SURVEY REPORT: EXECUTIVE SUMMARY

Transcription

1 The Rle f the Wrkplace in Return t Wrk an evidence base fr infrming plicy and appraches SURVEY REPORT: EXECUTIVE SUMMARY Prepared fr WrkCver SA by Dr Kate Barnett, Ms Nami Guiver, Mr Eric Parnis & Assc Prf Jhn Spehr The Australian Institute fr Scial Research April 2 nd 8

2 Prject Team This prject was cmmissined by WrkCver SA and undertaken by the Australian Institute fr Scial Research (AISR) at the University f Adelaide. Team members were Dr Kate Barnett, Deputy Executive Directr, AISR Mr Daniel Cx, Evlutin Research and AISR Research Assciate Ms Nami Guiver, Research Cnsultant and AISR Research Assciate Mr Eric Parnis, Senir Research Assciate, AISR Assc Prf Jhn Spehr, Executive Directr, AISR Ms Margaret Swincer, Manager, Research Strategy, WrkCver SA Acknwledgements The AISR and WrkCver SA are indebted t the aged care rganisatins and their staff wh cntributed t this research study either by participating in the surveys f managers and emplyees, in interviews, in the case studies, r in prviding advice. In particular, we wuld like t thank the staff wh acted as the pint f liaisn between the researchers and aged care staff Helen Radslvich, Plicy and Research, Helping Hand Aged Care Lynn Richardsn (and her team), Health and Safety Manager, The ACH Grup, and Chair f the Aged and Cmmunity Services Health and Safety Frum Cs Lambert, Wrkers Cmpensatin Manager, Member, SISA Aged Cmmittee Maureen Cffey, Barunga Village Inc, Prt Brughtn Anthea Daly, HS Executive, Life Care Maggie Gergiadis, Human Resurce Officer, UnitingCare Wesley, Prt Adelaide Nla Heffernan, Leahurst Hme fr Aged Care Nurses Sharn Hendersn, Quality Assurance and Safety Crdinatr, Trevu Huse Residential Aged Care, Gawler Virginia Hlness, OHS/Rehabilitatin Crdinatr, Ceduna District Health Services David Jeffs, Manager, Bethsalem Jude Sheidw, Human Resurces, Helping Hand Aged Care Gene Trenerry, Brightn Aged Care We wuld als like t thank the fllwing peple fr their input - Darryl Turner, Emplyers Mutual Olga Kelsey, Industry Claims Manager, Emplyers Mutual Luise Pike, Team Leader Aged Care, Emplyers Mutual Sally Ralph, Emplyers Mutual Tri Savvas, Claims Manager - Aged Care, Emplyers Mutual Lucy D Alia, Acting Manager f Stakehlder Cnsultatin, WrkCver SA Radek Stratil, Cnsultant Psychlgist, WrkCver SA Barry Shaw Principal Industry Advisr, SafeWrk SA Brian Adams Chief Advisr - Industry and Small Business Strategy, SafeWrk SA Ingrid Ormay Industry Advisr, Industry and Small Business Strategy, SafeWrk SA Mardi Webber Industry Advisr Manufacturing, SafeWrk SA AISR (8) Achieving effective return-t-wrk in the SA aged care industry: Survey Findings Reprt, Executive Summary, prepared fr WrkCverSA 2

3 Key Findings The wrkplace has a critical rle t play in preventing wrk-based injury and illness, and in prmting timely and effective return-t-wrk fllwing injury r illness. This is a key finding f the prject and f previus research. Aged care rganisatins frming the sample fr the prject survey have received psitive ratings fr their wrkplace cnditins, and with the greatest risk being assciated with slippery flrs, lse rugs and ther fall-inducing cnditins. The lwest ratings have been applied t factrs that prvide aged wrkers with a degree f cntrl ver hw they undertake their wrk, particularly in relatin t when they can take a break, hw they can structure their hurs. High levels f autnmy and cntrl are assciated with mre effective rates f return t-wrk. Peple wrking in plicy r administrative rles, and in ffice rather than residential care r clients hme settings, had greater degrees f cntrl than ther aged care emplyees. Wrkplace culture has a strng influence n return-t-wrk utcmes and while there was a trend fr mst rganisatins t be rated psitively, this did nt apply when cmmunicatin was pr between managers and staff r within wrk teams, when trust levels were lw within wrk teams, when wrk teams and management were nt supprtive t ill r injured wrkers, and in the presence f wrkplace bullying. Aged care rganisatins received their mst psitive ratings fr their supprtiveness t injured r ill wrkers and their lwest fr wrkplace bullying and trust between management and staff. Return-t-wrk has been fund t be significantly related t perceived standards f wrkplace safety. The survey sample have given their mst psitive rating t the value placed by their emplying rganisatin n wrkplace safety, and the psitive impact f the aged care sectr s emphasis n training in lifting and prvisin f lifting equipment has been reflected in the psitive ratings given t this issue. The receptiveness f management t wrkers raising safety cncerns has als been psitively assessed. The lwest ratings apply t inadequate training f managers and supervisrs in safety and injury management. The mst psitive ratings were applied t aged care rganisatins respnse t wrkplace injury r illness, and these were higher than thse given t safety and the preventin f wrkplace injury r illness. The mst psitive ratings were given t emplying rganisatins encuragement f early ntificatin f injury r illness, the use f a Returnt-Wrk Plan and the invlvement f supervisrs and the injured wrker in this and wrkplace accmmdatins made fr the wrker. The imprtance f appinting a Returnt-Wrk Crdinatr was als identified. The lwest rating has been given t cmmunicatin prcesses between all stakehlders invlved in return-t-wrk. AISR (8) Achieving effective return-t-wrk in the SA aged care industry: Survey Findings Reprt, Executive Summary, prepared fr WrkCverSA 3

