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FOWI Guide

What is a return to work program?

A return to work (RTW) program is a legally required written plan designed to outline the requirements of an injured and/or unwell employee returning to work.

Developing a Return to Work Program

A RTW program is developed on the basis of a medical certificate specifying what the returning employee can and can’t do. The employer (or workplace) then creates an individualised RTW plan outlining duties suitable for the returning employer to undertake until they are completely recovered or have reached their highest level of recovery. This plan also highlights the supports to be provided to the returning employee.

In general, a RTW written plan states:

  • the goals of the RTW program for that individual; and
  • the actions needed to support the returning employee.

Adopting a work design approach when developing an RTW program is critical for success. Unfortunately, work design is often not considered, resulting in unsuccessful RTW programs, which lead to considerable costs for the organisation and the returning employee.

Cost of ineffective RTW programs for organisations

Australian statistics reveal returning employees are absent for an increasingly longer period from work. This greater delayed return has resulted in an increase in the average cost Australian businesses pay for each serious compensation claim, from $5,200 in 2000-2001 to $6,800 in 2014-2015.1 This payment, known as the direct cost of workers’ compensation, includes insurance premiums and payments made directly to the injured or incapacitated worker. This figure is very conservative as it does not include the indirect cost of the RTW programs for Australian businesses such as production losses, and the cost of retraining current staff or training new staff to complete the injured/unwell employee’s job while they recover.

Over 2012-2013, Australian businesses undertaking RTW programs incurred significant financial losses including:2

  • 1.54 billon dollars of lost productivity; and
  • 201 million dollars for retraining existing employees and/or training new staff while the injured/unwell employee is recovering.

These costs are only part of the picture when it comes to the financial losses experienced by Australian businesses undertaking the current RTW programs.
This high turnover of staff also equates to Australian business spending $156 million advertising and recruiting new employees to replace injured or absent workers.3

Cost of ineffective RTW programs to the individual

Staying at or returning to work soon after experiencing a work-related injury or disease can be an important part of an employee’s recovery. Research shows that the longer an unwell employee is away from work, the less likely s/he will ever return. Developing a RTW program is crucial in helping an employee successfully return to work as soon as possible and continue their recovery process in a supportive environment.

Developing an RTW program, without considering work design can result in significant negative consequences such as poorer employee well-being, lack of motivation and lack of meaningfulness in their work.4

Often the response to changes in an employee’s capabilities is to provide them with simplified and unchallenging tasks leaving them unable to utilise their once valued and unique skills, knowledge and abilities.5 In turn, the returning employee may feel they are no longer making a meaningful contribution to their team and/or organisation. Ultimately, this can lead to poor mental health and can result in the employee prematurely leaving their employment.

Work design approach to RTW programs

Work design involves designing and organising work using the employee’s skills, knowledge and abilities to create challenging and meaningful tasks, which are supported by appropriate organisational resources. The primary goal of a work design approach is to optimise positive outcomes for both the organisation and the employee.6

Benefits of work design in RTW programs

A work design approach should be utilised when developing the goals and actions of the RTW program. Adopting a work design approach gives a much more holistic and tailored view of the considerations needed for the returning employee and the organisation.

A work design approach creates collaboration between the returning employee and their organisation. This collaboration ensures the RTW program provides challenging and meaningful work that both the organisation and the returning employee will benefit from, optimising the positive outcomes for all parties involved. Ultimately, a work design approach prevents the ‘round hole/square peg’ perspective which plagues RTW programs.

The benefits of adopting a work design approach for the RTW program include:

  • employees return to work twice as often;
  • half the number of lost work days;7
  • fewer reports of musculoskeletal symptoms;8
  • reduced absenteeism rates for returning employees; and
  • an improved psychosocial work environment, with increased support for the returning employee’s presence at work and great collaboration.9

All of the above have significant financial implications for organisations.

It is important that organisations understand the value of incorporating good work design when modifying the returning employee’s role and working environment. This includes providing the adequate resources to implement a work design based RTW program. For example, providing work design training and/or resources to those developing the RTW program and those supervising the returning employee.

Applying a Work Design-Based RTW Program

The following sections describes the work design based RTW program, and how it can be practically applied so your business can start reaping the benefits sooner.

