Early interventions for musculoskeletal disorders

Early Interventions for Musculoskeletal Disorders

Michael Donovan

Slide 1

Facilitator:

Hello and welcome to today's webinar on Early Interventions for Musculoskeletal Disorders. My name is Rachel Hawkins and I'll be your facilitator for today. Next to me is Mr Michael Donovan, Occupational Health Physiotherapist and our expert presenter.

Slide 2

Before I hand over to Michael, we will give you some tips on making the most of your webinar experience. Michael is very happy to take your questions throughout his presentation and you can ask any questions that you might have at any time using the box on the right hand side of your screen. Also to encourage you to interact throughout the presentation we have created some poll questions. Again, a simple prompt pops up on the right side of your screen and you will have a brief moment to be able to respond. It takes us a little bit of time to collate those so a minute or two and then Michael will be able to discuss those results with you or read them throughout his presentation.

Slide 3

Slide 4

There's the webinar help and now onto introducing our expert presenter.

As a result of feedback that we've received from Rehab Return to Work coordinators and other webinar participants including employers and allied health professionals we've received requests to talk about the concepts of early intervention. So we invited Michael to be our expert presenter for today. Michael was the recipient of a research grant from the Office of Fair and Safe Work Queensland and is currently exploring the concepts of early intervention in the manufacturing or meat processing industry.

Michael brings a wealth of experience as an Occupational Physiotherapist with experience both in a clinical and workplace or environment setting. So welcome Michael.

Slide 5

Michael Donovan:

Thank you very much Rachel for that lovely introduction and thank you for the invitation to present. Okay and thank you very much for the guests for taking your time out of your busy schedule to participate today.

Today I plan to discuss the benefits of early intervention for work related musculoskeletal disorders and also provide some real world examples. Just to point out early on here that the talk today will focus more so on those physical risk factors and those physical interventions. However, I ask you to be mindful of those psychosocial risk factors and also be mindful of how early intervention can be used to address these concerns. I'm happy to take questions throughout today's webinar so just follow the prompts on the screen.

Slide 6

So today's webinar will discuss the following.

Firstly, we'll give you some background to musculoskeletal disorders and early intervention. Secondly, I'll be talking about the levels of prevention and intervention. Thirdly, I'll be discussing some of those key components of successful intervention with some examples and finally I'm happy to take some questions as well.

Slide 7

So firstly, we'll like to start with a poll question and this is a two-part poll question. Firstly, we'd like you to identify what are the most common types of physical injuries at your workplace? So there's a few options up on the screen so please indicate which is the most relevant out of those five. Secondly do you currently have an early intervention strategy in place to manage these types of injuries at your workplace? And there's two options there for you to fill in as well. So I'll just give you some time to do that and then I'll move forward shortly.

Slide 8

While some of you are still filling in that questionnaire I'll just proceed. Firstly, let's discuss what are musculoskeletal disorders.

Well whilst there's no one true definition the common themes in the literature suggest that work related musculoskeletal disorders or WMSDs which I'll mention throughout today are broadly defined as conditions that affect the muscles, tendons, joints, ligaments, neural and skeletal tissues. However most of us will know them by some common examples and you can see some of those up on the screen now. Like I said today I'll be focusing on those physical musculoskeletal conditions rather than the psychological – cuts, burns, etc.

However, it is important to acknowledge that sometimes these conditions do not present upon their own and that at times several conditions can be rolled into one with one common overlap with WMSDs being the psychological. So getting in and acting early also helps address these risks as well. For further information on psychological injuries I also ask you to refer to the wonderful presentations in March by Dr Josie Sundin as well as some good recent presentations on musculoskeletal injury by Tammy Roberts and Shane Stockill from Workplace Health and Safety Queensland.

Now we're just getting some results up from the first poll and by the look of it the most common ones are in the back. Okay and it looks like a lot of you already have some strategies in place to implement some early intervention which is really, really good to see lots of proactive approaches going on out there although there is some people that are indicating "no." So hopefully this webinar will be of some help for you today. That's great.

