1. Management of Sickness Absence & Return to Work Dr. John Luby, FFOM

2. Sickness absence - the scale of the problem CBI report “Pulling together: 2001 absence and labour turnover survey”

3. Who manages sickness absence? CBI report “Pulling together: 2001 absence and labour turnover survey”

4. Absence management tools CIPD Report “Employee absence: a survey of management policy and practice” June 2001

5. Risk factors for high sickness absence Labriola M, Lund T & Burr H, 2006 (P<0.05) Odds ratio95% CI Work Environment Exposures Work with arms lifted, hands twisted 1.31.07 - 1.59 Extreme bending / twisting /of neck / back 1.451.17 - 1.78 Repetitive, monotonous work 1.251.00 - 1.56 Health Behaviour Smoking, current 1.611.32 - 1.96 Smoking, former 1.321.03 - 1.68 Obesity, BMI>30kgs / m² 1.571.09 - 2.25 Employer Characteristics Public sector 1.261.04 - 1.53 Health Global self-rated health, poor 1.691.29 - 2.19 Background Variables Gender, female 1.311.08 - 1.59 Age, 1 year incremental steps 1.021.01 - 1.03

6. Management of return to work ► “Prolonged absence from one’s normal roles, including absence from the workplace, is detrimental to a person’s mental, physical and social well being. Physicians should therefore encourage a patient’s return to function and work as soon as possible after an illness or injury.”  Consensus statement of the CMA, ACOEM & AAOS.

7. 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

8. 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 Physician’s Guide to return to Work”

9. Return to work issues ► Risk ► Capacity ► Tolerance  Background  Biomedical Models ► Biopsychosocial ► Severe objective impairment equals disability  Testing ► Functional capacity evaluation

10. Functional screening questions 1. Return to Work 2. The Grocery Store 3. The Molehill Sign 4. The Obstacle  Christian J. Reducing disability days: healing more than injury. J Workers Comp. 2000:9:30-55.

11. 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

12. Predictive factors for return to work ► Employee  Age  Sex  Social ► Job related  Task demands  Organisational factors  Physical work environment

13. Evaluation of work ability ► What does the job involve? ► What is the employee’s 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?

14. 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

15. 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 Physician’s 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)

16. Thank you!