I have recently finished working with a rehabilitation client. After 2 years of sickness and fatigue she is now back at work in a variety of freelance capacities. However, when she first came to me, she was fraught with difficulties: she had very little understanding of her conditions, of her functional capacity and seemed unwilling to accept that she had a 2 year benefit period that was fast approaching its end.
We had a musculoskeletal diagnosis, a mental health diagnosis and a fatigue condition diagnosis. This on its own would make any rehabilitation professional sink in their seat and think – “wow, this client might be a challenge.”
The insurer was well aware of the looming end of her 2 year benefit period and knew they wanted to help their member, however they had a very narrow view (in the beginning) of what this support or intervention should look like. After all, since they were going to be closing the claim in the coming 4 months, it wasn’t as if rehabilitation intervention was going to get this person off claim any sooner. Their biggest concern was that the client would wake up one day and realise they had no capacity, no support and no income and they didn’t want that for their member.
The treating doctor and psychologist were completely unaware of the 2 year benefit period and had wrongly assumed that like other jurisdictions this client’s treatment was being paid for and she could remain “unfit for work” and unemployed for as long as it took her to recover sufficiently.
As I completed my final session with this client, she was incredibly gracious in her thanks of the work we had done together: for the effort to help her understand what the agenda of the insurer was, and for the time I had invested in educating her and her treating health professionals about her circumstances. Apart from the intervention that was specific, timely and the right thing at the right time, she explained to me that without good rehabilitation she would remain sick, incapacitated and now without hope because she would have no income and no way of knowing how to access income.
It might seem that good communication was at the core of good rehabilitation. And while it is essential, GOOD rehab is also knowing what to communicate, when to communicate it and to whom the communication needs to occur and involve. You see, at one point during this process, the insurer wasn’t happy with my recommendations, the client didn’t trust me and the treating psychologist was very wary of my intentions. It was not feeling GOOD!
Good rehab is also about collaboration – more than simply the transfer of information between parties, it’s the collaboration to create a plan to achieve a goal where everyone’s agendas are taken care of.
Good rehab is also about doing the right thing at the right time, and about having the courage, insight and self-worth to be able to say to a client – ‘No I can’t support this decision you want to make’, or to an insurer, ‘please understand why I don’t agree with your opinion or your expectations of me’. Good rehab is about respect, it’s about empowerment and it’s about transformation.
Good rehab should create a pathway where a client comes into your service and leaves changed. This means we have a foundation of open communication and collaboration. So before the treatment, interventions, tactics and plans are trotted out for everyone to sign, we need to have a foundation that says, I know why I am here, and I know what is expected of me.
One of the things that gets in the way of GOOD rehab is “everyone else’ agendas”.
Everyone else’s agendas are easy to spot. And truth be told clients know when we are not acting in their best interests (or perceived best interests) and we need to be prepared to have discussions about this and help them understand the rules of the game they find themselves in.
Other people’s agendas, well… they actually stifle GOOD rehab. They interrupt trust, and let’s face it, rehabilitation, RTW, work and health is a hig- trust game!
Too often clients come to rehabilitation from a place of passivity in their treatment. They have been told what to do, and when to do it. The day before their injury, illness or disability they were functioning without health professionals, rehabilitation professionals and third-party payers. They were in control of their own life. Then they become sick, injured or disabled and whammo – they now have a new set of rules to comply with.
Medical practitioners telling them what they can and should do with their bodies, allied health professionals telling them what they should do, an insurance company asking them what they can do and when will they improve and this person called a “rehabilitation professional” is going to come and tell them what they will do for work. Control of their life as they knew it has completely changed.
Clients are in general sick, fearful, distrusting and incredibly cautious. They want to feel better and they want assurance that everything is going to be OK. And while we can’t make any promises, we can collaborate to help clients understand that with their involvement, their commitment, their agenda – then we will all work towards helping them improve so that they can take back control of their life.
With good rehab, we have collaboration. With collaboration, everyone has a say. The positional power, while it exists, is not the driving force of compliance. Collaboration says – we want to help you get back to work and to do this we want to help you improve your health, help you navigate the world of work, and help you feel safe that you can do this on your own when all the service providers have gone.
