Abstract
Introduction: Common health problems have a significant impact on work productivity (presenteeism), and sickness absence. The aim of this study was to examine the attitudes and beliefs of employees in the public sector about common health problems and work using the Flags system as a conceptual framework to identify problems and potential solutions. Method: 63 employees took part in 14 focus groups in two public sector organisations. Discussions were audio-recorded, transcribed, and analysed thematically using NVivo. Results: The study confirmed the importance of heath-focused clinical factors (Yellow flags), perceptions of work (Blue flags), and more objective characteristics of work and organisational policies (Black flags), which emerged as major themes. The social and moral norms surrounding sickness absence and presenteeism were frequently discussed, including the impact of absence on colleagues, guilt, legitimising illness, and trust. There were interactions between the different Flags, often mediated by managers via their relationships with employees and their role in implementing organisational policy. Conclusions: The Flags system was useful as a conceptual framework in this context for identifying a number of obstacles to working with health problems, many of which were potentially modifiable on worker, workplace, or wider systems levels.
Similar content being viewed by others
References
Buck R, Barnes MC, Cohen D, Aylward M. Common health problems, yellow flags and functioning in a community setting. J Occup Rehabil. 2010;20:235–246.
Collins JJ, Baase CM, Sharda CE, Ozminkowski RJ, Nicholson S, Billotti GM, et al. The assessment of chronic health conditions on work performance, absence, and total economic impact for employers. J Occup Environ Med. 2005;47(6):547–57.
Dew K, Keefe V, Small K. ‘Choosing’ to work when sick: workplace presenteeism. Soc Sci Med. 2005;60(10):2273–82.
Hemp P. Presenteeism: at work–but out of it. Harv Bus Rev. 2004;82(10):49–58, 155.
Johns G. Absenteeism and presenteeism: not at work or not working well. In: Cooper CL, Barling J, editors. The Sage handbook of organizational behaviour. London: Sage; 2008. p. 160–77.
Phillips C. The costs and burden of chronic pain. Rev Pain. 2009;3(1):1–5.
Phillips C, Main C, Buck R, Aylward M, Wynne-Jones G, Farr A. Prioritising pain in policy making: the need for a whole systems perspective. Health Policy. 2008;88:166–175.
Waddell G, Aylward M. The scientific and conceptual basis of incapacity benefits. London: The Stationary Office; 2005.
Waddell G. Preventing incapacity in people with musculoskeletal disorders. Br Med Bull. 2006;77–78:55–69.
Buck R, Wynne-Jones G, Varnava A, Main CJ, Phillips CJ. Working with musculoskeletal pain. Rev Pain. 2009;3(1):6–10.
Waddell G, Burton AK. Is work good for your health and wellbeing? London: TSO; 2006.
Wynne-Jones G, Buck R, Varnava A, Phillips C, Main CJ. Impacts on work absence and performance: what really matters? Occup Med (Lond). 2009;59(8):556–62.
Johns G. Presenteeism in the workplace: a review and research agenda. J Organ Behav. 2010; Advanced view published online July 2009.
Aronsson G, Gustafsson K. Sickness presenteeism: prevalence, attendance-pressure factors, and an outline of a model for research. J Occup Environ Med. 2005;47(9):958–66.
Young AE, Roessler RT, Wasiak R, McPherson KM, van Poppel MN, Anema JR. A developmental conceptualization of return to work. J Occup Rehabil. 2005;15(4):557–68.
Main CJ, Sullivan MJ, Watson PJ. Pain and work: organisational perspectives. Pain management: practical application of the biopsychosocial perspective in clinical and occupational settings. 2nd ed. Edinburgh: Churchill Livingstone; 2007. p. 369–91.
Wade DT, Halligan PW. Do biomedical models of illness make for good healthcare systems? BMJ. 2004;329(7479):1398–401.
