MANAGEMENT OF WORKERS COMPENSATION IN THE DISABILITY SECTOR WORKERS COMPENSATION ROOT CAUSE REVIEW

Transcription

1 MANAGEMENT OF WORKERS COMPENSATION IN THE DISABILITY SECTOR WORKERS COMPENSATION ROOT CAUSE REVIEW Whilst the Disability Safe Benchmarking project has identified a decline in the lost time injury frequency rate it is known that particular mechanisms of injury remain significant and contribute to the ongoing cost of workers compensation. Workers Compensation costs are unplanned and not funded so an increase in costs can lead to the need to cut staff and/or withdraw services. In a period of changing funding approaches a focus on prevention should have a positive impact on these costs. The Disability Safe project implemented a mini project in 2014 whereby organisations were asked to allow a review of the past 2 years of workers compensation claims in order to identify the root causes of the incident resulting in the claim and/or high claims costs. The aim of this review was to identify areas needing further attention and improvement. 18 Disability Service non-governmental organisations kindly agreed to this review and provided access to their claim file or in some cases database records. Approximately 297 claims were reviewed. Workers Compensation Insurance According to a previous survey the majority of disability services providers are classified under the residential (28.9%) and non-residential care services (29.6%) industry codes in their premiums. However education, home care and employment services were also highly represented. The calculation of a workers compensation premium considers the industry coding, the performance of the sector as a whole (industry costs of claim rate or ICCR) and the employer s claims experience (employer cost of claim rate or ECCR). The ICCR rate is set by WorkCover NSW to ensure that an adequate amount of premium is paid in order to adequately cover claims costs. Where the ICCR rate is lower than the ECCR rate the premium is likely to increase. Most of the organisations report having policies in the Medium, Medium-Large, and Large Premium classifications. A premium of over $2 million has been reported previously. 80% of providers renew their premiums on July 1. WorkCover has announced that it will be making changes to how premiums for medium to large employers is to be managed by introducing incentives for safe workplaces and incentives for providing suitable duties as well as reducing some of the administration processes. Details are not yet available. Root Cause analysis Information about root causes is usually identified in detailed incident reports or investigation reports and may from time to time be detailed in Rehab provider reports. As a large number of files viewed did not have a completed incident investigation or RTW plan/report on file it was difficult to extract the root cause in many cases. Basic data collected included time of day, day of week, service type, general and specific location of incident and agency and mechanism of injury. The largest number of incidents occurred in Accommodation Services, followed by Community Access. The highest number of incidents occurred in the Facility category mainly in vehicles, outdoor areas, bathroom and bedrooms. Whilst the time of day was not recorded in many cases the morning had a larger number of incidents than the afternoon and Tuesday had the most incidents recorded.

2 Day of week and Service Mon Tue Wed Thur s Fri Sat Sun Total Accommodation ADE admin 1 1 Administration Building services Clinical Nurse 1 1 Consultancy Community Access Employment Services Equipment and 1 1 Technology In home Individual and Family Support IT 1 1 Maintenance 1 1 Office admin 1 1 Respite Therapy 1 1 Warehouse Total Note: total numbers in particular services may reflect the profile of the organisations participating rather than risk level of those service types.

3 Location of incident Client home 36 Community 77 Facility 181 Facility/Community 1 Total 295 Note: again the location of the incident may reflect the service type and/or organisation participating. Vehicles were a common site of injury both for violent incidents and for manual handling and slip/trips/falls. Design and training issues both in vehicles, bathroom and bedroom were major areas of concern. Many of the incidents in outdoor locations related to the same causes (manual handling, violence of slip/trip/falls) but had far less obvious controllable causes.

4 Motor Vehicle Support worker Person Bedside table Clothing Environ ment Flooring Furniture /Fitting Object As can be seen from the following graph the main nature of injury was classified as musculoskeletal disorders followed by back injuries. Manual handling, violence and slip/trip/falls were the main mechanisms resulting in these injuries. The main mechanism and agency of injury are shown in the table below. Handling of objects and people were the main mechanism of injury and this was followed by workplace violence and slip/trips/falls. This aligns with the findings of the WHS Benchmarking undertaken yearly by the Disability Safe Project. Mechanism and agency main categories Self 3 Spray of fluid 2 Bullying/harassment 3 Other: MVA 1 4 Psychological 6 Workplace Violence 57 1 Slip/Trip/Fall Handling object Handling Person Total Contributing factors resulting in the incident were drawn from the descriptions of the incidents recorded on incident reports or investigations where available.

5 Consideration of seating location and staff levels, suitability of activity for the service user and suitability of equipment and transfer techniques are highlighted by these results. A significant number of injuries caused by assault occurred while the worker was driving. Also note the number of incidents relating to mobility activities for service user and worker.

