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Framing the Care of Injured Workers: An Empirical Four-Jurisdictional Comparison of Workers’ Compensation Boards’ Healthcare Policies

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Abstract

Purpose: The objective of this study was to explore how workers’ compensation policies related to healthcare provision for workers with musculoskeletal injuries can affect the delivery and trajectories of care for injured workers. The principal research question was: What are the different ways in which workers’ compensation (WC) policies inform and transform the practices of healthcare providers (HCPs) caring for injured workers? Methods: We conducted a cross-jurisdictional policy analysis. We conducted qualitative interviews with 42 key informants from a variety of perspectives in the provinces of Ontario and Quebec in Canada, the state of Victoria in Australia and the state of Washington in the United States. The main methodological approach was Framework Analysis. Results: We identified two main themes: (1) Shaping HCPs’ clinical practices and behaviors with injured workers. In this theme, we illustrate how clinical practice guidelines and non-economic and economic incentives were used by WCs to drive HCP’s behaviours with workers; (2) Controlling workers’ trajectories of care. This theme presents how WC policies achieve control of the workers’ trajectory of care via different policy mechanisms, namely the standardization of care pathways and the power and autonomy vested in HCPs. Conclusions: This policy analysis shed light on the different ways in which WC policies shape HCP’s day-to-day practices and workers’ trajectories. A better understanding and a nuanced portrait of these policies’ impacts can help support reflections on future policy changes and inform policy development in other jurisdictions.

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Data Availability

To preserve the participants’ anonymity, we do not and will not make the data available. Readers of the papers that might have questions about data can contact the corresponding author (anne.hudon@umontreal.ca).

Code Availability

To preserve the participants’ anonymity, we do not and will not make the codes available. Readers of the papers that might have questions about codes can contact the corresponding author (anne.hudon@umontreal.ca).

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Acknowledgements

The authors wish to thank all the key informant participants that generously provided their time to participate in this research project. The authors also want to thank all the informants in each jurisdiction that helped identify the key informants that took part in this complex multijurisdictional project.

Funding

This paper is based on the postdoctoral research conducted by Anne Hudon at University of Waterloo and University of Ottawa. This research project was supported by the Canada Research Chair in Occupational Health and Safety Law and from a Partnership grant—Healthy and Productive Work from the Social Sciences and Humanities Research Council of Canada (project title: Policy and practice in return to work after work injury: challenging circumstances and innovative solutions). Anne Hudon is currently supported by a Junior 1 Career Award from the Fonds de recherche du Québec—Santé (FRQ-S).

Author information

Author notes

  1. Deceased: Katherine Lippel worked as the postdoctoral co-supervisor of the first author, was a co-researcher on the development, conduct and analysis of the project leading to this manuscript and co-authored this work. She died on September 23rd, 2021.

Authors and Affiliations

  1. School of Rehabilitation, Faculty of Medicine, Université de Montreal, Pavillon du Parc, Office 402-5, C.P. 6128, Succ. Centre-ville, Montréal, QC, H3C 3J7, Canada

    Anne Hudon

  2. Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, QC, Canada

    Anne Hudon

  3. Centre de Recherche en Éthique (CRÉ), Montréal, QC, Canada

    Anne Hudon

  4. School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada

    Ellen MacEachen

  5. Faculty of Law, Civil Law Section, University of Ottawa, Ottawa, ON, Canada

    Katherine Lippel

Authors
  1. Anne Hudon
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  2. Ellen MacEachen
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  3. Katherine Lippel
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Contributions

All authors contributed to the study conception and design. Data collection and analysis were conducted by AH. EM and KL also contributed to the analysis via frequent discussions and meetings with the first author throughout the conduct of the study. The first draft of the manuscript was written by AH and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Anne Hudon.

Ethics declarations

Conflict of interest

Anne Hudon, Ellen MacEachen and Katherine Lippel declare that they have no conflicts of interest.

Ethical Approval

This study received ethical approval from the research ethics board at the University of Waterloo (Certificate No. 22901) and at the University of Ottawa (Certificate No. S-04-18-621). We certify that the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Informed consent was obtained from all patients included in the study.

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Not applicable.

