Adding value for clients during work disability assessments: A qualitative exploration from the perspective of medical examiners.

BACKGROUND: Value-based healthcare delivery focuses on optimizing care provided by measuring the healthcare outcomes which are most important to the clients relative to the total care costs. However, the understanding of what adds value for clients during work disability assessment is lacking. OBJECTIVE: To explore what medical examiners (MEs) perceive as valuable during the work disability assessment process, by exploring possible: 1) facilitators, 2) barriers and 3) opportunities to add value for the client during the work disability assessment. METHODS: For this explorative qualitative study, 7 semi-structured interviews were conducted with MEs in the Netherlands. Thematic coding was performed for all interviews. RESULTS: A large variety of facilitators (n = 22), barriers (n = 17) and opportunities (n = 11) were identified and inductively subdivided into four main themes: 1) coherent process, including all time related aspects, 2) interdisciplinary collaboration, including all aspects related to the collaboration between the ME and other professionals, 3) client-centred interaction, including all aspects related to the supportive interplay from the ME towards the client, and 4) information provision on all aspects during the work disability assessment process towards the client to ensure a valuable work disability assessment process. CONCLUSIONS: The overview of identified possible facilitators, barriers and opportunities to add value for clients from the perspective of the ME may stimulate improvement in the current work disability assessment practice and to better match the client needs.

Towards person-centred work-focused healthcare for people with cardiovascular disease: a qualitative exploration of patients' experiences and needs.

PURPOSE: To explore the experiences and needs concerning work-focused healthcare of patients experiencing problems with work participation due to cardiovascular disease based on all facets of person-centred care. METHODS: Nineteen patients who experienced or continue to experience problems with work participation due to cardiovascular disease participated in semi-structured interviews preceded by preparatory written assignments. The transcripts were analysed by means of directed qualitative content analysis. Adapted principles of the Picker Institute for Person-Centred Care provided a template for the analysis. RESULTS: 28 experiences and needs emerged and were grouped into the eight principles for person-centred work-focused healthcare. Randomly presenting one theme for each of the eight principles, the themes included: (1) frequent encounters with occupational healthcare professionals; (2) substantive work-related advice; (3) transparency in communication; (4) support for family; (5) information provision on the work-focused healthcare process; (6) personal control during the process; (7) empathy for the personal situation; and (8) tailored work-focused support. CONCLUSIONS: The identified experiences and needs for work-focused healthcare of patients experiencing problems with work participation due to cardiovascular disease clearly indicate the need to improve the delivery of person-centred work-focused healthcare to better meet the individual needs of patients.

Provided work-focused healthcare services do not always align with the patient's needs when experiencing disease-related sick leave, potentially impacting their ability to stay in or return to work.This overview of patients' experiences and needs for work-focused healthcare may provide professionals with better insight into the patients' needs and aids to adapt the healthcare provision to these needs.When professionals target the patient's needs, it may facilitate better provision of person-centred work-focused healthcare.

Work-focused healthcare from the perspective of employees living with cardiovascular disease: a patient experience journey mapping study.

