Managing Sickness Absence
Overview | Cases | General Management | The OH Nurse | The OH Physician | Prevention
The success of an effective sickness absence policy is good communication.
Overview
- A large proportion of sickness absence occurs as the result of ailments that could be avoided through a positive approach to workplace health.
- Successful reduction in levels of sickness absence requires a co-ordinated teamwork approach from managers, human resources officers and occupational health professionals.
- High levels of sickness absence which are the result of musculo-skeletal problems (back and limbs), stress and the effects of alcohol and smoking can be reduced by proactive intervention and prevention in the workplace.
For example:- well designed machinery with good ergonomically designed operation
- good job design which minimises repetitive actions and fast cycle times
- rapid intervention when an injury or illness occurs which leads to rapid and effective rehabilitation into the workplace
- The most effective sickness absence management policies have commitment from the most senior management down through line management to the employees and their representatives on the shop floor. If the managers are not prepared to be consistent and fair in dealing with absence then any strategy will fail.
Cases
There are primarily three types of sickness absence:
- Longer term on-going sickness absence, often leading to ill health retirement, or with extended recovery periods or high incidence of recurrence. Typically an OH Physician referral.
- One episode of illness usually certified by a doctor and leading to a few weeks off sick. Examples would include a leg fracture, a heart attack, or recovery from a hernia operation. The employee usually has an otherwise good sickness record. The absence is invariably genuine and unavoidable. Typically an OH Nurse referral.
- Recurrent short-term sickness absence often self certified and giving different reasons on different occasions. The causes are often vague and non-specific. There may be a pattern of Mondays or Fridays in the days off sick. Typically an OH Nurse referral initially, although some cases, particularly those that may involve stress, depression or psychiatric problems may need to see the OH Physician.
General Management
Key points in the effective management of sickness absence are:
- Effective and rapid communication of sick note information between line manager, human resources officers and the occupational health professional.
- Good record keeping. Recorded data should include reasons for sickness absence as well as the number of days taken off.
- Every episode of absence should include a return to work interview in which the manager tries to establish the reason for the absence. The interviewer should be trained and have a protocol to help them identify problems which may need early investigation or intervention by the occupational adviser.
- The organisation should investigate means of minimising absences which are the result of waiting lists in the NHS. Early rapid intervention may return an employee to work very quickly. There may be a case for funding private rehabilitation or physiotherapy. With work-related problems a good case can be made for a rapid private specialist opinion to avoid lengthy NHS waiting lists for hospital appointments.
- Scientific evidence suggests that employees who are off work for more than two months with conditions such as back pain lose the motivation to work and it can be quite difficult to get them back to work. Any work keeps them motivated and there is a good case for a rehabilitation process at work where the employee does "light duties" for a period of time. The rehabilitation phase must be carefully controlled and have a definite time scale with the explicit purpose of returning the individual to their own job within a set and predetermined time period.
The OH Nurse
The OH nurse has several roles in supervising sickness absence:
- He/she has a pastoral role. When an employee is off for an operation or following surgery he/she maintains a contact and link with the organisation by telephone and by visiting.
- His/her medical knowledge will enable him/her to advise the organisation on the likely duration of absence. The OH nurse can only be effective in the role if he/she is informed early of an employees illness.
- He/she can assist when difficulties are identified by the managers at the return to work interviews by advising on function etc.
- He/she can filter and assist in the selection of those cases which need the advice of the occupational physician.
- With an employee's consent he/she can communicate with the GP or specialist for further information.
The OH Physician
The occupational physician has a clearly defined role in managing sickness absence:
- Confirm the diagnosis and prognosis for the employee being fit to return to their job. This he/she does by clinical history and examination and communication with the employee's GP and specialist (with their consent).
- Offer advice on rehabilitation into the workplace including suitable alternative duties as appropriate.
- Identify potential occupational disease or causes for the ill health or injury.
- Identify cases where early retirement on the grounds of ill health is appropriate.
- Identify employees who may be covered by the Disabilities Discrimination Act 1995 and advise the employer of this fact.
- Assist in the identification of employees who are malingering.
Prevention
The occupational physician has a clearly defined role in managing sickness absence:
- Well motivated and happy employees are less likely to take time off sick. Many studies support this claim. Good working practices, negotiated hours of work and a caring environment all enhance the regularity of attendance at work. The OH practitioners can facilitate a good work environment by regular involvement in risk assessment, accident and near-miss investigations.
- Preventing sickness absence starts at the recruitment interview. Appropriate questions need to be asked on recent sickness absence and on injuries sustained. Questions about sickness absence need to be asked of referees.
- The pre-employment health questionnaire and medical assessment are not good indicators for predicting future sickness absence but the questionnaire can identify pre-existing problems which may render the employee incapable of the job. The Disability Discrimination Act 1995 has made employment decisions made at the pre-employment medical assessment very important because they can be challenged at Disability Tribunals.
