Breaking down the process of return to work allows a clearer view of where the process starts to get complicated, and it makes room for improvements along the way.

The process of return to work, as detailed in The American College of Occupational and Environmental Medicine guideline, (JOEM, Vol.48, N.9, Sep 2006) begins when an illness or injury occurs. At this point the question is asked, how much can this person do in the way of work and what can the person not do now that they could do before? Also, what is the person being medically advised against doing so as not to aggravate their condition?

Following this, the return-to-work coordinator, employer or case manager compares the demands of the person's job with their new restrictions. “To make this comparison,” the ACOEM guideline states, “the functional demands of the tasks or job must be known, including what knowledge, skills and abilities – physical, cognitive and social – are required.”

As the RTW coordinator, employer or case manager, it's impossible to give accurate help, advice and support if you aren't sure of exactly what the demands of the injured or ill individual's job are.

Once this is established it's possible to identify what actions are required to return the worker to their job. If the person is safe and comfortable to perform their job they should be able to return to it. If the person can do only temporary modified duties, then – states the guideline – “the employer must make arrangements and implement them.”

If neither option is applicable, then the person stays out of work until they have fully rehabilitated.

Sometimes, in situations that are uncomplicated, and where perhaps the medical condition is minor and the worker is motivated to return to work, the above steps are carried out simply and rapidly.  

Other times the situation and the injury might be more complicated. “At this stage the RTW process evolves into a negotiation between the employee (and his or her advisors) and the employer (and its advisors) regarding whether the employee can return to work,” states the guideline.

It might be necessary to again assess the person's current abilities, compare these with the demands of the person's job and identify actions required to help them back to a position where they can comfortably perform in that position. At this stage more people enter the picture and become involved in the return to work process, and “the situation can escalate with progressively more opinions, data, resources and time being required to decide when and if the employee can return to work.”

Doctors, specialists, insurance and WorkCover representatives, lawyers, independent medical and other sorts of experts may all need to become involved.

But this is not all there is to the return-to-work process. As stated in the guideline, “the process occurs in parallel or is influenced by four other well-known processes.” Namely that of personal adjustment to the injury or illness, medical care, disability benefits administration and the accommodation of any long-term altered work capabilities.

The way in which these processes are carried out, and the way the return-to-work path is tread, will “profoundly impact the overall health and well-being of patients, their families, employers and communities by determining whether people stay engaged or withdraw from work.”

To improve the return to work process the guideline recommends that workplaces “stop assuming that absence from work is medically required and that only correct medical diagnosis and treatment can reduce disability.” If a worker cannot work full days while they are recovering, perhaps they can work half days. If they are able to stand all day, can they do sedentary tasks instead. It isn't always necessary to wait at home for full rehabilitation before returning to work.

Being absent from work can have a significant negative impact on a person's life. It can affect social relationships, a person's sense of self-worth and identity (a major part of how we see ourselves is through what we do for a living), and their sense of belonging to a team amongst colleagues.

Many involved in the return-to-work process “do not fully realise the potential harm that prolonged medically excused time away from work can cause,” says the guideline. “Many think that being away from work reduces stress or allows healing and do not consider that the worker's daily life has been disrupted. With these attitudes, system-induced disability becomes a significant risk.”

Breaking the many steps in the return-to-work process down highlights the importance of rapid and early intervention following an absence from work due to illness or injury and the benefit to returning to the workplace even in a reduced or altered capacity. That there are so many players involved in cases means the cases can get bogged down in slow-moving bureaucratic administration. It is important that workplaces act more swiftly for the best interest of their employee, the company and the community.