ANALYSIS OF AN EARLY INTERVENTION DISABILITY PROGRAM
by
Laura Zaparinuk
BSW, University of Regina, 1999

THESIS SUBMITTED IN PARTIAL FULFILLMENT OF
THE REQUIREMENTS FOR THE DEGREE OF
MASTER OF ARTS
IN
DISABILITY MANAGEMENT

UNIVERSITY OF NORTHERN BRITISH COLUMBIA
April 14, 2013
© Laura Zaparinuk, 2013

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ABSTRACT
Analyzing the cost benefit of early intervention in disability management is a challenging area of
study due to the overall lack of standardized programs and measures. The purpose of this study
was to determine if early intervention is an effective way to manage disability related costs, to
assess data quality and provide recommendation to the Corporation on how best to measure its
return on investment into the early intervention program (EDP). The study is a mixture of
quantitative based analysis combined with an exploratory research design approach. Basic
descriptive and inferential statistics where utilized in conjunction with gathering other key
indicators to determine if an EIP is an effective means of managing disability related costs. This
research demonstrates the benefits and challenges of capturing data in order to measure the
overall value of investing in EIP. The study concludes with recommendations on how to
improve data collection and the importance of being able to show a statistically significant
positive change as a result of the EIP to ensure future investment on the health and wellness of
employees.

iii

TABLE OF CONTENTS
Abstract

ii

Table of Contents

iii

List of Tables

iv

List of Figures

v

Acknowledgement

vi

Introduction

1

Chapter One

Contextual Information on Early Intervention Programs
Background
Disability Management and Prevention

4
4

Chapter Two

The Challenges with Data Collection

14

Chapter Three

The Phases of Development for the Early Intervention Program
Phase 1- Social Assessment and Situational Analysis
Phase 2- Epidemiological Assessment
Phase 3- Administrative, Policy Assessment and
Intervention Alignment
Phase 4- Implementation
Phase 5- Process Evaluation
Phase 6- Impact and Outcome Evaluation

22
22
23

Chapter Four

Procedures Leading to the Research
Sample
Data Limitations
Methodology

35
36
36
36

Chapter Five

Primary Data Analysis Results

38

Chapter Six

Interpretation of the Data

43

Chapter Seven

Conclusion and Recommendations

56

References

24
26
28
33

63

LIST OF TABLES
Table 1: Role Similarities of Disability Management and Collective Bargaining
Representatives

8

Table 2: Process Evaluation o f Roles and Responsibilities within the
Early Intervention Program

29

Table 3: Pre and Post-EIP Average Costs

38

Table 4: Measure ofAverage (Mean) Cost o f EIP and STD Cost Post-EIP

39

Table 5: Comparison o f the post-EIP Cost with the Average pre-EIP Cost Value

40

Table 6: Comparison ofAverage Cost (Mean) o f Employees Who Accepted EIP and Those
Who Did Not

40

Table 7: Missing values within the key indicators and variables (in Percentages)

43

LIST OF FIGURES
Figure 1. Histogram of the age cohort.

46

Figure 2. Histogram of referrals post-EIP.

48

Figure 3. Primary disability types.

49

Figure 4. Histogram of STD costs.

51

Figure 5. Costs for those that accepted EIP.

52

Figure 6. Histogram of employees who returned to work post-EIP.

54

ACKNOWLEDGEMENT
I would like to thank the Corporation for their commitment and willingness for this
research project. To my supervisor Dr. Josee Lavoie for her support and commitment throughout
the last 5 years, as well as, Dr. Peter MacMillan and Arlene Ward for agreeing to be part of my
committee and supporting me to achieve my goal of completing a quantitative based thesis. To
the external examiner, Dr. Cindy Hardy, thank you for your input post oral defense. Most of all I
would like to thank my husband, Chad, Sierra and Oscar for their continued support, patience
and sacrifices in order for me to reach my educational goal.

INTRODUCTION
Disability management is best described as an overarching term that encompasses a full
spectrum of workplace programs designed to facilitate employment for employees who may
have an existing disability or sustained a disability (Dyck, 2006). Early intervention programs
(EIP) are a component within the initial part of the disability management spectrum and can be
defined as the area within the spectrum that focuses on prevention, as well as the provision of
support to an employee to navigate the options for rehabilitation and accommodation within the
first 30 days following a disability that may impact attendance and/or work performance.
Showing the cost benefits of early intervention in the discipline of Disability
Management is a challenging area of study due to the overall lack of standardized programs and
measures. EIP are usually the first programs to be eliminated during tough economic times. The
reasons that these types of programs often are the first to go is partially due to the time and
funding that is required to show a return on the investment, poor benchmarks and incomplete
data collection from the inception of the program. As a result many senior management teams
often do not have the time and/or the resources to capture and show the cost benefits of investing
in early intervention.
The purpose of this study was to determine if early intervention is an effective way to
manage disability related costs for the organization, to assess data quality and provide
recommendation to the Corporation on how best to measure its return on investment into the EIP.
This study was undertaken with a Coiporation with approximately 425 employees, which
when provided with the option, preferred to remain anonymous. For the purpose of this study, it
will from now on be referred to as “the Corporation” and every effort will be made to ensure that
it cannot be identified. The Corporation was willing and supportive during the research process,

and provided access to anonymized data. To respect the Corporation’s request, this thesis draws
on corporate documentation (e.g. program documentation, mission statement) without providing
explicit references.
The Corporation’s main mandate is to deliver supports and services to adults living with
disabilities. Their mission is to promote inclusion so that people with disabilities have more
choices about how they live, work and contribute. The Corporation has approximately 425 full­
time employees. In a corporation of this size, employees are key in facilitating the vision and
mission. In order for employees to carry out the vision and mission that promotes inclusion so
that people with disabilities have more opportunities within the community, it only makes sense
that they lead by example and implement a program that addresses the disability related needs of
its employees.
Prior to 2009, the Corporation did not have an EIP as part of its disability management
approach. It was as a result of discussion undertaken by the writer/researcher that the
Corporation made a commitment to continually improving the disability related services of its
own employees, which led to the development and implementation of the EIP. The
writer/researcher of this thesis was involved in developing the framework of the EIP and its
implementation with the Corporation’s Human Resource Department.
The purpose of this study was to determine if early intervention is an effective way to
manage disability related costs for the organization, to assess data quality and provide
recommendation to the Corporation on how best to measure its return on investment into the EIP.
The purpose of the EBP is to facilitate a proactive, appropriate and customized return to
work program for employees with occupational and non-occupational disabilities. The goal of

the program is to support effective return to work (RTW) in a caring, safe and timely manner that
will reduce the economic and social impact of work related illness and injury.
The Corporation’s primary interest in this study is to learn whether the EIP is an effective
means to managing health and disability related costs. While cost is not the only motivating
factor for early intervention strategies, it is a key factor that is beneficial for both labour and
management. Through reducing the economic impact of work related illness for both employee
and employer there are indirect benefits that draw attention to the investment in workplace
wellness. The secondary objective for this thesis is to assess data quality and provide
recommendations to the Corporation on how best to measure its return on investment of the EIP.
An exploratory research design was used to structure the research and determine the outcome
measures. Part of the analysis of the data also includes a formative evaluation and retrospective
analysis. This results in the final objective of the study which was to produce the Corporation
with some baseline benchmarks as well as to provide recommendations for data collection and
quality overtime.
The thesis begins with a review of relevant literature in regards to the current shift and
attention to disability management and focus on EIP as well as, the importance of labour
management commitment in program redesign. Chapter Two will review types of data collection
and the challenges with data collection for EIP. Once the reader is provided with some context of
EIP and research challenges, the phases of development for the Corporation’s EIP will be
summarized. An overview of the methodology for this quantitative based research will be shown
in Chapter Four. Data results along with a detailed interpretation will follow in Chapter Five.
This thesis ends with a discussion of the objectives of this study, a summary of key findings, and
concludes with recommendations for the Corporation.

4

CHAPTER ONE, CONTEXTUAL INFORMATION ON EARLY INTERVENTION
PROGRAMS
Background
A literature review has been conducted with the majority of information collected via the
internet, journal articles and text books in order to support the exploratory research approach.
The research criteria that were used to search relevant information for the literature review
included early intervention programs in unionized environments and methods of data collection
that are central to quantitative research regarding the cost benefits realized for the Corporation’s
EIP.
Databases searched included Pubmed and Google Scholar. Specific Canadian sources
such as Human Resources and Social Development Canada; National Institute of Disability
Management and Research; Public Health Agency of Canada; Statistics Canada and the
Corporation’s EIP Cost Comparison were also utilized. The literature provided information on
the importance of Early Intervention and Disability Management programs. Highlighted was the
importance of joint labour-management commitment along with a variety of methods for data
collection and the challenges that exist when doing a comparative analysis for EIP.
Disability Management and Prevention
It was not until 1981 where the United Nations started to realize that the effects of
disability in the work force, if not addressed, could have a significant impact on the economy and
labour shortage. They began to view all employees, including those with disabilities, as valuable
assets to the work force and worth retaining and investing in rather than providing everincreasing costs of providing benefits to support employees with disabilities to remain out of the
work force (Harder & Scott, 2005).

