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The goal of this blog is to provide useful information on every aspect of workplace health - from wellness and injury prevention through to rehabilitation and recovery at work.

Pre-Employment Health Assessments: Do they work?

Wednesday, February 01, 2017
Can best-practice pre-employment medical assessments be the basis of front-line risk assessment of your most vital asset; your people?

While the value of pre-employment medicals must be weighed against the cost incurred, the evidence reveals sound reasons for giving evidence-based practice serious consideration.
An evidence-based pre-employment medical programme can reduce the risk of injuries, improve safety and maximise productivity. However the latest research discourages a generic approach and suggests of job-specific medicals as the most effective strategy. 
It was estimated that in 2012/13 Australian businesses spent a staggering $8.4 billion on work related injuries alone. 

So we all know claims cost organisations, but do pre-employment medicals reduce the likelihood of claims? And if so, why? 

Let’s start with what the latest research suggests. In 2016 a Cochrane Intervention Review[1] drew the following conclusions: 

  • “Health examinations that focus on health risks involving particular jobs may be effective” 
  • “Adequately dealing with potential health risks by changing work tasks or physical fitness training may also be effective” 
  • “Need more and better quality evaluation studies” 

So it seems that the jury is still out as to whether pre-employment medicals predict occupational injury. This has been further re-enforced in high-performance sports teams where research on the success of using assessments to predict in-season injury risk is also debatable.[3] [4] [5]  

The focus of pre-employment practice has been to do functional assessments, but is this just a waste of money? 

According to the research, when you implement an effective pre-employment assessment program it needs to be job-specific. 

A key point of Cochrane’s Review was that non-specific pre-employment assessments have very little or no value for identifying injury predictability. In light of this it begs the question, why do companies get their prospective employees to undertake medicals or worse still, undertake them with the prospective employees’ chosen medical practitioner? (Yes this does still happen).   

Completing a job-specific pre-employment assessment supports compliance with Australian Human Rights Commission Act 1986 and state based Anti-Discrimination Acts, when making recruitment decisions, because it more accurately outlines whether or not a candidate is ‘fit to carry out the inherent requirements of the role’. Best practice pre-employment medical assessments are in fact the front-line risk assessment of your most vital asset; your people. An evidence based risk assessment report should detail any reasonable adjustments that would enable safe placement.
So is there more to pre-employment medicals than just functional screening? 

Actevate do not believe that inherent requirements should be solely focused on the physical aspects of the role. Instead they should take a biopsychosocial approach and include; 

  • Being able to perform both the functions and tasks necessary to achieving the job outcomes
  • Gaining insight into whether this person will be productive
  • Working to an appropriate quality standard
  • Ability to work with people whose jobs interact with theirs regardless of rank and position
  • Ability to work safely
  • Decision making and critical thinking ability[6] 

Actevate screens thousands of applicants nationally every year and we are proud to say that our customers have experienced a decrease in injury frequency, costs and duration of workplace injuries. We take pride in doing ourselves out of post-injury rehabilitation. We asked one of our long-standing customers from the Health and Community services sector to provide a two-year snapshot of their injury statistics. Compare the difference between their statistics and the industry standards in the table below:   

* SWA 2011/12 – Health and Community Services[7]  ** Industry-Specific Sector Benchmark Report[8]     

So what does this mean? Do pre-employment medicals actually reduce the risk of injury, protracted recovery and claims? 

It is our view that evidence based pre-employment, job-specific medicals serve to support claims mitigation through a combination of predicting, preventing and deterring. 

What is the deterrent effect? 

The process one goes through when completing a pre-employment assessment with a capable occupational health assessor includes obtaining relevant information of past injuries and physical and mental constraints. 
Building a biopsychosocial profile of the applicant enables us to establish markers that identify employment risk. It is hypothesized that prospective employees will recognise the factors identified by the assessor having a bearing in the lodgement, consideration of liability and bona-fides of a compensation claim.

In light of the current research into the predictive value of pre-employment medical assessments, it is our view that the real value of your investment is in the nature of the deterrent effect. So why not enhance the potential impact of the deterrent effect? The best way to do this is to reveal the findings of the forensic screening to your prospective employees in the form of a condition of their employment agreements. 

Actevate works collaboratively with many companies who understand the inherent value of the deterrent effect and builds strategies to execute on this. 

With an ageing workforce and policy changes to the retirement age, organisations will inherently take on greater human resource risks. Looking beyond the benefit of screening out high risk prospective employees, is the fact that if implemented correctly, pre-employment medical screening can provide relevant recommendations to improve a prospective employees’ productivity and safety at work. The Cochrane Study opined that implementing appropriate workplace management strategies has the ability to reduce ‘at risk’ employees with the resultant injury rate equalling that of low risk applicants. Some strategies you can implement to reduce ‘at risk’ employees include interventions such as manual handling training, strength conditioning and/or modification to job-design. 

Pre-employment assessment programs that provide robust workplace recommendations together with companies that take heed of these recommendations are likely to benefit significantly in the face of the emerging ageing workforce risk. In fact, ensuring the whole workforce is complying with strategies to maintain health and wellbeing as per their health assessment recommendations will have a significant impact on the prevention of injuries, productivity and culture within your organisation. 

So do pre-employment medicals work? 

A job-specific biopsychosocial pre-employment program that connects to your health, safety and wellbeing initiatives offers great potential to reduce injury rates, increase productivity and reinforce a culture of zero harm. This is done through identifying areas of weakness, screening out high risk applicants and providing management strategies for those that make it through to employment. 

-- Michael Baveas is General Manager at Actevate Pty Ltd

1. The Cost of Work-related Injury and Illness for Australian Employers, Workers and the Community 2012-13. Safe Work Australia;   
2. Schaafsma F, Mahmud N, Reneman MF, Fassier JB, Jungbauer FHW. Pre-employment examinations for preventing injury, disease and sick leave in workers (Review). Cochrane Database of Systematic Reviews 2016, Issue 1. [DOI: 10.1002/14651858.CD008881.pub2.]   
3. MHCC Mental Health Rights Manual; Chapter 7 Section C: Employment and Work.|C|1|3 
4. Dossa, K. et. al. 2014. Can injury in major junior hockey players be predicted by a pre-season functional movement screen – a prospective cohort study. J Can Chiropr Assoc 2014; 58(4)   
5. Bahr, R. 2016. Why screening tests to predict injury do not work—and probably never will…: a critical review. Br J Sports Med doi:10.1136/bjsports-2016-096256   
6. Chorba, RS. et. al. 2010. Use of a Functional Movement Screening Tool to Determine Injury Risk in Female Collegiate Athletes. N Am J Sports Phys Ther. 2010 Jun; 5(2): 47–54.   
7. National Disability Services (2015) Sector Report – 2014-2015 Work Health and Safety Benchmark Report.   
8. Safe Work Australia 2011/12 – Health and Community Services.

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