NOW, THERE ARE SIX PHASES OF  WORKSITE INFRASTRUCTURE  DEVELOPMENT THAT I'M 
GOING TO GO  THROUGH HERE RATHER QUICKLY.  THE FIRST PHASE WE ARE TALKING  
ABOUT ESTABLISHING THE INTERNAL  LEADERSHIP.  NOW, IN MANY CASES, WHEN I GET  
INVOLVED IN DEVELOPING  DISABILITY MANAGEMENT PROGRAMS,  AND I SPEND PROBABLY 
THE  MAJORITY OF MY TIME AT WORK  SITES, DEVELOPING THESE TYPES OF  PROGRAMS, 
ONE OF THE FIRST  THINGS I WILL DO IS TO DEVELOP A  JOINT LABOR MANAGEMENT 
RETURN TO  WORK COMMITTEE OR DISABILITY  MANAGEMENT COMMITTEE.  AND IF IT'S 
NOT A UNIONIZED  WORKSITE, THEN I CERTAINLY WANT  TO HAVE WORKER 
REPRESENTATION ON  THAT COMMITTEE.  WHY DO WE WANT TO DO THAT?  BECAUSE WE 
WANT TO HAVE THE  CHECKS AND BALANCES ON THAT  COMMITTEE THAT REFLECTS THE  
INTEREST OF BOTH LABOR AND  MANAGEMENT.  WE WANT TO ASSURE WORKERS THAT  
THEIR REPRESENTED IN THE PROCESS  OF DEVELOPING THESE TYPES OF PROGRAMS.  WE 
WANT TO PROMOTE THE MAXIMUM  UTILIZATION OF INTERNAL RESOURCES, AND 
OFTENTIMES LABOR  AND MANAGEMENT CAN WORK VERY  EFFECTIVELY TOGETHER TO  
ESTABLISH THESE RESOURCES.
   WE ALSO WANT TO ESTABLISH  CONTROL OVER EXTERNAL RESOURCES.  A BIG PART OF 
WHAT I DO IS TEACH  PEOPLE AT WORK SITES HOW TO HOLD  OTHER'S ACCOUNTABLE FOR 
WHAT THEY SAY THEY DO, INCLUDING PEOPLE WITHIN MY OWN  PROFESSION.  I WANT TO 
EMPOWER THE WORKSITE  THROUGH THE COMMITTEE TO MANAGE  THEIR OWN PROBLEMS AND 
THEIR OWN  DISABILITY MANAGEMENT PROGRAM.  WE WANT TO BUILD TRUST WITH  
WORKERS BY HAVING JOINT LABOR  MANAGEMENT REPRESENTATION.
   THE SECOND PHASE OF DEVELOPING A  PROGRAM IS TO ASSESS THAT  INDIVIDUAL 
WORKSITE'S NEEDS.  EVERY WORKSITE IS DISTINCTLY  DIFFERENT FROM THE NEXT.  
SOME WORK SITES HAVE MORE  PROBLEMS WITH BACK INJURIES.  SOME HAVE MORE 
PROBLEMS WITH  NONOCCUPATIONAL INJURIES AND  DISABILITIES.  FOR SOME, IT'S 
OLDER OR YOUNGER  WORKER PROBLEMS.  SO EVERY WORKSITE IS UNIQUELY  DIFFERENT.