5

Harder and Scott (2005) found literature dating back to 1975 that pointed out the short
comings of the medical model when it was utilized to address rehabilitative purposes. They
found that applying the medical model to rehabilitation created a clash because employees with
permanent disabilities and chronic illnesses did not fit within the scope of rehabilitation due to
the focus of the medical model on diagnosis and a cure to an identified pathology. This resulted
in no action in supporting people with disability to remain within the workforce resulting in
increased pressure on the economy and a strained labour force.
It was here where the shift in the approach to rehabilitation began to focus on prevention
as an all-encompassing topic that included everything from corporate culture, health and safety,
ergonomics, engineering design, accident investigation, root cause analysis, employee selection,
to health promotion programing. As a result disability management and prevention as a whole
emerged as the process of facilitating early and safe return to work while striving to decrease the
human and financial cost of disability (Harder & Scott, 2005).
Franchee et al. (2005) confirms research that describes the evolution of a wider
conceptualization of disability management that expands from the medical model and crosses
into a more bio-psycho-social model. As a result of this expansion disability management
professionals no longer focus on medical case management but cross over into organizational
culture shifts that focus on EDP, RTW outcomes, policies, and employee health and wellness. The
challenge with this new focus is the development of standardized outcomes, definitions of
disability, training and the acceptance of both the employer and employee (Franchee et al.,
2005).
Anema et al. (2009) conducted an exploratory analysis on disability policy in a six
country cohort study. The study revealed a substantial number o f differences between countries

6

in medical interventions and workplace interventions. The main outcome of the study was that a
policy change is needed to encourage interventions such as EIP or RTW and that these
interventions need to be supported by less strict compensation policies. They also identified that
a collaborative policy change is needed by politicians and stakeholders. The focus should be
more on a workplace that appreciates the humanity of each employee and to ensure that
employees are valued, feel secure and believe in a future. The study supported this by finding a
correlation that a system change from a medical model insurance system to more o f a bio­
psycho-social approach in Saskatchewan resulted in a decline in the number of claims and
duration of claims, as well as, increased recovery of those with whiplash injuries when this shift
in approach was applied.
While disability management is an overarching term that encompasses a full spectrum of
workplace programs designed to facilitate employment for employees who may have an existing
disability or sustained a disability. Operationally, Dyck (2006) identifies eight elements required
for any successful Disability Management Program within the spectrum as requiring:
“Management-Labour Commitment and Supportive Policies; Stakeholder Education and
Involvement; Supportive Benefits Programs; A Coordinated Approach to Injury/Illness
Management; A Communication Strategy; A graduated Retum-To-Work Program; Performance
Measurement and Workplace Wellness” (p. 194).
This research solely revolves around the element that occurs prior to and at the beginning
of a graduated RTW program within the disability management spectrum defined as Early
Intervention (Dyck, 2006). Early intervention deals with prevention, as well as the engagement
of support to an employee to navigate and facilitate the options for rehabilitation within the first
30 days they are absent from the work place. The next phases are the rehabilitation and return to

7

work (RTW) plan that assist and provide flexible and creative return to work options for the
employee to return to work in a timely fashion (Dyck, 2006).
The first and foremost key element identified within a comprehensive EIP is the
importance of “Management-Labour Commitment and Supportive Policies” (Dyck, 2006, p.
07). Without this commitment and supportive policies as the foundation of any disability
management program, there is potential risk of program failure because the goals, objectives and
benefits of the program are not clearly understood.
Dyck (2006) describes management-labour commitment as needing to be sensitive to the
impact of disability on employees, families, co-workers and the organization by which they are
employed. The importance of ensuring the employer is knowledgeable on relevant legislation
and “duty to accommodate” when developing supportive policies and management-labour
agreements that protect employability is also important. Indicators of management-labour
commitment include the design and implementation of a benefit plan that rewards a safe and
timely return to work as well as the employer being cognizant of the potential effect of
management practices on employee wellness. The indication of flexible and creative retum-towork options and the cooperation of management-labour efforts to reduce employee absenteeism
are also important factors to consider. Once management-labour is clear on the goal, objectives,
benefits and their responsibilities they are more likely to be engaged and therefore more inclined
to make future investment into a successful program.
Unions play an equally significant role as disability management professionals do in
improving workplace safety, health and wellness. Strengthening the relationship between
disability management professionals and union representatives creates the potential to implement
an EIP which in turn enhances accommodation and return to work opportunities within a

8

unionized environment. In order to facilitate and strengthen this relationship, it is important that
disability management professionals understand the roles and functions of collective bargaining
within the context of disability management as outlined in Table 1 below:
Table 1
Role Similarities o f Disability Management and Collective Bargaining Representatives

Disability Management Professionals

Collective Bargaining Representatives

1) Identify the goal of a disability

1) Identify and bargain for the goals within the

management program which is preventing

collective agreement that include issues such as

and managing employee absenteeism and

managing employee absenteeism and retention.

retention.
2) Incorporate objectives of evaluating and

2) Are concerned with personnel practices and

monitoring ill or injured workers to reduce

monitor the effects of employee absenteeism and

employee absenteeism and increase

employee retention strategies within

employee retention.

organizations.

3) Show the benefits and outcomes of a

3) Bargain for or against benefits and programs

disability management program that include

that are supposed to improve workplace safety,

cost effectiveness, retention and workplace

health and wellness.

wellness.
(Adapted from Shrey et al., 2006.)
Both disability management and the collective bargaining process involve activities such
as analyzing cost and labour market trends; having a clear understanding of how people currently
behave in the labour market and using data to predict and forecast future needs and
developments. Statistics Canada is the primary source of labour market data. Disability

9

management professionals along with those who are involved in collective bargaining will
conduct analysis on potential labour force and participation rates as well as labour productivity.
Similar to any disability management program, an unregulated labour market could be
devastating to many employers and affect them in a negative way. Issues covered in most labour
standards legislation that are also covered in a disability management program include,
maximum hours of work, vacation/sick pay, discrimination, health and safety. Through having
clearly defined standards and legislation benefits both the employer and employee are provided
with a guide and the tools needed to regulate the labour market. For example, minimum wages
specify the wage rates for various types of employment and individuals; maximum hours of work
specify the maximum number of hours per day or week that an employer can demand from
employees. Having basic disability management standards around issues such as “duty to
accommodate” within collective agreements bring more clarity to both employer and employee
(Phillips, 1981).
Unfortunately employers who have not set identified benchmarks that address disability
related absences at the inception of their disability management programs will have ongoing
challenges in measuring long-term trends and the cause and effect on performance of their
programs. This lack of outcome measurement results in having minimal data that that only
measures the cost from one fiscal year to another. While the data on cost is valuable it does not
provide enough information on the cause of what requires adjustment within the program to
reduce the costs or employee absence.
The lack of nationally standardized benchmarks also create challenges to measure
disability management programs globally leaving the only common measure of compliance with

10

Human Rights Legislation under “duty to accommodate” and discrimination clauses within some
collective agreements (Saint-Cyr, 2007).
Harder and Scott (2005) argue that in Canada, the Canadian Charter of Rights, the
Canadian Human Rights Act and the Employment Equity Act all clearly identify the
responsibility of accommodation. Each province in Canada has provincial human rights statutes
that address duty to accommodate to varying degrees. This makes Human Rights legislation
paramount in providing a solid foundation from which other benchmarks, such as absences due
to disability related limitations, can be developed to measure the wellness of employees and
advance the importance of disability management within the workforce.
Having standards and legislation across all jurisdictions incorporated within collective
agreements as it does for minimum wage, vacation pay and statutory holidays would strengthen
and force employers’ obligations in regards to achieving and ensuring disability management
programs address workplace wellness. It would also ensure programs were set up with consistent
measurable data that could be collected nationally.
In 1999, the Supreme Court of Canada decided two cases that had major legal
implications and reinforced the duty to accommodate individuals. The first case reaffirmed that
employers who design workplace standards have an obligation to be aware of the differences
between individuals and must build equality in workplace standards. The second case clearly
defined that employers governed by Human Rights Legislation, that have employees with
disability related conditions, should accommodate these employees if it does not cause undue
hardship to the employer (Human Resources and Social Development Canada, 2002).
Despite these two ground breaking decisions, “duty to accommodate” is still not
incorporated within many collective agreements to provide further clarity to employers and

11

employees in regards to their rights to accommodation in the workplace. Yet the literature review
indicated that organizations are concerned with the personnel practices of recording the
development and maintenance of its human resources. The literature review also indicated that
without this foundation incorporated finding other common benchmarks nationally, to measure
employee wellness, will create a challenge (Human Resources and Social Development Canada,
2002).

The development and maintenance of human resources is equally important to disability
management programs. Most organizations continue to monitor and are concerned with the
performance, training, development, and employee compensation (Phillips, 1981). Performance
appraisals are tools that are used to help employers and disability management professionals
determine the contribution of the employee within the organization. Hakala (2008) states that
employees performance is no longer an annual ritual but a continuous process for employees and
human resource consultants to ensure that an employee is clear on the organizational vision as
well as the progress in achieving the vision for each employee. While performance appraisals
and training are not a direct concern to collective bargaining professionals, they are key to
negotiations regarding workload expectations. As a result this provides the employee with clear
expectations and the employer with an understanding of their duty to accommodate should
disability become a factor.
Before this clarity can occur, the function of the Collective Bargaining Cycle needs to
change so that more theory and models of disability management can be incorporated. Similar to
disability management, employers involved within the collective bargaining cycle have
traditionally been reluctant participants. Disability management professionals must consider the
following eight attitudinal postures when implementing and incorporating a disability

12

management program within an organization as these attitudinal postures can transfer over into
preconceived prejudices and misunderstandings of persons with disabilities in the workforce. It
may also account for why standardization in defining disability and developing best practices
and benchmarks is so challenging.
Often there are many misunderstandings and attitudinal postures that result between
employer and employee. Phillips (1981) states eight possible categories of attitudinal postures of
employers and employees within collective bargaining as follows:
1. Ideology. The employee organization is dedicated primarily to an ideology, such as,
socialism or class equality, which the employer opposes. Ultimately, each party seeks to
destroy the other.
2. Conflict. The employer seeks to eliminate the employee organization while the
employee organization fights for survival and improved security arrangements.
3. Containment-aggression. The employer seeks to contain the employee organization
within limited bounds while the employee organization aims at extending its scope of
activities.
4. Power bargaining. Both the employer and employee organization accept the existence
of each other. Emphasis is placed in tough bargaining tactics to get all that is possible
from the opposite side.
5. Accommodation. This is characterized by serious bargaining within established
boundaries and willingness to compromise whenever necessary. Familiar routines are
followed and both parties maintain a “live and let live” policy.
6. Cooperation. Both the employer and the employee organization accept each other’s
problems as also being problems of their own. Even though the parties will have their

13

differences on traditional collective bargaining issues, each regards the other as a
responsible party.
7. Deal bargaining. This refers to secret deals between employers and representatives of
the employee organization. Each side gives something, but those employees not party to
the negotiations are never told the true extent of, or reasons for, the compromise. In
some cases, the end result may be detrimental to the membership.
8. Collusion. This implies that employers and employee representatives make illegal
agreements that adversely affect the interests of other employers, other employees and
the consuming public (p. 81-82).
The Centre for Chronic Disease Prevention and Control (CCDPC) estimates that 87% of
disabilities in Canada are chronic disease related (2008). This type of data is what union
representatives and/or labour management committees need to be aware of in order to understand
how important early intervention is in regards to disability management. Implementing an EIP
has the potential to greatly benefit the recovery of injured or ill personnel, and assist workers to
stay at work or return to productive and safe employment as soon as physically possible (SaintCyr, 2007).
In summary, the literature review shows convincing evidence that management-labour
commitment is a key element in the development of an EIP. The literature also illustrates that
EIP benefits both employer and employee when data is collected from the beginning as it
provides benchmarks that helps to define “duty to accommodate” legislation as well as address
the performance, financial and socioeconomic impacts on employees and employers.

