A Firsthand Look at the Importance of Disability Management in the Workplace

The mission is clear: get medically restricted people back to work. As a vocational rehabilitation counselor, I believe in this purpose because, without it, the American people and the future of our workforce are compromised. Now more than ever it is important to find ways of keeping Americans employed and engaged. However, doing so may require a change in our thinking and the way we are used to doing things—a shift in the way we define “employment.”

A year ago I journeyed to Australia. Like many other parts of the world, they’re experiencing similar disability management and return-to-work issues as we do here in the U.S. I thought I would be able to learn something from the Aussies and, in turn, leave them with a bit of “good old USA know-how.” I spent two very informative weeks with Dr. Mary Wyatt and her staff at Resworks, where they provide occupational health services, medical research, health consultation, injury management and information on medically unnecessary disability.

Dr. Wyatt is an occupational medicine physician who knows enough about medicine to see it as less important—when it comes to return to work—than a person’s beliefs, workplace attitude, or how our systems operate. Dr. Wyatt’s passion is to see better care of employees with health conditions and to provide access to the research that shows us how we can do better. This they do in order to make a difference. Upon hearing this, I thought to myself, “Well, that’s very admirable…but why?” I soon discovered some profound answers to that question.

The Crucial Importance of Work

The economic future of our people, our families and our communities may be determined by the way we perform disability management efforts toward keeping people employed. For the employee, the health impact of being out of work long-term means a two to three times higher risk of poor general health, with increased infections, cancer, high blood pressure and heart disease, a two to three times higher risk of mental illness, with a significantly increased risk of depression, and a 20 percent increase in the death rate. The health consequences of being out of work are equivalent to smoking 200 cigarettes a day.

Research suggests these negative health effects are due to decreased activity and exercise, the financial impact of reduced wages, reduced self-esteem and depression. In addition, there may be an increase in behaviors that are detrimental to health, such as drug and alcohol intake, overeating and smoking. Besides the physical repercussions, there is an increase in psychosocial problems and the development of a negative frame of mind. Because most people derive a personal identity from their work activities, a loss of work results in the person losing part of their identity, thus their self-image suffers. As a result, relationships are subjected to stress, which impacts the family. Separation and divorce are not uncommon with long-term work absence. The health of adolescents is poorer when one or both parents are out of work long-term. When an individual returns to employment, signs of general health and well-being improve. People who have returned to work are healthier than those who have not.

For the employer, workplace disability and subsequent work absence is no less devastating or costly. In 2000, United States estimates were close to $700,000 per year per 100 people. Financial losses include direct costs of increased disability insurance, workers’ compensation premiums, and fines for health and safety violations. Add to that the indirect costs of reduced productivity of the employee with the condition and reduced supervisor productivity as a result of increased time spent on return-to-work management issues at the expense of dealing with the organization’s core business. In addition, there are the administrative costs of recruitment and training of a new employee, and during this time the loss of or lowered productivity.

Poor management of people with work-related health problems reduces morale. It influences employees’ approaches to other areas: sick leave, productivity levels, quality and taking on extra work such as overtime. These impact the employer’s bottom line, particularly when customers are indirectly affected by work injuries. The organization’s reputation can also be damaged by news of major injuries or by their reputation for how they look after staff once an injury has occurred. All in all, it has been estimated that the overall cost burden for a work disability is met one-third by the employee, one-third by the employer and one-third by the community.

A Defined Process

The process of return to work, as detailed in The American College of Occupational and Environmental Medicine guideline, begins when an illness or injury occurs. At this point the questions are: How much can this person do in the way of work? What can the person not do now that they could do before? What is the person being medically advised against doing so as not to aggravate their condition? Following this, a return-to-work coordinator, employer or case manager compares the demands of the person’s job with their new restrictions. Once this is established, it is possible to identify what actions are required to return the worker to their job. If the person is able to perform their job they should be able to return to it. If the person can do only temporary modified duties, then, states the guideline, “the employer must make arrangements and implement them.” If neither option is applicable, the person stays out of work until they have fully rehabilitated.

