Seven “principles” used in return-to-work policies and practices

About impact case studies

This impact case study is part of a series that illustrates the diffusion, uptake and outcomes of Institute for Work & Health research, based upon our research impact model. The model differentiates three types of impact:
Type 1: Evidence of diffusion of research
Type 2: Evidence of research informing decision-making at the policy or organizational level
Type 3: Evidence of societal impact

This is a Type 2 case study

Published: December 2017

In 1997, the Ontario government enacted Bill 99, the Workers’ Compensation Reform Act, that outlined several changes related to return to work (RTW). This bill introduced the responsibility for employers and workers to maintain contact with one another and work cooperatively to achieve “early and safe return-to-work.” This change in practice left workplace parties searching for guidance—for example, what is the right way to stay in touch with injured workers when they’re off work? And what exactly does “early and safe return to work” look like? 

In response, the Institute for Work & Health (IWH) began conducting a series of systematic literature reviews to answer these important questions, focused on identifying the most effective workplace approaches to support RTW, stay at work and recovery for injured and ill workers. These reviews—extensively shared in the scientific community and cited more than 500 times—led to the development of the popular and widely used Seven “Principles” for Successful Return to Work

Seven Principles, an IWH success story

The Seven Principles guide is far and away the top item downloaded from the Institute’s website. From September 1, 2009 to September 21, 2017, Seven Principles was downloaded 19,644 times (total downloads) by 17,585 different people (unique downloads). Its reach extends even further. Over the same time period, the Seven Principles web page has been viewed over 31,000 times, ranking it in the top 20 most viewed pages in the history of IWH’s website. 

People are doing more than just downloading and reading the guide. In 2008, it was adapted into a tool for occupational therapy practice by the Occupational Therapist Educationally Influential (OT EI) Network, in partnership with IWH, the Ontario Society of Occupational Therapists and the College of Occupational Therapists of Ontario. The tool created by the OT EI Network, called Working Together, consolidated the principles into four stages reflecting occupational therapy practice processes. There is also evidence of the guide being adopted as a practice standard in other jurisdictions. For example, the Singapore Association for Occupational Therapists adapted the tool for use as a guide for occupational therapists in Singapore in 2016.

Seven Principles helps build successful RTW programs

The IWH's Seven Principles has been used by workplaces in their RTW and accommodation programs. For example, when management and union representatives at Niagara Health (NH) set out to design and implement a new RTW/accommodation policy and turned to the Ontario Federation of Labour’s Occupational Disability Response Team (ODRT) for guidance, the Seven Principles were a key factor informing the policy development. 

NH is the regional acute-care community hospital system in Ontario’s Niagara region, employing more than 4,800 workers. Employees are represented by three unions: Ontario Nurses’ Association (ONA), Ontario Public Service Employees Union (OPSEU) and Service Employees International Union (SEIU). In 2011, recognizing that their disability management policy needed renewal, NH management and union representatives jointly committed to developing a new RTW/accommodation policy, with support from not-for-profit external advisors and led by the ODRT. 

In developing the new policy, the external advisors incorporated components identified in IWH’s Seven Principles. Flo Paladino, executive vice-president of people and organizational development at NH, noted that IWH research made an important contribution to the design of the new policy, which includes an emphasis on early contact, the integration of supervisors in the development of RTW plans, the provision of education and training to managers and supervisors, and the designation of both disability case managers and—a distinctive feature—union representatives as RTW coordinators.

Paladino also affirmed the success of the initiative. The RTW/Accommodation policy we implemented in 2012 has enabled important improvement in the consistency of efforts to return our valued staff to work after a health absence, she said.

Improvements were found in the quality and consistency of disability management practices at NH, and the new policy was well received by employees returning to work following a health absence. In addition, the success of the strengthened policy was demonstrated by a reduction in average numbers of days off following a work-related injury—from 19.4 days in the three years before the change, to 10.9 days in the three years after. This 45-per-cent improvement was considerably higher than the 25-per-cent improvement seen among a peer group of 29 hospitals over the same time period.