14

CHAPTER TWO, THE CHALLENGES WITH DATA COLLECTION
The foundation in achieving a successful EIP is ensuring reliable data is collected and the
outcomes of the program are measurable using the data collected. Research conducted during the
literature review found that it is paramount to develop measurable benchmarks for all employees
not only within a program but across programs to define effective measures and enhance
disability management programs (Dyck, 2006).
Dyck (2006) and the American Institute of Medicine and National Research Council
(2002) state that there is a variety of data collection techniques available and that if more care
was taken to collect this type of data, more methods on ways to evaluate disability programs
would emerge. Due to a lack of standardization in regards to data collection, best practice has yet
to be determined. In Canada there is a variety of data collected on persons with disabilities. One
of the largest and most reliable data collected nationally is through the Participation Activity
Limitation Survey (PALS) (Statistics Canada, 2001).
PALS is a survey designed to collect information on both adults and children in Canada
who have a disability (specifically, those people whose everyday activities are limited because of
a condition or health problem). It provides information on the prevalence of certain types of
disabilities and the supports available for persons with disabilities. It also provides information
on the employment profile, income and societal participation (e.g., work, school, social
activities) of persons with disabilities. All levels of government, associations, researchers and
non-governmental organizations use the PALS data to support the planning of services needed
by persons with disabilities to ensure that they are able to participate fully in society (Statistics
Canada, 2001).”

15

Saint-Cyr (2007) indicates that her research showed that the probability of return to any
form of employment decreases rapidly with the passage of time away from work and that the
economic and social impact of work-related illness and injury has been well documented. She
goes on to state that it is estimated that worker disabilities cost Canadian employers a total that
ranges from $10 to $20 billion dollars per year. In addition, absences due to disability or illness
are among the most challenging human resource situations facing employers. This type of data
is what helps to provide the argument and reasoning on how EIP benefit the recovery of injured
or ill personnel, and help employers assist injured and ill workers to stay at work or return to
productive and safe employment as soon as physically possible (Saint-Cyr, 2007).
Human Resources and Social Development Canada (2002) identified that more research
is needed to identify clearly the full range of direct and indirect costs of disability. They also
noted that disability management interventions have failed at times to obtain support of senior
management despite impressive returns on the investment due to expenditure reductions and
accruals to programs other than those that incur cost (Human Resources and Social Development
Canada, 2007).
Unfortunately there is little reliable data collected nationally on EIP for employees with
disabilities and the effectiveness of EIP’s cannot be ascertained. Part of this is due to differences
of the definitions of disability and the differences between the purposes of each program. This
inability to find reliable data may also be due to fact that there are few studies in the literature
that measure the causal effect of health benefits on employee health (Nicholson, 2006).
In Canada alone Worker Compensation legislation is not consistent across jurisdictions.
For example, Worker Compensation Boards have no obligation to re-employ people who are
injured on the job in the provinces of Alberta, British Columbia, Saskatchewan, or Nunavut,

16

Yukon or Northwest Territories. Yet these jurisdictions all have retum-to-work programs that
are highly recommended by each of their own Worker Compensation Boards. This impacts a
researcher’s ability to gather reliable data because each jurisdiction has their own approach to
disability management and to program measurement. Determining the effectiveness of programs
also becomes challenging if there is no standard to which employers must adhere. Relying solely
on standards under Human Rights Legislation provides minimal benchmarks for an organization
to determine the effectiveness of the program especially as it pertains to early intervention
(Saint-Cyr, 2007).
Human Resources and Social Development Canada (1997) state that the consolidation of
RTW program criteria would help with assessing the effectiveness of disability related programs.
They also state that, “without agreement on at least the general goals of policies, it can be
difficult or impossible to focus evaluation efforts” (Human Resources and Social Development
Canada, 1997, p.5).
The National Institute of Disability Management and Research (NIDMAR, 2005) annual
report introduces the benefits of an auditing tool that they developed known as the Consensus
Based Disability Management Audit (CBDMA). The CBDMA tool is becoming internationally
known as a tool to support early intervention and the return to work of ill, injured and workers
who have disabilities. It is linked to best practices globally. It is a tool that helps to set a global
standard for professionals and provides data that highlights the benefits and need for disability
management programs.
NIDMAR (2005) claims that the CBDMA is a tool that measures the performance of
employer’s disability management programs through providing information about workers with
disabilities that are reintegrated back into the workplace. The development and testing of the

17

CBDMA included both large government and non-govemment corporations such as Labour
Canada, Weyerhaeuser Company, the Workers' Compensation Board of British Columbia and
Correctional Service of Canada, along with their unions (National Institute of Disability
Management and Research, 2005).
The CBDMA standards are designed to: “Establish a minimum acceptable benchmark for
disability management programs; Identify opportunities for disability management program
improvement; and encourage the adoption of best practices in disability management. Questions
are grouped into three main categories: Disability Management Policy and Workplace
Resources; Disability Prevention; Early Intervention and Timely Return to Work Process
(National Institute of Disability Management and Research, 2004)”.
The eight qualities that Dyck (2006) defines as the key elements of a quality disability
management program are measured through 16 different categories and include over 180
questions. The 16 categories within the CBDMA include: Joint Worker-Management Support
and Empowerment; Responsibility, Accountability and Authority; Workplace Culture and Policy
Development; Information and Communication Management; Benefit Design and Influences;
Knowledge and Skills of Disability Management Practitioners); Accident Prevention and Safety
Programs; Occupational Ergonomics; Health Promotion and Wellness; Injury, Disability, and
Lost-time Patterns; Disability Cost Benefit Data; Early Intervention and Worker Communication
Protocol; Case Management Procedures; Return to Work Coordination; Transitional Work
Options; Workplace Accommodations (National Institute of Disability Management and
Research, 2004).
The category that measures the Early Intervention and Worker Communication Protocol
focuses on the extent of early intervention and the immediate response to the rehabilitation needs

18

that prevent the employee from feeling powerless and reinforces their responsibility for recovery.
It maintains the focus that employee participation is critical to have the best and most successful
outcome. Emphasis is on support to the employee, ensuring access to information related to
treatment, accommodation and resources to facilitate a successful RTW. Measures involve the
effects of EEP and its role in maintaining direct, continuous contact with the employee and
reviewing all of the objectives to be included in the RTW plan to obtain the best outcomes. The
theory is that when this type of involvement is done in a caring fashion, it provides assurance
that both workers and management value the employee as a contributing member of the work
group (National Institute of Disability Management and Research, 2004).
By collecting data and measuring the outcomes o f a disability management program,
companies are able to analyze and see the value of the program by measuring the reduction of
absences and improvement of on the job productivity. However, one of the challenges that
Nicholson (2006) notes is that at times data only shows cost effectiveness for employees with
severe disability and not for the average employee.
Another important issue that does not receive much attention but should is what the
Institute of Medicine and National Research Council define as “coverage error” (p.75).
“Coverage error is produced by the failure to include all eligible people on the list or framework
used for identifying and sampling the population of interest. The use of screening questions to
identify the population of interest leads to an additional source of coverage error-the exclusion of
persons due to inaccurate classification at the time of screening” (Institute of Medicine and
National Research Council, p. 75.)
The Institute of Medicine and National Research Council (2002) identify potential
coverage errors that exist in each method of data collection. Often household-based surveys

19

eliminate from the sampling those with no fixed address and those admitted to institutions. An
example of this is within the PALS survey that uses the Canadian census for contacting people
and surveying those with no fixed address or in institution may not get counted or interviewed.
As well First Nations living on reserve are also not counted which impacts Canadian statistics
greatly and excludes a total population that also experiences disability issues (Statistics Canada,
2001).

Other areas that need to be taken into account that are noted are the person’s ability to
respond to the survey and those who do not respond at all. Taking a bio-psycho-social-cultural
approach could assist with this but it is also challenging. The Institute of Medicine and National
Research Council (2002) note that current data collection efforts fail to measure environmental
impacts and should examine both factors that cause barriers and ones that accommodate
disabilities.
Coverage error was not something that was required for this research but it is important
to mention because it may be helpful in future research by the organization to look at surveying
employees who have left the organization, accessed LTD, or experienced other environment
impacts and have accessed other interventions outside of the EIP to address any limitations that
may have affected their work.
The CBDMA does not identify clearly the coverage error of its auditing tool. What it
does say is that it was, “ developed using a consensus-based model, combining the key elements
identified as essential when administering successful disability management programs with
feedback from field trials to produce a tool that has not only content validity, but also relevance
and utility (NIDMAR, 2005)”.