Critical components of an effective work design-based RTW program are:

  1. Employee involvement and consultation;
  2. Designing SMART work; and
  3. Continually Measuring The Work Design Based RTW Strategies

1. Employee Involvement

Employee participation is crucial when redesigning work roles to ensure a satisfying experience for the returning employee’s and the RTW program in general.

There is a wealth of research evidence supporting the benefits of employee participation, both for the individual and the organisation. Employees who are more involved and have the potential to directly contribute to decision-making have a greater sense of responsibility, are more aligned with their organisation’s vision and values, and experience greater job satisfaction than less involved employees.10 In turn, organisational benefits include enhanced profitability and productivity, lower turnover, and overall greater effectiveness.11

A participatory approach provides all relevant stakeholders with the opportunity to express their view, concerns and ideas and enables a holistic discussion. Consequently, this approach has a greater likelihood of focusing on the critical factors for a sustainable RTW program, like the improving the work environment and team-oriented coordination which are often overlooked.12

Creating participation during the RTW program

A case conference is a method already commonly used in the RTW field. A case conference is a meeting between the relevant stakeholders involved in the RTW program and can occur either face to face or through a teleconference and videoconference. The RTW stakeholders include:

  • the employee;
  • the employer;
  • the treating doctor;
  • the workplace rehabilitation provider; and
  • the insurer.

To ensure a successful outcome, a case conference needs to be well planned with an agenda of the issues/areas to be discussed.

Case conferences provide a vital opportunity for the employee to come up with their own goals of what they would like to achieve with their recovery and to document these goals as part of their recovery plan. At the same time, including all relevant stakeholders provides greater insight into and selection of strategies to assist the returning employee and set appropriate timeframes.

An important note

All communication with the returning employee should be made simple, accessible and be framed positively. For example, instead of focusing on the employee’s injuries, communication should instead focus on their recovery, return to work and regaining full health. This reminds them they have control over their recovery and helps to engage them by removing as many barriers as possible, whether physical or mental.13

For more information regarding how to successfully conduct a RTW case conference, please read the following WorkCover WA fact sheet, which includes a template for developing a case conference plan. Alternatively, watch the WorkCover WA video outlining the RTW case conference program.

Overall, employee involvement creates a win-win situation, as the employee can see their organisation going beyond the legal requirements of compliance standards. At the same time, the organisation reduces their sick leave and staff turnover costs, as the employee returns sooner and is motivated to continue at their workplace.

2. Designing SMART work

There are substantial financial costs associated with a worker leaving their organisation part way through the RTW program due to poorly designed work.

A SMART work design for RTW employees involves a job with the following:

  • S = Stimulating job resources (e.g. meaningful tasks)
  • M = Mastery job resources (e.g., clear expectations)
  • A = Agency job resources (e.g., job control)
  • R = Relational job resources (e.g, supportive supervisors)
  • T = Tolerable demands (e.g., reasonable workloads)

Stimulating job resources (e.g., meaningful tasks)

When people return to work, they need to engage in work that is stimulating and interesting for them.

Giving a returning employee a limited number of tasks to complete in an unlimited timeframe, or only giving them tasks which are unchallenging and boring, are examples of a non-stimulating job. A lack of stimulating job resources can result in the returning worker losing motivation and satisfaction with their current work and organisation, and therefore not staying at work.14

Steps to take include:

  1. Tailoring the work to the needs of the employee by involving the employee in deciding which tasks and responsibilities will be part of their job.
  2. As far as is reasonably practical, ensure the tasks assigned to the returning employee are interesting and meaningful for the employee.
  3. Ensure returning employees understand how the work they are doing is important and useful.

Mastery job resources (e.g., clear expectations)

It is important to ensure that, when people return to work, they are clear about what they need to do so they can master their assigned tasks and experience a sense of competence.

Steps to take include:

  1. Ensure the role has clearly defined goals and objectives, so that the returning employee understands what is expected.
  2. Ensure the supervisor gives the employee regular feedback so the employee knows how s/he is doing, and feels appreciated.
  3. Ensure the returning employee has the skills required to accomplish their work goals. If the returning employee does not have the skills needed, discuss opportunities for skill development with them and their medical professional/s.

Agency job resources (e.g., job control)

The concept of job control is largely concerned with employees having autonomy to complete their tasks.

