Beyond Band-Aids: Why Holistic Care Matters for Workplace Injury Recovery

FFD - EP 7 - DRAFT

===

[00:00:00] Larry Earl: Okay. Well, Maitha Sullivan, give me a little background about how you got into occupational medicine and, uh, and your work at SafeWorks. What attracted you to the field and what do you feel like your biggest challenges are working at SafeWorks?

[00:00:14] Larry Earl: Oh my goodness. I love occupational medicine. I think this [00:00:20] is the place where many of us should really start. Because you see clients or patients at their most vulnerable when they have nothing else to lose and nowhere else to go. So about, oh goodness, 25 years ago, [00:00:40] I did HR at an oil factory here in town.

[00:00:44] Larry Earl: It's no longer around. And I did safety as well. And my biggest challenge then being in HR is trying to get my employees. to safety when they were not well, [00:01:00] so they could get treated. And in a small town like Champaign County, that was impossible. So, we have a chamber of commerce that we were part of, and we would attend it regularly every month.

[00:01:15] Larry Earl: And I ran into Dr. Fletcher. [00:01:20] And of course, you know, he's, he sells himself well. So he saw a few of our, of our employees and they really felt loved and cared for because they had a wraparound service. which we were missing at the time. So we were losing our patients [00:01:40] to restrictions and home and sickness and all kinds of things that happen when an employee gets injured on the job.

[00:01:48] Larry Earl: It's not just their injury on the job. It's what they're doing at home. Do they have small kids? Do they have a second job that now they're not able to do? Do they have [00:02:00] medical needs that they really cannot afford because nobody's looking at what else needs to be done. So, that was 21 years ago. Wow. And I have been with Dr.

[00:02:14] Larry Earl: Fletcher on and off for a long time. Now, was that role a clinical role or were you, [00:02:20] you mentioned human resources. Was that a different field for you? So it was human resources. So it was a totally different role and the cool thing is I had my R. N. degree, it's been about 28 years now. And so, Dr.

[00:02:38] Larry Earl: Fletcher was like, [00:02:40] come on, come and see what we do if you'd like to follow me. So I did. And best story of my life is that he recommended I go to N. P. school, gave me a recommendation, And the rest is history. Wow. And how long have you been there [00:03:00] now?

[00:03:00] Larry Earl: So I've been here on and off since like 20 2001? 2002? But I have a new role of clinical director since uh, It's the beginning of last year, which is a really awesome role. Right. Right. NAOHP conference where [00:03:20] we met and got to chat about some of these things that we're going to be talking about today even. So, so today's topic. Beyond band aids, why holistic care matters for workplace injury and recovery, let's jump into some of the questions that we've been discussing. First of all, how does a holistic approach to occupational health and workplace [00:03:40] injury recovery differ from the traditional band aid approach?

[00:03:44] Larry Earl: Well, I, so I'm an NP, I'm an RN, and I think of when my kids were young and would injure themselves. They got a band aid because it made it all better. It didn't fix much. If they had a scratch, that scratch still [00:04:00] needed to heal and needed to be taken care of. So for having a holistic approach, I think the biggest thing I have learned is taking care of the full employee from head to toe, whether it's emotional wise, social wise, [00:04:20] the multiple ways and multiple factors that we need.

[00:04:26] Larry Earl: Or must address for an employee to get back to work, um, is what's called holistic. I remind everybody, employees, employers, the people who support them, the case [00:04:40] managers, you and myself, that our role in getting employees from injured to back to full time is really multiple. Some that are well researched, which includes having a really supportive work environment.[00:05:00]

[00:05:00] Larry Earl: When we don't have that, and an employee doesn't feel loved and wanted, then they have no stake or need to come back. They just want to get sick. and stay home. This is really a topic that is timely because as we have seen since [00:05:20] COVID, our mental health has just deteriorated. Injuries continue to happen.

[00:05:26] Larry Earl: They're just more impacted now by mental health issues. Yeah, you know, that workplace environment issue is really one of the red flags, right? That you can, uh, elicit from a patient about whether they do feel [00:05:40] supported at work. And that can be a risk factor for delayed recovery if they don't have that support.

[00:05:49] Larry Earl: What role does mental health play, you talked about that already, in recovery from workplace injuries? How does it impact overall well being in the workplace?

[00:05:57] Larry Earl: Well, the, the [00:06:00] favorite areas, um, that I talk about roles. So, when an employee is not fully present, and working at the top of their scope, then they're not meeting their role responsibilities. What I say is [00:06:20] the impact that injuries, including the emotional impact, right? When an employee has an issue emotionally and is not able to come up or is not aware that the emotional fragility is causing them not to be [00:06:40] fully present.

