Getting Employee Back to Work | ReIntegrate

Follow-Up

Tilia Boussios — Mon, 06 Oct 2008 07:28:00 GMT

Many return to work processes run into difficulties or fail because of a lack of adequate and appropriate follow-up procedures when the individual returns to work. Some of the reasons for these problems include:

A Sense of Isolation on the Part of the Returnee: When the returnee goes back to work there is often a sense of fearfulness on the part of the returnee, the work colleagues and the supervisors they must deal with. This stems from a lack of knowledge about the nature of any impairment that the returnee might have and a lack of knowledge about the capabilities of the returnee. In addition, it is not possible to predict the future – very often neither the returnee nor management know how much work can be done by the returnee or the most appropriate working conditions suitable for the returnee. Often in these situations, a sense of politeness and a fear of raising the Return-to-Work issue can lead to a failure in communication between the returnee and the other stakeholders involved. Thus, the returnee can become further isolated as time passes.
Difficulties for Supervisors and Management in Deciding/Knowing the Appropriate Measures to Take: When problems arise in the Return-to-Work process, managers and supervisors may not have the knowledge base to understand the appropriate intervention. Those interventions which appear to be successful in the initial stages of Return-to-Work may not stand the test of time. If it becomes necessary to make changes to interventions, it is important that early warning signs of problems are dealt with by an individual with the expertise to resolve the problems.
Changes in the Health Status of the Returnees: Depending on the nature of the health impairment of the returnee, there may be changes in health status either for better or for worse, following his/her return to work. Both of which can lead to problems with the process. A change in health status may require changes in the range of measures which were taken to support the returnee in coming back to work. Equally, where there are improvements in health status, it is necessary to acknowledge this and to change the working conditions and work organization appropriately. Otherwise the returnee may become demotivated.
Attitude of Co-Workers: Co-workers who have not been adequately informed of the nature of the Return-to-Work process or of the nature of the impairments that the returnee suffers from, may hold inappropriate attitudes which will militate against successful return to work. Moreover, it is often the case that a person returning to work is unable to undertake as much work as before. This can lead to redistribution of the workload onto colleagues. This may also contribute to negative attitudes on their part.
Problems of On-the-Job Performance: Even the best managed return to work processes can run into problems with the amount of work the returnee is able to perform. While it may be recognized that they are able for less work than before, it may also be the case of that there is a variation in the amount of work which they are able to do. In addition, it may be the case that the demands and requirements of the job cannot be altered sufficiently to enable production to be maintained at a level which is required by the organization.
Too High Expectations Placed on the Returnee: A key factor in successful return to work is having a realistic view of what might be expected of the returnee. In some cases, the expectations on the returnee are too high. This will lead to a situation where communications may break down and the confidence of the returnee is seriously damaged, thereby threatening the success of the Return-to-Work process.
Too Low Expectations Placed on the Returnee: It can also be the case that the expectations placed on the returnee are too low. This can occur where there is a lack of knowledge about the capabilities of the person. From the returnees’ perspective, this can lead to feeling undervalued by the organization. They may also feel that it is a subtle way of easing them out of the workplace.
Inappropriate Work Accommodations or Assistive Technology: Though the design of work accommodations and assistive technologies is a relatively objective process and it can take time for the returnee to become familiar with these changes. In addition, it may be that the work accommodations and assistive technologies are less than optimal for the impairments that the returnee has. In situations like this it is important to reassess the needs of the individual.

The reasons for difficulties and failures of the Return-to-Work process are a combination of technical factors [e.g. problems with assistive technology or workplace accommodation], operational factors [e.g. actually performing the work in a productive way], management factors [lack of knowledge on the part of supervisors and managers] and social factors [e.g. negative attitudes by workmates or supervisors]. For a successful return to work process, it is therefore vital that progress continues to be monitored following an employee’s return to work.

The return to work coordinator has the responsibility of managing the follow-up procedures that are necessary. This involves contacting both the returnee and the supervisor or manager of the department where the returnee works on a regular and demand led basis. In addition, the Return-to-Work coordinator should have a plan and a schedule for engaging in follow-up activities.