Slide 9

We're just going to move onto the next poll question please and this is just to give us an indication of what sort of industry you work in. So there's a few up on screen now. If you can just indicate the one industry that you primarily work in and that way it will just help us guide the talk today and also future webinars for you. We'll just give you some time to fill that in now.

Slide 10

While the rest of you are still filling in that poll I'll also continue and we'll go onto the next slide. So looking at the most recent statistics in Queensland work related musculoskeletal disorders or WMSDs account for at least 58 percent of all claims lodged and up to 61 percent of all serious claims. It should be noted that the WMSDs are generally quite evenly distributed between the men and the women and WMSDs make up the most of the costs incurred which would ultimately impact on your premium. As well some industries have higher rates than others too particularly those in manufacturing, transport, construction and healthcare to name a few and we'll see what that's like when we get the results from that poll coming in. We will in a few minutes.

Therefore, WMSDs are a big problem for workers and their families, employers, insurers and the broader society with WMSDs being the third highest chronic health condition in Australia at the moment.

Slide 11

Now thinking back to that first poll question of what was the most common injuries in your workplace and the answer was "back" let's quickly look at how these can occur. Some of the WMSDs build up over a period of time and they're a result of accumulated and repeated exposures to hazardous tasks or activities. The terms 'repetitive strain injury' and 'occupational overuse syndrome' are often used at times. However the use of these terms in the scientific literature is somewhat controversial. So I'll just note them as overuse injuries today.

Also acute injuries are commonly attributed to a single traumatic event and is usually immediately apparent. So thinking back over those back injuries that was the most common one on that first poll have a think about whether most of your back injuries occur over a long period of time or they're sudden one off events. Okay.

The data indicates that the majority of MSDs are caused by body stressing or performing hazardous manual tasks. Slips, trips and falls and being hit by objects are considered the second and third most common mechanisms of injuries for MSDs. However, with my Physio hat on it's the overuse conditions and disorders that I'm really passionate about. Because they come on slowly they can provide you with that sort of warning bell and if you can pick up on them early I find that this is where you really get a chance to act pre-emptively and address these issues early before those aches and pains can actually develop into an injury.

I see this opportunity often in my role as an on-site Occupational Health Physio at workplaces and I know earlier we talked about back injuries as being the most common so we'll give an example of a back that I see in the workplace. For example, a forklift driver could be one that I see. The worker may report to their supervisor "Gees, my back's started off okay at work but it's just getting a little bit stiff today." They can't recall a specific event but state it's been coming on today or maybe even over a few days. I see this as a great opportunity to implement some early intervention strategies. So getting in at this stage has been shown in the research to reduce the chance that these early symptoms will develop into an injury and a subsequent compensation claim and I'll talk about strategies further on in this webinar.

Slide 12

We'll also put up some poll results now and it looks to me like there's a bit of a mix from manufacturing and healthcare in today's participants. Looking at it there's some broad representation over the whole industry which is great. Thank you very much.

So before I move onto early intervention strategies I'll also briefly discuss injury prevention and where early intervention sits. Prevention can take place at several levels. The aim of prevention in the primary stage is to eliminate or reduce the cause of injury, control exposure to risk and promote factors that are protective of health.

The aim of secondary prevention is to reduce progression of a disease through early detection usually by screening at an asymptomatic stage and early intervention. And finally the aim of tertiary prevention is to minimise the impact of a disease and prevent complications through effective management and rehabilitation.

So early intervention has been proposed in the scientific literature to sit within the secondary level and at the nexus between primary and secondary prevention. However getting in early with any of these stages is vitally important because the research shows that the longer a worker is away from work the less likely they are that they will get back to work. So don't delay with your interventions.

