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The WorkRx ®:    A work prescription (WorkRx®) is both a philosophy, as well as a practice.  The WorkRx philosophy and practice affirm that:

 

●   Health and productivity are connected 

 

●   Corporate, employee health and productivity factors can be merged into a practical plan, protecting the short and long term productivity for the employee and employer, alike.

 

A Corporate WorkRx ®   guides an organization to more effectively control the impact of health and productivity issues within   its work place.  It starts with a corporate plan that organizes and directs its resources. The following suggestions can be incorporated in your organization’s WorkRx ®, offering solutions to common health and productivity predicaments.

 

 

 

 

Excessive Lost Time!   Our organization is experiencing excessive lost time and costs from unknown or confusing reasons!   

 

This is a common experience for employers of all sizes and industry.  The first step in managing lost time is defining the internal and external drivers.

 

Key questions are:

 

·        Do our corporate policies, practices or labor management agreements encourage unnecessary or extended lost time?

·        Do specific healthcare providers extend lost time as part of their practice patterns?

·        Are there unique employee patterns or specific impairment types in our work force that generate the most lost time?

·        Are there identifiable lost time patterns that are connected to employee relations issues?

·        Are there lost time patterns consistent over time?  Are there identifiable patterns related to seasonal lost time, lost time patterns that are increasing or decreasing?

·        Are there lost time patterns unique to a specific managers and shifts, work days, work site or affiliate division

 

The following link offers a tool to define the quantitative impact of lost time. Once a lost time profile is in place an organization can take the next step in determining the appropriate resources to bring forward.

 

Impact Study - WorkRx Group.pdf

 

 

 

 

  

            Policies & Practices?   Our organization has inconsistent and/or competing health and productivity policies & practices!    

 

The common product of competing or fragments corporate policies is bureaugenic disability. That is, lost time created and/or reinforced by corporate policies and benefit programs. 

 

The most common disability creating policy is the notion of 100% or nothing. That is, the employers determines the  employee with an impairment cannot return to work unless they have recovered 100% work capacities and can do 100% of the job.  The rationale for this appears to be the sense that if a person comes back less than 100% this will increase work related injuries.   While possible, there is no data to suggest this actually occurs.

 

The following link offers sample corporate polices related to lost time management and return to work.     Please consider molding these sample policies to your organization following a review by your corporate legal counsel.

 

RTW Policies.pdf

 

A Policy that Works - Transitions Out and Back   Transitional work is one of the most effective corporate strategies to control unnecessary lost time.  Transitional work is not light duty.  Light duty is open ended and static.  Transitional work has a beginning and an end.  Most transition programs are between 30 to 45 days with 12 weeks being the maximum time for any return to work transition.  

 

Transitional work offers incremental steps toward full productivity embedded in a well developed WorkRx® (work prescription).  The WorkRx® is a stay at work or return to work plan that molds the current treatment program with an incremental resumption of job demands and worker capacities

 

Elements of a WorkRx®

·   Determine the current and/or projected functional impairments with the associated treatment to improve functional capacity

·   Define the extent of duration of the functional impairments and the expected course of treatment

·   Define work site accommodations that are required and possible

·   Identify any employee relation issues that may be a RTW barrier

·   Outline transitional work options and key benefit dates

·   Communicate plan to the respective supervisor and physician

·   Review WorkRx® bi-weekly or as appropriate in longer duration cases

·   WorkRx  is revised as appropriate in 30 day increments until at the point where the resumption of work is considered highly unlikely

 

Transitional Work (TW) Development Plan   The following steps can be applied in the development of a transitional work program

 

·   Make the business case to senior management – Defining the impact of lost time and the value of TW

·    Define preferred model – targeting key employee groups with eligibility, starting and stopping guidelines.

·   Communicate and coordinate with  internal and external partners

·   Integrate into benefit plan and labor contracts – Creating and applying incentives

·   Roll out program in stages – Anticipate and deal with resistance

·   Provide  Manager/supervisor education program

·   Connect with healthcare providers – Creating the WorkRx

·   Create program to deal with the less than motivated employee

·   Evaluate program  in 30 day increments for first year, quarterly there after

 

Please visit the following links for sample transitional work models

 

..\..\..\Publications & Presentations\Transitional Work Initiative\UCSF TransWork_ToolKit.pdf

 

 

 

 

   The Unmotivated or Just Stuck?  We are frustrated by employees: with chronic lost time, who appear to be unmotivated or have ongoing health   related job performance problems.

 

You are certainly not alone.   The employee who looks to be malingering generates a great deal of time and energy by the employer.    All too often the employer assumes a defensive or adversary relationship with this person.   When this happens, adversaries defend, dig in and protect themselves.  No one really wins.