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In general terms, the three most important elements of the follow-up process are:

Regular Monitoring: The Return-to-Work coordinator is responsible for developing a schedule of monitoring for individual returnees. This must be accepted by the returnee themselves, and by the main actors in the workplace with which they will interact. It should be sensitive to the health condition of the individual, the general needs and the needs of the employer.
The Availability of Support: Returning employees require support while re-adjusting back into the working environment. This support will help maintain his/her workability and will make the process of reintegration into the workplace smoother for all concerned.
Program Reviewing: The return to work programme should be reviewed frequently. Improvements will be made based upon feedback from workers, supervisors and service providers.

References

If you wish to read more about Follow-Up Procedures, you can access the Related Bibliography link on the right side of the screen.

Interventions

Tilia Boussios — Mon, 06 Oct 2008 07:27:00 GMT

One of the most challenging tasks of the person responsible for coordinating the return to work process is selecting the most appropriate interventions for the long-term absent employee.

Modified work is regarded by many as a cornerstone in the job rehabilitation process. Successful return to work programmes can depend on employer willingness to provide suitable duties to ill or injured workers with injuries who were either temporarily or permanently unable to perform their pre-injury/illness work duties.

Most employers experience difficulty in providing suitable duties to such workers. This can only be dealt with in the preparation phase before the launch of a return to work initiative to ensure that all relevant stakeholders such as worker representatives, management, supervisors, trade unions etc have agreed to the proposed return to work initiative.

A systematic review of the scientific literature on modified work published since 1975 found that injured workers, who are offered modified work, return to work about twice as often as those who are not. Similarly, modified work programs cut the number of lost work days in half. The available evidence also suggested that modified work programs are cost-effective.

However, there are many interventions that that can be made when a person has become ill or injured and is trying to return to work. Some of these can be initiated and/or carried out by the employer (e.g. providing technical aids) while some will need to be carried out by health professionals (e.g. a doctor would prescribe medication).

Interventions can generally be characterised under four headings:

Treatment
Condition Management
Capacity Building
Environmental support and accommodation

These are described in greater detail below.

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Treatment

Medication: Pharmaceutical courses of treatment prescribed by the employees medical advisors
Primary Health Care: Primary health care refers to the professional health care received in the community, usually from your GP or district health nurse. Primary health care covers a broad range of health services, including health education, disease prevention and screening.
Mental Health Services: Mental Health services are those health services aimed at people with mental heath difficulties (such as depression or anxiety) or those services aimed at improving the mental health of the general population. These services would include psychiatry services, counselling, mental health promotion etc.
Cognitive Behavioural Therapy (CBT): CBT uses a variety of techniques directed at three areas: cognition, behaviour and physiology, in order to help with emotional difficulties. The Cognitive Behavioural Therapist uses CBT to empower the client to generate cognitive and behavioural solutions to problematic aspects of his/her life.
Allied Health Services: Allied Health Professionals could be described as non-medical health professionals who are also involved in the prevention, treatment, or management of illness and the preservation of mental and physical well-being. They would include chiropractors, podiatrists, naturopaths, dieticians, dentists etc.

The interventions are the only ones that an employer cannot be directly involved in.

Condition Management [Condition Management is about enabling an ill or injured worker to better understand and manage their health condition, with a particular focus on their capacity to work]
- Self-monitoring
- Mediation
- Counselling
- Physical Exercise
- Diet and lifestyle
- Self-help groups
- Relaxation
- Cognitive Behavioural Therapy

An employer can facilitate some of the above interventions. E.g. by providing shower facilities for employees who want to cycle to work, by having healthy menu choices in the canteen or by providing areas where employees can relax on their breaks.

The next two type of interventions is where the employer can really become involved e.g by providing stress management training, re-training the employee, adjusting work conditions e.g. lowering noise levels for an employee by providing screens around their desk or increasing worker control over his or her work e.g. by allowing flexi-time.

