Occ-health pros look at stay-at-work programs to keep workers on the job

Spot employees with problems before issues become serious

Helping injured or ill employees return to work as quickly as possible has become a major concern for occupational health professionals (see the cover story in the April 2003 Occupational Health Management). It may be, however, that an even greater opportunity for improvement and cost savings lies in preventing workers from being absent in the first place.

Whether they are called stay-at-work programs, absence management, or attendance management, proactive efforts to spots problems before they become absences have caught the attention of a number of occupational health experts.

"The bottom line is you can have a substantial number of employees stay on the job," says Peter Rousmaniere, MBA, a workers’ comp and related disability consultant in Little Rock, AR. "However, in order to do that, one probably needs to invest a lot more energy in looking at symptomology prior to an event," he adds.

"A survey we did in 1997 on attendance rates in companies shows that rates at organizations that have good absence management programs are a lot higher — absences averaged 1.4%, compared with 5.3% at companies that did not practice it," adds Jennifer Christian, MD, MPH, chair of the Arlington Heights, IL-based American College of Occupational and Environmental Medicine’s Work Fitness and Disability Section and president and chief medical officer of Webility Corp., a disability management consulting firm based in Wayland, MA.

David Brown, DSL, a principal in Clarke, Brown Associates, Ltd. in Toronto, says that absence management really has two major components — attendance management and disability management — that must be approached in tandem. "We have found that with this approach, we save on average 32% off disability costs, and we just don’t get any lawsuits," he asserts.

Brown’s approach to attendance management involves the actual tracking, through proprietary software, of employees’ attendance. "You periodically review the results; and if certain employees cross the threshold you have established, you sit down with the people who fail to attend work the most," he explains.

The goal of attendance management, he explains, is to address multiple short absences (one or two days) that normally are too short to manage. "The goal is to reduce the frequency and to keep the person at work more than in the past," he notes.

Management’s attitude plays a major role, adds Christian. "In fact, it may not be that injury and illness are the only way to look at this," she notes. "People who come into the field really focus on the fact that the employer goes from a passive to an active position; he decides to actively manage attendance and view work force availability as critical to business success. Once the employer makes that decision, they start to look around for opportunities to intervene."

How it plays out

Brown’s approach plays out in a systematic fashion. If an employee knows he or she is not going to be at work, he or she has an 800 number to call. The computer system logs the absences, as well as the reason, sends an e-mail to the employee’s manager and enters the fact that he or she is not at work into the database.

"If you track attendance properly, you can put up a spreadsheet; and if you focus only on one or two standard deviations from the norm, that means you only have to have discussions with the top 2.5% people. In other words, 97.5% of the population has better attendance than they do," Brown explains. "The focus is to help them find ways to be at work."

Those employees sit down with their manager and a facilitator. They confirm that the absence records are correct and try to group them into "like" reasons. "Say the threshold is four absences per four months, and this person has six — most of them due to transportation problems," Brown offers. "You ask the employee, How can we work through this?’"

Even something such as transportation is an occupational health problem, Brown insists. "There’s almost always a mix of causes," he notes. "Besides, you’re trying to change attendance behavior."

If the main cause turns up as sickness, you’ve got to be careful because of privacy issues. "But, you can ask if there’s anything in the workplace that makes the condition worse," he suggests. "You can ask if there is something you can do at work to make it easier for the employee."

In addition, if a person has missed too much work and has identified the problem as health-related, you can check with the occupational health nurse or physician, or his or her primary care doctor and ask if all of the absences are related to the same medical condition, and what the prognosis is.

This moves the health care professional into a consultant role, Brown explains. "You’re not using the doc as a policeman, and you’re not treating the employee like a child, asking for a note every time they’re out," he asserts.

Whatever the cause, at the end of the meeting, both parties sign off on a game plan that outlines the future steps the employer and the employee will take to remedy the situation. "This sends a message to the employee that the employer expects him to be at work; but if he’s not, they want to deal with him in a supportive way," Brown says.