Slide 13

So primary prevention commences even before the worker steps into the workplace and even before an injury occurs. It's based upon a hazard reduction and risk management approach and utilises the hierarchy of controls. The links on the screen will send you to information on this topic. Again I also refer you to recent webinars last month by Workplace Health and Safety Queensland. Also the Hazardous Manual Tasks Code of Practice provides you with some really good practical examples of controlling risks and being aware of these and how they fit within the hierarchy of controls is really important for early intervention. So I urge you to familiarise yourself with this hierarchy and terms such as elimination, substitution, isolation, engineering, administrative and personal protective equipment or PPE controls. The higher the level of control the more likely it will be successful and these should be examined first.

So reflecting back on that example I gave earlier about the forklift driver that had a bit of a stiff back some examples of intervention that could be done at this stage would include assessing how they're using the forklift. Is the forklift the correct type for the role? Are they using a side standing forklift and twisting in their stance position instead of using a front-facing forklift instead? Is there a forklift camera operational or is there one fitted at all? Is it functioning properly or are they having to twist to look out of that forklift to see where they're putting their load to? Look at where the load is being moved to and from and could this be simplified to reduce or eliminate those awkward postures? Or is the driver sitting or standing in the forklift and does the driver or worker have control over their work demands and is there task rotation available? All these are examples of interventions that if addressed early can reduce the risk of a WMSD developing.

I'll also mention on that slide some safety and rehabilitation culture and psychological risk factors and because that also crosses over into the secondary level I'll discuss those on the next slide.

Slide 14

So what are some of the secondary prevention strategies useful for WMSDs? Once again reducing the worker's exposure to risk factors and using those hierarchy of controls such as risk assessment and ergonomic assessments, for example task rotation. But at this stage though it's likely that the worker is now also showing some physical signs. Therefore appropriate medical management is often required at this stage preferably involving someone who is familiar with you and your workplace and is proactive with regards to injury management. For example keeping the worker at work where possible and safe.

So I encourage you to develop really strong relationships with your local healthcare providers. Go and visit them, introduce yourselves and even ask them to come out and visit you if possible because the research shows that when a healthcare provider is disengaged with workplaces this can result in poorer outcomes such as longer durations of work absence. And the research also shows that a coordinated multidisciplinary care improves return to work outcomes. Coordinated care and workplace intervention were covered last month by Dr Venerina Johnston. So I also urge you to check that webinar out as well.

So at this stage and the primary stage too it's also important to look at your workplace safety and disability management culture and not just focus on the physical. Workplaces that have higher levels of commitment to safety and disability particularly at higher levels of management demonstrate better return to work outcomes and show better safety compliance. Be also aware of those psychosocial risk factors too. Workers that have higher levels of job control tend to have lower risk factors for WMSDs. Once again I'll refer you to the previous webinars.

In my personal experience I've found that at this stage one of the most important things is communication through early reporting of the concerns by the worker to the employer and without penalty. This is very important. The sooner you know the sooner you can act.

The concept of early intervention was raised by Anita Johnston in her webinar in April. This was an excellent webinar and in this Anita covered many concepts that are successful in return to work. I advise you to seek out this webinar as well. It shows that workers with strong levels of support from their supervisors show better return to work outcomes.

So going back to that forklift driver for example as well as those other risk management strategies mentioned perhaps start by asking the worker are they okay. "What's wrong?" "Can it easily be addressed?" You tend to find that the worker already has a good idea at a solution. Also having a good triage process to diagnose whether there is an injury or not or just some soft tissue tightness can be helpful at this stage. This is where good health professionals can be of use by providing an individual assessment, reassurance and the provision of early appropriate medical management for example keeping the worker at work where possible. These sort of strategies can be very useful at this stage. Finally, I urge you to keep good notes and records and have good triage recording and reporting systems in place because these may be necessary further on down the track if a compensable claim evolves.

Slide 15

So what are some examples of those early interventions that can be used?

Well firstly, look at eliminating the cause. In the forklift example I've given can the goods be delivered directly to the destination, therefore bypassing the need for warehousing in the first place? Maybe substituting one forklift for another? Another example in warehousing for back discomfort could be the mechanisation of pallet wrapping. Is the worker manually wrapping pallets and bending and twisting or could it be done by a machine therefore eliminating the back injury in the first place? Other examples in construction are using sharper knives or drills and I think we had some healthcare people as well. So utilising mechanical aids in the healthcare industry such as hoists and pallet slides are other good ways of minimising risk and WMSDs in this situation.

