5 Things You Need to Know About Supportive Workplaces

 

• We all get health complaints: mostly they are not caused by work, but work may become difficult in the face of the symptoms – i.e. the health complaint is work-relevant. Sometimes people can cope, sometimes they can’t – it depends on the balance between person, the work and the health complaint. Supporting people with health complaints at work is about getting that balance right. It is not enough to just rely on doctors to help your colleague cope with work.

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• The reason some people have difficulty coping is mostly not that they have a more serious condition or injury, it’s because they face obstacles – things that make it difficult for them to cope. The obstacles fall into 3 categories: the person [beliefs and behaviours]; the workplace [job demands, lack of accommodation], the context [process delays, unhelpful policies]. A supportive workplace is one that helps this person, at this time, with this complaint – it is about recognising and overcoming obstacles.

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• You need to be able to do 3 things: identify obstacles, develop a plan to overcome them, and take the appropriate action. It’s not that complicated, more a matter of common sense. But, it helps if you have the right culture and policies. You need a framework for who does what and when, so good communication is crucial.

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• It is vital to act early, before the obstacles become entrenched. Someone needs to act as a case coordinator or buddy – it could be the line manager. They will work with their colleague to figure out why they might be struggling - identify the obstacles and make a plan to tackle them. You must have a policy for who acts as the buddy – everyone must know who it is and what they can do.

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• Action points: commit to a supportive workplace; provide information and advice (the knowledge); foster early reporting of work-relevant health problems; adopt a can-do approach; engage the person in identifying obstacles and making the work plan; assess the job and offer modified work if needed (just until they are back to normal); contact the doctor if necessary (use a confidentiality waiver); allow graduated return to work plans; keep in touch - monitor progress and revise the plan if there are any setbacks.

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FACT: People can be helped to stay at, and return to, work

 

The pivotal thing is to provide a supportive workplace. There are seven key principles **:

 

FIRST PRINCIPLE: The workplace needs to have a strong commitment to health and safety - demonstrated by behaviours of all workplace parties. It's not just what we say to ourselves and others, it's what we do. As the old saying goes "actions speak louder than words". This is a collaborative issue. Support is needed at senior management level, and from all the employees. This means workers, and their representatives, also need to support inclusion of stay at work and return to work policies. Importantly, it’s not just a matter of management looking after workers - people need to take some personal responsibility for what happens to them. Everyone should aspire to being a coper rather than an avoider, and must engage with those who are helping them deal with their health at work.

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SECOND PRINCIPLE: Employers need to offer modified work, i.e. an accommodating workplace - early and safely. This means providing appropriate modified work, and taking care to ensure there is not an awkward fit for the worker and others. Usually, this can simply be worked out between worker and manager. Simple ergonomic principles apply. Only if there is difficulty coordinating staying at or getting back to work is there any need to consult an ergonomist or health and safety professional.

 

THIRD PRINCIPLE: Case coordinators need to ensure the work plan supports the worker without disadvantaging co-workers and line managers – they may need training in case management skills (in-house or from external suppliers). These coordinators need to ensure the plan supports the worker without disadvantaging co-workers and line managers. Planning how to keep someone at work, or ease them back into the workplace, involves more than just matching the sick or injured worker's abilities to job tasks. It can be seen as a 'socially fragile process' where line managers and co-workers can be thrust into new relationships and routines. If it is not properly managed, this may involve resentment instead of cooperation. Here are good examples of potential problems: (1) the sick or injured worker may have to deal with co-workers who resent having to take over some of their work and therefore feel that the worker has managed to get an ‘easier’ job; and (2) line managers may be expected to get the job done and fulfill production rates in spite of accommodating a sick or injured worker, and can’t see a way to offer the required accommodation. Workplaces that treat sick or injured workers as individuals who anticipate in the arrangements can avoid these pitfalls.

 

FOURTH PRINCIPLE: Line managers need to be comfortable about how to prevent extended sickness absence and work disability, and should be involved in developing plans for Stay at Work and Return to Work. They may need training in case management skills (in-house or from external suppliers). The minimum is to incorporate specific topics into safety training for line managers: (1) how to be positive and empathetic in early contacts with workers; (2) how to arrange modified work; and (3) how to follow-up and problem solve on a regular basis.

 

FIFTH PRINCIPLE: Employers and/or line managers should make early and considerate contact with the absent worker. This appears to be a core component of the process and should be done in a positive way. This means focusing on concern for the worker’s well-being, and avoiding issues such as causation or blame.

 

SIXTH PRINCIPLE: Someone in the company/organisation should be given clear responsibility to coordinate stay at work and return to work to make sure it happens – a designated case coordinator or buddy. Alternatively, the coordination role can be performed by someone external, such as a professional case manager with a direct line of communication to the workplace. Either way, simply having good intentions is not enough. It's important that communications do not break down, and that key actions are not overlooked or forgotten - the case coordinator needs to ensure everyone involved in the work plan knows what is expected of them and when.

