Serious injuries affect us more than just physically. We can become short-tempered or unsure of ourselves, we might begin to lack a sense of purpose or feel depressed. It can be very difficult to redefine who we are as we pick ourselves up after an injury or illness.

It's important to recognise the emotional distress that patients experience, even from seemingly minor injuries. Studies have shown that in the first few days of experiencing acute pain people express very high levels of emotional distress, such that a traditional depression screening would have them scoring in the significantly clinical level. This psychological effect of injury is something that should be addressed – and addressed early – in the rehabilitation process of injured workers.

One of the undisputed factors in helping return a patient to their former happy, healthy self is early intervention. What is more open to discussion is the means by which this intervention should be carried out.

Dr William Shaw, renowned US psychologist and senior research scientist at the Liberty Mutual Interest Research Institute for Safety in Massachusetts, a leading research house in this field, was a keynote speaker at the 2008 People at Work conference in Adelaide on just this topic.

Dr Shaw emphasised the importance of partnership in clinical and workplace strategies to reduce workplace disability. He explained that many of the workplace factors that contribute to long-term workplace absence could be addressed earlier by the effective teaming up of these two resources.

Managing the person's medical condition and their return to work at the same time makes sense. However communication between the treating practitioner and the workplace is often brief and can be ineffective. Employers may find it challenging to sort out duties that match the restrictions, and doctors may not understand the workplace jobs.

An essential medium between the workplace, the worker and their treater, is the return to work (RTW) coordinator.

RTW coordinators are a third party trying to negotiate between a worker and employer. They often have an abundance of first hand experience and knowledge of the workplace and its working conditions, but are stuck with whichever employer policies are in place. Their job is made easier, and they can work more efficiently, when they can engage in good communication between supervisor, worker and treater. In this way their expertise may be put to its most beneficial use.

This expertise, as outlined by Dr Shaw, should include skills in the following:

• Workplace mediation
• Social problem-solving
• Knowledge of the business and legal aspects of injury
• An understanding of ergonomics and workplace assessment
• Knowledge of medical conditions
• Clinical interviewing.

Return to work coordination is effective when there is a demonstrated commitment to health and safety. Employers and RTW coordinators should try to eliminate or ease risk factors in their workplace – for example heavy lifting, job stress or long hours – before they can create problems. If problems still arise, a workplace that listens and helps is one that encourages a worker to recover quicker. This sort of workplace will also foster worker loyalty and greater productivity.

Twenty studies involving RTW coordinators were looked at by Dr Shaw and his research team. They determined that RTW coordination should be defined by an interpersonal not an administrative process. It's not enough to email or fax correspondence. Coordinators should get to know the person, and face-to-face contact helps that.

The role of supervisors is also an important one in RTW coordination, and should be further developed. Often supervisors don't hear about an employee's problem until it has become serious, Workers are more likely to speak with their colleagues about a health complaint and to gain advice, before they seek it from a supervisor.

Supervisors should encourage early reporting in the workplace. How can they improve early reporting?

• They should be sensitive to the fact that employees might be reluctant to share problems with them for fear of coming across as a 'bad worker'
• Supervisors can talk to their staff and encourage early reporting
• Supervisors could help employees modify their work in more informal ways, which will further support early reporting
• Supervisors can also improve their practice by seeking appropriate training.

Dr Shaw and his team trained supervisors in:

• The principles and practice of more effective and supportive communication with workers
• The design of more effective ergonomic work settings; and
• How to build a more collaborative, less adversarial relationship with injured workers.

Key messages of his training were:

• Listen to the worker and let them explain what's wrong
• Provide support and reassurance that we, the workplace, want you back and value your employment
• Maintain contact with workers when they're absent from work so they don't feel that their workplace doesn't care about them
• Take medical restrictions from the doctor and adopt them, working on them with the worker and the RTW coordinator.

Shaw documented firsthand the positive results these workplace intervention practices lead to. Getting more communication going as well as workplace evaluation and RTW planning is essential.

Workers should be central to the RTW planning process. Direct communication with supervisors is important. Medical restrictions are also important but they're a starting point only. Supervisors need to interpret them and modify them to the right kind of restrictions for their particular work environment.

Dr Shaw emphasised the point of RTW study is not to help get someone who's out of work for 14 days down to 7 days, but to learn how to decrease the percentage of people who end up long-term out of work. It's the latter scenario that more often than not could have been improved by adopting better return to work strategies.

Once they are ready to be back at work, employees need to return to a position that will facilitate their continuing improvement. Once better, they should stay better. Communication between medical practitioners, the workplace and the worker is the best way to go about forming the strategies that ensure workers' health and safety. The better the working environment, and the more valued a worker feels in it, the more likely they are to want to return there as quickly as possible.


Liberty Mutual Interest Research Institute for Safety
Institute for Work and Health – seven principles for successful return to work