Also look at ergonomic change. We had some people in the administrative role joining us today. So look at things such as office redesign. Maybe reducing the reach by bringing that mouse a little bit closer. Look at your desk height or your working bench height. Maybe even utilise one of those new-fangled super stand desks to minimise the risks of sitting down all day. But that's another topic altogether.

What about alternative duties? Well we know the benefits of staying at work where possible play an important role in rehabilitation. Aim to stay at work and do this by the provision of some alternative duties as long as they are safe and applicable. Research has shown that modified work in the form of alternative duties, graduated work exposure and supported work environments reduces the length of work absence in your workers with musculoskeletal disorders. Work hardening programs in the form of physical conditioning have also been shown effective for workers with chronic and subacute pains. Once again the key findings in the literature for these types of interventions is the evidence for their effectiveness as soon as possible after the injury has occurred.

Some lower level examples of interventions include task rotation. This also helps break up the monotony of the work as well as education on working postures and manual tasks. So, in traditional management of these workplace injuries some of these interventions don't usually occur until after the medical investigations and diagnosis has been carried out. However, the early intervention approach focuses on what the workers are still able to do and on returning to work as quickly as possible. So don't wait until they've waited for their medical or doctor's appointment which in some cases I've seen can take up to two or three days and don't wait 'til they come back with that certificate which is ticked for alternative duties. See if you can pre-empt health professionals. In our forklift driver for example upon first reporting of the stiffness and before an injury has occurred perhaps implement some alternative duties for 24 hours and do this whilst you do those investigations of the risks and looking at some of the ergonomic factors. And then reassess the worker the next day.

The worker, their stiff back may better and you may have found the cause. It might have been a broken camera for example and the worker was twisting in their forklift. So the worker's now reported they're feeling better the next 24 hours later and you've already implemented a control option and fixed the cause in the first place. Therefore, the worker is back at work. They see a proactive safety and disability management culture. They feel valued in their job and a possible injury and claim has been avoided. And all it's cost you is getting the camera fixed and a day on alternative duties. This is much cheaper than a compensation claim.

Facilitator:

Hi Michael. We've just actually had a question with regards to those last points that you mentioned. In particular implementing some alternative duties for the 24 hours while you investigate the risks. How would you go about doing that if you were an employer or a supervisor? Do you start by having a chat with the worker? What would you suggest for an employer or a return to work coordinator?

Michael Donovan:

Thank you very much Rachel for that question and thank you to whoever proposed that. So at this stage it's really important to ask the worker how they're feeling and how they're going. Keep accurate records of what you're doing but also having a good idea of what the worker can and can't do at this stage. So for example in what we're talking about here, this worker with the staff back it may be their back involved but there's nothing wrong with their neck and their shoulders. Assuming they've gone off to see a health professional so getting some advice from that health professional of what the worker can and can't do is really, really important at this stage. Okay? Sorry, I'm just going back to – is that it Rachel? Yep, okay.

Slide 16

All right. So we'll move onto the next slide now. So what is early intervention and what does it look like? Well early intervention is multidisciplinary. An important feature of early intervention is the consultation and consensus between the stakeholders namely the employee, the workplace health and safety professionals and the workplace itself to ensure appropriate and timely risk management and work modifications. It requires engagement from multi levels of management otherwise it's doomed. The old "take a dose of cement and harden up" approach which you still hear every now and then, if that's used then in the long run the evidence shows that your claim rates, costs and durations will all be greater than a collaborative approach that takes in all considerations.

Early intervention needs worker engagement. My experience is that despite the myths and stories most workers want to stay at work and they don't want to go off sick where possible. So do your best to keep them in that environment that aids recovery and doesn't demoralise or demonise them. There must be open and prompt communication between all stakeholders including the health professionals.

