OPTIMAL RETURN TO WORK:

THE NEXT ITERATION

Ms Jessica Fullarton
Comcare, Australia

Key words: Return to Work, Personal Wellbeing, Functional Capacity, Work Environment, Work Conditions, Job Satisfaction, Support
BACKGROUND

METHODOLOGY

Workers compensation schemes around the world have used a range of measures to assess Return to Work (RTW) following a workplace injury or
illness. The vast majority of these measures, however, do not provide insights into the subjective experiences of injured workers.

PARTICIPANTS: Data was collected from a total of 791 workers with accepted workers' compensation claims from both premium paying (n=436) and
self-insured (n=355) organisations within the Comcare Scheme.

Comcare shared some of the initial work on a new measure called Optimal RTW at the 2012 Australasian Compensation Health Research Forum. The
measure aims to provide insights into the quality of an injured/ill workers RTW from their perspective.

QUESTIONNAIRE: The Comcare Injured Worker Survey collects information from injured/ill workers. Respondents took an average of 25 minutes to
complete the survey with an overall response rate of 79%. The questionnaire collects information on the attitudes, perceptions and experiences of injured/
ill workers.

In May 2013, the measure was expanded to capture a fourth construct: support.

The Optimal RTW scale is comprised of 18 items that are rated on a 5-point Likert scale, from 'strongly agree' through to 'strongly disagree'. The items
were grouped according to the four theoretical constructs: work environment, personal wellbeing, functional capacity and support.

AIM OF THE RESEARCH

The aim of this research is twofold: First, to better understand how four separate yet related theoretical constructs of RTW (work environment, personal
wellbeing, functional capacity and support) can be combined to provide better insights into the quality of an injured/ill workers RTW from their perspective;
and second, to positively influence an individual's recovery and RTW by:
> providing better insights into the factors which influence the success of an injured/ill workers RTW
> improving our understanding about the recovery and RTW pathway of injured/ill workers
> identifying opportunities for the Comcare scheme, including employers, to better support the recovery and RTW of injured/ill workers.

PROCEDURE: An independent research company conducted the survey in May 2013 using Computer Assisted Telephone Interviewing (CATI). Engaging
an independent research company ensured confidentiality and anonymity for participants.
SAMPLING: A probability proportional to size design was used with a minimum critical sample size of 30. The sampling framework considered the two
sectors of the scheme (premium paying and self-insured) and five cohorts with varying incapacity payment durations. A representative sample was
obtained.
ANALYSIS: SPSS was used to explore the theoretical model and factor structure as well as test the reliability of the new Optimal RTW scale.

RESULTS
The Optimal RTW scale was revised in early 2013 to incorporate an additional factor of support. The four factors now included in the Optimal
RTW Scale are believed to be a critical influence in the success and longevity of an individuals RTW. These factors are associated with:

.772
Have a say in how you organise your work

> work environmentthe way in which an individual interacts with and feels about their workplace, including their relationship with
their manager
> personal wellbeinghow an individual perceives themselves, including their level of self-esteem, self-concept, and locus of control

.757
Your opinions/suggestions considered at work

> functional capacitythe way in which an individual perceives their injury and their capacity to do their job
> supportan individual's perception of the support available/accessible to them.

Personal
Wellbeing

.635
Supervisor/manager committed to workplace safety

Functional
Capacity

.599
WORK ENVIRONMENT

Employees/management supportive of each other

40%

.530

Work
Environment

Your work is valued by others at work

Support
Optimal
RTW

.488
Others you work with are committed to safety
.477

Figure 1. Four factor model of Optimal RTW.

Principal components analysis with an oblique rotation was conducted. Figure 2 (right) illustrates the structure recommended by the analysis.
The total variance explained by the original three factor model was 60%. The total variance explained by the inclusion of the fourth factor and
all 18 items was 62%, which indicates that the model was strengthened with the inclusion of the support items. Of the 18 items, one did not
meet our criteria for saturation on one factor (>0.40) and non-saturation on other factors (<0.40). The final analysis therefore excluded this item
(Given your recovery, your skills and abilities are used appropriately) which was loading above 0.4 on two of the factors (0.485 and 0.412).
Previous analysis had supported including this item, however, it had the lowest loading of the 15 items analysed last year (0.418).
The final four factor model suggested that two of the factors should be renamed from Personal Wellbeing to Job Satisfaction and from Functional
Capacity to Work Conditions. The total variance explained by the final four factor model, with 17 items, is 63%.
The internal consistency across the 17 items included in the structure displayed in Figure 2 is high ( =0.90).

Feel part of a community at work

.840
Your work satisfies you
.839
JOB SATISFACTION

You enjoy work

9%

OPTIMAL RTW

.838
Your work is important to you
.846
Your hours are about right for you
.830

WORK CONDITIONS

8%

Amount of work you do is reasonable

.778
Get help/support when you need it
.767
Help/support is available to you
.731
SUPPORT

After injury/illness, got all help/support needed

6%

.490
Physically capable of doing job
.406
Emotionally capable of doing job

Figure 2. Variance contribution and item loading following factor analysis.

CONCLUSIONS

RESEARCH INTO ACTION

Our primary objective was to develop a scale to provide better insights into the quality of an injured/ill workers RTW from their perspective. The introduction
of support items and the continued development of the Optimal RTW scale has provided Comcare with confidence that the scale will provide both us and
employers with greater insights into the perceptions of injured/ill workers about the quality of their RTW.

The original three factor Optimal RTW scale was included in the inaugural Australasian RTW Survey in May 2013. This will enable analysis across other
jurisdictions with the potential for including the support factor items in future waves.

The analysis showed support for:

> including 17 of the 18 items
> the presence of four discrete factors (work environment, job satisfaction, work conditions and support)
> a model explaining a significant amount of the variance (63%)
> an increase in the variance explained by the three factor model which excluded support ( 3%).
A key outcome of the analysis undertaken has been the reaffirming and re-emphasising of the importance of the workplace and the role of work in helping
someone to return to and remain at work.

The next step for the Optimal RTW concept is to work with employers to test the usefulness of the tool within an organisational setting to ensure injured/
ill workers' RTW is optimal, sustainable and achievable from both the individual's and the organisation's perspective.

CONTACT DETAILS
Ms Jessica Fullarton
Senior Research Consultant
Comcare (Melbourne Office)
jessica.fullarton@comcare.gov.au
Comcare Research Team
GPO Box 9905
Canberra ACT 2601