New research support phased return to work (PRtW) strategies.

Most agree that good employment practice for phased return to work (PRtW) after ill health or injury is a good thing. However until now, research in this area has been sketchy at best. PRtW strategies tend to be overlooked, perhaps because it is regarded as part of HR and not an operations problem, or more simply not worthy of evaluation. Well that’s changing fast.

With the UK Government committed to clearing over a million people off the benefits list and back to work; and businesses generally looking hard at reducing staff costs, it is not difficult to see where the crosshair is going to fall. What is certain, ill-thought ‘fit to work’ policies, explicit or otherwise, will expose the clumsy business to risk. Even the proposed ‘fit note’ to be issued by GP’s is not guaranteed to facilitate clearer thinking about phased return to work practices.

The support for the principles of PRtW is probably universal. Take the case of Mrs A for example:

Mrs A is a 55 year old administrator. She is contracted to work 37 hours/week over 5 days, mostly seated at a workstation using display screen equipment, with one or two on-site meetings to attend each week.  She is returning to work after an eight month absence for cancer.  During this time she underwent major surgery followed by several months of anti-cancer treatment. She is keen to return to work.  Her doctor supports this and writes to the employer advising that she still suffers from fatigue and would benefit from a phased return to work…

No one I know would hesitate one moment to support Mrs A back to work. However, when the letter lands on the employers’ desk it will not be a person that decides on the PRtW leading to a good outcome and return to work. It will be a policy, and policies are complicated. And when faced with complication, a managers instincts are to simplify a situation.

For example, we almost always think about weeks in even numbers and this has the effect of extending the time away from work, which gives reason to dispense with them altogether. If the person would normally work a non-standard work patterns i.e. shifts, for some reason we seem to think that automatically disqualifies a phased return to work. Why? probably it is too hard to work out and frankly it is easier to “let them go”. Worse decide on a PRtW that is easy to manage rather than being any good. From the available research findings it seems psychosocial factors are set to be the greatest obstacle to PRtW than the medical factors.

Managers who know the employees best can give their feedback to GP’s and physicians, this will modify their habit of rounding up weeks in even numbers. This will reduce the time away from work and avoid alienating the employer. Knowledge about working patterns that phase the return back to work can easily be integrated into standard working practice.  For example, any phased return to work plan that takes longer than five weeks will probably need a second opinion. A key factor of a PRtW plan is momentum. If this is absent, it will fail those it is designed to help. We have a range of PRtW plans validated by a consultant occupational physician that can form part of a strategy to help reduce time, costs and uncertainty for employees like Mrs A – and for the employer for that matter.

Many people’s belief in the employer’s policy about PRtW was found to be weak among all of those likely to be involved in the process. This is not unsurprising given what policy is available is often ambiguous and relies largely on individual opinion. What was interesting was a strong disagreement that PRtW is primarily a HR function.

Communication can quickly breakdown when implementing PRtW, especially when ownership is either claimed or thrust onto one group (e.g. it must be an HR problem), or conversely excludes another (e.g. their manager).  Research has consistently demonstrated, unless measured, managers expressing a policy about what they say they do often bears little resemblance to what they actual do in practice. PRtW may be a strategy waiting for HR to take the lead. What is more certain, is the workplace is being re-defined by market forces, government policies and labour laws. PRtW is a people thing not an ‘instrument’ for cost cutting strategies. That alone is a good enough reason for Managers to get it right.

The author of the original research Dr Matthew Mills BM BS MRCS(ed) AFOM is a Consultant Occupational Physician.

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