Dr. J.'s Jottings: Upgrading Workers' Comp & Disability Benefits Systems

British Columbia - 1st to commit to a Canadian SAW/RTW

A group in British Columbia has just decided to hold a Summit in November, 2008! People from several BC organizations held their own feasibility meeting this week to decide whether it makes sense to bring the 60 Summits Project idea there. The meeting was apparently a great success. There was strong multistakeholder support for the content of the ACOEM work disability prevention guideline and a wish to be associated with the 60 Summits Project. They agreed to aim at an initial summit in November of this year.

The first planning meeting is tentatively set for Feb 13th at which time the organizational structure will be established. Dr. Larry Myette, Director of Strategic Workplace Health for the Healthcare Benefit Trust that manages benefits for many of the healthcare employers in BC, convened the feasibility meeting and has agreed to serve as interim chair of the group. Among other attendees at the
feasibility session were WorkSafeBC and the Canadian Institute for the Relief of Pain & Disability.

If you wish to help plan the BC Summit or simply be invited to the actual event, contact Dr. Myette, who can be reached at: (250) 479-4089.

60 Summits Project Update

Yay! I just learned yesterday that Montana will hold three Summits in April 2008 in conjunction with The 60 Summits Project. The Governor's Labor Management Advisory Council on workers' compensation will be the lead sponsor, along with the State of Montana, the Montana State Fund, the Montana Building Contractors Association and the Sisters of Charity Leavenworth Health System and others. Three members of the Labor-Management Advisory Council are on the Summit Planning Committee! Montana has been looking for a new model to adopt in the return to work arena, and will be engaging the whole state in a conversation about implementing the new work disability prevention paradigm.

In 2007, we:
  -- held 5 Summits in 2 states, one in Northern California, and four in North Dakota, for a total to date of 7 Summits in 4 states.
  -- got 6 new Summit Planning groups formed and off the ground in Arizona, Ohio, Florida, Massachusetts, Michigan and Montana.
  -- benefited from association with our Charter North American sponsors, Prudential Financial and Webility Corporation, whose generous contributions made many of our 2007 activities and 2008 plans possible.
  -- developed materials, methods and other key infrastructure including our new-and-improved website: www.60summits.org

As of yesterday, we already have 7 Summits on the calendar for the first half of the year (MN-1, MT-3, OH-1, AZ-1, and FL-1). We're entering several new states in the next few months.

Now that we've built a solid foundation, I'd like to open the throttle in 2008. My goal is to be halfway to 60 -- to have activity underway in 30 states and provinces -- by the end of 2008.

In 2007, I travelled all over the continent and met a lot of very good people with a lot of talent and pent-up energy they want to put into improving these "systems". I represented the 60 Summits Project at meetings in Arizona, British Columbia, California, District of Columbia, Florida, Illinois, Idaho, Illinois, Maine, Massachusetts, Michigan, Minnesota, Montana, North Dakota, Ohio, Oregon, Rhode Island, Quebec, Texas, and Washington. Meanwhile, the 60 Summits Project staff built the "guts" of The 60 Summits Project as an on-going endeavor: developing materials and methods that would set appropriate expectations and create strong planning groups and successful Summit events and follow-on action groups.

We are building an organization that has to be comfortable with local variation and individual eccentricities due to the volunteer nature of most of our groups -- but we are centering ourselves around some unifying themes and values. Key among them are a Partner Attraction Plan (see www.60summits.org) and the Commitment to Partnership. Together they lay out our mutual commitments to how we are BEING with each other in addition to what what we are DOING together.

It's been a challenging roller-coast type ride, and this project has consumed the vast bulk of my professional time and most of my creative energies. And wow, do I ever find it exciting and fulfilling! When I enter a room for a feasibility session (the next one is Feb 7 in Madison, Wisconsin), I am CONFIDENT that I am with a remarkable group of people -- because who else would accept our invitation?

