Getting Started | ReIntegrate

Overcoming Challenges

Tilia Boussios — Mon, 06 Oct 2008 07:18:00 GMT

The introduction of a return to work policy and programme can face a number of challenges. Similarly, difficulties at local level can also have a negative impact on the reintegration process for an individual. Return to work challenges fall into two main categories:

1. Organisational Challenges

Bad planning and poor execution
Inertia and resistance in the system
Lack of Resources
Unclear responsibilities
Dealing with external system supports
Perceptions of Insurance Risk
Lack of effective project management
Litigious Culture

2. Individual Challenges

Late identification of and intervention with the absent employee
Worker’s fears, motivation and attitudes
Lack of trust between the parties
Communicating with primary care professionals and/or GPs
Family resistance
Lack of work based and external services
Lack of experience on the part of the return to work coordinator
Conflicting interests
Extra burden on other employees
Lack of Supervisor Co-operation

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Oragnisational Challenges

Developing and introducing a return to work program or policy in an organization can face significant organization challenges. These include:

Bad Planning and Execution: The return to work programme must be introduced after careful planning and agreement with employees. The success of the process will depend on a working environment that invites and is open to change.
Inertia and Resistance in the System: For many organizations making the changes necessary to introduce a return to work system is faced with the barriers of inertia and resistance by the stakeholders in the organization. In order to overcome these problems, employers and employees must feel the reintegration process is worthwhile and of benefit to them.
Lack of Resources: Many organizations face the problem of a lack of resources when implementing a return to work system. The organisation must be adequately resourced to take on the reintegration process. These resources can be defined in terms of knowledge, human resources and in some cases financial resources. If the organization does not have these resources, and many cases they are available from external sources.
Unclear Responsibilities: Difficulties arise when it is unclear who has responsibility for the return to work process. It should be clear to all members of an organisation who is responsible for return to work and what the role involves.
Dealing with External System Supports: A major task in the return to work process is dealing with services that exist outside of the organization which do with the individual and sometimes the employer. The organisation must be able to deal with these external agencies and liaise with them to gain the necessary support for both the absent employee and the employer.
Perceptions of Insurance Risks: The major barrier to reintegrating an absent worker is the perception by some are all concerned that the returning employee constitutes an elevated insurance risk. Any potential risks should be well documented prior to implementation of the reintegration process. The organisation should have adequate information and resources to deal with any potential risks.
Lack of Effective Project Management: Implementing an effective return to work process is no different to implementing any other major project within the organization. The reintegration process must be well planned and managed efficiently and using all the tools of project management.
Litiguous Culture: In many countries a barrier to return to work concerns the interaction between the employer and employee and the insurance and legal systems. In order to overcome potential problems in this regard the process must be organised in such a way that all parties concerned are aware of their responsibilities and in agreement with implementation of the process.

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Individual Return to Work Challenges

There are a number of challenges which can arise when it comes to reintegrating an individual. These include:

