Workplace Risk Factors and What Employers Can Do About Them
What’s the most likely outcome?
I often start presentations about disability management and disability with a question: “What’s the most common outcome for an employee who leaves work with an illness or injury?” I’ve asked that question of claims managers, physicians, psychologists, attorneys, and workers’ compensation judges, and I’m always surprised by how long it takes for the audience to come up with the right answer: the worker gets better in a short time and goes back to work. Does that surprise you?
Timely return to work is true for roughly 90-95% of work absences. Yet audiences often fail to think of it, probably because the fraction for whom it doesn’t work out carries most of the total costs and consumes most of our energies - and we have a human tendency to remember the outliers, particularly when they are problematic. Understanding what employers can do to minimize the outliers makes a difference in the health outcomes for workers, and for the bottom line.
As I was reminded by my friend and colleague Dr. Glenn Pransky, former director of the Liberty Mutual Center for Disability Research and one of the foremost world experts in understanding work disability, “at least 90% of successful return to work is negotiated between the employee and employer and has very little to do with medical treatment.”
What impacts return to work?
Here’s what the evidence tells us about returning employees to work:
- Workplace risk factors that contribute to injuries and disabilities include low job control, time-pressured work, long overtime hours, high-physical demand work, and long-duration computer work with insufficient breaks.
- Most treatment options have limited- or poor-quality evidence to support them when it comes to shortening the duration of work absence. In general, high-quality medical care is the best medicine, whether it involves workplace injuries or not, and the most important consideration from the employee’s perspective is to make sure they believe their injuries are being addressed.
- Activity-based interventions (exercise, graduated return to work, vocational rehabilitation, and early return-to-work) have better outcomes than passive modalities.
- By far, the employer plays a bigger role in returning injured workers to their jobs than any other stakeholder.
When working on the American College of Occupational Medicine Guidelines for Disability Prevention and Management, we found a few surprises that are relevant to employers. One is that graduated return to work seems to work best when the injury is serious, and the employee has been out of work for more than six months. With less severe injuries and short-duration absence, return to full duty works as well or better. Similarly, allowing employees to return part-time leads to longer durations when the absence is short, but it shortens durations with more severe injuries and longer absence. Finally, when workplace interventions such as work-hardening are offered for low-back pain, the injured workers report less pain and better quality of life but remain afraid to return to work full duty.
The critical lesson here is that, whenever possible, the best strategy is to work with the employee and his or her physician to reassure them and return them to work full duty as soon as is reasonable.
Supervisors are the employer’s most important resource.
Specific strategies are available for employers that seem to make a difference. Offering modified work schedules and flexible hours helps ease fears about returning to work. Similarly, modifications that help make the job easier, such as assistive devices for heavy occupations, help workers return to work sooner.
This is especially true when the accommodations are made and communicated by the employee’s direct supervisor. Having the supervisor provide additional coaching and guidance, or when necessary, offering training to another job with the same employer, also reduces time out of work.
Well trained, empathetic, and knowledgeable supervisors are an employer’s best resource for keeping employees at work and bringing them back. Calling the employee just to check on them is one of the most effective interventions available. Empathetic responses from supervisors make a huge difference throughout the process. Knowing the company’s policies about leave and return to work is viewed by employees as making the supervisor more trustworthy, and it’s critical that the supervisor has the autonomy to make accommodations that facilitate coming back from an absence.
Finally, when supervisors engage with employees in a negotiation about return to work, if the supervisor is cooperative, empathetic, and flexible, employees are more likely to return to the job and more likely to express satisfaction in the company.
Remember that mental health is health.
As a psychologist, I would be remiss not to mention a critical component of keeping employees at work and helping them return. Remember that mental health is health, full stop.
A key variable in retaining talent and maximizing productivity is a sense of psychological safety, which can be defined as the employee’s belief that their talents and contributions are valued, and that their coworkers will not undermine their efforts.
This isn’t about simply making people “feel good,” and it absolutely doesn’t mean that employees aren’t accountable to standards. It means that expectations are clear, that employees are treated with respect, and that we give them as much autonomy as is appropriate to the job. It means that we support them in their efforts to do their jobs and support them to return if they must be out for an illness or injury.
The bottom line for employers is simple.
It’s not so much the programs we put in place that matter, but rather the way we treat employees, including when they are sick or injured. Making sure that quality care is available is crucial. But It’s even more important to provide physically and mentally safe workplaces, and to train supervisors that bringing employees back to work is a cooperative – and critically important - effort.
About Les Kertay, Ph.D., ABPP
Les Kertay, Ph.D., ABPP, is a licensed and board-certified clinical psychologist with nearly 50 years of clinical experience. He has spent the last 20 years focused on workplace mental health and disability, including in executive positions and consulting for disability insurance and workers’ compensation. Much of that work has focused on helping employers understand how they can create safe workplaces and effective stay-at-work/return-to-work programs, and in educating healthcare professionals. He is currently Senior VP for Behavioral Health at Axiom Medical, helping to build workplace mental health programs designed to deliver timely and appropriate mental health care to employees. Dr. Kertay is also an advisor to the editorial panel for the AMA Guides for the Evaluation of Impairment, served as co-chair for the ACOEM Guidelines for Disability Prevention and Management, and is a member of the Tennessee REWARD program Advisory Committee.
R.E.W.A.R.D. PROGRAM: RETURN EMPLOYEES TO WORK AND REDUCE DISABILITIES
Did you know the REWARD Program Toolkit includes a checklist for providing transitional duty assignments? For more information, download the REWARD Toolkit (tn.gov).
MEET WITH LIKE-MINDED EMPLOYEES
The REWARD Employer Support Network is an ever-growing group of Tennessee employers who are interested in (or are already) running great return-to-work programs. Listen and join the discussion on February 22, 2023 at 9:30 CST guided by Les Kertay, Ph.D., ABPP, guest speaker.
DISCLAIMER
Views expressed in the REWARD Report are solely those of the authors and may not reflect the official policy or position of the Tennessee Bureau of Workers’ Compensation, the Tennessee Court of Workers’ Compensation Claims, the Tennessee Workers’ Compensation Appeals Board, or any other public, private, or nonprofit organization. Information contained in the REWARD Report is for educational purposes only.