[00:06:41] Larry Earl: They stress how do people cope with injuries? I had said earlier that when you're stressed You may be at a higher risk for getting injured, right? Sure. So, how do we mitigate that stress? [00:07:00] How do we help you understand that if you need a minute to yourself, you can take that minute now. Is this always possible?

[00:07:09] Larry Earl: Probably not, but when we let our employees know that their performance is just as important as their injury, [00:07:20] Then we're good employers and good citizens. Yeah, well, well said. Let's talk about, again, you touched on this already, the biopsychosocial model. You know, we talked about multiple facets of life that need to be addressed when you have a workplace injury.

[00:07:39] Larry Earl: It's [00:07:40] not just about, you know, It's not about the sore knee or the sprained ankle or the sore back. It's about other types of things that allow a patient to get better. As you said, it's support at work, it's transportation to get to their appointments and their therapy. It's support at home. [00:08:00] Do they have the income from their workers comp care?

[00:08:03] Larry Earl: Is, you know, has all the paperwork been filed? Uh, you know, those types of things. So let's talk about biopsychosocial aspects.

[00:08:11] Larry Earl: So this is a really well researched model, right? And it's the interplay between that [00:08:20] biological, psychological, social factors. What I like to talk about is to think about how we understand health, illness, and recovery because it's a cascade. When we acknowledge that somebody is ill, then what's our next step, [00:08:40] right?

[00:08:40] Larry Earl: So, for you as an MD and myself as an MP, we understand that individual's health and well being are influenced by multiple things. Physically, can I climb that ladder so I can get to my forklift, right? [00:09:00] Psychologically, how is my head space? Uh, did I get enough sleep? Did I eat enough? Uh, is my blood sugar so low?

[00:09:10] Larry Earl: Have I lost an hour of sleep, which I know I have and I'm missing it. I hope it revives and I get it back soon. And the [00:09:20] environment. And really, truly, culturally, we are such a, a diverse population now that you will find all different cultures in one place. So how do we put this comprehensive, comprehensive framework for [00:09:40] addressing those complex needs of the injured workers?

[00:09:42] Larry Earl: They have all to be taken into, into account. if we want the full employee to come back to his or her job. Yeah, that's a great point. So how can employers prioritize mental health and holistic care for their employees to [00:10:00] promote this overall well being and productivity in the workplace?

[00:10:03] Larry Earl: There are many factors. My favorite ones, I talk about five of them, and the biggest one is having a creative, supportive work environment. So I think about when an employee comes [00:10:20] in in the morning, and I am their clinical director, and I'm not having a good day. Do I smile and shelve my bad day and go, Hey, how are you?

[00:10:32] Larry Earl: How are you doing today? So Or do they say hello and I grunt, right? That, that is not supportive at [00:10:40] all. Right. Do new moms and new dads, I have a few grandparents, show up after they've had a new baby and they want to show me a picture before the day begins and I'm like, you already have five patients deep.

[00:10:55] Larry Earl: Go away. Or do I go, Oh, let me see. It's a good picture. [00:11:00] Right. Are we offering mental health benefits to our employees? That's important. We know in some states that's hard, difficult to come by. And do we have any wellness programs, right? And what do they look like, right? [00:11:20] Are they inclusive? Are they for everybody?

[00:11:23] Larry Earl: And how flexible are they? Do I help promote their home and their job as a balance, right?

[00:11:33] Larry Earl: If they needed five minutes to take a phone call, would I allow that? Absolutely. So [00:11:40] those are my, the five factors that I look at and I think that we try to practice here. Do we always manage that? Eh, sometimes we fail, but then we get up the next day and we try it again. It's an aspiration, right? Yeah, right, right.[00:12:00]

[00:12:00] Larry Earl: What are some other common misconceptions about occupational health and workplace injury recovery, and how can they be addressed holistically?

[00:12:10] Larry Earl: I think my favorite one, and I've seen this because I've worked in a huge factory before, that an employee wants to get [00:12:20] injured so they can make money. We know that's not true. Most employees come in and fully prepared and ready to do the job they've done for 10, 20, 30 years, right? They're ready to go because they have [00:12:40] made a living for their children, for their families here.

[00:12:44] Larry Earl: How do we fix that? It's really by reminding everybody that not everybody is looking for free money or free services. And we need to believe our employees when they get injured or when they report [00:13:00] the injuries. Another misconception is, eh, mental health issues are super uncommon, you know, in the workplace.

