© Copyright 2000 Rogers Media. The following article first appeared in the February 2001 edition of BENEFITS CANADA magazine.

Disability Champions

The City of Medicine Hat and Canadian Pacific Railway have award-winning disability management strategies built on team-work and work accommodation. Their policies raise morale and encourage employees to return to work.

By Kathryn Dorrell

Employee feedback speaks volumes about the transformation in disability management at the City of Medicine Hat in Saskatchewan. "People have sent letters to the mayor saying 'in the past we were numbers and now we are people and we get better quicker at work,' " says Shelly Ptolemy, the organization's occupational health adviser.

The City of Medicine Hat, which employs 1,000 workers and has five unions, decided to establish a formal disability management program about two years ago. Previously, the City's disability programs were disorganized and "costs [were] escalating out of control," says Ptolemy. An external audit conducted in 1998 revealed that the City's long-term disability (LTD) case load was three to four times greater than the industry average and LTD premiums were set to rise by 44%. Ptolemy says these problems were a result of an increasing number of disability cases and the fact that there was no effort to integrate or manage the programs that existed.

"The biggest problem was distrust," adds Ptolemy, noting that union and management were in conflict and employees felt like the organization simply didn't care whether they came back to work, mostly because plan members were funding the LTD benefit.

The turning point was the creation of a disability management steering committee. The group consists of the City's five union presidents, five general managers and one commissioner, as well as two individuals from the human resources department.

The executive team worked for 18 months with an independent consultant to develop the City's current program, which won an award last year from the National Institute of Disability Management and Research (NIDMAR) in Port Alberny, B.C. In 2000, the institute handed out its first disability management awards designed to acknowledge plan sponsors and providers with effective programs that benefit both employees and the organization.

Ptolemy says the impact of the City's collaborative effort hit home at the NIDMAR awards ceremony last fall. One of the City's union presidents, Jack Coleman, stood up and said: "For 20 years, I've been fighting management to keep my people away [from work] and at home on the best sick leave and LTD benefits that I could get them. Now, I stand beside and behind Shelly and we work together to bring people back."

Today, all parties work together to reduce disability through early intervention initiatives and co-ordination of benefits such as the City's employee assistance program (EAP). Ptolemy says that once an individual is away from work for five consecutive days, the employee's case is identified as a disability and the individual is referred immediately to the EAP.

A case meeting is also held to review the individual's medical information and develop a strategy to assist them. "We have all the information at the table [with] the union, the employee and their supervisor. There may also be someone [such as a family member] to help the employee," says Ptolemy. She adds that she is also present, along with a representative from human resources who can explain the organization's disability benefits.

The essential elements of the City's disability management program are personal touches and the modified work component. Ptolemy says that she spends a lot of time taking doughnuts to employees at home and in the hospital and listening to them talk.

The work accommodation policy--which now includes permanent alternative placement in the City--guarantees that every individual with medical clearance to perform modified work is given a role within the organization, if one exists that meets their abilities. Otherwise, the City would be willing to pay for retraining. "Previously, the organization never made any effort to accommodate people," says Ptolemy. "If you couldn't do 100% you went home and stayed home until you could, and that's ridiculous."

Over the past year, the City's disability management program has helped reduce the number of employees on LTD by 31% and resulted in savings and cost-avoidance totalling $1.2 million. The efforts to assist employees are still ongoing with plans to implement a comprehensive wellness program incorporating sleep, nutrition and stress management.

SUCCESS AT CPR

Canadian Pacific Railway's (CPR) return-to-work program also received an award from NIDMAR. Like the City of Medicine Hat, it is helping to reintegrate employees into the workplace who would otherwise remain on disability leave. The initiative is voluntary for non-work related ailments, however, employees with work-related injuries are expected to participate.

Co-ordinating the program is no small feat considering Calgary-based CPR has 17,000 employees in locations across Canada and seven unions. The organization has a senior advisory committee for disability management that provides policy direction for the program as well as local committees at each CPR site. The committees co-ordinate the return-to-work program, which starts after the fifth consecutive day of absence.

The employer approaches each disability case on an individual basis. Once an employee, his healthcare provider and the plan sponsor agree that the individual is ready to return to work, any restrictions that the individual may have are documented. CPR also follows medical guidelines for mental and physical capabilities provided by Transport Canada for safety-critical positions in the organization.

The local return-to-work committee then looks at all of this information to determine if it can accommodate the employee in his original position. Hours and duties are modified if necessary, and the organization is also willing to make changes to work stations or equipment to assist the employee.

If the committee is unable to accommodate the worker through these means, it considers other positions within the same job classification and then bargaining unit. "There is a hierarchy of clear guidelines of how to place employees," says Nkemdirim.

Once a placement is determined, an accommodation and follow-up plan is developed. The returning individual and his supervisor evaluate the employee's performance within a specified time period to ensure that the individual is doing well.

Currently, CPR is developing a system that will track an individual's initial absence or injury through a leave and modified work program to his return on a full-time basis. It is also promoting the return-to-work program among management. "We are looking at ways to integrate [disability management] into the culture of the whole [organization] so it is part of how we do business," says Nkemdirim.

SHARED STRENGTHS

Overall, the City of Medicine Hat and CPR share several things in common when it comes to developing effective disability management strategies. For starters, they jointly developed policies and practices with all stakeholders. This ensured the co-operation of all groups within the organizations. In addition, both organizations' benefits packages, notably their respective EAPs, support their disability management goals and help to prevent illness, such as stress-related ailments, from occurring.

The other two cornerstones of these plan sponsors' strategies are work accommodation or job modification and accountability. Ptolemy says the City of Medicine Hat's insurance provider told her that permanent alternative placement was the key to curbing disability costs and bringing employees back to work. She adds that few employers consider permanent alternative placement in their policies.

As for accountability, CPR says it would like to incorporate disability management into all of its supervisors' performance appraisals, and possibly even their compensation packages. Meanwhile, Ptolemy encourages plan sponsors to charge the costs of sick time and modified work initiatives back to individual departments to promote accountability and foster better management practices in those areas of the organization.

The Romanow Commission has released its final report on the future of healthcare in Canada.

For Commissioner Romanow's recommendations, click here.

Click here for Senator Michael Kirby's report, "The Health of Canadians – The Federal Role: Recommendations for Reform."