Developing a Work Accommodation Operating Model for Workplaces and Work Ability Support Services.

PURPOSE: Workplace accommodation can help employees with disabilities remain employed or access employment rather than leave the labor force. However, the workplace accommodation process is still poorly understood and documented. AIM: The aim of this study was to develop a national operating model to make workplace accommodation interactive and procedural for workplaces and work ability support services and lower the threshold to making accommodations. METHODS: The collaborative development process was carried out by a multiprofessional expert team with eleven workplaces in the private and public sectors in Finland. The design of this study was conceptual and developmental. The development process of the operating model consisted of four phases: the orientation phase, the joint planning phase, the implementation advancement phase, and the instilling phase. RESULTS: The operating model has six stages: 1) identifying needs, 2) gathering knowledge, 3) exploring alternatives, 4) selecting solutions, 5) implementing solutions, and 6) monitoring and evaluating. The model defines the actions, roles, and responsibilities for each phase. To help implement the model, we published an information package, a guide, a planning formula, and a video animation in Finnish and Swedish. CONCLUSION: The operating model is a tool that workplaces and work ability support services can use to help working-aged people remain employed or access employment. Future studies should determine the workplace-specific functionality of this model using implementation research.

Changes in Presenteeism Six Months After Returning from Sick Leave Due to Mental Illness.

This study examines how psychological distress (measured by the K10 screening test) and presenteeism (measured by the quality and quantity method) change in the six months after returning to work from having taken a sick leave because of a mental illness. In a manufacturing company with approximately 2,600 employees, 23 employees returned to work after experiencing mental illness between April 2015 and March 2016, and all 23 agreed to participate in the study. We analyzed 18 cases for which we had sufficient data. Two of the employees were absent from work in the sixth month. We performed multilevel analysis for K10 and presenteeism over time on the 16 without recurrence. A significant decreasing trend was observed for both K10 and presenteeism. Eleven of the 16 employees were consistently below the K10 cutoff value of 10 for six months, and 5 had zero presenteeism in the sixth month, whereas 6 employees showed improvement in presenteeism that stopped midway through the study. An occupational physician judged that the employees could work normally with presenteeism of zero. After returning to work, it is important to monitor not only psychiatric symptoms but also presenteeism.

Returning to work after sickness absence due to common mental disorders: study design and baseline findings from an 18 months mixed methods follow-up study in Germany.

BACKGROUND: With nearly 30 % of the general population experiencing one mental disorder in 12 months, common mental disorders (CMDs) are highly prevalent in Germany and mainly affect the workforce. Therefore, the processes of successfully returning to work (RTW) and achieving a sustainable RTW (SRTW) are important not only for recovery but the prevention of negative consequences like job loss or disability retirement. While factors influencing and predicting the time until RTW are well-investigated in other countries, research on determinants of RTW and SRTW has received little attention in Germany. Consequently, this study aims to investigate the RTW and SRTW processes due to CMDs from the employees´ perspective in Germany. METHODS: This prospective cohort study uses a convergent parallel mixed methods design with a quantitative sample and qualitative sub-sample. Two hundred eighty-six participants of the quantitative study and a sub-sample of 32 participants of the qualitative study were included. The primary outcome of the quantitative study is the time until RTW and full RTW. The secondary outcome is the sustainability of RTW. The following measures will be used to cover work-, RTW- and health-related factors: working time, duration of sickness absences, functional ability, work ability, RTW self-efficacy, social support, work-privacy conflict, job satisfaction, job crafting and depressive symptoms. Quantitative and qualitative data will be integrated at the end. DISCUSSION: The paper provides an overview on study design, recruitment, sample characteristics and baseline findings of an 18 months mixed methods follow-up study in Germany. This study will provide evidence of (S)RTW processes and its influencing factors due to CMDs in Germany and therefore contribute to further improvement of its (S)RTW practices. TRIAL REGISTRATION: German Clinical Trials Register (ID: DRKS00010903, July 28, 2017, retrospectively registered).

Return-to-Work Following Depression: What Work Accommodations Do Employers and Human Resources Directors Put in Place?

