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

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Before We Start

 

Remember the goal is to reduce detrimental effect of common health problems on the organisation and its workers. In addition to providing good jobs you can make it possible for people to recover while they stay working by providing a supportive workplace.

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This means the workplace can accommodate people with health problems. By providing temporary modifications you make it possible for anyone to be able to stay at work, or return to work if they do need to have a short time off.

 

If you don't provide a supportive workplace it's effectively a showstopper. Here's the thing to remember - providing temporary modifications at work is far more effective than relying on healthcare alone. When it comes to helping people to keep working you can make this possible. Doctors, physiotherapists and other types of clinicians cannot.

 

The main aspect of a supportive workplace is just that - it offers support when it's needed. Job modifications are simple adjustments to the work or work organisation. The idea is to make things easier for the ill or injured individual with work-relevant symptoms. Job modifications can make the difference between being at work and being off sick. They need to be reasonable and temporary:

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• Reasonable so that they are only used when needed and work well for both the employer and the employee
   

• Temporary so they only last as long as needed

 

Some type of job modification is nearly always possible; it’s just a matter of figuring out the best balance of what and for how long. That needs the manager and worker to talk about it!

Supportive workplaces offer a classic ‘win-win’ scenario:

• Employers and line managers benefit from reduced levels and duration of sickness absence

• Workers benefit from faster recovery and less long-term problems

 

Supportive workplaces allow people to recover safely and quickly as soon as possible.

 

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Action 1. Identify Anyone Struggling to Cope With Symptoms at Work

 

Some people in every workplace will inevitably experience common health problems, 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 both health and productivity.

 

Struggling at work is something that is going to be identified by the worker themselves, or by another person seeing them. This means you should identify anyone at work who is struggling to cope with symptoms of common health complaints or minor injuries.

 

TIP: The most likely way you will recognise that you or someone else at work is struggling will be because their behaviour or productivity has changed.

 

We need to distinguish someone who is struggling to cope and has a work-relevant problem from the informal 'grumbles' about work that everyone has from time to time. You need to distinguish pay attention to the struggling worker from the grumbler.

 

Someone who says things like 'I don't like this job' is probably just grumbling, or having a bad day. However, if there is an obvious change in their behaviour - moving and doing tasks in an awkward or uncomfortable way, or productivity drops - this may be a sign that the person is struggling.

 

For mental health issues and difficulties dealing with stress there is a more detailed list of things to look out for. Again, the key thing is to notice changes that may indicate a work-relevant problem developing.

 

CHECK: Can line managers pick up signs of someone struggling at work? Do you know where to go for more information?

 

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Action 2. Identify Anyone Who is Reporting Problems or is Off Work

 

Everyone has an 'off-day' at work from time to time when we experience symptoms of a common health problem. Nearly everyone bounces back and life goes as before. So far, so good. Occasionally people struggle to return to their previous level of productive activity, or the symptoms seem to grumble on and their ability to cope decreases.

 

The reason why it is so important to identify these people is because you (together with that person) can do some simple things to prevent the problems becoming bigger and lasting longer. As you will learn the two key ways to do this are to tackle obstacles and help people rebuild their resilience.

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This means, in addition to identifying people who are appear to be struggling you need to identify anyone who says they are having difficulties, and anyone who is less productive or taking time off work.

 

TIP: Every workplace needs to have a simple and straightforward process to log reports of common health problems, and to promptly identify anyone who is off work (or doing reduced hours).

 

Aim to be able to do this within hours, not days. Identify Problems Early and Respond Rapidly

 

CHECK: Is there an effective process for knowing as early as possible when any worker is on reduced hours or is off work (and has a fit note).

 

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Action 3. Quickly and Easily Evaluate Someone’s Work Ability

 

Work ability is a measure of how people feel they are coping with work and health. The simplest way to evaluate it is to focus on how they feel they are coping with their work and health. Yes, there is a difference between what someone 'can do' and what they 'will do'. But, what we want to do here is get an overall idea of whether the person believes they are able to do their work. Remember, if you believe you can't do something you probably won't do it.

 

TIP: You can help to prioritise your colleagues who are likely to be most in need of help, by asking a simple question about how they rate their work ability. Work ability is a measure of how people feel they are coping with work and health.