Late Identification of and Intervention with the Absent Employee: Good planning and organisation will avoid this problem. In addition, an effective monitoring system for absence from work will help as will a clear policy on when to intervene.
Worker's Fears, Motivations and Attitudes: It should be remembered that for the absent employee, this is their first experience of long-term absence and the procedures necessary for return to work. They may be fearful, have neutral or negative attitudes towards the process and may have low motivation to take part. In order to overcome this, employees should be well informed about the process and future plans for return to work. Workers should understand how and if the process will affect them as individuals and the potential benefits to be expected upon implementation of the reintegration process.
Lack of Trust between the Parties: There may be low levels of trust between the various parties involved in the return to work process. Employees may fear that employers do not want them to return to work, while employers may fear that employees will not be able to work efficiently or that litigation could ensue if the return to work process fails. Organisations may avoid these issues by keeping employees informed and up to date with the process, both as a matter of policy in informing all employees about details of the return to work process, and as a practical measure throughout the return to work process for an individual.
Communicating with Primary Care Professionals and/or GPs: This communication process can be causing considerable misunderstanding and delay for the return to work process. GP’s primary responsibility is to their ill or injured client and they often don’t perceive getting back to work as a priority. Employers’ communications with GP’s may be seen as interference. Communications between GP’s and occupational physicians may be difficult. It is not easy to overcome these communications difficulties, but prior or early communication of policies on return to work to GP’s by employers can help.
Family Resistance: Families should be made aware of how the reintegration process will ease their relative back into work at a pace suitable for them. The process should be perceived as a therapeutic intervention, not as a threat to the individual’s rights.
Lack of Work Based and External Services: There is a range of services that can have been returned to work process some of which may be internal to the employer [especially larger employers], and others of which can be found in the external system. While the full range of services may not be needed in specific cases of return to work, it may be that some services are not available at all. However, it is often the case that the necessary services can be available from the private sector even if they are not widely available in the public services which are on offer.
Lack of Experience on the Part of the Return to Work Coordinator: Return to work coordinators are a major access to the return to work process. The return to work process should be well planned and executed by a trained person within the organisation who has a firm understanding of the process and some previous experience with implementation of similar programmes.
Conflicting Interests: There may be a perception of conflicting interests and to return to work process especially if the cause of absences in some way work-related. In order to avoid unnecessary conflict, it is advisable to clearly define every aspect of the process prior to the employee’s return to work and to demonstrate the benefits to both employer and employee of safe and early return to work.
Extra Burden on Other Employees: It can be the case that person returning to work is not able to work at the level they were previously able. This can lead to an extra work demands being placed upon work colleagues. If the implementation of a return to work programs should result in such demands, these should be clearly explained to all employees concerned.
Lack of Supervisor Co-operation: Supervisors may feel that they are unqualified to manage the returnee, or that the productivity of their workgroup is compromised by the returnee. It is essential to educate all staffs [including supervisors] about the benefits of returning to work if their agreement is to be secured. Offering incentives may encourage workers’ support for the process.

References

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

Marketing/Persuasion

Tilia Boussios — Mon, 06 Oct 2008 07:17:00 GMT

In parallel with organisational capacity building, it is also important to consider the views and attitudes of:

The workforce,
Their representatives (e.g. union shop steward),
Supervisors,
Line managers
Senior management and
The board room.

This requires not only a good understanding of the issues but also a solid strategy for persuading all the above vested interests of the advantages and cost-benefit of adopting an explicit and integrated workplace return to work policy and set of procedures.
Clearly the facts and figures form an important foundation to support the business case, but in addition, it is also critical to pay attention to the needs and concerns of each interested party. At the core of peoples’ concerns there is usually a lack of confidence in their own approach to disability or a complete lack of awareness of disability issues.

There are a number of critical steps and strategies that can be used to persuade the key opinion formers and key executives in an organisation that it is essential to adopt a policy based and systematic approach to return to work. Marketing of return to work requires an organisation wide and comprehensive approach to building the case.

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The major elements of an effective marketing campaign are listed below.

Identify your key stakeholders
Meet in face to face meetings
Be clear on the effected interest groups in the organisation
Identify a Leader/Champion for the policy and approach
Carry out an organisational needs analysis
Feedback the results to each group and ask them to respond
Produce a series of organisational case studies
Prepare a policy statement for approval by senior management
Disseminate to line managers and those with functional responsibility
Form a cross functional group to monitor the initial stages

It is an essential element of the marketing and persuasion process to identify the key stakeholders in your organisation. These would include:

Key Opinion Formers: Key opinion formers are people with a high status within the organisation. They are the people who can change the ways things are done in the organisation; they are those people who are listened to by others. They could include the Chairman of the Board, the managing director, the director of H.R., and the leader of the union representatives.
Key Interest Groups: The key interest groups are those groups within the organisation who are most likely to be effected by the introduction of a return to work programme . These would most likely include the workers, supervisors, line managers, Occupational Health personnel, Employee Assistance personnel, and H.R. personnel.

within your own organisation. Face to face meetings with key opinion formers and focus group meetings with key interest groups must then be held in order to consider their views, attitudes and concerns.

