By Dr. Michael Lacroix, Director of Behavioral Health Services, Coventry Workers’ Comp Services
When the Workers’ Compensation Research Institute (WCRI) recently sought to identify outcome predictors from workers’ compensation injuries, they got a bit of a surprise. Aside from the obvious—and expected—factors such as injury type and injury severity, another strong predictive factor emerged: low trust in the work relationship.1 Workers who responded “Yes” to the question “I was concerned I would be fired or laid off” were twice as likely not to have returned to work at the time of the survey. This finding raises some interesting questions with important implications for managing absence more effectively.
What makes trust critical?
Commitment and loyalty is a two-way street. When a survey asked workers what caused them to be engaged or disengaged in their work, the top two answers were “respect” and “trust.”2 In the case of a workers’ compensation injury, the employee needs to be able to trust that the employer is doing right by him or her. That means extending the trust to a network of individuals and organizations, including the insurance company, the third-party administrator (TPA), the doctor(s), the case management nurses, etc. That’s a lot of trust. If trust in the employer is shaky, that could involve a lot of mistrust.
Although doctors consistently rank high on honesty and ethics surveys, they still cannot take patients’ trust for granted—especially when an adjuster has suggested the injured employee see a doctor that he or she has never seen before. Trust must be earned. As the Russian proverb advises, “Trust, but verify.” Employees need to be able to verify the messages they get from the employer/adjuster/provider, so they can trust that they are doing the right thing.
Ultimately, trust is related to belief. If the injured worker does not trust the employer, it means that he or she disbelieves information provided by risk management/human resources, the adjuster, and possibly even the treating providers. This disbelief is based on a gut feeling that they are either lying, incompetent or not truly vested in the well-being of the injured worker.
How does trust affect recovery?
Much has been written on the impact of belief on symptoms. The placebo effect—essentially believing that a treatment will work—typically improves symptoms significantly, even when the “treatment” is a sugar pill. Conversely, psychosomatic medicine also recognizes that a person’s conscious and unconscious beliefs can create or aggravate medical symptoms. An injured worker’s understanding or misunderstanding about his or her condition can affect cooperation with treatment, which ultimately impacts return to work.3 Injured workers’ expectations about recovery and their ability to manage returning to work can affect the amount of time away from work and disability costs.4 Researchers in the Netherlands found that individuals’ perceptions of the impact of their condition had more influence on working time, levels of impairment and activity levels than did the actual physical or medical indicators.5
What can employers do?
Employers need to earn the trust of their employees, and that takes more than an e-mail from Human Resources. Trust must be earned through clear and consistent communication between an employer and their employees. This communication should occur long before an injury or illness so that the employee is fully informed on all procedures including return-to-work and know exactly what to expect. Employer policies should demonstrate a commitment to providing transitional duty during their recovery so that injured employees can return to the workforce as soon as it is medically appropriate. Taking a proactive approach to injury prevention by conducting ergonomic evaluations of workstations and offering health and wellness programs also conveys a commitment to employee safety and wellbeing. Staying connected when an employee is out of work also says a lot about an employer’s relationship with the employee and concern for his or her well being—the very foundation of trust.
Another way to foster a trusting relationship is to enlist the support of a credible source, such as a nurse. Year after year, according to Gallup’s ratings of Honesty and Ethics in Professions, the professionals trusted most by the public are nurses. Nurses rank even higher than doctors.6 At the hub of the workers’ compensation process, nurses trained in injury triage or case management connect with all the stakeholders and are well positioned to address all the factors that may present barriers and impact progress. Employers who utilize nurse triage services have an employee connected to a nurse within minutes of the injury. This conveys a genuine concern for the employee’s wellbeing. Training nurses in active listening and cognitive behavior therapy techniques (CBT) makes them even better equipped to establish a trusting relationship with the injured employee and help the employee overcome non medical barriers to recovery and return-to-work.
A relationship of trust can play an important role in supporting optimal return-to-work outcomes. It is possible to build and maintain such relationships between employees and employers as well as their various agents, but doing so takes real commitment and real work.
About Dr. Michael Lacroix
Dr. Michael Lacroix is the Director of Behavioral Health Services for Coventry Workers’ Comp Services. He is a licensed psychologist in Florida and has attained Diplomate status in Rehabilitation Psychology from the American Board of Psychological Specialties and as a forensic examiner from the American Board of Forensic Examiners. Dr. Lacroix has authored and/or presented over 100 scientific publications and papers throughout his career. His major areas of interest and specialization include trauma (short-term intervention as well as long-term consequences); rehabilitation psychology, with emphasis on issues of clinical and vocational assessment, behavioral medicine, with emphasis on psychosomatic disorders; and psychotherapy, with emphasis on cognitive-behavioral therapy and hypnosis.
About Coventry Workers’ Comp Services
Coventry Workers’ Comp Services is the leading provider of cost and care management solutions for property and casualty insurance carriers, (workers’ compensation and auto insurers), third-party administrators and self-insured employers. We design best-in-class products and services to help our partners restore the health and productivity of injured workers and insureds as quickly and as cost effectively as possible. We accomplish this by developing and maintaining consultative, trusting partnerships with our clients and stakeholders, built on a foundation of innovative and customized solutions that support the claims management process.
1. Robinson, Thomas. WCRI Identifies Trust in the Workplace as a Key ‘Predictor’ of Outcomes Important to Injured Workers. LexisNexis® Legal Newsroom Workers Compensation Law, July 6, 2014. Accessed online July 27, 2014.
2. Marciano, P. Carrots and Sticks Don’t Work. New York: McGraw Hill, 2010.
3. Peebles, J. E., & Moore, R. Illness schemata in patients with low back pain: Predictions of rehabilitation success. The Pain Clinic, 2000, 12, 237-246.
4. Franche, R.L., Frank, J., & Krause, N. Predictions of occupational disability: Models, factors, and outcomes. In Schultz, I.Z., & Gatchel, R.J., Handbook of Complex Occupational Claims. New York: Springer, 2005.
5. Scharloo, M, & Kaptein, A. Measurement of illness perceptions in patients with chronic somatic illness: A review. In K.J. Petrie & J.A. Weiman, Perceptions of Health and Illness: Current Research and Applications. Oxon: Routledge, 2013
6. Gallup® poll. Honesty/Ethics in Professions. Dec. 5–8, 2013. Accessed online July 29, 2014.
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This is not a paid placement.