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Workplace Factors
Views of employees on the role that employers should play in return to work

At a glance:
Employees believe that:

Supervisors are important in their return to work

Supervisors should make contact with them early after injury and maintain communication

If supervisors simply keep in contact by phone and invite the employee to work activities they will feel valued

A straightforward return to work program will help them

A positive workplace environment motivates them to return to work
Perspectives:
Employee
This study asked workers with back, neck or shoulder injuries what role they thought employers should play in their return to work after injury.

Those interviewed said that supervisors can play an important role in the process of returning to work. Supervisors can help by creating an environment in which issues about returning to work can be discussed, the employee can be given information and feel supported.

A straightforward return-to-work program assists return to work (see ‘Employers' perspective for the key elements of a successful return to work program).

You can assist by making sure that, as far as possible, you are available for contact and by keeping in touch with your workplace while on sick leave. Simple things like phone calls and attending staff get-togethers will help your return to work process.
Employer
This study asked workers what role they thought employers should play in return to work after injury. The participants had taken a leave of absence from work due to back, neck or shoulder problems in the past year. They emphasised the importance of a simple, unambiguous return-to-work program in helping them get back to work.

An effective return to work program should include:

Contacting the absent employee. This can include phone calls, written information about current activities (e.g., meeting minutes), and invitations to visit the work place for meetings, coffee breaks, or staff parties. It should be clear to everyone at the workplace who is responsible for making such contacts.

Information and feedback from the supervisor to other workers. Supervisors should explain the situation of the absent employee, the length of their expected absence, their possible reduced work capacity, and changes to work tasks or demands upon return.

Make adjustments to the tasks performed by the absent worker on return to work, if it is necessary to accommodate their problem. Other studies support this, showing that employees who are offered modified tasks return to work twice as often as those who are not. If this is done promptly, time lost from work can be reduced by at least 30%.

Systems for information and action: Information regarding return to work and a returning worker's duties should be updated and clear to all persons involved at the workplace, and employees should know how to ask questions or voice concerns. If this is not successful, there is a large risk that there may be misunderstandings and negative attitudes towards the returning employee. The work supervisor should set an active example for how the returning person will be treated by fellow workers.
Treater
Patients think that employers, and particularly supervisors, should play an important role in return to work. Return to work rates are improved if supervisors make early contact with workers when they are on sick leave, and then maintain it. Simple efforts like phone calls and encouraging the injured worker to participate in staff get-togethers have a positive effect on return to work.

Particularly important are clear systems and information channels that enable others in the workplace to understand what modifications may be necessary for the injured worker to return to work. A positive workplace atmosphere increases return to work success.

Health professionals can assist by involving supervisors, encouraging both supervisors and workers to maintain contact and keeping supervisors informed of the worker's progress and any changes needed at the workplace for return to work.

Employees who are offered modified tasks return to work twice as often as those who are not. If this is done promptly, time lost from work can be reduced by at least 30%.
Insurer
This study asked workers what role they thought employers should play in return to work after injury.

The participants had been on sickness absence because of back, neck, or shoulder problems. They emphasised the importance of a simple and unambiguous return-to-work program (see ‘Employers' perspective above for the key elements of a successful return to work program).

Assisting employers by providing information regarding communication with employees and return to work plans is useful. If a return to work is managed properly, time lost from work absence can be reduced by at least 30%.
Original Article, Authors & Publication Details:
C. Nordqvist1, C. Holmqvist1 and K. Alexanderson1 (2003).

Views of laypersons on the role employers play in return to work when sick-listed. Journal of Occupational Rehabilitation; 13(1):11-20

1Division of Social Medicine & Public Health Science, Department of Health and Society, Faculty of Health Sciences, Linköping, Sweden.
Background, Study Objectives, How It Was Done:
Identifying workplace practices that support return to work after injury, and those that are obstacles to return to work, in order to reduce disability
disability
A condition or function that leaves a person unable to do tasks that most other people can do.
 rates. The aim of this study was to ask workers who were off work with a sprain
sprain
Injury to ligaments caused by overstretching or overuse. The ligament is usually stretched but may be torn.
 or strain
strain
Injury to a muscle in which the muscle fibres tear or become irritated as a result of overstretching or wrenching
 condition about the issues that were important to them in their return to work, and to better understand the process from the worker's point of view.