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SEVENTH PRINCIPLE: Employers and healthcare providers (such as GP's, physiotherapists, and other practitioners) need to communicate about workplace demands. A key part of this principle is implementing the advice on a fit note. Clearly it is important the 'left and right hand know what each other is doing'. Ideally the worker needs to participate in the communication between employers and healthcare providers. Obtaining the worker’s consent is important – simple confidentiality waivers are useful.

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** adapted from Institute for Work & Health. Seven ‘principles’ for successful return to work. Institute for Work & Health, March 2007

 

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FACT: The workplace is very important

 

Work can be part of the recovery process. It provides all of us with important protective factors for our health, such as: routine, structure to day, social relationships, mental stimulus, self-esteem, activity, and a sense of wellbeing.

 

To achieve this we need to avoid the idea that work is a ‘risk’ and (potentially) harmful to physical and mental health. This is important because it leads to advice to stay off work, undue sick certification, over-cautious risk assessments, and the desire to somehow ‘protect’ the person from work. Certainly some work circumstances are dangerous and undesirable, but most work is beneficial for most people.

 

We need to shift the culture and emphasise that work is healthy, therapeutic and the best form of rehabilitation (while recognising that some work can be a hazard). This can be achieved by ensuring everyone gets advice and support to remain in, and return to, work (that is safe and healthy, described in the good jobs section).

The Challenge: What can you do to help change the culture to one that values work as an important outcome, and avoids the fallacy of thinking that time off work is always in best interest of the person?

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Avoiding the Slide to Disaster

 

If you really wanted to make sure that your employees do not come back to work you could

• Leave it all up to healthcare

• Pay no attention to people who are struggling with a health problem

• Do nothing and make no contact with absent workers

• Refuse to offer workplace modifications

 

Ask Yourself: What will this failure cost you in time and hassle, and what will it cost your company/organisation? Remember this will include recruitment and retraining costs for when you have to replace someone who never returns to work, and overtime costs, agency costs or loss of morale for asking people do more work to cover for the absent colleague over an extended period. Also, don’t forget the poor reputation that organisations with high absence and workforce turnover attract.

 

The contribution of the workplace is vital. You may be surprised to learn that when it comes to helping people stay at, and return to, work the most powerful influences comes from (in this order)

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1. The person with the health complaint, then

2. The line manager (and the level of support and company policy he/she has to operate under), and then

3. Healthcare providers (including doctors, physiotherapists, etc.)

 

This means that one of the most important things any employer can do is to provide a supportive workplace that enables workers to recover from common health problems while working.

 

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Supportive Workplaces

 

The section Supportive Workplace What To Do outlines the practical techniques needed and provides access to the various tools that you will find useful. This part of the toolbox gives you the full understanding of what needs to be done to provide a supportive workplace, why, when, and to whom.

 

We All Get Health Complaints, Only Some are Work-Relevant

 

Principle

When people have health or injury problems the workplace plays an important role in their recovery. Whenever possible we need to help people stay at work, even part time. This maintains their work ability, their skills and daily routine. Most importantly it helps them to stay active and to build resilience and tolerance. If a worker does take sick leave for even a short time we need to help them start back at work as soon as possible. Again, this may be part-time to begin with, building back up to full-time.

 

Quick Facts

We all get symptoms of common health problems at times. Some of us need to take a short time off work, and others don't. Some need to do things a bit differently at work for a while, others cope fine. It depends on the balance between person, the work and the health complaint. Supporting people with health complaints at work is about getting that balance right. It is not enough to just rely on doctors to help your colleague cope with work.

 

The longer someone stays away from work the harder it usually is to get back to work. Some never do - this disaster needs to be prevented.

 

Practical Implications

• There are two crucial things that every line manager needs to know how to do:

  1. Provide reasonable adjustments to the job for a period of time (not for ever). This allows people with health and injury problems the opportunity to stay at work at least part-time, or to begin returning to work. As a line manager you can make a great difference by making it possible for your employee to stay on the job somehow, or to get back quickly and safely. As a worker you can make a great difference by helping to work out what will make this possible and sticking to the plan: it’s always in your interest.

  2. Let people build up gradually as they recover. As humans we are not really like machines that are either on or off. Sometimes we need to be able to work back up ‘through the gears’. This allows us to adapt to our symptoms, to increase our tolerance, and to regain our natural resilience. Participating in our usual activities is healthy (including work), even if we need to do some of them more slowly or in a different way for a few days or weeks as we recover.

 

The Main Reason People are Unable to Stay Active and Working is Because They Face Obstacles

 

Principle

It is a mistake to assume that the reason people don't stay at or return to work is simply because they have more serious illness or more severe injuries. The more important factors influencing work as an outcome are psychosocial. This refers to the factors that contribute to the behaviour of going to work.

 

There are factors that increase the chance someone can and will stay at or return to work. These positive influences are enablers or facilitators. We need to look for these and support them whenever possible.

 

Then there are factors that reduce the chance of staying at or returning to work. These are obstacles. We need to look for these and find ways to help people overcome them.

 

Quick Facts

The reason people with common health problems become inactive and stay off work is mainly due to psychosocial obstacles.

