EXECUTIVE SUMMARY

Early engagement with injured workers is necessary to improve education and communication, prevent problems, and to facilitate collaboration between patient and case manager.

  • One important tactic in dealing with workers’ compensation cases and building trust is to empower the patient by providing educational resources and explaining why certain interventions are needed.
  • If left alone early in the process, the way the patient interacts with medical providers can change. This could lead to contention with their case manager.
  • It is important to not react negatively to an angry patient and to treat him or her with respect and kindness.

Engaging early with clients who were injured on the job can create a collaborative relationship between patient and case manager that helps the person’s recovery journey.

Injured workers often do not know what their next steps will be in returning to health and work. Sometimes, family members and friends give them opinions about what they should do. These opinions are not always accurate, says Michelle Despres, PT, CEAS II, REAS, CETS, vice president of physical therapy with One Call in Jacksonville, FL.

“If physical therapy is needed, it should be started as soon as possible after injury,” she says. “If you start within three days, the costs are lower and the [rehabilitation] time is less.”

Also, patients who start physical therapy early require fewer opioids and diagnostic tests. “If care starts within seven days vs. 30 days, it lowers costs and the outcomes are substantially better,” Despres says.

There are exceptions for patients who need to be immobilized, or if the physician does not want the care to start. But beginning within seven days will work for most musculoskeletal injuries with no breaks or fractures, Despres explains.

A client’s social factors and the case manager’s communication skills can affect early engagement. Despres offers these best practices for connecting with patients and engaging earlier:

Improve education and communication. One of the best ways to optimize collaboration is to provide patients with educational resources. Case managers need collaborative-friendly educational techniques and materials, Despres adds.

For instance, case managers can give clients information about preparing for physical therapy. One Call provides educational resources on how to prepare for physical therapy, MRIs, aquatic care, and other appointments.

“[A large part] of getting people well is empowering them to not only understand what is happening, but to take charge and be prepared,” Despres says. “Your life is a little out of control if you’re injured, and you can’t necessarily take good care of yourself. Having a [case manager] as a reassuring presence is important.”

Case managers can build trust with patients by acknowledging their pain and difficulty with therapy. They can say, “A lot of the things we will ask you to do will hurt, but they won’t harm,” Despres says.

Patients fare better when their therapist or case manager communicates why certain interventions or actions are needed. For example, if the physical therapist tells the patient to squat five times, the patient is more likely to do so if told why.

“There is a rationale behind educating people on the process, on what’s happening and what the recovery looks like,” Despres says.

Case managers can be the voice that tells patients it is OK if they are sore or hurting a little after therapy, but it is a building process that will help them return to normal activities and work. “The better you get, the more you do, and the more you do, the better you get,” she says.

Physicians’ time with patients is limited. If patients have many questions about their diagnosis and symptoms, the case manager might be the best person to ask.

Although doctors and case managers might not always give the answer the patient wants, it is important for the patient to hear accurate information from a healthcare professional instead of relying on internet searches, Despres says.

Reach out to patients before problems arise. If a case manager is too busy to contact the patient early, he or she is left to figure things out on their own.

“Some patients may do a fine job [of following healthcare instructions]; others may not,” Despres says.

Left on their own early in the process, patients might not understand what their providers have asked them to do, so they get off on the wrong foot. They also could be influenced by the opinions of their friends and family members who do not know their whole situation.

“They could start to bring in legal people, which changes how the person interacts with their medical providers,” Despres says. “If patient care is not appropriate or is not delivered early enough, we lose their trust.”

Sometimes, patients can become contentious with their case managers, creating an unfortunate situation. One way to prevent this is for the case manager to contact the patient within the first few days, which is when the patient is the most nervous and asks the most questions about returning to work.

“A lot of people are worried they may not be able to do their work,” she explains. “If you are 20 to 30 years into being a truck driver and suddenly can’t be a truck driver anymore, how are you going to provide for your family?”

If case managers engage with patients early, they can answer those questions and prevent long-term engagement problems.

Resolve attitude conflicts. Sometimes, healthcare providers become jaded with workers’ comp patients. This can be a problem, Despres adds.

For instance, a physical therapist might believe workers’ comp patients are less motivated and not as willing to perform their physical therapy exercises as other patients.

In another example, a case manager might have to call a patient who is behaving poorly. The case manager could be tempted to respond in kind.

“You get that one phone call where the person is horrible on the other side, but if you respond in kind, you can lose that person,” Despres says. “Remember — this is a human being and they are likely angry and bitter because they are afraid and in pain.”

Case managers should learn methods to turn these situations around and not react negatively to an angry patient, she says.

Despres has made it a personal challenge to actively take on patients who are angry and dissatisfied to see if she can turn them around on their care.

“I found that if I treated them with respect, kindness, and listened to their concerns, nine-and-a-half times out of 10, I could turn that person around and say, ‘Together, we will get through this, and I will give you the best I have,’” Despres says. “If the best isn’t good enough for them, we will come up with a plan B.”

One technique is for the case manager to not take the patient’s anger as a personal attack. It likely means the patient is upset at the world and afraid because of his or her injury or illness.

“Even though it feels personal, you should take that larger view and say, ‘I hear you. Get it all out. Now, let’s talk about how to get through this and do it together,’” she says.

Salvage fractured relationships. “The key is to listen with an open ear and listen to understand,” Despres says. “Ensure that compassion is there.”

Case managers must be clear with the sound of their voices over the phone about what they want the patient to do. They can ask open-ended questions, such as, “Can you tell me about your family? Tell me about your job. What do you like to do outside of work?” she explains.

It is important to get to know patients as individuals and not just as workers or someone on Medicare. “Come up with something to talk about that links you outside of the official relationship,” Despres suggests. “If you’re friendly, respectful, compassionate, and the spirit of what you’re asking of the patient is out of kindness and concern, that person will begin to hear it and react.”

Case managers should know any psychosocial factors that affect a patient’s ability to self-manage their care.

“If there’s something that is impacting the recovery journey, be thoughtful about whether [a new provider] needs to be brought in to help,” she says. “We don’t want to add any unnecessary services, but sometimes you have to make the call.”