He adds that if you solve the problem with one meeting, you’re really lucky. "What you often have to do is wait three to six months, review the situation, and if the problem has been fixed, you throw the employee out of the attendance management program. If not, you sit down and have a more serious conversation with them, and wait another six months — because the result of failed attendance management is often a lawsuit. But if you go through three or four of these meetings, you have a full record of how the company has tried to work with the employee."

The ergo approach

For an ergonomic symptomology approach to work, you’ve got to cast a wide net, Rousmaniere says. "If you randomly pick 10 different soft-tissue injuries in this country, you’ll find on average there are six other people at that very work site who have like jobs and whose injury risks are similar to the one being presented," he notes. "For the most part, the symptomology began well before the injury took place. What follows is that if you want to do a true remain at work approach, you probably need to get into symptomology not only on the employee who has the injury, but on the others as well."

Those symptoms often include numbness, pain, or guarding behavior (favoring), he notes.

Rousmaniere says he has been working with The Wyndham Group in Manchester, NH, and that Wyndham has found that well over 75% of the time there is a no-cost or low-cost solution to the problem. "The solutions often involve temporary changes to work — like work pace changes, the order in which tasks are done, surges of work, and so on," he explains.

They all address one or more of what Wyndham calls "the five horsemen of ergonomics": posture force, cold, stress, repetition, and vibration. "It usually shows up as multiple factors," Rousmaniere notes. "The key is to not wait until the symptomology gets so bad the employee has to miss work."

Wyndham also has found that 50% of the time it resolves symptomology the solution includes productivity improvement. "This is consistent with the belief that inside every worker injury, there is a productivity improvement struggling to get out," Rousmaniere offers.

There still is much to learn in this relatively new field, he concedes. "There is a piece of data which this field would love to have — and someone may have it — which is the median and average elapsed time for soft-tissue injuries between the onset of injury and the recognition of injury," he notes. "That process can go on for months."

Since absences never will be entirely eliminated, Christian says it’s important to be as prepared as possible — in advance — to deal with those absences when they do occur. "We must be able to respond on a dime," she says.

That ability can only come from practicing what she calls disability preparedness. "If companies can realistically predict they have people who will become injured or ill, they can have a whole plan laid out in advance so that when the injury or illness surfaces, it can kick right in," she explains.

There are several components to disability preparedness. First, there is the expectation within the company that when someone’s ability to work is altered, that the attempt will be made to minimize disruption. Second, any available, appropriate transitional tasks should be identified ahead of time. "There should be notebooks with those tasks described, and checkoffs for the docs," says Christian. Third, she says, you should have clearly identified incentive alignment and accountability associated with absences.

"Set it up so it is a win-win-win situation," Christian advises. "Have financial accountability in the management structure so that managers do better if they bring back an employee quickly or hold them accountable for leaving work, and see that the employee does better by staying."

Finally, have someone there as an advocate and support for both the supervisor and the employee. "It can be HR or medical," Christian offers. "If the employee is not experiencing this process as positive, if they feel treated unkindly or unfairly, or if they feel they are being put in danger, they need to have a place to go. For management, which is trying to figure out how to manage a problematic employee or a difficult interpersonal relationship on top of a medical condition, they may require help trying to figure out how to find appropriate transitional work and how to manage the employee. Failure to provide support to either of them can be the cause of a lot of problems."

[For more information, contact:

Peter Rousmaniere, MBA, Little Rock, AR. Telephone: (501) 347-7689. Fax: (309) 218-5376. E-mail: pfr@rousmaniere.com.
Jennifer Christian, MD, MPH, Webility Corp., 95 Woodridge Road, Wayland, MA 01778. Telephone: (508) 358-5218. Fax: (518) 358-0169. E-mail: mail@webility.md. Web: www.webility.md.
David Brown, DSL, Clarke, Brown Associates Ltd. Telephone: (416) 410-1096. Web: www.clarkebrown.com.]