Topical Seminar 3

Topical Seminar 3:
Workers’ responsibilities in work disability prevention – would they, should they, could they?

Session chair(s): Cindy Noben

Schedule Details

Monday September 29
15:45 - 17:15 Afternoon Concurrent Sessions (M O25 - M O37 and Seminar 3)
Topic: Disability prevention interventions
Room C

Seminar Objectives

Workers with health problems are confronted with various options for work disability prevention. In this seminar, we look at the workers’ own responsibility in disability prevention from three perspectives. First, "Would they, from an individual worker perspective, be inclined to assume greater responsibility in work disability prevention?" This topic is addressed in a qualitative interview study to examine the experiences of workers with chronic health problems. The results highlight that workers feel that the process does not do justice to their individual needs and their own unique experience of their health problems. Second, "Should they, from a normative perspective, be required to take more responsibility in work disability prevention?" We present the results of two qualitative interview studies to understand the expectations of stakeholders in the workers’ tertiary disability prevention (i.e. sick leave and return to work). We focused on Dutch employers (study I) as well as Canadian occupational health professionals (study II). The results show how the stakeholders, based on national legislation or local policies, expect workers to actively pursue- and be involved in tertiary work disability prevention. And third, "Could they, from an economic perspective, be advised to take more responsibility in work disability prevention?" This topic is addressed by means of economic evaluations to assess the feasibility of different newly developed interventions to stimulate workers to take responsibly in work disability prevention. Economic evaluations are conducted from the societal perspective, where one accounts for all costs and benefits despite of who bears or benefits from them. The results illustrate how such an evaluation also provides insight into whether and how the individual worker profits from the intervention.

During the round table we want to discuss: "Would workers be willing to, should they be expected to and could they be asked to take more responsibility for work disability prevention?" By organizing the abstracts together in one seminar we also aim to show the communalities and tensions between the perspectives, discuss how a balance can be struck between them and explore how they can enrich each other. We used data from multiple sources, methods and countries.

The seminar (moderated by A. de Rijk) starts with an introduction (10’), followed by four presentations (each 10’), 30’ round table discussion and 10’ closing thoughts to end.

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Presentation 1: Workers’ responsibilities in work disability prevention, would they?

Presented by: Bram Rooijackers

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Authors

Rooijackers B1, de Rijk A1

  1. CAPHRI, School for Public Health and Primary Care, Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, the Netherlands

Abstract

Background

We examined the willingness of workers with a chronic illness or disability in the Netherlands to shoulder more responsibilities with regard to tertiary disability prevention and return to work (RTW). To that end, we asked the following research question: ‘How do workers perceive their roles and responsibilities with regards to disability prevention and would they be willing to assume more responsibilities to prevent work disability?’

Methods

We conducted in-depth interviews (n=8) and 6 focus group interviews (n=42) among chronically ill people, which were transcribed verbatim. These transcripts were then analyzed using interpretative qualitative framework based on the precepts of the grounded theory approach and discourse analysis.

Results

While workers describe themselves as willing to take more responsibilities in work disability prevention, they argue that their willingness stems from necessity. From the perspective of workers, taking responsibility for disability prevention is seen as the most effective way of returning to work. They experience pressure from employers (e.g. loss of job), social security institutions (e.g. loss of disability benefits) and society (e.g. social exclusion) to prevent disability and RTW as quickly as possible. Taking greater responsibility is then framed by workers as ‘taking charge’ and overcoming undesirable aspects of their situations. Not taking charge in this manner is viewed as risky and framed as loss of control and agency in the disability prevention or RTW process, which is perceived as being too general and not taking the specific needs and problems of the individual worker into account.

Conclusions

Workers are willing to shoulder more responsibilities with regards to disability prevention and experience pressure to do so. They also feel that disability prevention interventions are too general and do not do justice to their own experiential knowledge of their chronic illnesses. As such, they define responsibility not only as taking a more active role in disability prevention, but also to introduce and defend their own needs in the disability prevention process.

Presentation 2: Workers’ responsibilities in work disability prevention, should they? Employer norms (part I)

Presented by: Nicole Hoefsmit

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Authors

Hoefsmit N1, de Rijk A1, Houkes I1

  1. CAPHRI, School for Public Health and Primary Care, Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, the Netherlands

Abstract

Background

Employers increasingly point at the workers’ own responsibility in tertiary work disability prevention, i.e. sick leave (SL) and return to work (RTW). This responsibility is anchored in Dutch legislation, which requires workers to cooperate with their employers during two years of SL. However, we do not know exactly what employers expect of their workers. Therefore our research question was: ‘In what ways do employers expect workers to take responsibility in tertiary work disability prevention?’

Methods

In-depth interviews (8 Dutch employer representatives, i.e. HR professionals) were conducted in 2009 and analyzed using an interpretative approach.