Here's a tip here. Get the health provider to give you a response whether it be a call or an email so long as the worker gives their consent of course. As a Physio I rarely come across a worker who does not want me to speak to their employer about what they can and can't do safely.

We're just getting another question coming in.

Facilitator:

Thanks Michael. So this question relates to employers. Once they've actually obtained approval from the worker to contact the treating Physiotherapist how can they prepare for those discussions? So do they have to have any documents ready? Also what are some of the questions that they should be asking? Thank you.

Michael Donovan:

Well speaking from my perspective as a Physio, if a worker has come in to see me with a work related concern it's really, really good as a Physio, as a health professional of any type, to have a good idea of what the worker is capable of doing. And even before that happens even getting a phone call and knowing that the workplace is supportive and proactive and they're really, really looking forward to keeping and help trying to benefit keep that worker at work where possible. So knowing that their worker is going to go back into a supportive and caring environment is essential and having an idea of what the worker can and does in the first place.

So for example, does their workplace involve lots of bending? Is there lots of lifting involved? What sort of lifting is required? That's quite important for the health professional to know so they can help guide you with regards to what the worker can and can't do safely. So sometimes a list of duties can be forwarded. A lot of workplaces already have a list of the functional and physical requirements of the job or even just a simple job description can be of use. And also having a list of what some of the alternatives the workplace have available can be helpful at this stage. Okay?

Facilitator:

Thanks Michael. The only other addition I'd make to that is if you are feeling unsure you've always got and you are insured with WorkCover Queensland you've always got your customer representative that can help facilitate that communication for you. Okay. There is a third question that we have. How do you prevent alternative duties from causing more harm medically?

Michael Donovan:

Thank you very much and that is a tricky one indeed. Having as much knowledge as possible about what the worker is planning on going back to do is really, really essential. So communication is one of the most essential things in this. Talking to the worker, talking to the supervisor, talking with the health professional. That's the most important thing because the worker knows if they're going to go and do this job "No, that's going to cause me grief." So having that open communication is the most important thing. If you just don't have that knowledge of what the workplace involves that's what I was talking earlier about with those disengaged health professionals. That's when you're more likely to run the risk of alternative duties causing more harm than good. But workplaces and employers and workers and health professionals that are all engaged and communicating and working well together that's when there's less chance that the alternative duties are going to cause any problems.

Once again though if it is a work related condition and if you're insured through WorkCover Queensland they can implement or send someone out to assist you with that if possible because that's part of the injury management process. Excellent.

All right so we'll go onto the next slide and talk about some of the evidence for early intervention.

Slide 17

Despite whichever stage of prevention the early intervention occurs in the available evidence suggests that early intervention including those with workplace involvement in the rehabilitation and coordinated care can improve return to work outcomes such as reducing the duration of sickness absence and also reducing productivity loss which is a very big important thing for industry and business.

But what about the rate of compensation claims and the costs associated? In one recent study that I've been involved in we've examined the effects of an early intervention program in a high risk industry that being the meat working industry.

Slide 18

So we looked at – we did a study on a meat working industry and we looked at the benefits or we examined the effect of an early intervention program that was implemented. This program consisted of workers immediately communicating and reporting any work related musculoskeletal concerns without punishment to their reporter. This was logged into a reporting register and if it was a workplace injury they would call and the insurer was notified and the worker was sent off to the doctor. The immediate triage of the WMSD occurred on site by their First Aid Officer and if required they got assistance with some healthcare providers to help facilitate this process.

At this stage, like I said if it was a work related injury they'd be sent off to their health professional and managed as usual through the medically-based workers' compensation system. Already a safety investigation had been flagged and a risk assessment was now in progress. Systems were being developed to assist the worker to return to work such as outlining alternative duties and sending these off with the worker to give to the doctor if necessary.

