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Session Overview
Session
Stakeholder involvement - income
Time:
Thursday, 06/Jun/2019:
1:00pm - 2:30pm

Session Chair: Marie-France Coutu
Session Chair: Thomas Johansen
Location: Room 96

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Presentations

Income Changes In Occupationally Injured Workers After Workers' Compenation

Sookwon Bae, Jonguk Won

Yonsei Univ. College of Medicine, Korea, Republic of (South Korea)

Objectives

The present study examines how the income of workers following industrial accident changes depending on their disability grades and economic activities.

Methods

We analyzed the 1st-4th data of the panel study of workers’ compensation insurance (PSWCI). The PSWCI was conducted with the 2,000 final samples selected from 82,492 workers who had undergone recuperation periods due to industrial accidents, and the survey has completed its 4th panel. Repeated measures ANOVA was used to compare the annual income before and after the industrial accident, and a general linear model was used to identify changes in income due to disability ratings and participation in economic activities.

Results

The wages before the industrial accident and the annual income varied among the disabilities ratings (p<0.0001). In addition, for affected workers, the average income during four years post-accident was lower than the income before the accident (p=0.0005). In the case of employed population, those with disability ratings between one and seven showed higher annual and average income for four years than income before the industrial accident (p<0.0001). However, for the unemployment group and others showed lower annual (p<0.0001, p<0.0001) and average income (p=0.0004, p=0.0003).

A regression analysis to see changes in income after the industrial accident showed that the group with a disability rating of 11-14 and no injuries had a suffered a greater income decrease than those with a disability rating of 1-3 (p=0.0262, p=0.0161), and the unemployment group saw a greater decrease in income than the employment group that had participated in economic activities (p<0.0001).

Conclusion

Workers who were affected by industrial accidents received lower incomes than before the accident, and even considering the different disability ratings, there was a greater decrease in income among the unemployed group than in the working group.



Earnings Recovery Following Permanent Impairment from a Work Injury

Emile Tompa, Cam Mustard, Qing Liao

Institute for Work & Health, Canada

Background:

Permanent impairment from a work injury can seriously compromise short- and long-term labour-market earnings. Knowledge on characteristics that bear on better or worse outcomes can help better target return-to-work supports. We investigate the determinants of labour-market earnings recovery of a recent cohort of workers’ compensation claimants with permanent impairments from Ontario, Canada.

Methods:

This study is based on a linkage of workers’ compensation claims data to longitudinal earnings data from tax files. Upwards of 95% of working age adults file taxes, so the linkage is highly representative of the workers’ compensation sample frame. The statistical analysis draws on two approaches: a matching of claimants with uninjured controls, and regression modelling of the determinants of post-accident labour-market earnings recovery. This outcome was based on a comparison of post-injury earnings of claimants with the average post-injury earnings of their matched controls.

Results:

As might be expected, earnings recovery was lower for higher levels of impairment severity. Earning recovery increased with years post-injury for claimant who were middle aged at baseline, but not for other age brackets. Higher pre-injury earnings levels were also associated with higher earnings recovery, but only for some age brackets. This variable may proxy for human capital. Claimants having a manual occupation experienced lower earnings recovery when compared to claimants with mixed or non-manual occupation, but only for some age brackets. Lastly, some types of injuries were found to be associated with higher or lower earnings recovery.

Conclusions:

Knowledge on the determinants of earnings recovery provides valuable information to workers’ compensation authorities and other service providers to assist with better targeting return-to-work supports. Matching claimants with contemporaneous uninjured controls provides a powerful method to distinguish between the impact of impairment versus other contextual factures on labour-market earnings recovery.



The Impact Of Income Support Systems On Healthcare Quality And Functional Capacity In Workers With Low Back Pain: A Realist Review

Michael Di Donato, Ross Iles, Tyler Lane, Alex Collie

Monash University, Australia

Background

Low back pain (LBP) is a leading cause of work disability. While absent from work, workers with LBP may receive income support from a system such as workers’ compensation or social security. Current evidence suggests that income support systems can influence recovery from LBP, but provides little evidence as to why and how these effects occur. This study examines how and in what contexts income support systems impact the healthcare quality and functional capacity of people with work disability and LBP.

