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“They've got a right, they've got entitlements and we've got to look after them. They're our employees, they're our resource, they're our responsibility.” – Annette Photios

 

A workplace of over 600 employees, some 60 Victorian sites, a predominantly mobile workforce and a list of challenges to overcome longer than your arm. This is what Annette Photios took on ten years ago when she became Workers' Compensation Manager at Hanson Australia, one of the world's leading heavy building materials companies.

Yet, in a three-year period Annette's workplace went from having 13 major claims (each of $100,000 plus) to having two. “We may finish up with three, it's too early to say, it is possible we may get one more. But that works out to an average of one a year and I can almost live with that...for now,” says Annette. "The aim is to have none."

Challenges to overcome

Business demographics
Workplace culture
Getting people to listen
Relationships with doctors

Three of the biggest challenges Annette faced when she took on the task of coordinating rehabilitation as well as managing claims were that of the business demographics, the blokey workplace culture and trying to get people to listen.

Business demographics

“We've got nearly 60 sites around Victoria,” said Annette. “A lot of them are small sites: one manager often looking after more than one site, one batcher and a few drivers. Our predominant sites are concrete plants and then we have quarries. So with all those scattered sites and a mobile workforce, RTW coordinating was going to be more of a challenge that if we were a factory and we had production lines and permanent people all under one roof.” Annette recognised that text book return to work coordination wasn't going to work in this situation, so she thought beyond that to develop and apply a unique system to suit her workplace.

“It was not going to work appointing drivers as RTW coordinators because they'd never be there, and batchers are usually too busy, so we appointed the managers. What we've done is make all our plant managers nominated RTW coordinators, which is really good from the point of view that we have commitment and ownership, and they take on the responsibility – though that took a while.”

There were other misunderstandings attached to the demographic of the workplace that Annette had to address with employees. In the concrete industry, with scattered sites and mobile employees, there was, said Annette, “a very strong perception that we had no light duties within the company, that there's nothing you can give a driver to do when he can't drive. And that includes quarry workers because they're still driving heavy machinery. I discovered that where there was rehabilitation happening they were often "Mickey Mouse make-up jobs – stick your head down and read the paper and count the paperclips. It was not very good, so that was an issue.”

Workplace culture

“It's a building industry,” said Annette. “It's a blokey industry. It's predominantly male. Your empathy and caring culture is not quite as strong.”

“We found initially that somebody's lost time injury was treated with a bit of anger and aggression sometimes, because it stuffed up everybody's ‘perfect performance', it affected their bonuses. The whole worksite team would be affected by a lost time injury, and although I believe that it's good to have benchmarks, it can work against you if you're not very careful, people start to hide injuries or become angry & resentful when they occur, because they suddenly start to lose something dear to them, either a bonus or good points records or whatever.”

When there was an injury, three kinds of managers emerged, said Annette. “Those who were cross, thinking people are bludging; those who were frustrated, because they didn't know what to do about it; and you've got those who'd go into what they thought was ‘caring mode' but it was actually over spoon-feeding and it wasn't doing anything to help the person back to work. It was ‘Come on, we'll fill out the claims form for you' and it was really taking away all responsibility from the employee, which I don't think is a good thing,” said Annette.

“It's got to be a combined effort.”

Getting people to listen

How do you get people to believe and understand that the rehabilitation of workers is actually in everyone's best interest? What makes people sit up and listen?

“I think taking the hard line works,” said Annette, who would confront management with figures demonstrating just how much the company was losing to claims from sick and injured workers. Being self-insured in Victoria is an advantage here because the costs are easier to identify and come directly off the bottom line.

“When you can show that people who should have been rehabilitated back are not and the result is a growing number of long-term claims with increasing costs, and it's all coming directly out of our provision, out of our funds - present a bag of those and suddenly everybody sits up and takes interest.”

"One of the challenges is driving the point home that today's significant claims will affect the business financially for several years into the future." 

Relationships with doctors

“Nearly all our “failures” have been where people have gone to their own doctor, which I certainly accept is their right and entitlement, but we find that it's so difficult to communicate.”

“It's nearly impossible to communicate with local doctors. And one of the other things we've found is that when they've referred an employee to a surgeon there were very quick decisions. Our drivers can have a culture of ‘quick-fix' and surgeons I believe are not very good at communicating the reality, for example saying ‘It's a simple, straightforward operation, you'll be right and dandy in a couple of weeks,' – but they don't tell them about all the physio and post-operative pain and the damn hard work.”