20

Dr. Ernest Skakun, Director of Psychometrics, Division of Studies in Medical Education
at the University of Alberta, and a recognized expert in the field of test design, performed the
targeted statistical analysis on CBDMA. Results showed that those with a disability management
program showed lower and fewer workers compensation claims for both short and long-term
disability. The evaluation also showed that all the elements of the CBDMA are relevant to the
measurement of quality disability management programs. Most notable were the Transitional
Work Options and Workplace Accommodations which was reported to show savings of more
than $100,000 in a single year operating location (National Institute of Disability Management
and Research, 2005).
The Correctional Services of Canada is currently using the CBDMA tool in fifty
institutions across Canada. It is interesting to note that other agencies, such as Worksafe BC and
Labour Canada, which were involved at the beginning of developing the tool, have not produced
any documentation on how the tool worked in their respective areas. There is also no
information on the difficulties identified and limitations with using the tool (National Institute of
Disability Management and Research, 2005). Research on the cost of implementing the tool
where a disability program does not exist also would be helpful to assess whether this tool can be
used across disciplines and jurisdictions.
Human Resources and Social Development Canada (2000) estimated that the annual
costs to the federal government of income support programs and provision of goods and services
to people with disabilities are more than $6 billion annually. This does not include the provincial
programs and private sector insurance plans, or the lost income and forgone taxes from people
who are capable to work but who face barriers which prevent employment. This type of
information is important for Unions to be aware of as it helps them to understand the need for

21

programs, such as EIP, and how it and a comprehensive disability management program can
greatly benefit the recovery of injured or ill union employees, and support these workers to stay
at work or return to productive and safe employment as soon as physically possible (Saint-Cyr,
2007).
While research is able to show that collecting data from disability management programs
helps to show the overall benefits of the specific program, it is important to ensure that
measurable benchmarks for all employees are established from the beginning. If this is not done
research will not be considered reliable or meaningful. Standardization of program benchmarks
will remain a challenge and defining and establishing an acceptable coverage of error range will
remain unknown. This lack of standard process prevents the attention and appetite for
corporations to promote and continuing to invest in prevention and employee wellness. It also
prevents the vision and view of how much people with disabilities can contribute to the
workforce. As a result cost will continue to rise in both short term disability (STD) and long
term disability (LTD) claims preventing the ability to have employees stay or return to a safe,
healthy and productive workforce.

22

CHAPTER THREE, THE PHASES OF DEVELOPMENT FOR THE EARLY
INTERVENTION PROGRAM
The Corporation began developing the EEP in 2009 but the program itself was not
implemented until January 2010. The Human Resource consultant liaised with the collective
bargaining representative and confirmed agreement with them before developing the program.
The following 6 phases provide detailed information on the planning and justification for the
development of the EIP. It is important to have this detailed information in order to understand
the context of the approach to the methodology of the analysis. Following is an explanation of
the implementation and the measures developed to effectively evaluate the program.
Disability is not gender or race specific and affects all therefore it is important to note
that while this EIP is specific to this Corporation, it is culturally neutral and can be adapted to
any organization. This Corporation states within their mission statement that they are committed
to preventing and managing absences away from work while ensuring employee health and
wellness. As stated earlier, an EIP is a component of a comprehensive disability management
program. It is the part of the program that encompasses prevention, as well as the engagement of
providing support to an employee to navigate and facilitate the options for rehabilitation within
the first 30 days they are absent from the work place. The purpose is to facilitate a proactive,
appropriate, customized RTW program for employees with occupational and non-occupational
disabilities.
Phase 1- Social Assessment and Situational Analysis
Before the inception of the EIP the Corporation had a rehabilitation committee that was
made up of one Human Resource (HR) representative and one union representative that reviewed
and assisted employees who were either on short or long term disability. The Rehabilitation

23

Committee was and continues to be an integral part of the process in assisting ill or injured
employees to return to work. The committee reviews cases on a monthly basis, assists in
identifying rehabilitation requirements and a return to work option. They also are responsible to
make recommendations regarding LTD and rehabilitative employment training and/or permanent
placement for eligible cases. Cases reviewed by the Committee are generally those in which the
return to work will be protracted or determined if the employee can handle full hours with
modified duties on a trial basis or recommended to access LTD benefits. Prior to the EIP, there
was no disability management coordinator or an Occupational Health Nurse to provide clinical
expertise and/or guidance (Human Resource Representative, Personal Communication, January,
2009).
The existing Rehabilitation Committee played an integral part in the development of the
EIP by assisting ill or injured employees’ return to work. It was believed that through the
addition of an occupational health nurse retained on a contractual, as needed basis, the
Rehabilitation Committee would gain the clinical expertise to support decisions and become
more responsive at the beginning of an illness or injury to facilitate a proactive, appropriate,
customized, early return to gainful employment. The EIP was set up with the objective to
ultimately depend on the participation of all stakeholders including the ill/injured employee
(personal communication, January, 2009).
Phase 2 - Epidemiological Assessment
The EIP data being researched was new to the Corporation. The data was limited and
there were challenges with collection. The Corporation itself was going through a change from
having no EIP to having one. Therefore it was in its infancy stages when this study was
conducted. It is important to note that existing tracking methods pre-EIP for STD costs was at

24

best rudimentary making it difficult if not impossible to determine the cost per individual and
number of individuals that received STD benefits without breaking confidentiality. Therefore
the only data available to use as a baseline was the total cost of disability benefits divided by the
total number of employees for the 2008/2009 fiscal year. There was no available data that was
broken down into specific indicators such as age or type of disability; it was only identified by
name and STD cost.
Phase 3 -Administrative, Policy Assessment and Intervention Alignment
As mentioned above, upon initial assessment it was determined that the Corporation’s
Rehabilitation Committee was at a disadvantage in disability management without the expertise
of a Disability Management Coordinator or Occupational Health Nurse. Therefore, the
Corporation contracted an Occupational Health Nurse on a as needed basis (Human Resource
Representative, Personal Communication, 2008).
In order to procure this service, the Corporation needed to complete a job demand
analysis for each position within the organization. This analysis provided a description of the
roles and responsibilities to allow for the development of a comprehensive retum-to-work plan
for each position. Completion of 5 job analyses cost the Corporation a total of $5,000 (Human
Resource Representative, Personal Communication, 2009).
The cost for the hiring of an Occupational Health Nurse on an ad hoc basis was $ 150/hr
(average of 4 hrs. per week); if there was a need for an Occupational Health Specialist, cost
would be $300/hr. As the cost was minimal and there was joint labour-management
commitment, the Corporation forged ahead with the EIP with their vision of improving and
investing in the health and wellness of their employees with disabilities (Human Resource
Representative, Personal Communication, 2009).

25

The next steps resulted in creating and developing the purpose of the EIP. Following are
the five goals developed for the EIP:
•

To assist and support employees to successfully return to work within the first 30
days following an injury or illness, reducing the cost of disability to both the
employee and the Corporation;

•

Ensure the earliest and safest return to work plan, while allowing employees to
maintain their benefits and a level of income, as well as to support their continued
contact with co-workers;

•

To work cooperatively and jointly with the Union and assist them to fulfill their
role of protecting jobs and benefits for their members;

•

To minimize the negative impact of disability on the employee’s family, co­
workers, supervisors and the community; and

•

To build mutual trust between all stakeholders through improved cooperation
(Human Resource Representative, Personal Communication, 2009).

Below is the policy statement developed by the Corporation (2009) to guide the
implementation of the EIP:
To recognize the responsibilities of both the Corporation and the union towards
employees who may become ill/injured. The Early Intervention Program is committed to
providing an early return to productive employment for employees who become disabled
through occupational or non-occupational injury or illness. The Early Intervention
Program will assist employees in achieving a timely and effective rehabilitation, while
maintaining their personal dignity and financial stability. Additionally, this program will
provide an effective means of managing health and disability related costs. This policy is

26

intended to achieve effective disability management by ensuring: prevention, early
intervention, ongoing case management and meaningful work consistent with the
employee’s physical and mental capabilities without risk of re-injury or risk to others.
Participation will not prejudice receiving the rights negotiated under the collective
agreement (p.2).
A confidentiality policy was also developed (2009) that required the committee to
maintain the confidentiality of the employee’s personal information throughout the process. Any
documents respecting employee’s medical information with respect to cases before the
Rehabilitation Committee are to be securely stored in locked filing cabinets as per regulated in
the Freedom of Information and Protection of Privacy Act.
The company that was hired to provide occupational health expertise maintains consistent
standards required of health care professionals. Confidential medical information is disclosed
only under legal requirement, or on written authorization of the employee. Any request for
consent of the employee to release medical information to the employer or others will specify the
nature of the information, the purpose for its release, the person to whom it may be released and
the time frame for which the consent is valid. Due to the potentially sensitive nature of medical
information collected while working with an employee, the detailed medical files are kept
confidential and stored separately in secure cabinets at the qualified companies office. Complete
confidentiality of personal health information is assured (Human Resource Representative,
Personal Communication, January, 2009).
Phase 4 - Implementation
The EIP program was implemented using an environmental change strategy. In the past
employees did not reach the Rehabilitation Committee until they were deemed requiring short-

27

term or long-term disability (STD/LTD). The environmental change strategy here required
agreement from the Corporation and the Union that the EIP is a voluntary program for all
employees. An employee who has been off with an illness or injury for a duration of over six
consecutive days, and where there is a doctor’s certificate that indicates a potential value of a
referral to the EIP will be contacted by the Human Resources Consultant (Human Resource
Representative, Personal Communication, January, 2009).
Employees who are currently working but experiencing symptoms that may lead to an
absence due to illness or injury will also be able to self-refer themselves to the EBP by contacting
their Human Resources Consultant. For employees who enroll in the program, the Human
Resource Consultant and the Occupational Health Nurse (where determined required) will
facilitate the RTW plan in consultation with the Manager/Supervisor. The Human Resource
Consultant monitors the RTW and consults with the Occupational Health Nurse when required.
The Union member from the Rehabilitation Committee may also be involved for cases that are
before the committee (Human Resource Representative, Personal Communication, and January,
2009).
If an employee turns down the EIP program and the absence continues, the Human
Resource Consultant will have a further conversation with the employee about the benefits of the
program or have the employee provide a self-directed plan on how they will be proactive and
take the steps required to RTW. For those employees that have been off work and claim they
were on sick leave, that have a pattern of missing work, the human resource consultant will ask
for a letter of clearance that states their limitations and inability to RTW. This letter will help the
human resources consultant determine if any accommodation needs are required to enable a
successful RTW and if the employee is eligible for leave benefits. Asking for this letter of

clearance is what is specified and required within the collective agreement when someone goes
off on sick leave for a longer period of time. If there is no letter of clearance provided to the
Human Resource Consultant, the employee will be referred to the EEP (Human Resource
Representative, Personal Communication, 2009).
Phase 5- Process Evaluation
Process evaluation is very valuable in the assessment of EIP. Process and input into this
program involved completing the job analysis for each position within the organization,
contracting out the expertise of an Occupational Health Nurse, developing goals and policies that
enabled the ability to identify quantifiable measurements to determine if the EIP would reduce
costs.
Table 2 outlines each stakeholder’s role and responsibility to be followed that includes
the injured/ill employees who were required to make themselves reasonably available to the
employer and the rehabilitation committee who all need to work consistently within the EIP
principles and actively engage in RTW plan (Human Resource Representative, Personal
Communication, January 2009).