Methods

We performed a realist review, a type of literature review that seeks to explain how social interventions and phenomena in certain contexts generate outcomes, rather than simply whether or not they do. Five initial theories about the mechanisms of the relationship were developed, tested, and refined by acquiring and synthesising academic literature from purposive and iterative electronic database searching. This process was supplemented by grey literature searching for policy documents and legislative summaries, and semi-structured interviews with experts in income support, healthcare, and LBP.

Results

Income support systems influence healthcare quality through healthcare funding restrictions, healthcare provider administrative burden, and allowing an employer to select healthcare providers. Income support systems influence worker functional capacity through the level of participation and share of income support funding required of employers, and through certain administrative procedures. These mechanisms are often exclusively context-dependent, and generate differing and unintended outcomes depending on features of the healthcare and income support system, as well as other contextual factors such as socioeconomic status and labour force composition.

Conclusion

Income support systems impact the healthcare quality and functional capacity of people with work disability and LBP through context-dependent financial control, regulatory, and administrative mechanisms. Future policy design and research efforts should consider how income support systems may indirectly influence workers with LBP via the workplace.



Benefits Of A Charter Of Partnership To Structure The Collaboration Between Researchers And Stakeholders In Work Disability Prevention: Findings From The FASTRACS Study

Sabrina Rouat1, Laure Guittard2, Julien Carretier2,3, Camille Vandame4,5, Marion Lamort-Bouché4,6, Philippe Sarnin1, Laurent Letrilliart2,6, Jean-Baptiste Fassier4,5

1GREPS EA 4163, Université Lumière Lyon 2, France; 2Health Services and Performance Research EA7425, Université Claude Bernard Lyon 1, France; 3Département cancer environnement, Centre Léon Bérard, Lyon, France; 4UMRESTTE UMR T9405, Université Claude Bernard Lyon 1, France; 5Occupational health and medicine department, Hospices Civils de Lyon, France; 6Collège Universitaire de Médecine Générale, Lyon, France

Context

An effective participation of the stakeholders in health program planning is believed to improve the relevance, acceptability, effectiveness and sustainability of interventions. Collaborative research may help researchers and stakeholders build a shared analysis of the problem and find concordant solutions. A charter of partnership was built to structure the collaboration between researchers and stakeholders of the FASTRACS project in France (Facilitate and sustain return to work after breast cancer).

Methods

The Intervention Mapping protocol was followed to gather an intersectoral collaborative advisory board. 25 participants were selected by purposive and snowball sampling among 4 categories of stakeholders: patients and associations, healthcare professionals and facilities, workplaces and institutions (social security, health, work and employment regional authorities). Six meeting were held (2016-2018). Discussions were transcribed and qualitative thematic content analysis were performed to identify needs, values and commitments of the stakeholders and the researchers. A draft of the charter was rated by means of an e-Delphi consensus method. It was modified according to the comments of the participants, and endorsed during a plenary meeting.

Results

The charter of partnership comprises 8 values and 4 commitments shared by the participants. It acknowledges the need of all the stakeholders and the researchers to work together. Shared and specific interests are also acknowledged. Discussions about the needs and values allowed the participants to know each other, and share their own context, strengths and limits. Benefits were an authentic input to build the logic model of the problem, define the change objectives of the intervention, and choose its components.

Conclusion

The next challenge is to secure and sustain the partnership during the implementation and the evaluation of the intervention, so that it may be adapted, sustained and scaled-up according to its results.



