The rise in use of injury management services draws attention to the way in which injury management is being deployed Emma Tyler asks whether it is being used to its fullest advantage.

In an environment of increased financial responsibility in the corporate market, human resource managers, health and safety co-ordinators and risk managers benefit in adopting a pro-active approach to assessing the health of their company. The options open to the corporate market are wider than ever and should be considered as a total approach to the way in which injuries and lost time are managed in-house.

Proactive risk managers, safety managers and HR managers should be asking themselves:

- Does our HR policy complement and match our safety and health policies?
- Can we manage some injuries in-house ourselves?
- Do we want to?
- Do we know where the majority of our injuries occur and what the most common mechanism of injury is?
- Are we addressing these problem areas effectively?
- Do we manage an employee who is injured or ill back to work, or do we wait for the next medical certificate?
- Do our supervisors talk to staff who are away from work? Do we record this?
- Do we employ the right people for the job? How do we check this? What are our attrition rates?

Injury management or vocational rehabilitation, while providing a service to assist injured workers or claimants back to health and work, is often implemented as a medical management tool. Changing the market approach to injury management is an ongoing process, and employers, together with their key strategic personnel, can influence this process significantly.

Injury management should be seen as part of policy and procedures within an organisation; it should provide benefit across all areas for the business.

If injury management has been adopted, then the risk manager, safety manager or HR manager's ability to clearly answer the questions above will be relatively easy. If they are difficult to answer, it is time to step back and take a look at the company's internal processes.

Why take an injury management approach as opposed to a medical rehabilitation approach?

The medical approach focuses on treating the injury and achieving symptom reduction. What it does not do from the outset is engage with employers and determine whether a partial or modified return to work can occur in conjunction with treatment and recovery. A medical approach can isolate the employer from the process and have a negative impact on the employer/employee relationship. It may also extend the time away from work, which may affect employees psychologically, financially and socially.

An injury management approach brings together the employer and employee to focus, not only on treatment and intervention, but also on the return to work process, reinforcing to the employee that the employer can accommodate reduced capacity and is supportive of their recovery. Injury management engages with all medical practitioners involved with the employee as well as the employer and other key parties. It is about ensuring that the best decision is made with all the facts to hand.

Many practitioners may deem an employee is unable to return to their usual work, but they often make that judgement without any information gathered from the workplace. Stating that a person will be totally unfit for their usual work for the foreseeable future should not be done lightly.

An injury management approach will ensure that a complete outline of the duties is provided to the practitioners prior to their making this decision.

If such a decision is to be made then it should be made within an appropriate time frame, so that vocational redirection activities can start promptly.

This also allows an employer to fill the position on a permanent basis.

Wherever possible though, it is within everyone's interest to maintain the employee in the usual workplace, be it in their usual duties or alternative duties.

Injury management as outlined above is the end point though. There are areas which need to be addressed prior to actually putting in place an injury management process.


Employing the correct people for the position is crucial. As employers we owe ourselves and our employees a duty of care to match a person to a job as appropriately as possible. Assess the jobs for critical function and then assess the potential employee against that function. Test new employees' hearing if working in a noisy working environment. Test a new employee's lung function if working in an environment subject to fumes or airborne particles. Doing this provides you with a baseline if employees later exhibit symptoms or report problems.

During employment

Employers, through lack of resources or time, often miss out on being able to take a pro-active approach to managing absence. This should be based on simple processes, such as ensuring that standard forms are developed for use when managing injuries and absences, providing some basic training to supervisors on how to talk to employees who are absent from work; and developing a return to work policy in line with safety and HR guidelines.

After an injury

Employers need to be aware that the longer an employee is left to manage an injury and recovery alone, the longer the return to work process can take. Employers who offer assistance and support early on will often achieve better return to work results.

So how can an employer manage the risk more effectively following a workplace injury? Staying in contact with employees is crucial. Some employers take the view that this is difficult. It is actually more difficult not to do it. The results of having no contact vary from: not being able to plan for cover in the position or department affected; not actually knowing when the employee is returning to work; the employee becoming angry about not being thought of; morale of others being affected, and the return to work being resisted by the employee.

Having contact with absent employees is about planning the discussion and making sure you approach the conversation in the appropriate manner.

