Year

2005

Degree Name

Doctor of Philosophy

Department

Graduate School of Public Health

Abstract

Workplace rehabilitation gained greater prominence as a means of both containing the costs of workers’ compensation claims and improving return to work outcomes for injured workers following a period of policy debate and reform from the late 1970s to the mid-1990s. As a result, rehabilitation was integrated into workers’ compensation arrangements throughout Australia. However, coal mines in NSW took a different path, one which did not fully integrate rehabilitation into its workers’ compensation arrangements (hybrid model). This thesis set out to examine why coal mines in NSW took a different path and the implications through the following research questions: 1) How did the hybrid model for workplace rehabilitation within workers’ compensation arrangements in NSW coal mines (at 1996) differ from that in place in other NSW industries? 2) Why was workplace rehabilitation not fully implemented into workers’ compensation arrangements for NSW coal mines? What factors influenced the decision-making process and led to the hybrid model (1987 – 1997)? 3) How did workplace rehabilitation programs in NSW coal mines (at 1996) compare to those recommended in the literature? 4) How did the hybrid model work in practice in NSW coal mines (at 1996)? What was its impact on the delivery of workplace rehabilitation? Was it working effectively? Where and Where not? Why and why not? 5) How could effective workplace rehabilitation programs be delivered in NSW coal mines? 6) What conclusions may be drawn in relation to the public policy process and what recommendations may be made for workplace rehabilitation policy in NSW coal mines? Using a policy analysis framework described by Hill1, this thesis examined the various influences on policy formulation and implementation in order to understand the public policy making process better. How the hybrid model differed from the recommended integrated model (research question 1) was determined through a comparison of the two models. This identified points of difference and therefore points of potential influence in policy development. An historical analysis and interviews were conducted to understand why the integrated model was not fully implemented in NSW coal mines (research question 2). This assisted the Researcher to identify individuals, groups and organised interests that were involved in the development of this policy, their roles and how they exerted influence over policy formulation. A literature review of previous research findings in rehabilitation and return to work was undertaken (research question 3). It uncovered information to support workplace rehabilitation as a means of delivering improved return to work outcomes for injured workers, as well as to identify the elements of an effective workplace rehabilitation program. This provided a basis for comparison between literature on workplace rehabilitation and what was in practice in NSW coal mines. To assess the operation of workplace rehabilitation in NSW coal mines (research question 4), a survey by questionnaire and interviews of stakeholders participating in its operation was conducted. This provided an understanding of how the hybrid model worked in practice and insight into the policy process, especially factors impacting on implementation. Next, a workplace rehabilitation audit was developed and trialed in six coal mines over a two year period to assess whether such a tool could improve the operation of workplace rehabilitation (research question 5). The trial provided additional information about workplace rehabilitation thereby adding to its knowledge base. It also provided information about the implementation of policy into operational settings and how it might be made more successful. Finally, all results from the policy analysis were reviewed to determine what set of recommendations might be made for: the workplace rehabilitation policy framework for NSW coal mines; improving the management of workplace rehabilitation in NSW coal mines; and for the conduct of future research (research question 6). In short, why a hybrid model for workplace rehabilitation was implemented in NSW coal mines instead of the recommended policy framework occurred for a number of reasons. Firstly, key stakeholders, CMI, Employers and Unions, were not represented in high level government policy making mechanisms for workplace rehabilitation policy. This made it difficult for them to participate in the development of policy principles which would later apply to them. As a result, they did not fully comprehend the new arrangements and how they might interact with workers’ compensation arrangements in place for NSW coal mines. Secondly, key stakeholders, particularly the Unions, were able to influence parliamentary processes to exclude their constituency from legislated elements of the recommended policy framework. Thirdly, key stakeholders including CMI, the Unions and to some extent Employers continued to operate under the old paradigm for workers’ compensation, that is, as a means of providing financial recompense in the event of an injury rather than as a means of providing workplace rehabilitation and return to work. This militated against acceptance of workplace rehabilitation as an integral component of workers’ compensation arrangements. Fourthly, the differences between the hybrid model and the recommended policy framework for workplace rehabilitation were not recognised. Subsequently, implementation of the hybrid model was not altered to account for these differences and therefore achievement of original policy objectives was limited. These factors restricted the integration of workplace rehabilitation into workers’ compensation arrangements in NSW coal mines. Through this research, an in-depth understanding of the development and operation of workplace rehabilitation policy in NSW coal mines in the period under review was gained. Factors that influenced the development of public policy were identified thereby contributing to the theoretical understanding of the policy process. Factors relevant to the operation of workplace rehabilitation policy were also uncovered and a method of improving the delivery of workplace rehabilitation programs was tested which provided important insights into policy implementation. The trial of the workplace rehabilitation audit demonstrated that using such a tool, specifically designed for NSW coal mines, could facilitate policy implementation thereby aiding achievement of original policy objectives. This thesis therefore informed policy theory and practice in an attempt to contribute to the further understanding of workplace rehabilitation and its ability to improve occupational health outcomes for injured coal miners.

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