Worker participation and return-to-work : a study among healthcare workers in the Winnipeg Regional Health Authority

Lrsr or Flcunns ..""""""""IX Ansrnacr """""x CnaptpR ONn INrnoDUCTIoN...""""" 1 1.0The Meaning and Value of Work... """""" I 1.1 Work and Health """"""""""' 1 1. 2 The Consequences of Loss of Work """"'2 2.0 Workplace Injury """"""""""" 3 2.I The Economic Costs """""""' 3 2.2*ealthcare Workers at High Risk.......... """"""""""' 4 2.3 Socio-Cultulal Costs """""""' 5 3.0 Return-to-work """' 6 3.1 Positive and Negative Factors in Retum-to-work...... """""""""' 6 3.2 Benefits of Return-to-work """"""""""' 10 4.0 Worker Participation........... """"""""""' 10 4.i Worker Participation in the Workplace """""""""" 10 4.2 Worker Participation in Return-to-work.... """""""' 11 5.0 The Winnipeg Regional Health Authority.""""""""12 6.0 The Research Questions """"' 13 CnaprnnTwoLTTBRATURERnvrBw ........'."""' 14 1.0 Workplace Culture, Return-to-work, and Worker Participation......... .....14 1.1 Definitions of Occupation and Health "" 14 1.2 Definition of Workplace Culture """"""I4 L2.lTheworlElacesetting...... """""""" /5 1.3 The Definition and Parameters of Return-to-work.'............ """'17 1.4 Definition of Worker Participation...'.......' """""""'20 1.5 The Importance of Worker Participation.'.........'... """"""""""'22 1.5.1 Wo,rker empowerment.,....... """"""' 22 1.5.2Meaningful participation """"""""' 23 2.0 History of Worker Participation in the \ilorkplace......-.... """"'23 Tner-n oF CoNTENTS lI/orker participation and RTW Friesen, 2004 IV Worker ParticiPation and RT"llt 2.1 Economic Ideologies and Worker Participation """""""' """""25 2.1.1Capitalism........ """ ""' 25 2.1.2Communism....."..' """ 26 2.l.3The need to integrate the labour and the labourer "' """ " " ' 26 2.ZWorkpLace Democracy......... """""""""'27 2.2.1 Employee involvement """"""""""' 27 2.2.2 Emptoyee ownership and worker cooperative"""""""" """"""""""" 28 2.2.3 Wirlcplace democràcy in Sweden and North America """""' 54 3. *ealthservices System Factors in RTV/."" """"""' 55 3.5 Insurance System Factors in RTW """"' 56 3.6 Economic, Social and Legislative System Variables in Successful RTW....'.'.'......'...... 58 3.6.1 Social and economic variables .'."...""' """"""' 58 Friesen, 2004 llorker ParticiPation and RTW 3.6.2Legislative variables """ 59 4.0 The Manitoba Experience of work Injury and Return-to-work """"""" 60 5.0 A Multi-system Model of worker Participation and Return-to-work in the ¿.TVorkp1ace................ "" o¿ 6.0 Purpose of the Research""""" 67 6.1 Purpose...'....'..""' """"""""" 67 6.2 TheResearch Hypotheses """""""" """' 68 CnaprnnTunBn Mnrnonol.ocY""70 1.0 Research Design ""70 1.1 Mixed Methods Design'.""""""""""""' 70 1 .2Rationaie for Use of Survey Method " " ' ' 7 I 1.3 Rationale for Use of Qualiiative Methodology"""" """""""""'73 1.4 Participation Solicited in Design of Research """""75 2.0 The Study Participants....""""" """""""'75 2.1 The Sample Population """"'75 2.1.1Sampling itrategyfor employee survey """"""' 77 2.1.2Sampt;g strotãgy for thà mãnager survey """' 80 2.1.3Samplinf strarcfiifor the quahtãtive interviews """"' """' 81 2.1.4Exclusion uiteria..-..""""" """"""" 81 3.0lnstrumentation.... """""""""' 82 3.1 Questionrruir" Development for Employee Survey """""""""" 82 3.2.Pre-testing of the Employee Survey """ 83 3.3 Selection of Su*.y qìesiio"s """""""" 84 3.3.lTheGeneralPerceivedSelf-EfficacyScale(þpendixII)..'........85 3.3.2The Work Environment S'Ltii'l'ppendix III) "' """""""""" 86 3.3.4The Oiganizational Policiæ o)odþroctices Questionnaire (Appendix IV)' " 88 j.3.5 Adaptation of instruments for current study """"' """""""' 91 3.4 Questionnaire Development for Manager Survey ""92 3.5 Qualitative Interview þuestions """""""' """""""" 93 4.0 Survey Administration.....""""""' """""'94 4.1 Use of Mail-in and Telephone Surveys """""""' ""'94 4.2Managing Non-Respondent or Missing Data """"' """"""""""97 5.0 Description of Dependent and Independent variables.............. """"""""" 98 5.1.Dependent Variables in Employee Survey """"""" 98 5.2.Independent Variables in thà Employee Survey """ 98 5.2.1 l4¡orker variables """""" 99 5.2.2 WorlElace variables .