The magnitude of economic and social costs related to common mental disorders has a profound impact on the workplace. Returning to work following depression is, therefore, a major issue for all stakeholders involved (employee, employer, human resources director, union, physician, etc.). Considering their role in the organization, Human Resources Directors (HRD) and employers have a decisive impact on the return-to-work (RTW) process. Purpose This study aims to determine which RTW accommodations are implemented, following depression, by one of the central stakeholders: HRD and employers. Methods 219 HRD/employers participated in a semi-structured telephone interview about RTW of employees after depression. From that interview, the question related to this article was: Do you put in place work accommodations for employees after a sick leave due to depression (yes or no)? If their response was positive, we asked: If yes, what were the work accommodations? Results 170 HRD/employers specified accommodations. The most common categories identified were related to: work schedule, task modifications, job change and work environment change. Accommodations directly related to the employee or the colleagues were considerably less mentioned and those concerning other RTW stakeholders, including supervisor, were almost absent. Conclusion Our results suggest that accommodations directly related to work aspects seemed to predominate in our sample of HRD/employers when an employee returned-to-work following depression. The relational aspect and the involvement of the different stakeholders are also not prioritized to accommodate the RTW. These results contrast with employer best practice guidelines for the RTW of workers with common mental disorders.

How Can Supervisors Contribute to the Return to Work of Employees Who have Experienced Depression?

Background In Western countries, work disability due to depression is a widespread problem that generates enormous costs. Objective The goal of this study was to determine the types and prevalence of supervisor contributions during the different phases of the return-to-work (RTW) process (before and during the sick-leave absence, and during the RTW preparations) of employees diagnosed with depression. Moreover, we sought to determine which contributions actually facilitate employees' RTW, and to identify the work accommodations most frequently implemented by supervisors at the actual time of their employee's RTW. Methods Telephone interviews were conducted in Québec (Canada) with 74 supervisors working with employees who were already back at work or still on sick leave due to depression. A sub-sample of 46 supervisors who had already taken measures to facilitate their employees' RTW was questioned about the work accommodations implemented. Results Most of the supervisors got along well with their employees before their sick leave and 72% stayed in contact with them during their leave. Nearly 90% of the supervisors encouraged their employees to focus primarily on their recovery before their RTW, but 43% pressured their employees to RTW as soon as possible. Cox regression analyses performed for the entire sample revealed that "the supervisors' intention to take measures to facilitate their employees' RTW" was the only significant predictor of the RTW at the time of the interview. The Kaplan-Meier survival curve showed that 50% of the employees were expected to RTW within the first 8 months of absence. Four of the most frequently implemented work accommodations were actions directly involving the supervisor (i.e. providing assistance, feedback, recognition, and emotional support to the employee). Conclusions This study shed light on the less explored point of view of the supervisor involved in the RTW process of employees post-depression. It highlighted the most frequent and effective supervisor contributions to the process. These results can be used to develop concrete action plans for training supervisors to contribute to the sustainable RTW of employees on sick leave due to depression.

How Do Organizational Policies and Practices Affect Return to Work and Work Role Functioning Following a Musculoskeletal Injury?

Purpose Organizational-level policies and practices that promote safety leadership and practices, disability management and ergonomic policies and practices are considered key contextual determinants of return to work. Our objective was to examine the role of worker-reported organizational policies and practices (OPPs) in return to work (RTW) and work role functioning (WRF) and the mediating role of pain self-efficacy and work accommodation. Methods A worker cohort (n = 577) in Ontario, Canada was followed at 1, 6 and 12 months post injury. Both RTW (yes/no) and WRF (WLQ-16) status (3 levels) were measured. OPPs were measured (high vs. low) at 1 month post-injury. Pain self-efficacy (PSE) and work accommodation (WA) were included in mediation analyses. Results OPPs predicted RTW at 6 months (adjusted OR 1.77; 95 % CI 1.07-2.93) and 12 months (adjusted OR 2.07; 95 % CI 1.18-3.62). OPPs predicted WRF at 6 months, but only the transition from working with limitations to working without limitations (adjusted OR 3.21; 95 % CI 1.92-5.39). At 12 months, OPPs predicted both the transition from not working to working with and without limitations and from not working or working with limitations to working without limitations (adjusted OR 2.13; 95 % CI 1.37-3.30). Offers of WA mediated the relationship between OPPs and both RTW and WRF at 6 months follow-up. PSE mediated the relationship between OPPs and RTW and WRF at 6 months. At 12 months neither mediated the relationship. Conclusions The findings support worker-reported OPPs as key determinants of both RTW and WRF. These results point to the importance of WA and PSE in both RTW and WRF at 6 months.

Work despite poor health? A 14-year follow-up of how individual work accommodations are extending the time to retirement for workers with poor health conditions.