BACKGROUND: People living with cardiovascular diseases (CVD) often experience work participation problems. Good work-focused healthcare, defined as the received advice, treatment, and guidance focusing on work participation, can support the patient and work place. However, experiences with work-focused healthcare are generally not always positive which is a barrier for work participation. Therefore, the objective of this study is to gain insight into the work-focused healthcare journey from the perspective of patients with work participation problems due to CVD, to understand their experiences and needs, and to derive opportunities for improving work-focused healthcare service at a system level. METHODS: Semi-structured interviews, preceded by preparatory assignments, were conducted with 17 patients who experience(d) work participation problems due to CVD. The patient experience journey map (PEJM) approach was used to visualize the patients' work-focused healthcare journey, including experiences and needs over time and place, from which opportunities to improve work-focused healthcare from the patient's perspective were derived. RESULTS: An aggregated PEJM consisting of six phases was composed and graphically mapped. The first phase, working, represents a period in which CVD health problems and subsequent functional limitations occur. The next two phases, short- and long-term sick leave, represent a period of full sick leave. The last three phases, start-, partial-, and full vocational reintegration, focus on the process of return to work that takes place ranging from a few months up to several years after sick-listing. For each phase the touchpoints, timespan, stakeholders, activities, experiences and needs from the perspective of the patients were identified. Finally, for better work-focused healthcare nine opportunities for improvement were derived from the PEJM, e.g. emphasize the need for work adjustment prior to the medical intervention, provide more personalized advice on handling work limitations, and putting more compelling pressure on the employer to create suitable work positions for their employees. DISCUSSION/CONCLUSION: This paper contributes insights to provide a more patient-centered work-focused healthcare trajectory for patients employed in paid jobs when living with CVD. The PEJM provides an understanding of the patients' perspectives throughout their work-focused healthcare journey and highlights opportunities for improvement towards a better suited and seamless patient journey, Although this research was conducted within the Dutch healthcare system, it can be assumed that the findings on integrated work-focused healthcare are largly transferable to other healthcare systems.

Development of the core of an ICF-based instrument for the assessment of work capacity and guidance in return to work of employees on sick leave: a multidisciplinary modified Delphi study.

BACKGROUND: Several occupational health disciplines are involved in return to work guidance, implying that good interdisciplinary collaboration is important. A shared conceptual framework and a common language for the assessment of work capacity and guidance in return to work is expected to be at the benefit of appropriate and sustainable employability of sick employees. The International Classification of Functioning, Disability and Health (ICF) can be considered a shared conceptual framework and is also promising in terms of a common language. The purpose of the current study is to reach multidisciplinary consensus among occupational health professionals on the content of an ICF-based instrument for the assessment of work capacity and guidance in return to work. METHODS: To obtain multidisciplinary consensus we conducted a modified Delphi study among twelve occupational health experts, including four occupational physicians, four insurance physicians and four labour experts. The study included two e-mail rounds and two virtual meetings. In the consecutive rounds the experts assessed ICF items as well as a list of non-ICF-based work-related environmental factors on their relevance for the assessment of the work capacity and guidance in return to work together with their interpretability. RESULTS: The four consecutive Delphi rounds resulted in 20 items that are minimally needed for the assessment of the work capacity and return to work possibilities of employees on sick leave. The final list included six items on personal functioning, seven items on social functioning and seven items on physical functioning. CONCLUSIONS: This set of items forms the core of an ICF-based instrument, which is expected to facilitate interdisciplinary and intradisciplinary communication because of the use of a shared conceptual framework. As such, it should be of help in the guidance in return to work of employees on sick leave and contribute to appropriate and sustainable employability.

The effect of the Progressive Goal Attainment Program on cognitions, perceptions, and work participation of workers with chronic health problems: study protocol for a randomized controlled trial.

BACKGROUND: Cognitions and perceptions of workers with chronic health problems, such as catastrophizing thoughts and fear-avoidance beliefs, can negatively influence work participation. The Progressive Goal Attainment Program (PGAP) is an intervention developed in Canada with the aim of decreasing limiting cognitions and perceptions and increasing work participation. The objective of this protocol article is to describe the design of a randomized controlled superiority trial to study whether PGAP is effective in decreasing limiting cognitions and perceptions and increasing workability and work participation of workers with chronic health problems in the Netherlands. METHODS: This study is a randomized controlled superiority trial with two (parallel) groups, in which workers on sick leave are randomly assigned to an intervention group (PGAP intervention) or to a waiting-list control group (care as usual). The PGAP intervention consists of a maximum of 10 weekly individual sessions provided by a trained PGAP professional in which the worker learns about staying active, planning activities, and setting goals. Participants in this risk-targeted behavioral activation intervention also learn to be more aware of their cognitions and perceptions and learn about solution-focused problem-solving skills in challenging situations. The primary outcome is the degree of catastrophizing. Secondary outcomes are other personal cognitions and perceptions (e.g., expectations regarding return to work, self-efficacy), health symptoms (e.g., fatigue, depression), work participation (e.g., sick leave status, work hours), and other work-related outcomes (e.g., workability, quality of working life). DISCUSSION: Although PGAP shows positive effects in Canada, we do not know whether this intervention is effective in the Netherlands. This study is the first randomized controlled trial to test the effect of PGAP on limiting cognitions and perceptions and on work participation of workers with chronic health problems in the Netherlands. If PGAP is effective it could be implemented in the Netherlands in order to stimulate workability and work participation of workers. TRIAL REGISTRATION: The protocol of this study is registered in the Netherlands Trial Register (NL9832) in October 2021.

