Workplace relationships can make or break you
If rapport isn’t there, program won’t work
An optimal stay-at-work program entails a delicate balancing act, both in terms of employee relationships and interventions.
"For example, some companies have safety programs that have created abusive treatment of employees," notes Jennifer Christian, MD, MPH, chair of the Arlington Heights, IL-based American College of Occupational and Environ-mental Medicine’s Work Fitness and Disability Section and president and chief medical officer of Webility Corp., a disability management consulting firm based in Wayland, MA.
Establishing the proper balance can be an ethical dilemma, she continues. "For example, when a company sets up its safety program, it has to be careful it sets up rewards for people who perform safely, but it can create a really strong potential for people to hide [unsafe practices]. You can end up with the same need to balance when you set up an absence management program. When do you get a case that looks like abuse?"
The facts alone don’t necessarily tell the whole story, she notes. "If I hurt myself and I was home, and the employer called and asked if I would you mind laying on a cot in the office and doing some work, I might not feel abused," she posits.
One of the key issues deals with the point at which an employer becomes paternalistic. "You would obviously have to protect yourself if it was something dangerous," she says. "But in the case of release to work, is it the doc’s job to tell the employer they are being unfair, or is it the employee’s? It’s not a black-and-white issue. When is it appropriate for the doc to become an avenging angel?’"
Balanced programming
You also must strive for balance in your programming, says David Brown, DSL, a principal in Clarke, Brown Associates Ltd. in Toronto. "If you just deal with attendance management, you’ll drive people to go on short-term disability. They’ll think, I may as well stay off work an extra day or two.’ On the other side, if you are really harsh on your disability side, you will drive people to multiple short absences."
On the disability side, "Too often we in occupational health cut out the two people who are often most important — the employee and the manager," he explains. "The manager is told not to deal with the employee. Then, he hears Joe is coming back to work with the following restrictions."
But it’s the employee who really knows what he feels capable of doing, and the manager who knows how flexible he can be. With the Clarke, Brown approach, the employee calls into a phone line, records his absence, and on day five he automatically pops up on the "to-do" list of the coordinator. The coordinator then calls the employee to see when he might return. If it’s a couple of days, he just makes a note. If it’s going to be longer, he sets up a meeting with the manager.
"This usually happens in the second week of absence," says Brown. "You confirm the tasks of the job with the manager, and go through the list asking the employee what he feels capable of doing, like, for example, taking phone calls."
In each case, the employee responds yes, no, or "maybe with some help." What you end up with is a list of things the employee can do, cannot do, or may be able to do with some help, he says. "The manager’s role is to see if they can accommodate the employee; you keep meeting until the employee has resumed all of the tasks."
The ultimate benefit of this balanced approach is improved manager/employee relationships, Brown says. "And in any research I’ve done, I’ve found the greatest predictor of whether someone will be at work regularly — or how long their disability will be — has very little to do with their medical condition but everything to do with their relationship to their manager."
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