 

“Assume that your work ability at its best has a value of 10 points. How many points would you give your current work ability?”

completely unable to work - 0 - 1 - 2 - 3 - 4 - 5 - 6 - 7 - 8 - 9 - 10 - work ability at its best

 

If your colleague scores 8 to 10, they will probably be able to stay at work (or return to work) with little help. If they score 3 to 7, you need to look for obstacles, devise a plan and start acting – without delay. If they score 0 to 3, they may need quite a lot of help, and you may need to consider getting professional advice. Repeat the question every week or so: your colleague’s score should be improving – if it’s not you need to re-evaluate the obstacles.

 

CHECK: Do line managers know how and when to use the work ability question?

 

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Action 4. Identify Obstacles Making it Difficult to Stay at Work or Get Back to Work

 

The most important thing for success is to identify obstacles to staying active and working, and plan to overcome these.

 

Two Types of Obstacles

• Modifiable – these are like ‘hurdles’ to be overcome

• Immovable – these are like ‘roadblocks’ to be navigated around

 

Three Sources of Obstacles

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

 

TIP: Remember Identify, Plan, Action - identify any obstacles, plan how to overcome them, and put this into action.

 

Guide to Identifying Obstacles

 

 

The Obstacles Question

 

A good way for line managers to pinpoint obstacles is to ask this question: “What three things about your health problem and your work are affecting your work ability – in other words, what’s making it difficult to stay at work, or get back to work?”

 

The answers will help point you to the obstacles that your colleague is struggling with. You should ask this after the work ability question. It will flag up the most important and immediate things that you’ll need to deal with.

 

If your colleague has scored 8 to 10 on the work ability question (see above, in Action 3), you may not need to look any deeper for obstacles, but remember new obstacles can crop up, so keep an eye on their work ability. If they scored 3 to 7 you will need to check the wider range of obstacles. If they scored 0 to 2, you should consider getting professional help in identifying the obstacles and developing the plan.

 

Managers and who are more experienced may want to use stem questions to develop a conversation to identify less obvious obstacles. This sequence of 6 basic questions can reveal person, workplace and context obstacles:

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1. What do you think has caused your problem?

2. What do you expect is going to happen?

3. How are you coping with things?

4. Is it getting you down?

5. When do you think you’ll get back to work?

6. What can be done at work to help?

 

CHECK: Do line managers know where to get the the questions they need to identify obstacles – do they know how and when to use them?

 

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Action 5. Manage Obstacles at the Workplace

 

Staying at work and getting back to work doesn’t just happen – action is needed!

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• It is not helpful to rely only on healthcare

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

 

Remember 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 occur in the workplace.

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The knack for understanding obstacles is to use a problem-solving approach. To be effective in the real world, think about these three aspects

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1. Identify obstacles to being active and working

2. Work out how these can be overcome or sidestepped

3. Get all players onside – so there is consistency, coordination and collaboration

 

TIP: Use the quick reference guides to obstacles for Line Managers and for Workers

 

Effective Interventions - Tools for Supportive Workplaces

 

The toolbox has a wealth of guidance on tackling obstacles. Detailed information is available for each of the following:

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• Information and advice about Health↔Work

• Promoting activity and work

• Dispel myths about how common these problems are, symptoms, activity, and work

• Transitional work arrangements

• Graded Stay at Work and Return to Work programmes

• Negotiated job modifications, and how to end them

• Stay at Work and Return to Work planning

• Case coordination, case management

• Activity scheduling, progressive goals

  • Using Activity Scheduling and Progressive Goals for Common Health Problems

    • Scheduling Activities - Useful to maintain activity level when condition is acute

    • Working to Quota - Useful to increase activity level and build tolerance

    • Planning Activity – Useful when a worker has low mood or less motivation

• Self-help skills

  • Tackling Common Health Problems - Quick Guide for Line Managers

  • Advice and Facts for Workers with Common Health Problems

 

CHECK: Does everyone knows what line managers and workers CAN DO?