In our push to put "meat in the hamburger", we haven't paid as much attention to developing our sponsor relationships. Now that we've built a strong engine that's really ready to take us places, I'd like to put a lot more fuel into it. The 60 Summits Project derives its revenue from a combination of sponsor contributions and fees charged for services to local Summit planning groups. It's time to build up our sponsorship contributions by attracting organizations that are a good fit with us and forming on-going mutually fulfilling relationships with them, too.

Sponsor contributions to The 60 Summits Project make it possible for us to:
  -- build and maintain our infrastructure including our new website (www.60Summits.org)
  -- bring the possibility of The 60 Summits Project to new states
  -- form new groups and support them until they get organized and off the ground
  -- provide partial matching grants for local Summits
  -- support the action coalitions that are springing up after Summits occur
  -- and, in 2008, to hold our first national conference.

Summit Planning groups, once established, decide whether they want to be an official part of The 60 Summits Project and to have our support, in which case we then charge fees for our services. The local Summit planning groups in turn meet their expenses by charging registration fees to Summit attendees and garnering support from local sponsors.

I'd like to speed this whole thing up and be able to enter new states more often. I'd also like us to provide even BETTER support to the local groups -- especially the action coalitions that are springing up after the Summits -- so they can really become an ON-GOING and EFFECTIVE force for positive change in their states. As I said, our 2008 goal is to be halfway to 60 by year's end -- to have activity underway in 30 states.

You may wonder how you can help. Here are two ways:

  1. By passing along names and contact information for people who will want to participate in this project in specific states, either as a Summit planner, attendee, or as a local sponsor.

  2. By becoming a sponsor of our North American effort at some level. Join Prudential Financial and Webility Corporation as North American sponsors, or find another level at which to to contribute that suits your situation.

Ask yourself if your company:

  ---Likes to underwrite worthwhile activities, and would see supporting this inspiring grassroots effort as the right thing to do.

  ---Sees itself as a potential beneficiary of our initiative, and wants to assure the success of The 60 Summits Project by providing visible endorsement as well as financial support.

  ---Will benefit from being visibly associated in the marketplace with The 60 Summits Project's cutting edge thinking and an initiative that is being hailed as "brilliant and fresh . . . a new paradigm . . . a clear blueprint for positive change."

Sondra Seay from Florida has joined The 60 Summits Project as manager of sponsor relations. You can reach her at sondra.seay@60Summits.org.

Happy News! Prudential sponsors the 60 Summits Project!

Yesterday it became official.  Prudential Financial is the first charter North American sponsor of The 60 Summits Project!  Their generous grant is going to make it possible for us to enter at least 5 additional states in the next few months. [We’re figuring out now which states are the best choices.  Any nominations?]  We will also be able to provide financial support in the form of partial matching grants to all the Summit planning groups now at work. 

In the last two weeks, The 60 Summits Project has been separately incorporated as a non-profit corporation in Massachusetts, and we have a new logo and website: www.60Summits.org.  It's still pretty basic.  More to come.

This rapidly-growing project is SUCH a great learning experience for us all.   For most of my life, I’ve been “ahead of the ball” but the pace of the 60 Summits Project keeps me scrambling.  Every step of the way, there’s something to improvise for the first time, an error to correct, an aha! and lesson for next time, and so on.  It’s very demanding, but truly exhilarating.  Happily, Prudential’s sponsorship also will allow us to further develop the central infrastructure we’ve realized is required to provide appropriate support services to existing and future Summit planning groups. 

To my knowledge, our grass-roots multi-stakeholder approach to creating positive change in disability benefits and workers’ compensation systems is unprecedented.  It is truly a joy to discover there are so many people of good will who are attracted to the 60 Summits Project because they are intent on making a positive difference.  I keep discovering that I’ve underestimated people.  In my previous life, I’ve sometimes been disappointed by people who initially looked promising.  The delicious thing about this project is that people whom I have never met or barely know keep showing up, taking on leadership roles, and then delighting me (and themselves and their fellow committee members) by demonstrating previously unseen skills, competencies -- and achievements! 

