SPE 108646

Management of Sickness Absence and Return to Work

John Luby, FFOM Independent Consultant

Copyright 2007, Society of Petroleum Engineers

This paper was prepared for presentation at the SPE Asia Pacific Health, Safety, Security and
Environment Conference and Exhibition held in Bangkok, Thailand, 1012 September 2007.
This paper was selected for presentation by an SPE Program Committee following review of
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Abstract

field of sickness absence management usually correlates well

with a range of human resource management issues
throughout the organization as a whole.
According to the UK CBI report Pulling Together: 2001
Absence and Labour Turnover Survey (1) which was
mentioned above, absence rates were lower when primary
responsibility for managing sickness absence was given to
Senior Managers or HR Managers. Occupational Health
professionals did not appear at first sight to be particularly
successful in managing sickness absence. However, it could
be suggested that this is due to

1. Sickness Absence:

(a) The Scale of the problem:

Sickness absence is a massive economic problem worldwide

in both the public and private sectors. In the UK, according to
the Federation of British Industries Report Pulling Together:
2001 Absence and Labour Turnover Survey (1), the gap in
sickness absence performance between public and private
sectors was at that time 10.2 days lost per employee against
7.2 days lost respectively. The gap in the sickness absence
performance between private sectors of the economy has
increased with transport and communication sectors being the
highest, after the public sector, at 9.4 days lost per employee.
The sectors with the lowest sickness absence rate are the
professional services which include physicians.

the causes of sickness absence not necessarily being

strictly medical,
management attitude in the particular organization and to
the probability, certainly in the United Kingdom, that
although the public sector organizations have more
comprehensive occupational health provision than those
in the private sector, the possible benefits of good
occupational health service provision is offset by nonmedical factors contributing to a high sickness absence
rate in that sector.

What is clear is that Senior Management commitment to

sickness absence management is highly effective.
(c) Absence Management Tools:
There is a number of management tools currently widely used
to address the issue of absence.

(b) Who Manages Sickness Absence?

In order to manage sickness absence it is important for
employers to first know their levels of absence and how they
compare with other companies in the same industry or
business sector. Benchmarking sickness absence as a key
performance indicator helps employers to identify gaps in
performance between their organization and the average
across a range of similar organizations. There is good
evidence to suggest that an organizations performance in the
The involvement of OH professionals was the favored
approach in dealing with longer-term absences.
This supports the earlier contention that non-medical factors
may be significant in sickness absence and predominantly so
in short-term rather than long-term absence.

In the Chartered Institute for Personnel and Development

Report Employee absence: a survey of management policy
and practice of June 2001 (2),

return to work interviews were seen by the respondents as

the most effective way of managing short-term sickness
absence

The CBI has stated that employers need to tailor their

absence policies to the causes of absence among their
employees - whether stress for non-manual staff or leave seen
as an entitlement among manual staff.
Effective management of sickness absence and the proven cost
benefits of retention of employees essentially results therefore,

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from regular discussions with the person and an interdepartmental approach. Bringing together experts from
Human Resources and Occupational Health departments to
discuss with the individual what policies can be put into place
and what procedures will be followed can be an effective
approach. The involvement of line management in the
monitoring and evaluation of sickness absence can at least
have major implications for the effectiveness of absence
management. It is also clear from the data that sensitivity is
required, disciplinary action being effective in dealing with
unjustified absence but leave for justifiable family reasons also
being effective.

Economics
Politics
Social attitudes
Legislation
Workers representation
Management attitudes
Health care worker attitudes

What is possible or acceptable in one country, industry or

company is not necessarily possible or acceptable elsewhere.
(b) Negotiation Strategies:

(d) Risk Factors for High Sickness Absence:

The commonsense SUCCESS (5) acronym approach is a useful

tool in all settings

In their recently published paper in Occupational Medicine,

Prospective study of physical and psychosocial risk factors
for sickness absence (3), Labriola, Lund and Burr in
Copenhagen investigated the associations between
psychosocial and physical work environment exposures and
sickness absence from work taking into account health, health
behavior and employer characteristics known to affect
sickness absence.

Sickness absence was associated with the above. The study

suggests a potential for reducing sickness absence through
multifactorial interventions towards smoking, obesity,
physical and psychosocial work environment exposures. The
study showed that differences in work environment exposures
account for 40% of the cases of high sickness absence.

2. Return to Work
Management of return to work is not only a business
imperative. It is also an imperative of the practice of good
Occupational Medicine.
To quote from the consensus
statement of the Canadian Medical Association, American
College of Occupational and Environmental Medicine and the
American Academy of Orthopaedic Surgeons (4)
Prolonged absence from ones normal roles, including
absence from the workplace, is detrimental to a persons
mental, physical and social well-being. Physicians should
therefore encourage a patients return to function and work as
soon as possible after an illness or injury.
Clearly we as Occupational Medicine Physicians must
strongly encourage rehabilitation and the more closely related
that rehabilitation is to the workplace then the more successful
it is likely to be. We must also avoid reinforcing or even, in
extreme cases, encouraging chronic sick-role behavior
amongst employees.
(a) Solutions:
There are no one size fits all solutions to sickness absence
management and return to work. Management of sickness
absence & return to work is heavily influence by

Set the stage

Uncover the issues
Confirm the issues
Confirm intent and authority
Evaluate the issues
Solve the problem
Satisfaction check

(c) Return to Work Issues:

In considering return to work issues we must bear in mind

the risk of further damage to the employees health and of

any health and
safety risk to fellow workers and included in this must be
commercial risk,
what is the employees physical and in some cases mental
capacity and perhaps in the real world most important of
all the
employees tolerance. This is the ability to tolerate
sustained work or activity at a given level. The patient may
have the ability to do a certain task but not the ability to do it
comfortably. Unfortunately tolerance is not a scientifically
verifiable concept and often two Physicians will hold
contradictory opinions which both claim to be scientific. Such
arguments are of no benefit to either the employer or the
employee and are best reconciled in private. A quote from the
AMA A Physicians Guide to Return to Work because pain
cannot be measured how does a Physician assess a patients
tolerance for work? Can any two Physicians come to the
same conclusion? (5)
(d) Functional Capacity Evaluation & Screening:
Almost all western societies use a biomedical model to
determine disability. This is a severe objective impairment =
disability model in which objective medical fact is all that is
considered. A biopsychosocial model is much better at
explaining and dealing with disability in problematic cases.
Functional capacity evaluation (FCE) is an attempt to assess
tolerance although it is far from a perfect tool. It lacks proven

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reliability and validity. Functional screening questions as

proposed by Christian (6) should include
Question 1: Return to Work
The patient is asked the following questions in relation to his
or her job:
Is your injury going to make it hard for you to do your usual
job the regular way?
Are you going to have any problem with your boss or coworkers about your injury?
Have you figured out a way to work despite your injury while
you recover?
If the answers are yes, yes, and no, returning to work
will be difficult.
Question 2: The Grocery Store
If the patient owned his or her own grocery store, would he or
she be able to find a way to work safely? If the answer is
yes, then absence from work is probably not medically
required. Therefore, a non-medical aspect (or psychosocial
issue) of the injury to this individual, and not the medical
condition, is creating the disability.
Question 3: The Molehill Sign
Is the patient making a mountain out of a molehill, or is an
apparently minor health condition having a major effect on the
individuals daily life and functions? This assessment requires
the physician to mentally compare this patient to other patients
with similar injuries or illnesses by objective disease or injury
criteria. If the answer is yes, motivation is the issue creating
disability, and the physicians job is to find the source: worker,
supervisor, employer, etc.
Question 4: The Obstacle
What is the specific obstacle preventing the individual from
working today?
This question may uncover situational or environmental
obstacles to returning to work.

(f) Impairment & Disability:

What do we mean by impairment and disability? The
American Medical Association defines impairment as the loss
of use or derangement of any body part, system or function
and disability as a decrease in or the loss or absence of the
capacity of an individual to meet personal, social or
occupational demands or to meet statutory or regulatory
requirements because of impairment (5).

(g) Guidance on medical restrictions & duration of

sickness absence:
There is no single authoritative guide on medical restrictions
and durations of sickness absence. The American College of
Occupational and Environmental Medicine Practice
Guidelines (7) give good guidance on restrictions and duration
of sickness absence together with good advice on management
of return to work. The American Medical Association A
Physicians Guide to Return to Work is a very useful small
paperback and is easily kept to hand in the consulting room.
The Medical Disability Advisor Workplace Guidelines for
Disability Duration is a large 2 volume book which is very
simply written and comprehensible to HR Managers as well as
physicians. Perhaps because of its simplicity it is the standard
reference book which I keep in my office. There is also the
Official Disability Guidelines from the Work Loss Data
Institute based on data from the CDC, OSHA and the National
Hospital Discharge Survey.
References:
(1) Confederation of British Industry Report Pulling
together: 2001 absence and labour turnover survey CBI
Publishing, London UK (2004)
(2) Chartered Institute of Personnel and Development Survey
Employee absence2001: a survey of management policy and
practice

(e) Work Prescription:

A valuable tool in managing return to work is the Work
Prescription, which clarifies to all concerned precisely what
should and what should not be undertaken.
Predictive factors for return to work bear a great similarity to
those for sickness absence: increasing age, female gender and
lower social class are all predictors of a poor outcome together
with the job related factors of demanding tasks, unfriendly
organizational structures and harsh physical work
environments. In the evaluation of work ability we need to
consider what the job involves, what is the employees
medical problem, is the employee a candidate for medical
retirement, is there a significant risk of substantial harm with
work activity and is the employee physically able to do the
job.
Of course, the more mundane but far more objective
considerations must be taken into account of precisely what
the job involves, the precise nature of the medical problem,
risk assessment and what the employee is physically capable
of.

(3) Labriola M, Lund T & Burr H, Prospective study of

physical and psychosocial risk factors for sickness absence,
Occup. Med. (October 2006; 56) 469-474.
(4) Consensus statement of the CMA, ACOEM & AAOS.
The Attending Physician's Role in Helping Patients Return to
Work after an Illness or Injury. April 2002.
(5) Talmage, J & Melhorn, JM. A Physicians Guide to
return to Work AMA Press (2005)
(6) Christian J.: Reducing disability days: healing more than
injury. J Workers Comp. (2000:9)30-55.
(7) ACOEM Occupational Medicine Practice Guidelines,
second edition, OEM Press, Beverley Farms, MA (2004)
(8) Reed, P. The Medical Disability Advisor: Workplace
Guidelines for Disability Duration fifth edition, Reed Group
Ltd., Westminster, CO (2005)
(9) Work Loss Data Institute Official Disability Guidelines
twelfth edition, WLDI, Corpus Christi, TX (2007)

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