Job control has two main components:

  1. An employee having discretion in what skills they use to complete their day to day tasks; and
  2. The employee having the authority to make decisions regarding their tasks.15

Ultimately, increasing a returning employee’s control over their work tasks provides job flexibility which is crucial for a successful RTW program.16

Research highlights that it is easier for employees to return to work when they have increased control around planning their work in response to their current health condition and needs.17 Returning employees with low flexibility in the scheduling of their work tasks are more likely to take unplanned leave days.18,19

On the other hand, if an employee can take unscheduled rest breaks, it is likely to increase their active participation in the RTW program by 45% above those who have limited job control.20

Overall, increasing a returning employee’s control over their work schedule and job tasks, improves their experience and the RTW program in general.

There are four steps to increasing the returning employee’s job control:

  1. Provide task autonomy and decision making that enables improved scheduling and skill usage in line with the returning employee’s capabilities. Employee participation is crucial to ensure the returning employee is satisfied with their increased task control. Case conferences involving the employee and their medical professional/s will help determine how to appropriately increase the control around planning work in response to their current health and capabilities.
  2. Train managers to provide supportive supervision, assign increase decision making, and actively encourage participation from the returning employee when determining work objectives.
  3. Develop and maintain a workplace culture which ensures all employees are consulted and can comment on any workplace changes impact on their tasks. A consultative work environment will encourage the returning employee to provide feedback and make decision regarding their work tasks.
  4. Consult with the returning employee when developing and reviewing performance monitoring systems to ensure their input into the evaluation system.

Resource

For more advice and help to increasing job control for you returning employee, please visit the follow link:
SafeWork NSW tip sheet focused on levels of control and work-related stress.

Relational job resources (e.g., supportive supervision)

Creating a supportive work environment provides a positive work experience for an employee who may have had reservations about returning to work.

Research indicates a supportive work environment leads to improved RTW outcomes; a reduced amount of time spent away from work and a reduction in turnover rates.21 Supervisors have an important role, as research shows supervisors who are responsive to an employee’s needs, treat them fairly and are supportive of their recovery greatly aid in their successful adjustment to work after injury or illness.22

Furthermore, supervisors’ daily interactions with the employee enables them to advocate for the employee’s condition and accompanying restrictions to co-workers struggling to understand the RTW program.23 In turn, supervisor support and advocacy for the returning employee helps to reduce stigma surrounding RTW programs and fosters co-worker support. These interactions and support are important for a successful RTW program.

Supervisors are the first line of support, so it is crucial for them understand the requirements and restrictions of the returning employee. Once supervisors have been educated and trained regarding RTW, all employees need to be trained to provide appropriate support for their returning co-worker.

There are five steps involved in building a supportive work environment.

  1. Train supervisors to encourage and establish open communication so a returning employee can discuss their concerns about work-related stressors through their recovery process.
  2. Train supervisors in basic ergonomic principles and in the skills needed to manage the complex psychosocial work environment to increase their understanding and ability to help.24
  3. Ensure supervisors have organisational support and resources behind them so they view their RTW role as a priority and understand the importance of a successful RTW program.25
  4. To help co-workers support and assist the returning employee, it is helpful to involve co-workers in the planning, monitoring and evaluating the RTW program.
  5. Provide additional support and assistant to the returning employee when they undertake new or modified tasks.

Resource

For more advice and help in creating a supportive work environment for you returning employee, refer to the SafeWork NSW tip sheet focused on Support from supervisors and/or co-workers regarding work-related stress.

Tolerable job demands (e.g., reasonable work loads)

High job demands:

Giving a returning employee too many tasks to complete in a limited timeframe, or assigning them to highly emotionally demanding situations, are examples of non-tolerable job demands. For example, a very high workload can be overwhelming when the returning employee is adjusting to their new capabilities.

High job demands can cause stress and ill-health, and consequently the worker could experience a relapse of the health condition that originally caused their work absence.26

Excessive job demands can also impair performance.

Recovering from injury and/or illness is already stressful for an individual which is why employers responding to this with tailored, reasonable job demands can help to reduce their employee’s stress and improve the RTW outcomes. Therefore, it is vital to spend time planning the returning employee’s workload to ensure it is appropriate for their capabilities.

There are five steps that will help you achieve tolerable demands for your returning employee.

