Bouncing backOn 1 Apr 2003 in Personnel Today Comments are closed. Previous Article Next Article Many OH nurses take an active role in the process ofrehabilitating the worker. A new model helps to identify the key issues andachieve effective team working with management to succeed in this process, by RebeccaElliott & Sue Gee Sue Gee is a senior occupational health adviser within a large city councilin West Yorkshire. Having recently taken over responsibility for the educationsector, Gee has tackled the increase in sickness absence referrals due toworkplace stress by implementing a rehabilitation model. This is in line with government guidelines, which have placed vocationalrehabilitation high on the national agenda. Indeed, the Health and SafetyExecutive (HSE) is making the availability of rehabilitation one of its keytargets for 2010 in the Securing Health Together1 document. Scale of the problem Keeping people in work is essential to the wealth of the country. Withdemographic changes pointing to an ageing workforce in the next 10 to 15 years,the potential pool of staff is due to decline over the next decade and it isimperative that we keep these people in work as long as possible. Currently, 19 million work days are lost because of workplace injuries andillness, and rehabilitation can reduce this enormous loss of talent andproductivity.2 Retention of teachers is particularly important, as recentinternational research3 identifies shortages in the profession that threaten todiminish the quality of education at a time when the need for new knowledge andskills is growing dramatically. In a recent Occupational Health Review survey,4 it emerged that employersare increasingly looking to address the issue of long-term sickness absencethrough such rehabilitation programmes. And statistics released by the Department for Education and Skills (DfES)indicate that periods of sickness absence lasting more than 20 days accountedfor 45 per cent of sickness absence by state school teachers – 283,600 teacherstook sickness and absence leave in total (56 per cent of the workforce) and outof a total 2,799,00 days taken, 1,258,700 days were taken in episodes lastinglonger than 20 days.5 The number of teachers taking early retirement on thegrounds of ill health has risen by 10 per cent.6 Bradford Council’s rehabilitation programme Rehabilitation is the process of assisting the worker back into the workenvironment, to their full capacity or potential. Within any model, it is basedon consultation and co-operation, in particular working with management tofacilitate the process. There have been reports of individuals returning to work as part of arehabilitation process following work-related stress episodes and the problemsreoccurring, resulting in claims against the employer.7 The model used byBradford Council identifies specific action points for the employer to take tohelp promote the success of the process, ensure a successful return to workand, therefore, lessen the chances of any tribunal action. On meeting with clients who were currently absent from work with workplacestress issues, it was often the case that not only were they experiencingproblems (real or perceived), but that often the attempts that had been made toaddress the issues had resulted in animosity or conflict. This then compoundedthe problem. In practice, it can be difficult for the occupational health nurseto see the issues raised by the client and to understand how they had arrivedat their perceptions. At the initial interview, a client’s thoughts, ideas and dialogue are oftencentered on subjective feelings – “nobody listens to me, nobody caresabout what I think, I don’t feel valued”. To turn these feelings into action, evidence needs to be collated tovalidate the client’s interpretation of the situation and thus create a changein the working environment and facilitate effective rehabilitation. This evidence can then be shared with the manager to identify theadaptations required to ensure a safe return to work. Sue Gee has developed this model in a similar way to a solution-focusedapproach.8 The model (see box, p27) aims to elicit three things: – The client’s perception of the problem – The evidence that supports their perception of the problem – Possible solutions to the problem that can be used as a negotiation toolwith the management. Stage 1 It is imperative that at the first meeting trust is established and that theemployee understands that whatever the particular circumstances, occupationalhealth will accept their perception and interpretation of the situation. It has to be made clear that OH will not endorse or agree with theirperception, but will accept that the client believes it to be so. (In otherwords, we will not be used as a tool to tell management they are not doingtheir job.) It is important to do this before using the model as it ensures thepractitioner can stay impartial and not get into conflict with either theclient or management. It is also important to stress that the process is tofacilitate a way forward; that it is not a blaming exercise, but rather anopportunity to reflect upon the situation and the circumstances around