The study was part of a larger project that followed a group of people for 11 years from 1985. The larger study followed 213 persons, 60% of whom were women. The group was 25–34 years old, from a middle-sized city in Sweden. They all had a new sick-leave absence due to back, neck or shoulder problems during the year, which lasted at least 28 days. The study participants proved to be a high-risk group for disability pension, as 22% received a pension for their injury during the 11-year period of the study.

In 1996, a questionnaire was distributed to 204 of the study participants, and 18 of those who returned the questionnaires were chosen to be interviewed in person. Participants were divided into five groups for the interviews. During the interview two short, fictional cases of back disorders were presented: a female nurse on sick-leave for 3 weeks due to shoulder pain, and a male factory worker with low-back pain. The participants were asked to give advice to these persons. Finally the respondents were asked about their own experiences, and what factors they thought hinder or promote return to work. The interviews lasted 1.5 hours.
Study Findings:
The group interview sessions discussed factors that hinder or promote return to work with employees who were absent because of back or shoulder conditions. The factors discussed included personality, physiology, family, coping strategies, health care, and unpaid and paid work.

The discussion of the effect of paid work on recovery was primarily concerned with factors influencing return to work after sick leave. Although the person leading the discussion did not mention the role of the employer, this was a recurrent topic in the interviews, and the importance of an employer-established “return-to-work program' was emphasised in most groups.

The participants indicated that a central aspect of an employer's return-to-work program should be to maintain contact with the absent employee. They suggested that if a supervisor was unable to telephone an absent employee, they should direct someone else to. They talked about the importance of discussing back and shoulder problems as early as possible.

The following are quotes from interview participants:

D: It's like you said about being needed, it's really important to feel that, above all.'

B:'...it isn't customary to call an absent person at home and say anything like “you're on long-term sick leave, and it's Friday, and we're going to have coffee together this afternoon, come and have coffee with us; nothing like that. But I think you should"

C:' In that case I think it's important that someone… that the supervisor takes care of it and calls the person. It's really easy to call and ask: how are you doing? It mightat least it would cheer the person up";

According to the interview participants, another essential aspect of a return-to-work program is adjustment of work demands upon return. That is, if the tasks performed by the returning employee are not adjusted or modified to suit his or her present work capacity, there can be misunderstandings with fellow workers, who might take it for granted that the person is able to perform their duties as usual. This supports other studies that show that if an injured employee is offered modified tasks they are twice as likely to return to work. If this is done promptly, time lost from work can be reduced by at least 30%.

Insufficient or incorrect information about the health problems of the returning employee, and the effects on their present work capacity, can lead to misunderstandings, such as resentment that the injured worker is not pulling their weight, but getting normal pay.

The interview groups pointed out that it is also necessary to maintain systems for spreading information about return to work and disability.

Workers felt that their supervisors were often busy and didn't have enough time to fulfil their responsibilities regarding prevention and handling of conflicts at the workplace. The participants felt the number of supervisors had decreased, and said they were often not present at work sites. “They don't have time for this kind of thing.'

The groups frequently discussed that good social relationships at the workplace are important for keeping an employee with health problems at work.

Participants suggested an effective return to work program would include:

Contacting the absent employee

Supervisors giving information and feedback to other workers concerning the injured employee's condition

Giving clear guidance to employees about how an injured worker should be treated on returning to work
Conclusions:
The study makes the following recommendations:

The employer should make contact with an absent worker as soon as possible

The supervisor should inform people who work with the person on sick leave about their situation

When the absent employee returns to work, the workplace should be willing to make adjustments to their work tasks if necessary

It should be clear how workers can ask for information and advice about return to work

Everybody at the work site should know who is responsible for workplace injury and return to work matters
 
People consistently mentioned the importance of supervisors in creating a positive emotional atmosphere at the workplace. In reducing absence due to back injuries it was shown that improved working conditions are as important as medical treatment and 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.
 and more important than personality and other individual characteristics.
 
References:
PubMed Abstract
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