4 Intrductin Cmmissined by WrkCver SA and undertaken by the Australian Institute fr Scial Research (AISR) at The University f Adelaide, the Return-t-Wrk prject is designed t increase understanding f wrkplace factrs that affect the achievement f psitive return-t-wrk utcmes. The Prject is fcused n the aged care sectr in the first instance, and is planned t be extended t ther industry sectrs in Suth Australia ver time. It has been undertaken using a mixed methdlgy f quantitative and qualitative research methds. These are its main cmpnents A review f the research literature, fcused n wrkplace factrs that affect injury and illness, and effective return-t-wrk fllwing injury r illness. Structured interviews and fcus grups with key stakehlders in WrkCver SA, Emplyers Mutual (the sle agency fr claims management in Suth Australia), aged care industry representatives and researchers specialising in return-t-wrk. Tw Case Studies f Gd Practice in achieving return-t-wrk in the aged care sectr. Analysis f unit recrd data f all WrkCver SA claims fr the 2 years 6 and 7. A survey f managers and a survey f emplyees frm the Suth Australian aged care sectr. The tw questinnaires were pilted with tw rganisatins prir t their release late in 7. The survey was active fr tw mnths and was clsed in February 8. The prcess fr distributing the survey was tailred t each rganisatin in rder t minimise disruptin and was ffered with a chice f hard cpy r n-line participatin. The survey sample Ten rganisatins agreed t participate in the survey, and these cvered a range f lcatins (rural, uter metrplitan and metrplitan), and a mixture f fr- and nt-fr-prfit agencies. There was als a mixture f small, medium and large rganisatins, prviding lw t high level residential care and cmmunity care. A ttal f 7 individuals have participated in the emplyee survey and 55 in the manager survey - yielding an estimated respnse rate f 22% fr emplyees and 69% fr managers. In structuring the sample, we had sught a mixture f participants based n wrkers cmpensatin claim histry. We achieved this with 21.2% f the emplyee sample having had a past wrkers cmpensatin claim and returned t wrk; a further 1.8% (1 peple) having had an active claim and had nt returned t wrk at the time f the survey; the majrity (68.5%) having never been injured seriusly and with n claim histry; a further 7.6% (42 peple) had been injured in their wrkplace but had n claim histry. In brief, statistical cmparisns (Mann-Whitney U-tests) 1 revealed the fllwing statistically significant relatinships based n claim histry and ther variables: Nurses were significantly mre likely t have made a claim cmpared t staff as a whle, and als t Care wrkers and Other wrkers (ie mainly grup managers and allied health staff) in particular (p<.5); 1 This is a test that is used t determine if a statistically significant difference exists between tw grups. AISR (8) Achieving effective return-t-wrk in the SA aged care industry: Survey Findings Reprt, Executive Summary, prepared fr WrkCverSA 4

5 Part-time emplyees were significantly mre likely t have made a claim cmpared with all ther emplyees as a whle, and Casual staff in particular (p<.5); Female emplyees were significantly mre likely t have made a claim than male emplyees (p<.5); Older emplyees were significantly mre likely t have made a claim than yunger emplyees (p<.5); Emplyees with a Degree, Masters Degree r Dctrate were significantly less likely t have made a claim than emplyees with ther levels f educatin (p<.5); Emplyees with a physical disability were significantly mre likely t have made a claim than thse with a psychiatric disability (p<.5) r n disability (p<.1); Unin members were mre likely t have made a claim than nn-members (p<.1). The prprtin f emplyees making a claim did nt differ significantly acrss: Settings (ie residential aged care sites, clients hmes, administratin centres, cmmunity care sites); First language (English/Other); Birthplace (Australia/Other English-speaking/Nn-English speaking). The Return-t-Wrk Indexes The survey instrument develped and trialled in the Suth Australian aged care sectr is designed t be a) repeated t measure change ver time within rganisatins and in the sectr, b) applied t ther industry sectrs. In designing the survey, the AISR drew tgether findings frm the literature review and frm ur scping interviews with aged care prviders, WrkCverSA, SafeWrkSA and Emplyers Mutual staff. These clustered int a number f themes which are reflected in the subsequent cnstructin f five Indexes, each gruping tgether questins relating t factrs that are knwn t affect wrkplace injury rates and t affect return-t-wrk 2. These invlve: The cnditins f the wrkplace The degree f cntrl r autnmy wrkers have in relatin t their wrk rle and respnsibilities and hw these are undertaken The culture f the wrkplace fr example, supprtiveness shwn t injured r ill wrkers, the degree f trust, quality f cmmunicatin Safety in the wrkplace and the preventin f injury and illness The way in which the wrkplace respnds t injury r illness, including prvisin fr return-t-wrk. Separate surveys were prvided fr emplyees and managers, with bth being cnstructed t enable reprting against the Indexes. Respnses represent aggregated measures that prvide a snapsht f verall rganisatinal climate and capacity t achieve effective return- 2 The respnse categry Unsure, and cases where n respnse was given - Nt stated - were excluded frm these statistical calculatins. AISR (8) Achieving effective return-t-wrk in the SA aged care industry: Survey Findings Reprt, Executive Summary, prepared fr WrkCverSA 5

6 t-wrk. Further analysis invlving tests f significance (fr example, based n the presence r absence f a current r past wrkers cmpensatin claim, r wrk setting) prvides mre detailed infrmatin abut the rle f the wrkplace in prmting health and safety and its respnse t injury r illness. The five Indexes can be used as a measure f bth achievement and challenges that need t be addressed. They can be used as a risk management tl thrugh early identificatin and management f prblems, and as a baseline t assess the impact f interventins designed t enhance the rle f the wrkplace in the return t wrk. The ttal Return-t-Wrk Wrkplace Index represents the emplying rganisatin s perceived capacity t design and perate the wrkplace t prevent r minimise wrkrelated injury r illness and t achieve timely 3 and effective return-t-wrk (as perceived by its emplyees and managers). Using a five pint Likert scale, survey participants rated their wrkplace n a number f features fr each f the five Indexes. The scale prvided a range frm 1 (which represented the least favurable rating) t 5 (representing the mst psitive rating). Taken tgether, the ttal survey sample findings prvide ratings f this sample f the Suth Australian aged care sectr as a whle. As the chart belw illustrates, bth surveys shared cmmn questins t derive three f the Indexes, while tw f the Indexes were specific t the survey f emplyees. Feedback frm managers was designed t btain an assessment f their emplying rganisatin s wrkplace (as ppsed t their experience as emplyees f that rganisatin). Feedback frm emplyees was designed t capture perceptins f bth the wrkplace and their wn experience as wrkers in their emplying rganisatin. Return-t-Wrk Wrkplace Index Wrkplace Index Sub Indexes Survey f Managers Survey f Emplyees Index I: Wrkplace cnditins Index III: Wrkplace cntrl Index III: Wrkplace culture Index IV: Wrkplace Safety (prmtin f safety and preventin f injury) Index V: Wrkplace Respnse t Injury (and illness/ facilitatin f return t wrk) 3 We use the term timely rather than early t acknwledge that premature return t wrk is likely t militate against effective return-t-wrk utcmes. AISR (8) Achieving effective return-t-wrk in the SA aged care industry: Survey Findings Reprt, Executive Summary, prepared fr WrkCverSA 6

