COlDlDunication: A Marketing Tool CHERYL CASS BALDWIN Farnum Industrial Rehabilitation, Keene, New Hampshire
Good communication can be the most e.JJective therapeutic and marketing tool used within an industrial rehabilitation program. Effective communication among professionals is a key way to establish and maintain an atmosphere of professional cohesiveness (Osborne and Courts, 1991). The benefits of good communication are numerous. Strong treatment planning, smooth transitions back to work, identifying symptom magnifiers, eliminating team splitting, and having new learning opportunities for professionals are among the benefits found most often in industrial rehabilitation (Brown, 1991). Keywords: Communication; Treatment planning; Industrial rehabilitation; Team building
The professionals who make up an industrial rehabilitation team are often not able to meet on a regular basis. The basic team consisting of the occupational therapist, the physical therapist, the psychologist, and the vocational counselor usually meet weekly, but the other members including the employer, the insurance adjuster, the rehabilitation consultant, and the medical doctor meet only once or twice during the course of a program and not all of the members attend those meetings. Therefore, it is very important to keep those team members up to date on information through phone calls and written reports, at least once a week, and more often when appropriate. It is also important to remember that the client is a part of the team and needs to be kept abreast of progress. By communicating with all of the team members at regular intervals, the team is able to develop a strong treatment plan that can be followed by all involved parties. The employer is most important in this instance. When the client is returning to work on light duty with restrictions, it is important for the employer to know the restrictions and carry them out. During a therapeutic
return to work, the client may be returning for only 1 hour per day. The therapist is not able to be with the client each day, although it is recommended that the therapist be with the client the first day. The employer therefore needs to know what to expect from the client and then be able to report back to the therapist on the outcomes of the work. If each team member knows exactly what the plan is and they agree with it, the plan becomes strong and the client will know what to work toward. During the return-to-work phase, many problems can occur if each team member is not up to date on the plan for return. Most important to the client is their weekly check and the amount of that check. When returning to work, the client mayor may not be receiving payment at their preinjury salary. The workers' compensation company must know the amount the client will be paid and the number of hours each week that the client will be working so that they can determine the amount of the weekly compensation check. Before returning to work, the client must have a release from their medical doctor. For the doctor to reWORK 1994; 4(1):68-70 Copyright © 1994 by Butterworth-Heinemann
Communication: A Marketing Tool
lease the client and write appropriate restrictions, the doctor must have current information on the status of the client and the client's present functional capacities. Many doctors are now turning to industrial rehabilitation therapists for assistance in determining whether a client is ready to return to work. It is important that the team members keep in close contact throughout the returnto-work process and not just at the initiation of the process. Problems can arise at any phase of the process and can be solved simply if each member knows in which direction the client is heading. Close contact with team members and having all available information prior to a functional capacity evaluation can help to spot symptom magnifiers. Information on the number of doctors that a client has seen and all of the treatments the patient has tried (medications, therapy, etc.) can help in the evaluation. It is also helpful to know what type of compensation the client is receiving. Sometimes compensation calculations are made inadvertently so that the client actually receives more staying home then helshe would if they returned to work. Many different facts can prove that someone is symptom magnifying, but the therapist should use objective testing along with information gathering to make this determination. The therapist should be positive before making any accusations. Industrial rehabilitation clients can, at times, be manipulative and can try to split team members. This is done by playing therapist and employer off against each other or other team members. This can happen within the program between different therapists. The best way to prevent this is to communicate with all team members throughout the program and make each member aware of any decisions that are made regarding the client. When asked a specific question by the client, the team members should confer and together determine an appropriate response. By being aware of the actions of other team members actions, the chance for the client to split the team is decreased significantly. Through open communication and being free to voice ideas and opinions to all team members, learning opportunities are created (Brown, 1991). Each client is a different person and should be
69
looked at as a whole person; therefore, that client should be treated as an individual and the treatment plan the team writes should be tailored to that client. This opens lines for communication to new ideas and learning experiences among team members. Different approaches can be used to accomplish the specified goals. The learning is endless when a team is creative and allows for each member to playa role.
