Imagine life without Return to Work Plans

Return to work plans trigger me. I mean they are not quite as bad as their maternal manuscript, the injury management plan, that boringly verbose and unapologetic testament to command and control that comes in the post four weeks after any smidgeon of relevance has withered on the vine, but they are more ubiquitous, and hence, more troublesome.

Acknowledging our penchant for retrospective rationalisation of our non -conscious, emotion laden sensemaking, let me indulge in the illusion of attempting to impose rational thought on my free-will free zone.

My argument is that the obliviously overconfident demeanor of the return to work plan advocates induces a backfire effect. At least it does with me. The idea that we can ensure a result by getting everyone to sign off, is intellectually lazy.

The weaponization of the document is troubling. Despite the rhetoric of collaborative goal setting, my experience is that power-infused stakeholders are often seeking to set a compliance trap. Even in its most innocuous form, it still reinforces process over people and injects a discourse that implies that recovery from injury has a linear trajectory.

I recently sat in a meeting with a RTW coordinator and a worker and listened to the disingenuous lie that he is “holding the insurer at bay” on referral to an “independent” doctor but if an upgrade wasn’t forthcoming then he couldn’t hold them back much longer. I know the lie because in a past, less enlightened life, it was in my tool kit.

John Vervaeke, says we are suffering from a meaning crisis. He says that one of the notable characteristics of this nihilistic phase is the normalization of bullshit. He is very specific about the definition of bullshit and the example I provide above is typical. It was a wafer thinly veiled threat that sought to secure a commitment to the idea that her recovery is not only predictable but overdue. Just a few quick signatures on an RTW Plan and we would have a “legal document” that could be waved around if the upgrade wasn’t forthcoming. This is a common strategy.

If Edgar Schein[1] is worth listening to on culture, then openness and trust surpass pre-injury duties as an end goal. When we sit around a table with a worker who is being pressured under the weight of the power differential and seek a signature, we are endorsing a paternalism that ignores what Donald Michaels[2] refers to as “the ubiquitous role of inadvertence” within a “model of power based on coercion and fear”.

A RTW Plan is not a substitute for a trusting relationship between a worker and their employer. It is a lazy avatar for meaningful relationship and conversation. If you are unconvinced, I challenge you to produce a written plan for the arguably more important enterprise of being in a long term relationship with your partner. And if you’re tempted to argue that there are many people involved in the RTW process I would invite you to consider how you communicate within your family unit of adults and children and grandparents and cousins and friends. Why do we not have written and signed plans for the goal oriented activity of family coherence? Where are our written and signed plans outlining how we intend to facilitate the education of our children?

What is the trajectory of all this plan signing?

I fully acknowledge the frequent breakdown of communication and trust between partners and within families but I’m not persuaded that the solution involves written agreements that get reviewed every few weeks. Perhaps meaningful conversation and cultivated trust nested within imperfect relationships and genuine interest in collective wellbeing provides a better frame?

I wonder if, rather than developing all of these plans, some focus (via the much under-valued tool of conversation) on building relationships between the key actors might allow for the emergence of more salient risks.

We like plans because they provide us with comfort. They allow us to believe we have considered and mitigated the risks. We suffer under the illusion that because we all met for a sole purpose, to discuss the preferred outcome, and because we have written it down and signed off, then we have cast our risk identification net wide and captured the relevant risks.

But risk assessment is highly subjective and people are fallible. Karl Weick warns us of the danger of oversimplification when managing the unexpected. Kahneman and Tversky[3] tell us that…

 “The human mind has difficulty coping with complicated probabilistic relationships, so people tend to employ simple rules of thumb that reduce the burden of processing such information. In processing information of uncertain accuracy or reliability, tends to result in simple yes or no decisions”.

The worker I described above is a highly intelligent project manager. She was alert to the disingenuous protection being espoused. She immediately recognised the differential between what Schein refers to as espoused values and the underlying assumptions and character of the organisation she works within. Trust was eroded. RTW Plans don’t induce trust.

In Learning to plan and planning to learn[4], Donald Michaels encourages us to consider that,

Changing towards long range social planning would require that people working in organisations, and in the social and natural environments linked to them, find it rewarding to;

  • Live with and acknowledge great uncertainty
  • Embrace error
  • Seek and accept the ethical responsibility and the conflict laden interpersonal circumstances that attend goal setting
  • Be open to changes in commitment and direction…

Consider the effect the typical RTW Plan, and the pseudo-collaborative activity they embrace, has on our relationship with uncertainty around recovery. Imagine how the individual, who has signed off under implicit (and sometimes explicit) threat of non-compliance, feels when the predicted upgrade milestones aren’t met.

In anticipation of the argument that we can do RTW planning within the true spirit of collaboration and cooperation, I would wholeheartedly agree.  I find myself scaffolding people around that theme. But where that spirit is alive and well do we really need sign off? What if we were to have a conversation with a worker and ask what they think their duties and capacity are? And then include their peers or supervisors in the conversation?  Today and in two days and again next week. The information that yields, in my experience, often deviates from the written plan. And that deviation is valuable learning fodder.

Rosa Antonia Carrillo[5] has developed a thesis around the beliefs of what she terms relationship centred safety leadership. She emphasises the importance of trust and psychological safety. She observes that when things go wrong we grasp at procedures and rules when we should really be facilitating relationships through the medium of conversation.

Imagine talking to each other about the deviations instead of relying on the organisational hubris generated by the plan. Imagine the learning that the deviations might facilitate if we can accept that our predictive planning powers are limited. Imagine enacting a trial of tasks at work and expecting things to go wrong. Imagine talking about what went wrong, without blame, and modifying in response to the learnings.

[1] Edgar Schein

[2] Michael, Donald N., Learning to Plan and Planning to Learn, Miles River Press 1997 p 338

[3] Amos Tversky and Daniel Kahneman, “Judgment under Uncertainty: Heuristics and Biases,” Science, 27 September 1974, Vol. 185, pp. 1124-1131.

[4] Michael, Donald N., Learning to Plan and Planning to Learn, Miles River Press 1997 p 323

[5] Safety on Tap podcast #29: The 8 beliefs of relationship centred safety  hosted by Andrew Barrett