7 Presentatin f the five Indexes and accmpanying analytical framewrk Fr each f the five Indexes we present 1 The respnses t each cmpnent f that Index, shwing the Mean, Median, Mde and Standard Deviatin. 2 A Ttal Scre fr that Index (achieved by gruping the scres int categries). 3 Cmparative analyses undertaken n the ratings f a) managers and emplyees b) thse with and withut a wrkers cmpensatin claim histry c) thse wrking in residential care facilities and thse wrking in clients hmes (fr the Wrkplace Cnditins Index nly) and d) n the basis f different wrk rles (fr the Wrkplace Cntrl Index nly). Where statistical significance was reached in the abve analyses (using the Mann-Whitney U test), the findings are reprted, and these have highlighted a number f implicatins fr reducing wrkplace injury and illness and fr achieving effective return-t-wrk. Tw f the Indexes (Cntrl and Safety) have been presented with tw versins, with the secnd remving specific items f the Index. Findings: Overview Cllectively, the survey findings reinfrce the findings f previus research regarding the imprtant rle f the wrkplace in relatin t return-t-wrk, and the significant scpe that exists fr emplyers t prevent injury and t achieve effective return-t-wrk when this des ccur. As the chart belw indicates, the majrity f the aged care prviders in this sample have been psitive in their assessment f the aged care wrkplace in Suth Australia. Hwever, it is als imprtant t nte that a prprtin f emplyees (particularly thse with an active r past claim fr wrkers cmpensatin) reprt cncerns, which warrant analysis and attentin. The Index t receive the highest verall mean scre was the Wrkplace Respnse t Injury r Illness Index, receiving 4.5 frm emplyees and 4.6 frm managers, fllwed by the Wrkplace Safety, then Wrkplace Cnditins, and Wrkplace Culture Indexes. The Wrkplace Cntrl Index had the lwest scre, and was the nly Index t receive an average ttal rating belw 4 with means f 3.5 and 3.7 fr the tw versins calculated frm findings. AISR (8) Achieving effective return-t-wrk in the SA aged care industry: Survey Findings Reprt, Executive Summary, prepared fr WrkCverSA 7

8 Ratings fr the five Wrkplace Indexes cmpared Index Emplyees Managers Mean Median Mean Median Wrkplace Cnditins n/a n/a Wrkplace Cntrl (1) n/a n/a Wrkplace Cntrl (II) n/a n/a Wrkplace Culture Wrkplace Safety (I) Wrkplace Safety (II) Wrkplace Respnse Findings: The Wrkplace Cnditins Index Emplyees in general have given psitive ratings f their rganisatins, with the lwest average rating (that is, the least psitive) being 3.3 indicating that wrkplace temperature is t ht r t cld, fllwed by slippery flrs and ther fall-inducing cnditins (4.). The mst psitive rating was 4.7 indicating that wrkplaces were unlikely t expse emplyees t vibratin frm equipment, nr have excessive nise levels (4.4). A Wrkplace Cnditins Index scre (i.e. the mean f all stated Wrkplace Cnditins items) was calculated fr respndents with at least 5 valid respnses ut f the 9 cmpnent questins. This yielded an average scre acrss all f the items in this Index f 4.2 and a median scre f 4.3. Chart 37: Wrkplace Cnditins Index: ttal scre Wrkplace Cnditins Index NB. Includes nly thse emplyees with a valid Index scre (n=532).5 % f sample Very lw (<2) 2.3 Lw (2 t <3) Mderate (3 t <4) High (4 t <5) Wrkplace Cnditins Index (categries) 8.8 Very high (=5) AISR (8) Achieving effective return-t-wrk in the SA aged care industry: Survey Findings Reprt, Executive Summary, prepared fr WrkCverSA 8

9 Further analysis f these findings was undertaken t take accunt f different wrk settings. This fund a significant difference in relatin t slippery flrs, lse rugs and ther factrs that can lead t a fall (p<.5) with emplyees wrking in residential care settings being mre psitive than thse wrking in clients hmes. Such cnditins can be expected t be mre difficult t cntrl in a hme setting than in a residential facility. This finding is f further interest when cmpared with the finding that wrkplaces bringing greater risk f falls are als significantly assciated with emplyees with a past r active wrkers cmpensatin claim. Analysis n the basis f wrkers cmpensatin claim histry fund statistically significant differences between the ratings f emplyees with, and withut, a past r active wrkers cmpensatin claim in relatin t the fllwing three Wrkplace Cnditins Index items vibratin frm equipment - bearing in mind that this was the mst psitively assessed wrkplace cnditin fr the sample as a whle (p<.5) being in skin cntact with chemicals (p<.5) slippery flrs, lse rugs and ther fall-inducing cnditins (p<.5). There was als a statistically significant difference (p<.5) n the verall Wrkplace Cnditins Index scre, based n wrkers cmpensatin claim histry. This yielded a Mean ttal scre f 4.1 fr thse with a claim histry, cmpared t the higher Mean f 4.2 fr thse with n claim histry, and a Median scre f 4.2 fr thse with a claim histry cmpared t the higher Median f 4.3 fr thse with n claim histry. Wrkplace Cnditins Index by Claim/N Claim NB. Includes nly thse emplyees with a valid Index scre (n=532) Claim (active r previus) N claim (never made a claim) % f valid respnses Lw (2 t <3) Mderate (3 t <4) High (4 t <5) Very high (5) Wrkplace Cnditins Index (categries) There was a statistically significant difference between the Index scres fr Claim/NClaim (Mann-Whitney U= , p<.5) Findings: The Wrkplace Cntrl Index Researchers have identified that the degree f cntrl by individual emplyees ver their wrk (fr example, in the rdering f tasks and timing f breaks) is critical t psitive health utcmes and is thus imprtant in managing injury r illness, with lw levels f cntrl being assciated cnsistently with jb strain and ill-health disease (Karasek & Therell: 199; Planyi: 4; Cats & Max: 5). Emplyees rated their perceptin f seven aspects f cntrl ver their wn duties/rle within their wrkplace n a 5-pint Likert scale with higher scres indicating greater cntrl. AISR (8) Achieving effective return-t-wrk in the SA aged care industry: Survey Findings Reprt, Executive Summary, prepared fr WrkCverSA 9