However, the most important factor in an effective campaign is a Leader in the organisation who is willing to act as Champion for the process. A Champion can be a senior manager, a financial officer or a HR manager but the most effective leader is the CEO or Managing Director. Without the support of top management and the board, the challenges facing the person responsible for developing the return to work programme will be increased.

Persuading people of the importance of introducing a workplace return to work programme is not about telling them about the advantages or trying to convince them with facts or figures, you must carry out an Needs Analysis which actually listens to the concerns of all interested parties and which can then form the basis of a series of feedback meetings during which the case can be made.

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There are ample resources available to help you with the ‘buy in’ process, in the form of:

Organisational case studies from both inside and outside the E.U.,
The experiences of those who have undertaken the tasks before,
Reports from representative organisations e.g. IBEC/ICTU Workplace Safety Code, and
Material from the ‘Business Case’ Section on the website.

References for the first three types of resources can be found in the bibliography.

An important lesson to be learned from available resources, including research and case studies, is that badly planned and poorly executed return to work programmes can create problems not only for the returning worker but also for the employer.

One study, in Ontario, Canada, explored the impact on small workplaces of a particular set of policies and practices, called 'early and safe return to work'. These policies emphasised workplace self-reliance and return to work before complete recovery via 'modified' work accommodation. The study found that employers experienced conflict between their administrative role in the return-to-work process and the demands of running a small business.

References

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

Business Case

Tilia Boussios — Mon, 06 Oct 2008 07:11:00 GMT

Absence from work due to sickness has become an issue of major importance to employers as the direct and indirect costs involved are substantial.

According to research conducted by the Confederation of British Industry (CBI), long-term absence of 20 days or more accounted for 43 per cent of all working time lost in 2006 (public sector - 52%; private sector - 38%) and cost £5.8bn. In the same year absence cost £537 per employee and accounted for 3.3 per cent of working time.

A striking finding was that companies that offered rehabilitation programmes and flexible working can help employees back to work and thus lose less time to absence. The best performing organisations lost only 2.7 days per employee, while the worst lost 12 days.

More recent figures produced by the Chartered Institute of Personnel and Development (CIPD), based on a survey of human resource managers, estimated the average annual level of absence in 2007 as 3.7%, or 8.4 working days per employee and an average reported cost of absence of £659 per employee per year. There was a reported 31% increase in stress-related absence compared with a year earlier.

The analysis of return to work programmes in other countries supports the business case for better return to work programmes and also strongly indicates that a no fault approach to compensation and greater involvement of employers in the rehabilitation, retraining and return to work process could be an important facilitator of lower costs.

A survey of Canadian employers particularly within the manufacturing sector, identified that those companies adopting a Disability Management (DM)* approach, reported disability related cost reductions of between 30-50%.

An investigation of the effectiveness of rehabilitation programs undertaken by 503 injured workers in the US in 1996 found that every $1 spent on rehabilitation services yielded a reduction of system costs of $2.31.

*The term Disability Management refers to a set of policies and procedures which are designed to reduce the number of employees who exit a company on the grounds of illness or impairment.

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The tables below provide an illustration of the type of information that is available to illustrate the economic costs of long-term absence and hence why it makes good business sense to develop a work-based return to work programme.Absence from work due to sickness has become an issue of major importance to employers as the direct and indirect costs involved are substantial.

Table 1: Financial Services (Profile 2007)