THE INDUSTRIAL REHABILITATION PROGRAM Effective communication needs to begin at the moment the referral is received. Most often the referral comes from the doctor. When this is so, it is appropriate to then call the doctor's office and request all of the doctor's notes. If the referral came from another source, the doctor still needs to be contacted for verbal approval and for the notes. After the doctor's notes have been requested, the client should be contacted to schedule an appointment. The following information needs to be asked of the client, the employer, the insurance company, the rehabilitation consultant, the lawyer (if applicable), and any other doctors that may be involved. Names and phone numbers should be recorded. Before the evaluation takes place, the insurance company should be contacted for prior approval. Some company's do not require this, but it is best to call and ask. If a rehabilitation consultant is involved, often that person is able to be a liaison between the insurance company and the industrial rehabilitation program. It is recommended that the therapist make contact with the insurance company to verify whether that is the case. It is important to have the client sign a release ofinformation so that all team members can be contacted with pertinent information. Immediately following the evaluation, it may be appropriate to contact team members. This would be true in the case of a symptom magnifier or if there is discrepancy with the diagnosis. If work hardening is not recommended, the evaluation report can be written and sent to the appropriate team members. If the client is to begin a
70
WORK / JANUARY 1994
work hardening program, the insurance company should be contacted for prior approval. At this time the employer should be contacted for a job description to assist with fabricating job simulation tasks. The employer can update the therapist on recent changes within the company or of any concerns that may be present concerning the client. Once the client has started the work hardening program, the core team should meet formally on a weekly basis and informally throughout the week. It is recommended that the client be reevaluated biweekly and that all team members be kept up to date on the client's progress. This is especially helpful to the employer so that the company knows that the client is working toward a return to work. The insurance company also needs to be kept up to date on progress and often the company will ask for expected date of return to work. A job site analysis is recommended before the client returns to work. The client, the therapist, and the employer should be present for this evaluation. Other team members can be present if able. This evaluation allows for the employer and client to get reacquainted and discuss the job demands before the client starts back to work. The therapist can be a facilitator in decisions regarding restrictions on the job and in helping the client to use newly learned body mechanics and techniques to decrease injury. Upon discharge from industrial rehabilitation, the client's functional capacities are once again
reevaluated and discharge information is sent to all team members. It is recommended that an evaluation be sent to all members asking for feedback on the program and the whole process.
CONCLUSION Using this model of communication within the industrial rehabilitation program, clientele has more than doubled. It is important to have an attitude that allows for effective communication (Brown, 1991). That includes both giving and taking information and being open to new suggestions and ideas. It is important to be honest and admit when you don't know the answer to a question. Poor communication leads to poor treatment planning and poor outcomes with industrial rehabilitation clients (Murphy, 1990). All team members feel important in this effort, and they are twice as likely to refer a client to your program the next time. One word of caution when using this model, make sure there is a signed consent for release of information on file for every client.
REFERENCES Brown, K. C. (1991). Strategies of effective communication. AAOHN j, 39, 292-293. Murphy, T. (1990). Improving nurse/doctor communications. Nursing 90, 114-118. Osborne, W., and Courts, N. (1991). Better communications make more compassionate hospitals. Nursing Management, 22, 31-32.
Good communication can be the most e.JJective therapeutic and marketing tool used within an industrial rehabilitation program. Effective communication among professionals is a key way to establish and maintain an atmosphere of professional cohesiveness (Osborne and Courts, 1991). The benefits of good communication are numerous. Strong treatment planning, smooth transitions back to work, identifying symptom magnifiers, eliminating team splitting, and having new learning opportunities for professionals are among the benefits found most often in industrial rehabilitation (Brown, 1991). Keywords: Communication; Treatment planning; Industrial rehabilitation; Team building
The professionals who make up an industrial rehabilitation team are often not able to meet on a regular basis. The basic team consisting of the occupational therapist, the physical therapist, the psychologist, and the vocational counselor usually meet weekly, but the other members including the employer, the insurance adjuster, the rehabilitation consultant, and the medical doctor meet only once or twice during the course of a program and not all of the members attend those meetings. Therefore, it is very important to keep those team members up to date on information through phone calls and written reports, at least once a week, and more often when appropriate. It is also important to remember that the client is a part of the team and needs to be kept abreast of progress. By communicating with all of the team members at regular intervals, the team is able to develop a strong treatment plan that can be followed by all involved parties. The employer is most important in this instance. When the client is returning to work on light duty with restrictions, it is important for the employer to know the restrictions and carry them out. During a therapeutic
return to work, the client may be returning for only 1 hour per day. The therapist is not able to be with the client each day, although it is recommended that the therapist be with the client the first day. The employer therefore needs to know what to expect from the client and then be able to report back to the therapist on the outcomes of the work. If each team member knows exactly what the plan is and they agree with it, the plan becomes strong and the client will know what to work toward. During the return-to-work phase, many problems can occur if each team member is not up to date on the plan for return. Most important to the client is their weekly check and the amount of that check. When returning to work, the client mayor may not be receiving payment at their preinjury salary. The workers' compensation company must know the amount the client will be paid and the number of hours each week that the client will be working so that they can determine the amount of the weekly compensation check. Before returning to work, the client must have a release from their medical doctor. For the doctor to reWORK 1994; 4(1):68-70 Copyright © 1994 by Butterworth-Heinemann