6 Whilst not clearly identified due to the lack of investigation reports or detailed incident reports some influencing factors leading to the incident are shown in the graph above. Common threads including the display of challenging behaviours from clients such as biting, scratching, punching or kicking with or without obvious triggers but also issues around floor surfaces and other environmental deficiencies, equipment being used and a service which was aimed at fulfilling organisational or funding requirements rather than client needs. Main preventive strategies documented appeared to fall into the areas of: providing further training, reviewing/revising procedures to be followed maintenance and equipment provision. However, even when investigations were undertaken no action was documented in many cases. Approximately 50% of claims reviewed had a RTW plan available and some claims did not have a RTW plan on file even when worker was certified fit for suitable duties. There was no evidence of contact with the treating doctor in over 50% of claims. Doctor Contact RTW Plan No Yes Not known N/A Total N/A 1 1 No Not known Yes Total Conclusions: If the Disability Services Sector is to lower the number of workplace injuries and therefore the cost of workers compensation there are some clear actions needed: 1. Effective hazard reporting, response and maintenance systems are required, so that identified issues are addressed prior to an incident occurring. These are only effective if the required action is then implemented. There were several cases where it was known that the glass window was cracked, or the light switch was wet and no action was implemented till after the incident. 2. Effective incident reporting systems need to be implemented, which include investigation processes and the provision of suitable duties, to minimise time lost. This will require a cultural change within organisations so that incident reporting is regarded as the norm and a positive approach to safety. Early intervention activities which ensure that suitable duties are always available and employees have an expectation of undertaking suitable duties if injured is also required. 3. Further embedding of person-centred approaches such as, clear role definition for workers, workers as supports rather than enforcers and greater choice over activities for service users, may lead to less incidents in the intentional assault category noted above.

7 4. Training and competency assessments for workers appear to be deficient in many cases. Whilst initial induction training is undertaken, it is the task specific training and review through regular competency assessments which needs attention. Funding levels to reflect training needs will be vital. 5. Effective risk management approaches need to be implemented so that service users needs are fully understood and matched to trained staff, suitable equipment and environments. This will require access to appropriate support services and equipment for service providers. Specific mobility assessments from qualified personnel should be accessible and should consider the physical demands on the worker as well as the needs of the service user. Funding should be provided for equipment that meets the needs of both workers and service users. 6. Initial intake assessments, or the observation of any behaviour of concern should trigger a referral for the development of an appropriate management plan. The plan needs to consider environmental design, staffing and equipment to ensure that service users needs are accommodated without placing workers at risk. Embedding of effective WHSIM systems within the management systems of organisations is necessary to highlight that safety and early intervention are essential components any of business operation and service delivery. Significant resources are available to the Disability Sector to help establish effective WHS and Injury Management practices within organisations through the Disability Safe Project which offers face to face and online training, as well as technical advice and information through the Disabilitysafe website. GOOD PERFORMER INTERVIEWS This mini project also tried to identify the basis for good performance so that this could be communicated to the sector. Five good performers were formally interviewed but a number of others were also asked to provide details of what they were doing to achieve their results. All interviewees were in a WHS/HR Management role with time in the role varying from 2 to 7 years. The majority had come from a WHS/HR management role in the past and reported either to the CEO or the HR Manager directly. All had direct access to the CEO and the Board and reported on performance regularly. All organisations had a formal consultation process via committees combined with additional mechanisms via staff meetings, and safety officers. The majority reported that their WHS Management systems were not well developed or utilised prior to their appointment and workers compensation claim numbers and premium costs were high. Actions taken to address these issues were: Implementation of pre-employment psych and physical assessments Development of a range of policies and procedures in consultation with staff Implementation of early reporting strategies Development of branding for WHS to make it more readily accessible Development of intranet sites to ensure user friendly and accessible information

8 Training of middle managers who then had responsibility for training their staff Internal auditing systems with reporting so that all are aware and there is the ability to escalate issues Inclusion of WHS on staff meeting agendas and use of local representatives to feedback actions being taken Allocation of responsibility for early intervention strategies to local managers and support to them to ensure implemented Embedding of WHS responsibilities in all job descriptions Emphasis on incident investigation and implementation of controls Barriers encountered included resistance to change, reluctance to accept responsibility for actions, concern over the cost and time involved. To overcome the barriers a supportive approach with frequent visits and training, ongoing consultation and involvement of senior managers. Other suggestions included use of technology to simplify adoption. Results speak for themselves with the following outcomes noted varying in size due to varying sizes of organisations: Premiums have decreased by over $350,000 in one organisation. Cost of claims has reduced in all organisations. Lessons learnt: Ensure support of senior managers Ensure every staff member has measurable performance requirements for health and safety Ensure access to easily understood online systems Train and assess and reinforce regularly Intervene early if an injury occurs, support the worker but challenge any certificates for time lost by making suitable duties available