Employer (employee nos.)	Estimated annual cost of long-term absences	No. of employees currently on long-term absence	Most effective means of managing long-term absence
Computershare (1,430) (W)	£120,000	7 (actual)	External occupational health service
esure (600) (S)	£350,000 (for all types of sickness absence)	12 (actual)	Occupational health/company physician
Europe Arab Bank (320) (W)	-	1 (actual)	HR
GMAC (300) (W)	-	4 (approx.)	External occupational health service
Lifestyle Services Group (LSG) (329) (W)	£5,000	2 (actual)	HR
Money Advice Trust (150) (W)	£63,000	4 (actual)	External occupational health service
National Australia Group (10,000) (W)	-	200 (approx.)	Occupational health/company physician
Old Mutual (140) (S)	£30,000	1 (actual)	External occupational health service
Open + Direct Insurance (170) (W)	£3,000	1 (actual)	Line manager
Provident Insurance (430) (W)	£686 per employee, but much higher if management time is taken into account	5 (actual)	HR
Prudential UK (4,700) (W)	£6 million (direct and indirect costs)	50 (approx.)	HR
Wesleyan Assurance Society (850) (W)	£1 million	15 (approx.)	External occupational health service

Table 2: Chemicals and Pharmaceuticals (Profile 2007)

Employer (employee nos.)1	Estimated annual cost of long-term absences	No. of employees currently on long-term absence	Most effective means of managing long-term absence
Barloworld Scientific (300) (S)	-	7 (actual)	HR
Boots Manufacturing (1,300) (W)	£2 million	50 (approx.)	Line manager
Constar International UK (180) (W)	£50,000	3 (actual)	Occupational health/company physician
GR Land Health Products (150) (W)	£70,000	3 (actual)	-
Huntingdon Life Sciences (1,200) (W)	£1.25 million	-	Line manager
Intervet UK (285) (W)	£40,000	1 (actual)	External occupational health service
Perrigo (720) (W)	£94,000 in sick pay.

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The case for introducing a return to work policy and programme into an organisation must be based on sound business principles.
There are numerous benefits associated with the development of work-based return to work programmes. You will need to understand these benefits, if and when you decide to start building the case for implementing a return to work programme within your organisation.

The primary benefits for both the employer and the worker are listed below:

Benefits to the Employer

Productivity Maintained
Reduced Absenteeism
Enhanced Staff Morale
Decreased Replacement/Training Costs
Retention of Knowledge and Skills
Increased Staff Loyalty
Reduced Early Retirement
Reduced Risks to Quality

Benefits to the Absent Worker

Maintaining His/Her Ability to Work
Income Maintained
Self-Esteem Protected
Improved Mental and Physical Health

References

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

Principles

Tilia Boussios — Fri, 03 Oct 2008 11:32:00 GMT

The principles upon which an effective return to work programme must be based are not very different from those required for the success of any new work-based health policy initiative. The following principles are considered important in most good practice organisations (Click on the Principles to see an explanation):

Early Intervention: One very important element in the return to work process is early intervention. Early intervention involves a continuum of actions that begins with early monitoring after three days, the offer of assistance at six weeks, the offer of a return to work assessment at twelve weeks and the assignment of a case manager to coordinate the interventions indicated by the assessment.
Worker Involvement: This principle operates at all levels of the process. It is essential that where relevant worker representatives play an active role in planning and developing the company RTW policy and practice. Equally, the local worker representative should be involved in the return to work process for an absent worker. Finally, the ill or injured worker who is long term absent should be involved as an active participant within the return to work process and should continually receive feedback on the outcome of assessments or interventions and contribute to RTW decisions.
Boardroom Commitment: Even if the worker, his/her representative, management and supervisor are enthusiastic about the return to work programme, it is highly likely that the programme will lack sustainability if commitment is absent at boardroom and senior management level. The key to success of any organisational initiative is Leadership. It is extremely important that those responsible for promoting the RTW policy and practice manage to obtain the backing of senior management and the Board of the organisation. This can involve getting sign off from the Board, ensuring it receives regular reports, gaining external accreditation for the programme and reporting on the results, costs and benefits in the Annual Report of the company.
Policy Based Approach: It is not advisable to start implementing a programme as a response to an individual’s needs, without ensuring that the relevant return to work polices are in place, otherwise he or she may well feel ‘picked on’. The starting point must always be to gain agreement amongst all parties on the return to work policies and guidelines. They should be written down, agreed and integrated into the standard operating procedures of the company.
Integrated Policy Platform (e.g. OSH, WHP, HR, Non-Discrimination): It is important not to perceive RTW policy as a stand alone policy. If it is integrated into other workplace policies it has a better chance of being integrated into the day to day practice of the organisation. In addition to a specific return to work policy, it is essential to integrate return to work into existing policies including Health and Safety, Workplace Health Promotion, HR, Non-discrimination etc.
Clear Responsibility and Accountability: Establishing clear responsibilities and reporting relationships ensures that misunderstandings do not arise during the RTW process and also enables the effectiveness of the system to be monitored and assessed. This function is responsible for all aspects of the process, i.e. for maintaining contact with the ill or injured employee, liaison with external agencies providing medical and vocational rehabilitation, co-ordination of internal services and functions (OSH, HRM, training, line management) and provision of job design and job placement services.
Customised and Flexible Responses: The ill or injured worker should not be ‘slotted’ into a ‘one size fits all’ return to work system. Company responses, although based on the policies and procedures of the company, should still be flexible and customised to the individual’s needs so as to get them back to work in as safe and timely a manner as possible.
Properly Resourced: In order to ensure an efficient return to work process, adequate resources need to be established by the employer. Appropriate resources include an adequate and specific budget for the return to work programme, in addition to training for return to work management (as this is a relatively new concept and it is unlikely that the necessary skills would be available without such training).
Proactive Approach to Individual Health Concerns: It is usually more desirable and more cost effective to implement proactive interventions to prevent an employee from entering the long-term absence net by offering solutions to health issues prior to absence. Equally when a person comes back to work, it is essential to be proactive in responding to any health complaints raised by the returning worker.