[00:13:10] Larry Earl: Now, we know that's not true. We know they're very common, aren't they? Our employees, right, super common. Our employees have a different life. They may [00:13:20] spend 10 hours with us. five days a week, four days a week, but do they have high blood pressure? Do they have a child who is sick? Do, are they taking care of a spouse who is unwell, right?

[00:13:35] Larry Earl: That would make you need a little mental health [00:13:40] support. So we do have mental health issues. You know, employees, and we need to acknowledge that and be gentle with that. And I think the one that I really, really like is when I, as an employer say, Dr. Earl, the [00:14:00] reason you're injured is because you're careless and you just, you just don't care for this job.

[00:14:06] Larry Earl: We know that's not true. Most of us, as I said, we come in fully. ready to do a good job, that ladder [00:14:20] was left in a place where I just couldn't see it, right? So making, making it really simple and saying that ladder was in the wrong place, you fell on it, let's do a better job of sweeping the place up before we leave at night and at [00:14:40] least leaving the light on.

[00:14:41] Larry Earl: For the day people who come in at 6 a. m. not to fall on that ladder. There you go. And that's, you know, that leads into one of our next questions. What are some strategies for creating a supportive and inclusive work environment that values and prioritizes employees mental health and overall well being?

[00:14:59] Larry Earl: [00:15:00] So you just mentioned a strategy. What others can you tell us about?

[00:15:04] Larry Earl: Um, I had talked about promoting mental health awareness. Uh, in many companies. We have EAP programs, that's Employee Assistance Programs, right? But most employers don't have [00:15:20] anything to do with that. I think we need more than just an EAP. We need, uh, a cheerleader in the office who is able to recognize that this employee looks a little different today.

[00:15:37] Larry Earl: What is it? Did they lose [00:15:40] that one hour of sleep? Is it they're just they have a flu today, right? And then we destigmatize mental health, right? It is not a bad thing to say Today i'm having a rough day. I'm a little depressed. I'm a little anxious I [00:16:00] woke up anxious, right? We all do have moments when things just don't go right for us.

[00:16:07] Larry Earl: And how are we providing that support to that employee who says, man, today I'm just having a bad morning, right? We need to have somebody good enough, [00:16:20] available, who can sit down even for three minutes to say, what can I do for you right now, right?

[00:16:29] Larry Earl: And really encourage employees to have that balance in their lives. If you're scheduled seven days in a row with us today, [00:16:40] do we maybe need to cut that down to just six and a half days? Right. My employees want to be here every day. I'm like, yeah, I'll stay. Right. But we need to encourage our employees to also give us feedback, right?

[00:16:58] Larry Earl: How many times? [00:17:00] As a medic, as a director here, do I go, Oh, how are you doing today? I'm always afraid to ask that. Because what if there's something I cannot handle? So am I optimally at my top scope today? Maybe not. [00:17:20] So maybe I need somebody else. Who can step in my shoes, like Dr. Fletcher, or Tanya, or Dr.

[00:17:28] Larry Earl: Brown, when I'm overwhelmed myself. Yeah, acknowledging and celebrating what our employees achieve, right? So yesterday you came in, you were [00:17:40] tired, you looked rugged, you'd lost an hour of sleep. We helped you get back home. We're so excited to see you today, right? It's an achievement to get employees out of bed. And we want them to know that we are glad they're here, [00:18:00] hanging out with us and walking with us.

[00:18:03] Larry Earl: So that concept you mentioned of the cheerleader, Right? Someone who can identify, uh, perhaps those that are not at the top of their game today. Is that, um, an occupational health nurse? Is it someone in human resources? Is it a co worker that's [00:18:20] been, um, perhaps specially trained to help, uh, other co workers?

[00:18:25] Larry Earl: Uh, what, what's the, there's no one size fits all, I'm sure. So how does a company, um, sort of nurture that type of a person to be available? And then what are the outside resources that might be available [00:18:40] to, uh, support that role as well?

[00:18:45] Larry Earl: Yeah, so we all know some of us have zero nurturing skills, right? And so, as a cheerleader, we want to choose all kinds of cheerleaders. We need a [00:19:00] diversified team of cheerleaders. It would be nice for the nurturing people on our teams, to be the ones who are like, yeah, be on the lookout, right? They need to look out and go, Oh, I think we might just having a rough day today.

[00:19:14] Larry Earl: Let me help her. We also need to have companies [00:19:20] really endorse, encourage, and pay for mental health. Um, fast aid, right? That's a new, relatively new thing. We thought fast aid was just for when you scratched your finger or had a paper cut. But we have a whole [00:19:40] new facet of fast aid, and it's mental health.