Communication: A Marketing Tool
lease the client and write appropriate restrictions, the doctor must have current information on the status of the client and the client's present functional capacities. Many doctors are now turning to industrial rehabilitation therapists for assistance in determining whether a client is ready to return to work. It is important that the team members keep in close contact throughout the returnto-work process and not just at the initiation of the process. Problems can arise at any phase of the process and can be solved simply if each member knows in which direction the client is heading. Close contact with team members and having all available information prior to a functional capacity evaluation can help to spot symptom magnifiers. Information on the number of doctors that a client has seen and all of the treatments the patient has tried (medications, therapy, etc.) can help in the evaluation. It is also helpful to know what type of compensation the client is receiving. Sometimes compensation calculations are made inadvertently so that the client actually receives more staying home then helshe would if they returned to work. Many different facts can prove that someone is symptom magnifying, but the therapist should use objective testing along with information gathering to make this determination. The therapist should be positive before making any accusations. Industrial rehabilitation clients can, at times, be manipulative and can try to split team members. This is done by playing therapist and employer off against each other or other team members. This can happen within the program between different therapists. The best way to prevent this is to communicate with all team members throughout the program and make each member aware of any decisions that are made regarding the client. When asked a specific question by the client, the team members should confer and together determine an appropriate response. By being aware of the actions of other team members actions, the chance for the client to split the team is decreased significantly. Through open communication and being free to voice ideas and opinions to all team members, learning opportunities are created (Brown, 1991). Each client is a different person and should be
69
looked at as a whole person; therefore, that client should be treated as an individual and the treatment plan the team writes should be tailored to that client. This opens lines for communication to new ideas and learning experiences among team members. Different approaches can be used to accomplish the specified goals. The learning is endless when a team is creative and allows for each member to playa role.
THE INDUSTRIAL REHABILITATION PROGRAM Effective communication needs to begin at the moment the referral is received. Most often the referral comes from the doctor. When this is so, it is appropriate to then call the doctor's office and request all of the doctor's notes. If the referral came from another source, the doctor still needs to be contacted for verbal approval and for the notes. After the doctor's notes have been requested, the client should be contacted to schedule an appointment. The following information needs to be asked of the client, the employer, the insurance company, the rehabilitation consultant, the lawyer (if applicable), and any other doctors that may be involved. Names and phone numbers should be recorded. Before the evaluation takes place, the insurance company should be contacted for prior approval. Some company's do not require this, but it is best to call and ask. If a rehabilitation consultant is involved, often that person is able to be a liaison between the insurance company and the industrial rehabilitation program. It is recommended that the therapist make contact with the insurance company to verify whether that is the case. It is important to have the client sign a release ofinformation so that all team members can be contacted with pertinent information. Immediately following the evaluation, it may be appropriate to contact team members. This would be true in the case of a symptom magnifier or if there is discrepancy with the diagnosis. If work hardening is not recommended, the evaluation report can be written and sent to the appropriate team members. If the client is to begin a
70
WORK / JANUARY 1994
work hardening program, the insurance company should be contacted for prior approval. At this time the employer should be contacted for a job description to assist with fabricating job simulation tasks. The employer can update the therapist on recent changes within the company or of any concerns that may be present concerning the client. Once the client has started the work hardening program, the core team should meet formally on a weekly basis and informally throughout the week. It is recommended that the client be reevaluated biweekly and that all team members be kept up to date on the client's progress. This is especially helpful to the employer so that the company knows that the client is working toward a return to work. The insurance company also needs to be kept up to date on progress and often the company will ask for expected date of return to work. A job site analysis is recommended before the client returns to work. The client, the therapist, and the employer should be present for this evaluation. Other team members can be present if able. This evaluation allows for the employer and client to get reacquainted and discuss the job demands before the client starts back to work. The therapist can be a facilitator in decisions regarding restrictions on the job and in helping the client to use newly learned body mechanics and techniques to decrease injury. Upon discharge from industrial rehabilitation, the client's functional capacities are once again
reevaluated and discharge information is sent to all team members. It is recommended that an evaluation be sent to all members asking for feedback on the program and the whole process.
CONCLUSION Using this model of communication within the industrial rehabilitation program, clientele has more than doubled. It is important to have an attitude that allows for effective communication (Brown, 1991). That includes both giving and taking information and being open to new suggestions and ideas. It is important to be honest and admit when you don't know the answer to a question. Poor communication leads to poor treatment planning and poor outcomes with industrial rehabilitation clients (Murphy, 1990). All team members feel important in this effort, and they are twice as likely to refer a client to your program the next time. One word of caution when using this model, make sure there is a signed consent for release of information on file for every client.
REFERENCES Brown, K. C. (1991). Strategies of effective communication. AAOHN j, 39, 292-293. Murphy, T. (1990). Improving nurse/doctor communications. Nursing 90, 114-118. Osborne, W., and Courts, N. (1991). Better communications make more compassionate hospitals. Nursing Management, 22, 31-32.
