The ideal of consumer choice in social services: challenges with implementation in an Ontario injured worker vocational retraining programme.

PURPOSE: Social service programmes that offer consumer choices are intended to guide service efficiency and customer satisfaction. However, little is known about how social service consumers actually make choices and how providers deliver such services. This article details the practical implementation of consumer choice in a Canadian workers' compensation vocational retraining programme. METHOD: Discourse analysis was conducted of in-depth interviews and focus groups with 71 injured workers and service providers, who discussed their direct experience of a vocational retraining system. Data also included procedural, policy and administrative documents. RESULTS: Consumer choice included workers being offered choices about some service aspects, but not being able to exercise meaningful discretion. Programme cost objectives and restrictive rules and bureaucracy skewed the guidance provided to workers by service providers. If workers did not make the "right" choices, then the service providers were required to make choices for them. This upset workers and created tension for service providers. CONCLUSIONS: The ideal of consumer choice in a social service programme was difficult to enact, both for workers and service providers. Processes to increase quality of guidance to social service consumers and to create a systematic feedback look between system designers and consumers are recommended. Implications for Rehabilitation Consumer choice is an increasingly popular concept in social service systems. Vocational case managers can have their own administrative needs and tensions, which do not always align with the client's choices. Rehabilitation programmes need to have processes for considering what choices are important to clients and the resources to support them.

The role of health care providers in long term and complicated workers' compensation claims.

INTRODUCTION: Health care providers (HCPs) play a central role in workers' compensation systems. In most systems, they are involved in the legitimization of work-related injury, are required to provide information to workers' compensation boards about the nature and extent of the injury, give recommendations about return-to-work capability and provide treatment for injury or illness. This study identifies problems that occur at the interface between the health care system, injured workers, and workers' compensation boards (WCBs) that may complicate and extend workers' compensation claims and the mechanisms that underlie the development of these problems. METHODS: Interviews were sought with injured workers, peer helpers and service providers from a variety of geographic locations in order to get a broad picture of return to work problems and concerns. This analysis includes data from total of 34 interviews with injured workers who had long term and complicated claims. Interviews were also conducted with 14 peer helpers and 21 service providers. RESULTS: We identified four domains related to injured workers' interface with the health care system that played a key role in complicating and prolonging compensation claims. These problems, related to health care access, conflicting or imperfect medical knowledge, limited understanding of compensation system requirements and confusion about decision-making authority, resulted in frustration, financial difficulties and mental health problems for injured workers. CONCLUSION: Recommendations are made about how compensation system parties can find better ways to serve injured worker health care needs and facilitate a smooth relationship between the compensation board and HCPs.

The "toxic dose" of system problems: why some injured workers don't return to work as expected.

Introduction Most workers who incur an injury on the job follow a relatively straightforward path through a workers' compensation claim, recovery and return to work. However, a minority of compensation claims is prolonged and can be disproportionately costly. We conducted this qualitative study in order to gain an understanding of systemic, process-related problems affecting injured workers who had failed to return to work as expected. Method A total of 69 in-depth interviews were conducted with injured workers with complex and extended workers' compensation claims and with return-to-work (RTW) providers such as health care providers, insurers, legal advisors, and workplaces. The study was based in Ontario, Canada. A modified grounded theory analysis led to the identification of common mechanisms in RTW problems. Results We identify problems with return to work and extended workers' compensation claims in dysfunctions in organizational dynamics across RTW systems including the workplace, healthcare, vocational rehabilitation and workers' compensation. These system problems are difficult to identify because they appear as relatively mundane and bureaucratic. These appeared to have damaging effects on workers in the form of a 'toxic dose' affecting the worker beyond the initial injury. Conclusions Worker's problems with extended claims were linked to RTW policies that did not easily accommodate conflict or power imbalances among RTW parties and by social relations and processes that impeded communication about RTW situations and problems. Avenues for intervention are located in a shift to a critical lens to RTW process that addresses differences of knowledge, resources, and interests among different parties.

Reducing musculoskeletal burden through ergonomic program implementation in a large newspaper.

OBJECTIVES: To assess the impact of a workplace ergonomic program to reduce musculoskeletal burden among newspaper employees and to understand relationships among participation, risk factor changes and health status within an employee cohort. METHODS: We conducted repeat cross-sectional surveys, with 1,003 employees from all major departments in 1996 and 813 in 2001, generating a cohort of 433 participants in both surveys. Elements of the ergonomic program included employee RSI (repetitive strain injury) training, pro-active assessment of workstations and workstation modifications, and encouragement of early treatment through on-site physiotherapy. Potential risk factors included biomechanical and work organizational aspects of office work. Health status measures included pain intensity and the Work-Disability of the Arm, Shoulder, and Hand (DASH). Repeat cross-sectional analyses incorporated modifications for shared variance. For the cohort, a theory of change informed path analyses using MPLUS. RESULTS: Among respondents in 2001, 69% reported participation in RSI training and 56% had workstation assessments. Among those with pain, 57% had consulted a health practitioner, including the on-site physiotherapist. In repeat cross-sectional analyses, the proportion reporting moderate pain or worse, at least once per month or for longer than 1 week, declined from 20 to 16% (p=0.01). Among the cohort, pain intensity and work disability in 1996 were the strongest predictors of 2001 health status (both p<0.001). Stable or increased supervisor awareness and concern about RSI was associated with decreased pain in 2001(p<0.01). Participation in RSI training was associated with increases in decision latitude (p<0.05), which themselves were associated with decreased work disability in 2001 (p<0.05). Increased time mousing was associated with increases in work disability (p<0.05). CONCLUSIONS: Implementation of a worksite ergonomics program was associated with a reduction in frequent and severe pain in the workforce. Changes in work disability were affected by multiple factors.

Feared identity and obsessive-compulsive disorder.

We tested predictions from cognitive-behavioural theory that people with obsessive-compulsive disorder (OCD) regard their intrusions as revealing unacceptable aspects of their character. We compared an OCD sample with anxious controls (AC) and non-anxious controls (NAC) on a measure of the extent to which intrusions led to negative inferences about the self, assessed the discrepancy between their actual and feared self, and recorded the traits making up the feared self. The OCD sample did not differ from AC on self-discrepancies, but did differ from both control groups on the measure of negative inferences about the self. In addition, the feared self of the OCD sample was significantly more likely to consist of bad and immoral traits.

Paddling upstream: a contextual analysis of implementation of a workplace ergonomic policy at a large newspaper.

Efforts to implement workplace ergonomic programs aimed at reducing the burden of work-related musculoskeletal disorders (WMSD) have to address multiple physical and psychosocial aspects of work environments yet often contextual factors limit their success. We describe the processes involved in an ergonomic program to reduce neck and upper limb WMSDs at a large Canadian newspaper. Using qualitative data collection and analysis methods, we illustrate the impact of key contextual characteristics of: (1) the program (management commitment, union involvement, experience and skill of program leaders, and researcher involvement); (2) the organization (drive for productivity, management control, organizational culture); and (3) the broader social context (economic climate, nature of newspaper work, technology and nature of WMSD). We argue for increased attention to identification and response to the contextual factors affecting program implementation in order to more successfully address upstream determinants of WMSD.

Ergonomic handbook for the clothing industry

This document presents potentional ergonomic problems and solutions for workers in the textile industry. Information is relevent to both employers and employees in the industry. Publication from 2001, 69 pages, in PDF format.