29

Table 2
Process Evaluation o f Roles and Responsibilities Within the Early Intervention Program
_______ Role_________________________________Responsibilities_________________
Ill/Injured Employee
Completing all required forms; Speaking with all parties involved to
discuss the potential for early RTW or accommodation plans;
Participating in an agreed upon early RTW/accommodation plan if
approved by the ill/injured employee’s physician and; Cooperating
with any recommended medical and rehabilitation intervention
plans, if approved by the employee’s physician; Employees also
have a right to self-refer to the EIP.
Manager/Supervisor

The Manager will ensure employees complete the Doctor’s
Certificate after six (6) consecutive scheduled days off from work
and provide a completed a copy to the Human Resource Consultant;
The manager is responsible to provide a safe working environment,
to keep in touch with the employee and to maintain the connection
with the workplace; The manager should be consulting with the
Human Resource Consultant and employee to develop a suitable
RTW plan; Management is responsible to control other workplace
responses such as co-worker support of the returning employee
keeping in mind the health and safety of all; The manager is
responsible to ensure other workers are not burdened which could
potentially increase illness or injury; The manager is responsible to
promote positive support in the transition back to work.

30

Rehabilitation
Committee

Rehabilitation Committee members consisting of the Union and
Employer will participate in the design and implementation of the
EIP; Provide direction to the Human Resource Consultant; Contract
out medical expertise when required to assist with RTW plans;
Consider recommendations from the Occupational Health Nurse
where one is involved; Approve individual RTW plans where there
will be a direct cost to the EIP, and approve costs; Review ongoing
effectiveness of the EIP; Make recommendations regarding LTD
Rehabilitative Employment training or permanent placement for
eligible cases; Approves STD Trials as per the union agreement;
Attend all meetings and provide input and enhancement or changes
to the EIP; Assist in disability management prevention and health
promotion; Provide Quarterly Reports.

Human Resource
Consultant

To be an active participant on the Rehabilitation Committee; To
assist in decision making in regards to RTW plans; Receive the
Doctor’s Certificates from Managers/Supervisors for employees
who have been absent for over 6 days. Based on the information
provided on the Doctor’s Certificate, make a determination of value
to the employee of participating in the EIP; Make initial contact by
telephone (within one working day) after
notification with the ill/injured employee to determine if the EIP
process should be initiated; Explain the EIP to the employee,
including the roles and responsibilities of all parties involved in the

31

program; Send out the Early Notification Package if the EIP process
is required; If the employee is interested in participating in the EIP,
provide the Occupational Health Nurse with basic information on
the employee (name, phone number, address, last date worked, etc.)
as required; Gather and review information about the employee’s
illness/injury and develop a RTW/accommodation plan in
conjunction with the Rehabilitation Committee and Occupational
Health Nurse where medical expertise is required; Follow-up with
the employee and manager to ensure the RTW plan was successful
or if it requires adjustment; Assist with transition back to work;
regular, modified or rehabilitative. Monitors the RTW and report on
outcomes; Educate the workforce on the importance of disability
programs; Collect and evaluate information to monitor the success
of the program; Communicate program outcomes to Senior
Management; Provide knowledge transfer on the program
parameters; Provide monthly reports.
Union Representative

To be an active participant on the Rehabilitation Committee; To
provide notification from the employee if required Provide
information to the employee when required; Ensure the guidelines
within the Collective Agreement are being followed and respected;
To assist in decision making in regards to RTW plans that are
presented to the Rehabilitation Committee; Represent the employee
in matters of job security and re-employment options; Promote and

32

educate employees on the benefits of the Early Intervention
Disability Management Program.
Occupational Health
Nurse

To be an active participant on the Rehabilitation Committee on an as
needed basis; To be contracted and involved with employees on an
as needed basis as determined by the Rehabilitation Committee;
Gather and review information about the employees illness/injury
and develop an RTW/accommodation if appropriate; In consultation
with the employee’s physician and Rehabilitation Committee refer
the employee for independent medical examinations; In consultation
with the employee’s physician refer the employee for additional
treatment services (i.e. Counseling, physiotherapy); Communicate
with the employee, employee’s physician, appropriate employer
designate, appropriate union designate and the Rehabilitation
Committee throughout the employee’s absence to monitor his/her
progress to ensure that the RTW plan is followed; Provide status
reports.

33

Phase 6 - Impact and Outcome Evaluation
The clear goal of any disability management program is directly related to the purpose of
the program which is to prevent and manage absence from work. As Dyck (2006) quotes, “You
can’t manage what you can’t measure” (p. 145). Quantitative data are data that can be counted or
quantified and were the main type of data utilized to determine the impact and outcome of
implementing the EIP. Descriptive statistics were used to summarize the characteristics of the
sample which consisted of 95 employees and 9 different variables. Inferential statistics were
used to evaluate whether the observed relationship is by chance or reflects a relationship among
the factors (Marlow, 2005).
The collection of reliable data may result in being able to demonstrate measurable
outcomes that show the benefits and areas that require improvement within any program. Some
key areas that are measured to show the impact and outcomes of an EIP for the purpose of this
analysis include measuring and collecting data that relates to cost effectiveness, and efficient
collection of data (Dyck, 2006).
In order to collect efficient data that relates to cost effectiveness of the program it is
imperative to review the goals and measurable indicators in the original purpose of implementing
the EIP. This is done by evaluating and measuring the existing policies and costs that are
directly related to best practices so that benefits of the program can be measured not only within
the performance of the specific program but compared and analyzed nationally.
The use of data will help to determine the hypothesis of whether EBP is cost effective to
the organization and help to measure the overall impact of the EIP on the organization and its
employees. A solid methodology needs to be established that outlines the hypothesis, the

34

variables to be measured, and the sample size. Without this foundation it is very difficult to
determine the impact and outcome of any EIP.

35

CHAPTER FOUR, PROCEDURES LEADING TO THE RESEARCH
Before accessing the data a research proposal was provided to the University of Northern
British Columbia (UNBC) Research Ethics Board to ensure the study was ethical and feasible.
Along with the proposal was a formal letter of approval from the Corporation to conduct the
research. Upon review of the research proposal and approval to conduct the research from the
Corporation, the UNBC Research Ethics Board provided their approval to move forward with the
research.
The research began with a request of the raw data from the Human Resource
representative who was in charge of data collection and management of the EIP program. The
data were delivered in an EXCEL file. The raw data itself had missing data points due to
capacity issues within the organization and the inability to enter all data in real time. Univariate
statistics were used to identify the percentage of missing data in each indicator that was of
statistical relevance in explaining the outcomes of the research. As mentioned in Chapter 2,
missing data was identified as a significant challenge in researching EIP and proved to be a
challenge in this research as well.
Central to quantitative research is the question of sample size and sampling techniques.
The study sample included solely the employees of the Corporation. For the purpose of this
research it is important to establish that the Corporation maintained and adhered to strict
standards to protect the privacy of its employees through collecting and only providing
anonymized data. The data remained anonymized not only to protect the privacy of employees
but was also due to the fact that the identity of the employees was not required.

36

Sample
The sample included approximately 425 full-time equivalent employees. The time span
and costs being measured begin in the fiscal year of April 1, 2008, to December 31,2011. All
illness events lasting six days or longer were included in the analyses. Illness events less than six
days were considered outside the scope of this research.
Data Limitations
Since the Corporation was primarily interested in finding out whether the EIP was as an
effective means of managing disability related costs, the variable being tracked by the
Corporation over time was the cost of ill or injured employees pre-EEP and post-EIP. Excluded
were costs from other prevention programs such as the Employee Assistance Program (EAP). As
mentioned, cost was the only measurable variable available to formulate a comparison for a cost
benefit analysis pre and post-EIP. The pre-EIP data available to the researcher was not broken
down into specific indicators such as age cohorts, gender, or type of disability.
Methodology
An exploratory research design was used to first identify deficits in the data to determine
whether EIP is in effective means of managing disability related costs for an organization, to
assess data quality and provide recommendation to the Corporation on how best to measure its
return on investment into the EIP (Borden & Abbot, 2008).
The hypothesis for this research is that the EIP has provided an effective means to
managing disability related costs for the Corporation. The dependent variable, cost, was assessed
(1) with and without the EIP, and (2) pre and post-EIP. Data collected was for employees in the
organization who received any type of STD benefit that resulted in a cost for the organization.
Data collected for EIP costs were independent from the STD cost. The EIP cost for each

37

employee who accepted the program received additional benefits to STD benefits such as paid
assessments to support and determine the best RTW plan. Each employee who received any
STD/EIP benefit was then categorized using the following 9 key indicators to establish a baseline
and to determine if there was any correlation between indicators and post-EIP cost as follows:
1. Number of employees referred to the EIP
2. Number of employees referred who declined EIP
3. Number of employees who accepted EIP
4. Age Cohort
5. Gender
6. Referral date to the EIP
7. Missing data
8. RTW date
9. Primary disability type
When assessing the data the researcher realized that there were challenges with data
quality. There was missing data that was primarily due to a rudimentary system in its collection
which resulted in error and missing data that is further discussed later on in the analysis.
As a result of the data collection challenges only two analytic statistical methods were
utilized to address the primary research question: a one-sample t-test, and an independent groups
t-test. The one-sample t-test involved comparing the post-EIP cost to the pre-EIP cost. The
independent groups t-test involved comparing the EBP costs for individuals who accepted referral
into the program with the costs for individuals who did not accept the referrals. Descriptive
statistics were applied to relevant indicators to help support and identify future recommendations
on how best to measure the benefits of EIP for the organization.

