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© 2018 Government of Singapore
A Great Workforce A Great Workplace
1
Legal and policy approaches to implementing
return to work program in Singapore
International Forum on Disability Management 2018
Vancouver, Canada
October 14-17, 2018
Dr Sylvia Teo
Sr Principal Specialist(RTW Unit)
TWSH & RTW, WSHC, TAL
© 2018 Government of Singapore
A Great Workforce A Great Workplace
2
Earlier return to work Subjects in intervention group RTW about 10 days earlier than control group
(Control= 48 days, Intervention= 38 days, p=.029) Potential cost savings Savings from reduced absent work days due to the RTWC intervention
Costs
Net Benefit of RTWC intervention = $1,516.43 - $672.43 = $844 per injured employee
Control Intervention Savings Savings from reduced absent work days of 10 days $0.00 $1,516.43 $1,516.43
Net Savings $1,516.43
Control Intervention Differential Costs
Medical outpatient cost $277.06 $348.87 $71.81 RTWC intervention costs (based on 6.7hrs by RTWC and 2hrs by RTW executive) $0.00 $600.62 $600.62
Net Differential Cost $672.43
Cost Benefit of RTWC Intervention
© 2018 Government of Singapore
A Great Workforce A Great Workplace
3
Changes to Work Injury Compensation Act (WICA) wef from 1 Jan 16
• Higher compensation limits for medical expenses, up to $36,000 or 1 year from date of accident, whichever is earlier
• Cost of Medical Treatments includes charges relating to:
• physiotherapy, occupational and speech therapy • Cost of medicines, artificial limbs, surgical appliances • Emergency medical transport • Fees for medical reports • Case management • Psychotherapy • Functional capacity evaluation; and • Worksite assessment
Amendment
to facilitate
RTW-related
activities
© 2018 Government of Singapore
A Great Workforce A Great Workplace
4
I in 4 were unemployed 7 in 10 had no change in job-scopes
Employment Status % n Base for % Calc.
Not Employed 23.8% 97 407
Employed 76.2% 310
Employed in the same company 58.7% 182 310
Employed in different company 41.3% 128
Employed with a change of job scope 26.5% 82 310
Employed with no change of job scope 73.5% 228
Employed with reduced take home pay 16.1% 50 310
Employed with no reduced take home pay 83.9% 260
Findings from the study “Social and Financial Impact of Work Injuries for Local Workers” by WSHI
2014
What are the main challenges?
© 2018 Government of Singapore
A Great Workforce A Great Workplace
5
Physical and Psychological Impact
10.3%
6.4%
10.6%
24.6%
39.1%
44.2%
0.0% 10.0% 20.0% 30.0% 40.0% 50.0%
Did not face any challenges
Felt discriminated at work
Felt a lack of support/ understanding at work
Fear that certain work activities will lead to harm/ injury
Difficult to perform work at previous stds
Felt tired easily/ other physical discomforts at work
standards
Findings from the study “Social and Financial Impact of Work Injuries for Local Workers” by WSHI
2014
© 2018 Government of Singapore
A Great Workforce A Great Workplace
6
31% stated change of job
scope
24% would like to have flexi-
hours
30% stated job
redesign
Types of support needed
© 2018 Government of Singapore
A Great Workforce A Great Workplace
7
Local Non-Local
Grand Total
% of Total
NATIONAL UNIVERSITY HOSPITAL (SINGAPORE) PTE LTD 463 830
1293 21.2%
TAN TOCK SENG HOSPITAL 443 968 1411 23.2%
SINGAPORE GENERAL HOSPITAL 399 396 795 13.1%
CHANGI GENERAL HOSPITAL 395 415 810 13.3%
NG TENG FONG GENERAL HOSPITAL 340 456 796 13.1%
KHOO TECK PUAT HOSPITAL 300 433 733 12.1%
ALEXANDRA HOSPITAL 9 8 17 0.3%
KK WOMEN AND CHILDREN HOSPITAL 7 1 8 0.1% RAFFLES HOSPITAL 39 50 89 1.5%
WEST POINT HOSPITAL 20 85 105 1.7%
OTHER PRIVATE HOSPITALS 16 9 25 0.4%
Total 2431 3651 6082 100.0%
96% of WIC cases are seen at 7
Public hospitals
Distribution of WIC Cases 2016
Where Do our injured Employees go?