   THEREFORE, WE HAVE TO GO THROUGH  AN AUDIT PROCESS WITH WORK SITES TO 
DETERMINE WHAT THE NEEDS AND  OPPORTUNITIES ARE.  AND THERE ARE A NUMBER OF 
FOCUS  AREAS THAT WE LOOK AT WHEN WE  DEVELOP PROGRAMS.  WE ANALYZE THE 
ROLES, THE  FUNCTIONS AND RESPONSIBILITIES  OF PEOPLE CURRENTLY AT THE  
WORKSITE AS RELATES TO MANAGING  INJURY AND DISABILITY.  WE LOOK AT 
COMMUNICATIONS, THE  INFORMATION NETWORKING THAT GOES  ON.  MOST WORK SITES 
ARE DOING SOME  THINGS VERY WELL.  HOWEVER, THERE  MAY BE GAPS IN TERMS OF 
HOW THEY  RESPOND FROM THE CONTINUUM OF  THE POINT OF INJURY ALL THE WAY  TO 
-- THROUGH RETURN TO WORK.  SOME WORK SITES HAVE -- THERE IS  PROBABLY NO 
WORKSITE I'VE EVER  WORKED WITH THAT HASN'T AT LEAST  TRIED SOME FORM OF A 
LIGHT DUTY  PROGRAM.  UNFORTUNATELY, MANY LIGHT DUTY  PROGRAMS FAIL.  AND WE 
SPEND MOST OF OUR TIME  TRYING TO FIX THOSE BROKEN LIGHT  DUTY PROGRAMS BY 
INSTALLING MORE  PROGRESSIVE TRANSITIONAL WORK  PROGRAMS AND MORE EFFECTIVE  
DISABILITY MANAGEMENT PROCESSES.
   WE HAVE TO IDENTIFY WHAT THE  LOST TIME, THE COST FACTORS ARE  FOR EACH 
INDIVIDUAL EMPLOYER.  IDENTIFYING THE STEPS FROM THE  POINT OF INJURY TO THE 
RETURN TO  WORK.  WE HAVE TO WORK WITH LABOR AND MANAGEMENT TO SUPPORT THE  
PROGRAM THROUGH LABOR MANAGEMENT  AGREEMENTS.
   WE CERTAINLY HAVE TO BE  SENSITIVE TO THOSE ISSUES THAT  ARE SO IMPORTANT 
TO LABOR.  THEY WORKED LONG AND HARD TO  DEVELOP THESE TYPES OF CONTRACTS  
AND THEY CERTAINLY HAVE THEIR  OWN SELF INTEREST.  ALTERNATE DUTY OPTIONS AND  
ACCOMMODATION, WE HAVE TO  DEVELOP THOSE TYPES OF PROCESSES  AS WELL.  AND A 
WHOLE HOST OF CONTROLS  THAT ARE BENCHMARKS TO SOME OF  THE BEST WORKSITE 
PROGRAMS IN  THE COUNTRY.  CONTROLS LIKE THE EARLY  INTERVENTION, ERGONOMICS, 
CASE  MANAGEMENT, HAVING RELATIONSHIPS  WITH MEDICAL TREATMENT PROVIDERS  IN 
THE COMMUNITY, HAVING THE  ACCOUNTABILITY, THE  RESPONSIBILITY AT THE 
WORKSITE  TO PROMOTE RETURN TO WORK  ACTIVITIES.  AND A WHOLE HOST OF OTHER 
TYPES  OF CONTROLS THAT ARE ESSENTIAL  TO EFFECTIVE DISABILITY  MANAGEMENT 
OUTCOMES.
   PHASE 3 IS WORKSITE EDUCATION.  WE NEED TO EDUCATE PEOPLE AT  WORK SITES, 
WE HAVE TO TRANSFER  THE KNOWLEDGE AND SKILLS AND THE TECHNOLOGY OF 
REHABILITATION TO  THE WORKSITE.  WE WANT TO EMPOWER EMPLOYERS TO  TAKE 
CHARGE, TO TAKE GREATER  CONTROL OF THE PROBLEMS THAT  EXIST.  WORKSITE 
INJURIES AND  DISABILITIES START AT THE  WORKSITE.  THE SOLUTIONS ARE AT THE  
WORKSITE TO THESE TYPES OF  PROBLEMS.  AND WE NEED TO ENCOURAGE AND  SUPPORT 
AND EDUCATE EMPLOYERS TO  HANDLE THESE TYPES OF ISSUES  THEMSELVES AS MUCH AS 
POSSIBLE AND TEACH THEM HOW TO UTILIZE  OUR RESOURCES AND REHABILITATION  
MORE EFFECTIVELY AND  EFFICIENTLY.