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Two international codes of practice which are relevant to return to work are:

The NIDMAR Code of Practice for Disability Management *, and
The International Labour Organisation (ILO) Code of Practice on Managing Disability in the Workplace

The NIDMAR Code is relevant to all people affected by chronic illness or disability regardless of its cause, type, or nature and who have the ability to obtain, return to, or retain employment.

The objective of the Code is to promote workplace based systems of Disability Management (DM) policies which are:

Agreed by management and labour representatives, unions and the individual worker,
Supported by the coordination of work accommodations, health care and rehabilitation interventions, and
Underpinned by the promotion of continued safe employment for persons with disabilities, supported by external voluntary and statutory service providers.

The second code, the ILO Code, takes a broader view of managing disability in the workplace, but still provides some very useful insights into how an effective in-house system for responding to disability can be built.

According to the ILO Code, inclusive workplace strategies are characterised under four levels of description:

Policy & Legal System
Mediating Mechanisms
Context – social and workplace
Individual

The first two of these relate to the external influences upon the company in terms of the way in which the jurisdiction responds to disability and the responsibilities of employers, e.g. workers compensation vs. social welfare systems. In addition to the external services available to provide support to employers in terms of counselling and case management.

The latter two refer to the local context in terms of the factors operating in the work and non-work situation and the level of impairment being experienced in the individual’s life.

*The term Disability Management (DM) refers to a set of policies and procedures which are designed to reduce the number of employees who exit a company on the grounds of illness or impairment.

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In order to review the current ‘RTW’ position within a company and to plan more effective approaches, the following areas must be taken into account:

Workplace Enablers such as:	Workplace Drivers, such as:
Policy & Strategy Organisational Culture Processes & Procedures Knowledge & Resources	Agreed Labour Management Support Responsibility and Accountability Internal and external communications
Workplace Processes, such as:	Workplace Strategies, such as:
Job Retention Reintegration Career Development Confidentiality of Information	Priority assigned and integral to HR strategy Conformance with national policy & legislation Recruitment, Equal Opportunities and Retention Linked to Occupational Safety and Health measures; Risk Analysis; Including early intervention and workplace rehabilitation; Mentoring of employees Collaboration and consultation Worker representatives Disabled workers or their representatives Occupational health services Expert agencies with specialist knowledge Provision for workers who hold family responsibility for a disabled person or persons Matching workers properly to the job in terms of ability, work capacity and interest Regular Evaluation and Continuous Improvement Participation and access