-......""'"""""' 99 5.3 Dependent Variables in Manager Survey """""""' 100 5.4.Independent Variables in the I4*ugt' Survey """ 100 5.5 Summary of Study Variables """""""" 101 6.0 A Summary of the Data Analysis Plan""' """""""' 103 6.1 Overall Approach to Analysis of Employe eData"""'""""""" 103 6.1.1Factolanalyses...' """" 104 6.L2 Correlatioi analysls..'......'.."' """" 104 6.1.3Regression analyses .-...--......' """"' 104 Friesen, 2004 vl Worker participation and RTW 6.1.4Between-groups analyses.'.. """""' 104 6.2 OverallApprðach to Analysis of Manager Data...'...... """"""' 1046.3 Analysis óf Qualitative Data."""""""" 105 6.4 Summary of Analysis Plan".""""""""' 106 7.0 Ethical Considerations """"" 111Cna.prBn Foun Rnsulrs """""""" 112 1.0 Employee Survey Results """t12 i.1 Response Rate and Analysis of Non-response.......... """""""" II2 1.2 Descriptive Data... """""""' 1 15 1.3 Exploratory 4na1yses.............. """"""" 118 1.3.1 Bivariate Correlation-.......-"""""" 118 1.3.2Factor Analysis ."""""' I19 1.4 Factor Analyses Preparatory for Prediction Models ............"... 120 i.5 Fit with the Multi-system Model of .Worker Participation and RTW in the Workplace """""""' 122 i.6 Tésting the Models for Prediction of Worker Participation in the Workplace.........'...124 1.7 Between-groups Analyses... """"""""" 127 1.7.1 Time-loss groups """"" 127 1.7.2 lilorþlaci groups.....'....'..... """"" 128 2.0 Manager Surwey tr'ioAiog, ""' 130 2.1 Response Rate "' 130 2.ZDeicriptive Findings....'.".'.... """""""' 131 2.3 Exploratory Analysis .......'.'.... """""""132 2.4 Cimpæison in Types of Worþ1aces......"...... """" 134 2.4.1 Duration of time-loss and cost of W4CB premiums.......'..... 134 2.4.2.Comparison of worlqlace characteristics """ 134 2.4.3Comparison oiworker participation """""""' 135 2.5 Testing the Multi-System Model of Worker Participation and RTW in the Workplacã """""""' 137 2.5.1 Pred¡ctors for average duration of time-loss due to injurymanager data'........ I37 2.5.2Predíctorsfor cost of llCB premiums """"""' 138 3.0 Qualitative Anaþsis Findings................ """"""""" 141 l.i tarticipant Destriptions....-... """""""' 141 3.2 Themes and Issues '....'.......'.""""""""' 145 j.2.J Informationtheme........ """"""""" 146 3.2.2Worker input theme...-.... """""""" 146 3.2.3Choices theme """"""" 147 3.2.4Decisíon-makíng theme...-..'.""""" I4B 3'2'5 other themes """""""" 149 3.3 Summary of Themes........".'.... """"""'152 Cu¿.prnRFryn DIscussloN..... """"' 153 1.0 Discussion of Findings from Employee Data """""' 153 1.1 Exploratory Analyses'.......'.....'."""""" 153 l.l.l Descriptton of employee,ç'......'....... """ """""' 153 Friesen, 2004 vll I\/orlcer ParticiPation and RTW L 1.2 FittviththeModelofWorkerParticipationcmdRTl|¡in the Workplace """"' ""' 154 1'2PredictorsofWorker.Parlicipationinthe.Workplace.....'..'..,...i551.3 Worker Participation Differénces Among Groups """""""""' 159 2.0 Discussion of finOings from Man agerData""""""':"" """""' 160 2.1Typeof Workplace and Average ñuration of Time-loss injuries """"""" 160 2.2predictors foriu"rug" Duration of Time-Loss Injury ............' 161 1r1 2.3 Predictors for Cost of WCB Premium """""""""" rur 3.0 understanding the Nature of worker Participation in RTW """"""""" 162 3.1 Worlcers' lnfluence in the'Workplace and N¿åningful Participation""' "" 163 1rf 3.2Thelmportance of Trustand Respect"""""""" '---""""" ""' ruu 3.3 The t "ar,ring curve in worker piticipation in RTV/ ............. 168 3.4 Structure Facilitates Participation""""""""""

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