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Modified work programs: common barriers to implementation

At a glance:
Modified work programs provide ill or injured employees with more manageable tasks so they can get back to work sooner. The duties are gradually scaled up to normal levels. These programs can halve the amount of sickness absence employees take and halve the number employees that never return to work.

Despite their value, modified work programs are not always successfully implemented. Barriers to implementation include a lack of options for modification, a lack of employee understanding about the program and negative attitudes toward the program.
Getting back to work as soon as possible is very important. The longer it takes to get back to work, the less likely an ill or injured employee is to ever return.

People with an injury sometimes believe others will arrange their return to work. The employees who achieve the best return to work results don't share this attitude, they are more likely to come up with their own practical solutions. Being proactive also tends to get positive, helpful responses from employers and others involved in managing a return to work.

Modified duties are best when they're productive, meaningful, and based in your normal work area. The best arrangement is generally a modification of your usual job, rather than new and unfamiliar duties.
Supervisors and line managers are often the best people to identify modified duties, especially when they are trained in the process. Best practice training of supervisors involves education in communication, return to work and basic ergonomics. Well trained supervisors are more likely to provide modifications that ensure safety and maximum productivity.

Employees sometimes have negative attitudes towards modified duties programs, which can prevent the program from running smoothly. The best way to address negative attitudes is to be positive about the program, and provide information to staff on the way it operates and how powerful initiatives of this type can be. It may help to stress the benefit gained by both the employee and the organisation: the employee has a better chance of recovering, and the organisation has a better chance of retaining valuable staff.

It's best to provide this information to everyone, not just those who become involved in the program. When an employee is involved in a program of modified duties, the attitude of their co-workers can affect their feelings about the program and their commitment to it. Educating the whole workforce about the program means co-workers are more likely to be supportive and accommodating.
A lack of employee understanding of modified work programs can prevent programs being successful. Treating practitioners
treating practitioner
A health professional that treats patients. In return to work this may include doctors, physiotherapists, chiropractors, osteopaths, psychologists, masseurs, etc.
  are well informed about modified work, and are in an ideal position to educate patients involved in programs of this kind. Important points to communicate include:

An understanding of the consequences of remaining off work, such as isolation, 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.
 financial impact, and impact on the family

The importance of remaining active for physical and mental well-being

The fact that remaining off work makes it harder to return. After a lengthy absence work habits are less ingrained and a new routine has been established, making change harder.

Modified duty programs need to be regularly updated, with a clear focus on returning people to their normal level of activity. Long breaks, such as five to 15 minutes every hour, tend to alienate people from their work colleagues and can cause more problems than they solve. Restrictions need to be practical and relevant. When an employer receives a certificate stating that an employee cannot lift more than 1 kg, for example, they're likely to be frustrated and find the modification difficult to accommodate.
Modified duties help people get back to work. Insurers are aware of the many barriers to a successful return to work, and can encourage all parties to be positive about the process, and work out how they can contribute effectively.

Insurers can also encourage employers to put effective procedures in place, and ensure that the workplace is aware of the return to work system.
Original Article, Authors & Publication Details:
M. van Duijn1, H. Miedema2, L. Elders1 and A. Burdorf1. (2004).

Barriers for Early Return-to-Work of Workers with Musculoskeletal Disorders According to Occupational Health Physicians and Human Resource Managers. Journal of Occupational Rehabilitation, 14(1): 31-42

1Department of Public Health, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
2Netherlands Expert Center for Work-Related Musculoskeletal Disorders, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
Background, Study Objectives, How It Was Done:
The benefits of keeping sickness absence as short as possible are well established, and many return-to-work programs are designed with this goal in mind.

Providing modified, more manageable tasks to the injured employee is a common strategy for minimizing sickness absence, since it allows a return before the person has fully recovered. This is especially the case for employees with musculoskeletal
Involving the muscles and the skeleton. This term includes the limbs, neck, shoulders and back. 'Musculoskeletal problem' refers to many different conditions that can affect the tendons, muscles and related structures.
 injuries related to heavy physical work. The demands of the work are gradually increased during rehabilitation
The process of helping a person back to their former abilities and quality of life (or as close as possible) after injury or a medical condition.
 until the person is able to return to their regular job. Previous research found this strategy to double the number of employees who returned to work, and halve the total number of sick days taken.

Unfortunately, modified work programs are not always successfully implemented. Managers and employees have been found to follow advice about workplace changes less than 60% of the time.

This study investigated the barriers that occupational physicians and human resource managers encountered when they tried to implement modified work programs for employees with musculoskeletal disorders.

A questionnaire on the subject was completed by 44 Human Resources managers and 13 occupational physicians.
Study Findings:
The barriers most commonly reported by Occupational Physicians and Human Resource managers were:

Employees not properly understanding the program
Employees having a negative attitude to the program
A lack of options for modifying work task
Difficulty modifying work tasks because of an employee's level of education

Below is a summary of the questionnaire's findings.

  Possible barriers to implementing a modified work program, suggested by the researchers Percentage of human resources managers who found this to be a problem Percentage of occupational physicians who found this to be a problem
Stage 1: Being aware of the information Insufficient information about modified work provided by occupational health services for workers and employers 26% 15%
Stage 2: Understanding the information Insufficient understanding of the employer 5% 23%
Insufficient understanding of the employee 52% 77%
Stages 3 and 4:
Adjusting attitudes and intentions
Negative attitude of employer 21% 31%
Negative attitude of employee 52% 54%
Negative attitude of co-workers (e.g. lack of support for the injured employee) 40% N/A
Concern about the possibility of taking more sick leave if the employee returns to work too early 21% 46%
Stage 5: Making practical changes to implement the program
Lack of possibilities to change work tasks 45% 54%
Lack of possibilities to change the organisation of the work 45% 38%
Lack of possibilities to change working hours 4% 5%
Difficulty in changing work tasks because of the level of education of the employee 62% 54%
Stage 6: Maintaining the changes
Lack of specific procedures in place in the workplace 21% 50%
Lack of positive experiences with the program 40% 17%

Less than 5% of companies believed it would be difficult to modify the number of hours a returning employee worked, which may provide a useful alternative to modified work duties. The researchers also mentioned that informal changes to work tasks might be overlooked by managers, but might help injured employees when they return to work. They pointed out that issues like management structure and workplace culture can influence the return-to-work process.

Physicians in this study were less satisfied than managers with the standard of return-to-work procedures in the workplace. They were also more worried than managers about the possibility of overloading the employee too quickly with physical work.
Modified work programs can be very valuable. They halve the amount of time employees spend away from work following an injury or illness, and halve the number of employees that do not return at all. Despite their value, these programs are not always implemented successfully.

Human Resources managers and Occupational Physicians generally agreed on the main barriers to implementation, identifying a lack of options for modified tasks, a lack of knowledge about modified work programs, negative attitudes of injured workers and a lack of support from co-workers. Both groups felt that a key problem was that less physically demanding work typically required a higher level of education, which employees often did not have.

The researchers suggested that actively involving employees in developing return-to-work programs would help overcome many of the barriers identified. This approach would help companies to develop a shared understanding of problems, a cooperative approach to decision making and active participation in the programs.
PubMed Abstract
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