However, if there was no injury and it was caught early enough, for example the worker was reporting some muscular stiffness or struggling to keep up with the pace of work and the worker did not want to go off and see the health professional and they were really keen to stay at work they were managed on site through collaborative strategies which included assessing their work tasks, assessing for any risks – for example checking the sharpness of their boning knife, checking their workstation was set up correctly, checking their technique.

They were also offered some work modification or alternative duties and if required had the access and opportunity to see an on-site health professional who would provide some self management advice and most importantly some reassurance. The worker would be reviewed every 24 hours and would hopefully be returned to normal duties or if the symptoms persisted or worsened they would then be sent off to see a medical practitioner.

At all stages thorough record keeping took place and at no time was the worker denied the access to see a health professional or a doctor if they so wished. The insurer was also notified immediately if it was a work related injury and thorough record keeping was done throughout this whole process.

So what we did is we looked – examined the outcomes such as the rate of injuries, the costs associated and the length of workplace disability for two years before this intervention strategy took place and two years afterwards and we found some quite astounding results.

Firstly, there was a significant reduction in the rate of compensation claims. So that is the number of claims that happened over a working period per 1,000 workers or per $1 million in wages - whichever one you want to use. But there was a reduction in rate by 18 percent which is quite a fair bit. There was also a significant reduced average cost per claim for those that did end up in the workers' compensation system and most of this was made up by a significant decrease in the lost time injury costs. There was also a reduction in the duration of time off work by 37 percent for those workers that did require some work absence.

We also compared what happened in the remainder of the industry over that same four year period and the two years before and two years after. Basically the industry itself showed a non significant increase in the average claim costs and no change in the work duration lost. So this study shows that a coordinated multidisciplinary combined workplace based and clinical intervention delivered upon immediate reporting of a musculoskeletal concern had positive health benefits in a high risk group of workers. It showed that early reporting and intervention did not open those floodgates for compensation claims. Okay? So it really dispelled that myth. It showed and it did not lead to worse outcomes for the worker.

Slide 19

So there's growing agreement amongst researchers that the most effective method to prevent the development of musculoskeletal disorders is to provide appropriate primary and secondary interventions and provide these as early as possible. Like I said earlier, there is emerging evidence that early management of the injured worker prior to the injury resulting in time off work and facilitating appropriate interventions for rehabilitation can reduce the cost of work absence and also improve productivity as well as reducing claim costs. Early intervention has also shown cost benefits in a recent study in the National Health Service in the United Kingdom.

Slide 20

However, there are some barriers to early intervention too. These can include the initial impression that it's going to be too costly. However the overwhelming research shows that investing a few dollars up front can save much more later on. There's also that misconception that early reporting will open the floodgates. However, the evidence now disproves this. There can be employee behaviour issues. For example the fear of dismissal by employees, that they don't want to look – or the fact that they don't want to look soft or come across as a whinger. This is where a supportive work environment is really, really helpful. And it's also important where that communication is vital. Getting out on the floor, asking the workers "Are you okay?" and asking them questions can help break down some of these barriers.

Also when return to work is not considered important this can be a barrier to early intervention and this barrier can come from many sources – from the worker, their family to the employer and the health professional. So really trying to break down this barrier is really, really important. Returning to work has been shown as one of the most vital factors in getting a worker back to work.

There's a question coming through.

Facilitator:

Hi Michael. Thank you. Just on that topic of barriers to early intervention someone's identified that they've got a barrier at their workplace with a lack of involvement I suppose with reporting and communication. What are some ways to increase involvement in reporting and communication at the workplace to assist with that early intervention because that's as you've highlighted one of the first steps? It's quite important. Thank you.

Michael Donovan:

Thank you very much for that. So lack of reporting at the workplace can come from many factors. It can come from the management level, it can come from the supervisor level and it can come from the worker level as well. So we'll choose one of those in this question. We'll say that the lack of reporting is coming from the worker level.

So if workers aren't reporting early enough their aches and pains to you you've really got to examine why that is occurring. Is it because there is fear of losing their job? That can be a big one. Is there a fear that not reporting is not going to make them look tough and strong in the workplace? So having a supportive workplace and really engaging with the workers and letting them know "Look it is okay to report these things. You're not considered soft," that will help. Use some examples as well.