38

CHAPTER FIVE, PRIMARY DATA ANALYSIS RESULTS
When looking solely at the average costs per FTE pre and post-EIP, the data appears to
support the hypothesis that early intervention has provided an effective means to managing
disability related costs for the Corporation. In Table 3 below, the $1536.54 pre-EIP cost value
was calculated by taking the total disability related cost for the organization for the year and
dividing it by the number of full time employees ($655,164.91/426.39 FTE’s = $1536.54/FTE).
The post-EDP cost was calculated in the same way ($564,236.33/421.69 FTE’s=$1338.03/FTE).
Table 3 below illustrates the results of these cost calculations:
Table 3
Pre and Post-EIP Average Costs
Fiscal Year
pre/post-EIP
(Apr 1-Mar 31)
pre-EIP
2008-2009
Implementation
Phase
post-EIP

TOTAL
COST/YEAR
$655,164.91

TOTAL # OF
FTE’s
426.39

AVERAGE
COST/FTE
$1536.54

2009-2010

$515,372.13

426.39

$1208.69

2010-2011

$ 564,236.33

421.69

$1338.03

The challenge with looking solely at disability related cost per FTE each year is that other
variables may have a direct impact on cost increases or decreases for the Corporation. The values
in Table 3 include all employees for the organization. Therefore, the cost includes employees
that may have not received any disability benefits which does not provide an accurate cost or
number of employees who received disability benefits. It is important to point out the time span
from pre-EIP and post-EIP is minimal and that the difference in PTEs is not significant but helps
when comparing pre and post-EIP cost to support the hypothesis by showing a savings of
$198.51 per FTE since the implementation of the EIP.

39

Tracking other key indicators such as age and disability type helped to further support
the hypothesis of whether EIP is an effective means of managing disability related costs for this
cooperation and provided baseline data of where the Corporation may want to focus in future
prevention efforts having a direct result of the identified cost savings. For example, through
collecting other key indicators from January 1, 2010 to December 31, 2011 the data identified
that there were a total of 95 employees who required short term disability assistance that resulted
in a cost to the organization. That is approximately 25 percent of the organizations employees
that received STD costs in as little as 15 months. While the disability claims for this organization
are high it is important to highlight that there was a 12.9 percent reduction in disability related
costs within the first 15 months of the EIP program.
Table 4
Measure ofAverage (Mean) Cost o f EIP and STD Cost Post-EIP
Mean/Std.Deviation
EIP Cost
Employees (n=95)
Mean
$1,340.40
Std. Deviation

$921.06

STD Cost
$5008.15
$5293.28

Table 4 provides the results and the average disability related costs for 95 out of 425
employees who may or may not had received EIP and/or STD costs but were known to be away
from work for longer than 6 days due to disability. Data points were only available post-EIP.
Table 4 is different than Table 3 as it shows the cost per 95 employees who may have been
referred to EIP and/or received STD and/or EIP benefits rather than an average cost across all
425 employees who may or may not have received or required disability benefits providing a
more accurate disability related cost per employee. The next table (Table 5) below is a
comparison of post-EIP cost with the average pre-EIP cost of $1536.54.

40

Table 5
Comparison o f the post-EIP Cost with the Average pre-EIP Cost Value
Cost
Std. Deviation
Std. Error Mean
Mean
Employees (n=19)
EIP

$1,340.4011

$921.06139

$211.30597

Table 5 illustrates data for 19 employees that were confirmed to have received EIP
benefits resulting in the ability to apply the one-sample t-test and a comparison of the mean postEIP cost to the average pre-EIP cost value of $1536.54. The one-sample t-test was not
significant, t (18) = 0.93, p = .366. The non-significant effect means that one cannot conclude
that the EIP reduced disability related costs for the organization. Cohen’s d test is an estimate of
the difference between two means expressed in standard deviation. The Cohen’s d test was
significant d=.21. For a one-tailed, one-sample t-test for a d effect size of .21, the post-hoc
power was .23. This means there was a 23% chance of finding a significant effect for the onesample t-test.
The following table (Table 6) below illustrates both the STD cost of those that accepted EIP and
those that declined EIP.
Table 6
Comparison o f Average Cost (Mean) o f Employees Who Accepted EIP and Those Who Did Not
Accepted EIP Cost
EIP
STD Cost
STD Std. Deviation
Referral
Std. Deviation
Employees (n=19)
Yes
No

$1,361.29
$797.68

$946.03
$246.94

$8313.91
$8,455.91

$6,528.06
$2,911.98

An independent groups t-test was conducted to compare the EIP costs for individuals
who accepted referral into the program (N = 15) with the costs for individuals who did not accept
the EIP referral (N = 3). Levene’s test for equality of the group variances was conducted prior to

41

the t-test, and it was non-significant, F= 2.87, g = .11. The t-test for results for when equal
variances are assumed was non-significant, t (16) = 1.0,/> = .331. However, the variances were
clearly different ($946.03 versus $246.94), and Levene’s t-test was probably non-significant
because of the small sample sizes (15 versus 3). The t-test results for when equal variances were
not assumed was nevertheless also not significant, t (13.89) = 1.99, j> = .066.
Although independent group’s t-tests are known to be robust for small sample data sets, a
non-parametric test was also conducted to provide further confirmation of the above findings.
The Mann-Whitney U test for the EIP cost comparison of employees who did and who did not
accept referral was also non-significant, g = .314.
For a one-tailed, independent group’s t-test with a d effect size of 1.34, the post-hoc
power is.65. This corresponds to the value that was almost significant (p= .066). While the data
for the dependent variables is statistically non-significant, there are some notable observations.
EIP costs for those who refused EIP should not have shown a cost but a cost existed. STD costs
showed an increase for those that refused EIP compared to those that received EIP. The standard
deviation of cost was also greater for those that refused EIP. An explanation for this will be
covered later within the analysis.
In conclusion, the univariate strategy was applied in the collection of disability
management data as a way to show the challenges in data collection with EIP. The purpose of
analyzing the raw data was to determine whether the hypothesis that the EEP was an effective
means of managing disability related cost for the Corporation. Exploratory research was used to
identify the cost benefit using baseline data prior to the EIP to clearly define the intervention and
to operationalize and measure the effects of the EBP post implementation. The Levene’s test
provided us whether or not the data was an appropriate for the t-test. The One-Sample t-test was

42

used in testing the null hypothesis to measure each variable independently of the EIP post
implementation. While some of the results confirmed challenges with data collection. Some cost
savings in disability benefits were realized post-EIP and when combined with the data received
and the observations the hypothesis can still be considered supported and is explained in more
detail in the next chapters.

43

CHAPTER SIX, INTERPRETATION OF THE DATA
The opinion of the human resource consultant for the Corporation (2011), who was
responsible for collecting this data, strongly expressed that the data collection was extremely
rudimentary and believed to be an inefficient way to capture the data. Challenges in data
collection were due to having to input the data manually on an excel spreadsheet per employee
and the absence of a standardized system for capturing the different variables from a variety of
systems such as but not limited to STD and EIP costs.
Table 7
Missing values within the key indicators and variables (in Percentages)
Missing Data
RTW
EIP Cost
Referral

STD Cost

Employees (n=95)
% of Missing Data

57.9%

32.6%

80.0%

71.6%

Table 7 illustrates that four out of 9 key indicators had a high percentage of missing data
points that related to capturing EIP data for analysis.
Out o f425 employees 95 had been referred to EIP and received STD and/or EIP benefits
depending on whether or not they accepted the referral. The missing data here is showing that
while an employee may have been referred to EIP they had missing data points regarding RTW,
EIP costs, or STD costs. The challenge in data analysis is that the employee may have been
referred to EIP but did not have a return to work date, EIP costs may have not been entered or
STD costs were not available. Another example is that it may have not indicated that a referral
was made to EIP but yet there was an EIP cost associated with the employee. The purpose of
showing this is that a high percentage of missing data is consistent with the information that was
identified during the literature review and is one of the key challenges in determining the

44

benefits of EIP. It is also important to illustrate because STD costs from April 2011 to December
2011 were not completed in time for this analysis and accounts for 27 out of the 95 employees
that did not have an identified STD/EIP cost listed in this variable but it was known that they
were in receipt of either benefit.
Exclusive of this data were costs from other prevention programs such as the Employee
Assistance Program (EAP) and for employees who were ill and under the six consecutive day
mark. Following employees who may have a pattern of missing work but do not trigger the
referral process to EIP may be a key indicator of preventing further illness.
The challenge with collecting data on 9 different indicators and EIP costs variables is the
complexity and time it takes to retrieve the data that is tracked manually for each quarter within
the fiscal year. Without determining an easier and more comprehensive process for data
collection the results may actually prove not to be beneficial for an organization of this size.
However, should the hypothesis prove to be accurate any savings that are realized could
potentially be reinvested in a more sophisticated data base to efficiently and effectively capture
the data.
Overall the univariate strategy seems to support information in the literature where Dyck
(2006) and the American Institute of Medicine and National Research(2008) state that while
there is a variety of data collection techniques available, if more attention was drawn to collect
EIP data more methods on ways to evaluate disability programs would emerge. The lack of
standardization leaves organizations such as this Corporation with the inability to determine what
best practice is and what type of data is relevant to capture and measure a successful outcome.
Human Resources and Social Development Canada noted disability management
interventions have failed at times to obtain support of senior management despite impressive

45

returns on the investment due to expenditure reductions and accruals to programs other than
those that incur cost (Human Resources and Social Development Canada, 2007). If best
practices were followed, standardized nationwide and adhered to by all jurisdictions, the
effectiveness of EIP could be monitored, evaluated and documented for employers and
organizations such as this Corporation.
In a cohort study o f455 adults on long-term disability in the province of Quebec, Canada
it was determined that occupational factors influencing RTW differed by gender. Women’s risk
factors included older age, poor economic status, having dependents and working greater than or
equal to a 40 hour work week. In men the risk factor noted where above age 55, physical
workload and working greater than or equal to a 40 hour work week (Lederer, 2012).
Tracking the gender of those who accessed STD/EIP in this research proved to be
effective data to analyze as the univariate statistics showed minimal missing data. The data
analysis confirmed that 65.3% were female and 28.4% were male, 3.3% did not indicate gender.
This Corporation is more likely to have a higher ratio of female to male employees due to the
nature of more females employed within social services.
When the collection of employee gender data is combined with the data collected within
the age cohort this type of information proves to be invaluable. From the data we were able to
see that the majority of the Corporation’s employees accessing EIP/STD are within the 50-59
years old age cohort.
The age of employees are separated into five different cohorts in Figure 1 below. The
largest age cohort that accessed disability benefits was between the ages of 50-59 years of age.