 

Line Managers Can

• Prevent harm

• Facilitate Stay at Work and Return to Work

• Maintain contact with the person

• Provide information about job tasks

• Identify potential selected duties

• Facilitate workplace accommodations, temporary modifications

• Enable graduated Return to Work

 

TIP: Use the resources - Developing an Action Plan, Developing a Stay at Work Plan, Developing a Return to Work Plan

 

Workers Can

• Participate collaboratively with line manager

• Identify parts of your job you can still do

• Identify parts of your job you think you will have difficulty with

• Think about things you will need to discuss or negotiate with your line manager and co-workers

• Cooperate with your line manager

• Identify any other problems or obstacles that may make it difficult for you to stay at, or return to, work

 

TIP: Use the resources - Developing an Action Plan, Developing a Stay at Work Plan, Developing a Return to Work Plan

 

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Action 6. Provide Reasonable Modifications to the Job for a Period of Time (not for ever)

 

There are lots of different terms used to describe workplace accommodations, including alternative duties, modified work, selected duties and ‘light duties'.

 

The most important thing about workplace accommodations is that they should be temporary not permanent.

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• Temporary job modifications allow the person to continue working while they recover

• Permanent job modifications mean that the person has a new job description

 

The key practical issue is to work out what is reasonable in the way of temporary job modifications. There is no formula for this!

 

Temporary

 

Supportive workplaces generally need only provide reasonable job modifications or adjustments for a limited period of time.

 

Graduated (graded) programmes to return to full-time work are effective, and usually simple to set up and manage. For common health problems and minor injuries they require periods of days, or a few weeks at most.

 

Reasonable

 

A reasonable accommodation is any modification or adjustment to a job or the work environment that enables a worker to perform essential job functions. The purpose is to enable the employee to stay at work, or return to work, while they are recovering from symptoms of common health problems.

 

Provision of reasonable job accommodation is the foundation of a supportive workplace. It is no one's interest to make, or agree, to unreasonable requests. This means that co-workers, line managers, and others should not be disadvantaged; and they should not experience excessive difficulties. It is all about common sense: ‘what will make it possible for this person to stay at work (at least part-time)?’

 

There are issues that may arise, such as:

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• The sick or injured worker may have to deal with co-workers who resent having to take over some of his or her work and therefore feel that the worker has managed to get an ‘easier’ job.

• Line managers may be required to fulfil production quotas in spite of accommodating a returning worker, and may not have the work that such accommodation requires fully acknowledged.

 

These can be dealt with effectively. Workplaces should create individualised plans that anticipate and avoid these pitfalls, and will be much more likely to have better outcomes.

 

TIP: Use the resource on providing temporary Workplace Accommodations.

 

CHECK: That you have looked at the resource on providing Reasonable Adjustments.

 

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Action 7. Let People Build Up Gradually and Steadily as They Recover

 

A key collaborative role for line managers and workers is to establish, negotiate, and monitor both ‘stay-at-work’ and ‘return-to-work’ programmes.

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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, 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. Be clear about the goal for activity and work.

 

Return to Work Goals

 

When someone is ill or injured they can be helped to stay at or return to work, either part-time or full-time. The possible goals for work involve combinations of:

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• The job – it can be the Same, Modified, or Different

• The workplace – can be the Same, or Different

 

Always start with the work goal “Same job, Same workplace, and Full-time” unless there is a very specific reason not to (other than symptoms of the health complaint or injury). This often requires temporary modification to their job.

 

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.

 

TIP: Use the resources Techniques to increase tolerance and resilience and Graduated return to work and activity

 

Graduated or Phased Return to Work

 

One of the most successful strategies in helping people to return to work, following extended absences, is to implement a graduated or phased programme that involves an increase in work hours, work tasks, or both. Sometimes this reaches a plateau where maximum improvement has been reached; sometimes it allows accurate determination of ability to return to previous job tasks, or the need for being moved into another role. In the absence of a job opening it can also be used as a job trial to demonstrate employability to a prospective employer.

 

There are two key variables: (1) amount and type of job tasks to begin with, and (2) the rate of increase over a specified duration. This is best achieved through careful consideration of the job description and any potential safety issues. It’s a question of balance. For the best success, it is important to ensure that the plan supports the returning worker without disadvantaging co-workers and supervisors.

 

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Finally: A Quick Round-Up

 

Remember that it is you who can make a difference.

 

The basic principle to always follow is do not let what you cannot do interfere with what you can do *

* attributed to John Wooden

 

Ways to Make a Difference

 

DO

Be enabling and facilitating

Focus on ability, not disability

Emphasise what the person can (still) do

 

AVOID

Sabotaging activity and work, or encouraging disability

Asking about how the person has been feeling

Suggesting the person uses their symptom (e.g. pain, fatigue) as their only guide to activity and work