Collaboration doesn’t say – get back to work in the next 6 weeks otherwise your benefits might cease
Collaboration doesn’t say – we will re assess your eligibility for benefits in the next month
Collaboration doesn’t say – this is what your insurer wants you to do so you will have to do it
Collaboration doesn’t say- I need you to just get a job so my stats look good.
Clients and stakeholders can hear these messages even when the words are not spoken. I cannot tell you how many times I have had a client say to me:
‘The insurer just doesn’t want to pay me any more that’s why they want me to go back to work.’
‘You are paid by the insurance company so you are going to do whatever they tell you to do to make sure your boss gets paid’
I’ve even had clients come to me angry in their incorrect knowledge that I would only get paid when they went back to work so they assumed I would push them into any job just to get paid- this is just incorrect and I speak into this immediately. But this statement does highlight the lack of trust a client often comes into the process of rehabilitation and RTW with.
How then can we respond to these core issues of lack of trust in a way that builds an environment for collaboration and mutual agreement in goal setting?
What if we tried responding like this?
Client: The insurer just doesn’t want to pay me any more. That’s why they want me to go back to work.
Yes Mr Smith you are correct, insurance companies are big public companies and they want to keep their shareholders happy. So it is in their interests that you are no longer on claim. However, insurance companies also know that getting off claim isn’t enough – you need to be well enough to get off claim and stay off claim. They are also selling you a product so they know that you might need it again, so they want to make sure that when you are off claim that you are able to pay your premiums again, because premium collection is a part of how they are funded.
So yes, they do want you to go back to work. But it not just work tomorrow then back on claim. Insurance companies also read and participate in research. They also know that the longer you are away from work, the worse your health will become. They know that the longer you are unwell, the less chance you have of being able to work. So it serves their interests once again to ensure you have the health and RTW support you need to 1. Get well 2. Maintain your wellness. 3. Maintain your wellness at work.
Client: You are paid by the insurance company so you are going to do whatever they tell you to do to make sure your boss gets paid.
While it is true that I am paid by the insurance company, I am paid to do a job. I have ethical commitments to my professional associations and a standard of professionalism that I am bound by. So while I am paid by the insurer, and they might have a specific idea in mind about what they would like us to work on together, they cannot demand me to act in a way that is unprofessional or unethical or outside of my skillset. Insurers also do not have to fund me and the work we do together. They actually see me as a resource for you and are willing to pick up the tab. There is no obligation on their part. They are entering into this because it helps them to know you are being cared for, looked after and supported in improving your health and returning to work.
One of the biggest problems I am hearing time and time again from insurance company representatives, advisors, brokers, treatment providers and our clients is that everyone appears to have a different agenda and no one seems to want to collaborate to make a lasting plan. Everyone appears short sighted; applying an economic rationalist approach. Or we have a range of key stake holders or looking for the next hack, or silver bullet , technique or tactic to help someone return to work.
Some of the most powerful and transformational moments I have experienced with clients is when:
1. They feel heard by an insurer
2. A treatment provider helps them to see how treatment is moving them towards their goals
3. A rehabilitation professional has explained the power and control they will have once they return to work.
Collaboration can’t be prescribed or compliance-managed. Collaboration must be built and an environment created where to problem solve and collaborate together is acceptable and expected. Sure, we are the RTW professionals, sure the treatment providers are the experts in treatment – however we can do more to help clients take ownership of their recovery process than simply telling them – this is best practice and it is what you will do.
After all, what Simon Sinek has to say about people not buying what you do but why you do it applies just as much to rehabilitation and RTW as it does to leadership and sales. *
So how do we respond to these core issues of lack of trust and everyone else’s agendas in a way that builds an environment for collaboration and mutual agreement in goal setting?
These are a few ideas about what I think makes GOOD rehab GOOD. I am sure we can create a long list of the elements… swhat else do you think makes Good rehab Good? What have I missed? I would be keen to read your thoughts.
Jo Muirhead is a Rehabilitation Counsellor with over 20 years of experience in vocational rehabilitation. She owns two successful businesses and is the Founder, Director and Principal Consultant of Purple Co, a team of specialist consultants that help people manage their illness, disability or injury and reclaim their lives through work.