The research on work and health is clear: Being off work is unhealthy. Having meaningful, productive activities that meet functional abilities is healthy and part of recovery from a health incident. Sometimes, the most difficult part of the process is determining the return-to-work timing and a suitable work offer.
In 2004, the Institute for Work and Health funded a systematic review outlining the "Seven ‘Principles’ for Return to Work Success," which reported on strategies that reduce disability durations and costs. (The paper was updated in 2014.) One of these principles is communication between the health-care professional, employee and employer to guide the offer of safe return-to-work options.
This appears straightforward, but how can employers determine the right response to a health-care provider note stating "light duties"?
For one, it is preferable to use the term "suitable work modifications" as "light duties" gives the impression of less productive work or alternate work from the normal job.
An employer should always strive to follow the hierarchy of return to work by first modifying the employee’s own job instead of offering jobs that are created or beyond the employee’s skill set.
A prime example is when an employer has a modified work pool or job bank. This creates segregation from the regular work population and makes it difficult to return to regular duties.
What is ‘suitable work’?
An employer must begin by collecting meaningful information about the medical risks or contra-indications for the employee and how long these risks would last. Then the employee and employer can determine suitable work options. It is important, in all cases, to manage the case with the correct information and functional needs of the employee. Employers do not need to know diagnosis but they do need to understand the medical restrictions of the worker.
The health professional providing answers does not know your workplace, your work risks or your work processes so the employer should ask for information that will allow it to adjust the work duties to meet not only the employee’s medical restrictions and functional abilities but also business needs.
The employer should ask about the worker’s medical contra-indications and risks, and the length of time the employee is expected to require adjustments to work — this information should be provided by the treating physician.
The duties within the workplace the employee can do should also be explained. Focus on the tasks of the job and the employee’s abilities — this information comes best from the employee.
After meeting with the employee to understand what he can do, access information from the right health-care professionals to understand functional abilities. In most cases, auxiliary professionals better understand functional capacity once the medical risks are identified by the physician.
•Physiotherapist: Ask about endurance, capacity for activities such as walking and stairs, and safety in the performance of certain activities based on the treatment program.
•Psychologist: Ask about emotional risks and strategies to improve coping skills at work.
•Occupational therapist: Ask about physical and cognitive functional capabilities and strategies to overcome functional barriers at the workplace.
•Speech language pathologist: Ask about cognitive and speech-related function.
It’s better to present a return-to-work plan to the health-care provider that has been developed with the employee using standard precautions (such as MD Guidelines) — and asking about any risks if attempting the proposed plan — than asking for a complete functional abilities form or medical note. These duration guidelines can assist with offering suitable work that will not be a risk to the employee and they each have a section on return-to-work accommodation suggestions.
The employer can write down the employee’s perceptions around what he feels he is able to do (such as using a computer) and not able to do (such as lifting heavy packages). Once the restrictions and functional tasks are known to the employer, a job match can occur.
Once this process has been completed, the return-to-work offer can be designed. If there are large gaps, you may wish to consider work hardening, volunteering in a local facility or starting the return to work as a second person to alternate the tasks.
In return-to-work planning, the process of finding suitable work is a team effort and involves good communication and problem-solving with the various stakeholders. To document the offer, make sure to always offer the return to work in writing.
Suitable return-to-work offers or light duties are as variable as employees and the work they do. The key ingredient is creative, open problem-solving with the correct information. Remember: Everyone is an individual so every light duty is individual. Nancy J. Gowan is an occupational therapist and president of Gowan Consulting in London, Ont. She can be reached at firstname.lastname@example.org or visit www.gowanhealth.com for more information.
Points to remember in offering suitable work
•Discuss return to work at the first opportunity after the injury and illness.
•Begin planning work adjustments with the employee’s own job — this will allow him to use skills and talents and resume regular duties more quickly.
•Focus on what the individual can do at work — use a "can do," "can’t do," "maybe do" checklist.
•Break down the tasks when reviewing the job to avoid "all or nothing" responses.
•Acknowledge safety and medical restrictions.
•Offer support and coping strategies and suggestions at the workplace.
•Focus on the individual as a valued employee doing meaningful and productive work.
•Deal with issues regarding relationships or communication at work.