Results

First, employers considered it the workers’ responsibility to seek treatment for their health problems. Second, they expected workers to aim for RTW during (instead of after) medical recovery. Some employers noted to tell workers about their intentions to ask the social insurance office for permission to stop wage payment if the workers would not put more effort in RTW after one year of SL. Third, employers expected workers to participate in the employers’ initiatives for cooperation such as planning meetings between the workers and the employers. They used legislation to convince workers of the necessity of these meetings. Employers also expected workers to inform them about RTW possibilities. Finally, when workers had not yet resumed work after one year of SL, employers considered it their own (and not the workers') responsibility to decide about RTW. In this case, the employers expected workers to accept their decision.

Conclusions

The employers expected workers to actively pursue RTW (besides medical recovery) and used legislation to convince workers of doing this.

Presentation 3: Worker responsibilities in work disability prevention, should they? Work re-integration professional norms (part II)

Presented by: Karin Maiwald

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Authors

Maiwald K1,2, Meershoek A3, de Rijk A1, Nijhuis FNJ4

  1. CAPHRI School for Public Health and Primary Care, Department of Social Medicine, Faculty of Health, Medicine and Life Sciences , Maastricht University, the Netherlands
  2. Work-Health Connexion Consulting, Nelson, Canada
  3. CAPHRI School for Public Health and Primary Care, Department of Health Ethics and Society, Faculty of Health, Medicine and Life Sciences, Maastricht University, the Netherlands
  4. CAPHRI School for Public Health and Primary Care, Department of Work and Social Psychology, Faculty of Psychology, Maastricht University, the Netherlands.

Abstract

Background

In disability management, workers are encouraged to take responsibility in early return-to-work (RTW) and get involved in RTW planning. It is assumed that this helps to realize pointed support in RTW. In the healthcare sector in British Columbia (BC), Canada, the work re-integration professional is given the responsibility to prepare a RTW plan for a worker who reported sick and to get the worker perspectives on the plan. However, we do not know exactly what professionals expect of the workers. The research question was: 'When executing the BC Healthcare RTW policy, what do the re-integration professionals expect from the workers involved?'

Methods

A social-constructivist perspective was taken, aiming to show the processes of giving meaning to the policy in the work context. We conducted 9 interviews with the professionals who were each involved in the RTW process of various re-integrating workers at different worksites within one healthcare organization. We then analyzed how the professionals interpreted the policy and what problems they experienced in implementing the RTW policy.

Results

Professionals expect input and consent from the workers, that they explain well their condition and ability in contact moments, and that they bring in their points effectively in group meetings with the managers. However, in practice, the content of views by workers is not a consistent part to create plans on. Also, workers cannot fully explain problems nor defend their position in group meetings. It is thus difficult for professionals to unite the different perspectives in one plan. Needing consent at a set moment creates tension in the context of the timelines of the policy. Contact moments with professionals are not fruitful as workers hesitate to bring in their views.

Conclusions

Professionals have expectations of workers that are in line with the policy, but do not seem realistic. Workers cannot always give steadfast input, they do not always dare to bring in their views in meetings and give consent (because legal status plans), and they are uncertain regarding the course of their illness.

Presentation 4: Employees’ Responsibilities in work disability prevention, could they?

Presented by: Cindy Noben

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Authors

Noben C1, Evers S1, Rijk de A2, Nijhuis F3

  1. CAPHRI, School for Public Health and Primary Care, Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, the Netherlands
  2. CAPHRI, School for Public Health and Primary Care, Departement of Social Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, the Netherlands
  3. CAPHRI, School for Public Health and Primary Care, Department of Work and Social Psychology, Faculty of Psychology, Maastricht University, the Netherlands

Abstract

Background

When conducting economic evaluations in occupational health settings one often assumes that costs (eg. healthcare costs, intervention costs) for society or employers are the main drivers in developing or adjusting the policy. However, many argue health should be the most important objective of any intervention and is that to be valued, not costs. In fact, economic evaluations also assess the advantages for workers in their analyses. In our study we also assess the direct beneficial consequences from a worker perspective when economically evaluating interventions aimed at supporting workers to take responsibilities in disability prevention.

Methods

The beneficial consequences for workers when improving their responsibility in work disability prevention interventions have been economically evaluated in several cost-effectiveness and cost-utility analyses. Study materials presented here are derived from a published study whereby workers (N=617) at elevated risk for mental health complaints due to high job demands were advised and assisted in taking more responsibility in order to prevent decreased work functioning; and thus to prevent work disability. Another intervention enhancing workers' responsibility, provided at the organizational level, focused on cooperation regarding return to work between workers and their employers (N=103). Quality of life, productivity and health served the main outcomes and were analysed in RCTs comparing the intervention with the control condition.

Results

Several factors are associated with resource investment in worker responsibility and work disability prevention: improved health, improved quality of life, improved work functioning, and reduced healthcare uptake rates. Preliminary results show a link between improved worker responsibility and health increase on the one hand and improved quality of life on the other as they both influence work functioning. Interventions that support workers to take responsibilities in disability prevention suggest cost-savings and improved work functioning in favor of the intervention group.

Conclusions

Interventions supporting workers to take responsibilities in disability prevention can be associated with a greater likelihood that beneficial effects are obtained for fewer costs, which is of interest for individual workers and benefits society as a whole.