People can be helped to stay at, and return to, work

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The pivotal thing is to provide a supportive workplace using seven key principles:

 

FIRST PRINCIPLE: The workplace needs to have a strong commitment to health and safety - demonstrated by behaviours of all workplace parties. It's not just what we say to ourselves and others, it's what we do. As the old saying goes "actions speak louder than words". This is a collaborative issue. Support is needed at senior management level, and from all the employees. This means workers, and their representatives, also need to support inclusion of stay at work and return to work policies. Importantly, it’s not just a matter of management looking after workers - people need to take some personal responsibility for what happens to them. Everyone should aspire to being a coper rather than an avoider, and must engage with those who are helping them deal with their health at work.

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SECOND PRINCIPLE: Employers need to offer modified work, i.e. an accommodating workplace - early and safely.This means providing appropriate modified work, and taking care to ensure there is not an awkward fit for the worker and others. Usually, this can simply be worked out between worker and manager. Simple ergonomic principles apply. Only if there is difficulty coordinating staying at or getting back to work is there any need to consult an ergonomist or health and safety professional.

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THIRD PRINCIPLE: Case coordinators need to ensure the work plan supports the worker without disadvantaging co-workers and line managers – they may need training in case management skills (in-house or from external suppliers). These coordinators need to ensure the plan supports the worker without disadvantaging co-workers and line managers. Planning how to keep someone at work, or ease them back into the workplace, involves more than just matching the sick or injured worker's abilities to job tasks. It can be seen as a 'socially fragile process' where line managers and co-workers can be thrust into new relationships and routines. If it is not properly managed, this may involve resentment instead of cooperation. Here are good examples of potential problems:(1) the sick or injured worker may have to deal with co-workers who resent having to take over some of their work and therefore feel that the worker has managed to get an ‘easier’ job; and (2) line managers may be expected to get the job done and fulfil production rates in spite of accommodating a sick or injured worker, and can’t see a way to offer the required accommodation. Workplaces that treat sick or injured workers as individuals who anticipate in the arrangements can avoid these pitfalls.

 

FOURTH PRINCIPLE: Line managers need to be comfortable about how to prevent extended sickness absence and work disability, and should be involved in developing plans for Stay at Work and Return to Work. They may need training in case management skills (in-house or from external suppliers). The minimum is to incorporate specific topics into safety training for line managers: (1) how to be positive and empathetic in early contacts with workers; (2) how to arrange modified work; and (3) how to follow-up and problem solve on a regular basis.

 

FIFTH PRINCIPLE: Employers and/or line managers should make early and considerate contact with the absent worker. This appears to be a core component of the process and should be done in a positive way. This means focusing on concern for the worker’s well-being, and avoiding issues such as causation or blame.

 

SIXTH PRINCIPLE: Someone in the company/organisation should be given clear responsibility to coordinate stay at work and return to work to make sure it happens – a designated case coordinator or buddy. Alternatively, the coordination role can be performed by someone external, such as a professional case manager with a direct line of communication to the workplace. Either way, simply having good intentions is not enough. It's important that communications do not break down, and that key actions are not overlooked or forgotten - the case coordinator needs to ensure everyone involved in the work plan knows what is expected of them and when.

 

SEVENTH PRINCIPLE: Employers and healthcare providers (such as GP's, physiotherapists, and other practitioners) need to communicate about workplace demands. A key part of this principle is implementing the advice on a fit note. Clearly it is important the 'left and right hand know what each other is doing'. Ideally the worker needs to participate in the communication between employers and healthcare providers. Obtaining the worker’s consent is important – simple confidentiality waivers are useful.

 

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The workplace is very important

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Work can be part of the recovery process. It provides all of us with important protective factors for our health, such as: routine, structure to day, social relationships, mental stimulus, self-esteem, activity, and a sense of wellbeing.

 

To achieve this we need to avoid the idea that work is a ‘risk’ and (potentially) harmful to physical and mental health. This is important because it leads to advice to stay off work, undue sick certification, over-cautious risk assessments, and the desire to somehow ‘protect’ the person from work. Certainly some work circumstances are dangerous and undesirable, but most work is beneficial for most people.

 

We need to shift the culture and emphasise that work is healthy, therapeutic and the best form of rehab (while recognising that some work can be a hazard). This can be achieved by ensuring everyone gets advice and support to remain in, and return to, work (that is safe and healthy, described in the good jobs section).

 

The contribution of the workplace is vital. When it comes to helping people stay at, and return to, work the most powerful influences comes

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1. The person with the health complaint, then

2. The line manager (and the level of support and company policy he/she has to operate under), and then

3. Healthcare providers (including doctors, physiotherapists, etc.)

 

This means that one of the most important things any employer can do is to provide a supportive workplace that enables workers to recover from common health problems while working.

 

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We All Get Health Complaints, Only Some are Work-Relevant

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When people have health or injury problems the workplace plays an important role in their recovery. Whenever possible we need to help people stay at work, even part time. This maintains their work ability, their skills and daily routine. Most importantly it helps them to stay active and to build resilience and tolerance. If a worker does take sick leave for even a short time we need to help them start back at work as soon as possible. Again, this may be part-time to begin with, building back up to full-time.

 

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The Main Reason People are Unable to Stay Active and Working is Because They Face Obstacles

 

It is a mistake to assume that the reason people don't stay at or return to work is simply because they have more serious illness or more severe injuries. The more important factors influencing work as an outcome are psychosocial. This refers to the factors that contribute to the behaviour of going to work.

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There are factors that increase the chance someone can and will stay at or return to work. These positive influences are enablers or facilitators. We need to look for these and support them whenever possible.

 

Then there are factors that reduce the chance of staying at or returning to work. These are obstacles. We need to look for these and find ways to help people overcome them.

 

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You Need to be Able to Identify and Tackle Obstacles

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The most important thing for success is to identify obstacles to staying active and working, and plan to overcome these. Remember there are two types of obstacles: (1) modifiable – these are like hurdles to be overcome; (2) immovable – these are like roadblocks to be sidestepped. The three places to look for obstacles to staying active and working are the Person, their Workplace, and the Context in which they function.

 

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Identify Problems Early, and Respond Rapidly

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Some people in every workplace will inevitably experience common health problems, even though good jobs reduce their frequency. The sooner they are identified the faster they can be dealt with and this reduces the impact on the workplace and helps maintain productivity. Identify anyone at work who is struggling to cope with symptoms of common health complaints or minor injuries. Identify anyone who is off work (i.e. reduced hours, or stopped altogether).

 

The key thing then is to respond, and to do so rapidly. Do this by:

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• Identifying the obstacles to being active and working

• Providing appropriate workplace accommodations and modifications

 

This is the very core of what it means to have a Supportive Workplace.