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Written by Jason Parker   
Tuesday, 07 November 2006
Return to Work Motivation:

Getting an individual to agree, cognitively, that RTW is a good idea is far easier than getting the same individual to actually RTW and to continuing working.

Before we can begin to impact a person and the choices they make, we need to understand a few things about motivation.  In our context we need to understand what a person is motivated for in order to facilitate the change.  We can’t change people only facilitate their change.  Our greatest opportunity to facilitate change is to begin understanding the values people hold, the criteria they have, and the goals they want.

People are always motivated for something.  Have you ever gotten off the phone and asked, “Why isn't this person motivated?” Or, “This person is just not motivated to return to work.”  In fact the person may be motivated to return to work but not to an alternate job, or to what you maybe expect them to be motivated for.  You may think that they are not motivated.  Rather than asking “Why”, a better question is to ask  “What is this person motivated for?”
Discovering and understanding what an individual's motivations are toward creating change is key.  Change does not necessarily require a transformation in terms of behaviour; it can also mean a change in direction. 

If you are having difficulty motivating a person chances are they have more reasons to say no to you than you have reasons to motivate them or facilitate their choices.  It is also likely that you have not tapped into what is most important to them yet.  Having the flexibility to continue to offer more choices and looking for opportunities to understand and uncover the most important things to a person will dramatically improve your chances to have a positive impact for that person.

In 1979 Mitchell came up with a formula to attempt to explain what return to work motivation is comprised of.  He postulated that return to work motivation was a function of 3 things to determined whether a person would be motivated to return to work or not.
RTWM ∫ (V + Pos/C)

V = Value or Utility of Work
POS = Perceived Chance of Success
C = Real or perceived cost of returning to work.
                                        (Mitchell 1979)

Stop for a moment and think about what we are trying to accomplish.  What is it that we are ultimately trying to do in our jobs?  We are working towards a timely return to work/file resolution, which can mean a file closure whether or not this person actually returns to the workplace. 

Look at the equation for a minute…why would a person return to work?  Values.  According to the equation, the value a person places on work has the largest impact on their motivation to returning to work versus staying at home. 

As you can see, a person’s determination of the value of work or the importance of work to them has a much bigger influence on the outcome.  Essentially, for some work is such an important part of their live and literally blended into the very essence of who they are and how they feel about themselves.  For others, it simply is a means to an end and can be likened to a bad habit with not real meaning. 
“Why is it important for you to return to work?”
People will return to work for emotional reasons.  When asked, “Why is it important for your to return to work?” a claimant respond once by saying, “Hmmm, why is it important for me to return to work?  I guess I am having difficulty answering this because there is no emotional reason for me to return to work.”

The second part of the equation is related to the worker’s perceived chance of success in returning to work.  Or, what expectations of recovery do they have.  There are 2 parts to expectation of recovery.  First is what is the worker’s expectation and secondly, what expectations of recovery has the doctor discussed.  An interesting study that was done on 1566 WCB (WCB Ontario) injured workers found that workers with more positive expectations spent less time off work and receiving workers’ compensation benefits than those with more negative expectations.  It was found that these recovery expectations have a direct influence on the recovery process.  Specifically, what expectations were discussed with the doctor. 
Expectations

1.       What expectations have you discussed with your doctor?
2.       What expectations have your discussed with your patient?

In another study by Izabela Schultz et al (2002), it was found that workers’ cognitions were a significant factor, namely perceptions of current health and physical status and expectations of recovery.  Furthermore, a key point identified in the Schultz (2002) study stated “Secondary prevention interventions should be designed to address modifiable cognition-based factors, with particular emphasis on expectations of recovery.”  Discovering what expectations the worker has of their recovery as well as what the doctor has discussed in terms of expectations of recovery can go a long way to helping improve recovery outcomes.

The last part of Mitchell’s equation deals with the judgment a person will make about the cost of returning to work.  This may be a real cost or a perceived cost.  The cost can also be positive or negative depending on the perception of the person.  They may gain or lose financially.  The perceived cost may be in increased pain or discomfort.  “The cost may be silently determined that, 'If I go back to work, the pain will kill me!'”  (Mitchell 2000)

By focusing on the values and beliefs of the Worker we begin having a more dramatic impact on their outcome.  According to the Schultz study, “A well-coordinated, education and early activation approach involving, primary care physicians, employers, and workers’ compensations systems, and targeting worker’s belief, perceptions, and expectations would likely be most effective.”  By starting with the 3 factors of Return to work Motivation identified by Mitchell (1979) we are begin developing a framework that is most effective in managing workplace injury that is rooted in their values about work, beliefs, and expectations of recovery.


References:


Cole DC. et al (2002).  Listening to injured workers:  How recovery expectations predict outcomes:  A prospective study.  Can Med Assoc J 2002: 166:749-54


Mitchell, K (1979).  Vocational rehabilitation of the myocardial infarction patient.  In D. Gentry & R. Williams (Eds.), Psychological aspects of myocardial infarction and coronary care (2nd ed.).  St. Louis, MO: Mosby


Mitchell, K (2000).  The Dance of the Invisible Impairments:  Chronic Pain Syndrome and the Disability Insurer.  American Pain Society Bulletin 10.4 (July/August 2000)


Schultz, I.Z. et al (2002).  Biopsychosocial Multivariate Predictive Model of Occupational Low Back Disability.  Spine Volume 27, Number 23, pp 2720-2725.  Lippincott Williams & Wilkins, Inc.

Last Updated ( Monday, 08 January 2007 )