Early intervention: why it’s important to get it right (before anything else)
Dr James Murray
Dr James Murray
Of course, data and analytics play a critical role in a workplace health and safety strategy, however, your data is only as good as the population seeking treatment. In other words, if only a small portion of your workers are volunteering for treatment, your data is not a true reflection of your workforce.
So – how do you create a safety culture? How can you create trust between your workers and your healthcare provider? Do you have the right processes in place? How can you maximise your investment in a workplace health and safety program?
Let’s looks at what ‘early intervention’ really means, what best practice looks like, and how important it is to get it right. We’ll also look at some real life examples.
We follow the national work health and safety, and workers’ compensation authority, Comcare’s definition:
does not impact on a worker’s ability to lodge a workers compensation claim and should happen whether or not an employee has made a claim for workers’ compensation
is about acting early to minimise the impact and duration of emerging symptoms or actual injury or illness
participation is voluntary and provides early appropriate treatment and support to employees
allows workers to nominate their preferred treating practitioner.
We use early intervention to increase the level of resilience and capability of workers in manual handling or repetitive roles, to prevent the onset of symptoms or aggravation of underlying conditions or diseases. We also use early intervention to break the cycle of symptoms, and create realistic care plans for patients. It’s about managing each case individually, and getting the best outcome possible for the patient.
Workers at a red meat abattoir were experiencing episodes of trigger finger that were escalating to surgery. Trigger finger is a problematic condition that often struggles to recover with conservative management. The workers were using a vibrating knife with a circular blade, that can be large or small. It requires the pressing of a trigger to activate the knife, which then results in both compression and vibration in the hand using the tool. This results in the thickening of the finger flexor tendon in the palm of the hand and the formation of a nodule, that can become caught under the complex series of pulleys in the hand (usually the A1 pulley). Repeated use of the finger flexors will cause this condition to prolong. Workers were usually removed by their doctor from knife-handling roles, without further instruction given regarding rehabilitation, or return to work coordinators or case managers.
What was observed during floor walks at this site, was that the workers were usually placed into packing roles that required the use of both hands. Some of the forces that workers need to do when packing are pinch grip (to pull the bags from the roller and pull the bags over the meat), palmar grip (when picking the meat up from the slicers or from the belt) and power grip, for the cuts that allowed it. This requires considerable load through the finger flexors and will cause the trigger finger to continue if left unchecked. After commencement as injury management provider, it was recognised that this practice was preventing the workers from being able to recover.
Workers with this condition were then placed into jobs that required the use of only one hand (the non-affected hand) and provided with suitable treatment and home rehabilitation advice. This resulted in improved outcomes for the injured workers and a more timely return to full duties, preventing the need for surgery.
The earlier you notice an employee is experiencing potential signs of ill health or injury, the sooner you can take steps to help them. Acting early is critical to the recovery process.
Musculoskeletal and psychological concerns were referred straight to a GP or hospital with no other care or triage. As a result, we were seeing poor patient outcomes. A common outcome was that patients became ‘medicalised’ – they entered the medical system and got stuck in a cycle of pain/medication without considering other options and with no real intention of treating the problem, rather than the symptom.
Currently, my observation is that early intervention is misunderstood – there is a misconception that it belongs in the “pre-claims” space. Some businesses plan for workers compensation claims. It is accepted that claims will occur and should therefore be budgeted for, rather than prevented. There is a focus on “resolving” claims. We know that many musculoskeletal issues cannot be completely “resolved”. They need to be managed within the worker’s capacity.
We have a long way to go, but with the right resources, systems and programs in place, early intervention will become part of the business strategy to manage the workforce. Managers will understand what early intervention is. Every employee will have a tailored care plan, and all staff will be at work, on full duties. Our ageing workforce will be supported – with the intention to have workers on full duties until they retire. On-site healthcare providers will understand early intervention, your business, and your people, and will be trusted advisors.
A red meat abattoir had been experiencing problems rehabilitating boners that were experiencing wrist pain. The employer had followed the usual path of temporarily placing the injured workers onto “light duties” as per the instructions of the treating doctor to reduce the lifting load of the worker and avoid “excessive wrist twisting” and the worker’s injury was managed by a physiotherapist externally.
It was noted that injured workers were very slow to recover. They were continuing to experience frequent pain when doing their job and when at rest, and a painfully restricted range of motion.
After arriving on-site to provide injury management solutions, our Work Healthy Australia provider undertook a floor walk to examine all of the jobs that were performed. During this floor walk, the provider was told of the issues the employer had been having in rehabilitating the workers. It was noted that the injured workers were being asked to cut the intercostal meat from the rib cage. This job, while requiring a relatively low force to cut compared with boning, still required significant twisting of the wrist. “Excessive twisting” had not been defined by any observer prior to that. Repetitive twisting, even under a low load, can still cause or aggravate an existing injury.
It was suggested to the employer that workers with this type of injury be asked to do jobs where either their wrist remained neutral, or if they could do light jobs that they can do one-handed. This resulted in vastly improved recovery times for boners with injured wrists.
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