Guest blog by Jo Vallom-Smith
Supporting employees in their return to work (RTW) is a core function of occupational health physicians (OHPs) and occupational health advisers (OHAs). Often, these conversations happen in brief, one-off consultations, making efficiency and clarity paramount. This guide focuses on evidence-based RTW strategies that maximise impact in time-limited interactions.
1. Designing a Phased RTW Plan
Length and Structure: Phased RTW plans typically span 4-8 weeks but must be bespoke to the individual. While some general principles can guide planning, such as gradual increases in hours and responsibilities, the pace and structure should be tailored to the employee’s condition, job demands, and recovery progress (Heslin et al., 2022). Factors influencing the length include the nature of the condition (e.g. physical vs. mental health), duration of absence, and workplace support available.
Guidance on Progression: Individual needs and circumstances should guide the progression of work hours or responsibilities. E.g. Shorter RTW Plans: Appropriate for recent, less severe absences where recovery is well-advanced and Longer RTW Plans: Necessary for employees recovering from chronic conditions, managing multi-faceted conditions that involve physical, cognitive, and psychological difficulties, complex job demands, or experiencing fatigue or deconditioning from a prolonged absence. Where feasible, it can be valuable to reassess regularly to adapt the plan based on symptoms, functional capacity, and feedback from the employee and employer.
Incorporating Job Demands: Recognise that a phased RTW is not just about time; it is about managing physical, cognitive, and emotional demands. Begin with less demanding tasks and gradually reintroduce more complex responsibilities.
2. Understanding Job Demands
Physical Demands: Assess whether the role requires higher risk demands such as repetitive movements, prolonged sitting or standing, or heavy lifting; Recommend ergonomic changes or assistive devices to reduce strain.
Cognitive Demands: Determine if the job requires sustained concentration, multitasking, or decision-making under pressure. Suggest strategies like scheduled breaks or limiting complex tasks initially.
Emotional Demands: Address roles with significant interpersonal interaction or conflict potential. Consider phased exposure to challenging interactions.
3. Using Work as Therapy
Therapeutic Value of Work: Work can be a powerful therapeutic tool, fostering a sense of purpose, improving self-esteem, and supporting recovery through meaningful activity (Waddell & Burton, 2006). Returning to work can counteract feelings of isolation and helplessness by providing routine and social interaction.
Building Confidence Through Achievement: Start with achievable tasks to help the employee experience success early in the process. This can build their confidence and readiness for more complex responsibilities. Highlight the role of work in helping employees regain skills and stamina gradually, avoiding the pitfalls of prolonged inactivity.
Monitoring and Adjusting: Although not always feasible, regular check-ins with the employee can ensure that work continues to have a positive impact on recovery. Adjust the workload or pace if signs of symptom exacerbation, fatigue, or stress emerge.
4. Leveraging Multidisciplinary Expertise
The wider offering of the multidisciplinary team may be beneficial for more complex cases needing specialist input. They may also be able to offer face-to-face or workplace assessments as needed.
Occupational Therapists (OTs): OTs are invaluable for many complex cases, particularly where vocational rehabilitation or multi-diagnoses are involved. They can assess functional capacity and recommend strategies for energy conservation, managing cognitive and psychological difficulties, accessibility difficulties and managing complex work demands.
Physiotherapists: Physios are well-placed to support physical recovery, especially for musculoskeletal conditions. They can develop graded exercise programs and advise on ergonomic adjustments to minimise strain and maximise productivity.
Mental Health Professionals: For employees with psychological barriers, involving counsellors, psychologists, or Employee Assistance Programmes (EAPs) can be instrumental in addressing underlying mental health concerns and building resilience.
5. Supporting Employers
Education on RTW: Provide clear guidance to employers about the purpose and structure of phased RTW plans. Emphasise their role in maintaining open communication and supporting adjustments. Consider education for colleagues and managers to understand the employee's condition and its impact.
Addressing Concerns: Help employers understand legal obligations, such as reasonable adjustments under the Equality Act 2010 (UK). Share resources that highlight the return on investment (ROI) of well-supported RTW programmes, such as:
- Chartered Institute of Personnel and Development (CIPD): Reports on the business benefits of workplace health initiatives.
- Society of Occupational Medicine (SOM): Research on productivity gains and cost savings linked to RTW interventions.
- Health and Safety Executive (HSE): Guidance on managing sickness absence effectively and reducing workplace costs.
Practical Tips for Time-Limited Consultations
Be Specific: Avoid general recommendations; focus on actionable, role-specific adjustments.
Focus on Positives: Highlight what the employee can do, using this as a foundation for discussions.
Leverage External Resources: Recommend Access to Work grants, community services, or apps to bridge gaps in workplace support.
Use Technology: Suggest apps or tools that can aid in self-monitoring symptoms, such as fatigue or stress.
Evidence-Based Takeaways
Phased RTW Benefits: Gradual increases in work hours reduce the risk of relapse and build capacity over time (Heslin et al., 2022).
Early and Sustained Support: Proactive interventions during the early stages of absence improve long-term RTW success rates (Black & Frost, 2011).
Workplace Adjustments: Targeted, role-specific adjustments are more effective than generic accommodations in promoting RTW sustainability (Van Oostrom et al., 2009).
Focusing on actionable, evidence-based strategies in RTW consultations allows OHPs and OHAs to support both employees and employers effectively, ensuring sustainable and productive outcomes.
References
- Bakker, A. B., & Demerouti, E. (2007). The Job Demands-Resources model: State of the art. Journal of Managerial Psychology, 22(3), 309-328.
- Black, C., & Frost, D. (2011). Health at work: An independent review of sickness absence. London: The Stationery Office.
- Heslin, M., et al. (2022). Effectiveness of phased return-to-work programs: A systematic review. Journal of Occupational Rehabilitation, 32(4), 543-560.
- NICE. (2021). Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management (NG193). Retrieved from https://www.nice.org.uk/guidance/ng193
- NICE. (2021). Myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome: diagnosis and management (NG206). Retrieved from https://www.nice.org.uk/guidance/ng206
- Sharpe, M., & Bass, C. (2011). Mental health and work: Key considerations in managing RTW. Lancet Psychiatry, 8(3), 253-261.
- Van Oostrom, S. H., et al. (2009). Workplace interventions for preventing work disability. Cochrane Database of Systematic Reviews, (2), CD006955.
- Waddell, G., & Burton, A. K. (2006). Is work good for your health and well-being? London: TSO.
Jo Vallom-Smith is an Occupational Therapist who works in Occupational Health.