The relationship between the living lab approach and successful implementation of healthcare innovations: an integrative review.

OBJECTIVES: The concept of living labs as a research method to enhance participation of end-users in the development and implementation process of an innovation, gained increasing attention over the past decade. A living lab can be characterised by five key components: user-centric, cocreation, real-life context, test innovation and open innovation. The purpose of this integrative literature review was to summarise the literature on the relationship between the living lab approach and successful implementation of healthcare innovations. METHODS: An integrative literature review searching PubMed, EMBASE, PsycINFO and Cinahl databases between January 2000 and December 2019. Studies were included when a living lab approach was used to implement innovations in healthcare and implementation outcomes were reported. Included studies evaluated at least one of the following implementation outcomes: acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration or sustainability. Quality was assessed based on a tool developed by Hawker et al. RESULTS: Of the 1173 retrieved articles, 30 studies were included of which 11 of high quality. Most studies involved a combination of patients/public (N=23) and providers (N=17) as key stakeholders in the living lab approach. Living lab components were mostly applied in the development phase of innovations (N=21). The majority of studies reported on achievement of acceptability (N=22) and feasibility (N=17) in terms of implementation outcomes. A broader spectrum of implementation outcomes was only evaluated in one study. We found that in particular six success factors were mentioned for the added-value of using living lab components for healthcare innovations: leadership, involvement, timing, openness, organisational support and ownership. CONCLUSIONS: The living lab approach showed to contribute to successful implementation outcomes. This integrative review suggests that using a living lab approach fosters collaboration and participation in the development and implementation of new healthcare innovations. PROSPERO REGISTRATION NUMBER: CRD42020166895.

Workers' views on involving significant others in occupational health care: a focus group study among workers with a chronic disease.

PURPOSE: To explore workers' views and considerations on involving their significant others (SOs) in occupational health care. METHODS: Four focus group interviews in the Netherlands, with 21 workers who had visited an occupational health physician (OHP) due to work absence caused by a chronic disease. Data was analyzed using thematic analysis. RESULTS: We distinguished four main themes: (i) attitudes towards involving SOs, (ii) preferences on how to involve SOs, (iii) benefits of involving SOs, and (iv) concerns with regard to involving SOs. Workers expressed both positive and critical opinions about involving SOs in occupational health care. Benefits mentioned included provision of emotional and informational support by SOs before, during, and after consultations. According to workers, support from SOs can be enhanced by informing SOs about re-integration plans and involving them in decision making. However, workers were concerned about overburdening SOs, and receiving unwanted support from them. CONCLUSIONS: According to interviewed workers, engagement of SOs in occupational health care can help workers with a chronic disease in their recovery and return to work. However, they felt it is important to take SO characteristics and the worker's circumstances and preferences into account, and to balance the potential benefits and drawbacks of involving SOs.Implications for rehabilitationThis study suggests that the worker's re-integration process could benefit from informing significant others about the return to work plans, involving them in decision-making, and explicitly discussing how the significant other can support the worker.Occupational health physicians have an important role in informing workers about the possibility and potential benefits of involving their significant others in the re-integration process.The involvement of a significant other in the re-integration process needs to be tailored to the specific situation of the individual worker, taking into account the preferences of both the worker and significant other.Findings suggest that it is important that occupational health physicians, workers and significant others are not only aware of the possible benefits of significant other involvement, but also of potential drawbacks such as interference during consultations, overburdening significant others, and significant others providing unwanted support.