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The easiest way to look for obstacles is to use the Person, Workplace, Context framework.

 

Practical Implications

We all need some key skills as line managers and workers:

 

Identify - identify anyone at work who is struggling to cope with symptoms of common health problems or minor injuries; identify anyone with a fit note; identify anyone who is off work (i.e. reduced hours, or stopped altogether). There are two main ways problems at work can be identified: (1) The individual worker reports problems (e.g. to line manager, OH, or HR), takes time off work or seeks healthcare; or (2) Either the line manager, or a co-worker, notices changes in performance and behaviour. This means the worker may say something to you or other, or you or others may notice something. There are signs you can look and listen for.

 

Work Ability – check people's work ability - how they feel they are coping with work and health.

 

Obstacles – identify any obstacles to staying at work or getting back to work.

 

Plan and Do – plan how to manage those obstacles, and put it into practice.

 

The section Supportive Workplace What To Do describes each of these in detail.

 

 

What's in a Word? 'Barriers' versus 'Obstacles'

 

The term 'barrier' is in common use to describe things that make it difficult or impossible to make progress in all sorts of areas of life. We want to avoid inadvertently encouraging people to feel it is impossible or too difficult to tackle a problem. That is, we don't want you to give up before trying! Barriers are deliberately constructed to stop access; obstacles are things that just happen to be in the way. The main reason we prefer the term 'obstacle' is because it does not give the impression of being solid and immovable. It may help to think of life like an 'obstacle course'. There are some obstacles that you can climb over or under, but others you have to find a way to get around. None of them should be thought of as impenetrable or unassailable. The principle is simple: with the right level of support, encouragement, and problem-solving it is possible for all of us to find ways to tackle the obstacles that get in the way of being active and working.

 

You Need to be Able to Identify and Tackle Obstacles

 

Principle

The most important thing for success is to identify obstacles to staying active and working, and plan to overcome these. Remember there are two types of obstacles: (1) modifiable – these are like hurdles to be overcome; (2) immovable – these are like roadblocks to be sidestepped. The three places to look for obstacles to staying active and working are the Person, their Workplace, and the Context in which they function.

 

Quick Facts

The reason why some people take lots of time off work is usually not because they have a more serious health condition or more severe injury. It’s not about what has happened to them. It’s about why they don’t recover in the normal way – and that is because they face obstacles to recovery and participation. Many of these are in the workplace.

 

Stay at Work and Return to Work does’t just happen – action is needed!

• It is not helpful to rely on healthcare alone - it is not good enough to start thinking about work after healthcare has finished or failed.

• The workplace must be involved from day 1 to help people to continue working whilst recovering.

 

The flip-side of obstacles is things that act as positive influences on work outcomes: having respect for one's employer; feeling satisfied with your job; understanding your health problem; and, experiencing support or incentives from your work colleagues.

 

Practical Implications

• Identify obstacles to staying active and working, that way you can plan to overcome them. There are two types of obstacles, those that are modifiable and those that are not. Avoid falling into the trap of assuming that immovable obstacles cannot be navigated around.

• The three places to look for obstacles to staying active and working are the Person, their Workplace, and the Context in which they function.

  • Person - thoughts, feelings, and behaviours

  • Workplace - workers, line managers

  • Context - family members, co-workers, company policies, etc.

• Tackle obstacles to staying active and working using the Identify, Plan, Action framework.

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Identify Problems Early, and Respond Rapidly

 

Principle

Some people in every workplace will inevitably experience common health problems, even though good jobs reduce their frequency. The sooner they are identified the faster they can be dealt with and this reduces the impact on the workplace and helps maintain productivity. Identify anyone at work who is struggling to cope with symptoms of common health complaints or minor injuries. Identify anyone who is off work (i.e. reduced hours, or stopped altogether).

 

The key thing then is to respond, and to do so rapidly. Do this by:

• Identifying the obstacles to being active and working

• Providing appropriate workplace accommodations and modifications

 

This is the very core of what it means to have a Supportive Workplace.

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Quick Facts

When someone is ill or injured they can be helped to stay at or return to work, either part-time or full-time.

 

Delays result in worse outcomes.

 

Practical Implications

• Always start with the work goal “Same job, Same workplace, and Full-time” unless there is a very specific reason not to (excluding symptoms of the health complaint or injury).

• This often requires temporary modification to their job, and this is what is called an ‘accommodating workplace’.

• The option of changing the work goal (e.g. to a different job, or the same one with permanent modifications) is always available later. However, it should not be the first option and is not the best option for the worker.

 

Actions

 

Line managers and workers need to be able to:

 

1. Recognise when a colleague is struggling to cope with symptoms or injury

2. Respond to anyone who reports symptoms or is off work

3. Quickly and easily evaluate someone’s work ability (i.e. how they feel they are coping with work and health)

4. Identify any obstacles to staying at work or getting back to work

5. Manage workplace obstacles

6. Arrange reasonable modifications to the job for a period of time (not for ever)

7. Help people build up gradually as they recover