[00:19:45] Larry Earl: Um, I know here in town we have people who do that training, and it's really an awesome thing for employers to go ahead and send a few people who are willing [00:20:00] Because it's a tough job. Some of us do not want to carry your, your burdens outside. We talked about EAP, but EAP is not really hands on right now.

[00:20:16] Larry Earl: We need a An immediate now. [00:20:20] The naturess who are hanging out with us. We need that those mental health, um, assistants who are trained in that. Their extension. And then we need to have people who we can say, Hey, Dr. Earl, Well, Mytha's struggling today. We know you're, uh, [00:20:40] The champion of mental health. Would you have a few minutes today to just call her and see how she's doing?

[00:20:48] Larry Earl: And then we need to train our managers to reach out often instead of thinking, Oh, I got to call her again, reach out. We want to [00:21:00] keep you as an employee, because you know, and I know, replacing an employee is such a tough thing. Yeah. We don't want to lose anyone if we don't have to lose them. Yeah, retention is really key.

[00:21:14] Larry Earl: Uh, you know, you mentioned, uh, some ways to, uh, Engage with [00:21:20] outside resources and certainly in mental health. I think telehealth resources are, um, probably one of the better things that have come along in terms of getting accessed. It's so difficult to get access on a bricks and mortar basis, right? For for mental health services.[00:21:40]

[00:21:40] Larry Earl: Um, what do you, uh, Uh, how have you been able to engage any telehealth services or do you know that, uh, how that's happening for companies that, uh, you know, can't have a mental health person on staff or in the clinic or in, uh, the workplace?[00:22:00]

[00:22:01] Larry Earl: Yes, actually we, so our company has, it's called PMHP and these, uh, the people who send you a weekly, maybe even bi weekly. topic of what's new in, [00:22:20] in the news today. And they have a whole section of psych MPs and psych MDs who you can call and they're available at the end of the line when you need them without any weight.

[00:22:35] Larry Earl: Now I am in a college town, so we [00:22:40] have a ton of telehealth services. the, uh, We ourselves participate in it. So if there's a crisis and an employee needs us, we want to, we want that employee to call and say, I am in a crisis. I need to talk to someone, right? [00:23:00] We may have five patients waiting, but then we have to have that energy to say to a patient, if you give me five minutes, please and thank you.

[00:23:12] Larry Earl: I need to take this phone call. Most employers and employees can be talked to [00:23:20] for exactly two minutes. to say, I am here. I'm available. You can come if you really need to come. And or by extension, do we need to call 911 if it's that critical? Or do we need to send you in? Right? But it's [00:23:40] important that we continue to advocate for telehealth services.

[00:23:45] Larry Earl: Those have been a lifesaver. Yeah, indeed. You know, let's talk about, uh, you know, talking about Identifying folks that have risks for mental health and [00:24:00] biopsychosocial aspects of care. How do we look for those red flags and identify any risk factors that should make us more proactive in addressing these issues with patients, with workers, especially for injured workers?

[00:24:16] Larry Earl: Because these things, you know, these things lead to delayed recovery. How do we identify those [00:24:20] risks?

[00:24:23] Larry Earl: So red flags sometimes are so red, you can see them before they even happen, right? And then there are red flags that everybody goes, wow, I did not see that coming, right? Comprehensive assessments, and these need to be continuous. [00:24:40] You don't do an assessment on Monday and go, yeah, We're good for the rest of the year, right?

[00:24:46] Larry Earl: When you get that careful planning, assess your needs, and this needs to be done. If you need to do it every day, by all means do it every day. We do [00:25:00] know that things may change in a blink of an eye, right? You may be sitting there having a great time seeing your patients, get a headache, don't feel good, fall out, have a really bad outcome, right?

[00:25:18] Larry Earl: How are we committed? [00:25:20] to helping our employees on the job if something like that happens. Do we have an interdisciplinary approach, right? In my clinic, if that happens, you just push a button and somebody comes to help. And you open the door and you say, [00:25:40] I need help, and somebody comes to help. Are we looking at early intervention?

[00:25:47] Larry Earl: I think sometimes we don't pay attention to those things we need to pay attention to. So you come in limping in on Monday. Well, for me, it's because I wore my new high heels [00:26:00] on Sunday. That's my excuse, right? But maybe it's not. Maybe I fell. Now, I'm limping. Who does that assessment of you might think you're limping today.