Assessing significant others' cognitions and behavioral responses in occupational health care for workers with a chronic disease.

PURPOSE: To examine current practices of occupational health professionals in assessing significant others' cognitions and behavioral responses that may influence work outcomes of workers with a chronic disease. METHODS: A survey study among occupational health professionals, focusing on the assessment of illness perceptions, work-related beliefs and expectations, and behavioral responses of significant others of workers with a chronic disease. We performed linear regression analyses to investigate which factors are related to occupational health professionals' assessment practices. We used thematic analysis to analyze qualitative data on occupational health professionals' reasons to assess or overlook significant others' cognitions and behavioral responses. RESULTS: Our study sample included 192 occupational health professionals. Most seldom asked about significant others' cognitions and behavioral responses. Organizational norms and occupational health professionals' self-efficacy were related to reported assessment practices. Reasons to assess significant others' cognitions and behavioral responses included recognizing their influence on work participation, and occurrence of stagnation. However, occupational health professionals indicated some doubt whether such assessment would always contribute to better care. CONCLUSIONS: It is not common practice for occupational health professionals to assess significant others' cognitions and behavioral responses, although they recognize the influence of these factors on work outcomes. More research is needed as to how occupational health professionals can best address the role of significant others, and apply these new insights in their daily practice.Implications for rehabilitationMost occupational health professionals do not commonly ask about significant others' cognitions and behavioral responses despite the possible influence of these factors on work outcomes.Occupational health professionals may be able to better support workers with a chronic disease by paying more attention to the influence of significant others.Aside from asking about practical support, occupational health professionals should consider asking about significant others' illness perceptions, work-related beliefs and expectations, and other behavioral responses.

Influence of significant others on work participation of individuals with chronic diseases: a systematic review.

OBJECTIVE: It is widely recognised that significant others (SOs), such as a partner, family member or friend, can influence health outcomes of individuals with a chronic disease. However, not much is known about which specific cognitions (ie, illness perceptions and expectation of work ability) and behaviours (eg, emotional and practical support) of SOs influence work participation. Therefore, we aimed to identify cognitions and behaviours of SOs that are related to work participation of individuals with a chronic disease. DESIGN: A systematic review and thematic synthesis. DATA SOURCES: PubMed, Embase, PsycINFO, SocINDEX and Web of Science were searched until 28 March 2017. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: We included studies reporting on cognitions and behaviours of SOs related to work participation in populations with various chronic diseases. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers extracted the data and performed a quality assessment using the Quality Assessment Tool for Quantitative Studies from the Effective Public Health Practice Project 2007 and a checklist for assessment of qualitative studies derived from the Cochrane Supplemental Handbook Guidance. Evidence was thematically synthesised. RESULTS: Out of 5168 articles, 18 were included (15 qualitative and 3 quantitative) of moderate to high quality. Studies were on cancer, chronic pain, brain injuries and mental health disorders. After thematic synthesis 27 factors could be distinguished. Consistent evidence was found that SOs' positive and encouraging attitudes regarding work participation, encouragement and motivating behaviour and open communication with patients are facilitators for work participation. Consistently reported barriers were SOs' positive attitudes towards sickness absence and advise, encouragement or pressure to refrain from work. CONCLUSIONS: Our findings show that several cognitions and behaviours of SOs can facilitate or hinder work participation of individuals with a chronic disease. Intervening on these factors by involving SOs in disability prevention and return to work intervention strategies may be beneficial. More prognostic studies are needed, as the current evidence is mostly based on qualitative studies.