10 The verall perceptin f Wrkplace Cntrl has been less psitive than the rating f Wrkplace Cnditins and had the lwest verall scre f the five Indexes. The lwest mean rating (2.9) was applied t the capacity t adapt my wrking hurs within limits while the highest (4.) related t being able t cntrl r change the rder f my tasks. Hwever, it shuld be nted that these tw items have strngly bimdal distributins, (that is, mdes at bth 1 and 5 ) and is likely t reflect the fact that sme wrk rles in aged care are mre difficult than thers t be structured arund individual wrker need (fr example, direct caregiving rles cmpared with plicy r administrative rles). Therefre, a secnd versin f the Wrkplace Cntrl Index was generated which excluded these tw items. Remving the tw items with bimdal scres increased the Mean rating t 3.7 and the Median rating t 4. cmpared with Versin 1 f the Index. Chart 5: Wrkplace Cntrl Index: Ttal scre Versin I Chart 51: Wrkplace Cntrl Index: Ttal scre Versin II Wrkplace Cntrl Index NB. Includes nly thse emplyees with a valid Index scre (n=544) Wrkplace Cntrl Index (Versin II) NB. Includes nly thse emplyees with a valid Index scre (n=543) % f sample % f sample Very lw (<2) Lw (2 t <3) Mderate (3 t <4) High (4 t <5) Very high (=5) Very lw (<2) Lw (2 t <3) Mderate (3 t <4) High (4 t <5) Very high (=5) Wrkplace Cntrl Index (categries) Wrkplace Cntrl Index - Versin II (categries) All f the items frming the Wrkplace Cntrl Index were tested fr significance n the basis f having, r nt having, an active r previus wrkers cmpensatin claim. One f the items I can adapt my wrking hurs within limits had a significant difference shwing that emplyees wh had made a cmpensatin claim rated their wrkplace as prviding less cntrl ver wrking hurs than was the case fr thse with n claim histry (p<.5). Further analysis was undertaken f findings in relatin t the tw Wrkplace Cntrl Index items with bimdal distributins - I can decide when t take a break, and I can adapt my wrking hurs within limits. This indicated that there were grups f emplyees within the sample with very different levels f cntrl in terms f wrking hurs and timing f breaks. Fr this reasn, we undertk further investigatin f the data n the basis f a) wrkplace setting and b) rle in the rganisatin. Significant differences were fund in the ratings given by emplyees wrking in residential care facilities r clients hmes cmpared with thse wrking in ffice-like settings. Staff in administrative centres, cmmunity care ffices and similar settings were mre likely t agree AISR (8) Achieving effective return-t-wrk in the SA aged care industry: Survey Findings Reprt, Executive Summary, prepared fr WrkCverSA 1

11 that they culd decide when t take a break than were staff in residential aged care (Mann- Whitney U=11948., p<.1) and staff wrking in clients hmes (Mann-Whitney U=3124.5, p<.1). Staff in residential aged care were significantly less likely t agree that they culd adapt their wrking hurs cmpared with staff wrking in clients hmes (Mann-Whitney U= , p<.1) and staff wrking in Other (administrative, cmmunity care ffices etc) settings (Mann- Whitney U= , p<.1). The level f flexibility in wrking hurs and breaks is likely t be mre a functin f the rle f the emplyees than f their wrk settings and there were differences reprted fr each rle in terms f the ability t decide when t take a break and the ability t adapt wrking hurs. Care wrkers tended t reprt the least flexibility in taking a break, and plicy/administratin staff tended t reprt the mst flexibility in thse areas, with nurses smewhere in between the tw. Statistical cmparisns indicated significant differences between the rle grupings (Nurse, Care Wrker, Plicy/Admin, Dmestic/Hme Maintenance), with the exceptin f the cmparisn between care wrkers and dmestic r hme maintenance wrkers. In terms f the ability t adapt wrking hurs, staff wrking in plicy r administrative rles clearly cnsidered themselves t have greater cntrl than did nurses, care wrkers and dmestic r hme maintenance wrkers. The difference between the plicy / administrative rle and the ther rles was statistically significant (p<.1). Findings: The Wrkplace Culture Index A number f researchers have identified wrkplace culture as being critical t the management f successful return-t-wrk (Rberts-Yates: 3, 6; Franche et al: 4; Australian Institute fr Primary Care: 6). Amng the wrkplace culture factrs affecting return-t-wrk are the supprt ffered by supervisrs and c-wrkers, verall rganisatinal climate, and wrkplace cnflict and stress (ibid: 42-47). Researchers have als identified that wrkplace bullying is a cause f emplyees under-reprting accidents and injuries, and that the incidence f injuries related t ccupatinal vilence (bth verbal and physical abuse) is higher in aged care than in ther fields (invlving clients as well as wrkers), despite indicatins f substantial underreprting f wrkplace vilence r bullying. Assaulted wrkers were fund t have increased incidences f burnut, absenteeism, and turnver (Daniels & Marlw, 5: 17). The survey f emplyees and the survey f managers asked respndents t rate their wrkplace n a number f factrs that cllectively are relevant t verall wrkplace culture. The items included in this Index encmpassed cmmunicatin, trust, bullying, encuragement f emplyees t raise wrk-related cncerns with managers, and supprtiveness fr injured r ill wrkers. Emplyees have given psitive ratings abut mst aspects f their rganisatins wrkplace culture. The mst psitive average rating was If an emplyee becmes ill/injured, the wrk team are usually supprtive, clsely fllwed by If an emplyee becmes ill/injured management/supervisrs are usually supprtive (4.3) and If an emplyee becmes ill/injured, my clleagues wuld be willing t help with the wrklad (4.3). The lwest mean rating being 3.6 (It is unusual fr peple t experience bullying in my rganisatin) fllwed by There is a gd level f trust between managers and staff (3.7). Given the research findings cited abve regarding wrkplace culture, these tw issues are imprtant in risk assessments f aged care wrkplaces. AISR (8) Achieving effective return-t-wrk in the SA aged care industry: Survey Findings Reprt, Executive Summary, prepared fr WrkCverSA 11