Influencing Collective Decision-Making in the Work Rehabilitation Context: An Exploration of Return-to-Work Stakeholders’ Strategies

Marie-Michelle Gouin1, Manon Truchon2

1Université de Sherbrooke, Longueuil, Canada; 2Université Laval, Québec, Canada

Objective: When return-to-work (RTW) stakeholders are in conflict, they negotiate and try to influence collective decision-making. Yet, these strategical processes are poorly documented. This study sought to explore stakeholders’ use of strategies during negotiations throughout a work rehabilitation program for musculoskeletal disorders.

Methods: We conducted a secondary analysis of an exploratory multiple-case study (N=6) that aimed at exploring collective decision-making during a work rehabilitation program. Each case included all RTW stakeholders and required a two- to six-month follow-up for deeper understanding of negotiation processes. Data were collected through observation of planned meetings (in clinical settings or the workplace), field notes, and semi-structured interviews. The first inductive analysis identified negotiated decision-making processes and their subjects (one to nine, depending on the case). We reanalyzed these negotiations inductively to identify the strategies used by stakeholders and the factors potentially influencing their use.

Results: Stakeholders were found to use three different types of strategies to influence collective decision-making: (1) shaping negotiation structure (e.g., seeking/involving allies in a meeting to gain influence); (2) fostering collaboration (e.g., gathering/disseminating information (without distortion), mediating, supporting); and (3) forcing others (e.g., distorting information, confronting, trading-off). Unlike the last two, the first type of strategy was used during stakeholders’ preparation (e.g., stakeholder ensuring that support was secured from another meeting participant). Regarding fostering and forcing strategies, in practice, both were found to be intertwined. Their use depended respectively on the stakeholders’ openness (or not) to other stakeholders’ positions, which might have been influenced by their power, concerns, expectations regarding RTW, the climate of trust, and the context (of the injury and the RTW).

Conclusion: This study furthers understanding of the complex strategical processes involved in RTW. It provides essential knowledge that could serve to facilitate RTW stakeholders’ collective decision-making, which in turn may be vital to RTW success.



The Role of Unions in Influencing the Social Organization of Return to Work

Ulrik Gensby1,2,3, Marie Laberge3,4,5,6, Ellen MacEachen3,7

1Team Arbejdsliv ApS, Denmark; 2Helix Competence Centre, Linköping University, Sweden; 3Institute for Work and Health, Toronto, Canada; 4School of Rehabilitation, University of Montreal, Canada; 5CHU Ste-Justine Research Centre, Montreal, Canada; 6CINBIOSE Research Centre, UQAM, Montréal, Canada; 7School of Public Health and Health Systems, University of Waterloo, Canada

Background: The the role of unions has been less investigated in relation to return to work (RTW). Very little is known about the type of knowledge sources and associated facilities unions use to support capacity building in RTW, and any perceived obstacles that unions encounter in playing their role during the RTW process. The objective of this study is to conduct a critical analysis of the role of unions in the social organization of RTW.

Methods: The study is an exploratory and embedded case study. A purposeful sample approach was used to select participants from various departments in a large Danish hospital. 30 participants were interviewed in five focus groups; supervisors (n=6), unions (n=6), safety representatives (n= 6), co-employees (n= 6), and re-entering employees (n=6). A theory-driven semi-structured interview guide was used to explore key themes linked to the engagement and expertise of unions and their associated facilities in the RTW process through the lens of an industrial relations approach.

Results: Unions may take different roles in the social organization of RTW. Five prominent roles were identified each representing various leverages and obstacles unions encounter in playing their role in the RTW process, but also envisioning what they could have done. Some aspects of unionized practice seem detached and scarcely expressed in the formal context of RTW policy and work disability management.

Conclusion: The results clarify how different workplace stakeholders view the role of unions in the social organization of RTW. Promoting an explicit focus on the type of expertise and knowledge sources unions can provide, and how such knowledge may facilitate or impede local RTW capacity building is a promising means to investigate further in the work disability context. Using an industrial relations approach may help researchers understand how RTW is mediated by conditions of local labour relations.



 
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