© 2018 Government of Singapore
A Great Workforce A Great Workplace
8
RTW Unit
• Drive RTW programme
• Oversee and coordinate implementation of the RTW programme
• Monitor progress and review its effectiveness
Affiliated RTW Centers
• Dedicated clinics offering RTW services
• Sited within the acute public hospitals which handle 96% of the WIC cases
National RTW programme
© 2018 Government of Singapore
A Great Workforce A Great Workplace
9
Awareness gap
• Educate key stakeholders on the benefits of RTW through engagement and outreach (e.g. info-graphics, guidelines, advisories)
Capability gap
• Build a pool of certified RTW coordinators through funding formal certification programmes#
Process gap
• Set up affiliated RTW centres in public hospitals and:
• Develop RTW workflow
• Identify workers who can benefit early
• Monitor outcomes
Funding gap
• Provide seed funding to public hospitals to kick-start RTW programme
• Set up a new RTW Grant to support injured workers and employers to RTW
# Complete NIDMAR (National Institute of Disability Management and Research) course and eventually obtain either CDMP
(Certified Professionals in Disability Management)/CRTWC (Certified Return to Work Coordinators) certification
RTW unit (WSHC) to drive efforts and build capabilities
National RTW Programme seeks to address gaps
© 2018 Government of Singapore
A Great Workforce A Great Workplace
10
Affiliated RTW Centers
• Seed funding for 2 years
• Development of a clinical operational workflow for RTW services
• Manpower cost of 1 RTW Co-ordinator
(Occupational therapists/Physiotherapists)
• Manpower cost for 1 RTW administration executive
• I.T. for collecting outcome indicators and for building infrastructure (equipments)
• Training of RTW Co-ordinators in NIDMAR certification
Public Hospitals -- Dedicated clinics offering RTW services
© 2018 Government of Singapore
A Great Workforce A Great Workplace
11
MOM’s RTW grant
• Allows the employer to claim up to 90% of the job re-design costs (e.g. workplace modifications, purchase of equipment/tool), capped at $1,000 per RTW injured worker, and
• Allows the injured workers to claim for RTW-related interventions if his/her medical expenses exceed the Work Injury Compensation(WIC) cap of $36,000, capped at a maximum of $7000 per RTW injured worker.
• Application for the RTW Grant must be supported by the Return-To-Work Co-ordinator.
MOM’s RTW Grant
© 2018 Government of Singapore
A Great Workforce A Great Workplace
12
Monitoring
Demographics • Employee’s info • Company’s info • Injury suffered • Medical
treatment
Work-related outcomes
• Time to RTW • Income prior
injury and post RTW
• RTW rate at 3,6,9 months
• Category of RTW
Health-related outcomes
• Quality of life
measure (EQ5D/5L)
• Functional ability at 3, 6 9 mths
• Self-efficacy scale
RTW Programme specific indicator
• Medical and
rehabilitation costs incurred
• Take-up rate and reasons for non-participation
• Drop-out rates, reasons for drop-out
• ROI
RTW Co-ordinators will collect and report the following indicators to MOM
Key performance Indicators in assessing effectiveness of program : a.Return to work rate (target 90%) b.RTW Participation rates (target 90%)
Monitoring
© 2018 Government of Singapore
A Great Workforce A Great Workplace
13
Workplace Safety & Health Performance Awards(WSHPA)
• Lost Time Injury- Bonus criteria
• Track records of loss time injury will be taken into consideration as bonus criteria
• Definition of loss time injury
- Any work-related injury where the worker does not return to work the following workday
Workplace Safety and Health Awards
© 2018 Government of Singapore
A Great Workforce A Great Workplace
14
Workplace based Model
RTW Co-ordinators are appointed by
company
e.g. Keppel Offshore and
Marine
Hospital-Based Model
RTW co-ordinators are occupational/physiotherapists
/medical social workers or nurses
First hospital to roll out RTW clinical services is TTSH in Oct
2017
Insurance-Based Model
RTW
coordinators are appointed by
insurance companies
e.g. AIA, AXA
RTW Models in Singapore: Current
© 2018 Government of Singapore
A Great Workforce A Great Workplace
15
Jul-Dec 2017 Jan-Jun 2018 Jul-Dec 2018 Jan 2019
Oct 2017 – Tan Tock Seng Hospital
Feb 2018 – Singapore General Hospital May 2018 – Ng Teng Fong General Hospital Jun 2018 – Changi General Hospital, National University Hospital
Jan 2019-Sengkang General Health
RTW Clinical Services For both Singaporeans and Foreign workers 2 service delivery models of care a. OT-led b. Multidisciplinary model of care (OM/rehab physician)
Nov 2018-Khoo Teck Puat Hospital
Training of RTWCs 3 RTW Co-ordinator workshops, NIDMAR (web-based) learning, On-the-Job training
The Present : “ The Hospital Model” of RTW program
© 2018 Government of Singapore
A Great Workforce A Great Workplace
16
RTW Milestones
• Engaged TTSH to conduct a RCT to showcase benefits of RTW Co-ordinator based system for rehabilitation of injured employees.