Standing at a hospital bed after an incident and saying to an injured employee, 'We'll chat about you coming back to work later' is not a good idea. An employer may think that is reasonable. However, an injured worker just wants to focus on getting better and to make sure the family is going to be all right.

An employer who contacts his employee and shows concern about his recovery and how it is affecting him will develop a more positive relationship, and an employee is more inclined to attempt to return to work quickly.

Advocating supervisor contact is a pro-active policy to encourage through HR. However, if it is not backed up with training for those supervisors, it can be a disaster for the company.

Making the change

How can we make the change? The first issue is to work out whether you have support. To gain support you need to go armed with information. Ask yourself the questions mentioned previously; let them act as your trigger as to whether you need to address the way in which incidents, injuries and absences are managed.

The point of looking at this in a holistic way is to ensure our companies move forward with the skills and knowledge to manage our workforce and productivity. In the UK, with issues such as chargeback of NHS fees to employers liability claims coming into force next year, we need to take a proactive approach in order to mitigate our loss wherever possible.

Is this an area you can afford not to address?

- Emma Tyler is UK operations manager, Corpore Ltd, Œ CASE STUDY A CORPORATE APPROACH

PROBLEM: An employer - ABC - with approximately 2,400 employees on 84 sites across the UK has a business which involves process line work and manual labour. ABC was interested in positively affecting its employers liability insurance premium over the long term, and also wanted to adopt a proactive absence and injury management programme. No strategy was in place to manage absence, particularly relating to reported work injuries.

SOLUTION: The solution was a 'joined up' approach supported by company executives, human resources departments (HR) and occupational health and safety (OH&S), broker, insurer and captive insurer. It was decided to make the solution part of internal processes to effect a cultural change in the long term, and to consult a specialist adviser with a range of services, to enable ABC to determine what was best practice for the company and apply it across all sites.

ABC and Corpore met for discussions about how such a programme could be implemented and rolled out company-wide. The initial stage was to complete a mini-pilot to determine the way it would best fit ABC's ethos and internal processes, and to point to any areas which might need to be addressed before rolling it out to the company as a whole. Upon completion of the pilot a formal agreement was undertaken to provide an absence and injury management service.

This programme was the joint initiative of the company's HR and OH&S departments. It has been addressed in policy and procedural changes and training is to be provided to safety coordinators regarding how the process will work and how they can better engage with employees. ABC has actively used injury management by ensuring that assessment and support are undertaken as quickly as possible. Many of the referrals are pre-claim and may not even result in a claim. However, ABC is seeking to provide a service to their employees who have reported incidents in the workplace, which have resulted in time away from work. This ensures that the employee has been provided with the optimal chance of recovery from an early stage.

HOW IT WORKS: ABC forward notifications to Corpore within an agreed time frame post injury. Corpore initiates contact with the employee and determines, through a phone assessment by a health professional, whether a return to work is likely within 30 days. If the assessor feels that this is likely they maintain contact, providing the employee with support and facilitating private treatment in an effort to assist with recovery. Where a return to work is unlikely within 30 days, the case is referred to an injury management consultant and follows an assessment and intervention process.

If cases convert into a notification of claim, then the rehabilitation has already commenced or even been completed, the relationship with the employer has been maintained and the claim can be dealt with efficiently without negatively impacting on the employee/employer relationship.


PROBLEM: Ms Smith had been employed by XYZ for six years. She was a technically efficient worker and an important member of the team. In October 2003, Ms Smith started to experience anxiety/panic attacks exacerbated by certain types of situations; the subsequent impact on her work was considerable. She was unable to attend staff meetings and was moved to a separate office, as the open plan office increased her feelings of anxiety.

Her productivity dropped by 50% and she had used all of her sick pay.

XYZ, while valuing her as an employee and thinking they were being supportive, allowed this situation to remain for 12 months before determining it was no longer appropriate. XYZ thought their only option was to review her employment.

SOLUTION: XYZ's HR department, however, determined that an external person might be able to assist in maintaining the employee at work. In October 2004, Ms Smith was reviewed by an injury management consultant with a counselling background. It was considered that change could be achieved over a period of time if all parties committed to the process.