it,which should enable a move to a satisfactory outcome. The client is given a piece of paper and asked to put theirperceptions/feelings about the situation in one column. In another column, theyare asked to evidence their perceptions. An example of this may be the client has said “nobody listens tome”. As a standalone statement this is difficult to evidence, therefore,just as a court of law would do, the comments need to be justified or evidenced.Clients are then asked to detail specific examples of how they have arrived attheir belief. Stage 2 The clients are then asked to write down the five most important issues intheir work situation that need to be addressed (using specific examples fromthe evidence), and how these should be resolved so they can return to theirworkplace and perform their job – this is the development of the wish list. The aim of the wish list is to find out what the client wants and to usethis information as a negotiating tool with their manager. The benefit is thatalthough all their wishes cannot be guaranteed, in most cases some can beachieved. Approaching it in this manner means that the individual plays a major partin their return to work, with the additional benefit that they are directlyresponsible for enabling some or all of the problems to be resolved. From themanager’s perspective, it provides valuable information that allows them toassist the employee in a positive way. The chief advantage of this approach is that it takes the sting of blame outof the situation – in other words, the manager is not made to feel neglectfulor stupid. By having a thorough understanding of the process, they have avalued part to play in the rehabilitation role and in helping the employee. Stage 3 – Implementation The first two stages are completed in confidence with the OH staff and thenext stage is to meet with the client and their manager. The purpose of this isto open communication between the two parties and allow the client to sharetheir views in a positive way. However, there are a number of considerations tokeep in mind when running the meeting: – It is vital that the information is given in a way that makes a managerwant to listen and respond – Once the client has shared the information, an opportunity must be givenfor the manager to respond – The role of the OHN is to actively listen, be aware of eye contact andother non-verbal communication. Only interrupt to clarify issues when it isnecessary – If progress is made and agreement reached, try to get both parties toagree to review dates to discuss adjustments/ support and, if possible, arrangea return to work date. Reiterate the support that will be available on returnto work – Before closing the meeting, ask both parties if all the pertinent issueshave been addressed. Conclusion Once a return to work is in progress, it is important to monitor thesituation carefully. It is imperative that any policy directives ensure thatall parties are aware of the restraints of medical confidentiality and that theOH practitioner works to the Nursing and Midwifery Council Code of ProfessionalConduct.9 An ongoing audit is demonstrating this model to be effective in practice,and research is currently being undertaken by the department to help identifyareas for improvement. To the manager, this model helps them adhere to the Management of Health andSafety at Work Regulations as part of their risk assessment.10 By being givenassistance in identifying specific areas in need of redress, the manager candocument if changes have been completed or why they have been left uncompleted.This information would also be invaluable to the organisation should therehabilitation become unsuccessful and an industrial tribunal pursued. Rebecca Elliott, BSc (Hons), PGCE, RGN, OHNC, MILTHE, seniorlecturer/course leader occupational health, Leeds Metropolitan University. SueGee, BSc (Hons) RGN, principal occupational health adviser, BradfordMetropolitan Council References 1. Health and Safety Executive (2000), Securing Health Together: A Long TermOccupational Health Strategy for England, Scotland and Wales, London 2. Tudor, O (2001) Rehabilitation the missing link, NHS Plus charteredSociety of Physiotherapy conference, accessed online www.tuc.org.uk 3. ILO UNESCO, ILO Study cited in European Health and Safety Magazineaccessed online Nov 2002, www.ilo.org/public/english/dialogue/sector/papers/education 4. Ballard, J (2002), Rehabilitation at Work, Occupational Health Review 5. DfES, Teacher sickness absence 2001 provisional, DfEE, London. Accessedonline November 2002, www.dfes.gov.uk/statistics/ DB/SFR/s0335/index.html 6. Hinsleff, G (26/05/02) Sick leave Rises as Teachers Buckle, The Observer,London 7. Moore, N (September 2002) Managing Stress Returnees, Occupational Health 8. De Shazer, S (2002), Paradox is a muddle, an interview with Steve deShazer, Rapport 34, pp41-49, Accessed online November 2002, Mark McKergowAssociates, www.mckergow. com/interview.htm 9. Nursing and Midwifery Council (2002), Code of Professional Conduct,London 10. Health and Safety Executive (1992), Management of Health and Safety atWork Regulations, HMSO, London Related posts:No related photos.