Most of us are pretty familiar with occupational risk; we know that slippery floors, heavy lifting, loud noises, tall ladders and wobbly scaffolding can lead to injury. While we might not always succeed at controlling occupational risks, we are more or less comfortable with them as there is an established hierarchy to deal with them. 

Non-occupational risks, however, aren’t so familiar. These risks are “biopsychosocial” and they form an essential part of understanding the influences on a successful return to work. Yet when it comes to understanding them – or even being aware of their existence – many of us are in the dark.

Professor Niki Ellis, OHS expert, host of ABC TV’s 2008 StressBuster program, deputy CEO of the Australian Institute of Health Workforce and acting CEO of the Safety, Rehabilitation and Compensation Commission, would like to see this return to work “black hole” of knowledge illuminated.

At the 2009 Comcare Conference Professor Ellis deconstructed OHS and return to work processes by focusing on the biopsychosocial needs of workers. In doing so she revealed a problem: the established model does not meet the current needs of workers.

How many of us are aware that fear of pain, feelings about work or family, relationships with co-workers, sense of purpose in work and in life will all influence the way workers approach rehabilitation and return to work?

We should be. These factors influence motivation to get better and back to normal life routines, and impact upon sense of self-worth and confidence.

Professor Ellis is a strong supporter of the UK initiative of “fit notes”, with the aim of replacing paper-based sick notes with an electronic “fit note”, focusing on what people can do rather than what they cannot. The fit note removes the “fear factor” from return to work, and allows the employee to feel confident in their ability to get back to job without risking further health damage.

While a sick note can take on the very black and white, “either you can work or you can’t” approach, fit notes acknowledge the grey area in between. An employee may not be able to perform their role exactly as they did before the injury, but most workplaces will have other roles available to someone while they are recovering. Fit notes encourage these roles to be found.

The “fit note” also relies on improved communications in return to work by establishing a better dialogue between employers and medical practitioners, working together to establish the capacity of the employee to undertake alternative roles in the workplace as they rehabilitate.

If employers and medical practitioners can understand that bio-psychosocial factors are something to consider, room for positivity in return to work can be fostered while the negative is addressed. Take the time to ask : how do you feel:

• about your return to work?
• about your job?
• about things at home?
• about your health?

Employees can be assisted to work through concerns about relationships with colleagues, and their levels of confidence and enthusiasm about returning to the workplace after time off for an injury.

Injury management, said Professor Ellis, needs reconceptualising. It is the positive in the return to work and injury management that needs to emphasised, both in the workplace and in the public mind.