Management of Management of Sickness Absence & Sickness Absence &

Return to WorkReturn to Work

Dr. John Luby, FFOMDr. John Luby, FFOM

Sickness absence - the scale of the Sickness absence - the scale of the problemproblem

CBI report “Pulling together: 2001 absence and labour CBI report “Pulling together: 2001 absence and labour turnover survey”turnover survey”

Who manages sickness absence?Who manages sickness absence?CBI report “Pulling together: 2001 absence and labour CBI report “Pulling together: 2001 absence and labour

turnover survey”turnover survey”

Absence management toolsAbsence management toolsCIPD Report “Employee absence: a survey of CIPD Report “Employee absence: a survey of management policy and practice” June 2001management policy and practice” June 2001

Risk factors for high sickness Risk factors for high sickness absenceabsence

Labriola M, Lund T & Burr H, 2006Labriola M, Lund T & Burr H, 2006

  (P<0.05)       Odds ratio 95% CI

Work Environment Exposures          

Work with arms lifted, hands twisted       1.3 1.07 - 1.59

Extreme bending / twisting /of neck / back       1.45 1.17 - 1.78

Repetitive, monotonous work       1.25 1.00 - 1.56

Health Behaviour          

Smoking, current       1.61 1.32 - 1.96

Smoking, former       1.32 1.03 - 1.68

Obesity, BMI>30kgs / m²       1.57 1.09 - 2.25

Employer Characteristics          

Public sector       1.26 1.04 - 1.53

Health          

Global self-rated health, poor       1.69 1.29 - 2.19

Background Variables          

Gender, female       1.31 1.08 - 1.59

Age, 1 year incremental steps       1.02 1.01 - 1.03

Management of return to workManagement of return to work

► ““Prolonged absence from one’s normal roles, Prolonged absence from one’s normal roles, including absence from the workplace, is including absence from the workplace, is detrimental to a person’s mental, physical detrimental to a person’s mental, physical and social well being. Physicians should and social well being. Physicians should therefore encourage a patient’s return to therefore encourage a patient’s return to function and work as soon as possible after function and work as soon as possible after an illness or injury.”an illness or injury.”

Consensus statement of the CMA, ACOEM & Consensus statement of the CMA, ACOEM & AAOS.AAOS.

SolutionsSolutions

► There are no “one size fits all” solutionsThere are no “one size fits all” solutions►Management of sickness absence & return Management of sickness absence & return

to work is heavily influence byto work is heavily influence by EconomicsEconomics PoliticsPolitics Social attitudesSocial attitudes LegislationLegislation Workers’ representationWorkers’ representation Management attitudesManagement attitudes Health care worker attitudesHealth care worker attitudes

Negotiation strategies for return to Negotiation strategies for return to

workwork ► SSet the stageet the stage►UUncover the issuesncover the issues► CConfirm the issuesonfirm the issues► CConfirm intent and authorityonfirm intent and authority► EEvaluate the issuesvaluate the issues► SSolve the problemolve the problem► SSatisfaction checkatisfaction check

With apologies to the AMA “A Physician’s Guide to With apologies to the AMA “A Physician’s Guide to return to Work”return to Work”

Return to work issuesReturn to work issues

► RiskRisk► CapacityCapacity► ToleranceTolerance

BackgroundBackground Biomedical ModelsBiomedical Models

►BiopsychosocialBiopsychosocial►Severe objective impairment equals Severe objective impairment equals

disabilitydisability

TestingTesting►Functional capacity evaluationFunctional capacity evaluation

Functional screening questionsFunctional screening questions

1.1. Return to WorkReturn to Work

2.2. The Grocery StoreThe Grocery Store

3.3. The Molehill SignThe Molehill Sign

4.4. The ObstacleThe Obstacle

Christian J. Reducing disability days: healing more Christian J. Reducing disability days: healing more than injury. than injury. J Workers CompJ Workers Comp. 2000:9:30-55.. 2000:9:30-55.

Work prescriptionWork prescription

► Is absence from work medically required?Is absence from work medically required?► Patient condition / job demand mismatch?Patient condition / job demand mismatch?►Medical restrictionsMedical restrictions

What the patient should not do, orWhat the patient should not do, or What the employer should do!What the employer should do!

► Functional limitationsFunctional limitations What the patient is unable to doWhat the patient is unable to do

Predictive factors for return to workPredictive factors for return to work

►EmployeeEmployee AgeAge SexSex Social Social

►Job relatedJob related Task demandsTask demands Organisational Organisational

factorsfactors Physical work Physical work

environmentenvironment

Evaluation of work abilityEvaluation of work ability

►What does the job involve?What does the job involve?►What is the employee’s medical problem?What is the employee’s medical problem?► Is the employee a candidate for medical Is the employee a candidate for medical

retirement?retirement?► Is there a significant risk of substantial harm Is there a significant risk of substantial harm

with work activity?with work activity?► Is the employee physically able to do the Is the employee physically able to do the

job?job?

Impairment and DisabilityImpairment and Disability

► ImpairmentImpairment The loss, loss of use, or derangement of The loss, loss of use, or derangement of

any body part, system or functionany body part, system or function

►DisabilityDisability A decrease in , or the loss or absence of, A decrease in , or the loss or absence of,

the capacity of an individual to meet the capacity of an individual to meet personal, social, or occupational demands, personal, social, or occupational demands, or to meet statutory or regulatory or to meet statutory or regulatory requirements because of an impairmentrequirements because of an impairment

Guidance on medical restrictions & Guidance on medical restrictions & duration of sickness absenceduration of sickness absence

► ACOEM Practice Guidelines ACOEM Practice Guidelines (ISBN 1-883595-42-8)(ISBN 1-883595-42-8) Also good advice on management of return to work Also good advice on management of return to work

► AMA - A Physician’s Guide to Return to Work AMA - A Physician’s Guide to Return to Work (ISBN (ISBN 1-57947-28-7) 1-57947-28-7) Also good advice on management of return to workAlso good advice on management of return to work

► The Medical Disability Advisor: Workplace The Medical Disability Advisor: Workplace Guidelines for Disability Duration Guidelines for Disability Duration (ISBN 1-889010-(ISBN 1-889010-03-0)03-0)

►Official Disability Guidelines Official Disability Guidelines (ISBN 1-880891-22-0)(ISBN 1-880891-22-0)

Thank you!Thank you!