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All hands on deck! Designing and implementing a return to work program

At a glance:
Return to work programs affect injured employees, co-workers, management, supervisors, unions, and health care practitioners, all of whom can bring very different perspectives to the table. Successful programs involve all of these groups in the design and implementation of the program. Trust, communication and cooperation are essential to running a successful program.
Perspectives:
Employee
Clear communication is very important in the return to work process. Without it, employers can feel that employees are being uncooperative, and vice versa.

When a return to work policy has been mapped out before injuries occur, everybody knows what their rights and obligations are. This can reduce tension.

A return to work program is most likely to be effective if everyone involved has had a say in its design. Done well it's a team thing.

People with an injury sometimes stay off work as they are fearful of work harming their condition, or delaying recovery. Other studies have shown that early return to function helps speed recovery for most people. If you are unsure about whether your condition would be helped or harmed by being active talk to your treating health professionals.
Employer
The social environment of the workplace can be important in determining return to work outcomes. As employer you are the key driver of developing a return to work program. If people feel part of the team, comfortable with their colleagues, and have an investment in maintaining productivity, they are more likely to return to work successfully.

Much of the effort required to manage return to work will only be made if people feel that others are working towards the same goal. If management does not strongly support return to work programs, supervisors and employees are not likely to either.

Some people need to return to work before they have fully recovered, which means continuing to work while in pain. A person needs to feel supported to manage this process.
Treater
The quality of return to work management at the workplace is variable. Many stakeholders find it frustrating when it is poor. It's important that all stakeholders get a say in the design and implementation of return to work plans – this makes it likely that the program will be widely supported.
Insurer
This study across three areas of Canada found results that are echoed in Australian studies. Attitudes and beliefs of all stakeholders play a major role in successful return to work programs. The manager and supervisor are key drivers of the workplace environment and culture, meaning their attitude to return to work programs can define the way other stakeholders react to them. The employee, treating practitioners, the union and co-workers all need to be involved in return to work planning.
Original Article, Authors & Publication Details:
Baril R, Clarke J, Friesen M, Stock S, Cole D.
Management of return-to-work programs for workers with musculoskeletal
musculoskeletal
Involving the muscles and the skeleton. This term includes the limbs, neck, shoulders and back. 'Musculoskeletal problem' refers to many different conditions that can affect the tendons, muscles and related structures.
 disorders: a qualitative
qualitative
A way of assessing a situation without using direct measurement. The outcome is described as a summary in words rather than in numbers. This is in contrast to quantitative assessment, where the result is expressed as a number. A summary of a group of peoples’ beliefs about motivation is qualitative and expressed in words rather than numbers. Average days off work is a quantitative measure as it is expressed as a number of days.
 study in three Canadian provinces.
Social Science & Medicine 2003;57(11):2101-2114.
Background, Study Objectives, How It Was Done:
Return to work programs aim to improve injured workers' quality of life. They improve workplace morale and reduce compensation and sickness absence costs. Return to work programs usually involve case management, early intervention
intervention
A treatment or management program. Interventions often combine several approaches. In this field approaches include training in problem solving, adaptation of work duties, graded activity, an exercise and stretching program and pain relief.
 and workplace changes (to the work performed, equipment used, training provided) These programs are not always easy to put into practice.

In this study, researchers interviewed 258 people involved with return-to-work programs to determine their views on what made the programs successful or unsuccessful. Participants included injured employees, employers, co-workers, union representatives, health and safety coordinators and healthcare workers.

The interviews were conducted one-on-one or in small groups.
Study Findings:

Injured workers, co-workers and unions:

The worker's personal characteristics (their health, social position, skills) were important in determining whether or not they were able to return to work. This study focused particularly on workers' beliefs and attitudes.

Whether or not a worker wanted to return to work was crucial in determining their success in the program. Workers had a number of reasons for not wanting to return, including:

An unwillingness to work while in pain
A belief that they were entitled to time off
Embarrassment about their injury
A fear that they would aggravate the injury

Workers, unions and health and safety workers reported that the way they approach return to work depends on the employer's attitude. Workers were more likely to communicate positively with their employer if they believed the employer cared about their wellbeing. If workers believed that their employer's main focus was cost control they were less motivated to participate in return to work programs.

Workplaces that focused on prevention and made changes to assist injured workers were more likely to describe their employees as cooperative.

Return to work programs were more likely to be successful if workers felt respected by their colleagues and supervisors. It was also important that employers value their workers' opinions and involve them in decision-making. If co-workers are involved in the return-to-work process, they are more likely to be happy with workplace changes that care for injured workers.

Return to work programs are more likely to be successful when unions and managers work together to develop them.

Supervisors, management and occupational health and safety coordinators:

Return to work programs create more work for supervisors and the responsibility to support them competes with their responsibility to meet productivity targets. Supervisors were more likely to support programs when management acknowledged both of these challenges.

Supervisors had varying levels of knowledge about rehabilitation,
rehabilitation
The process of helping a person back to their former abilities and quality of life (or as close as possible) after injury or a medical condition.
 meaning some believed workers should not return until they had fully recovered, and some were unable to effectively choose alternative work tasks.

When companies contested compensation claims frequently, it sometimes made workers less supportive of preventative safety programs. In some cases, putting an effective return to work program in place reduced the number of appeals the company made.

The manager's attitude towards the return to work program strongly influenced the workers' attitudes. Return to work programs were more successful when managers believed they were important and encouraged workers to participate in decision making.

Return to work programs were better supported when there was good communication within the workplace and decision making processes were inclusive. When a group affected by a return to work program (unions, management, co workers etc) did not have their views taken into account, it increased conflict.

The workplace compensation system:

Many interviewees said that delays in processing compensation claims held up return to work programs and increased costs. Workers found the compensation system confusing, frustrating and overwhelming.

The system was also poorly understood by employers and treating practitioners. Many interviewees felt it was inconsistent.

Incentive schemes to reduce workplace injuries (e.g. insurance premium refunds) are problematic. These schemes give management an incentive to get employees back to work, but some interviewees felt they simply suppressed reporting.

Healthcare professionals:

The advice of healthcare professionals is critical in deciding whether an employee is entitled to compensation, what tasks they can still perform, what changes might be needed in the workplace and when people can return to work. These decisions affect patients' livelihood and wellbeing, which can place healthcare providers in a difficult position.

Some employers objected to doctors approving long periods of sick leave. These employers often believed that certain doctors lacked knowledge of musculoskeletal injuries and occupational medicine, and gave inappropriate treatment and vague advice. Some doctors reported that they lacked the time and resources to manage occupational medicine well.

Physiotherapists and occupational therapist were described as valuable resources in return to work programs.
Conclusions:
Many groups with different perspectives are involved in return to work programs. The greater the range of perspectives taken into account in designing and administering a return to work program, the more successful it is likely to be. The attitude of management is particularly important since it can determine attitudes throughout the rest of the workplace.

Interviewees generally agreed that trust, respect, positive relationships, good communication and cooperation are essential in running a successful return to work program.
References:
No PubMed Abstract
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