Capacity Building
- Stress Management
- Coping skills
- Problem Solving
- Work conditioning [is concerned with the restoration of work-related functioning; it addresses issues such as flexibility, strength, endurance, coordination, etc ]
- Re-training
- Rehabilitation
Environmental support and accommodation
- Work Factors
  - Reduce Physical or Psycho-social Demands (e.g. less lifting or less meetings)
  - Adjust Work conditions (e.g. noise levels)
  - Adapt Work Organisation (e.g. altering sequence of tasks)
  - Provide Technical Aids (e.g keyboard designed to be used single-handedly)
  - Provide Transitional Work
  - Redeploy to another position in the company
  - Increase worker control over his or her work (e.g. time out)
  - Targeted Support through Mentoring, Job Coaching, Employee Assistance Programmes, Co-workers or the person’s supervisor
  - Changing workplace attitude and ethos (e.g. Disability Awareness Raising)
- Non-work Factors
  - Family advice and support
  - Empowering Friends and other Social Supports
  - Use of Community Facilities (e.g. local gym)

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The most relevant and useful toolkit to assist in the management of return to work, discovered during the research carried out as part of the Reintegrate Project, was the Get Back! Pack. This toolkit provides the person responsible for the return to work with a set of guidelines that includes:

An Employee's Guide and Checklist: This Guide and Checklist is designed to help employers respond when an employee develops a work disability. It is one of a pair, the other being for the employee. These form part of a pack, with further guidelines for disability service providers. The whole series is designed to help everyone work together to identify a satisfactory solution and strategy.
An Assessment Checklist for Service Providers: This Guide is for service providers carrying out employment assessments with an individual experiencing difficulties at work for one of the following reasons: Disability, ill-health or accident, An existing disability or health condition which has altered , Their working environment or conditions have changed, An assessment of equipment or environmental needs is required
A Case Management Guide for Service Providers: This guide is written for service providers and is concerned with good case management which is crucial to the success of a job retention service. Effective case management is also crucial to the success of an employer’s return to work programme and hence this guide is also informative for employers.
A Report Writing Guide: This guide offers a report writing model for service providers engaged in job retention case work. It details the types of information that may have to be gathered over time and suggests how these may be presented so that the whole file tells a clear story. It also focuses on how reports may be used. It is equally informative for an employer’s return to work system.
Disability Specific Guides (Stress related difficulties, Brain Injury, Muscular or skeletal impairment, Blind or Partially Sighted Employees): These guides were written for service providers (but are also relevant for employers) working with employees who are experiencing difficulties at work due the particular type of disability listed above. It indicates who can benefit from the service and the professional background needed for service provision. It also describes procedures for assessment, intervention and development of the return to work plan, and it lists relevant resources

Early Intervention

Tilia Boussios — Mon, 06 Oct 2008 07:26:00 GMT

Perhaps the most critical feature of a successful return to work practice relates to early intervention. This refers to the timing of interactions with the absentee and any other significant stakeholders in the Return-to-Work process.

Most people can understand intuitively that intervening early will increase the chances of successful Return-to-Work. But what exactly does this mean? How early is early? Does the definition of early intervention change according to the nature of the illness and the injury that the absent employee has? Other questions regard the definition of the intervention, who should undertake these interventions and who are the targets of these interventions.

Early intervention obviously refers to the time after an employee becomes absent. However, in some circumstances it can also be used to refer to the phase prior to return. Where there is good workplace health monitoring in place and regular workability assessments are made, it is possible to predict with some accuracy the employees who are most likely to become absent in the future.

In the case of early intervention prior to absence, staff health monitoring is a key element of preventing absence due to illness. Equally, good health and safety practice is also an early intervention at this time.

One practice which is particularly useful at this time is to assess the workability of staff. This is an approach which is being implemented in Finland with great success. Occupational health services undertake these assessments on a routine basis and then put in place interventions which are designed to improve health and workability and to prevent absence and disability from occurring. Easy-to-use and reliable methods are available for evaluating work ability or the need for maintenance activities. The methods used must measure known risk factors that predict poor health or loss of work ability, and which can be controlled by activities that maintain work ability.