[00:26:13] Larry Earl: How's it going? Are you, are you okay? Right? And how do we help you not climb on that [00:26:20] ladder? Because you're limping. You may not be climbing on that ladder. But we need you to do your job. So, do we have leeway? And support what other people can come to my rescue, right? And by all means, if [00:26:40] we fail in all this and you get injured, what are our policies of returning you back with restrictions, with just one eye and a patch?

[00:26:54] Larry Earl: So my clinic, you can come back with three eye patches, right? Because we [00:27:00] can sit you at a desk and help the transcriptionist people do their job. If we don't have that, then what are, right. Yeah, modified duty has to be part of that supportive environment that a company allows for patients, right? If they're just off duty, uh, it's very [00:27:20] difficult to get recovery if you're not in the workforce.

[00:27:23] Larry Earl: So, I agree, those modified duty programs are just, uh, really crucial. Make sure they have them. Yeah. Yeah. And I think also it's training our supervisors, right? Because if they need somebody to be on that [00:27:40] forklift, they need somebody on that forklift. I can't get on it. I don't want to get on it. I'm, I have a broken toe for my high heels.

[00:27:50] Larry Earl: How do you expect me to do that? Right? So it's supervisors need training and then always evaluate what you're [00:28:00] doing at the end of the day. If you have done all that and you don't survey and look back at what you've done, then you don't have the data that it was successful or not. And then you have time to pivot, update, change, delete.

[00:28:18] Larry Earl: Add new [00:28:20] people, change the way you're doing, change a policy if it needs to be changed. And I always tell my employers that not all employees are going to sue, but we always want to think of that, especially if we see red flags. We want to be [00:28:40] prepared for anything and everything. Well said. Hey, uh, we have a couple of minutes here to finish up. Let's talk about, you know, there's, there's this disconnect, uh, between the time that a worker's compensation case runs out and when someone is [00:29:00] truly ready to return.

[00:29:01] Larry Earl: to work. I wanted to address that. How can we improve this for better outcomes?

[00:29:09] Larry Earl: So every now and then we just come to a place where there's no other place to go. I think creating a supporting, supporting [00:29:20] environment, right? Do we provide education and training, or have we, Um, so planning should begin the minute that employee is injured. So here's the plan. That comes from HR. When you get injured, we file a claim, we send it to these guys, this is the name of [00:29:40] your adjuster, we'll send it to SafeWorks, they will see you for whatever you need, they will do whatever they need to do to get you back to us, right?

[00:29:48] Larry Earl: Here are, we will take restrictions. In the meantime, we only give this much time. Oh, your adjuster has decided today that [00:30:00] you're done, right? Do we have short term disability? Do we have long term disability? What else do we have to draw on? Can you come back on a restricted duty until we resolve this, right?

[00:30:14] Larry Earl: Or do we just need to say, go away? You're out of money. We can't help [00:30:20] you. Do we, do we want to help you apply for disability, right? We are getting older and older, uh, employee, employees now, right? They're 72. They've been injured. This hip is not going to be fixed for another 10 days. [00:30:40] Can they really afford not to be paid?

[00:30:44] Larry Earl: What's, what's our stopgap? Do we have one? How do we balance that short term disability? Is it available? Yes or no? This is part of policy making because we all know that at some point, [00:31:00] Somebody's going to be injured. Do we address that with a supportive smile and say, Hey, this is what we do in this case, but we need to plan from the beginning and hopefully to when we return you fully to the job.

[00:31:18] Larry Earl: And have no gaps in care. [00:31:20] Are we sensitive with that? Are we culturally sensitive? What are our biases, right? Yeah, yeah, well put. You know, uh, well beyond the strict medical model of looking at a sore knee and just treating it, uh, collaboration, communication between [00:31:40] healthcare providers you touched on, employers, the case workers, the, um, the adjusters, it really, this is what it takes a village, right?

[00:31:49] Larry Earl: a team of folks to address all these different issues to avoid delayed recovery and get people back to healthier, happier, more [00:32:00] productive lives and, and, and more productive workforce. Uh, well, Mytha Sullivan, I want to thank you so much for joining this discussion today on, uh, why holistic care matters for workplace injury recovery.

[00:32:12] Larry Earl: It's been delightful to have you today. Thank you so much. Appreciate it. Thank you for having me. Yeah. I appreciate you. And, uh, [00:32:20] you know, more conversations to come in the future, I'm sure. Uh, thank you all for joining us today. That'll wrap it up for, uh, today's episode of Fit for Duty. Thanks for joining us.

[00:32:31] Larry Earl: Thank you.