What Gets Measured, Gets Action?

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ISCRR CEO Alex Collie recently published the following article:

Counting work-related injury and illness in Australia: Do we measure up?

The following quote from the article illustrates one aspect of the problem with our data collection:

“One finding from this report is that fewer than 50% of the injuries reported in Australia in 2014 became accepted workers’ compensation claims.”

The article also highlights  the relative absence of psychological health data being collected:

“Perhaps the best example of this is that very few mental health conditions are accepted in workers’ compensation schemes, yet as many as 20% of working age adults will have experienced a mental health condition in the past twelve months.”

Alex cites initiatives in the United States as a potential model to follow:

Developing a Smarter National Surveillance System for Occupational Safety and Health in the 21st Century

Alex’s article succinctly highlights the deficiencies in our data collection.

This blog is about the negative health impact of our compensation systems on individuals injured in the workplace. Consistent with this article, I am aware that in my local jurisdiction there are significant barriers to entry into the system. Indeed many well-intentioned doctors advise their patients against claiming because of the risks inherent in the system. Many claimants whose injuries become complex have their claims disputed and a significant proportion lose their entitlements. Almost all psychological claims seem to be disputed.

Measuring the health outcomes using workers compensation data is a flawed approach, particularly when many of the worst outcome cases are managed outside the system. We do need better methods to capture the data about health outcomes for those injured at work.

Our systems might work well for those with simple, visible and straightforward physical injuries, but probably do not for a significant proportion of injured workers, particularly those with complex secondary complications or pre-existing vulnerabilities.

As workers are encouraged to work into their senior years this will become even more important.

I commend Alex on his initiatives in more meaningful data collection.

The real data has the potential to break through the complacency amongst many that think our systems are working well.

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About Tasworkdoc

As an occupational physician in private medical practice in Hobart, Tasmania - the southernmost state of Australia, I see workers referred by their general practitioners with various types of work-related injuries and diseases. These are mostly musculoskeletal injuries, both of traumatic and gradual onset as well as various associated psychological disorders. With interaction with patients for treatment and providing advice about rehabilitation, I have the opportunity, first-hand, to observe interactions between individual patients and compensation systems. I also conduct independent medical assessments, including impairment assessments for musculoskeletal injuries and asbestos-related disease compensation. This provides another perspective of workers within compensation systems.
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3 Responses to What Gets Measured, Gets Action?

  1. How does one measure anything- first a standard must be agreed upon- a stand ruler is 30cm long- we just agreed to that standard. A standard human pregnancy is 9mths- the variants are plus of minus a few days- we agreed that the measure of time is 9mths. A standard measure of anything is what we as a society agree to.
    The standard healing time of a broken bone is 6 weeks.
    Then come in the variants- age, gender, life circumstance, pre-break wellness, nutrition, hydration just to name a few.

    To attempt to measure outcomes in workers compensation is difficult because each silo within the workers compensation concept uses a different measurement- there is no accepted standard measurement.
    Return to work is not a measurement because with set timeframes within the various legislations, it could mean that instead of returning to work, the injured worker may have simply run out of pre-set time.
    Treating medical providers and IME’s have different opinions on how the injury is or isn’t healing.
    Then there are the legal impacts and the stress levels that produces for injured workers.
    Then there are the various employer, family, friends, community, society pressures/expectations.
    While some of the employer, family, friends, community, society will be supportive, others will not be.

    It is not possible to find a standard that measures a injury (regardless of type) for a 16yr who has just entered the workforce as a part time employee and a 56yr old who has been working since the age of 16. Same injury- just a 40 year age gap.

    Throw into the mix the number of unreported workplace injuries-treated by the employer and the employee to sidestep the intrusive and oft unproductive workers compensation industry- or the number of injured 457 visa holders who know that if they are unable to return to work their visa is cancelled, or the number of new-Australians who simply do not know that workers compensation is a right that they now have, or the casual employees who know that they won’t have a job should they lodge a claim.
    All of it blends into a cacophony of information that has no framework or way of understanding against any form of measurement.

    Workers compensation has become an industry of professional strangers, it needs to remember that it started out to be about the welfare of injured workers and that very small long forgotten bit of information should be the standard measurement- what is the best for the welfare of injured workers- when we get that right the rest just falls into place.

  2. Macky says:

    Peter –

    Victorian Ombudsman table her report yesterday into investigation of conduct of claims agents and independent medical examiners in the Victorian WorkCover system with a particular focus on complex claims. Thought you may be interested to read. As damming as the report is, doubtful that there is anything that will shock you.

    Ombudsman media release:
    https://www.ombudsman.vic.gov.au/News/Media-Releases/Media-Alerts/WorkSafe-complex-claims-process-needs-fixing

    “Investigation into the management of complex workers compensation claims and WorkSafe oversight” Report:
    https://www.ombudsman.vic.gov.au/getattachment/0eb3f52a-6488-46f5-beb0-5cf051db359d

    http://www.theage.com.au/victoria/dirty-tactics-by-insurance-companies-make-injured-workers-miserable-20160909-grd648.html

    http://www.theage.com.au/victoria/worksafe-system-failing-particularly-vulnerable-people-ombudsman-20160912-gre7li.html

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