12 These findings mean that emplyees have rated their rganisatin s respnse t injury r illness as being mre psitive than its levels f trust and preventin f bullying, bth f which are indicatrs f verall wrkplace culture. This trend t rate highly the supprtiveness f managers and emplyees twards injured wrkers was reinfrced by findings pertaining t the Wrkplace Respnse t Injury Index which reprted psitive ratings frm mst emplyees and managers fr supprt prvided t injured wrkers, and was cmparatively mre psitive than the assessment given f wrkplace safety and preventin f injury (Wrkplace Safety Index). Managers have als been psitive in their assessment f their rganisatins wrkplace culture. In agreement with emplyees, they have given their least favurable rating t It is unusual fr peple t experience bullying in this rganisatin (3.9), fllwed by There is a gd level f trust between managers and staff (4.2). Their mst psitive rating was given t If an emplyee becmes ill/injured management/supervisrs are usually supprtive (4.6), fllwed by Cmmunicatin between managers and staff usually wrks well (4.4) and If an emplyee becmes ill/injured, the wrk team are usually supprtive (4.4). Systematic literature reviews prvide evidence that clear cmmunicatin, cperatin, and establishing cmmn agreed gals between the injured wrker, health prviders, supervisrs and management are critical fr psitive clinical and ccupatinal utcmes (Australian Institute fr Primary Care: 6; Rberts-Yates: 6; Franche et al: 7; 4). Emplyees have given psitive average ratings t cmmunicatin in their wrkplaces, with cmmunicatin within their wrk teams rated at 4.1 while cmmunicatin between wrkers and managers was rated less psitively at 3.8. Managers have been mre psitive, rating cmmunicatin within wrk teams at 4.3 and cmmunicatin between wrkers and managers at 4.4. The degree f trust in relatinships between emplyers and emplyees has als been fund t be imprtant, as this is fund t affect the sense f cntrl wrkers have ver their wrk and the amunt f stress experienced, with attendant health cnsequences (Cats & Max, 5: 38). Emplyees have given a psitive average rating (4.1) t the level f trust within their wrk teams but a less psitive rating t the degree f trust between wrkers and managers (3.7). By cntrast, managers take a mre psitive view than emplyees prviding an average rating f 4.3 fr the level f trust within wrk teams and an average rating f 4.2 fr the degree f trust between wrkers and managers. Research findings cnfirm the relatinship between effective return-t-wrk and supprtiveness f supervisrs/managers and c-wrkers t injured wrkers (Kenny: 1998; Franche et al: 4; Rberts-Yates: 3, 6). Emplyees and managers have given a psitive average rating t the supprtiveness f wrk teams (4.4 each) and f manager r supervisrs (4.3, 4.6) and the willingness t help injured clleagues with wrklad (4.3 and 4.2). There has been a reasnable degree f agreement between managers and emplyees in rating their wrkplace culture, with the nly statistically significant difference relating t the perceived effectiveness f cmmunicatin between managers and staff, (Mann-Whitney U = 152, p<.1). This crrespnds t the emplyees lwer rating, cmpared with managers, f the degree f trust between staff and management, described abve. The ttal average scre fr this Index frm emplyees was 4. (median scre f 4.3) and frm managers was 4.3 and (median scre f 4.3). While these ttal scres are psitive, they represent an average scre within which nearly 15% f emplyees gave their wrkplace a Lw t Very lw rating. Chart 76: Wrkplace Culture Index - Emplyees AISR (8) Achieving effective return-t-wrk in the SA aged care industry: Survey Findings Reprt, Executive Summary, prepared fr WrkCverSA 12

13 Wrkplace Culture Index: Emplyees NB. Includes nly thse emplyees with a valid Index scre (n=543) Wrkplace Culture Index: Managers NB. Includes nly thse emplyees with a valid Index scre (n=53) 69.8 % f sample 46.4 % f sample Chart 77: Wrkplace Culture Index - Managers Very lw (<2) Lw (2 t <3) Mderate (3 t <4) High (4 t <5) Wrkplace Culture Index (categries) 17.3 Very high (=5). Very lw (<2) 1.9 Lw (2 t <3) 18.9 Mderate (3 t <4) High (4 t <5) Wrkplace Culture Index (categries) 9.4 Very high (=5) There was a statistically significant difference between emplyees with r withut a past r active wrkers cmpensatin claim. This yielded a Mean scre f 3.8 fr thse with a claim histry, cmpared t the higher Mean f 4.1 fr thse with n claim histry. Chart 79: Wrkplace Culture Index Claim and N Claim cmpared Wrkplace Culture Index by Claim/N Claim NB. Includes nly thse emplyees with a valid Index scre (n=543) Claim (active r previus) N claim (never made a claim) % f valid respnses Very lw (<2) Lw (2 t <3) Mderate (3 t <4) High (4 t <5) Very high (5) Wrkplace Culture Index (categries) There was a statistically significant difference between the Index scres fr Claim/NClaim (Mann-Whitney U= , p<.5). All f the items frming the Wrkplace Culture Index were tested fr significance n the basis f having r nt having an active r previus wrkers cmpensatin claim. The fllwing six items were fund t shw a statistically significant difference, being mre psitively rated by thse with n claim histry, cmpared t thse with an active r past claim Effective cmmunicatin between managers and staff (p<.5) Effective cmmunicatin within wrk teams (p<.5) Gd level f trust within wrk teams (p<.1) Wrkplace bullying (p<.5) Wrk teams are supprtive t ill/injured emplyee (p<.5) Management/supervisrs are supprtive t ill/injured emplyee (p<.5). AISR (8) Achieving effective return-t-wrk in the SA aged care industry: Survey Findings Reprt, Executive Summary, prepared fr WrkCverSA 13