A period of counselling with Ms Smith was undertaken, focusing on her situation and how to manage and change it. After several counselling sessions, Ms Smith agreed to try and return to her usual working environment. All parties were involved in the process and a plan was developed to gradually return Ms Smith to the open plan office. The plan took into consideration a number of influencing factors, such as time of day, peak office times, staff meetings and engagement with other staff.

The plan was implemented in November. Over the Christmas period a setback was experienced by Ms Smith, and the consultant subsequently conducted further counselling sessions. A new plan was implemented to re-commence the return to work plan in March.

Within several weeks of re-commencing the plan, Ms Smith had substantially increased her amount of time in the open plan office and achieved a full return to the usual office environment by mid-April. After ensuring that an office move was completed without negative impact on Ms Smith, the case was closed in May 2005.


[LB] - XYZ have retained a technically proficient staff member.

- They have not needed to adopt an adversarial approach in seeking termination of Ms Smith's employment.

- They did not incur costs for advertising and training a new staff member.

- Supervisors are now better aware of how to managing this type of situation.

- Ms Smith has regained her confidence and self-esteem within her working environment, which has also affected her home life positively.

- Ms Smith has a positive view of her employer due to the support provided to her.

- Ms Smith's team members are also aware of XYZ's support and have become a closer knit team.


A UK survey showed that some 22% of employees who took sick leave in the past year admit that they could have gone into work if they had really wanted or needed to, according to Watson Wyatt.

The survey also found that 40% of employees would be less likely to take days off sick if it meant they would not be paid for the days that they were absent. However, the majority - 56% - say their sickness absence was not affected by pay. Four out of five employees say that they receive full pay when absent from work on a full time basis.

David Cross, head of healthcare and risk consulting at Watson Wyatt, said: "A number of employers have tended to look at reducing absenteeism rates purely by incentivising employees through remuneration policy. While this works for some employees, pay is not the prime motivator for the majority taking a 'sick day'. This clearly implies that employers need to take a more holistic approach to absence. We believe that a balance of financial incentives, allied with a focus on the working environment is more likely to pay dividends. This should include both the proactive interrogation of absence as well as a focus on the potentially detrimental health consequences of that environment."

This is confirmed as a priority in the survey, where over a quarter of employees (26%) said that stress at work had contributed to at least one of their absences in the past year.

"Given the increasing requirements on employers to mitigate both the occurrence and severity of work-related stress, many employers will wish to reconsider their approach to such issues," said Cross.

In Watson Wyatt's 2005 Healthcare Survey of more than 250 leading UK employers, representing in excess of a million employees, 58% of employers said they were concerned by the level of absence in their organisation.

The average number of days lost each year through employee absence was 9.7, which is higher than the Confederation of British Industry's recent figure for private sector employers of 6.4.

Over three quarters of organisations said they did not have a firm understanding of, or control over, the cost of absence to their business, and over a third did not know the cost at all. 26% said they only formally start to manage employee absenteeism after four weeks.

"If companies realised what absenteeism was costing them in real terms, rather than the usual woolly estimates, the issue would be higher up the agenda," said Cross. "As companies struggle to manage absenteeism we have noticed a trend towards outsourcing. This can help in recording data, and also introduces consistency and control into the absence management process."


"Hugh James are delighted to have acted as a catalyst in working with AIRMIC and CBI Wales in presenting the "Looking after your Workforce 2005" Conference at Celtic Manor, South Wales.

It is well recognised that effective management of staff is crucial for all businesses regardless of size.

As each of the the speakers confirmed, get your people management right and morale, productivity and customer service and satisfaction will soar - get it wrong and staff will become disaffected and miss production targets, service standards will drop and customers go elsewhere.

Looking after our people includes developing a 'good health' culture within our organisations, managing absences positively, introducing early and effective rehabilitation, recognising the early onset of stress and the benefits of positive counselling. Staff invariably thrive and succeed in firms where the environment is uplifting and overtly strives to provide benefits for all employees.

It is a disturbing statistic, but work absences in the public sector last year alone cost the taxpayer over £4bn. By better management public sector absences, if reduced to the same levels as the private sector, would save around £1.5bn per year - an astonishing prospect.

At Hugh James we know these are difficult issues which, if better handled, would result in significant savings in terms of both cost and people resource.

We are confident that by working with CBI and AIRMIC in highlighting these areas we can help Corporate UK to identify the problem and find the right solution.

Hugh James - 'Working in Partnership'.