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Healing or Harming? Healthcare Provider Interactions with Injured Workers and Insurers in Workers’ Compensation Systems

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Abstract

Introduction Healthcare providers (HCPs) are influential in the injured worker’s recovery process and fulfil many roles in the delivery of health services. Interactions between HCPs and insurers can also affect injured workers’ engagement in rehabilitation and subsequently their recovery and return to work. Consideration of the injured workers’ perceptions and experiences as consumers of medical and compensation services can provide vital information about the quality, efficacy and impact of such systems. The aim of this systematic review was to identify and synthesize published qualitative research that focused on the interactions between injured workers, HCPs and insurers in workers’ compensation systems in order to identify processes or interactions which impact injured worker recovery. Method A search of six electronic databases for literature published between 1985 and 2012 revealed 1,006 articles. Screening for relevance identified 27 studies which were assessed for quality against set criteria. A final 13 articles of medium and high quality were retained for data extraction. Results Findings were synthesized using a meta-ethnographic approach. Injured workers reported that HCPs could play both healing and harming roles in their recovery. Supportive patient-centred interaction with HCPs is important for injured workers. Difficult interactions between HCPs and insurers were highlighted in themes of adversarial relations and organisational pressures. Insurer and compensation system processes exerted an influence on the therapeutic relationship. Recommendations to improve relationships included streamlining administrative demands and increasing education and communication between the parties. Conclusion Injured workers with long term complex injuries experience difficulties with healthcare in the workers’ compensation context. Changes in insurer administrative demands and compensation processes could increase HCP participation and job satisfaction. This in turn may improve injured worker recovery. Further research into experiences of distinct healthcare professions with workers’ compensation systems is warranted.

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Notes

  1. Reflexivity refers to the comments made by the authors of each article on how the context, selection of participants or data collection process affected the results obtained in their study.

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Acknowledgments

The project was funded by WorkSafe Victoria, the Transport Accident Commission and Monash University, Victoria, Australia. The authors wish to thank Dr. E MacEachen for the use of quality appraisal and data extraction proforma previously developed for a systematic review of qualitative literature on return to work. The project No FS-M-11-029 was funded by WorkSafe Victoria and the Transport Accident Commission, (TAC) Victoria, Australia. ISCRR is a joint initiative of TAC, WorkSafe Victoria and Monash University.

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Authors and Affiliations

  1. Institute for Safety Compensation and Recovery Research (ISCRR) and Department of Epidemiology and Preventive Medicine, Faculty of Medicine Nursing and Health Science, Monash University, Level 11, 499 St Kilda Rd, Melbourne, VIC, 3004, Australia

    Elizabeth Kilgour & Alex Collie

  2. Monash Centre for Occupational and Environmental Health (MonCOEH) and Department of Epidemiology and Preventive Medicine, Faculty of Medicine Nursing and Health Science, Monash University, 6th Floor, The Alfred Centre 99 Commercial Road, Melbourne, VIC, 3004, Australia

    Agnieszka Kosny

  3. Family Violence Unit, Ministry of Social Development, Level 7, Bowen Street, Wellington, 6140, New Zealand

    Donna McKenzie

Authors
  1. Elizabeth Kilgour
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  2. Agnieszka Kosny
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Corresponding author

Correspondence to Elizabeth Kilgour.

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Appendix

Appendix

Quality Assessment Questions

The questions from the quality assessment framework developed by Spencer [44] and modified by MacEachen [40] were reordered to fit the focus of the review. Each question was rated out of five using the suggested underlying quality guidelines. Questions 1 and 2 were regarded as important screening indicators. If reviewers did not score the first two questions at 2 or above, the assessment was not continued as it was evident that the article was not of sufficient relevance to be included in the review.

  1. 1.

    How has knowledge/understanding of interactions between key parties in workers’ compensation systems been extended by the research?

  2. 2.

    Scope for drawing wider inference about interactions between key parties in workers’ compensation systems—how well is this explained?

  3. 3.

    How well does the study address the original aims and purpose?

  4. 4.

    How credible are the findings?

  5. 5.

    How defensible is the research design?

  6. 6.

    How well defended is the sample design/target selection of cases?

  7. 7.

    Sample composition/case inclusion—how well is coverage described?

  8. 8.

    How well was the data collection carried out?

  9. 9.

    How adequately has the research process been documented?

  10. 10.

    How well was the approach to/formulation of the analysis conveyed?

  11. 11.

    Contexts of data sources—how well are they retained/portrayed?

  12. 12.

    How well has diversity of perspective and content been explored?

  13. 13.

    How well has detail, depth and richness of data been conveyed?

  14. 14.

    How clear are the links between data, interpretation and conclusions?

  15. 15.

    How clear and coherent is the reporting?

  16. 16.

    How clear are the assumptions/theoretical perspectives/values that shaped form and output of the study?

  17. 17.

    What evidence is there of attention to ethical issues?

The question excluded in this modified version was “How clear is the basis of evaluative appraisal?” which applies only to evaluation research.

Rating Calculation Guidelines

Each of the quality assessment questions were rated out of five and scores were then totalled to achieve the overall rating of the article. An overall score was calculated for the article and levels of quality were assigned as; Very low (0–15), Low (16–30), Medium (31–55) High (56–70) Very high (71–85). The questions included in each section, and the possible maximum scores for each section are listed below;

Question

Category

Rated score

Maximum score

1–4

Findings

 

20

5–7

Design and sample

 

15

8–9

Data collection

 

10

10–13

Analysis

 

20

14

Auditability

 

5

15

Reporting

 

5

16

Reflexivity and neutrality

 

5

17

Ethics

 

5

 

Total score

 

85

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Kilgour, E., Kosny, A., McKenzie, D. et al. Healing or Harming? Healthcare Provider Interactions with Injured Workers and Insurers in Workers’ Compensation Systems. J Occup Rehabil 25, 220–239 (2015). https://doi.org/10.1007/s10926-014-9521-x

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