Not back at work after 3 weeks

If a person is not back at work within three weeks urgent attention is needed.

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This graph shows that the likelihood of return to work goes down the longer the person is off work. If the person is not back by:

•	20 days the chance of getting back to work is 70%

•	45 days the chance of getting back to work is 50%

•	70 days the chance of getting back to work is 35%

The first few weeks are crucial. If work absence continues beyond a few weeks it is time to "pull out all stops".

Assess the influencing factors?

Have the basics of return to work been done?

Has the workplace called the employee to provide support, ask what can be done to help, openly discussed return to work? Has the employee been advised of the company's policies and procedures for injury management and relevant pay issues? Did communication with the treating practitioner take place early, preferably before the employee was seen by the doctor?

Does the employer have a proactive approach to the management of work disability? Does the workplace have a partnership with employees to assist them back to work? Are employees actively engaged in the process of return to work management?

Take a deeper look at influencing factors

A serious medical condition may require a longer time off work, however this is an uncommon situation.

o	Has the workplace done all that can be done to support the person?

o	Does the person wish to be at the workplace?

o	Is the employee overly worried about their condition?

o	Have there been other problematic cases within the person's department?

o	Is there an underlying workplace issue not yet dealt with eg. relationship problems?

o	Does the employee feel supported to return to work?

o	Is the supervisor doing a good job of keeping in touch with and assisting the employee?

o	Are the duties being offered suitable?

o	Have corrective actions been put in place to prevent the issue recurring?

Is the supervisor an active player?

o	Early management by the supervisor reduces long term problems. It actually reduces the supervisor's workload by preventing:

o	the person staying on unproductive duties

o	a cycle of up and down hours of work

o	a culture of multiple employees being on restricted duties

Does the supervisor understand this? Are they comfortable communicating with the employee about personal matters? Are they a good listener? Do they understand the importance of their role? Do they need support themselves?

Involve key people

The key people to involve are the employee and their supervisor. How that is done depends on the person and the situation. The principles of management include:

A relationship of trust allows better and deeper communication

The supervisor is usually the best person to talk to the employee. If this is not possible involve someone at the site who the employee has confidence in. This may be the department manager, production manager, human resources staff, the return to work coordinator, or the site nurse.

Ensure the focus is on the person's well being

In the quest to reduce lost time injuries (LTIs) the attention might have been on statistics rather than the employee. Ensure the person's well being is the priority and that they understand this. Communicate the importance of return to work as part of their recovery, and the urgency of the matter.

Many people are not aware of the long term problems that result from staying off work. Staying off work in the short term significantly increases the chance that they will be off work in the long term. Talk openly, for example: "We know it is important for your health to get back to work early. People who stay off work get isolated and depressed, and become less fit. It doesn't take long for these things to start. What can we do to help?"

Get the employee involved

o	People do better when they participate in decision making, and are active in their return to work.

o	Has the employee been asked what they can do? Asked to suggest duties they consider to be appropriate?

o	Do they expect to return to their usual job, are modifications to the normal job possible that would allow them to do that work?

o	What can the employee suggest that would help them at the moment?

o	Is the person an active participant in their health care? Is he/she happy with their current treatment and providers? Do they need more time and /or advice from their treaters? Would a second opinion help them?

Who else should be involved?

When the important people get involved, actions and outcomes are more likely. Ask the CEO or MD to give the person a call and check on their well being. Employees feel cared for, significant and engaged. (The boss also gets involved, with a heightened interest in the outcome). The supervisor and other managers will be more active when they are aware that management is interested in the issue.

Arrange a team meeting with the supervisor, human resources and senior management. Discuss the factors impacting the situation and plan strategies to deal with the issues. A common feature of long term cases is a lack of understanding and management of the key issues in the early stages. Does the employee have a lingering gripe about a pay issue, being passed over for promotion, a roster change that was recently introduced? Do they have a spouse with health problems and need assistance?

Influence the doctor

The best way to influence the doctor or other treating practitioners is by influencing the employee. If the employee wants to be back at work, nine times out of ten, the doctor will agree.

Other important components include:

Make sure the doctor is aware of the company's approach

o	Be reasonable, accommodating and helpful.

o	Let the doctor know about the organisation's commitment - offer to help where you can.

o	Advise treaters about the duties available at the site

o	It may be of value to meet with the doctor, as long as the employee is comfortable with this approach

Let treaters know how important you consider return to work to be for your employee. Tell the doctors and other treaters that you know the chances of return to work goes down significantly if your employee is not back at work within weeks. And that you will do what you can to support the employee.

Positive influences

While it is common to wait for the employee to be certified fit for some types of work before drawing up a return to work plan. It is better to adopt an early proactive approach that involves the employee in suggesting duties that are appropriate, writing up a return to work program, and then seek the doctor's input.

o	Other treaters, such as the physiotherapist, may be more proactive with return to work. Seek their input and that may influence the doctor.

Other strategies

Involve others:

If there is a workplace relations issue blocking return to work, involve an industrial or organisational psychologist. Unless the problem is dealt with, return to work will not happen, or be slow, difficult and less likely to be successful.

Arrange an independent medical review by an Occupational Physician, with or without a work site visit. The simple action of arranging a review can sometimes prompt change, once the employee or treater becomes aware of the activity and other medical input. Use any further medical information, such as an independent medical report, to constructively influence the situation. "Dr Y recommends these restrictions, are these suitable, or do you recommend other restrictions?"

Review the situation with the case manager at the insurer or Work Cover Agent. What do they believe is needed, what strategies can they offer or recommend?

Consider using an occupational rehabilitation provider to assist, if things are not progressing as expected.

What does the medical evidence recommend for the person's condition? Prompt the person and their treaters to use best practice, print out and give them, or send them, relevant information from www.rtwknowledge.org

Next Step:
Return to work approaches