“We've had successes and we've had failures and even the successes have been very, very cross with what little they'd been told by their specialist surgeons about recovery, what they can do and what it all entails.”
 
“I believe it's a huge area that needs improving.”

Turning things around

Looking after people
Communication
A multi-disciplinary approach

Annette was helping her workplace to understand that looking after employees was looking after people, a resource integral to maintaining the financial position of the business. Slowly, the workplace culture was shifted.

Looking after people

“There was a change within the business when the plant managers were made more responsible for the drivers, because we'd had a slightly different structure, so that helped, but basically we got their attention through costs, and showing that not only did we need to comply to legislation, but we needed to get our costs down and do the right thing by our people.”

“Then I got senior management commitment and a senior logistics manager to come on board which was incredibly helpful, because the majority of our injury claims were coming from one employee group, our concrete truck drivers, because that's the majority of our people. And we had had a couple of really bad years. 2003, ‘04 and ‘05 were horrendous, and then we started to turn things around.”

Communication

“We now had a senior manager on the team and what we started doing was to bring in the plant manager and the injured worker and we'd sit down and do a RTW plan, discuss what was happening and talk about everybody's responsibilities. We were coaching the manager and we were coaching the employee and we were putting out a strong message that we are serious about rehab and we're serious about safety and this is how we're going to assist employees back to work.”

“I think we started getting employees' trust, and we started getting commitment from the site managers. There was a resistance to start with, but by bringing them together with us to discuss all the issues openly, we were making it very clear that this is the process that we're going to follow. So we overcame a few things with that.”

A multi-disciplinary approach

“We also started setting up a multidisciplinary team, because I don't believe that anybody can do this on their own.”

“RTW coordinators can't do it on their own, none of us can.”

“So we set up one preferred medical clinic and we started having meetings to discuss all the difficult claims. We'd have them at least quarterly or more often if needed, and we'd go through the portfolio. We'd have doctors, RTM coordinators (external RTW coordinators at this stage because when claims get really difficult I always bring in external support and assistance), our people and sometimes we even had our lawyers.”

“We were having multidisciplinary meetings tailored to the particular problems that were developing and going on at the time. And basically it was trying to get the communication going and we were also trying to analyse what makes a lost time claim go bad, versus a similar injury that doesn't go bad if it's not work-related. You know, that age-old question. We came up with ‘attitude' as a big factor, and then it was the communication – or the lack of.”

Creating solutions

Communicating with doctors
Preferred medical providers
Case study 1
Case study 2

Communicating with doctors

“We've tried to overcome the problem of communicating with doctors by making a DVD, and we're making more, showing the duties of a truck driver. We've kept it short and it has captions as well as a voice over – we understand that doctors have a very short time-frame. We've sent the DVD to doctors, to independent medical examiners; it's gone to conciliation.”

“We found that there were huge misunderstandings.”

“There is an assumption that because our guys drive a big truck, it's a big job. A big heavy truck – a big heavy job. There were assumptions that they shovelled the concrete in at one end and shovelled it out at the other end and then laid the stuff. They don't.”

“It's not a very physical job at all. We also found that many doctors thought the drivers did long-distance driving, which actually cracked us up, but then we know that concrete sets! Lord knows what you'd get at the other end, something very solid in that barrel. But, that's understandable, because I didn't know what concrete truck drivers did before I came here. And although the job was more physical in the past, a lot has been automated now. The drivers put the shoots on and off for some deliveries which used to be a heavy part of the job but chutes have gone from steel to aluminium and plastic and they're much lighter; it's not a very physically demanding job.”

“The GPs really are a major issue. The current Hanks review of the workers' compensation legislation is recommended that doctors be given more of an incentive to become involved in RTW, indeed even the injury management process, and look, I wish them the best of luck. It's a challenge, because doctors are so busy, and they just can't or don't want to take the time; it's hard to even get reports out of them.”

“They're also not good at writing out certificates. Especially surgeons. If you get one, it's often not accurate. Half the time they don't even provide one, and then when you're chasing them up, they're just not on the same planet. They don't understand that this is disadvantaging their patient, because we can't pay them if we don't have a certificate. And that's one thing that will make things go down the gurgler very quickly. If someone isn't getting paid, they're not going to be happy with the company, they're not going to be happy with anything. We've put some things in place now and we make sure people get paid no matter what, because we don't want people to be unhappy and feel as if they're getting mucked around.”

