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Workplace Factors
Flexibility in the workplace assists people on long-term sickness absence to return to work

At a glance:
In flexible workplaces people take less sick leave, they are more likely to remain at work despite a long term illness and they return to work quicker after injury. The study found:

18% of the women and 15% of the men who reported high levels of flexibility at work were still on sick leave.
45% of the women and 49% of the men who reported low levels of flexibility at work were still on sick leave.
When a workplace provides some flexibility for a return to work the outcomes are better. Workplaces are more able to be flexible when there is a good understanding of issues. It is important the employer has a constructive understanding of what you can and can't do.

Arranging modified duties for return to work is a challenge for many employers. Your help in planning can make a significant difference. Provide as much information as you can, such as when you will be able to return to work, increase activities or duties, or return to your normal job.

When you contribute in a positive way the employer will be more motivated to help.
The current return to work system revolves around treating practitioners
treating practitioner
A health professional that treats patients. In return to work this may include doctors, physiotherapists, chiropractors, osteopaths, psychologists, masseurs, etc.
 statements on a medical certificate.

The success of return to work often involves support and flexibility in the workplace. Return to work restrictions need to be followed. When people feel they are able to voice a problem, they are more likely to return to work with confidence. Creating trust in the process increases the chance of a successful outcome. When the employer is prepared to accommodate an employee's needs and offer flexibility, confidence and motivation to be in the workplace increases.

Most people have a positive commitment to return to work when they are treated well. People who are not committed to return to work need clear boundaries. They need to be given them to understand that personal responsibility and work commitment will be taken seriously.

If the employee's concerns are not heard and addressed, it will be difficult to deal with their situation effectively.
People returning to work do better when they feel they are productive, able to contribute and are seen as one of the team.

Medical conditions can require restrictions, either to help the recovery process, or so the person does not experience significant levels of pain.

Employers are in a better position to be flexible when they have an adequate understanding of the nature of the condition and there is positive communication.

Providing unnecessarily strict restrictions, for example no lifting over 1 kg for a person with back pain, limits the employers opportunities to provide tasks. This can cause the employee to be unproductive, which in turn causes distress
Severe suffering, pain, anxiety or sorrow
 for the employee and frustration for the employer.

On the whole there is little evidence to support severe or strict restrictions for most medical conditions. Therapy has moved from a rest approach for conditions such as back pain to a more active approach, for example high-level sports people rarely restrict activities for long periods.

Encourage people back to maximum function, and encourage a partnership approach with the employer to identify suitable tasks that facilitate this.
This study showed flexibility in the workplace improves return to work outcomes.

A partnership approach improves the likelihood of communication and flexibility.

Encourage employers to have a whole of company approach towards managing return to work.

Supervisors do better and are more satisfied when they have appropriate training.

Senior managers should be engaged. Senior managers influence the company's approach, and can provide leadership in positive management of return to work.

All of these factors will help employers provide a flexible and welcoming workplace for return to work.
Original Article, Authors & Publication Details:
Johaon G1, Lundberg O2, Lundberg I.3 (2006)

Return to work and adjustment latitude among employees on long-term sickness absence. Journal of Occupational Rehabilitation; 16(2):181..

1 Division of Occupational Medicine, Department of Public Health Sciences, Stockholm, Sweden
2 Centre for Equity Studies, Stockholm University/Karolinska Institutet, Stockholm, Sweden
3 National Institute for Working Life, Stockholm, Sweden
Background, Study Objectives, How It Was Done:
Long-term sick leave increases the risk of poverty, social isolation and unemployment. Paid sick leave is also costly for the employer. It's therefore important to help people return to work after sick leave.

Whether or not they are able to return depends on their ability to work. This is determined by the person's health and the working conditions. The flexibility to adjust workplace factors according the worker's health can increase an employee's ability to work. This is referred to as “adjustment latitude' and may involve changes to working hours, the workplace environment and procedures etc. Permanent changes to work arrangements such as a move from full-time to part-time work, or a change in the tasks performed at work can be equally important.

Research has shown that employees take less sick leave when working in flexible workplaces.

Employees have also been found to be more likely to return to work after injury, or to remain at work despite long-term illness in flexible workplaces. For example, when flexible working hours are available people with long term health problems are more likely to remain productive in the workplace.

The study was carried out in Sweden in 2001. 3056 insured employees (1783 women and 1273 men) answered a questionnaire about flexibility at work and whether or not they had been able to return after a period of sick leave. They were white-collar workers in the private sector aged 21 – 66. The workers chosen had been on sick leave for at least 90 days during the previous year (2000) and had been diagnosed with one of 16 specific conditions selected by the researchers. About 65% of the women and 57% of the men selected had psychiatric disorders, including depression
A symptom of mood disorder characterized by intense feelings of loss, sadness, hopelessness, failure, and rejection. Major depression is likely to interfere significantly with everyday activity, with symptoms including insomnia, irritability, weight loss, and a lack of interest in outside events. The disorder may last several months or longer and may recur, but it is generally reversible in the short run.
 and burnout.

The questionnaire established how much flexibility was available in the individual's workplace. 9 examples of flexibility in the workplace were given (able to postpone work, able to work from home etc) and employees were asked whether these options were available to them. The employees were also asked whether they had returned to work full time or part time, or if they had not been able to return. The association between flexibility and returning to work could then be observed.

Other factors besides workplace flexibility can influence return to work. Such factors include an individual's socioeconomic position and health, their level of demand from home duties, how enjoyable they find their work and the job culture within a particular employment sector. For this reason the study matched employees from the same sector and socioeconomic position. This allowed the researchers to compare people who had similar home, health and work situations on their surveys. Similar subjects were compared only to each other so that individual differences were taken into account and did not confuse the results.
Study Findings:
Many subjects reported that they had flexibility in:

Postponing tasks
Asking for help
Choosing which tasks to perform

Fewer reported that they were able to:

Take longer breaks
Leave work early
Work undisturbed
Work more slowly
Work from home.

Women were less overall likely to report that they had flexibility in the workplace.

Of the women who had 90 days or more sick leave in 2000, 32% were back at work full time in 2001, 34% were back at work part-time and 34% were still on sick leave. For the men, 33% were back at work, 32% were part-time and 36% were still on sick leave.

As expected, employees who reported that they had more opportunities for flexibility in the workplace were more likely to have returned to work. This was the case for both psychological
Refers to a person's perceptions, thought processes, emotions, personality and behaviour. Psychologists can treat mental health problems.
 and physical illnesses.

In the group of employees who said that they had the most flexibility at work (access to 7- 9 of the 9 examples given) only 18% of the women and 15% of the men were still on sick leave. In comparison, among the group with the least flexible workplaces (access to 0-3 examples of flexibility) 45% of the women and 49% of the men were still on sick leave.

It was also found that employees were more likely to return to work if they were younger, had good health or had more demanding home responsibilities. When these influences were taken into account, employees in a flexible workplace were still more likely to return to work.
As in previous research, this study showed that employees are more likely to return to work after a long period of sick-leave if there are opportunities for flexibility in their workplace. For people who returned to work part-time due to their illness, the study found that the reduction in hours alone might not be enough – flexibility at work was still important.

The researchers concluded that both health and flexibility at work were important influences on a person's ability to work, and therefore their likelihood of returning to work after a long illness. Adaptations to work might include a lessened work-load, training or changes in hours, equipment or tasks performed, amongst other things. The researchers also pointed out that it's important for these changes to take place at an appropriate time course of a person's illness and recovery. They also suggested that there is a need for more research into which changes are most effective in helping people return to work.
PubMed Abstract
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