Role of the Occupational Therapist in an On-Site Occupational Rehabilitation Progratn A Case Study Jackl Johnson, BAppSc (OT) GradDipSafatySc Industrial Rehabilitation Service Sydney, Australia
Occupational rehabilitation is concerned with restoring the person to the highest level of function in the work place (physically, socially, and psychologically). It is aimed at maintaining the injured person's work habits and skills by either maintaining the injured employee at work or returning the employee to work after an injury. Occupational therapists have traditionally been involved in this process. The literature in the professional journals supports this. Phyllis Ross (1982) in her article in the British Occupational Therapy journal emphasises the aim of rehabilitation as being to decrease the time absent from work, therefore, ensuring the injured employees' job security and maintaining good work habits and skills. Recent legislative changes in most states of Australia place a large emphasis on the rehabilitation of the injured employee. In New South Wales each employer was required to establish a "workplace based" occupational rehabilitation program by December, 1988. This presents as a challenge to most employers, and all of us as occupational therapists have an important role in ensuring such programs are de-
veloped and implemented successfully. That is, it is successful for both the injured employee and the employer. This article presents a case study of an organization that has successfully implemented such a program. The Ford Motor Company, Homebush Assembly Plant, has had a work place-based rehabilitation program since 1984. The case study will focus on the role of the occupational therapist, and the key factors that have assisted in the success of the program and the results of the program. I will first provide a briefbackground to the industry and the program.
BACKGROUND The Homebush Assembly Plant is responsible for the assembly of the Laser motor car, a small fourcylinder passenger vehicle. It has one major Trade Union representing it's employees. This is the Vehicle Builders Employee's Federation. In 1984, the Industrial Rehabilitation Service commenced contracting an occupational therapist and an ergonomist (whose background was also that of occupational therapy) to the Ford Motor Company, providing on-site occupational rehabilitation. On-site at Ford, the occupational therapist and ergonomist roles aim to complement the existing WORK 1993; 3(3):73-76 Copyright © 1993 by Andover Medical
74
WORK / SUMMER 1993
occupational health, safety, management and engineering resources: • Occupational Health Nurse/Safety Co-ordinator • Sessional Physiotherapist • Sessional Doctor • Management • Supervisor and it maXImIzes the process of the employee involvement process existing within the plant. The aims of the program are: 1. Decrease the number of accidents/injuries in the work place. 2. Minimize the time lost through injury. 3. Assist management and supervisors in developing an understanding of rehabilitation and prevention and to help maintain this level of understanding. The program links both prevention and rehabilitation. The program ensures that the prevention of injury is given a high priority. The rehabilitation process can not be effective unless the causative factors ofthe injury have been identified and controlled. This helps to ensure a successful return to work without the risk of aggravating the injury or the risk of another employee being injured on the same job.
THE REHABILITATION PROCESS The rehabilitation process at the Ford Sydney Assembly Plant is a formalized one and is structured to ensure that early intervention occurs. The occupational health nurse initially assesses the injured employee and makes a decision regarding the medial attention needed and whether the injury requires rehabilitation. The criterion used for referral to the occupational therapist is the likelihood of the injury affecting the performance of the employee's normal work duties. Once an employee is referred, the occupational therapist assesses the employee and his/her prein-
jury work duties and workstation in consultation with the employee and supervisor. The occupational therapist then liaises with the employee's treating doctor and other treating health professionals. During the process of rehabilitation the occupational therapist provides: • Counseling to both the employee and their family • Ongoing assessment of their functional status • Upgraded activity program (selected duties are identified and used as the basis for this) • Advise on activities of daily living • Education in correct body mechanics, therefore minimizing the risk of further injury • Design and implementation of an upgraded return to work program. If a job needs major ergonomic changes to ensure further injuries are prevented, the occupational therapist would refer to the ergonomist. The supervisor can refer directly to the ergonomist for assistance. The ergonomist assesses the job and consults with management and engineering regarding changes that will minimize the problems. Once an upgraded selected duties program has been formalized in consultation with the treating doctor, employee, and supervisor, the injured employee then returns to work (it is important to point out that most employees do not actually lose time but are placed on the rehabilitation program and upgraded gradually). Once the employee commences the upgraded program the occupational therapist monitors the employee on the job at least weekly, with the occupational health nurse, and continues to liaise with the treating doctor and the line supervisor. The employee is gradually upgraded until he/she has returned to full-time "normal duties."
RESULTS OF THE PROGRAM To measure the effectiveness of the program, it is critical that performance indicators are identified and used to measure the program on a regular basis. Two of the performance indicators that can
Role of On-Site OT
75
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100 go BO
1\:1
~
Z
1\:1 0
II: 1\:1 II.