46

50
45
40
35

-a 30

§ 25

U 20

15
10

5

0
20-29

30-39

40-49
50-59
Age Cohort

60-69

Figure 1. Histogram of the age cohort.
This figure illustrates the highest and lowest age cohort within the sample. The total
number of employees in each age cohort for the entire Corporation was not available for
comparison purposes at the time of this analysis therefore there is potential for a non-response
bias to occur when analyzing this data. It is important to reiterate that without knowing the
percentage of employees within this age cohort for the whole organization this conclusion maybe
misleading without further data to confirm. The reason it is misleading is that the numbers did
not include the total number of employees for the Corporation. It only identified the gender and
age of the 95 employees within the sample that accessed disability benefits post-EIP. The
information does indicate the need to further review the organization’s EIP to ensure early
intervention strategies are gender and age sensitive to enhance the overall benefit. It also
indicates the importance of gathering future data on gender and age of employees for the whole
organization to determine and compare if disability intervention strategies need to be more
concentrated to a specific age cohort. The fact that the age cohort and the gender cohort had

47

limited missing data indicates that there was not a challenge on collecting this data compared to
the other variables.
The EIP for this crown corporation is voluntary for employees. The process by which the
employees accept or decline EIP is through the contact of the HR consultant receiving a doctor’s
note after an employee has been off sick for more than 6 consecutive days and determining
whether EIP referral is appropriate. The employee is then contacted via phone by the HR
consultant. The histogram in Figure 2 shows a negatively skewed distribution in the referral to
the EIP data.

I.

Figure 2. Histogram of referrals post-EIP.
There is a negatively skewed data distribution by -.557 in regards to the referrals to EIP
throughout the 15 months. While the distribution of referrals is negatively skewed it indicates
that overall the total number of referrals dates captured in the data was 40 (N=40) out of 95
employees. This means that 55 employees were missing referral dates in the data. This helps to

48

show whether there are certain months in which there were more referrals than others helping the
Corporation to see if there is a trend overtime and future analysis required.
A negative distribution indicates that the referral process has been established. The data
also showed that the peak times for referrals where in April and July o f2011/2012. When the
numbers from 2010 to 2011 are compared, it showed a greater number of referrals overall in
2011. This was expected as the program was not fully implemented until January 2010. A
consistent referral process over time will benefit the data in regards to an increase of employees
being referred and tracked and can eventually be compared with those that declined EIP.
Due to the referral to EIP data revealing that the total number of statistically relevant
referrals was 18 out of 95 employees’ leads to further questions to determine whether or not the
number of employees accepted or declined EIP was accurate. The large number of entries with
no data in the Accepted Referral Cohort indicates the need for further review and assessment of
the referral methods and tracking of information for the Corporation. It is possible that this
missing information from the raw data within the excel spreadsheet may have had a different
meaning in regards to data collection rather than what was determined at time of the analysis
research.
The types of primary disability data tracked showed that 57.9% of the disabilities were
related to the ‘other’ category (i.e. chronic illnesses, rheumatoid arthritis, chronic fatigue )
supporting similar literature reviewed that chronic illness makes up for 87% of disease in Canada
(Centre for Chronic Disease Prevention and Control,2008).

49

Figure 3. Primary disability types.
This figure illustrates the different types of disabilities for employees that accessed some
sort of disability benefit post-EIP. The overall collection of data and breakdown for primary
disability type proved to be effective by capturing data for each disability type. Disability type
was categorized into 4 different types resulting in the following:
1. 14.7% of the employees had disabilities related to mental health. The Mental Health
category included health issues related to depression, anxiety, poor judgment, not sleeping and
bi-polar.
2. 6.3 % of the employees had disabilities related to musculoskeletal injuries that
included health issue related to strains/sprains to joint, back pain and soft tissue damage.
3. 57.9% of the employees had disabilities within the “other” category that included
health issues related to chronic illness such as rheumatoid arthritis, chronic fatigue, sleep apnea.
It also included conditions such as stroke, cardiac issues, cold and flu. This category accounts for
a variety of disability types in order to protect the identity and privacy of the individuals.

50

4. 20% of the employees had temporary disabilities related to surgical procedures mainly
due to the time required to receive surgery and/or post-surgery recovery.
5. 1.1 % of the employees were not listed within any category.
The employees that were captured in these numbers were employees that had been off
work for more the 6 consecutive days. The need for this type of data is helpful to determine
future prevention needs or accommodation requirements that may be needed. For example, if
there was a high number of musculoskeletal injury the organization may want to look at the
workstation ergonomics.
Saint-Cyr (2007) indicates that it is estimated that worker disabilities cost Canadian
employers a total that ranges from $10 to $20 billion dollars per year. In addition, absences due
to disability or illness are among the most challenging human resource situations facing
employers.
An example of cost benefits of early intervention was a study completed for early
intervention on individuals with rheumatoid arthritis (RA). According to the most objective
measures of RA progression, very early intervention proves to be cost-effective. The cost-effectiveness of
very early intervention was the result of drug treatment that reduced the progression of joint erosions and
subsequent functional disability and found that both early intervention strategies increased qualityadjusted life and saved long-term disability costs (Dowd, 2010).
Collecting information on disability type is what helps to provide the argument and
reasoning on how EIP benefit the recovery of injured or ill personnel. It also helps employers
assist injured and ill workers to stay at work or return to productive and safe employment as soon
as physically possible (Saint-Cyr, 2007).
While STD costs and EIP costs for each disability type were tracked separately it was
still difficult to determine using the one sample t-test as to whether the EIP proved to be

51

economically beneficial to the organization as the statistical results were insignificant. Both STD
cost and EIP (Figure 4 & 5) showed positively skewed histograms indicating the data could not
be used to determine whether EIP was cost effective or not.
The following histogram is the range in costs for those employees that accessed STD.

SO-QO

KflOQM

Figure 4. Histogram of STD costs.
This figure demonstrates that out of 27 employees who received STD the mean cost was
$5,008.16 per employee. Within these 27 employees the lowest cost was $92.06 with the highest
cost per employee being $ 17,295.11 creating a standard deviation of $5,293.23. The data
indicated that 68 (28.4%) employees had missing variables in regards to the cost of STD. With
the distribution being positively skewed this histogram indicates that further analysis through
non-parametric testing is required to determine if the mean cost can be used as an appropriate
measure of cost.

52

The next figure is different than Figure 4 as it is showing the costs for each employee that
accessed EIP.

KOO

JIOOOOO

*2,00000

S3.00000

S400000

Figure 5. Costs for those that accepted EDP.
Comparatively EIP costs for 19 employees (N=l 9) showed a mean cost of $ 1340.40 per
employee. The lowest cost was $75.00 per employee and the highest cost was $3,178.93 per
employee creating a standard deviation of $921.06. Again the histogram above shows a
positively skewed distribution indicating the need to apply further analysis through nonparametric testing to determine if the mean can be used as an appropriate measure of cost.
This may be due to the fact that even though an employee is referred to EDP there are still
both STD and EIP costs associated with an employee. In addition, the fact that STD costs from
April 2011 to December 2011 were not completed in time for this analysis and made up for 27
out of the 95 cases that did not have an identified cost also needs to be taken into consideration
of this analysis.

53

While the data separates the EIP cost from STD cost it is impossible to show through this
specific measure whether the investment of EIP costs are directly correlated to the reduction of
cost per employee without further long-term economic evaluation. Review of existing literature
in regards to cost effectiveness of programs such as this showed that the study of economic
impacts is underdeveloped and lacking within existing literature (Tompa, 2009).
Tompa (2009) found that challenges in regards to undertaking economic evaluations are
due to reasons such as policy and labour legislation, substantial difference in the perception of
health risks, burden of costs and consequences for different stakeholders and the lack of one
measure to accurately capture the cost of work related disability. Due to the small sample size,
data collection challenges and the fact that this EIP program has only been running for 15
months the validity and measure of the cost data in isolation is not strong enough to show that
the EIP was due to the reduction in disability related to costs the organization. What this does
signify is the importance of tracking the data, improving data collection and identifying a
measure to accurately capture the costs and impacts of the EBP.
The RTW histogram (Figure 6) on the next page shows a normal distribution in regards
to return to work.

54

12-

JUC1Q010

J«W01/2011

JUC1/2011

MnOtOM2

Figure 6. Histogram of employees who returned to work post-EEP.
The return to work dates tracked show a normal distribution in the histogram showing
that 64 (N=64) out of 95employees had return to work dates. The remaining 31 employees did
not have return to work dates reflected in the data. The mean of March 10, 2011 indicates the
average return to work date for 64 out of the 95 employees with a standard deviation of 184.07
days before or after Mar 10, 2011.
The data confirmed that 64 out of the 95 had returned to work. This showed a 67% return
to work rate. The remaining 31 employees did not have return to work dates reflected in the data
which indicates they may still be off work or the data was missing. Solid RTW to data is key into
measuring the success of EIP overtime. It is necessary as overtime the measurement of RTW and
whether an employee returns to work sooner when enrolled in EIP or not will help to determine
the benefits of EDP overall.

