Take Home Messages:

The return to work and length of absence of sick or injured workers is influenced by many factors besides physical illness. The time between illness or injury and return to work is often longer than necessary. Psychological factors play an important part of the recovery process, as does the role played by doctors, employers and insurers and the general administrative processes. By addressing these factors, the workplace absences by sick or injured workers may be reduced.
 

Why the research matters: 

Prolonged absences from the workplace by sick or injured worker is both harmful to the individual and a source of significant economic burden. The time between illness or injury and return to work is influenced by many factors and is often longer than necessary. Therefore, it is important that these factors are examined so that these workplace absences can be reduced.
 

What the research involved:

In Canada and the USA, a benefit system called the stay-at-work/return-to-work (SAW/RTW) system determines whether a worker with a medical condition stays at work, or when and how a worker returns to work after they have recovered from illness or injury. This study looked at this process and provided recommendations for improvement.
 

Summary of research findings:

The study made four main recommendations for improving this process to reduce the number of people that are unemployed due to illness or injury:

• Aim to prevent workplace absences caused by medical conditions
  • Only a very small fraction of sick days taken by workers are due to medical advice that work of any kind should be avoided or that the worker cannot physically attend work. Most people can undertake some kind of work, but this may require a modification of their usual tasks.
  • It should not be assumed that just because a medical diagnosis has been made that the worker is unfit for all types of work.
  • Clinicians, employers and insurers need to determine whether the worker’s absence from work is:
    • Medically necessary;
    • Based on the discretion of the patient or the employer: often due to lack of effort to make changes enable the worker to attend work during the illness or recovery; or
    • Unnecessary: due to a medical diagnosis that does not impair the worker’s ability to work, psychological factors such as job dissatisfaction, or due to communication or administration problems
  • Unnecessary prolonged absences from the workplaces are associated with a longer recovery time and the longer a worker is away from work, the less likely they are to return to full time employment. Wherever possible, mechanisms should be put in place to facilitate the earliest possible return to work and resumption of normal activities.
• Address behaviours and circumstances that result in workers being determined as unfit for work and prolong absence from work
  • People have emotional reactions to illness and may face stress, fear and uncertainty following a medical diagnosis. Failing to cope with these emotions may result in a longer recovery time and delay return to work. Return to work programs should include support to enable workers to deal with these emotions.
  • Factors such as workplace stress and job dissatisfaction may impair return to work. These factors should also be addressed by return to work programs.
  • Return to work programs also need to acknowledge that physical illness may trigger psychological problems. The mental health of people with slow recoveries should be assessed and treatment provided if necessary.
  • Financial incentives provided by benefit programs may cause workers to seek a particular diagnosis. Benefit programs should be reviewed to insure that workers have incentives to return to work rather than take sick days.
• Realise that motivation of those involved in facilitating return to work may impact on the effectiveness of the process
  • Doctors rarely receive extra payment for time and effort in managing return to work cases. By providing doctors with financial compensation for the extra work required by return to work cases, a more in depth and effective evaluation and management may be provided beyond only treating the physical condition.
  • Pressure is often placed on the treating doctor to set return to work dates or determine fitness for work, and they may feel pressured to make these assessment based on what the patient wants. Doctors should instead be asked to provide information about the capabilities of the patient and the limitations caused by the condition, with return to work determined by employers and insurers. It should be emphasised to doctors that mechanisms are in place to allow the worker to recover on the job.
  • Employers should be required or given incentives to provide programs that enable workers to recover on the job, such as modifying tasks, and educated about the benefits of facilitating the earliest possible return to work.
• Invest time and resources in improving the current return to work systems
  • Few doctors receive specific training in disability prevention and management. Treating doctors should be educated about their role in the return to work process and appropriate reimbursements provided.
  • Awareness needs to be raised the maintaining normal daily activities and staying physically active speeds up recovery. Doctors should only recommend physical inactivity when absolutely necessary.
  • Improve communication between doctors, employers and insurers.
  • Employers should create detailed job descriptions so that doctors can treat sick or injured workers appropriately.
     

Original research:

Preventing needless work disability by helping people stay employed.

Stay-at-Work and Return-to-Work Process Improvement Committee.

J Occup Environ Med. 2006 Sep;48(9):972-87.

Link to PubMed abstract