa.

Teresa listed some of the difficulties RTW coordinators might deal with in their roles as:

• Difficulties in communicating with treating practitioners
• Non progressive RTW; fulltime hours achieved but still on modified duties, which is non-productive for the workplace
• Lack of authority with their role as RTW Coordinator; unable to make appropriate decisions
• Inconsistent approach to RTW
• Lack of suitable duties or unable to identify duties to match capacity

“There isn't any one magical answer to resolve these RTW barriers, but there is a mixed bag of strategies that can be applied as each RTW is very different as we are dealing with human beings, and there will be varying psychosocial issues,” said Teresa, who outlined the following strategies:

Difficulties in communicating with treating practitioners:

• A good job description, one that includes the physical requirements of the job/tasks makes the treating practitioner's job a lot easier because it allows the doctor to concentrate on the specific descriptions
• Refer to an Occupational Rehabilitation Provider, (health professionals such as psychologists, occupational therapists and physiotherapists). Being an independent party, the likelihood of successful communication with the injured worker's treater about diagnosis, treatment and RTW options is greater
• Utilise your Injury Management Advisor with your authorised agent: you pay your premium, you are entitled to utilise their services. You can utilise this person to attempt communication with the treating practitioner – they are more likely to get through to the treater and better able to discuss diagnosis and potential RTW
• The practice manager is the KEY; they are the gate keepers of the treating practitioner. Establish and build a relationship with this person and you will be more likely to obtain contact and outcomes.

Non-progressive RTW (when fulltime hours are achieved but still on modified duties):

• Ensure all RTW plans are progressive, aimed towards the ultimate goal of returning to pre-injury duties
• Have a list of RTW duties. This is vital to the creation of a RTW plan. Don't frantically run around trying to identify suitable duties post an injury. Have a list or library prepared. These tasks or jobs should be real duties identified from the site which means they are productive duties. An Occupational Rehab Provider should either have created the RTW duties library (with management verification) or at least have had some involvement with the validation process, as it is essential the relevant medical approval of duties is obtained – it will ensure the process of practitioner approval is much more achievable
• Be careful not to keep offering the same duties for a prolonged period of time, if a worker does the same job for 12 months it can be deemed as their ‘normal role' . If you are having difficulties in progressing the RTW plan, get an occupational rehab provider involved; their role is to determine capacity and match it accordingly with the goal to reach pre-injury hours and duties
• On occasions RTW coordinators are reluctant to progress the RTW plan due to difficulty in matching tasks to the injury, but they are not expected to. RTW coordinators are not medical experts; that is why there is an Injury Management Advisor or you are able to use an Occupational Rehab Provider. These experts ARE able to match tasks to an injured worker's capability while they recover.

Lack of authority with their role as RTW Coordinator - unable to make appropriate decisions

• Access RTW Coordinator training. If you don't know what your role entails and the legal obligations, how can you act accordingly?
• The coordinator must also have adequate time to complete required tasks
• The role of the coordinator needs to be defined; it should have a job description and get signed off by higher management/senior management
• Network and educate middle management; they play an essential role in RTW and a coordinator will need a good relationship with these people
• If you are the coordinator, advertise your role. Let your workforce know who you are – don't wait until an injury occurs to be recognised as the RTW coordinator
• Attend weekly OHS Committee meetings. RTW coordinators need to know what's going on in their workplace. Prevention is as important as rehabilitation – know what the potential risks are, near misses and what risk controls are in place in your business.

Inconsistent approach to RTW

• By law an occupational rehab program or risk management program must be developed if an employer's remuneration exceeds $1 million or a worker becomes incapacitated for 2 or more days. These programs should be specific, clear and outline the employer's responsibility in the RTW process.
• If there is more than one workplace, do a bit of research to understand what currently takes place in the space of RTW. Identify any inconsistencies and align them so that one process is used throughout the organisation.
• Ensure you have management buy in, you cannot make changes unless you have their support. Some people are reluctant to change
• Whatever process you do implement, ensure it works effectively first. Have dry runs or consultation with key stakeholders.

Lack of suitable duties or unable to identify duties to match capacity (Case study)

• Know your workplace and your resources; RTW training will explore what this involves
• The development of a library of RTW duties will better assist you and your managers with identifying duties to match your injured worker's capacity
• Sometimes you simply won't be able to match duties to an injured worker's medical capacity – you are not expected to, you aren't a medical expert, that is why WorkCover pays for an Occupational Rehab Provider (like Nabenet) to come in and work with you in identifying what is suitable for the injured worker to do whilst recovering from their injury.

In regards to RTW training, Teresa believes “The messages of most impact are those of being proactive, providing early intervention and focusing on communicating with all stakeholders when planning return to work,”. She also included “establishing and maintaining a contact routine, working closely with employees, looking after them and being empathetic through their recovery regardless of liability status. The treating practitioner also plays a vital role, and training will equip RTW Coordinator's to achieve a win/win outcome.”

“Early and regular contact with workers cannot be emphasised enough. All statistics around RTW show after 12 weeks off work, an injured worker has only a 50% chance of returning to work, and by the 6 month mark this percentage is closer to 10%. So you see particularly for an employer, it's vital to have the right people trained and educated to achieve early and successful RTW outcomes.