Given many OECD countries' efforts to extend their citizens' working years, research underscores the importance of work accommodations to maintain older workers and enable them to work despite poor health or declines in physical functions. Nevertheless, few studies have investigated the associations between poor health conditions and opportunities to accommodate work in accordance with individual needs and preferences. In this study, we differentiate between three types of poor health conditions (disease, illness, or sickness). We examine the separate effects of these health conditions as well as of possibilities for work accommodations (working hours, pace, planning), on time to retirement. Additionally, we examine the potentially joint effect of poor health and low opportunities for work accommodations. The analyses are based on a representative sample of 1143 Swedish workers from Panel Survey of Ageing and the Elderly (PSAE) with a baseline (2002/2003) age of 55-64 years. Using complementary register data on income, we followed the labor market activity of these individuals until the end of 2015. We employed Cox proportional hazard regression to estimate the time to retirement and adjusted for demographical, socio-economic, and work-related covariates. In comparison to those with good health, having disease, illness, and sickness is associated with a higher risk of earlier exit from the labor market, and the joint effect of poor health and low opportunities for work accommodations increases this risk. High influence to accommodate work while having a disease or sickness supports work participation, while these patterns of associations were not equally consistent for individuals with illness. This study highlights the importance of increasing older individuals' opportunities to make their own work accommodations, particularly in the presence of disease and sickness, and thereby combat the negative effects of poor health on time to retirement.

Work disability negotiations: supervisors' view of work disability and collaboration with occupational health services.

Purpose: To introduce the Finnish practice of collaboration aiming to enhance work participation, to ask supervisors about its reasons and usefulness, to study supervisors' needs when they face work disability, and to compare the experiences of supervisors whose profiles differ. Materials and methods: An online questionnaire based on the Finnish practice of collaboration between supervisor and occupational health services (OHS) went to supervisors in six public and private organizations. A total of 254 supervisors responded, of whom, 133 (52%) had collaborated in work disability negotiations, representing a wide variety with differing professional profiles. Results: In their role of managing work disability, supervisors appeared to benefit from three factors: an explicit company disability management (DM) policy, supervisors' training in DM, and collaboration with OHS. Reasons for work disability negotiations were long or repeated sick-leaves and reduced work performance. Expectations for occupational health consultations focused on finding vocational solutions and on obtaining information. Supervisors assessed the outcomes of collaboration as both vocational and medical. Supervisors with differing professional profiles prioritized slightly different aspects in collaboration. Conclusions: Collaboration with OHS is an important option for supervisors to enhance work modifications and the work participation of employees with work disability. Implications for Rehabilitation Work disability negotiation between supervisor, employee, and occupational health services (OHS) is an effective method to enhance work participation. Collaboration with occupational health can advance work modifications and also lead to medical procedures to improve work performance. Supervisor training, companies' explicit disability management policy, and collaboration with OHSs all advance employee's work participation. Collaboration with OHSs may serve as training for supervisors in their responsibility to support work participation.

Return to work or job transition? Employer dilemmas in taking social responsibility for return to work in local workplace practice.

PURPOSE: The aim was to analyze the role and activities of employers with regard to return to work (RTW), in local workplace practice. METHOD: Semi-structured interviews were conducted with sick-listed workers and their supervisors in 18 workplaces (n = 36). The analytical approach to study the role of employers in RTW was based on the three-domain model of social corporate responsibility. The model illustrates the linkage between corporations and their social environment, and consists of three areas of corporate responsibility: economic, legal and ethical. RESULTS: Employers had difficulties in taking social responsibility for RTW, in that economic considerations regarding their business took precedence over legal and ethical considerations. Employers engaged in either "RTW activities" or "transition activities" that were applied differently depending on how valued sick-listed workers were considered to be to their business, and on the nature of the job (e.g., availability of suitable work adjustments). CONCLUSIONS: This study suggests that Swedish legislation and policies does not always adequately prompt employers to engage in RTW. There is a need for further attention to the organizational conditions for employers to take social responsibility for RTW in the context of business pressure and work intensification. IMPLICATIONS FOR REHABILITATION: Employers may have difficulties in taking social responsibility for RTW when economic considerations regarding their business take precedence over legal and ethical considerations. Rehabilitation professionals should be aware of that outcomes of an RTW process can be influenced by the worker's value to the employer and the nature of the job (e.g., availability of suitable work adjustments). "Low-value" workers at workplaces with limited possibilities to offer workplace adjustments may run a high risk of dismissal. Swedish legislation and policies may need reforms to put more pressure on employers to promote RTW.