Difference Between Early Return-to-Work and Work Hardening
Posted on Fri, Nov 11, 2011 @ 02:00 PM
The following post was written in response to a colleague in Botswana who is involved in building the country’s rehabilitation system:
As you may know, work hardening is best suited to injured individuals who have not yet made the cognitive shift from being a patient to being a worker. This type of case is usually a result of mismanagement of disability and rehabilitation. This includes, for example, the use of impairment ratings to determine disability, traditional physical rehab without consequences for non-compliance, etc. This specialized service was originally designed by Dr. Leonard Matheson as an environment within which an individual could safely test the bounds of their beliefs about work-ability and their functional work-ability.
Typically, an individual enters work hardening when traditional medical and rehabilitation services have not resulted in successful return-to-work and function. The concept of early return-to-work by definition assumes that the injured individual receives the appropriate services early on in their healing and rehabilitation journey that results in preclusion for the need to enter work hardening.
The environment within which these services are rendered is critical to successful recovery. Chief among the barriers to early success are societal and physician induced disability. Some United States court cases related to these subjects are: Poljarevic v Independent Foods, EEOC v Hussey Copper, and Gillen v Fallon Ambulance Services. (These cases can all be found on our website. Please click on the links to download the case or to watch an archived webinar.)
As you establish your services, one of the first issues you will need to deal with is how society holds return-to-work as a value:
Does the average individual see rehabilitation and return to function as a gift?
Does the average individual see disability as an entre to a period of inactivity and lack of function in life?
One of your main tasks is to recruit the legal system, the disability system, and the medical system to foster function and a strong work ethic as positive values. Another of your challenges will be to set up a system within which physicians are rewarded for a focus on return-to-work and function rather than a focus on protecting themselves by setting unrealistically low, prophylactic work restrictions and attendant disability. My meaning here is to free the physicians to think in terms of the injured individual’s health and work-ability rather than a defensive response to potential legal ramifications of the unlikely incident of re-injury based on set limitations. It would be best to encourage physicians to not set limitations or restrictions at all, but rather to set abilities. (It is unlikely that a person will get hurt if they set restrictions that are too high, so we don’t want physicans to set limitations/restrictions at all. We want them to set abilities, not restrictions.)
If you can foster a system that uses work-ability measures as the target, rather than work restrictions you will, in the long run, build an environment that focuses on return-to-work. One of the tools in which you can utilize to foster accurate identification of work-ability is the functional capacity evaluation. I encourage you to consider your FCE training in light of the legal system. Tailor your reports and your work product to the needs of that system with a focus in supporting physicians and society to concentrate on return-to-work.
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