The best work disability programs improve productivity and reduce sick leave. They also reduce compensation costs by the integration of return-to-work management with health promotion and injury and disease prevention. In Australia, there are positions called return to work coordinators (RTW coordinators) and the people in these roles serve an important function—so important, in fact, that the government mandates every employer with more than 20 employees must have an RTW coordinator. These people often come into the role from other areas, such as safety, human resources or even production. This stipulation makes a lot of sense.

Recent research on RTW coordinators has shown that the skills and approach of the person performing the coordination has a significant impact on return-to-work outcomes. The activities of an RTW coordinator are plentiful—and they are fundamental to the successful return to work of an ill or injured employee. RTW coordinators have strategic roles, like developing policies, relationships and management structures that streamline return-to-work processes and management, as well as day-to-day roles and operational activities.

The most important competencies identified for effective RTW coordination are considered to be job accommodation, worksite communication and conflict resolution, where good communication skills are required. The RTW coordinator also plays a part in the area of ergonomics, which is the science of fitting the task to the person. To illustrate this, think about the everyday example of driving a car. Having an adjustable driver’s seat means that short and tall people are able to drive the same vehicle. Without the ability to adjust the seat, driving the vehicle would be uncomfortable for some and impractical for others. Car-seat adjustment is a simple, ergonomic intervention people use every day, often without even realizing that they’re putting ergonomic principles into action. The good news for businesses is that well designed ergonomic workstations have good health outcomes—and the bottom line also benefits through increased productivity.

Poor occupational ergonomics have poor outcomes. When employees are required to work in awkward positions or perform repetitive tasks that place a load on the body, aches and pains often result. This might sound harmless enough, but these aches and pains can develop into more significant (and costly) health problems over time, including back complaints, tendonitis and shoulder problems.

Clever organizations take advantage of worker expertise to achieve optimal ergonomic outcomes. Best practice occupational ergonomics is collaborative and participatory, which recognizes that the employee is an expert on his or her job, who can be taught the basic principles of ergonomics while providing input on how their workstation could be improved. When the ergonomic plan involves everyone who has a stake in the outcome, the interventions decided upon are more likely to succeed. The staff are more likely to feel part of the organization, and morale is improved.

A Focus on Safety

A critical component to integrated management of disability is safety. Often focusing on workplace injuries, safety is another advocate for both the employee and employer, working to develop a culture of safe work practices with a goal of eliminating workplace accidents and hazards.

As with ergonomics, safety is both reactive and proactive in the work environment. In addition to reporting and calculating the frequency and severity of workplace injuries and illnesses pursuant to requirements of OSHA, careful analysis of injury reports not only measures changes, trends and hopefully accident-prevention progress but affords opportunities to provide management and employees safety education during an investigation into reported injury cases. Taking actions to remedy a procedural or practice issue, fix an equipment malfunction, or respond to hazardous substances are examples of what occurs following the reporting of an injury. Communication with management and employees ensures not only a comprehensive accident investigation and follow up but is an educational opportunity that emphasizes everyone’s responsibility in safety and prevention initiatives.

Finding solutions to issues before they become agents of injury or illness, including how tasks are performed, the availability and design of equipment, and the functionality of the environment, is dependent on data collection and analysis, adoption of basic prevention procedures, investigations or accidents, safety inspections, environmental hazard assessment and controls, written safe work procedures and employee safety training. By reducing the risk and severity of workplace injuries coupled with designing a safe work environment and the applied science of ergonomics, employees are more efficient, more productive and ultimately safer in the workplace.

With the increased human and financial costs we are experiencing with an aging workforce and unstable job economy, we can no longer view the accommodation of medically restricted people as optional. In leaving Australia, I not only brought home the traditional boomerang, signifying an anticipated return trip, but all the information and materials I had obtained as well. They have been placed in an online professional journal, which you can find at www.rtwmatters.com. Here you will find a large collection of practical time- and effort-saving resources to use toward your return to work and disability management efforts. While you’re there, please feel free to add some of your own. As the Aussies say, “It is the power of partnerships.”