14 These findings supprt previus research in highlighting the imprtant rle that wrkplaces and the culture they embdy can play in achieving effective return-t-wrk. Findings: The Wrkplace Safety Index Numerus researchers have linked a cmpany s safety climate (that is, the reflectin f wrkers perceptins f the pririty given t safety in their wrkplace) t injury rates (Planyi: 4). Australian research has fund that return-t-wrk is significantly related t higher perceived standards f ccupatinal health and safety characteristics f wrkplaces (Kenny: 1998). The Wrkplace Safety Index included items assessing wrkers knwledge f cmpensatin and claims prcesses because researchers have frequently identified the need fr injured wrkers t be infrmed abut the cmpensatin prcess and its assciated rights and respnsibilities (Franche et al: 4) and that return-t-wrk is significantly related t psitive perceptins f methds f infrmatin disseminatin t wrkers abut their rights and entitlements (Kenny: 1998). The Index als includes items relating t the training f emplyees and managers in ccupatinal health and safety and injury preventin. The imprtance f this in achieving effective return-t-wrk is a theme in the research literature (Franche et al: 4). Emplyees were psitive in their ratings with the highest assessment made f the perceived value placed by their emplying rganisatin n wrkplace safety (4.5) and the prvisin f equipment t prevent injury frm heavy lifting (4.5), and the availability f lifting equipment (4.4). This is likely t be a reflectin f the emphasis that has been placed by the aged care sectr in recent years n training in lifting and manual handling f clients, and the prvisin f equipment fr lifting including making sure that sufficient lifting equipment is available. Emplyees have als been psitive in rating the prvisin f training in lifting t prevent injury (4.3) and the encuragement f bringing t the attentin f managers issues abut wrkplace safety (4.3). The least psitive ratings pertained t the infrmatin prvided t emplyees t ensure familiarity with wrkers cmpensatin rights and bligatins (3.7) and prcesses (3.6), and prcesses assciated with making a claim (4.). Managers were extremely psitive in their ratings with the highest assessment made f the perceived value placed by their emplying rganisatin n wrkplace safety (4.75) in line with emplyees ratings - and the capacity f management t listen t wrkplace safety issues raised by emplyees (4.75). In agreement with emplyees surveyed, the least psitive ratings related t the infrmatin prvided t emplyees t ensure familiarity with prcesses assciated with making a claim (3.75) and t the amunt f training managers received in injury preventin (3.7). Given hw psitive managers have been in mst f their ratings, the lwer assessment given by them t the training they receive in injury preventin shuld be interpreted as a need fr further training n this issue. Further analysis f findings shwed a significant difference in ratings given t managers training in injury preventin, based n whether r nt a claim fr wrkers cmpensatin was invlved. In calculating a ttal Wrkplace Safety Index scre, it was fund that 52.6% f emplyees gave their rganisatin a High rating verall (that is, a mean scre between 4. and 4.9 inclusive) and AISR (8) Achieving effective return-t-wrk in the SA aged care industry: Survey Findings Reprt, Executive Summary, prepared fr WrkCverSA 14

15 a further 17.5% gave the mst psitive rating pssible f 5. This prvided an average scre acrss all f the items in this Index f 4.2 and a median scre f 4.4. Hwever, it shuld be nted that nearly 9% gave a Lw t Very Lw rating. Managers were similar in their assessment, with 67.9% giving their rganisatin a High rating verall and a further 5.7% giving the mst psitive rating pssible f 5. This prvided an average scre acrss all f the items in this Index f 4.25 and a median scre f 4.5, which is slightly higher than that f emplyees. Chart 112: Wrkplace Safety Index Versin I - Emplyees Chart 113: Wrkplace Safety Index Versin I- Managers Wrkplace Safety Index: Emplyees NB. Includes nly thse emplyees with a valid Index scre (n=544) Wrkplace Safety Index: Managers NB. Includes nly thse emplyees with a valid Index scre (n=53) % f sample % f sample Very lw (<2) 7.4 Lw (2 t <3) Mderate (3 t <4) High (4 t <5) Very high (=5). Very lw (<2) 3.8 Lw (2 t <3) Mderate (3 t <4) High (4 t <5) 5.7 Very high (=5) Wrkplace Safety Index (categries) Wrkplace Safety Index (categries) A secnd versin f the Wrkplace Safety Index was generated, which excluded the three items regarding emplyees knwledge f wrkers cmpensatin and claim prcesses. Emplyees average scre acrss all f the items in this secnd versin f the Index increased t 4.3 and the median scre t 4.6. The average scre fr managers als increased slightly t 4.3 and the median scre remains at 4.5. AISR (8) Achieving effective return-t-wrk in the SA aged care industry: Survey Findings Reprt, Executive Summary, prepared fr WrkCverSA 15

16 Chart 114: Wrkplace Safety Index Versin II- Emplyees Chart 115: Wrkplace Safety Index Versin II- Managers Wrkplace Safety Index (Versin II): Emplyees NB. Includes nly thse emplyees with a valid Index scre (n=541) Wrkplace Safety Index (Versin II): Managers NB. Includes nly thse emplyees with a valid Index scre (n=53) 66. % f sample % f sample 1.7 Very lw (<2) 7. Lw (2 t <3) 15.3 Mderate (3 t <4) High (4 t <5) Very high (=5). Very lw (<2) 3.8 Lw (2 t <3) 18.9 Mderate (3 t <4) High (4 t <5) 11.3 Very high (=5) Wrkplace Safety Index - Versin II (categries) Wrkplace Safety Index - Versin II (categries) The Wrkplace Safety Index (excluding the three items regarding emplyees knwledge f wrkers cmpensatin and claim prcesses) was further analysed by cmparing the ratings f emplyees n the basis f claim histry. Again a statistically significant difference was evident (p<.5), with thse with n claim histry rating their wrkplaces apprach t safety and injury preventin in a mre psitive way. This yielded a Mean scre f 4.1 fr thse with a claim histry, cmpared t the higher Mean f 4.3 fr thse with n claim histry, and a Median scre f 4.3 fr thse with a claim histry cmpared t the higher Median f 4.6 fr thse with n claim histry. Chart 116: Wrkplace Safety Index emplyees with and withut a claim Wrkplace Safety Index (Versin II) by Claim/N Claim NB. Includes nly thse emplyees with a valid Index scre (n=541) Claim (active r previus) N claim (never made a claim) % f valid respnses Very lw (<2) Lw (2 t <3) Mderate High (4 t <5) Very high (5) (3 t <4) Wrkplace Safety Index - Versin II (categries) Statistically significant difference between the Index scres fr Claim/NClaim (Mann-Whitney U= , p<.5). The imprtance f training in ccupatinal health and safety and injury preventin, fr bth emplyees and managers, was evident in the analysis n the basis f claim histry which fund AISR (8) Achieving effective return-t-wrk in the SA aged care industry: Survey Findings Reprt, Executive Summary, prepared fr WrkCverSA 16