• Focus on Medical Rehabilitation with RTW services done on ad-hoc basis
1st RTW Seminar (Visiting Expert Series) 1st RTWC workshop by TTSH – 14 persons trained, from TTSH, insurers, loss-adjustors, private healthcare sector and Voluntary Welfare organizations
Minister’s Approval for Implementation of RTW Program on 14th Feb Establishment of a Return to Work Unit in WSH Council on 1st April Tan Tock Seng Hospital provides RTW clinical services by Oct 17
2010-12 2015 2017
Visit to SOCSO Rehab Centre in Malacca led by Senior govt official with a total of 17 delegates from Singapore National Employers Federation, insurers, healthcare sector and Ministry of Manpower(MOM)
2016
Conducted 3 RTWC work shops to train 40 Allied Healthcare professionals 7 Occupational and Physiotherapists successfully attained professional NIDMAR certification-CDMP/CRTWCs
2018
RTW Milestones
© 2018 Government of Singapore
A Great Workforce A Great Workplace
17
Workplace based Model
RTW Co-ordinator are appointed by
company
Eg. Keppel Offshore and Marine
Insurance-Based Model
RTW Co-ordinator are appointed by
insurance companies
Eg. AIA, AXA,
Liberty Mutual
RTModels in Singapore: Longer Term
The Future:
“ The Workplace Model” of RTW program
Partnership
Collaboration
Mutual support
Embedding Injury Management in Workplace OSH Policy to complement hospital model
Identification of suitable staff to take on role of RTWC (Workplace Safety and Health officers, nurses, HR managers)
Development of competencies /capability in RTW coordination through certification
Active referral of injured worker to RTW program by
company-based RTWC (system of referral)
Effective Injury Management Program with proper disability management, including support for injured workers to limit further harm (prompt care, appropriate return to-work policies, modification of work)
© 2016 Government of Singapore
A Great Workforce A Great Workplace
19
Challenges
• RTW is not legislated in Singapore- “Opt out”
• Current program is limited only to Work Injury Compensation Insurance cases
• Singapore has a significant proportion (a third of total workforce) of migrant workers
• Employer has flexibility of terminating worker
• Charges on RTW-related intervention is not controlled by the government
• Shortage of hospital-based Allied Health professionals in the acute hospitals
• Lack of policies on injury management at workplace
Legislative and Policy Challenges
© 2018 Government of Singapore
A Great Workforce A Great Workplace
20
• Reports injury early and seeks treatment •Compliant to medical treatment and rehab •Adheres to RTW plan •Trust RTWC •Remains motivated and keen to RTW
Provision of a supportive environment to IW, includes • Time off for medical treatment /rehab •Provision of job accommodation •Retention of IW •Prompt payment of bills
Supported by
• Provide occupational rehab services • Hospital-based RTWCs initiates RTW process through
A. Initial Assessment, FCE B. Individualised RTW plan C. Identify barriers and challenges D. Conduct worksite assessment
• Monitoring outcome indicators • Ensure IW receive medical treatment and due compensation • Engage Tripartite partners to support RTW • Step in to facilitate RTW in specific cases
• Processing and paying WIC compensation •Step in to facilitate RTW in specific cases(complicated, delayed recovery) • Tracking of cost of rehab and case management services in insurers’ database
Affiliated RTW Centres RTW Unit and Tripartite partners
Desired RTW Framework