Monitoring progress key in implementing return-to-work program: IWH study

Workplace study of innovative return-to-work program highlights progress and opportunities for improvement

Published: April 28, 2016

With broad support across the workforce for its new comprehensive program for accommodating employees with health impairments, a health-care organization partnered with the Institute for Work & Health (IWH) to identify opportunities to improve return-to-work (RTW) processes and outcomes. The resulting study suggested enhanced training and communication around such questions as who initiates contact with injured workers, how to communicate to co-workers and what work modification might look like for workers with mental health issues.

Led by former IWH Research Associate Dr. Kathryn Skivington, the study was based on interviews with 30 managers and RTW coordinators within 18 months after the introduction of a new return-to-work program at a large health-care organization employing 4,000 people. The study found widespread support for the program and the program’s innovative inclusion of labour and management representatives in RTW planning. It also noted that differing perspectives and priorities between union representatives and managers were still sometimes present. A paper based on this study has been accepted for publication in the journal Work (doi:10.3233/WOR-162437).

The message here for other organizations introducing or updating RTW programs is that, even with widespread management and labour support for these programs, areas of uncertainty will arise during implementation, says IWH President Dr. Cam Mustard, a senior scientist and co-author on the paper. Monitoring the implementation process helps identify areas where roles and procedures need to be clarified.

Program shaped by evidence

The health-care organization involved in this study introduced the new RTW program to improve the consistency of disability case management and accommodation. The new program was comprehensive in that it included all the components identified in a 2012 systematic review by Dr. Ulrik Gensby, currently a visiting scientist at IWH, and in the Institute’s Seven “Principles” for Successful Return to Work.

One distinctive aspect of the program was the recruitment of union representatives to act as RTW coordinators, such that every returning worker would have a representative from his or her own union to support the development of a return-to-work plan. RTW coordinators worked alongside the organization’s occupational health and safety department, which was responsible for managing the RTW process. Some of the RTW coordinators undertook RTW duties in addition to their regular work; others set aside time out of their union work to perform their RTW coordination.

In her paper, Skivington highlights a number of implementation issues described by the managers and RTW coordinators interviewed for the study—the kinds of issues that often pose challenges to RTW processes in other workplaces, as well. For example, some coordinators and managers expressed uncertainty over when to initiate contact with absent workers and who was specifically responsible for it. Some wondered how to support returning workers without disadvantaging co-workers. Some grappled with the tension between the need to protect injured workers’ privacy and the idea that greater communication within a team may facilitate better teamwork.

Supporting the return of workers with mental health conditions was also identified as a challenge. Some felt that they did not have the training to provide the appropriate accommodation for workers with mental health issues, especially those with recurring, episodic problems. The lack of confidence to deal with mental health issues points to a real need for high quality research on effective RTW practices in mental health disability episodes, says Skivington.

Divergent perspectives remained

Although the program was set up to involve both managers and union representatives in the process of returning people to work, the study found that participants sometimes had divergent views on certain implementation issues. One example was the pressure identified by some managers to stay within budget and maintain quality patient care while accommodating employees with modified duties in their department, whereas some union representatives placed a higher priority on the quality of the accommodation.

It’s in the nature of this collaborative model that there will be times when perspectives of the employer and of the labour union are different, and that’s the point, says Mustard. When those differences arise, they are discussed and resolved in the process of deciding how to best provide accommodation to an employee. Indeed, the process of talking through these issues allows participants to better understand each others’ perspectives.

This study is part of a larger evaluation of the new RTW program at the health-care organization, including an analysis of the program’s impact on disability days and worker satisfaction with the program. Watch for more in a future issue of At Work.