For the rest of this module we will concentrate on interventions following absence.

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What does early intervention consist of?

Early intervention should take place within the context of a strong and well communicated return to work policy. The following activities are important in making early interventions:

Communication with the Employee: In the initial stages of absence, an early intervention involves communicating with the absent employee. The purpose of this communication is to acknowledge the absence, reassure the employee and understand the employee’s expectations with regard to return to work. It may be appropriate to find out more about the nature of the illness or injury which is causing their absence. These communications are generally undertaken by the Return-to-Work coordinator. Human resource management personnel may also be involved.
Communication with Professionals Involved and Treatment: Depending on the nature of the illness or injury which is causing the absence, there will be a need to communicate with the health care and other professionals who are involved in treatment and rehabilitation. The purpose of this communication is to establish the nature and severity of the employee’s impairment and to begin to develop a return to work plan. This communication process is best handled by the Return-to-Work coordinator, but will also involve the occupational health physician.
Communications Internal to the Organisation: There is also a need for communications within the organization. The aim of these indicators is to keep people informed as regards when the absentee might return, and the nature of the work that he/she would be able to undertake.
Planning for Return: This process involves the coordination of all the relevant stakeholders [the absentee treatment and rehabilitation services, human resource management and line management] in the development of a return to work plan. The aim of this plan is to enable a safe return to work. It will contain a number of elements – an assessment of the Work ability of the returnee; plans for Work organization changes; making available assistive technology if needed and plans for monitoring the returnee.

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When should early intervention take place?

Early intervention should not be confused with early return to work. Early intervention refers here to the communication processes and planning processes which take place before the absentee returns to work. Early return to work refers to enabling the absentee to come back to work in a safe, healthy and timely manner.

The figure below illustrates when early intervention and early return to work should occur:

Communications begin during the notification period for illness. This varies country to country according to national legislation, custom and practice, and is usually three days in duration. Whatever the length of this notification period, it is important to begin communication with the employee as soon as is feasible. This communication should be maintained throughout the entire recovery process and Return-to-Work process.

There is another set of activities which take place during the recovery period. These include communications with all of the stakeholders involved, and beginning the planning process for return to work.

Finally, when the employee returns to work it is important to maintain communications between the internal stakeholders of the enterprise and to implement the Return-to-Work plan in a flexible manner.

It is difficult to specify exactly when these activities should take place. It is a useful rule of thumb to say that they should take place as early as possible. However some flexibility is required depending on the circumstances of the absentee. If, for example, the absentee is incapable of communications in the early stages of absence, it is appropriate to communicate with the absentee’s family initially. Providing that the employee’s circumstances improve, communications with the employee directly may follow.

In addition, the nature of the illness will influence the length of the recovery phase. It is generally recognized that people with mental illnesses can often take longer to recover to sufficient working capacity, enabling them to return to work. Equally the length of the Return-to-Work phase will depend on the nature of the illness, the returnee themselves and other circumstances.

References

If you wish to read more about Early Intervention Procedures, you can access the Related Bibliography link on the right side of the screen.

Case Management

Tilia Boussios — Mon, 06 Oct 2008 07:26:00 GMT

What is a case manager?
A case manager is a rehabilitation professional who is trained the strategies and skills required to coordinate the reintegration process for an ill or injured individual, to help him or her to achieve a more productive and independent life and to mediate between the various vested interests in the process including the medical professionals, lawyers, employer, co-workers, family and the employee. They are generally an external resource person, who is hired by an organisation, normally the insurer, the legal practice or the employer, to coordinate the return to work process of the absent ill or injured worker.

When do they become involved?
Case managers become involved with clients at different phases of the disability process. Some people may have recently acquired an illness or injury. Others may have a developmental disability that as a result of a change in their circumstances is creating difficulties for them. Thus the case manager engages with the worker at whatever stage in the disability process that person is and co-ordinates appropriate interventions, supports and resources in order to get them back to work in as safe and as timely a manner as possible.

