At Purple Co, we are often sent referral requests to “engage” a client in recovery, rehabilitation and RTW. Now, most of us hear that phrase and think – OK this means the client isn’t engaged, and that can mean a couple of things:
– The client is resistant to being engaged.
– The client is going to be difficult.
– The client has no understanding of what rehabilitation can offer.
When the referral is coming from an insurer, an employer or a regulatory authority where the request to “get the client engaged” is being made, I now stop and think: hang on, what’s going on that one of the KEY parties in the process is finding it difficult to engage a client in a process of recovery, rehabilitation and RTW? What can I do that’s different, useful and helpful to all parties involved?
And this is where it’s important to have an understanding of what engagement is, and to know what engagement can offer a client, the insurer, the regulator and the employer. I think we have a problem in the occupational rehabilitation space, in that we think we know what engagement is – we certainly know what it feels like when it happening, because it is GOOD – but can we define it, can we explain it and can we create a pathway for engagement?
Engagement is a process – not a switch that we can turn on and off.
After all, when we spend all the time and effort to help a client understand how rehabilitation can help, often working with their treating health professionals to help them understand our role and how we can help. We use all of our motivational interviewing techniques and coaching skills to help the client, and their significant other, understand that we are there for the best interests of the rehabilitation process, and not just an extension of the insurer (who of course only wants to cut their benefits – myth to be busted) but we have something of value to offer, and that value is to help this client take back control of their life – ONCE we have the client engaged, that’s awesome – but our role in engagement doesn’t stop there. You see engagement isn’t a onetime thing that happens and then it says, is just as easy to help a client become disengaged as it is to become engaged.
However, have you ever noticed that your definition, my definition, an insurance company representative’s definition and a client’s definition of being engaged is really different? And what about being “actively engaged”?
Well, being the evidence-based practitioner that I am, I thought it would be helpful to go to the dictionary to find a common definition of “engagement” – and this is what the Merriam-Webster Dictionary had to say…
I hope you agree with me that these 5 definitions of the same word are rather, well different…
So, I went searching for some more answers in the research and writing about workplace engagement, and here’s what I found…
Sean Graber wrote an interesting piece for the Harvard Business Review. What was really interesting to me was in my research to find a common understanding and definition of employee engagement, I was coming up against a lot of competing definitions. Graber sums this up really well:
Each year, companies are spending nearly three-quarters of a billion dollars in an effort to improve employee engagement — yet you’ll get wildly inconsistent answers if you ask managers what that means. Academics, consultants, and leaders have been grappling with that question for decades. Their working definitions range from the simple (“discretionary effort”) to the mind-bending (“complex nomological network encompassing trait, state, and behavioral constructs”).
However, what I have learned in all of the research I did for this blog post is this: everyone thinks that engagement is important. While there are appears to be wide-ranging and sometimes seemingly opposing explanations for what engagement is, the research is rather clear on what engagement brings us:
– Less turn over.
– Less attrition of staff.
– Grater scores in productivity.
– Greater scores in customer satisfaction.
So by now you might be like me and thinking, “all I know is that when clients are engaged then everything works, so I’m going to keep doing what I’m doing and pray that I know what I’m doing and that everything will be fine, because let’s face it, this thing called engagement doesn’t appear to be as simple as we might have thought at the beginning of this post…”
OK – so then I thought, what about patient engagement in recovery, surely someone has researched that! And yes, they have, at great length. I found this article particularly useful:
“Engagement in this context was defined as a patient’s deliberate effort to work toward recovery by participating fully in their rehabilitation therapies.”
I really loved the use of the word deliberate. I think that sums up how we know someone is engaged in the recovery, rehabilitation and RTW process: they are being deliberate in their beliefs, attitudes and behaviours.
And then came this insight…
“Fear of pain, depressed mood and cognitive issues were rated as the most frequently encountered barriers impacting patient engagement. Making therapy tasks meaningful and explicitly related to personal goals of the patient was the most commonly reported practise for enhancing therapeutic engagement.”
It now seems really easy, doesn’t it? Have you noticed that the clients who have experienced the greatest success are the ones who are the most engaged, and by most engaged I mean these are the people who are doing all of their treatment, who call you and chase you up for things, who want to know “what’s next” who are planning how they want to return to work, and who understand that we are a resource for them in this whole entire process? In short, they are being deliberate in their beliefs, attitudes and behaviours.
That’s what active engagement looks like. It looks like the client wants to be here in the process with us. They have skin in the game. They know that they need to put in the work to get the results and they want the results.
And this level of engagement is wonderful in the pre-return to work stages of the process. How then do we take this level of engagement and apply it to a workplace where there are new factors, new people, new opinions that matter, new corporate goals?
Engagement for the rehabilitation professional requires us to have a working knowledge of the way engagement turns up in every part of the recovery, rehabilitation and RTW process. It also calls on us to understand and accept that it’s not just the client who needs to be engaged. Often clients need the “engagement” of their significant other, their treatment providers, their employers, their colleagues to support their own engagement. Have you ever noticed how precarious engagement of a client can be when there are other voices in their heads questioning why they are doing what they are doing?
How then can we as rehabilitation professionals, support engagement and be the creators of the space where being engaged can occur? I think there are some clues in what has been discussed here:
- Having activity that is meaningful and has purpose where there is a reason to be doing something, including suitable duties, treatment activities, and pre-vocational activities.
- Making sure that clients understand the WHY of what we are recommending not just the “here’s what needs to be done” component.
- Making sure clients understand the “how” behind where we’re headed, not just the “what” of the next step.
- Having everyone agree to and be accountable for their actions and behaviours (everyone including us, the Rehabilitation Professional).
Engagement is obviously multifaceted. Patient engagement isn’t enough for recovery, rehabilitation and RTW. Employee and workplace engagement isn’t the whole answer. We need to understand how we will take patient/client engagement into a workplace and then manage the new demands of engaging employees, supervisors, managers and others in a workplace.
Be encouraged by this! Your skills extend beyond just prescribing a RTW plan or suitable duties or a treatment plan. Our role is to foster engagement in all stages of the process – which means taking all the elements of recovery, rehabilitation and RTW and bringing them together to help the client make sense of it all – and it looks like:
This is how you’re able to take back control of your life.
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.