Factors influencing return to work outcomes

Multiple factors across four key domains - personal, workplace, insurance and compensation, and health care - work together to influence RTW outcomes for an individual worker. This fact sheet provides a summary of the evidence available for each domain.

Personal domain

The personal domain includes biological, psychological, behavioural and social factors relating to the worker.

In this domain, modifiable factors known to influence RTW include:

• self-efficacy – workers with greater belief in their ability to achieve goals have better RTW outcomes
• recovery expectations – workers with stronger expectations of recovery have better RTW outcomes
• perceived work ability – lower perceived work ability is associated with less positive RTW outcomes
• pain catastrophising/fear avoidance – workers who describe a pain experience in exaggerated terms, feel helpless or avoid pain-related situations are likely to have less positive RTW outcomes
• concern about making a claim – associated with less positive RTW outcomes.

Workplace domain

The workplace domain considers the working environment, relationships, design, support systems and how a workplace accommodates RTW.

Modifiable factors in the workplace domain include workplace support, early workplace response and contact, RTW planning and provision of suitable work.

Workplace support

Positive workplace culture is characterised by an employer’s commitment to physical and psychological health and safety, positive workplace relationships, and a supportive recovery environment.

Workplace culture and systems can significantly influence RTW outcomes. Employers can influence RTW outcomes before an injury by:

• developing effective systems to prepare for, respond to and manage injuries
• promoting the health benefits of good work
• establishing expectations of recovery at work following an injury
• building the RTW capability of RTW coordinators, managers and supervisors
• ensuring workers understand their rights and responsibilities (e.g. early reporting of injury).

Evidence confirms a worker’s perception of their experience with their employer during the RTW process is one of the most significant influences on RTW outcomes. A positive perception of their experience in the workplace can result in positive RTW outcomes.

Early workplace response and contact

Early injury reporting enables provision of early intervention and support. Workers who are not concerned about making a claim are more than three times more likely to RTW. A positive response from a worker’s supervisor when reporting an injury is associated with a durable RTW.

Early contact with the worker following injury provides the opportunity to demonstrate genuine concern, understand their situation and circumstances, and identify options for appropriate support, including recovery at work.

RTW planning

RTW improves when the process is planned, and the actions of the worker, the workplace and external parties are coordinated.

In the early stage of a claim, a written RTW plan increases the likelihood of RTW by 1.7 times. After 30 days, a plan becomes more critical increasing the likelihood of RTW by more than three times.

Providing suitable work

There is strong evidence that recovery at work and early return to good work can help recovery and prevent secondary complications associated with time away from work.

Insurance and compensation domain

This domain includes claims agents, insurers, regulatory authorities and other government and non-government agencies.

Modifiable factors in the insurance and compensation system domain include prompt liability and approval decisions, and a positive experience with the insurer.

Current evidence-informed claims management frameworks promote tailored, person-centric claims management characterised by:

• a biopsychosocial approach to understanding the worker’s situation and their needs
• the worker having ownership of RTW goals and outcomes
• claims processes and supports that are tailored to account for identified risks to recovery, and focus on the worker’s experience, goals and outcomes
• commencement of support and intervention as soon as practicable
• attempts to ensure expectations of all involved are aligned throughout the RTW process.

This evidence-informed approach is less likely to result in the following factors associated with a negative influence on RTW:

• perceived injustice by the worker in relation to the claims process
• differences of opinion with the insurer
• lawyer involvement.

Healthcare domain

The healthcare domain includes the provision of treatment and rehabilitation to facilitate recovery. In this domain:

• treatment with a focus on RTW improves RTW outcomes
• for workers with a mental health condition, work-focused cognitive behavioural therapy (CBT) can reduce time away from work, and the costs associated with work disability. Evidence does not support traditional CBT as being effective in improving RTW outcomes
• RTW is improved by contact between the healthcare provider and the workplace (this correlates with evidence indicating multi-domain interventions positively influence RTW)
• a higher level of medical intervention is associated with a negative influence on RTW.

In terms of a ‘best practice’ approach:

• nominated treating doctors are well-placed to advise and educate workers that, in most cases, recovery at work is in their best interest for their future quality of life and that of their family
• allied health practitioners use a biopsychosocial approach, set goals relating to function, participation and RTW, and empower the worker to manage their injury.

Coordinated multi-domain intervention

Coordinated interventions across two or more domains are more likely to positively influence RTW outcomes than single domain interventions.

Collaboration between stakeholders is necessary to align expectations, develop a common goal and plan, and optimise RTW outcomes. For a comprehensive understanding of the available evidence, and references read Reversing the trend – improving return to work outcomes in NSW.

A pdf copy is available to download.