What does a case manager do?
A case manager co-ordinates appropriate environmental interventions and supports and mobilises personal resources in order to improve an ill or injured individual’s activity levels or to improve their levels of participation in society e.g. returning to work.

The ill or injured absent worker will most likely have an impairment of function (e.g. their leg does not function properly; they are depressed) and/or activity limitations (e.g. they cannot run; they cannot cope in a crowd). However the case manager focuses not only upon those personal factors but also upon the barriers and challenges created by the external environment. The environment can be a source of inhibiting factors that can work against a person achieving their full potential. Therefore, the case manager must try to find solutions to these factors and facilitate the worker in overcoming these challenges. The case manager can harness important external resources that are available, such as assistive technology and training in order to help in the return to work process.

The case manager, once they have taken account of all the personal and environmental factors that are relevant to an individual trying to get back to work, needs to develop an intervention plan. An intervention plan is a document that provides suggested solutions or actions to the identified needs of an individual. The plan should build on what a person ‘can do’.

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When creating an intervention plan, the case manager has to ensure that the person is placed at the centre of the process. They can do this by:

Actively involving the worker in the return to work process,
Providing the absent individual with accurate and accessible information about their strengths and weaknesses,
Assisting them in problem solving, decision making and life planning in so far as they are capable,
Adopting an holistic approach (An holistic approach does not just look at the physical injury or illness of the person, but views the factors that effect the person as a whole, e.g. emotional wellbeing and attitudes in society (external factor).) to identifying the individual’s needs,
Ensuring the intervention plan provides solutions to those identified needs, building on what a person ‘can do’,
Continually feeding back to the individual the outcome of assessments and interventions.

The case manager also needs to take a multi-disciplinary approach, that is, they need to liaise with various different people involved in achieving a positive outcome for the ill or injured person. This could be various professionals e.g. a physiotherapist or G.P., the family of the individual, or the employer.

A final essential ingredient is that the case manager adopts a comprehensive approach. While it is important that appropriate interventions are provided to respond to the physical/functional needs of the individual and to ensure that they achieve a maximum restoration of function and experience minimal activity limitation, the case manager must consider a number of other contextual items.

In particular, the case manager needs to evaluate the following contexts:

Other Personal: (e.g. financial and economic situation within which the person finds himself or herself post injury, the individual’s attitude)
Environmental: (e.g. availability of accessible transportation, availability of grants for the employer)
Social: (e.g. the support networks provided by family and friends)
Occupational: (e.g. job demands, culture of organisation)

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The case manager needs to overcome a range of contextual constraints in order to achieve a successful return to work for the ill or injured absent worker. Some of these challenges are described below.

The Purchaser: A wide range of organisations, companies and agencies can purchase the services of a case manager. Insurers, defendant lawyers and personal injury lawyers may all decide for a variety of reasons to contract case management services. Statutory insurers are also beginning to adopt the case management approach. Individual employers and employment services are also potential purchasers. Each of these will have a variety of reasons for contracting a case manager. In some cases it may be seen as a way to reduce claims for compensation, in other cases case management is a service provided to clients by an insurer, in other cases it may be about preventing social exclusion and promoting return to work. Whatever the needs and values of the purchaser, the case manager is in a position that requires them to balance the needs of the individual and the purchaser.
The Disability Process: The stage at which the case manager becomes involved with a client will also place constraints on the type of activities that can be included within a case management plan. For example, case management is often applied at an early stage after an acquired injury or illness with a view to minimising an individual’s activity limitations and returning an employee to work. On the other hand, case management can be mobilised for someone who has a longstanding impairment, which is, as a result of changing circumstances, impacting on their participation.
The Status of the Claim: Whether an individual is involved in litigation is a critical constraint on the role of the case management plan. If there is no claim, or if the case manager is working in a situation where ‘no fault’ insurance is in place, the main focus of the case manager is unambiguous and easily defined i.e. getting the employee back to work in a timely and safe manner. It is only where the claim for compensation is in process that the case manager has the added burden of balancing the ill/injured individual and other interests in the case management process. If the claim and liability is undisputed then the task is less complex. However, where a claim is contested, the role of the case manager can become significantly constrained.
Systems Values and Approach: The legal and regulatory framework of a particular country will also impact significantly on the flexibility with which the case manager can operate. In some ways, Ireland and the UK are unique in the adoption of an adversarial system to establishing appropriate compensation for a workplace illness or injury. In other jurisdictions, a ‘no fault’ approach has been in operation for many years for example within the Dutch system, where responsibility lies firmly with employers to compensate a worker.
Level of Customer Knowledge: A major constraint on case managers in developing effective intervention plans is the extent to which the purchaser has knowledge and awareness of the potential impact of such plans and the degree to which they are able to judge between alternative products or services. Across Europe, it would be fair to say that case management is at a relatively early stage of evolution and effort is required to raise awareness amongst employers of the potential benefits of case management.
Level of Fragmentation/Availability within the Provider Network: A skilled and knowledgeable case manager will have identified a range of needs and challenges to be overcome by the individual in order to achieve a more productive and independent life. In jurisdictions where case management is an emerging profession and where rehabilitation services have been traditionally centre based rather than community based, it can be difficult to identify appropriate, high quality and experienced providers.

