At the simplest level the injured person works it out and implements change themselves. This happens every day in many workplaces. Affording people flexibility to do this helps prevent 'medicalising' the condition. At the other end of the spectrum, trained professionals can be brought in to identify appropriate work duties, see table below.
 At every level, the employee should be engaged in the discussion.
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Each level of sophistication has its advantages and disadvantages, listed below. The advantages of external professional input should be weighed against the disadvantage of taking the decision making process away from the key people involved in return to work, ie. the employee and the supervisor.
Duties arranged by
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Pros
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Cons
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Examples
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Employee modifies job
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| • | Can be implemented in office, factory based, and other jobs |
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| • | Changes may not be sufficient |
| • | Employee may not have a good understanding of what can be done |
| • | Problem may go unattended |
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| • | Driver gets out and takes stretch breaks |
| • | Machine operator finds a stool to sit on |
| • | Office worker rearranges where the files are kept |
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Discussion between employee and supervisor
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| • | Develops a partnership approach |
| • | Employee feels cared for |
| • | Supervisor understands the issues |
| • | More significant changes may be possible |
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| • | Supervisor may have limited understanding of ergonomics |
| • | Supervisor may have limited time and focus and be unsupportive |
| • | Others may wish to 'follow suit' and have their job made easier - culture of restricted duties develops |
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| • | Supervisor becomes aware of the person's shoulder problem and provides a trolley to move the tray of parts |
| • | Call centre worker with back pain provided with a wireless headset by the line manager so they can stand up and move about intermittently |
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Internal return to work coordinator
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| • | Coordinator has a broader understanding of what can be achieved |
| • | Has a big picture approach across the organisation |
| • | Sees patterns of problems which supports site improvements |
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| • | Coordinator sets up a discussion with the production manager and the machine operator with back pain is changed to a less demanding job for three months |
| • | Coordinator becomes aware of a bank teller off work with neck pain. The coordinator identifies 'back office' duties that allow more flexibility in work tasks. The coordinator writes up a return to work plan as the basis for discussion with the teller and the treating doctor |
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External rehabilitation professional
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| • | Greater level of knowledge, experience and skills in ergonomics and job modifications |
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| • | Significant level of coordination can be required |
| • | Consultant not familiar with all aspects of the job |
| • | Externalises the decision making |
| • | More coordination required if there are ongoing problems |
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| • | A finance administrator with forearm pain has been off work for four months. The employer has not been successful in identifying appropriate duties. A rehabilitation professional attends and ensures the workstation setup is appropriate. They also identify problems in the relationship between the employee and manager, and recommend mediation to be arranged to defuse the conflict |
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Ergonomist
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| • | More sustained changes can be implemented |
| • | May identify other changes that will assist in preventing further problems |
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| • | Cost of modifications are likely to be higher |
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| • | Two people operating a compactus report back problems when manoeuvring a large bale into position. An industrial ergonomist reviews the compactus and recommends the addition of a hydraulic arm that will lift the bales and remove the manual handling causing the problems |
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Next Step:
Relationships & Communication
