When RTWMatters attended a training day at the Victorian Equal Opportunity and Human Rights Commission in late February, we felt like the cat that got the cream. Surrounded by a roomful of vocal, switched-on RTW Coordinators, learning about how anti-discrimination legislation impacts RTW, and all within easy reach of the coffee and sweets; we thought life couldn't get any better. But we thought too soon!

Midway through the very informative morning (which you can get the juice of here) facilitator Chris Gill asked the workshop participants to brainstorm about what makes RTW hard work for employers, injured workers and treating practitioners. Jackpot! From that point on, our love affair with the buttery, chocolaty pastries was over--we were all ears.

Below is a summary of the group's perceptions of common RTW difficulties that result in stakeholder-stumbles. Where possible, we've linked to RTWMatters articles that offer solutions; where not--well, we RTWMatters writers have got our jobs cut out for us! Don't hesitate to drop us a line if any of this rings a bell and you want to share your frustrations / experiences / hard-won wisdom...

What makes RTW difficult for employers, workers and treating practitioners...

The employer

Employers may struggle to:

• Understand the relevant legislation, and their related obligations;
• Deal with premium issues;
• Feel motivated to develop a RTW plan;
• Foster cooperation and communication amongst stakeholders;
• Engage the direct manager of the person who is returning to work; and
• Ensure that the process is both legal and beneficial.

The sometimes vexed relationship between the employer and the treating practitioner was a recurring theme of the brainstorming session. Potential difficulties include:

• Making initial contact with the doctor;
• Dealing with doctors who lack experience of RTW, the workplace and the relevant legislation;
• Misunderstanding restrictions in the workplace;
• Struggling to obtain relevant medical information; and
• Securing the doctor's buy-in.

Our series on RTW relationship hurdles has practical suggestions on how to manage the doctor / employer relationship: access part one and part two here. We've also compiled ten tips for "Dealing with the Doc".

The employer's relationship with the injured worker was also identified as a potential source of difficulties, including problems:

• Building rapport and establishing trust;
• Finding suitable duties, particularly for staff with limited skills and slow recoveries;
• Ensuring that modified duties are not only suitable, but meaningful;
• Dealing with "difficult" employees, who might:
  • Work outside their capabilities;
  • Assert their legal entitlements, where these are seen to inconvenience or disadvantage the employer; and
  • Behave in a disruptive, confrontational or aggressive manner;
• Managing productivity; and
• Dealing with the occasional employee who do simply does not want to return to work.

You might be interested in one or two RTWMatters' articles about modified duties and this practical case study might also come in handy.

The injured or ill worker

Unsurprisingly, the RTW Coordinators in attendance identified workplace difficulties faced by returning workers, including:

• Interacting with managers who are responsible for OHS, HR and RTW;
• Taking time off work to attend medical appointments;
• Feeling dislocated from the workplace;
• Trying to re-integrate without feeling embarrassed;
• Ignorance of their rights;
• Fear of being victimised by management because of injury / workers' comp claim;
• Co-workers’ perceptions of “bludging”; and
• Being pressured to accept inappropriate duties.

Injured workers are also at risk of being tripped up by issues to do with workers' compensation systems, including:

• Failing to understanding their rights and responsibilities, 24 hours a day, seven days a week;
• Confusion about injury management and workers' comp jargon;
• Battling bureaucracy;
• Dealing with wage step downs; and
• Lacking a financial incentive to RTW, courtesy of employers who top up workers' comp payments.

Personal issues can also make RTW more difficult to manage, such as when the worker:

• Fears re-injury;
• Has poor pain management skills;
• Struggles to get past a "why me?" attitude;
• Feels guilty;
• Has a sense that their dignity has been compromised;
• Experiences financial troubles;
• Worries about job security;
• Experiences conflict at home; and
• Becomes anxious or depressed because of their ill-health.

The treating practitioner

Some of the difficulties faced by treating practitioners in the RTW process are linked to knowledge deficits, including:

• A lack of understanding of what the worker actually does;
• Problems in defining the injury;
• Not exceeding the worker’s capacity (i.e. identifying suitable duties);
• No practical knowledge of the duties and culture in the relevant workplace.

There are a couple of great SuperDoc articles that provide insight into these issues; check them out here and here.

Relationship difficulties may also cause problems for treating practitioners, including;

• Distrust;
• Dealing with the sometimes unrealistic expectations of the employer, or worker, or both;
• Consulting with the employer, particularly without remuneration;
• Dealing with changes in claim managers;
• Distinguishing between medical and psychosocial issues;
• Balancing the welfare of the worker versus the need to return to full duties as soon as possible;
• Pressure leading to unrealistic certificates of capacity;
• Having their professionalism called into question; and
• Discussing complex medical information with lay people.

A third arena in which RTW difficulties might arise for the treating practitioner is that of workers' comp process, including:

• Getting tangled in red tape;
• Struggling to have accounts paid; and
• Maintaining confidentiality and professionalism.

Thanks very much to Chris Gill of the Victorian Equal Opportunity and Human Rights Commission, who facilitated the discussion from which these notes are drawn, and to the RTW Coordinators whose frank and fair discussion of RTW difficulties made this article possible.