“They've got a right, they've got entitlements and we've got to look after them. They're our employees, they're our resource, they're our responsibility.”

Preferred medical providers

“So we're getting better communication and medical management now with a network of preferred provider clinics and we're hoping we're going to get better results from GPs in the future, but to be quite honest most of our employees now – and I mean most, about 90% – are wanting to go to our preferred providers, or are happy to.”

“We do fitness-for-duty medicals, which was once a year and is now every second year, so they've been there [to see the medical provider] to have their fitness-for-duty medical and they're comfortable; they know the doctors and the clinics… The reason that we use them is that they're close to our sites, they understand out business (most of the clinic doctors have visited the sites), we'll get an appointment quicker, and they have occupational physicians – because it is a specialty now, I fully believe it's a specialty … generally the whole thing is so much better, and our workers are now saying, ‘Can I see the doctor down the road?'.

Case study 1

An employee of Hanson provided a certificate from his GP saying the he was undergoing tests and he was put off work for varying symptoms, all of which were a little bit vague, but related to fumes in his truck cabin. He and his manager were brought in to speak with Annette, and it was obvious he was extremely nervous and worried about his health. Doctors had sent him off for a lot of tests and he was very anxious and worried.

This is one of the really nice examples of team work. “The senior managers of the transport depot swung into action,” said Annette, and began to gather maintenance records for the particular truck, tested the truck under numerous conditions, and took measurements “to see if we could identify if there was anything in the cabin – which we could not”. “In the meantime we managed to get a RTW certificate for modified duties outside of the truck, not driving at all, but he was in such a nervous state this poor man that even the banging and hammering noises from the workshop, which is on the same site was making him jump three feet in the air, so he went off again.”

“We kept communicating with him, his managers kept communicating with him, we told him every inch of the way what we were doing, we pended the claim, we had an independent medical examination done. We told the employee what we were doing and why, and we kept reassuring him that everything was going to be fine. By this stage we were starting to get quite suspicious that his doctor was barking up the wrong tree and in fact worrying this man unnecessarily. We kept trying to contact the treating doctor and we had absolutely no success whatsoever.”

“The long and the short of it is we were able to reassure him that there was nothing in the way of noxious fumes or gasses in the truck. We did eventually get him back to work in another truck. We wrote to the doctor and we sent the doctor the independent medical report and we also sent the test results. Then the doctor went off on a different track and it did turn out that the employee had some health problems that were totally unrelated to work. We actually rejected the claim, but he's still with us. He came back to work with no problems – he's still working and he's happy here. I think that was just terrific team work because usually when you start pending and rejecting claims things can go a bit pear-shaped.”

“We cared, we were doing all the appropriate testing and on-site assessments, we were telling the employee every inch of the way what we found. We were transparent, lots of communication, and – without bagging his doctors – saying ‘maybe go back and have another talk to your doctor about what other things this might be, because we really don't think it's us; and you're really worried and upset and we don't want you to be unnecessarily upset about all of this, because we don't believe this is the problem'. So that was, I believe, a huge success, because it had the potential to go down the gurgler badly.”

Case study 2

One young employee who did not have a very significant injury, “but probably gave us three months of sheer unadulterated hell”, consistently misbehaved at the workplace, then got injured, and the misbehaviour carried over to his rehabilitation which he wouldn't take seriously or carry out properly. “He took no responsibility and made no effort,” both in work and rehab, and was consequently sacked.”

“It went to court and we were successful regarding the sacking and our decision to terminate his entitlements. It sent a very strong message that we are serious about rehabilitation – but there was an expected behaviour and just because you've got an injury and are on rehab, it is not a reason for us to put up with behaviour we wouldn't put up with normally. We're fair, we're reasonable, we want to help you, but we expect you to help us look after you – we're not going to put up with unacceptable behaviour.”

“It sent a strong message that this is a serious thing and you have to take a role in your own rehabilitation. It was a big example, because if you don't take a tough line sometimes it makes a mockery out of rehabilitation.”

Ingredients for success

Advice
Maintaining momentum
A summary of tips

Advice for others in RTW

“Communication and team work comes right up the top.”

“I think sometimes it's very easy to say, ‘Oh, well that's the RTW coordinators job', and just lob it onto one person. I think that's impossible; you've got to have a team approach and I think that this sometimes needs to involve external professionals.” This might be external help or preferred medical providers – together with a workplace culture change so that employees are happy to get medical attention from the preferred providers, who understand your workplace.

