Successful Accommodation: Having A Solid Disability Prevention and Management Process- The Proof is in the Real Case Studies

By Jane Sleeth, Optimal Performance Consultants Inc
Three out of four Canadian adults experience some form of back/ neck discomfort at some point in their lives.  In our practice, we have found that in workplaces across Canada, this number can be even higher.  Thanks in large measure to technology, jobs have become more sedentary. Longer than normal hours of work, combined with the static nature of many modern jobs, or limited recovery time for more demanding manual materials handling tasks, combine to make back injuries a problem that has not gone away.  The reality in Alberta workplaces- whether office/administrative or manual labour- is that back injuries can occur spontaneously; they can cause prolonged periods of time away from the workplace; and they tend to be a costlier injury from a medical/ benefits point of view, from compensation rates to your business, and time and productivity loss.

Back and neck pain have not disappeared from the workplace and the toll on employers and employees include economic disruption and negative impacts on profitability, productivity and overall health.  Back and neck pain is the leading cause of lost workdays (see Alberta Worker’s Compensation data and private insurance data,) second only to colds and flu as a reason to visit the doctor.  Neck pain affects over fifty per cent of those who already have problems with the lower back. 
One of the reasons why back and neck pain remains so expensive to employers, employees, and the insurance community, is that the best science if often not applied to the challenge.  The result of not using best medical and rehabilitative evidence; best healing-time evidence; and, best case management evidence, is that back and neck pain often become a chronic impairment.  If a person is directed to excellent clinics and the condition is not over medicalized, it does not need to become so.  When companies and employees fail to use the best science, it often results in lost time from the workplace and even the misconception that back and neck pain result in a disability.  (To be clear: this article is about mechanical low back pain, which is the most common type of back “injury” encountered in the workplace.  This article is not about fractures, infections, tumours of the back or neck, or about cause equine syndrome or spinal stenosis.)
With respect to ongoing disability management in the workplace and return to work processes, the following are true and should be applied in the common mindset:
·      Neck, back pain and injury can be well controlled and, in most cases, eliminated for long periods of time.
·      Day-to-day neck, back pain and injury should NOT lead to a disability or a disability mindset.
·      Review of workstation, equipment, and tools used within the work environment to ensure proper design and accommodation is the first step to assisting employees by preventing injury and allowing for a faster return to work. 
·      Disabilities can be caused by a slow response or none at all from Facilities/ Operations, Engineering/ Design as well as supervisors/ managers in the workplace in addressing the ergonomics and work demands within a job.
·      Return to work and stay at work accommodations for employees should not result in increased physical or mental demands for their colleagues.
A Successful Case Study, Alberta, 2010
XYZ Pharma Warehouse is the pseudonym of a unionized Alberta company that has a process in place for preventing and managing disability, including an active, timely return to work/ stay at work process. The union representative and external case manager along with the HR Manager had narrowed down three active, evidence-based rehabilitation clinics close to the XYZ Warehouse where employees would be referred for any and all musculoskeletal injuries that occurred whether inside or outside the workplace.  Visits to these clinics would include an assessment by the Physiotherapist, to rule out any neurological or other potentially serious issues.  XYZ Disability Management policy accepts only XYZ forms, and not physician, PT or chiropractor’s notes.  
 Ms. Carr works as a Picker/ Packer.  Her job demands include walking to all areas of the warehouse to fill orders; pick out orders and place items into a wheeled cart; push cart to packing area; pick up and pack items and load onto skids as each package or box is filled with the order.  A Job Demands Analysis on this job in the warehouse had revealed that the job demands were lower when a rotation scheme was used daily.  Ms. Carr had described back discomfort to her supervisor in previous months.  She sustained a back injury early one Monday morning while getting ready for work. 
Typical of most back pain and injury, it was unclear as to whether the workplace or other activities contributed to the back pain.  Despite her pain, she attended work that day.  She attended the local Physiotherapy clinic prior to her arrival at work that day.  Ms. Carr was found to have a typical mechanical low back injury, which healing timelines find improve in eighty per cent of cases within two weeks.  She then attended a workplace meeting with her Supervisor and Case Manager, per the Disability Management policy, as she had been medically and functionally cleared to attend work that day.  The meeting was to work out a return to work/ stay at work plan ad set out in the Collective Agreement.       
In that meeting, Ms. Carr suggested that she work in the Pick side only of her job, and not perform the Packing/ Loading tasks.  The Supervisor found this accommodation would be challenging over a period of time as changes to the rotations would lead to increased workloads for the remaining Picker/ Packers, particularly if the accommodation lasted longer than two to three weeks.  Ms. Carr felt her current levels of back discomfort would require her to work on the Picker side of the job for one to two weeks.  The Supervisor and Case Manager agreed that this accommodation would allow Ms. Carr to remain in the workplace in a productive manner while ensuring her coworkers were not negatively impacted by increased job demands for an extended period of time.  The Supervisor met with the rest of the Picker/ Packer team and the Union representative to communicate the plan and how it would affect everyone. The Plan was agreed upon and put into writing, with the agreement to meet again if there were any changes in function, symptoms or job demands.  Ms. Carr then worked on the Picker side of the job for the agreed upon period of two weeks.  Upon review with her Physiotherapist, it was recommended that this be extended by one week, to allow her to further improve her core stability to manage the demands of the Packer job functions.  Ms Carr worked her regular shift and hours as the evidence points toward not using graduated return to work plans in particular for any musculoskeletal injuries which have no neurovascular involvement and have resulted in <6 weeks of time away from the workplace. (see CBI Health longitudinal follow up research, Hall H., Melles, T)
Following three weeks of accommodation within the Picker side of the job, Ms. Carr resumed all job demands and the full rotation with her team/ coworkers; to both Picker and Packer.  She continued to experience some discomfort in her low back for another three weeks, but was able to perform her job tasks and remain in the full rotation.  Given the negative associations often linked with accommodation, it is important to present a positive case study.  Throughout this case study, references have been made to the details of the Disability Management program.  The background work, program development and auditing, meetings with union representatives, policy development and writing of procedures occurred over a period of two years.  During this time, a philosophical shift in the mindset on accommodation, with employees and managers realizing that at some point in all of their careers, such accommodation may become necessary.  Managing illness and injury in the workplace benefits nearly everyone at some juncture. 
A solid program with less emphasis on medical models and more emphasis on abilities and keeping employees at work results in positive, cost-effective, successful outcomes.  This case study from our practice, and others like it across the country are proof that Disability Prevention and Management work, and are worth the time to design and implement.

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