Management of Sickness Absence

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Management of Sickness Absence Return to Work

• Dr. John Luby, FFOM

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Sickness absence - the scale of the problemCBI
report Pulling together 2001 absence and labour
turnover survey
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Who manages sickness absence?CBI report Pulling
together 2001 absence and labour turnover survey
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Absence management toolsCIPD Report Employee
absence a survey of management policy and
practice June 2001
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Risk factors for high sickness absence Labriola
M, Lund T Burr H, 2006
  (Plt0.05)       Odds ratio 95 CI
Work Environment Exposures          
Work with arms lifted, hands twisted       1.3 1.07 - 1.59
Extreme bending / twisting /of neck / back       1.45 1.17 - 1.78
Repetitive, monotonous work       1.25 1.00 - 1.56
Health Behaviour          
Smoking, current       1.61 1.32 - 1.96
Smoking, former       1.32 1.03 - 1.68
Obesity, BMIgt30kgs / m²       1.57 1.09 - 2.25
Employer Characteristics          
Public sector       1.26 1.04 - 1.53
Health          
Global self-rated health, poor       1.69 1.29 - 2.19
Background Variables          
Gender, female       1.31 1.08 - 1.59
Age, 1 year incremental steps       1.02 1.01 - 1.03
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Management of return to work

• Prolonged absence from ones normal roles,
  including absence from the workplace, is
  detrimental to a persons mental, physical and
  social well being. Physicians should therefore
  encourage a patients return to function and work
  as soon as possible after an illness or injury.
• Consensus statement of the CMA, ACOEM AAOS.

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Solutions

• There are no one size fits all solutions
• Management of sickness absence return to work
  is heavily influence by
• Economics
• Politics
• Social attitudes
• Legislation
• Workers representation
• Management attitudes
• Health care worker attitudes

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Negotiation strategies for return to work

• Set the stage
• Uncover the issues
• Confirm the issues
• Confirm intent and authority
• Evaluate the issues
• Solve the problem
• Satisfaction check
• With apologies to the AMA A Physicians Guide to
  return to Work

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Return to work issues

• Risk
• Capacity
• Tolerance
• Background
• Biomedical Models
• Biopsychosocial
• Severe objective impairment equals disability
• Testing
• Functional capacity evaluation

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Functional screening questions

• Return to Work
• The Grocery Store
• The Molehill Sign
• The Obstacle
• Christian J. Reducing disability days healing
  more than injury. J Workers Comp. 2000930-55.

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Work prescription

• Is absence from work medically required?
• Patient condition / job demand mismatch?
• Medical restrictions
• What the patient should not do, or
• What the employer should do!
• Functional limitations
• What the patient is unable to do

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Predictive factors for return to work

• Job related
• Task demands
• Organisational factors
• Physical work environment

• Employee
• Age
• Sex
• Social

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Evaluation of work ability

• What does the job involve?
• What is the employees medical problem?
• Is the employee a candidate for medical
  retirement?
• Is there a significant risk of substantial harm
  with work activity?
• Is the employee physically able to do the job?

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Impairment and Disability

• Impairment
• The loss, loss of use, or derangement of any body
  part, system or function
• Disability
• A decrease in , or the loss or absence of, the
  capacity of an individual to meet personal,
  social, or occupational demands, or to meet
  statutory or regulatory requirements because of
  an impairment

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Guidance on medical restrictions duration of
sickness absence

• ACOEM Practice Guidelines (ISBN 1-883595-42-8)
• Also good advice on management of return to work
  
• AMA - A Physicians Guide to Return to Work (ISBN
  1-57947-28-7)
• Also good advice on management of return to work
• The Medical Disability Advisor Workplace
  Guidelines for Disability Duration (ISBN
  1-889010-03-0)
• Official Disability Guidelines (ISBN
  1-880891-22-0)

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Thank you!