Barnes MC, Buck R, Williams G, Webb K, Aylward M. Beliefs about common health problems and work: a qualitative study. Soc Sci Med. 2008;67(4):657–65.
Johansson G, Lundberg I. Adjustment latitude and attendance requirements as determinants of sickness absence or attendance. Empirical tests of the illness flexibility model. Soc Sci Med. 2004;58(10):1857–68.
Kendall N, Burton AK, Main CJ, Watson PJ. Tackling musculoskeletal problems: a guide for clinc and workplace (A new method of identifying obstacles using the psychsocial falgs framework). London: The Stationary Office; 2009.
Main CJ, Burton AK. Economic and occupational influences on pain and disability. In: Main CJ, Spanswick CC, editors. Pain management: an interdisciplinary approach. Edinburgh: Churchill Livingstone; 2000. p. 63–87.
Wynne-Jones G, Varnava A, Buck R, Karanika-Murray M, Griffiths A, Phillips C, et al. The examination of the work organisation assessment questionnaire in public sector workers. J Occup Environ Med. 2009;51(5):586–93.
Kendall N, Linton SL, Main CJ. Guide to assessing psychosocial yellow flags in acute low back pain: risk factors for long term disability and work loss. Wellington, New Zealand: Accident Rehabilitation and Compenstaino Insurance Compensation of New Zealand and the National Health Committee; 1997.
Shaw WS, van der Windt DA, Main CJ, Loisel P, Linton SJ. Early patient screening and intervention to address individual-level occupational factors (“blue flags”) in back disability. J Occup Rehabil. 2009;19(1):64–80.
Kitzinger J. The methodology of Focus Groups: the importance of interaction between research and participants. Soc Health Illn. 1994;16(1):103–21.
Morgan DL. Focus groups. Ann Rev Sociol. 1996;22:129–52.
Blaxter M. Health. Cambridge: Policy Press; 2004.
Finch J. The vignette technique in survey research. Sociology. 1987;21:105–14.
Dey I. Qualitative data anlysis: a user friendly guide for social scientists. London: Routledge; 1993.
Wynne-Jones G, Katie Webb, Buck R, Cooper L, Button L, Main CJ, Phillips CJ. What happens to work if you’re unwell? Beliefs and attitudes of managers and employees with musculoskeletal pain in public sector organisations, J Occup Rehabil. 2010. Online first doi:10.1007/s10926-010-9251-7.
Grove B, Secker J, Seebohm P. New thinking about mental health and employment. Oxford: Radcliff Publishing; 2005.
Shaw WS, Means-Christensen AJ, Slater MA, Webster JS, Patterson TL, Grant I, Garfin SR, Wahlgren DR, Patel S, Atkinson HJ. Psychiatric disorders and risk of transition to chronicity in men with first onset low back pain. Pain Med. 2010;11:1391–1400.
Parsons T. The social system. New York: Free Press; 1951.
MacEachen E, Kosny A, Ferrier S, Chambers L. The “toxic dose” of system problems: why some injured workers don’t return to work as expected. J Occup Rehabil. 2010;20:349–66.
Ståhl C, Svensson T, Petersson G, Ekberg K. The work ability divide: holistic and reductionistic approaches in Swedish interdisciplinary rehabilitation teams. J Occup Rehabil. 2009;19:264–73.
Acknowledgments
This research was funded by the Welsh Assembly Government and the Wales Centre for Health. We wish to acknowledge the Well-being in Work steering group for their advice and support and we would like to thank the participating organisations and employees. We would like to thank Lori Button and Lucy Cooper for their assistance with data collection and coding and Maria Barnes for her comments on an earlier draft of this manuscript.
Conflict of Interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Buck, R., Porteous, C., Wynne-Jones, G. et al. Challenges to Remaining at Work with Common Health Problems: What Helps and What Influence Do Organisational Policies Have?. J Occup Rehabil 21, 501–512 (2011). https://doi.org/10.1007/s10926-011-9288-2
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10926-011-9288-2