RTW Matters

RTW matters latest newsletter advises why they wish they hadn’t had that tattoo done last year – and I couldn’t agree more.
<a href="Process SERVING People“>This brief excerpt from their update:

Last year, RTWMatters’ New Year’s Resolution was to flex our collective bicep, bite the pain bullet and get a “People over Process” tattoo.
A reader and soon-to-be blogger for RTW Matters wrote saying:

“I’ve been struggling with one of your resolutions—People over Process. I do understand the sentiment that drives you to that tattoo but I’ve spent a working life focusing on improving processes!

“If the staff of an organisation have no carefully thought through and established processes then they will be mired in uncontrollable work, forced to learn the same lessons over and over, to reinvent ways to do things again and again and have no time to deal with people.

“The secret is to be clear about the purpose of the organisation (“what are we here for”) so the processes are not an end in themselves but exist to deliver better outcomes for people.

Developing, and more importantly, implementing and using ‘good’ processes can be bloody difficult. It might sound easy, but good intentions are not simply enough.

Why?

RTWMatters’ Publisher Robert Hughes believes that, “in some instances process does become an end in itself and then it can lose sight of the problem it was intended to resolve. This kind of lost process is often that which is developed at arm’s length from the problem the process is notionally intended to resolve.”

Oh yes indeed. It’s the same argument I have had for some time about ‘quality management’. Let’s not get all excited about ‘tidying up’ some of the messy processes involved in helping people with chronic pain – let’s think first about what we’re hoping to achieve by it, and how we’re going to measure whether it’s worked. Then once that’s identified I’m sure there will be more ways than one to get to the same end point – and that variation is what distinguishes humans from machine parts.

I hope you enjoy this taste of RTW Matters, and take a peek at their content – and maybe subscribe, it’s worth it!

This just in from RTW Matters – Dr Mary Wyatt analyses the New Zealand RTW Monitor results and makes her predictions about whether, in the light of financial pressures and declining RTW rates, NZ is in for a RTW thaw or a snap freeze. It’s available only for subscribers, but here’s a brief summary… (oh and subscription isn’t much in financial terms but packs a punch in information terms!)

RTW rates are declining in both New Zealand and Australia

ACC indicates that this is because of ‘a number of factors, including the ageing population, the increasing complexity of claims, and claims management inefficiencies. The resulting impact has meant that clients are staying on the Scheme longer and costing more.’

As an aside, I wonder how it can be that claims are becoming more complex? Can someone enlighten me? Certainly I don’t see this in pain management: people with chronic pain are, almost by definition, complex, and this has not changed on iota in the 20 years I’ve been working in pain mangement. The only significant changes I’ve seen are that fewer people are attending for pain management with multiple surgeries, and more people are referred slightly earlier than the previous pain duration of 3.5 years.

The focus of the Government for ACC is cost containment

The ACC has taken the common scheme approach of dealing with financial problems by trying to moving long-term claimants out of the scheme. Long term claimants are the most costly part of any scheme, and removing them is the most cost-effective ways to deal with cost blowouts.

Mary Wyatt points out that one strategy used by ACC to do this is the increasing use of FCE to ‘predict’ whether someone can return to work. As she says, ‘As a tool to define a person is having a work capacity and therefore no longer being eligible for scheme payments, they may be an effective, however this does not mean they are valid. Moving people on from the system after a few years is basically declaring a failure of rehabilitation. If they are capable of returning to the workforce at that point, why haven’t they done so earlier?’

I’d mitigate this last statement by saying that because of legislation, economy and fear, amongst other reasons, people who are ‘fit to work’ in some capacity may not always obtain employment, hence the ‘work testing’ or ‘vocational independence assessment’ that ACC conducts in New Zealand. The intention of the legislation is not ‘return to work’ but ‘return to work readiness’. The end of rehabilitation assessment is a slightly different approach from some areas of the world and consists of:

(1) a review of the assessment recommendations that have been made over the course of the claim to establish whether all rehabilitative efforts have been completed

(2) a vocational assessment that details the work options a person may be able to do given ‘education, training and experience’ – without considering functional ability

(3) a medical assessment that reviews the medical status of the person and, in collaboration with the person reviews the various work options to establish whether he or she can sustain ’35 hours or more’ in any of them

For those unfamiliar with New Zealand legislation, there is no ability to litigate for personal physical injury, as ACC provides 24 hour ‘no-fault’ cover forpersonal physical injury for all people whether working or not, funded by levies from employers, employees and various other taxes. It was first introduced to New Zealand in 1974, and has continued to be a model for many commentators on accident compensation.

It’s difficult to establish why rehabilitation ‘performance’ appears to be less effective than previously. I can only observe that management of claims is often fragmented, that multiple treatment providers are often involved with quite contradictory aims, that contracts for services to claimants appears very prescriptive and often clumsy, and that case management can be quite different depending on the individual case manager working on a claim. Perhaps one factor could be the increased use of ‘multidisciplinary’ pain management but using teams of clinicians who rarely meet, may not have any specific education, training or experience in pain management, and who’s membership changes often, and within a programme framework that may be ‘pain management lite’ – or less than the recommended 50 – 100 hours of consolidated input (Main, Sullivan & Watson, 2008).

Back to RTW matters – as a taster, take a look at the free information available, and make your own mind up about its value.

Main, C., Sullivan, M., & Watson, P. (2008). Pain Management: practical applications of the biopsychosocial perspective in clinical and occupational settings. 2nd Ed. Churchill Livingstone, Elsevier, Philadelphia.