There is a particular focus on training managers as if a RTW is to be successful, the driving forces must be empathy and communication with workers. Therefore managers who can effectively communicate with employees will find that their RTW rate increase, their premiums go down, and their workplace becomes more productive.

Nabanet trains return to work coordinators, HR, frontline managers and PHS representatives. If you would like more information please contact Teresa Coffey, Business & Training Development Manager on: 9329 3898 or teresacoffey@nabenet.com.au


CASE STUDY
Cobram in northern Victoria is the home of Murray Goulburn Co-operative Co. Ltd, the nation's largest cheese manufacturer. Having started here in 1951, it has expanded to seven other locations in Victoria, and even one across the Tasman. In Cobram, Murray Goulburn has around 500 staff members, making it by far the town's largest employer. One of these staff is Bev Campbell-McClair. More than 20 years ago she came for an afternoon job interview. She started work at 8.00pm that very same day.

It was two days before Christmas. Bev worked on the processing floor. It's a lively environment, full of large machines and pallets loaded with tonnes of cheese ready to be shredded and sliced. On the 22nd of January 24, Bev pulled an empty pallet off a pallet lifter (a job that is now done with a hand fork-lift). Her foot slipped forward just at the wrong moment, and the weight of the pallet broke her ankle.

It was only eight days later that Bev was back at work. Her foot was in plaster and she was in a wheelchair. "I would rather be doing things than sitting at home feeling sorry for myself," she says. Nabenet recommends employers have an alternative duties register (RTW Task Library) to simplify the process of finding injured workers new tasks.

Murray Goulburn maintains such a library in order to bring its people back to work as soon as possible. Being in a wheelchair obviously limited what Bev could do, but she was determined to be active – and Murray Goulburn supported her. After some consultation she moved off the cheese shredder and started labelling waxed blocks – something that can be done sitting down.

Unfortunately the healing process did not go smoothly. Some weeks later the plaster came off but she didn't last an hour at work – the pain was just too intense. Bev had been experiencing a burning sensation in her foot, but had been met with some scepticism from doctors when she described this. This even led her to question if the pain was real, or just imagined. GIO approved more specialised treatment. When Bev visited neurosurgeon Dr Paul D'Urso, she asked him, “Is it just in my head or what?" His reply was simple. “It's not in your head, it's in your foot.” Dr D'Urso identified a crushed nerve - the cause of the high-level pain that she had been experiencing.

The treatment was to bury a simulator in her hip with two wires running close to her spine. A magnet is used to turn it on and off, and the battery has to be replaced every four years - not a simple process. The simulator did not eliminate the pain, but brought it from a level nine or ten, down to a bearable level three. Bev loved her old job and being part of the team, but it was not going to be possible for her to return to her pre-injury duties on the processing floor. Apart from the pain, she could not lift anything heavier than five kilograms. The best option was to retrain. Murray Goulburn offered her a place working in the office.

“I'd never used a computer,” says Bev. “I didn't know how to turn one on.” It was a scary prospect for someone who was more at home feeding 20kg blocks of cheese into shredders than CDs into disk drives. But Bev persevered, and when a vacancy came up in dispatch she applied and got the job.

Bev's return-to-work was reasonably complex and lengthy, and required a significant amount of medical intervention. Everyone worked hard to support the process, quickly approving the various stages of treatment, ensuring all bills were paid promptly, and staying in touch with Bev and Murray Goulburn.

“Everything went smoothly,” says Bev.

Apart from the week following the initial accident and some time off for medical treatment, Bev has continued to work through this entire process. This could not have happened without the support of her employer. They found appropriate tasks, and even had a taxi bring her to work when she couldn't drive. “If there was no taxi available, my supervisor would pick me up," says Bev. “I have really been looked after and I appreciate that.”

Murray Goulburn has a number of initiatives to support injured workers return to work. Acting in conjunction with GIO, the Work Safe Return to Work Fund and Nabenet, they created a toolkit for managers and supervisors, for injured workers, and for doctors and other health advisors.

They also created a job task library. The library divides each job into individual tasks. It has been put on their website so that doctors can access it, allowing the doctors to easily identify which duties are suitable for an injured worker or a new starter.

For example, if a job is in a wet area it would not be appropriate for someone with an open wound. The Cobram factory has piloted the process, and it will soon be rolled out to other Murray Goulburn sites around Victoria.

Responding to the recommendations of local medical practitioners, Murray Goulburn now ensures that a company representative accompanies injured staff not only on their initial visit to the doctor, but also on subsequent visits. By that time doctors know more about the injury, meaning they are more able to advise what duties will be suitable when the employee returns.

This policy avoids misunderstandings that can lead to workers being placed at risk of exacerbating their injury. It is part of an effort for more communication between the various parties.

While it is often the physical impact of an injury that gets the most attention, it is arguably the mental and emotional components of the recovery process that are more important.

“I knew if I sat at home it would cause problems for me, mentally. I was in a lot of pain, the tablets were not working and keeping busy was my way of dealing with it. Some mornings I don't feel like going to work, but once I get going I feel fine,” said Bev.

The statistics tell us that injuries that are covered by workers compensation claims cost significantly more and take far longer to be resolved than when the same injury is experienced by a private individual. Is the difference one of approach? The positive attitude that Bev has demonstrated in her unswerving determination to get back on the job is to be admired.