17 that thse with n claim histry prvided significantly mre psitive ratings abut wrkplace safety and injury preventin in relatin t these six items f the Wrkplace Safety Index Emplyees receive enugh training in ccupatinal health and safety issues (p<.1). Emplyees receive enugh training in Injury preventin (p<.5). Managers receive enugh training in ccupatinal health and safety issues (p<.5). Managers receive enugh training in injury preventin (p<.5). Emplyees receive enugh training in lifting t prevent injury (p<.5). Managers listen if emplyees raise wrkplace safety issues (p<.5). This finding reinfrces the imprtance f a safety-fcused wrkplace culture that fsters pen cmmunicatin and trust between managers and emplyees, and prvides emplyees with the cnfidence t raise safety issues knwing that management will listen t them. Althugh aged care emplyees and managers have been generally very psitive in their assessment f wrkplace safety, this needs t be tempered by additinal cmments prvided which identified as a risk t safety, the extreme pressures faced due t insufficient resurces. One f the reprted results f this is a tendency t rush and t take risks with lifting and manual handling in rder t save time. The inter-related pressures f limited time, resurces and staff numbers can vertake the benefits f training. Findings: The Wrkplace Respnse t Injury Index While the Wrkplace Safety Index examined rganisatins capacity t prevent wrkplace injury r illness, the Wrkplace Respnse t Injury Index explred the apprach taken in respnse t injury r illness. Bth emplyees and managers have been mre psitive, verall, abut their rganisatins respnse t wrkplace injury and illness and t achieving return-t-wrk, than abut their rganisatins capacity t prevent injury and illness. A number f researchers have fund that early interventin (including early ntificatin and treatment, early return-t-wrk and wrkplace mdificatin) is a critical factr in enabling early return-t-wrk as well as reduced csts assciated with health care and wage replacement (Rberts-Yates: 6; Franche et al: 7, 4; Kenny: 1998; Australian Institute fr Primary Care: 6; Pransky et al: 4). Early interventin relies n timely reprting (Pransky et al: 1999) and the lack f this may cmpund the seriusness and cstliness f injuries (Jhnsn & Fry: 2). The Wrkplace Respnse t Injury Index assesses the cmmunicatin between the different players in the return-t-wrk prcess, the timeliness f ntificatin f an injury, the develpment f a return-t-wrk plan, the invlvement f injured emplyees in that plan, the invlvement f supervisrs/managers in that plan, and the prvisin f supprt and redesign f wrk rles r wrkplaces t enable early return-t-wrk. Based n the findings f previus research, these are all factrs that influence the achievement f psitive return-t-wrk utcmes. Emplyees gave their mst psitive average rating (4.8) t plicies encuraging emplyees t ntify as early as pssible if they have been injured. It was clear frm ur initial interviews with managers frm the participating rganisatins that several had been prmting early ntificatin in respnse t a trend fr aged care industry emplyees t under-reprt injuries. The ratings fr the ther wrkplace-based respnses are als very psitive. In line with research findings n the factrs that enable an effective return-t-wrk, very psitive ratings have been AISR (8) Achieving effective return-t-wrk in the SA aged care industry: Survey Findings Reprt, Executive Summary, prepared fr WrkCverSA 17

18 given t develping a return-t-wrk plan (4.6), invlving supervisrs (4.6) and the injured wrker in that plan (4.5), and wrk redesign t accmmdate the injured wrker (4.5). Given the number f stakehlders invlved in the RTW prcess, crdinatin f their inputs is essential, and is ften facilitated by the appintment f a persn designated t achieve this utcme. The presence f a Return-t-Wrk Crdinatr has emerged as ne imprtant strategy fr facilitating return-t-wrk, and supervisrs and managers have als been fund t play an imprtant rle (Australian Institute fr Primary Care: 6; Franche et al: 4). Crdinatin is als imprtant because it supprts effective cmmunicatin between the varius peple invlved in the return t wrk prcess. Cmmunicatin between treatment prviders and the wrkplace that is fcused n preventing re-injury is a critical factr in reducing absence frm the wrkplace and achieving an early return-t-wrk (Franche et al: 7). A crdinated and cllabrative apprach between all stakehlders has been fund t be essential fr the effective management f return-t-wrk (Australian Institute fr Primary Care: 6; Franche et al: 4; Yassi et al: 2). The mst negative rating (3.95) was applied t the cmmunicatin prcesses between management and thse managing the wrker s injury r illness. Hwever, it shuld be nted that nly 56% f emplyees wh had never made a claim were able t prvide a rating fr the cmmunicatin prcesses between return-t-wrk stakehlders, cmpared with 79.5% f emplyees wh had experience f making a claim (which is understandable if they have nt had direct experience with a wrkers cmpensatin claim). In deriving a ttal scre fr the Wrkplace Respnse t Injury Index emplyees average scre acrss all f the items in this Index was 4.5 and the median scre was 4.8. Managers ratings were mre psitive and yielded an average scre acrss all f the items in this Index f 4.6 and a Median scre f 4.8. Chart 139: Wrkplace Respnse Index - Emplyees Chart 1: Wrkplace Respnse Index - Managers Wrkplace Respnse t Injury Index: Emplyees NB. Includes nly thse emplyees with a valid Index scre (n=442) Wrkplace Respnse t Injury Index: Managers NB. Includes nly thse emplyees with a valid Index scre (n=53).4 % f sample % f sample Very lw (<2) Lw (2 t <3) Mderate (3 t <4) High (4 t <5) Very high (=5).. Very lw (<2) Lw (2 t <3) Mderate (3 t <4) High (4 t <5) Very high (=5) Wrkplace Respnse t Injury Index (categries) Wrkplace Respnse t Injury Index (categries) AISR (8) Achieving effective return-t-wrk in the SA aged care industry: Survey Findings Reprt, Executive Summary, prepared fr WrkCverSA 18

