The "Toxic Dose" of System Problems: Why Some Injured Workers Don't Return to Work as Expected

被引:150
作者
MacEachen, Ellen [1 ,2 ]
Kosny, Agnieszka [1 ,2 ]
Ferrier, Sue [1 ]
Chambers, Lori [1 ,2 ,3 ]
机构
[1] Inst Work & Hlth, Toronto, ON M5G 2E9, Canada
[2] Univ Toronto, Dalla Lana Sch Publ Hlth, Toronto, ON, Canada
[3] Ontario HIV Network, Toronto, ON M4T 1X3, Canada
关键词
Return to work; Qualitative; Injured workers; Workers' compensation; System challenges; UPPER-EXTREMITY; COMPENSATION SYSTEM; BACK-PAIN; CONSEQUENCES; DISABILITY; OUTCOMES; MANAGEMENT; DISORDERS; HEALTH; FAMILY;
D O I
10.1007/s10926-010-9229-5
中图分类号
R49 [康复医学];
学科分类号
100215 ;
摘要
Introduction Most workers who incur an injury on the job follow a relatively straightforward path through a workers' compensation claim, recovery and return to work. However, a minority of compensation claims is prolonged and can be disproportionately costly. We conducted this qualitative study in order to gain an understanding of systemic, process-related problems affecting injured workers who had failed to return to work as expected. Method A total of 69 in-depth interviews were conducted with injured workers with complex and extended workers' compensation claims and with return-to-work (RTW) providers such as health care providers, insurers, legal advisors, and workplaces. The study was based in Ontario, Canada. A modified grounded theory analysis led to the identification of common mechanisms in RTW problems. Results We identify problems with return to work and extended workers' compensation claims in dysfunctions in organizational dynamics across RTW systems including the workplace, healthcare, vocational rehabilitation and workers' compensation. These system problems are difficult to identify because they appear as relatively mundane and bureaucratic. These appeared to have damaging effects on workers in the form of a 'toxic dose' affecting the worker beyond the initial injury. Conclusions Worker's problems with extended claims were linked to RTW policies that did not easily accommodate conflict or power imbalances among RTW parties and by social relations and processes that impeded communication about RTW situations and problems. Avenues for intervention are located in a shift to a critical lens to RTW process that addresses differences of knowledge, resources, and interests among different parties.
引用
收藏
页码:349 / 366
页数:18
相关论文
共 84 条
[31]  
Kennedy Margaret Q, 2003, AAOHN J, V51, P204
[32]  
Keogh JP, 2000, AM J IND MED, V38, P498, DOI 10.1002/1097-0274(200011)38:5<498::AID-AJIM2>3.0.CO
[33]  
2-I
[34]  
KIRSH B, 2001, MAKING SYSTEM BETTER
[35]  
Kirsh Bonnie, 2003, Work, V21, P221
[36]  
Korzycki M, 2008, WORK, V30, P277
[37]   Compensation for musculoskeletal disorders in Quebec: Systemic discrimination against women workers? [J].
Lippel, K .
INTERNATIONAL JOURNAL OF HEALTH SERVICES, 2003, 33 (02) :253-281
[38]   Therapeutic and anti-therapeutic consequences of workers' compensation [J].
Lippel, K .
INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY, 1999, 22 (5-6) :521-546
[39]  
Lippel K., 2007, Managing claims or caring for claimants: Effects of the compensation process on the health of injured workers
[40]   Evaluation of the north country on the job network: A model of facilitated care for injured workers in rural upstate New York [J].
Lipscomb, HJ ;
Moon, SD ;
Li, LM ;
Pompeii, L ;
Kennedy, MQ .
JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL MEDICINE, 2002, 44 (03) :246-257