Assessing the Threshold

Tilia Boussios — Mon, 06 Oct 2008 07:25:00 GMT

One way of characterising the multiple and complex factors that are operating when a person exits the workplace to long-term absence and when he or she attempts to return to work is to view the factors, as constituting a threshold made up of:

Personal Factors: Include factors such as:
* The nature of the illness: workers with chronic illness are more likely to become long-term absent (as compared to acute illness ),
* Age: older workers are more likely to cross the threshold to absence due to illness,
* Educational level,
* Gender: women are more likely than men to remain out of work as a result of long-term absence, and
* The motivation of the individual.
Workplace Factors: Include factors such as:
* The presence of policies for retention and reintegration,
* The presence of supportive services such as OSH,
* Disability management policies and procedures,
* The nature of the job e.g physical and psychosocial demands,
* The attitudes of management, supervisors and co-workers,
* The availability of training and retraining,and
* The availability of alternative work.

All the above contribute to increasing the likelihood that an ill or injured worker will be retained in work. Conversely, the absence of such factors in a workplace lowers the absence threshold and raises the return to work threshold.

External Factors - Non-Work and System Factors: Includes two different types of factors as follows:
Non-work factors, such as:
* Personal and social circumstances of the worker,
* Financial circumstances of worker,
* Caring responsibilities,
Systems factors, such as:
* Important services including:
o Rehabilitation services,
o Training and retraining services,
o Disability management services.
o Welfare services and benefits systems.

A key issue concerns the level of co-ordination between these services and the strength of the relationship that such mechanisms have with the workplace.

Public policy in the areas of retention and reintegration. Relevant policy areas include:

Social insurance
Equality
Social inclusion
Vocational training
Levels of benefits and the accessibility of benefits to the ill or injured worker

A key question for policy level responses is the extent to which they actually focus upon the retention and reintegration of chronically ill or disabled workers. In many instances, public policy has confusing and conflicting objectives, for example, where benefits may be seen solely as income replacement measures rather than as a means to provide resources for reintegration.

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The diagram below illustrates how the different factors act as inhibitors or enhancers to an individual’s decision to go absent (The Absence Threshold) or to return to work (The Reintegration Threshold). The factors are shown in general terms on the right hand side of the diagram and the various outcomes that can occur are illustrated at the bottom of the diagram.

Figure 1: The Threshold Model

One of the first steps towards developing a relevant effective return to work plan for an individual, is to assess the individual’s return to work threshold. This would be kick started by compiling a list of all the relevant personal, workplace and external (non-work and systems) factors. This would then be used to produce the Back to Work Threshold Specification, which would include a list of inhibitors and enhancers, effecting the individual’s decision to return to work.