The Northern California Summit on Promoting Stay at Work and Return to Work is next week (June 21).  This ad hoc group composed of many stakeholders has put together a powerhouse of an agenda and guest list.  Check out their website at: http://www.saw-rtw-californiasummit.com.

Definition of "disability" in the ACOEM SAW/RTW Guideline

Two people have communicated "upset" to me recently about the negative way that disability is referred to in the new ACOEM Guideline on Preventing Needless Work Disability by Helping People Stay Employed.  When the second one spoke up, I got curious and checked the text of the Guideline.  Oh my gosh!  A critical definition was eliminated when the editor cut about 20 pages from our committee’s original white paper in order to make the final Guideline a more manageable length.  That omission has created understandable confusion.  And it turns out other key background information was also eliminated that helps clarify the context for the document.

On page 9 in the original white paper that was the source material for the Guideline, we defined “disability” this way:

"In this paper, we use the word 'disability' the same way that employers use it in their benefits programs and employment policies, and the same way that insurance laws, regulations, and policies do. We use 'disabled' to mean someone who is absent from work or not working at full productive capacity for reasons related to a medical condition. Please note that confusion is common regarding the word 'disability' since it is sometimes used to describe physical or functional impairments. For example, a person who has an impairment that affects one or more life functions is considered to have a disability under the Americans with Disabilities Act (ADA). However, people with ADA-qualifying impairments who are working at full productive capacity would NOT be considered 'disabled' according to our definition, because they are at work."

On page 10 in the original white paper, we also made it clear where the main focus of the Guideline was intended to be.  Here’s what we said:

"The focus of this paper is on the surprisingly large number of people who end up with prolonged or permanent withdrawal from work due to medical conditions that normally would cause only a few days of work absence. Many of those who end up receiving long-term disability benefits of one sort or another have conditions that began as common everyday problems like sprains and strains of the low back, neck, shoulder, knee and wrist, or depression and anxiety. As we will discuss below, prolonged work withdrawal (disability absence) by itself can produce unfortunate consequences, and this is one of our major concerns.
"On the other hand, many of the people who receive disability benefits have severe illnesses like a major cancer or schizophrenia or have suffered catastrophic injuries such as amputations, blinding, major burns, or spinal cord injuries, or have had major surgery. These people, too, are susceptible to the influences described in this paper, although the effects may be overshadowed by the obvious difficulties of coping with medical problems of this magnitude, and the need to learn skills and methods to deal with any resulting impairments. In these cases, a prolonged period of work absence is often unavoidable. The traditional rehabilitation approach delivered by an array of professionals was designed to meet the needs of these people. The question still arises: what amount of this work disability could be prevented?
"We contend that a considerable amount of the work disability due to common everyday conditions (and an unknown fraction of the disability that follows more serious conditions) is avoidable, as are its social and economic consequences. We believe that a lot of work disability can be prevented or reduced by finding new ways of handling important non medical factors that are fueling its growth."

So, I have added these important sections to the “Introduction to the Guideline.”   The revised version will appear on our website  (www.webility.md) in the next day or two. I will also make a point of clarifying the definition of disability whenever I talk about the Guideline in the future.

I'm grateful to the people who spoke up, especially because they spoke up passionately enough that I got curious.  I was sure that definition was in there, and couldn't figure out why they didn't "get it."  Their speaking up helped me correct a misunderstanding that has been hurtful to people who don’t need more problems -- and that might have weakened the Guideline’s effectiveness. 

My personal goal -- and imagine that I speak for the 20 other physicians who developed this Guideline with me -- is for this Guideline to help all people who experience illness, injury, age or any other kind of “differentness” -- particularly those for whom this represents a change -- to get the support they need so they can continue to have productive lives in society and the fullest practicable participation in life.