Return to Work

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Introduction

Health conditions that affect working-age people can have a significant impact on their ability to maintain or find employment, which could put the families' financial security at risk. Chronic diseases (cardiovascular diseases, diabetes, cancer, musculoskeletal diseases), accidents and injuries and mental diseases may result in absenteeism and reduced productivity, persistent disability and reduction of income, social exclusion and material deprivation for the families involved. And a negative impact on work life or unemployment can negatively affect physical and mental health needing more medical consultations.

Work is an important component of quality of life. Studies show that not having a job or experiencing work-related issues are associated with lower self-esteem, less self-efficacy, and a weaker belief in one’s ability to perform or return to the workplace. In contrast, engaging in work life provides many benefits: improved mental and physical health, better social support and financial independence; it is a source of identity and contributes to peoples’ social status.

The persons who are recovering from an illness and returning to work after the sick leave may face many challenges. Many continue to experience ongoing negative consequences of the illness itself or the treatment (including pain, fatigue, and low mood), which may, in turn, affect their daily functioning, including work-related aspects. The ability to maintain or return to work depends, on the health conditions and also is importantly influenced by a person’s physical, social, attitudinal and political environment. It is important to understand the work environment resources which could facilitate or hinder the success of the professional transitions since they represent potentially challenging periods in workers’ careers.

Healthcare and Welfare Policies

The problems and challenges faced by people with chronic diseases should be considered when drafting legislation and company regulations designed to help formulate innovative and person-centered responses to effectively manage the workforce and ensure employee wellbeing while ensuring continued employer productivity.

Factors impacting the Return to Work

Barriers:

• Lack of motivation among managers
• Lack of knowledge among managers on
  • employees having health problems
  • the capability of individuals with chronic health problems to continue working
  • to what extent workplace can intervene in employees’ health concerns
• Lack of funding and resources
• Lack of communication within work community
  • Prejudice and stigma associated with health problem
  • Employees fear sharing their health problems
• Supporting RTW/work participation difficult if disease is not detected or treated early on

Facilitators in the implementation of interventions facilitating work participation of employees with chronic health problems:

• Employer’s motivation to foster work participation
• Information available on best practices
• Funding
• Designating the responsibility for designing support practices to a certain quarter at the workplace
• Finding flexible solutions for performing work tasks
• Educating managers and teams
• Culture of openness
• Respect and trust in employees and their work ethic
• Involving employees in planning work adaptations
• Employees stating their needs clearly

Effective management policies and supportive legislation are necessary to support chronically ill workers and help them return to work. These policies can cover professional education and retraining for workers who need to change their roles or duties. Programs to help people to return to work should include inclusion, maintenance of their health, and return to work. Implementing initiatives promoting social inclusion depend on the employers, human resources managers, set of legislative and political rules. Investing in healthcare and welfare policies is necessary to ensure the long-term viability of social security systems for the working-age population.

Intervention Strategies

Many countries have a "quota system" that allocates a percentage of jobs to people with chronic diseases to help employees retain their jobs if they develop an illness while employed.

Certain countries the private sector providers like NGOs and communities help people with decreased ability to reintegrate into workforce. Smooth co-ordination and active co-operation between the health system (treating people and managing their condition through medical rehabilitation), the benefit system (providing income support when needed) and the national employment system ( helping those with sufficient remaining work capacity to find a job) would improve employment outcomes for the people with health problems.

Policy makers should implement measures that promote job retention among people with reduced work capacity. There is need for good incentives to work for people with health issues or disabilities and for the public authorities to provide the necessary employment support and enhance the workers' employability. Employers are key players in preventing health problems at work and facilitating swift return to work for people who are absent due to sickness. Financial incentives are needed for the employer in order to retain the people with sickness. The role of medical professionals and workers' representatives influence the return to work

Important components of RTW interventions are RTW coordination, occupational training or conditioning, workplace-based interventions, work accommodations, and contact between the various stakeholders

actors that have a negative and positive impact on work life as well as needs of persons with chronic health conditions in seven European countries. Our study shed light on the

importance of

• Changing the attitudes of supervisors and co-workers to counteract the stigmatization of persons with chronic health conditions in the workplace.
• Work-related aspects such as career development, stress at the workplace, work structure and schedule as well as workload were also named by the participants as factors having a positive and negative impact on the work life. Our results
• stress the importance to adapt the workplace and environment according to the needs of persons facing chronic health conditions and to enable these persons to maintain a job or return to work in the long run. In light of an aging (work) population and an increase of chronic health conditions in European countries this will be one of the most important tasks employers and politicians have to take into account during the next decades. This study provides first-hand evidence for recommending strategies of integration and reintegration at work for persons with chronic health conditions in European countries.

Factors having an impact on the work

According to the online survey in Seven European Countries the factors identified to have a Negative Effect on the Work Life were

• Work-related aspects: Career development: having difficult advancement opportunities or lack of development when having a chronic health condition; Stress: most frequently impacting the work; Work structure, schedule: Having no breaks leading to stress and worsening of symptom; Workload and work pace: too many duties, high pressure responsibility set by employer.
• Health-related aspects: Problems with concentration; Emotional issues such as anxiety that the person may not be able to perform duty well.
• Stigma: Stigmatization makes it hard to deal with at the workplace. Lack of understanding by the employers, managers or colleagues led to discrimination and conflicts at workplace.

And the factors which Positively impacted the work life:

• Work-related aspects are having a standard salary, employment status (permanent contract/stable position), Flexible work schedule or regular working hours, breaks and working patterns enabled structured daily routine, Short commute time, Job autonomy, diverse job role.
• Person- related aspects: Thoughts, belief and motivation were important for coping with chronic condition: “being creative”, “being calm”, “positive thinking”, “self-discipline”
• Interpersonal relationships: Relationships with colleagues and supervisors play an important role in the integration in the workplace.

The study sheds light on importance of changing the attitudes of supervisors and co-workers to counteract stigmatization of persons with chronic health conditions in the workplace. There is a need for developing new strategies of integration and reintegration at work for persons with chronic health conditions. For instance:

• Work-related aspects to work without interruption, have flexible working models, working hours and fixed or flexible breaks, reduced workload (for less stress and less pressure), workplace to be adapted to the needs of people with health problems (possibility of home office or transportation to and from work), Workplace adaptation to the needs of persons with chronic health conditions (less responsibility, having a choice, no lifting of heavy weights or no external working tasks)
• Financial support, Support of others such as coworkers and supervisors and Service-related support (job-benefits)
• Attitude of colleagues and recognizing the efforts of employee needed to solve the problem stigmatization, discrimination and isolation.

Approaches differ with various occupation

Return to Work varies in different countries

Common principles for successful return to work:

1. The workplace has a strong commitment to health and safety, which is demonstrated by the behaviours of the workplace parties.

2. The employer makes an offer of modified work (also known as work accommodation) to injured/ill workers so they can return early and safely to work activities suitable to their abilities.

3. RTW planners ensure that the plan supports the returning worker without disadvantaging co-workers and supervisors.a

4. Supervisors are trained in work disability prevention and included in RTW planning.

5. The employer makes early and considerate contact with injured/ill workers.

6. Someone has the responsibility to coordinate RTW.

7. Employers and health-care providers communicate with each other about the workplace demands as needed, and with the worker’s consent.

8. The worker has access to multidisciplinary resources (including clinical interventions for the management of pain, disability, depression and poor expectations for recovery), where necessary, working in combination with the other stakeholders.