55

In conclusion the limitation of data and data entry challenges were primarily due to the
manual tracking of the information on a quarterly basis as well as a lack of capacity for an
employee to do data entry in real time. In future, the recommendation would be to have one
person complete the data entry in real-time utilizing a statistical program that is developed to
automatically compute the measurements and statistics required. One suggestion would be to
have the contracted OHS nurse complete the data rather than the HR consultant.
Programs such as Microsoft Access or IBM SPSS are pieces of software developed to
track such data. Utilizing the CBDMA too would be ideal as the measures and tools have
already been developed and found to be effective and statistically significant. While training
would be required the CBDMA also has built in help support when difficulties occur.
Another challenge with the data was the time span in which the study was conducted.
Using the first year post EIP data studied over a longer period of time such as 5 years would
allow the challenges in data collection to be resolved and refined as well as provide a more valid
baseline to compare and determine if the EIP is an effective way of managing disability related
cost for the organization.

56

CHAPTER SEVEN, CONCLUSION AND RECOMMENDATIONS
The three objectives of the study were to determine:
1) Whether the information collected supported the hypothesis that the EIP is an effective way
to manage disability related costs for the organization.
2) To assess data quality and;
3) Provide recommendation to the Corporation on how best to measure its return on investment
of the EIP.
The costs pre and post-EEP showed a cost saving of $ 198.51 per FTE in the first year
post-EIP. This is a notable 12.9% drop in cost and therefore cannot be left to the probability of
chance. The cost to implementing the EIP was minimal to the organization that invested $5,000
for job demand analysis and acquired an OHS nurse on a contractual as needed basis. There was
no increased cost incurred to the rehabilitation committee. While the EIP and STD costs were
positively skewed and cannot be used to prove the cost savings over the last 15 months there are
additional costs that may have impacted the data that were not included within the research. For
example, inflation and the introduction of HST where not factored into this study. The data
collection itself had been defined as rudimentary and challenging. There was no element of
coverage error included within the study yet looking at each variable through a univariate
strategy identified challenges and successes along with valuable information to formalize further
enhancements and improvements to the program. Therefore, combined with the numerous
independent key indicators and the overall cost saving at this time the research has shown that
EDP is in fact an effective way to manage disability related costs for the organization overall.
The researcher has concluded this because without tracking basic cost data, the
Corporation would not be aware that $564,236.33 year is being spent on almost a quarter of its

57

employees accessing some type of disability benefit. Overall through measurement o f 9 key
indicators this research study was able to identify and categorize the information providing the
Corporation with areas to address challenges in the future such as gathering age cohort data for
the whole organization and possibly shaping the EIP to concentrate and address the disability
related needs of a specific group in order to further reduce the costs and improve staff wellness
over time.
The strengths of this research was the Corporation’s joint work with the union in advance
of its development and implementation of the EBP, the tracking and identifying of multiple
indicators from the inception of the program, and developing an EBP that is consistent with best
practice. Overall the ability to obtain and analyze this type of data even with the challenges of
data collection is useful and provides a better understanding of where improvements and
enhancements are required from the beginning rather than finding this information years
afterwards. It has also provided a solid baseline to evaluate the program over time and assist with
identifying trends within each indicator and the variable of cost.
The potential weakness within this research is that limited historical data was available
to be used as a baseline to determine disability related cost prior to implementation of the EIP.
The data collected prior to the EIP was not detailed and only pertained to average cost per
employee. In addition, due to the introduction of the new program, initial costs may have been
skewed with the results showing higher costs and limited cost savings. Inflation, introduction of
the harmonized sales tax during this time span may also have an indirect affect showing cost
savings.
To gain a more holistic analysis of the benefits of the program including the EAP
referrals as well as tracking data of employees under the six consecutive day mark would assist

58

in further managing disability related costs. Having a survey of employees who have
participated in the program would also add to the ability to assess the quality of the service and
provide more information in regards to the referral process.
This research has shown that while early intervention is an effective way to manage
disability related costs for an organization, overall there are challenges that exist with showing
and identifying the benefits for organizations. Tracking of information is cumbersome if there is
no system in place. Further, the lack of nationally standardized common tools or recommended
systems to capture the data easily or efficiently in a cost effective manner add additional
challenges.
Dyck (2006) points out that very often, disability management programs and other
company programs such as EAP, Occupational Health and Safety (OHS) along with Human
Resource departments function independently in “silos” (Dyck, 2006). In regards to the analysis
of this Corporation, this may contribute to the challenge in data collection as the programs are
not integrated. EAP and OHS are contracted out to third parties. Further, the Human Resource
Consultant is responsible for gathering data and monitoring the EBP, but this responsibility is
only one of many other human resource responsibilities for the organization.
As Dyck points out (2006), EAP professionals can assist employees by focusing on
attendance prior to EBP referral. When EAP, OHS, Human Resources and disability management
consultants work together, Dyck (2006) believes that synergies can be realized. For example,
knowing and understanding common problems identified within the EAP program may assist in
realizing further prevention needs for the Corporation.
The analysis of the EIP showed that 57.9% of the disabilities types accessing STD/EIP
where categorized under ‘other’ which is inclusive o f chronic illness’s such as cardio vascular

59

disease, cancer, chronic respiratory disease and diabetes. Breaking chronic illness categories
down further may prove helpful to understand and effectively expand resources available under
the EIP.
The Centre for Chronic Disease Prevention and Control (CCDPC) estimates that 87% of
disabilities in Canada are chronic disease related (2008). Chronic disease is an ongoing
condition that affects an individual’s health over a long period of time and possibly the entirety
of a person’s life. Most often there is no cure. However, if taken seriously chronic disease can
be managed to obtain the best health outcome as possible (American Academy of Family
Physicians, 2008).
The top 6 chronic illnesses in Canada listed in one year by the CCDPC (2008) and
number of people that experience these types illnesses in one year are as follows:
Cardiovascular Disease

32,072

Cancer

26,904

Chronic Respiratory Disease

5,285

Diabetes

2,816

Mental Disorders

2,513

Musculoskeletal Diseases

586

Note that mental disorders and musculoskeletal disease are listed as chronic illness and
are already separated out in the data collected for the Corporation’s EIP. Through combining
EAP and OHS stats these programs can assist employees through supporting self-management
strategies with employees who suffer from chronic illness prior to and post EIP. This has the
potential to further reduce the amount of time required to work with these employees as well as
reduce the need for STD/EIP. Improved health outcomes have a direct effect on a successful

60

RTW of the employee or maintaining the employee at work. However, in order to do this,
identifying a pattern of sick time prior to the EIP would have to occur and contact with the
employee prior to the consecutive 6 days off would require agreement with the Union and have
to be established of what is reasonable and when to approach the employee.
The integration of the OHS, EAP and human resource consultant may prove to be
beneficial to this organization. In addition each stakeholder in the process needs to commit and
promote employee wellness which is not mentioned in the EIP program roles. Overtime if the
existing cost savings continues to be achieved for this organization the savings could be re­
invested to an integrated model and into overall wellness that has a potential to create more
savings.
Dyck (2006) found that organizations tend to view this focus on preventive resources as
energies spent on “failure costs”. Yet research has shown that companies that focus on
prevention activities experience lower “failure” costs. A study conducted by AON consulting in
1999 showed that high performance leadership, communication, support of work-life balance
help to avoid workplace ‘failures’. Through approaching health as an investment rather than a
cost, savings are sure to be realized (Dyck, 2006).
Finally through the integration of the program and multiple systems of tracking data, it
can become more efficient and effective through having the ability to develop a single system to
collect data. It would provide for the opportunity to undertake for a true economic evaluation
methodology and reduce the impractical limitations of data collection. Integration would
provide the Union and Employers with a better understanding of the disability related needs of
employees resulting in better employee health outcomes. Integration would also enhance a

61

business positive work culture through the ability to assess the projected impact of future costs,
organizational resilience, employee morale and corporate culture (Dyck, 2009).
Nicholson (2006) and Dyck (2006) believe, “that to make smart health
investments, a company needs to know the financial impact of both health programs and
benefits” (pg.145). The majority of evidence based research on disability programs aside from
EIP focuses on the cost effectiveness of the program. Large Government and Non-Government
organizations are motivated and more interested in disability management programs due to the
potential cost savings of implementing such a program. It is therefore crucial that both disability
management professionals and collective bargaining representatives have a knowledge base and
understanding of each other’s roles and responsibilities. Once disability management
professionals are more informed in regards to collective bargaining they will be in a better
position to facilitate a relationship with collective bargaining representatives and utilize their
skills to move disability management to the forefront. As a result, collective bargaining
representatives will be more aware and understand the effectiveness and cost saving benefits of
disability management programs and will be able to communicate this to management during the
bargaining process. In addition, it will provide information that could reduce the majority o f the
attitudinal postures around the issues of “duty to accommodate” and disability management as a
whole. Through strengthening these partnerships and creating an understanding of disability
management policies and standards, key elements such as “duty to accommodate” have a better
chance of being incorporated into collective bargaining agreements. This would result in
providing employers and employees with a common understanding and preventing many human
rights legislation violations of employers and overall further increase the goal of inclusion of
employees with disabilities.

62

Through collecting data and measuring the outcomes of the Corporation’s EIP, this
research has shown by example the benefits of having clear measureable benchmarks at the
outset of the program and the benefits of having labour, management and union acceptance. The
financial value of the program was also determined by showing that early intervention is an
effective proactive component to disability management through ensuring early, ongoing case
management. The result of investing in EEP is a means to effectively managing the Corporation’s
disability related costs for its employees over the long term.
Given the current structure of the EIP and the limitation of the data collected, this
Corporation continues to be in the infancy stages of advancing its vision to effectively manage
the disability related costs of the organization. With continued investment and ongoing
assessment for this EIP, the disability management program as a whole for this Corporation will
eventually be leading the way for its employees and other like organization.

63

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