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Appendices

Appendix

Interview Guide

*Please note that this interview guide was used to conduct semi-structured interviews with key informants in four distinct jurisdictions. During our interviews, we chose to leave a lot of flexibility for participants in answering these questions and aimed to follow and explore their narrative on the topic of our study without using the interview guide rigidly. As such, for some participants, these questions were mainly used as probes to allow the exploration of the different dimensions we were interested in, but the questions were not asked in this specific order or in their entirety each time.

  1. (1)

    Icebreaker questions

    1. •

      Before we start discussing first-line healthcare providers, could you tell me what is your role in your organization?

    2. •

      And how long have you been doing this? [get an idea of their experience]

  2. (2)

    Current first-line HCPs’ policies

    1. •

      Could you talk to me about the current policies regarding first-line HCPs for injured workers compensated by the WCB in your jurisdiction?

    2. •

      In your opinion, what are the positive aspects of the way access to healthcare for workers with MSK injuries is currently organized in your jurisdiction?

    3. •

      What are the negative aspects of this organization of care?

    4. •

      According to your knowledge and experience, which professional group do you think is currently “the most involved” in the care of injured workers in your jurisdiction?

  3. (3)

    Impact on quality of care

    1. •

      Do you think first-line HCPs are significant players regarding the quality of care and the RTW process of injured workers?

      1. o

        If so, why? and how?

    2. •

      In your view, how do first-line HCPs impact return-to-work for injured workers?

      1. o

        What elements could be improved in that regard?

      2. p

        What would you change if you were currently in charge of first-line HCPs’ policies in your jurisdiction?

    3. •

      Overall, what do you think about the current “continuity of care” for injured workers in your jurisdiction?

      1. o

        Could you give me some concrete examples of that?

      2. p

        How does it impact the quality of care? And the return-to-work process?

    4. •

      How does the current organization of care influence the trajectory of workers who are working in non-standard employment relationships (such as part-time workers, workers working for temporary agency, workers working with temporary contracts, on-call workers)?

      1. o

        If so, are there particular issues that arise relating to access to health care or support for return to work?

    5. •

      How does the current organization of care influence the trajectory of workers who are recent immigrants or temporary foreign workers?

  4. (4)

    Choice of provider

    1. •

      In your experience, which type (or types) of professionals should have the official responsibility of being the first-line HCPs for injured workers? Why do you think so?

    2. •

      Are there any other types of HC professionals that could also play the role of “first-line HCPs” for injured workers with MSK injuries in your jurisdiction?

      1. o

        Why would these be well suited for this job?

    3. •

      Do you think it is important for injured workers to choose their own provider? If so why?

    4. •

      How do different healthcare providers influence further use of healthcare services in your jurisdiction?

  5. (5)

    Training and characteristics of practice

    1. •

      What type of training do you think the “first-line” HCPs should have in order to provide care for injured workers?

    2. •

      What other attributes to you think first-line HCPs should have?

      1. o

        Are these attributes related to philosophy of care? Something else?

    3. •

      What other characteristics are important for first-line HCPs to fulfill their roles?

  6. (6)

    Financial issues

    1. •

      Are you aware of the reimbursement fees (or fee schedules) for the different types of providers acting as first-line HCPs?

      1. o

        Do you think it has an impact on the workers’ recovery or their return-to-work process? If so how?

      2. p

        Would you make some change to these reimbursement issues? Which ones?

    2. •

      Who do you think lobby for these reimbursement fees?

    3. •

      According to you, what are the economic impacts of the choice of the first-line HCPs for workers’ compensation?

    4. •

      According to your knowledge, what role do politics and lobbies play in determining first-line HCPs for injured workers?

Overall closing questions

  1. •

    Looking back on this very interesting discussion we just had, what are the most important changes you think should be made with regards to the first-line of care or first-line HCPs’ policies for injured workers with MSK in your jurisdiction?

Closing

I have now completed my questions.

Do you have anything else that you would like to say that we have not yet discussed?

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Hudon, A., MacEachen, E. & Lippel, K. Framing the Care of Injured Workers: An Empirical Four-Jurisdictional Comparison of Workers’ Compensation Boards’ Healthcare Policies. J Occup Rehabil 32, 170–189 (2022). https://doi.org/10.1007/s10926-021-10021-8

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