19 N statistically significant difference was fund between emplyees and managers respnses fr this Index as a whle. Hwever, analysis f individual items fund a significant difference (p<.1) between them in relatin t their ratings f the effectiveness f cmmunicatin between all parties invlved in the return-t-wrk prcess. Cmparative analysis f this Index n the basis f emplyees claim histry did nt quite reach significance. The majrity f managers indicated that the strategy f having a specific return-t-wrk plicy and/r set f prcedures was less likely t be in place (89.1% f managers) than was the use f a designated Return-t-Wrk Crdinatr and ccupatinal health and safety (OH&S) assessments f the wrk envirnment (94.5% f managers fr each). Findings: Return-t-Wrk - Enablers and Barriers The emplyees and managers surveyed have prvided a significant amunt f infrmatin abut factrs that facilitate and factrs that inhibit effective return-t-wrk. This is evident in their respnses t the items frming the five Wrkplace Indexes. T this infrmatin can be added the respnses f the 127 individuals with a past r active wrkers cmpensatin claim wh were asked t describe the factrs that had assisted and the factrs that hindered their return-t-wrk. Respnses have been gruped int fur categries wrkplace related factrs WrkCver related factrs, treatment-related factrs and ther factrs which include the wrker and their persnal and ther supprt surces. These fur sets f factrs will all have a bearing n recvery and return-t-wrk, but it is clear that the wrkplace is identified as a critical surce in enabling return-t-wrk, and preventing this. Setting aside the nature f the injury and the effectiveness f treatment prvided, much depends n the accmmdatins made t wrk rles and cnditins, and the attitudes f supervisrs/managers and wrk clleagues. Treatment-related enablers cllectively were identified by 65.4% f these respndents, clsely fllwed by wrkplace-related factrs, identified by 63.%. The mst cmmnly identified facilitatr was the treatment itself (5.4% f the 127 peple wh had made a claim), which is lgical. Hwever, the secnd mst cmmnly identified facilitatr was the re-design f wrk rles and ther mdificatins that accmmdate injury r illness (25.2%), fllwed by management supprt and flexibility (14.2%), adequate time t recver (13.4%), supprt frm clleagues (13.4%) and a Return-t-Wrk Plan (7.1%) as well as the wrker s wn persnal qualities (7.1%). The supprt prvided by WrkCver staff r case managers was the seventh mst frequently identified facilitatr (5.5%). The identificatin f wrkplace/wrk rle mdificatin as the mst imprtant wrkplacebased facilitatr f return-t-wrk is als the strategy that was mst cmmnly identified by bth emplyees and managers when asked t indicate hw aged care rganisatins supprt an early return-t-wrk fr injured r ill wrkers emplyees. This was fllwed by reducing hurs, then by prviding flexible hurs, retraining fr a different wrk rle and the prvisin f assistive equipment. This is an imprtant achievement by aged care prviders.

20 The mst cmmnly identified barrier was the injury r illness itself and the difficulties assciated with it (19.7% f these respndents). Hwever, the secnd mst cmmnly identified facilitatr was managers r supervisrs attitude, lack f knwledge r lack f actin (12.6%), fllwed by the nature f the jb, including a lack f suitable alternative wrk duties and accmmdatin (9.4%). Of the fur categries f barriers, thse relating t the wrkplace cllectively represented 31.5% f respnses, ahead f the ther three types f barriers. Cnclusins The Return-t-Wrk survey has been designed t increase ur understanding f wrkplace factrs that affect the achievement f psitive return-t-wrk utcmes. This has included the develpment and applicatin f five Indexes which seek t measure wrkplace factrs that affect return-t-wrk, while assessing the capacity f participating aged care rganisatins t supprt effective return-t-wrk. Survey findings supprt thse f the existing research literature and ne change has been identified as needed t the Indexes. The AISR suggests that the Wrkplace Respnse t Injury Index have ne additinal item that identifies the appintment f a Return-t-Wrk Crdinatr. Obviusly any applicatin t ther industries will require a review and tailring f individual items, particularly thse that are part f the Wrkplace Cnditins Index. With regard t the prcess used t distribute the surveys, the AISR has had psitive feedback abut the tailring f this t suit individual rganisatins, and abut the chice f written r n-line feedback. The suitability f this apprach t ther industry sectrs wuld need t be determined n an industry by industry basis, but the principle f tailring based n cnsultatin with key stakehlders is upheld. The type f feedback fr ther sectrs wuld include the ptin f telephne interview, especially fr peple with limited literacy and English language prficiency. At the same time, it is recgnised that interview based feedback is mre labur intensive and therefre, mst cstly. The tailring apprach t adds t csts because f the time spent in cnsultatin and fine-tuning prcesses. Hwever, the AISR cnsiders that this is a necessary cst in rder t ensure that survey questins are relevant and the prcess negtiated fr participatin is realistic. An issue fr cnsideratin is future applicatins f the Wrkplace Respnse t Injury Index is the inclusin f cntractrs as well as emplyees with nging appintments. Where cntractrs represent a significant prprtin f the wrkfrce it will be imprtant t include them, despite the difficulties assciated with btaining their participatin (fr example, their emplying agencies requiring payment fr their time t participate, r rganisatins nt perceiving cntractrs t be part f their wrkfrce). Table 28 summarises the key achievements f the aged care prviders studied, based n ratings f 4.1 r better by managers and emplyees, and the challenges that require their fcus, based n ratings f 4. r less. Where there is agreement between managers and emplyees, the item has been highlighted. Wrkplace Cnditins and Wrkplace Cntrl are all highlighted as they are based n emplyee ratings nly. AISR (8) Achieving effective return-t-wrk in the SA aged care industry: Survey Findings Reprt, Executive Summary, prepared fr WrkCverSA