Does bipartite return-to-work policy work? - Work Wellness and

Manager Involvement in Work Re-Integration? Karin Maiwald Agnes Meershoek, Angelique de Rijk, Frans Nijhuis Policy on manager involvement in work re-integration: Managers’ experiences in a Canadian setting WORK: A Journal of Prevention, Assessment & Rehabilitation. 2014; 49(3):483-494.

Work disability with sickness absence • • • •

Economic & sociological problem Ambition: work participation and social inclusion Early interventions Reduce work participation problems -correct medical diagnosis -understanding workers’ situation & health related problems • avoid worsening symptoms and limitations • get the necessary support

• Bipartite approach • Main research question large study: “Does the bipartite approach function for addressing work disability with sickness absence?” Work-Health Connexion Consulting

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This study: Managers’ experiences with the return-to-work policy Overview today • The policy studied • The policy evaluation approach • Managers’ struggle to implement the policy • Inflexibility & inability of arrangements • What to do? Three proposals

Work-Health Connexion Consulting

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The policy studied • Reformed disability management (2009) in British Columbia Healthcare setting • Specific strategy: Collaborative return-to-work planning • Various other strategies


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Social arrangements public healthcare system

provincial workers compensation benefits

employment based short term disability benefits

insurance corporation of British Columbia

provincial social assistance disability benefit

other disability schemes and support programs employment based long term disability benefits


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Selected policy evaluation approach • Policies often turn out differently & in unexpected ways in practice • Discretionary space -individual differences & circumstances -transformations • Interpreted -professional norms, social customs, etc. • Unpredictable consequences Work-Health Connexion Consulting

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Aim & RQ • How are the managers experiencing their NEW role in organizing RTW trajectories and do they consider the policy as supportive for work reintegration process? • Insight in the practice ---> adjust(ed) to the dynamics in daily practice


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Methods • • • •

Study setting Qualitative research design Clinical managers & direct supervisors Purposive sampling strategies


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Table 1 Detailed summary of participant characteristics Clinical managers and supervisors (10 interviewees) Participants supervise(d) workers Medical disorder with cause of sickness absence of Orthopaedic* (as diagnosed by physician)

Positions Age Gender Health care services *

Work-related Not-work related Motor vehicle accidents

Systemic Mental disorder Regional Supervisor; Team Director; Team Leader; Clinical Supervisor; Regional Practice Lead; Charge Nurse; Supervisor 35-60 years of age 8 Female 2 Male Hospital; Community Health Centre; Clinic; Residential Care

The type of health problem is categorized according to insurance coverage. Motor-vehicle accidents which are not work related fall under a different coverage than non-work related illness or injury.

Methods • • • • • •

Study setting Qualitative research design Clinical managers & direct supervisors Purposive sampling strategies Ten in-depth interviews Analysis


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Findings • Three main phases 1. Return to work plan design 2. Execution of the return-to-work plan 3. Final integration strategy RTW is not clearly structured—not simply onward & upward and ever evolving Work-Health Connexion Consulting

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1. RTW plan design: Feeling unheard • Policies & procedures unclear to them • Expected routine not happening • Concerned @ RTW plan development


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They said: “Well, she can come back supernumerary.” And I said, “What do you mean, supernumerary? I’m three positions down. So there’s no way you can come and be somebody’s shadow here. It doesn’t work like that”. Details are not worked out


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2. Execution of the RTW plan: Getting frustrated • Key role I think that the manager has a really key role in helping the employee see what’s happening in the workplace. I think that’s the extent of it. We have to help them and that we’re interested in having them back to work but not having them back to work if they’re not able. (…) if they’re not able [to complete work], then it becomes a risk issue for themselves and a risk issue for care. Work-Health Connexion Consulting

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2. Execution of the RTW plan: Getting frustrated • Workers did not function as well as expected • Difficulties create unwanted tension • Unfulfilled expectations on monitoring -Not responding in a timely manner -Countered to follow set structures -Countered to follow agreements


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3. Final RTW strategy: Getting overextended • Workers’ capacity: unpredictable & unexpected limitations (RTW trajectory is capricious) • Healthcare service delivery difficulties create tension


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He is needing to be directed much more than he did prior to going off on his illness. He is missing treatments and medications and, you know, those small mistakes that I don’t believe he ever made prior to being off.


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3. Final RTW strategy: Getting overextended • Workers’ capacity: unpredictable & unexpected limitations (RTW trajectory is capricious) • Healthcare service delivery difficulties create tension • + Tension: promotion opportunities • Lack of follow up care by the OH professionals


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They didn’t understand the disabilities we were talking about (…) The people in terms of [name organization] were useless, absolutely non helpful.


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Good experiences reported • Understanding  shift in relationship(s).. • Interactions with Physician • Exchanges with other knowledge allies Effort (and took time)


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I had to do a lot of work around articulating what we were seeing and whether that made any sense for him and gave him stuff to take to his physician. (…) What worked well was finally to help both this employee and his physician realize that by continuing to put him in the workplace he was going to lose any prospective (…) which in my mind was completely unfair. Work-Health Connexion Consulting

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Tension formal rules & daily practice • DM program (RTW policy) did not comply with the work managers had to do: -In early RTW planning input moments: they do not know -In RTW plan execution: expected to support & think along, yet encountered lack of recognition -In final strategy: cannot get or keep adjustment(s) in place in all situations Managers are in a tough spot! Work-Health Connexion Consulting

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Paradox • Common in this context: Workers also struggled in receiving RTW services • Managers and workers: Given responsibility, but cannot complete these in daily practice • Plus: managers feel they cannot get blamed for poorly implemented policy


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What to do: Three proposals Misfit: inflexibility & inability of arrangements • Regulate (control & grip) implementation process • Create flexibility for RTW policy implementers (OH professionals & managers) • More professionalism: skills & competencies in conversations Try-out reflexivity activities on collaborative decision making: choices and arguments Work-Health Connexion Consulting

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(former)

• Thank you!


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More information (this webinar) •

Maiwald K, Meershoek A, de Rijk AE, Nijhuis FJN. Policy on manager involvement in work re-integration: Managers’ experiences in a Canadian setting. WORK: A Journal of Prevention, Assessment & Rehabilitation. 2014; 49(3):483-494. (Open Access)

Related publications • Maiwald, K. Does bipartite return-to-work policy work? An evaluation based on stakeholders’ experiences in a Canadian healthcare setting. University Press Maastricht, May 2014 (doctorate thesis, at: www.workhealthconnexion.com). •

Maiwald K, Meershoek A, de Rijk AE, Nijhuis FJN. Policy on professional support in return-to-work: Occupational health professionals’ experiences in a Canadian setting (Accepted for publication in WORK: A Journal of Prevention, Assessment & Rehabilitation, April 2014).

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Maiwald K, Meershoek A, de Rijk A, Nijhuis FJN. How policy on employeeinvolvement in work reintegration can yield its opposite: Employee experiences in a Canadian setting. Disabil Rehabil. 2013;35(7):527-537.

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Maiwald K, de Rijk A, Guzman, J, Schonstein E, Yassi A. Evaluation of a Workplace Disability Prevention Intervention in Canada: Examining Differing Perceptions of Stakeholders. J Occup Rehabil. 2011;21(2):179-189. (Open Access)

Contact information: Karin Maiwald, PhD Work-Health Connexion Consulting E: [email protected]; T: (+1) 250.551.8042; W: www.workhealthconnexion.com