  1. The focus needs to be on tailoring the work to the needs of the employee, and this is where employee participation (see employee involvement) is vital. Case conferences involving the worker and their medical professional/s will help to ensure the level of job demands aids in employees’ recovery process.27 This means getting the right balance between having stimulating work (see Stimulating job resources above) and ensuring the work demands remain tolerable.
  2. Provide mastery resources – that is, ensure each task has clearly defined goals and objectives, so that the returning employee understands what is expected.
  3. Provide agency resources, that is, provide the returning employee with autonomy over how to complete their tasks allows them to achieve their appropriate workloads in ways that work for them.
  4. Provide relational resources, that is, train managers to provide supportive supervision. Actively encouraging participation from the returning employee for workload and job design decisions.
  5. Consult with the returning employee when developing and reviewing performance monitoring systems to ensure they accurately capture the workload expectations.

Resource

For more advice and help in creating an appropriate workload for you returning employee, refer to the SafeWork NSW tip sheet focused on role clarity, role conflict and work-related stress. 

3. Continually Measuring The Work Design Based RTW Strategies

The final key feature of a work design based RTW program, is to continually measure the strategies effectiveness.

There should be:

  • Regular monitoring of the work design and redesigns for returning employees, which can be achieved through meeting with the returning employee and asking for their feedback and input into the monitoring process.
  • Ongoing discussions with experts and stakeholders (both internal and external) to help with these refinements.
    • Sources of internal advice can include employees, supervisors, and HR professional. This can be achieved through either interviews or focus groups.
    • External advice can be sought to fill expertise gaps where required from professionals including Organisational Psychologists.
  • Regular monitoring of workplace indicators, by:
    • comparing your internal worker’s compensation data prior to implementing the work designed focused RTW with data collected afterwards. This data can include:
      • the number of leave days an injured and/or unwell employee has taken;
      • the number of complete days the returning worker has stayed at work;
      • turnover data of injured/returning employees;
      • financial data regarding leave and turnover including associated advertising and induction costs.
    • conducting surveys to understand employee perceptions about the RTW programs.

A culture of continuous improvement allows for flexibility and the resources to adapt to workplace changes. At the same time, organisations geared towards continuous improvement can learn from things like near misses and injuries at work and use this information to improve their work design and grow as a company.

Always comply with legal requirements

The most effective way to prevent the need to develop and implement an RTW program is to undertake everything reasonably practical to prevent injury and disease in your workplace. This means ensuring your employees are not exposed to physical and psychological hazards while working.

For more information regarding the Australian and Western Australian Occupational Health and Safety Regulations, please click the following links:

National Occupational Health and Safety

Work Health and Safety Act 2011

Western Australian Occupational Health and Safety

The Occupational Health and Safety Act (1984) WA

Occupational Health and Safety Regulations (1996) WA

However, once an employee becomes injured or unwell at work, ensuring your RTW program is effective by applying a work design approach not only maximise business outcomes but also ensures the individual employee’s well-being.