A Back to Work Intervention Plan for the individual can then be drawn up, to tackle the inhibiting factors and to draw on the enhancing factors, in order to facilitate a timely and safe return to work for the individual. This process is illustrated below.

Figure 2: Return to Work Threshold

References

If you wish to read more about Assessing the Threshold Processes, you can access the Related Bibliography link on the right side of the screen.

Additionally, a more detailed description of the return to work threshold is provided in the Reintegrate RTW Threshold Framework. It was compiled as part of the development of the training content with the aim of providing a practical guide to reviewing the challenges facing an absent worker.

Maintaining Workability

Tilia Boussios — Mon, 06 Oct 2008 07:24:00 GMT

In essence, the approach taken to managing the reintegration process for an absent employee should be similar to the management of any other personnel issue in the organisation. It should involve policy, planning, resourcing and monitoring actions. Following this course of action enables the return to work programme not only to achieve maximum effectiveness but it also to enables its effectiveness to be demonstrated.

In terms of getting the long-term absent employee back to work there are a number of steps in the process. These are:

Maintaining Workability
Assessing the Return to Work Threshold
Early Intervention
Case Management
Interventions
Follow Up

The first of these, Maintaining Workability is described in this section. For information on the other steps please refer to the relevant sections on the e-learning environment.

What is Maintaining Workability?

The Maintaining Workability (or maintaining an individual’s ability to work) concept was originally developed in Finland (see Ilmarinen and Louhevaara, 1999). It is concerned with ensuring that employees have the good health and job related skills necessary to undertake work in a health conducive environment.

The concept was developed in response to evidence that workers who had low levels of work ability (or low ability to work) were much more likely to become long term absent from work. In Finland, there were high rates of long term absence throughout the 1980’s and 1990’s and the Maintenance of Work Ability programme was developed as a direct response to this situation.

There is ample evidence that a focus on promoting health and wellbeing amongst employees not only reduces absence but also contributes to more positive return to work outcomes. A major approach to this process concerns the maintenance of work ability.

Studies carried out in the 1980’s and 1990’s by the team led by Ilmarinen at the Finnish Institute of Occupational Health demonstrated not only the power of the concept of workability to predict long term absence, but also the fact that deteriorations in workability could be reversed with appropriate interventions.

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What are the elements of a Maintaining Workability Programme?

Maintaining workability is a priority strategy in the prevention of absence but it is equally important when an absent worker is in the process of coming back to work.

Programmes set up to maintain an individual’s ability to work, focus on four areas of intervention:

Work environment,
Work community,
Individual functional capacity and health,
Professional competence of individual.

The first two of the above interventions are aimed at the work context and the second two are aimed at the individual themselves.

Interventions at the working environment level focus on the traditional risk factors to be found in the workplace and consist of improvements to the ergonomics of work tasks, health and safety and work hygiene.

Interventions directed at the work community are largely concerned with improving the psychosocial work environment and with improving the quality of management and supervision so that these take account of the changed working capacity of the individual employee.

The Maintenance of Work Ability interventions aimed at the individual’s functional capacity and health are concerned with improving the individuals’ health and wellbeing, mainly through health promotion interventions, and with improving functional capacity through improving psychological and social capacities.

The second focus of intervention at individual level, professional competence, is concerned with improving the job related knowledge and skills of the individual employee, either to cope with their new health situation or for purposes of coping with the demands of a new or altered job.

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Although some of the Maintaining workability interventions are easier to undertake than others, it is important to make each of the four types of interventions above to achieve an effective outcome. The interventions work in tandem with each other and are not independent elements.

Surveys of employers indicate that the most frequent interventions are of the health promotion variety, but when these are effectively combined with the other three types of interventions, results in terms of improvements in workability are more positive.

However, in the case of returning long term absentees to work, there is still a need to ensure that good practices in relation to the other steps mentioned at the beginning of this section (early intervention, case management etc) are in place. This requires an active response on the part of the employer and also external players.

References

If you wish to read more about Maintaining Workability Procedures you can access the Related Bibliography link on the right side of the screen.