Use some sporting analogies. We're a very sporty country and think of your workers as industrial athletes. So you'll say to your workers through toolbox talks, through morning messages that "Look if you were a footy player and you felt your hammy starting to twinge and tighten up, boom, you'd straight away tell your Physio and your Trainer and your sporting team that there's something going on to prevent that hammy twinge becoming a tear."

The same thing occurs in the workplace that you've really got to encourage the workers through a supportive environment that early reporting is really, really helpful and this comes from a good safety and organisational leadership culture. Workplaces that have really good overall organisational cultures' traits such as supportive environments and safety leadership, in workplace health and safety, in disability management all show that that can help increase your communication from the workers from the bottom level up and help sort of break down some of those barriers.

Facilitator:

I'll let you finish before we ask you a few more. So what would you suggest - and you might need to take this on notice and come back to this one – what would you suggest or perhaps have you had any experience in the past if the workers' union prevents direct conversations with the treating professional? How would you overcome that? Or is that a little bit more complex than being able to give a quick and easy response in this webinar?

Michael Donovan:

Thank you for that question and that is a – that is a dicey one as well. But it is one I have encountered once in my experience over the 20 years. And once again it just comes down to communication again. See if you can have a discussion with the union and their representative and find out why that is the case. In the case that I've encountered the reason why that conversation wasn't happening was coming down to workplace security and job security again. And in that instance you really have to respect the worker's rights. You have to gain their consent to talk to the workplace. So if that's the case then you have to respect that but having that conversation with for example in this question the union is a good place to start but it is a tricky one to manage.

Facilitator:

Okay. Thanks so much Michael. We'll let you finish your presentation and then we might come back to some other questions if we have time.

Slide 21

Michael Donovan:

Thanks for that Rachel. So really we're just coming back to the summary now. So this slide to summarise some tips for early intervention. Encourage immediate reporting and have systems in place for reporting and recording. This is also really, really important in case you need to look back on your notes or it is required later on if a claim is opened.

Where possible or if possible implement a risk management approach and use those hierarchy of controls. Where possible implement safe and sound alternative duties. Don't wait until there's an injury or until they come back with that medical certificate. And if you've never seen any suitable duties plans or alternative duties there is a lot of information on the WorkSafe Queensland website and there is a link there up on your screen.

Engage cooperative and collaborative health providers. If required go with the worker to the health provider as long as consent is gained. Have a letter of introduction with your contact details on it. Okay? Have ready to give to the health provider a list of their normal tasks and a list of possible alternative tasks. Let them know that there are alternative jobs there to do.

I've been to many workplaces in the past where I've been told before attending, "There's no light duties here mate. Everything's really, really hard," but with a little bit of investigation and better communication it's always possible to find something that the worker can do where they've felt valued and engaged in staying back in the workplace. One of the worst things to do is just to stick a worker in the corner and have them twiddle their thumbs all day. So keeping the worker feeling that they're engaged in the workplace and that they've got a place there is really, really important. Okay?

And finally make sure you track your injuries and your complaints through good, thorough record keeping. That way you can see if patterns emerge and this is probably something that your health and safety teams do quite regularly using their first aid registers, injury registers, incident reports. That way you can see trends evolving and you can get in and act early with those primary strategies to prevent injuries happening in the first place.

Slide 22

Slide 23

So finally, at the end of the slides here there's some extra resources if you need to go to, to the Work Health and Safety website. And is there any more questions coming through yet Rachel? Okay. Just hang on a tick.

Facilitator:

We do have a question. Do you have any views whether early intervention programs such as back care classes and specific gym fitness programs are also effective?