~
Eli:
70 ISO
!50
40 30 20
10 0
19B15
19B7
19BB
19B9
1990
1991
YBAR
Figure 1.
be used include: the return to work rate and the time lost from the work place (i.e., workers' compensation absenteeism figures). The return -to-work rate for 1986 was 83 % ; in 1987 it was 93%. By 1991, the program was achieving a 98 % return-to-work rate (Figure 1). However, return-to-work rate alone is not an adequate measure of the success of the program. The amount of time lost is important. The physical and psychological status of the injured employee is affected if they are unable to work for an extensive time period. The percentage of employees who lost more than 7 days had decreased from 14 % of the referrals to 10% of the referrals (i.e., 18 people against eight people). Workers' Compensation absenteeism has decreased during the existence of the program. It has decreased from 4.5 % to consistently being below 1.5% of the total available labor hours.
SUMMARY To summarize, it can be seen that on-site rehabilitation can minimize the number of injuries and maximize the time lost through injury. The results provide a win-win situation for all, that is, the injured employee maintains his/her self-esteem, general fitness, improves physical functioning, financial security, and maintains work skills. The employer gains from successful rehabilitation, the Ford story emphasizes this. By decreasing Workers' Compensation absenteeism, claims costs are reduced and, therefore, the Workers' Compensation premiums are reduced, productivity is maintained, quality is maintained, the cost of recruiting and training new employees is minimized and the morale of the work force can remain high. It is important to recognize that a successful program needs many ingredients. The success of
76
WORK / SUMMER 1993
the Ford Sydney Assembly Plant Program can be attributed to: • The commitment of management towards rehabilitation • The existing trust relationships between the union, management, and the employees • The early reporting of injury • Close coordination and liaison between the injured employee, employer, doctor, physiotherapist, nurse, and supervisor • The provision of professionally assessed selected duties • Regular monitoring on-site and upgrading appropriately
CONCLUSION Successful work place-posed rehabilitation does work. The success is based on using "real" work tasks for the upgrading of physical functioning to ensure all parties benefit.
REFERENCES Holmes, D. (1985). The role of the occupational therapist- Work evaluator. Am] Occup Ther, 39, Matheson, 0., Schultz, V. (1985). Work hardening: Occupational therapy in industrial rehabilitation. Am] Occup Ther, 34, Ross, P. (1982). Basic work assessment and rehabilitation procedures. Occup Ther,
Occupational rehabilitation is concerned with restoring the person to the highest level of function in the work place (physically, socially, and psychologically). It is aimed at maintaining the injured person's work habits and skills by either maintaining the injured employee at work or returning the employee to work after an injury. Occupational therapists have traditionally been involved in this process. The literature in the professional journals supports this. Phyllis Ross (1982) in her article in the British Occupational Therapy journal emphasises the aim of rehabilitation as being to decrease the time absent from work, therefore, ensuring the injured employees' job security and maintaining good work habits and skills. Recent legislative changes in most states of Australia place a large emphasis on the rehabilitation of the injured employee. In New South Wales each employer was required to establish a "workplace based" occupational rehabilitation program by December, 1988. This presents as a challenge to most employers, and all of us as occupational therapists have an important role in ensuring such programs are de-
veloped and implemented successfully. That is, it is successful for both the injured employee and the employer. This article presents a case study of an organization that has successfully implemented such a program. The Ford Motor Company, Homebush Assembly Plant, has had a work place-based rehabilitation program since 1984. The case study will focus on the role of the occupational therapist, and the key factors that have assisted in the success of the program and the results of the program. I will first provide a briefbackground to the industry and the program.
BACKGROUND The Homebush Assembly Plant is responsible for the assembly of the Laser motor car, a small fourcylinder passenger vehicle. It has one major Trade Union representing it's employees. This is the Vehicle Builders Employee's Federation. In 1984, the Industrial Rehabilitation Service commenced contracting an occupational therapist and an ergonomist (whose background was also that of occupational therapy) to the Ford Motor Company, providing on-site occupational rehabilitation. On-site at Ford, the occupational therapist and ergonomist roles aim to complement the existing WORK 1993; 3(3):73-76 Copyright © 1993 by Andover Medical
74
WORK / SUMMER 1993
occupational health, safety, management and engineering resources: • Occupational Health Nurse/Safety Co-ordinator • Sessional Physiotherapist • Sessional Doctor • Management • Supervisor and it maXImIzes the process of the employee involvement process existing within the plant. The aims of the program are: 1. Decrease the number of accidents/injuries in the work place. 2. Minimize the time lost through injury. 3. Assist management and supervisors in developing an understanding of rehabilitation and prevention and to help maintain this level of understanding. The program links both prevention and rehabilitation. The program ensures that the prevention of injury is given a high priority. The rehabilitation process can not be effective unless the causative factors ofthe injury have been identified and controlled. This helps to ensure a successful return to work without the risk of aggravating the injury or the risk of another employee being injured on the same job.
