Having too many employee absences can weaken an employer’s foundation, leading to concerns over smooth business operation and a strong and consistent workplace culture. But there are ways to minimize the impact of the bumps in the road caused by absences and modified work from employee disabilities — such as effective disability management programs.
Only a few Canadian employers know the real cost of disability. Just 54 per cent track employee casual absences, according to a 2013 Conference Board of Canada report, while only 27 per cent track employee disabilities, according to a 2007 survey by Hewitt Associates. And even fewer employers (22 per cent) use that information to determine the related costs, outcomes and impact, according to a 2011 Towers-Watson survey. Hence, only a small number of employers use targeted prevention and mitigation strategies to effectively address medical absences.
So, let’s look at potential obstacles:
Obtaining information: Employers, as per Canadian human rights legislation, have a legal duty to inquire about the nature of an employee’s real or perceived disability, along with the related prognosis, expected return-to-work date, and possible residual work limitations. This means there’s a need for suitable communication vehicles, such as a policy on early intervention and case management, a report of absence form, a Job Demands Analysis of the employee’s “own job,” and a Functional Abilities Form. Many employers do not use these tools. Without the above information, the provision of reasonable accommodation is challenging, if not impossible.
Psychological disabilities: The incidence of psychological disabilities and disorders has increased, and the workplace mirrors this occurrence. These costly disabilities are estimated to be twice the price of physical disability situations and more challenging to resolve because of:
• employees trying to work through a psychological illness or injury
• the difficulty in getting the right treatment
• the lack of psychologically safe and healthy workplaces
• employees in support services being positioned as standalone, “siloed” programs as opposed to being integrated.
Time lags in medical care: Medical time lags are common, especially in rural and remote areas. A related issue occurs when an attending physician conservatively treats the employee’s illness or injury, despite little evidence of recovery. The outcomes are lengthy work absences and delayed return-to-work experiences. Having access to a disability management service provider can facilitate care though the availability of their network of healthcare practitioners. Unfortunately, few employers have arranged for this type of mitigation.
Why is this a common occurrence? Health-care practitioners receive a one-sided viewpoint of the “job” and work environment. Many employers just accept a “medical certificate” as opposed to providing the health-care practitioner with a Job Demands Analysis of the employee’s job, and requesting that a Functional Abilities Form be completed.
Secondly, the right information is often being asked from the wrong health-care practitioner. Physicians treat and cure, but are limited in their ability to quantify an employee’s physical or psychological capabilities. If seeking that type of information, the Functional Abilities Form should be sent to a physiotherapist, occupational therapist or psychological counsellor. Competent disability management case managers can facilitate employer access to timely and accurate medical information.
To turn these challenges into opportunities, the employer must understand the issues, provide leadership, and create a supportive corporate culture and work environment. Upstream action is extremely effective at preventing unwanted downstream consequences:
Adopt a joint labour-management approach to attendance control and disability management. Employers working with their unions can design, implement, evaluate and continuously improve their attendance control and disability management efforts.
Formalize the disability management program (DMP). The “cornerstones” of a program include:
• Early intervention: An employer-initiated response aimed at keeping an ill or injured employee connected to the workplace and preventing medical absence in the first place. Early intervention decreases the number of sick days and increases the likelihood of successful and sustainable return to work.
• Claims management: The administration of income-loss claims through employee benefit insurance plans (short-term disability, workers’ compensation and long-term disability insurances).
• Case management: The assessment, planning, implementation, co-ordination, monitoring and evaluation of services available to meet an employee’s health needs. Focusing on competent disability case management greatly improves the organization’s DMP outcomes.
• Return-to-work planning: A “socially fragile process” in which the returning employee, supervisor and co-workers face the challenge of renegotiating work relationships and duties. Work accommodation must be mutually beneficial; it must meet the employee’s capabilities and the organization’s business needs.
• Return-to-work placement: Ideally, employees should return to their own job — a known position in which they can excel and receive co-worker support. The placement must be monitored to ensure that recovery is realized; an action rarely undertaken by employers.
• Confidentiality: In managing employee personal health information, all individuals are legally required to protect its confidentiality.
• Documentation: For disability claim management, case management and return-to-work planning and placement, documentation is crucial. It enables monitoring of the employee’s recovery and return-to-work outcome, and demonstrates the organization’s duty to accommodate due diligence.
• Program evaluation and continuous improvement: Data collection and analysis enables the employer to understand the true cost of disability, and identify improvement opportunities.
• Ethical disability management practice: The ethics of the disability situation must be objectively weighed so the decision-making is rational and based on facts, rather than emotional issues.
• Legal compliance: Disability management is impacted by law. Stakeholders must be aware that specific acts and regulations change; they should obtain legal counsel to ensure they have the most current case law information when setting up programs or dealing with specific disability cases.
Create an integrated disability management program. Employers that have created an integrated program have achieved strong performance outcomes, such as reduced employee group benefit. This involves:
• Maximization of organizational resources and expertise: Linking the HR program, attendance control programs, disability management program, occupational health and safety program, and employee assistance program into an integrated disability management program.
• Disability management practitioner expertise: Position these practitioners to guide, steward and govern the organization to be able to effectively and efficiently control absenteeism and manage disability.
• Competent disability case managers are vital to the successful and sustainable recovery and return-to-work process.
Evaluate the program: The disability management program has to be regularly evaluated to ensure it is delivering value. For this to happen, the organization has to establish program goals, objectives, action plans and performance targets, as well as to regularly measure and evaluate their achievement.
Create a supportive work culture: By creating a supportive work culture that maximizes human performance, management creates a work environment in which safe work practices, a respectful workplace, meaningful employee support, hiring practices that provide good person-job fit, adequate information and equipment, employee education and training, and encouragement to perform at a high level are the norm.
Assess case management: To effectively manage employee illness and injury and diminished functional capacity, a case manager conducts a case management assessment. Hence, the barriers and drivers to a safe and timely return-to-work outcome are identified. Effective case management involves changing barriers into drivers for a successful return to work.
Employers face significant challenges in disability management. Yet, by providing strong leadership and creating a corporate culture focused on establishing an approach to effective absence control and disability management, a solid foundation is created on which to build.
Dianne E. Dyck is an occupational health nurse and occupational health and safety specialist at Progressive Health & Safety Consulting in Calgary. She can be reached at (403) 282-9330 or firstname.lastname@example.org.
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