Michael Donovan:

Thank you very much for that and I'm just wondering where that question's come from too. So going back to that hierarchy of controls which I talked about earlier, those sort of programs such as work hardening programs, exercise classes I think or the gym fit classes, they sit in the lower end of that hierarchy of controls. So the evidence to their benefit is not as strong as those higher level hierarchy of controls where you're trying to eliminate the risk of the source in the first place. And those kind of controls tend to be trying to change the worker rather than the workplace. And usually the symptoms that the worker is getting is more the effect of something that's happening in the workplace. So trying to treat the symptoms is not as effective as treating the cause.

So although a lot of workplaces do have those back care classes and manual handling classes and there is a place for them, they shouldn't be done exclusively at the expense of those higher level controls such as eliminating the cause of the problem in the first place.

Facilitator:

We've got one more question. How can we encourage employees to use our health providers?

Michael Donovan:

Thanks for that question. I think you would naturally get – well I tend to find I get used quite well as a health provider in a workplace if you've got that engagement with the workers themselves and if the workers can know that you know the type of work you do, you're familiar with their role and you have that communication with them, workers will tend to use the providers that you tend to encourage. But you can't force a worker to see your provider if they don't want to.

If an injury claim has occurred they do have the right to see whichever provider they want although I usually find workers want to stay at work and want to get back to work and if they can see a health provider is engaged and has that knowledge of what's happening in the workplace that the workers tend to gravitate towards those providers in the first place – doctors, occupational therapists, physiotherapists – that have a knowledge of what's going on in the workplace.

You come across as knowing a lot more. You have that level of communication between the worker and the worker goes "Yeah. This person really knows what I do and what I'm talking about," and they tend to gravitate towards those providers than those that haven't a clue whatsoever.

Facilitator:

Well thank you for your informative presentation Michael. This information that you shared on the different concepts of early intervention and some of the myths that you've busted especially about the costs in reporting I think will be very valuable. The outcomes of your research also are very exciting for the Queensland scheme. So we look forward to hearing more about those in the future, perhaps a future webinar.

Thanks everybody for your questions today. It's been a great opportunity to interact with our speaker. As Michael mentioned there are various resources and he's made reference to a lot of the previous webinars that we've delivered. We've also got a lot of information available on the WorkSafe website. So please look at those.

Slide 24

Michael's been kind enough to also provide us with a reference list and we will ensure that a copy of that is available to you in PDF along with the transcript and copies of the slides.

We've created a Return to Work Coordinator Community so that you can receive regular communication and also current information from the Office of Fair and Safe Work Queensland and you can join using the address on your screen. You can also subscribe to e-bulletins and that's where you can be the first to hear about any future upcoming webinars as well. And we've got a couple coming up next month on ergonomics and also what kind of positive attributes can assist a supervisor to successfully return someone back to work.

Slide 25

We recently launched the Safe Work and Return to Work Awards and they will be held in October. These awards recognise and celebrate outstanding workplace health and safety as well as return to work achievements. And we all know that you do an exceptional job at that over across the state. By entering you can be acknowledged and raise your profile as a leader in both work health and safety rehabilitation and return to work. There's prize money up for grabs. So I think it says up to – it went up to $2,000 prize money and you can share solutions and network with other work health safety and rehabilitation leaders. And I know Queenslanders love to network.

Make sure you register to attend the Injury Prevention and Return to Work Conference in October. Already we've sold close to 100 tickets. So it will again prove to be Queensland's peak professional development event for work health safety and workers' compensation in the state.

Slide 26

Finally, we have some Work Health and Wellbeing forums. Michael talked about the benefits of I guess leadership and a good wellbeing and health and wellbeing culture within the workplace. So make sure you logon to the link that's provided on your website and there will be workshops held right across the state between June and September.

Slide 27

Finally, I just wanted to let you know about an upcoming webinar. So 'What do supervisors need to do to ensure positive outcomes for injured workers?' So this will be the second part of our series with Dr Venerina Johnston. So her first webinar presented some of the evidence that supports what supervisors need and this will actually give you some more of the specific. So we hope you can join us for that as well.

Thanks again for all of your support. Have a great afternoon and we'll be in touch again next month.

Good bye.

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