   WE HAVE TO DEVELOP GUIDELINES AS  TO HOW THE PROGRAMS WILL WORK.  WE OFTEN 
DEVELOP POLICIES AND  PROCEDURES, GUIDELINES,  OPERATIONAL GUIDELINES FOR THE  
DISABILITY MANAGEMENT PROGRAM.  WE HAVE TO ESTABLISH THE  PARAMETERS OF THE 
PROGRAM.  WHAT ARE THE ROLES AND FUNCTIONS  OF THE RETURN TO WORK COMMITTEE  
MEMBERS?  TRANSITIONAL WORK.  IF WE'RE GETTING WORKERS  INVOLVED IN 
TRANSITIONAL WORK  PROGRAMS, HOW DO WE DETERMINE  WHO WILL BE ELIGIBLE TO  
PARTICIPATE IN THE PROGRAMS?  WE HAVE TO IDENTIFY WHO IS MOST  LIKELY TO 
BENEFIT FROM THESE  TYPES OF PROGRAMS.  WE HAVE TO START THE PROCESS  
INTERNALLY, EARLY INTERVENTION.  WE HAVE TO START THE REFERRAL  PROCESS OF AN 
INJURED WORKER OR  DISABLED PERSON TO THE  DISABILITY MANAGEMENT PROCESS AS  
QUICKLY AS POSSIBLE.
   THE OPERATIONS OF THE PROGRAM  INCLUDE WORKER ASSESSMENT,  ANALYZING JOB, 
DEVELOPING  ACCOMMODATIONS, DEVELOPING JOB  BANKS, RETURN TO WORK PLANNING  
TYPES OF ACTIVITIES AT THE  WORKSITE.  WE HAVE TO DETERMINE THROUGH  POLICIES 
AND PROCEDURES WHO IS GOING TO MONITOR THE SAFE WORK  PERFORMANCE OF A WORKER 
WHILE THEY ARE INVOLVED IN A RETURN TO  WORK PROGRAM.  THE TIME PARAMETERS OF 
THE  PROGRAM ARE ESSENTIAL TO  DELINEATE AS WELL.  HOW LONG IS THE PROGRAM 
GOING TO  LAST?  HOW DO WE KNOW WHEN A WORKER HAS DONE AS WELL AS HE OR SHE 
CAN DO  AS A RESULT OF BEING IN THE  PROGRAM?  I TEND TO FAVOR 8 WEEK  
TRANSITIONAL WORK PROGRAMS,  BECAUSE WE FOUND HISTORICALLY  THAT MOST 
WORKERS, IF THEY HAVE THE RIGHT RESOURCES, ARE ENABLED  TO RETURN TO THEIR 
ORIGINAL JOBS  WITHIN 8 WEEKS.  WE MAKE EXCEPTIONS IF WORKERS ARE NOT ABLE TO 
MAKE THAT  TRANSITION IN 8 WEEKS, BUT THEY ARE DEMONSTRATING IMPROVEMENT.  WE 
WANT THE EMPLOYER TO STAY WITH THEM, TO CONTINUE  ENCOURAGING THEM AND 
WORKING  WITH THEM.
   WE HAVE TO HELP THE  EMPLOYERS DEVELOP THE FORMS,  COMMUNICATION TOOLS 
THAT THEY  NEED INTERNALLY AND EXTERNALLY.  THE RESPONSIBILITIES, WE HAVE TO  
DELEGATE RESPONSIBILITIES AT THE  WORKSITE TO SOMEONE WHO IS GOING  TO 
FUNCTION AS THAT INTERNAL  DISABILITY MANAGEMENT  COORDINATOR.  THAT IS A KEY 
PERSON AT THE  WORKSITE WHO IS A POINT PERSON FOR COMMUNICATIONS  WITH PEOPLE 
OUTSIDE THE WORKSITE AS WELL AS WITHIN.  THE CASE MANAGER, WHAT THEIR  ROLE 
IS AT THE WORKSITE, NOT TELEPHONIC CASE MANAGEMENT, TRYING TO DEAL WITH 
INJURED  WORKER PROBLEMS OVER THE PHONE  WITH A SUPERVISOR AND DOCTOR, BUT 
BEING AT THE WORKSITE,  INTERACTING WITH THE SUPERVISOR, LEARNING ABOUT THE 
JOB, INTERACTING WITH THE WORKER AND  COACHING THAT WORKER TO RETURN TO WORK.
