Why was this study done?
Studies over the past few decades have identified health-care providers and workers’ compensation case managers as playing important roles in the rehabilitation and return to work (RTW) of injured workers. Breakdowns in communication and collaboration between these stakeholders can lead to delayed or ineffective treatment and, further down the line, to delayed return to work. This study set out to explore sources of conflict and communication difficulties between these parties.
How was the study done?
Researchers interviewed 97 health-care professionals and 34 case managers in four Canadian provinces: Newfoundland and Labrador, Ontario, Manitoba and British Columbia. Workers’ compensation boards in the first two provinces chose not to participate in the study. As a result, interviews were held with only private-practice case managers in Ontario, and no interviews were held with case managers in Newfoundland and Labrador. All participating health-care providers had treated at least one injured worker in the previous year. These providers included general practitioners (59), allied professionals such as physiotherapists, occupational therapists, psychologists and chiropractors (19), and specialists such as surgeons and physiatrists (19). Interviews were conducted in 2015.
What did the researchers find?
Communication and collaboration barriers were found not only between health-care professionals and case managers, but also among practitioners of different health disciplines (i.e. physicians, physiotherapists and occupational therapists).
Some barriers stemmed from different work cultures and environments. Case managers, who worked standard 9-to-5 shifts, found physicians difficult to reach during those hours. Physicians, in turn, reported difficulty quickly reaching case managers for approvals to proceed with treatment. Case managers preferred phone calls for case consultations, whereas physicians preferred written correspondence to preserve confidentiality and create a paper trail of decisions.
Health-care professionals and case managers held philosophical differences about RTW. Both agreed on the value of work in rehabilitation, but they differed on the appropriateness of claimants returning to work before fully recovering (with health-care professionals being more reluctant than case managers to support this practice). These differences often led to suspicions about each others’ motives and biases (i.e. cost containment or patient advocacy). Case managers also questioned health-care providers’ knowledge about workers’ compensation systems.
As result of these communication challenges, injured workers sometimes became the conduit of information between case managers and health-care providers and/or among health-care providers from different disciplines. This led to concerns about the accuracy and completeness of the information being shared by workers. Communication challenges also resulted sometimes in delayed or ineffective treatment and, further down the line, in delayed return to work.
What are the implications of this study?
Communication barriers between health-care providers and case managers appear to stem from differences in communication styles, professional priorities and philosophical perspectives about the timing and appropriateness of return to work. Greater clarity about the system and the roles of different stakeholders—including clearly defined expectations, goals and decision-making methods—may improve collaboration and communication.
What are some strengths and weaknesses of the study?
Past research has shown that stakeholders involved in return to work may not communicate effectively; this research is unique in providing insight into how and why communication breaks down. A strength of this study is the consistency of themes found across four Canadian provinces. A weakness of the study is the low number of case managers who took part. As well, the perspectives of injured workers and their employers may provide insight into communication challenges between health-care providers and case managers, but they were not part of this study. Finally, this qualitative study can only describe communication breakdowns; it does not shed light on the prevalence of such breakdowns.