Previous installments of this series looked at the role of supervisors in preventing and minimizing injury. Let's shift the focus to another supervisory function that directly affects safety performance: return-to-work (RTW).

The Liberty Mutual Research Institute for Safety conducted a study that looked at those aspects of supervisor involvement most valued by workers for post-injury recovery and return to work. Here's a look at what the study says and what its results mean for your RTW program.

The Supervisor's Role in RTW Programs

What role should supervisors play in a company's RTW program? In most cases, it's the supervisor who knows the worker best and who is thus the appropriate choice to serve as point person in dealing with the injured worker during the RTW process. The supervisor is also in the best position to do the things necessary to shepherd the process to a successful outcome - keep the worker informed, interpret corporate policies, ensure the worker access to company and medical resources, monitor his health and fashion the appropriate accommodations necessary to ensure his return.

But as is the case with injury prevention intervention, supervisors must be specifically trained to recognize and perform RTW functions effectively, notes William Shaw, PhD, lead investigative researcher for the Liberty Mutual study. If companies don't provide this training, there's likely to be a disconnect between workers and supervisors that undermines the RTW program.

Shaw explains how this can happen. Supervisors may believe that injured workers are no longer their concern and try to push the responsibility for them off on, say, the company nurse or safety coordinator. The supervisor's resentment of the injured worker's reduced productivity and need for accommodations, special attention and support might also foster a negative attitude that diminishes the overall effectiveness of the RTW process, he notes. Such lack of support from a supervisor can be especially frustrating and upsetting to a worker after a traumatic event, such as a workplace injury or illness.

Bottom line: Supervisors have the potential to make the RTW process effective, but companies must make a conscious effort to train their supervisors to realize this potential. And that leads us to the Liberty Mutual study.

The Liberty Mutual Study

Researchers wanted to design a training program for supervisors that would maximize supervisors' RTW potential. But designing such training from a "management down perspective" only doesn't work, says Shaw. Because the injured worker is the one who's suffering the most, his perspective is critical to designing an effective supervisor training program, Shaw explains. However, until recently, few studies focused on what workers expect and want from their supervisors during the RTW process. Without this information, it's hard for companies to achieve the maximum RTW potential from their supervisors.

That's why the Liberty Mutual Research Institute study is so useful. The study concentrates on those aspects of supervisor involvement most valued by workers for post-injury recovery and return to work. The researchers conducted 30-minute interviews with 30 workers from four companies: a synthetic fabrics manufacturer, a food processing and packaging plant, a network of nursing homes and a discount clothing retailer. These workers performed a wide range of jobs and faced a variety of workplace hazards. The researchers asked the workers questions about the potential role of supervisors after a worker suffers a workplace injury, such as what things a supervisor did after a workplace injury to make things better - or worse.

The Study's Results

The workers' responses were grouped and, as a result, 11 themes or areas of worker concern were identified:

Accommodations. Workers may need accommodations when they first return to work after an injury. And they want their supervisors to be more involved in the accommodation process by:

• Helping facilitate accommodations;
• Ensuring that accommodations are meaningful and helpful - not token modifications or "cookie cutter" changes that are the same for all injured workers;
• Using ergonomics principles when providing accommodations; and
• Marshalling corporate resources to provide accommodations, such as notifying and coordinating the efforts of appropriate departments within the organization.

Communication. Workers expressed their willingness and even need to communicate better with their supervisors after they get hurt.

Responsiveness. Workers felt that supervisors often respond too slowly or even ignore workers when they complain about their injury or illness. Supervisors may feel like they have to treat injured workers carefully because of fears of liability, explains Shaw. But the study suggests that workers want supervisors to be responsive and take immediate action when they get sick or injured. They also want supervisors to be their advocates and work on their behalf during the RTW process, he adds.

Concern for worker welfare. Workers understand that supervisors are concerned about production and other work-related demands. But they want supervisors to balance those demands against workers' health and safety and show genuine concern for workers as people, says Shaw.

Empathy/support. Injured workers want their supervisors to show empathy and provide emotional support. For example, they'd like supervisors to appreciate the challenges they face when recovering from an injury.

Validation. Supervisors often feel that it's their job to validate or confirm workers' injuries or health complaints. But when they do so, workers would like them to recognize that some injuries are inevitable. They also want supervisors to behave with sensitivity rather than suspicion.

Fairness/respect. Workers want their supervisors to treat injured workers fairly and respectfully.

Follow-up. Workers appreciate it when supervisors make an effort to stay in touch with injured workers while they're out. They also note that supervisor follow-up should include monitoring workers' symptoms while they're on restricted or modified duty.

Shared decision-making. Supervisors should include workers in the decision-making process when it comes to identifying potential injury factors and suggesting possible accommodations.

Coordination with medical providers. Some workers suggested that it's important that supervisors interact with medical providers, especially to design optimal work restrictions and accommodations.

Obtaining co-worker support. A few workers acknowledged supervisors' efforts to inform co-workers of temporary restrictions for returning workers and to obtain their support and cooperation.

What it Means

Several lessons can be learned from the Liberty Mutual study:

• The efforts of on-site nurses, case managers and others to facilitate injured workers' return to work shouldn't substitute for the involvement of supervisors;
• Supervisors should be encouraged to maintain supportive and regular contact with workers who are out after an injury, even if their return to work isn't imminent; and
• Engaging both supervisors and workers in the accommodation process may result in more effective work modifications than using cookie cutter approaches that rely solely on job descriptions and doctor recommendations. After all, inadequate accommodations can force injured workers to go out on disability - again.

Conclusion

You should review your company's RTW program in light of the lessons learned from the Liberty Mutual study and consider making changes to it, if necessary. For example, make sure your supervisors are more involved with injured workers, both while they're out and when they return to work. Supervisors who meet injured workers' RTW expectations can reduce a company's workers' compensation costs and lost work time, which translates into increased productivity, says Shaw. Companies that improve the way supervisors respond to employees' injuries and RTW issues will also likely see reduced future disability costs. But supervisors need to be trained to meet workers' expectations. Researchers developed supervisor training in RTW practices that incorporated the results of the worker expectation study.

Next week, I'll finish the series by telling you about another study that shows how such training can pay off.

BY THE NUMBERS

The Costs of Employer Health Insurance

By Glenn Demby

In the U.S. and Canada, most people get health insurance coverage through plans sponsored by their employers. It's no secret that the premiums employers pay to insurers to secure this coverage have been steadily increasing for a long time. A new study from the California Health Care Foundation documents the extent of the economic effect of rising health care premiums on employers in the U.S. Some of the key numbers:

39 The percentage increase in wages and salaries between 1996 and 2005

97 The percentage increase in health insurance costs to employers between 1996 and 2005

8 The percentage of total compensation employers pay that goes to health insurance in 2005 (up from 6% in 1996)

34 Among companies offering health insurance, the percentage by which insurance costs rose relative to payroll between 1996 and 2005

According to the study, premium contributions as a share of payroll were highest for businesses that are unionized, have a high share of full-time workers and that pay low wages. Low wage businesses experienced the highest health insurance cost increases.

Source: Christine Eibner, Kanika Kapur and M. Susan Marquis: "Employer Health Insurance Costs in the United States," California Health Foundation,

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