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Stay at work rates also can be impacted
Occupational health professionals seem to paying an ever-increasing amount of attention to return-to-work (RTW) efforts, and yet, argue some experts, they and their employers are often overlooking the most important piece of the return-to-work puzzle: the first-line supervisor.
"The first-line supervisor and the everyday work group are key, central, critical to an employee’s ability to stay at or return to work successfully," asserts Jennifer Christian, MD, president and chief medical officer of Webility Corp., a disability management consulting firm based in Wayland, MA. Exactly who this individual is, is defined not so much by his or her title as by their relationship to the worker, Christian explains. "It is the person who is the face-to-face representative of the employer to the worker," she notes. "The supervisor is often the one who creates the quality of the microclimate in which the supervisees are working — and, when the chips are down, in some way personifies the quality of the relationship between the employer and the employee."
Christian would go so far as to assert that the smaller microclimate in which the employee works is more powerful in terms of return to work than the macroclimate, or the company at large. "There are people who work in dysfunctional companies who are highly motivated and fantastic employees, and part of the reason is that there is someone who has created a high-performing work group within that company," she explains.
Barbara Wleklinski, MS, workplace injury network (WIN) program manager, Carle Clinic Association, Urbana, IL, is in complete agreement. "You can have the most well-developed and written RTW program with upper management and policy support, the necessary essential program structure with timelines and clear entry and exit criteria, and it will fall on its face without training the people who need to execute the program," she asserts. Carle Clinic Association is a physician-owned, 286-plus multipractice and subspecialty group. Wleklinski leads the WIN program, which provides 16 hours of training, technical assistance, and program development services for small employers to design disability management programs.
Christian uses case studies to illustrate just how important the supervisor can be. "In one case study we use, we tell the story of Bob, who has eczema," she relates. "As many occ-health professionals know, it is partly an allergic reaction; but if you are upset, it can also become worse. The company docs put him out of work for a month, saying that dust in the shop exaggerated the symptoms. In the past, Bob had asked the other guys to shut the shop door, and they had refused and made fun of him. So he says to himself, Why should I be at work with these guys, and what’s with the supervisor, that he allows guys to be picked on?’ So in this case, the supervisor either creates an environment in which Bob wants to give his all to his job or he doesn’t."
How an employee is treated after he or she is hurt is crucial, she continues. "Some problems can be created by treating a good employee poorly after they are hurt," she offers. "Let’s say no one calls while they are home; that neglect can have a serious impact. Also, there’s a lot of harassment and teasing that go on when people can’t do their jobs, and it hurts if they feel they are not being protected by their workgroup or supervisor."
In one particularly egregious example, an employee for a gas company fractured his ankle and was told by his doctor not to stand on that foot, but his supervisor insisted upon his standing anyway. "Failure to treat employees with respect makes them feel in danger and not cared for," says Christian.
Recognizing a critical need
Unfortunately, says Christian, far too few employers recognize just how critically important supervisors are to keeping employees at work or helping them return more quickly after an illness or an injury. In fact, she says, most companies do not provide the necessary training for their supervisors. "Typically, supervisors have not had any training in this area; and if they have had any, it is likely at the paperwork level," claims Christian. "This is even globally true for disability management people; even claims adjusters and case managers are not trained that much in interpersonal skills."
The lack of trained supervisors inevitably impacts the ability of the occupational health professional to do their job. "It absolutely limits what an occ-health professional can achieve," Christian says. "The three key players in this area are going to be the worker, the supervisor, and the doctor. When any one of those three is not fully engaged and supportive it jeopardizes the outcome; it impacts the engagement of the worker." (See guidelines.)
She goes on to point out that doctors tend to believe they know more about the patient than the employer. "In reality, the supervisor may know the employee far better as a person, and has observed them in actual circumstances at work, and could be a real ally in protecting somebody and analyzing the facts."
In light of this critical need for supervisor training, Christian’s company, Webility, has created and is now beta-testing a web-based course for supervisors. "Our approach has been to design our web-based training as a management development course for supervisors," she explains. "The three co-authors are a physician (me), a lawyer/HR executive, and a safety training professional. We promise the supervisors who take it that they will feel more comfortable and will become better people managers as a result. In the background, the course is surveying the supervisors as they take the course. When Webility sends the group results reports to company management, they get a picture of the group’s perception of RTW reality."
Wleklinski had, in fact, urged Christian to create such a course. "I asked Jennifer to develop training for supervisors because it is needed, and there is not much out there organized to meet employer/trainers’ needs," she notes. "If management expects to reduce disability absence-related costs, then they need to put their money where their mouth is and train the people how to do it."
The course takes about an hour to complete, and covers such major topics as readiness to manage disability; decision making in terms of staying at or returning to work; management issues; and transitional work assignments. The underlying theme throughout each of the sections is the need to relate to the employee in a positive, supportive way. "Do not send unintended messages; do not act angry or annoyed," the course instructs. "Be aware that all the people who work for you are watching you, and will learn lessons from how you respond to a sick, injured, or impaired employee."
"We set out to create leadership, or to point out leadership opportunities," Christian explains. "A unique part of our training is that we focus on how you should act within this process — what are the overarching principles and purposes for doing what you do. It’s sort of analogous to being more than a technical safety program director. The technical director will know how the building itself will be made safe; we build the will to carry out the plan."
"Jennifer’s program offers a basic foundation for supervisors and a tool for safety/HR trainers to open the doors of communication with labor and management to explore the benefits of early return to work as part of the treatment process," says Wleklinski. "It offers a guide to the benefits of transitional employment and early RTW. Naturally, one should not assume that once finished with the course that we have mastered competency, but it does hit the right chords and sets a tone and framework for making decisions."
"We plan to beta-test with employers of various sizes and in a variety of industries," Christian notes. "There are very good reasons to want to have your supervisors be better trained — especially if you are in the midst of an improvement initiative."
[For more information, contact:
• Jennifer Christian, MD, President and Chief Medical Officer, Webility Corp., Wayland, MA. Telephone: (508) 358-5218. Web site: www.webility.md.
• Barbara Wleklinski, MS, Workplace Injury Network Program Manager, Carle Clinic Association, Urbana, IL 61801. Telephone: (217)-355-6224.]