References

  1. Safe Work Australia. (2017). Australian Workers’ Compensation Statistics: 2015-2016.
  2. Safe Work Australia. (2017). Australian Workers’ Compensation Statistics: 2015-2016.
  3. Safe Work Australia. (2017). Australian Workers’ Compensation Statistics: 2015-2016.    
  4. Haveraaen, L. A., Skarpaas, L. S., Berg, J. E., & Aas, R. W. (2016). Do psychological job demands, decision control and social support predict return to work three months after a return-to-work (RTW) programme? The rapid-RTW cohort study. Work, 53(1), 61-71.
  5. MacEachen, E., Clarke, J., Franche, R. L., Irvin, E., & Workplace-based Return to Work Literature Review Group. (2006). Systematic review of the qualitative literature on return to work after injury. Scandinavian journal of work, environment & health, 32(4), 257-269.
  6. Grant, A. M., & Parker, S. K. (2009). 7 redesigning work design theories: the rise of relational and proactive perspectives. Academy of Management Annals, 3(1), 317-375.
  7. Krause, N., Dasinger, L. K., & Neuhauser, F. (1998). Modified work and return to work: a review of the literature. Journal of Occupational Rehabilitation, 8(2), 113-139.
  8. Moore, J. S., & Garg, A. (1998). The effectiveness of participatory ergonomics in the red meat packing industry evaluation of a corporation. International Journal of Industrial Ergonomics, 21(1), 47-58.
  9. Loisel, P., Gosselin, L., Durand, P., Lemaire, J., Poitras, S., & Abenhaim, L. (2001). Implementation of a participatory ergonomics program in the rehabilitation of workers suffering from subacute back pain. Applied Ergonomics, 32(1), 53-60.
  10. Holland, P., Pyman, A., Cooper, B. K., & Teicher, J. (2011). Employee voice and job satisfaction in Australia: The centrality of direct voice. Human Resource Management, 50(1), 95-111.
  11. Amah, E., & Ahiauzu, A. (2013). Employee involvement and organizational effectiveness. Journal of Management Development, 32(7), 661-674.
  12. Gensby, U., & Husted, M. (2013). Inclusion through action: A participatory approach to return-to-work policy change processes in organizations. International Journal of Disability Management Research, 8(4), 1-16.
  13. Behavioural Insights Unit, the Department of Education (NSW) & Allianz. (2016). Applying Behavioural Insights to Return to Work.
  14. Bakker, A. B., Demerouti, E., De Boer, E., & Schaufeli, W. B. (2003). Job demands and job resources as predictors of absence duration and frequency. Journal of Vocational Behavior, 62(2), 341-356.
  15. Haveraaen, L. A., Skarpaas, L. S., Berg, J. E., & Aas, R. W. (2016). Do psychological job demands, decision control and social support predict return to work three months after a return-to-work (RTW) programme? The rapid-RTW cohort study. Work, 53(1), 61-71.
  16. Krause, N., Dasinger, L. K., & Neuhauser, F. (1998). Modified work and return to work: a review of the literature. Journal of Occupational Rehabilitation, 8(2), 113-139.
  17. Fukuoka, Y., Dracup, K., Takeshima, M., Ishii, N., Makaya, M., Groah, L., & Kyriakidis, E. (2009). Effect of job strain and depressive symptoms upon returning to work after acute coronary syndrome. Social Science & Medicine, 68(10), 1875-1881.
  18. Theorell, T., Harms-Ringdahl, K., Ahlberg-Hulten, G., & Westin, B. (1991). Psychosocial job factors and symptoms from the locomotor system–a multicausal analysis. Scandinavian Journal of Rehabilitation Medicine, 23(3), 165-173.
  19. Kristensen, T. S. (1991). Sickness absence and work strain among Danish slaughterhouse workers: an analysis of absence from work regarded as coping behaviour. Social Science & Medicine, 32(1), 15-27.
  20. Infante-Rivard, C., & Lortie, M. (1996). Prognostic factors for return to work after a first compensated episode of back pain. Occupational and Environmental Medicine, 53(7), 488-494.
  21. Haveraaen, L. A., Skarpaas, L. S., Berg, J. E., & Aas, R. W. (2016). Do psychological job demands, decision control and social support predict return to work three months after a return-to-work (RTW) programme? The rapid-RTW cohort study. Work, 53(1), 61-71.
  22. Gates, L. B. (1993). The role of the supervisor in successful adjustment to work with a disabling condition: Issues for disability policy and practice. Journal of Occupational Rehabilitation, 3(4), 179-190.
  23. Shaw, W. S., Robertson, M. M., Pransky, G., & McLellan, R. K. (2003). Employee perspectives on the role of supervisors to prevent workplace disability after injuries. Journal of Occupational Rehabilitation, 13(3), 129-142.
  24. Baril, R., Clarke, J., Friesen, M., Stock, S., & Cole, D. (2003). Management of return-to-work programs for workers with musculoskeletal disorders: a qualitative study in three Canadian provinces. Social Science & Medicine, 57(11), 2101-2114.
  25. MacEachen, E., Clarke, J., Franche, R. L., Irvin, E., & Workplace-based Return to Work Literature Review Group. (2006). Systematic review of the qualitative literature on return to work after injury. Scandinavian Journal of Work, Environment & Health, 32(4), 257-269.
  26. Janssen, N., Van den Heuvel, W. P. M., Beurskens, A. J. H. M., Nijhuis, F. J. N., Schröer, C. A. P., & Van Eijk, J. T. M. (2003). The demand–control–support model as a predictor of return to work. International Journal of Rehabilitation Research, 26(1), 1-9.
  27. MacEachen, E., Clarke, J., Franche, R. L., Irvin, E., & Workplace-based Return to Work Literature Review Group. (2006). Systematic review of the qualitative literature on return to work after injury. Scandinavian Journal of Work, Environment & Health, 32(4), 257-269.