Most human resources professionals are fairly familiar with the concept of disability management, probably because of increasing disability and absence-related costs. In 2013, the Conference Board of Canada estimated absenteeism expenditures in the Canadian economy were $16.6 billion annually, and rising, and of course there are indirect costs related to absence and disability.
Trying to measure costs and implement best practices can be a complicated process, involving numerous steps and several stakeholders. The good news is there are three key steps that will improve results, along with the experiences of employees and managers involved in the disability management process:
• Expand your understanding of disability.
• Assist employees in a safe return to work, as opposed to trying to prove whether they’re disabled.
• Create a culture where workers feel they’re able to return to work.
Disability not a medical concept
This can be a difficult concept to grasp. When this information is shared with HR professionals during presentations, they typically respond with incredulous looks and challenging questions. This is completely understandable as, on the surface, this statement seems incongruent. To understand this, we need to differentiate between impairment and disability.
Impairment is a loss of a body part, function or an alternation of health status, which is assessed by medical means, usually through a physician. In addition, physicians diagnose and treat medical conditions or illnesses.
Disability is essentially an alteration in an individual’s ability to meet personal, social or occupational demands due to impairment. Disability is a complicated psycho-social problem that extends far beyond the illness or impairment.
Many factors contribute to this complexity including an individual’s self-efficacy, his values or beliefs, his relationship with the employer, economic factors, the availability of modified work, as well as an employer’s policies and practices, cultures and values.
Viewing disability from this perspective is particularly critical to ensure a disability management program avoids an over-reliance on a “medical case management” model. In this model, stakeholders (employers, workers’ compensation boards and disability insurers) rely on physicians to determine whether an employee is disabled or not.
Thus begins an endless loop of having to write physicians for updates and “clearance” as to when an employee will be able to return to work in some capacity. It can be frustrating and typically correlates to longer durations of disability.
Research has shown physicians’ perspectives on disability echo this frustration. And the Canadian Medical Association has said it believes it is the employer’s responsibility to supervise an employee who is away from work. The association also objects to being asked to police absenteeism and act as truant officers.
Expanding the understanding of disability also means seeking greater insight into absence management. Most employers only have a general sense of how they are doing with respect to absence trends and costs. Tracking this type of information and taking stock of where they are at takes some effort, but is well worth it.
Ideally, an employer wants to adopt an integrated approach to this across all absence types (occupational and non-occupational), pre- and post-absence. Often, organizations may track information and have processes for workers compensation absence, but not for non-occupational absence.
Assistance versus resistance
Organizations need to regularly assess their climate to determine whether they support return to work and accommodation. An assistance model moves away from the traditional medical model, where the employee and employer devote most of their time to proving or refuting disability, which creates a resistance to a return to work.
In other words, when an employee is absent from work, the first question an organization should ask is: “How can we help her return to work as quickly and safely as possible?” versus “Is she disabled?”
Assistance also means organizations need to ensure employees, direct supervisors or managers, case managers and human resources collaborate and communicate on developing safe, early return to work plans. Several studies have found supervisory support and behaviour is an important predictor of return to work of individuals with any type of disorder. Supervisors and leaders are essential to creating a supportive workplace culture facilitating return to work and accommodation, particularly for employees with mental health disabilities.
It’s normal for leaders to feel anxious at the prospect of talking to an employee about this. But what if they receive vague information from a physician, such as: “Employee should avoid heavy lifting?” They could request further information from the physician but this may delay the return to work process. The better approach would be to talk to the employee about what he feels his capabilities are, and to the direct supervisor about what the actual job duties are. They’ll likely be able to obtain more detailed information.
Most information on functional abilities from physicians is based on an employee’s self-report. Physicians typically do not have a patient do any kind of functional capacity testing during a 15-minute appointment. They typically ask about their activities of daily living, their perception of their functional abilities, and then document and report that information. Plus, a physician is acting as the patient’s advocate. Why not at least start a discussion with the employee about what she feels she can and cannot do?
This approach is also more effective in identifying and strategizing in situations where there are factors contributing to the employee’s absence that may not be entirely related to impairment or illness. And it implies that as an organization, there is a level of acceptance pertaining to the employee’s absence.
This is not to be confused with a belief or acceptance of the reasons contributing to the absence but as recognition the employee is in fact away from work, regardless of the reason. This establishes a less adversarial approach where employers can better identify and take action in situations where an employee’s absence is complicated or due to personal or family conflicts, job performance issues, skill deficits or workplace conflicts.
Culture of accommodation
Does your workplace culture support return to work and accommodation for employees with physical and mental health disabilities? If you went off work due to a disability, would you feel supported and optimistic about your organization’s ability to accommodate you in a modified return to work? These blunt questions must be asked because they hold the potential to significantly impact the health, well-being and productivity of workers. Often, if an employee doesn’t feel his presence is valued and his employer is willing to facilitate his return to work, he may be less motivated to return.
This also illustrates why organizations need to have a clearly defined, early return to work program for employees across all absence types. They shouldn’t wait until someone is away from work to explore potential accommodations. They should be proactive.
It’s about taking a team approach involving multiple stakeholders (including direct supervisors, unions and occupational health and safety) to develop policies and procedures to accommodate employees in modified return to work programs. Review what you are doing for workers’ compensation claims and integrate best practices. Spend some time soliciting feedback from employees about factors they identify as obstacles to modified return to work. Be open to reconsidering the status quo.
Employers might need to review the functional demands for some jobs to identify potential, modified return to work opportunities. Does the health and wellness program support a commitment to helping employees stay at work? Maybe attendance policies should be reviewed. Ideally, policies and procedures should: support injury and disability prevention; outline stay-at-work practices for those needing accommodation before absence; identify potential, modified duties throughout the organization; and define roles and responsibilities in transitional return to work programs.
An effective disability management program requires organizational commitment, collaboration and the active participation of all stakeholders involved in the process and from senior management. The results will be an improved experience for all involved and significant costs savings from lower absence durations.
Dan Licoppe is a Winnipeg-based senior disability consultant and Samia Jarjoura is the Montreal-based national lead consultant for disability management at Aon Hewitt. For more information, visit www.aon.ca.
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