THE REHABILITATION PROCESS The rehabilitation process at the Ford Sydney Assembly Plant is a formalized one and is structured to ensure that early intervention occurs. The occupational health nurse initially assesses the injured employee and makes a decision regarding the medial attention needed and whether the injury requires rehabilitation. The criterion used for referral to the occupational therapist is the likelihood of the injury affecting the performance of the employee's normal work duties. Once an employee is referred, the occupational therapist assesses the employee and his/her prein-
jury work duties and workstation in consultation with the employee and supervisor. The occupational therapist then liaises with the employee's treating doctor and other treating health professionals. During the process of rehabilitation the occupational therapist provides: • Counseling to both the employee and their family • Ongoing assessment of their functional status • Upgraded activity program (selected duties are identified and used as the basis for this) • Advise on activities of daily living • Education in correct body mechanics, therefore minimizing the risk of further injury • Design and implementation of an upgraded return to work program. If a job needs major ergonomic changes to ensure further injuries are prevented, the occupational therapist would refer to the ergonomist. The supervisor can refer directly to the ergonomist for assistance. The ergonomist assesses the job and consults with management and engineering regarding changes that will minimize the problems. Once an upgraded selected duties program has been formalized in consultation with the treating doctor, employee, and supervisor, the injured employee then returns to work (it is important to point out that most employees do not actually lose time but are placed on the rehabilitation program and upgraded gradually). Once the employee commences the upgraded program the occupational therapist monitors the employee on the job at least weekly, with the occupational health nurse, and continues to liaise with the treating doctor and the line supervisor. The employee is gradually upgraded until he/she has returned to full-time "normal duties."
RESULTS OF THE PROGRAM To measure the effectiveness of the program, it is critical that performance indicators are identified and used to measure the program on a regular basis. Two of the performance indicators that can
Role of On-Site OT
75
RTW RATE :fiOLlilWlNG RE:fiERRAL IIOR REHAB
100 go BO
1\:1
~
Z
1\:1 0
II: 1\:1 II.
~
Eli:
70 ISO
!50
40 30 20
10 0
19B15
19B7
19BB
19B9
1990
1991
YBAR
Figure 1.
be used include: the return to work rate and the time lost from the work place (i.e., workers' compensation absenteeism figures). The return -to-work rate for 1986 was 83 % ; in 1987 it was 93%. By 1991, the program was achieving a 98 % return-to-work rate (Figure 1). However, return-to-work rate alone is not an adequate measure of the success of the program. The amount of time lost is important. The physical and psychological status of the injured employee is affected if they are unable to work for an extensive time period. The percentage of employees who lost more than 7 days had decreased from 14 % of the referrals to 10% of the referrals (i.e., 18 people against eight people). Workers' Compensation absenteeism has decreased during the existence of the program. It has decreased from 4.5 % to consistently being below 1.5% of the total available labor hours.
SUMMARY To summarize, it can be seen that on-site rehabilitation can minimize the number of injuries and maximize the time lost through injury. The results provide a win-win situation for all, that is, the injured employee maintains his/her self-esteem, general fitness, improves physical functioning, financial security, and maintains work skills. The employer gains from successful rehabilitation, the Ford story emphasizes this. By decreasing Workers' Compensation absenteeism, claims costs are reduced and, therefore, the Workers' Compensation premiums are reduced, productivity is maintained, quality is maintained, the cost of recruiting and training new employees is minimized and the morale of the work force can remain high. It is important to recognize that a successful program needs many ingredients. The success of
76
WORK / SUMMER 1993
the Ford Sydney Assembly Plant Program can be attributed to: • The commitment of management towards rehabilitation • The existing trust relationships between the union, management, and the employees • The early reporting of injury • Close coordination and liaison between the injured employee, employer, doctor, physiotherapist, nurse, and supervisor • The provision of professionally assessed selected duties • Regular monitoring on-site and upgrading appropriately
CONCLUSION Successful work place-posed rehabilitation does work. The success is based on using "real" work tasks for the upgrading of physical functioning to ensure all parties benefit.
REFERENCES Holmes, D. (1985). The role of the occupational therapist- Work evaluator. Am] Occup Ther, 39, Matheson, 0., Schultz, V. (1985). Work hardening: Occupational therapy in industrial rehabilitation. Am] Occup Ther, 34, Ross, P. (1982). Basic work assessment and rehabilitation procedures. Occup Ther,