“Getting the work culture to the stage where there is trust, where the employees believe that the company is serious about safety, that it wants to do the right thing by them, and that rehab is just part of the company's accepted practice. It's just a general process."

“If you are injured we will help you get back to work; not let you sit at home.”

“Also, be proactive. We noticed that blokes don't like going to doctors. And we were finding that some of our employees were carrying injuries for a long time and waiting till it got really bad before they would do anything about it. So we've started an informal program where our managers are more responsive. Instead of someone pulling in to the plant at the end of the day and saying 'Oh my back's a bit sore today – but oh, naa, she'll be right', we've got our managers saying ‘No, no, let's get that reported now in case something happens in the future' and ‘How about I make you an appointment and we get you to see a preferred provider'. This way, instead of injuries being reported at the stage where they need surgery, earlier medical attention can prevent things from ever getting that far.”

“And the guys are quite happy now with this – they did mumble a bit; they said ‘Oh, I'll just see how I feel tomorrow', but you see, that's when we can lose them. Because they stiffen up over night, wake up the next morning and they can't move. Then they're off to their own doctor. And we've lost it. No communication, no team work, no coordinated approach and goals.”

“So being proactive is for both those reasons. To try to maintain control so we can manage the injury effectively, but also to try to deal with the problem before it becomes chronic. Like frozen shoulders and stuffed necks – we want to get them treated early, so a bit of physio now and a bit of good medical management stops it from being a long-term claim with an injury that's never going to get better.”

Maintaining momentum; 

“We're finding that the managers just do it now, they just get on with it. They'll ring up and tell us ‘Fred's had an injury and I took him to the doctor this morning and the doctor said yep, he can do dah dah dah, so I'll be sending the RTW plan in tomorrow' – and we go ‘Lovely! Give us a ring if you've got any problems.' We haven't had anyone come in here for a full-blown meeting in about a year.”

There are 60 sites within Annette's workplace, and over 50 RTW coordinators. The Operations Managers, Annette and her claims officer, Melissa, act as a resource for all. She trains the RTW coordinators annually. Trainee managers and some Batchers are also trained to provide assistance to managers who look after more than one site. “We've got a lot of them. I believe that's the only way to manage it. It's their employees, it's their resources they're losing if that person goes off – there's more commitment… I believe this works. It certainly works for our particular demographics.”

“I think there's an advantage in managers doing the job, because they have more commitment once they realise what the results are if they don't do it. They've generally got a higher skill level too. Basically they're going to have more ownership and more commitment, and take on the responsibility more if you can demonstrate what will happen if they don't, both financially and in loss of people skills. Getting that commitment at management level and getting them to agree that ‘This can work if we can work together as a team'. is vital.”

“It's not that hard. It takes time. Another important thing you've got to have is a good prevention program. You've got to do prevention. You've got to have effective OH&S management and you've got to work together. If we see a trend, we'll pass it on to our risk manager and vice versa. We're working together towards the same goal.”

“I see it as such a waste of a life when someone doesn't get back to work after an injury and the system turns them into a chronic invalid. No amount of money gives you back your health, and you see so many marriages break up as a result of these long-term claims. It's just a waste of people's lives.”

A summary of tips

• Early intervention. “We rehab from day one. Absolutely everyone. We go in to full rehab from day one of an injury, or even before the injury occurs in some instances.” 
   
• Consider the option of providing psychological counselling for an employee before surgery to allay anxiety related to the surgery, but also to work through the information that doctors and surgeons might not always pass on (for example what to expect in post-operation rehab) 
   
• Have other another employee who's had the same operation or been through the same experience with a positive outcome talking to the employee who is just about to go through the same thing, to share frustrations, discuss each others' progress and exchange advice. 
   
• Make sure you know the job the injured worker does – exactly. When Annette realised that no one at her work knew exactly what every task was for one particular, specialised employee who was injured on the job, she organised an ergonomist to visit and conduct a risk assessment of “every single thing he did”. When the worker returned part of his rehabilitation involved working with the ergonomist and together organising equipment and aids and appliances to improve the working situation. When he first returned he wasn't actually working, but organising his own rehabilitation. The ergonomic report was very useful for Annette and the workplace, “because now we have a much better knowledge of what happens out there and we've made changes for the better; it's good for the future.” 
   
• Teach employees that they have an important role to play in their own rehabilitation.
   
• Convince managers that their role in rehabilitation is equally important and that positive results are beneficial to the business.