Workplace embedded injury prevention advocacy
By providing care at employers’ offices and front-line workspaces, physical and occupational therapists break down mistrust in the potentially adversarial relationship between employers (who want their workers to return to work) and employees seeking health services. Having onsite therapists breaks down access barriers, familiarizes workers with the services offered, and demonstrates employers’ concern for their employees. The therapist-employee interactions establish relationships and produce increased levels of trust. Why does this build trustworthiness? Putting patient welfare first and providing access deliver the message of caring and compassion to employees.
How It Works
Workplace embedded physical and occupational therapists engage with workers, supervisors and safety professionals during ergonomics or rounding activities to promote injury prevention through collaborative problem solving. Evidence-based medical information is used to foster injury prevention activities to resolve worker problems or decrease risk, doing so in a way that minimally disrupts business practices. Therapists can serve as a bridge between workers, supervisors and safety personnel by translating functional risks/problems to practical productivity and cost-benefit information that forms the basis of meaningful prevention intervention design options. The health provider is seen as a fair and neutral party in a complex system that benefits both workers and workplace stakeholders. Workers gain better access to health services and employer stakeholders are viewed as supporting their human resources. At the same time, employers experience reduced healthcare and disability costs. Collaborative dialogue can identify where well-intentioned processes are inhibiting optimized care or creating institutional/cultural obstacles to care, by addressing stereotypes of worker motivation and misaligned process barriers that can lead to costly or severe injuries. The joint problem solving and intervention planning optimizes the worker, business, safety, and health strategies in a manner that allows more trust in medicine while showing business and medicine can be aligned. Therapists in workplaces remove barriers to care and workers tend to engage more readily with a work culture that adapts to see worker advocacy in healthcare as a business advantage.
Skills and Competencies
Workplace embedded injury prevention advocacy builds on worker/work assessment skills of physical and occupational therapists, including an understanding of the physical and psychosocial aspects of worker health along with the impact of organizational need and regulatory health barriers/facilitators. Value and respect for all team members and their ability to contribute to root cause analysis of physical/structural/cultural barriers for healthy work are also important, as well as willingness to have honest and considerate dialogue. Therapists must have integrity, an understanding of care paths for injured workers, and relational skills to develop a therapeutic alliance and be seen a neutral facilitator by all stakeholders.
Origins
Blue collar workers often work long shifts and may experience limited availability of after-hours healthcare. They may have limited knowledge of healthcare practices and little understanding of a complex workers compensation system (often described as adversarial). These workers may feel a sense of hierarchical marginalization that can lead to lack of, or deferred, care. Onsite therapists help reduce the inequity of a medical system generally established around a first shift delivery or potentially geographically distanced locations. Onsite care also helps remove access barriers, although use of services can be complicated by potentially misaligned organizational incentives or a culture that suppresses injury reporting. Front line business performance measures and incentives commonly focus on reducing injury reporting. Culturally, this strategy may lead to lack of reporting or even peer pressure to avoid reporting. Advocating for early and appropriate care or risk mitigation can help reduce misaligned incentives and lead to improved work practices that foster the right intervention for workers at the right time without negatively impacting business operations. The embedded advocacy approach was initiated as a way to help transform work culture and eliminate perception that healthcare is problematic and would automatically remove workers from jobs or negatively impact business costs.
Effectiveness
Many workplaces with established onsite therapists providing care and intervention have experienced significant reductions in work-related injuries and associated costs year over year. Workplace data has shown when workers utilize the onsite services, and/or where there is greater integration and visibility of the therapist in the workplace, there is a significant decrease in injury claim costs. Trust is built through relationships. The established presence and integration of the therapist in the workplace seems to facilitate that evolution of trust. One workplace even attributed a drop in its commercial healthcare costs to the program after the first 1-2 years of implementation. A number of research studies have shown the benefits of early intervention and lower lost time/costs associated with keeping workers connected to the workplace as part of secondary or tertiary prevention and care. The Workers Compensation Research Institute (WRCI) has published studies on the impact of early physical therapy (Effect of Timing of Physical Therapy for Acute Low Back Pain on Health Services Utilization, Mueller, 2020) and trust in the workplace as a factor predicting work injury outcomes (Predictors of Worker Outcomes, Victor, 2014).
Scalability
Workplace embedded injury prevention advocacy is a scalable practice and has been replicated in numerous types of organizations, although situational specifics and relationships may vary. Workplace culture, processes and integration of a physical or occupational therapist can have a 3-6-month learning curve to allow stakeholders to become familiar with the strengths and opportunities of the personnel and workplace.