What research can do: Drawing on IWH’s Seven ‘Principles’ in return-to-work policies, practices

The evidence-based guide on successful return to work has shaped workplace policies and clinical practice in Ontario and beyond

Published: November 8, 2018

In 1997, the Ontario government enacted Bill 99, the Workers’ Compensation Reform Act, that outlined several changes related to return to work (RTW). This bill introduced the responsibility for employers and workers to maintain contact with one another and work cooperatively to achieve “early and safe return to work.” This change in practice left workplace parties searching for guidance. What is the right way to stay in touch with injured workers when they’re off work? And what exactly does “early and safe return to work” look like?

In response, the Institute for Work & Health (IWH) began conducting a series of systematic reviews to answer these important questions, focused on identifying the most effective workplace approaches to support RTW, stay at work and recovery for injured and ill workers. These reviews led to the development of the popular and widely used Seven “Principles” for Successful Return to Work.

The Seven Principles guide is far and away the top item downloaded from the IWH website. But people are doing more than just downloading and reading the guide. In 2008, it was adapted into a tool for occupational therapy practice by the Occupational Therapist Educationally Influential (OT EI) Network, in partnership with IWH, the Ontario Society of Occupational Therapists and the College of Occupational Therapists of Ontario. The tool, called Working Together, consolidated the principles into four stages reflecting occupational therapy practice processes. There is also evidence of the guide being adopted as a practice standard in other jurisdictions. For example, the Singapore Association for Occupational Therapists adapted the tool for use as a guide for occupational therapists in Singapore in 2016.

The IWH’s Seven Principles has also been used by workplaces in their RTW and accommodation programs. For example, when management and union representatives at Niagara Health set out to design and implement a new RTW/accommodation policy, the seven principles were a key factor informing the policy development.

In 2011, Niagara Health management and representatives of the hospital’s three unions—Ontario Nurses’ Association (ONA), Ontario Public Service Employees Union (OPSEU) and Service Employees International Union (SEIU)—recognized that their disability management policy needed renewal. They jointly committed to developing a new policy, with support from not-for-profit external advisors and the Ontario Federation of Labour’s Occupational Disability Response Team (ODRT) leading the renewal.

The new policy incorporated components identified in IWH’s Seven Principles. Flo Paladino, executive vice-president of people and organizational development at Niagara Health, noted that IWH research made an important contribution to the design of the new policy. It includes an emphasis on early contact, the integration of supervisors in the development of RTW plans, the provision of education and training to managers and supervisors, and the designation of both disability case managers and—a distinctive feature—union representatives as RTW coordinators.

Paladino also affirmed the success of the initiative. The RTW/Accommodation policy we implemented in 2012 has enabled important improvement in the consistency of efforts to return our valued staff to work after a health absence, she said.  The new policy was well received by employees. It led to improved quality and consistency of disability management practices at Niagara Health. In addition, the policy’s success was seen in reduced duration of time off after a work-related injury—from 19.4 days in the three years before the change, to 10.9 days in the three years after. This 45-per-cent improvement was much higher than the 25-per-cent improvement seen in a peer group of 29 hospitals over the same period.

The guide can be found at: www.iwh.on.ca/tools-and-guides/seven-principles-for-successful-return-to-work. This column is based on an impact case study, published in December 2017.