   THE WORKER HAS RESPONSIBILITIES  IN RETURN-TO-WORK PROGRAMS.  THE 
SUPERVISOR IS A KEY PERSON  AT THE WORKSITE.  WE HAVE TO TRAIN THE WORKSITE  
SUPERVISOR, WE HAVE TO PROVIDE  THEM WITH THE KNOWLEDGE, THE SKILLS, THE 
SUPPORTS THAT THAT  SUPERVISOR NEEDS TO BRING ABOUT A SUCCESSFUL RETURN TO 
WORK.  THE PHYSICAL THERAPIST, OCCUPATIONAL THERAPIST THAT WILL  BE INVOLVED 
AT THE WORKSITE, THIS IS A MAJOR PARADIGM SHIFT FOR THERAPISTS THAT HAVE NOT 
BEEN  TRAINED TO WORK AT WORK SITES.  SO WE HAVE TO WORK WITH THESE  PEOPLE 
TO HELP THEM MAKE THAT TRANSITION TO DOING WHAT THEY DO AT THE WORKSITE.
   AND WE HAVE TO HAVE DISPUTE  RESOLUTION PROCESSES.  IF WORKERS ARE 
DISPLEASED WITH  THE PROGRAM THAT HAS BEEN  DESIGNED TO BE OF BENEFIT TO  
THEM, THERE NEED TO BE WAYS TO RESOLVE  THOSE ISSUES AND PROBLEMS HOPEFULLY 
INFORMALLY.
   PHASE 4.  THE INTERNAL AND EXTERNAL  COMMUNICATIONS OF GUIDELINES.  ONCE 
WE DEVELOP THE POLICIES AND  PROCEDURES AND GUIDELINES, THEY  NEED TO BE 
COMMUNICATED.  EVERYONE AT THE WORKSITE NEEDS  TO UNDERSTAND HOW THIS PROGRAM  
WORKS, WHAT THE BENEFITS ARE, THE PROCEDURES, WHAT EVERYONE'S  
RESPONSIBILITIES ARE AND SO FORTH.  THE EMPLOYER NEEDS TO  COMMUNICATE THESE 
POLICIES AND PROCEDURES TO THE WORKER  COMPENSATION SYSTEM, INSURANCE 
CARRIERS THAT ARE PROVIDING THEM  AS A CUSTOMER SERVICES, AND THE 
REHABILITATION PROFESSION AS  WELL.
   RESOURCE INTEGRATION, PHASE 5.  ONCE WE HAVE THE PROGRAM  DEVELOPED, WE 
HAVE TO IMPLEMENT  IT.  WE HAVE TO PILOT TEST IT.  WE RELY VERY HEAVILY ON 
THAT  INTERNAL DISABILITY MANAGEMENT  COORDINATOR TO FUNCTION AS A LIAISON 
BETWEEN A CASE MANAGER,  BETWEEN SA A SUPERVISOR, THE INJURED WORKER, HR 
PERSONNEL AND  OTHER PEOPLE THAT ARE STAKEHOLDERS IN THIS PROCESS.  THE 
DISABILITY MANAGEMENT COORDINATOR HAVE BEEN OFTEN IS  THE BEST PERSON TO 
ASSESS THE NEEDS OF THE WORKER IN RELATION  TO THE WORKSITE, TO ACTUALLY 
DEVELOP AND IMPLEMENT THAT  RETURN TO WORK PROGRAM, AND  AGAIN, SERVES AS A 
LIAISON AMONG  OTHER PEOPLE.
   AND FINALLY, IN PHASE 6, WE HAVE  TO EVALUATE THE EFFECTIVENESS OF  THE 
PROGRAM.  WE HAVE TO ANSWER THAT QUESTION.  IS THIS PROGRAM DOING WHAT IT  
HAS BEEN INTENDED TO DO?  AND HOW WELL DOES IT DO THAT?  AND IN WHAT WAYS CAN 
WE IMPROVE  THE PERFORMANCE OF THE  DISABILITY MANAGEMENT PROGRAM?
   OKAY.  THANK YOU.