 

The Motivation Paradox1 suggests that, contrary to the notion that ill or injured people who are unable to successfully return to work in a timely manner are unmotivated, in fact, most are stuck. They are stuck, because they either:

  Don't recognize or know how to solve the health and productivity predicament they are in

  Are fearful of moving forward, or

  Are immobilized by ambivalence and resistance to changing the status quo.

 

The following individuals are likely to be labeled as unmotivated:

  Individuals whose work disability seems to be exaggerated;

  Extended lost time that is influenced by co-morbid behavioral health impairments;

  Eroding or chronic health problems;

  Frequent or repeat users of intermittent FMLA;

  Individuals with poor job performance prior to the health problem.

 

Ambivalence and resistance are the central drivers in being stuck. Ambivalence is the push & the pull between ideas, behaviors priorities and strategies. This is the result of competing forces, natural stages of change and is typically below awareness until brought to light.

 

Resistance is creating & maintaining barriers that protect the status quo (SQ), reduce anxiety related to change or offers a rationale for the present behaviors.  In developing insight, please explore: 1. rewards and losses in the changing the behavior, 2. Calibrate the level of comfort/discomfort is there with the SQ?  To understand what type of resistance is offered Listen for:

§          Yes…. But

§          It is not that important to…..

§          It is not my fault……

                  

Gaining insight to the individual’s ambivalence and resistance to return to work offers a window to:

 

1. Understand why a person may delay or be unsuccessful in coming back to work

 

2. Why an employer may not want an individual back to work

 

3. Ultimately how cynicism and an adversary relationship are generated and reduce the effectiveness of stay at work and return to work efforts.

 

Here are several suggestions that may reduce your frustration with the “Unmotivated”:

 

·   Review your current performance management process.

 

Are you disabling poor performers? Are you extending the poor performers lost time?

It is highly likely that your “unmotivated” employee who is on disability claim has a history of poor or eroding job performance.  Research suggests that job dissatisfaction, a high number of supervisors in a short period of time or low job performance becomes a negative influence. Likewise, if the supervisor feels this person is a poor performer, he or she may feel that having the person continue on disability is a good thing.

 

·   Calibrate the level of presenteeism in your work place

 

Presenteeism, or lost productivity due to health risks or an emerging medical condition while the person continues to work is a starting point for difficulties in return to work. If you are using a health risk appraisal within your wellness program, it likely has a presenteeism scale. If not please visit the following sites to review the application of the WLQ, Work Limitations Questionnaire or the HPQ, Health Performance Questionnaire.

 

WLQ    http://160.109.101.132/icrhps/resprog/thi/wlq.asp

 

    HPQ    http://www.hcp.med.harvard.edu/hpq/

 

·   Define the connections between FMLA leave and worker’s compensation and short term disability claims

 

Excessive use of FMLA (that is > 2 full or intermittent FMLA claims in a six month period) suggests an emerging employee health problem, an emerging family issue or an emerging employee relations conflict.  In either case, the employee will be required to solve a health and productivity predicament.  A common characteristic of folks who appear unmotivated are that they may be unable to solve the predicament they are in.  They are stuck!  

 

If this is the case, it is worth the time to explore the contributors that maybe reinforcing the lack of moving forward, timely problem resolution or looking disengaged 

 

A practical benefit strategy is to link the administration of FMLA with your organizations short term disability administration.   Research suggests that integrating such management pays dividends.

 

 

  

 

Table 1 illustrates this connection.

 

                                   

 

 

 

 

 

·   Develop skills in dealing with ambivalence and resistance in dealing with either health related job performance deficits or return to work initiatives

 

An employer’s occupational health and human resource professionals or a disability manager for a public or private disability, health or worker’s compensation insurer can focus on the client’s ambivalence and resistance by making the following commitments.

 

Adversary to problem solver   Adversaries make people dig in and defend….Developing a set of skills that are applied in a time sensitive, problem solving focused employer/employee relationship can lead to desirable changes.  The employee is accountable for solving his or her health and productivity predicament.

 

Recognition is transformational  The recognition of the employee’s priorities and expectations embedded within the ambivalence and resistance to change invites an improved understanding of what is possible and being accountable to solve the predicament

 

Continuous engagement Reducing isolation creates accountability, consistency and accuracy of information. Correspondingly, continuous engagement creates the opportunity to reinforce incremental success.  Time invested pays off.

 

Incremental change  Everybody is going somewhere, but, how far, how quickly and are they really ready to go?.. Creating incremental change offers a greater likelihood

 

Specific clinical skills can be acquired by participating in the WorkRx® Insight Program. Also applying the Judgment Index TM offers the opportunity to calibrate strengths and weaknesses in some 15 return to work indicators.  To consider using the Judgment Index – RTW please go to the WorkRx JI – RTW services