Journal of Occupational Rehabilitation

, Volume 22, Issue 3, pp 322–332 | Cite as

Management of Long Term Sickness Absence: A Systematic Realist Review

  • Angela Higgins
  • Peter O’Halloran
  • Sam Porter


Purpose The increasing impact and costs of long term sickness absence have been well documented. However, the diversity and complexity of interventions and of the contexts in which these take place makes a traditional review problematic. Therefore, we undertook a systematic realist review to identify the dominant programme theories underlying best practice, to assess the evidence for these theories, and to throw light on important enabling or disabling contextual factors. Method A search of the scholarly literature from 1950 to 2011 identified 5,576 articles, of which 269 formed the basis of the review. Results We found that the dominant programme theories in relation to effective management related to: early intervention or referral by employers; having proactive organisational procedures; good communication and cooperation between stakeholders; and workplace-based occupational rehabilitation. Significant contextual factors were identified as the level of support for interventions from top management, the size and structure of the organisation, the level of financial and organisational investment in the management of long-term sickness absence, and the quality of relationships between managers and staff. Conclusions Consequently, those with responsibility for managing absence should bear in mind the contextual factors that are likely to have an impact on interventions, and do what they can to ensure stakeholders have at least a mutual understanding (if not a common purpose) in relation to their perceptions of interventions, goals, culture and practice in the management of long term sickness absence.


Sickness absence Occupational health Management Organisations 


  1. 1.
    Evans A, Walters M. From absence to attendance. 2nd ed. London: Chartered Institute of Personnel and Development; 2003.Google Scholar
  2. 2.
    Dibben P, James P, Cunningham I. Absence management in the public sector: an integrative model? Public Money Manag. 2001;21(4):55–60.CrossRefGoogle Scholar
  3. 3.
    Chartered British Institute, CBI On the path to recovery. Absence and Workplace Health Survey 2010, Accessed 01 Apr 2011.
  4. 4.
    James P, Cunningham I, Dibben P. Job retention and return to work of ill and injured workers: towards an understanding of the organisational dynamics. Employ Relat. 2006;28(3):290–303.CrossRefGoogle Scholar
  5. 5.
    Black C. Working for a healthier tomorrow: review of the heath of working age population. London: Department of Work and Pensions; 2008.Google Scholar
  6. 6.
    National Institute for Health and Clinical Excellence (NICE). Managing long-term sickness absence and incapacity for Work. Public Health Guidance 19; 2009.Google Scholar
  7. 7.
    Waddell G, Burton K. Concepts of rehabilitation for the management of low back pain. Best Pract Res Clin Rheumatol. 2005;119(4):655–70.CrossRefGoogle Scholar
  8. 8.
    Munir F, Yarker J, Haslam C. Sickness absence management: encouraging attendance or ‘risk taking’ presenteeism in employees with chronic illness? Disabil Rehabil. 2008;30(19):1461–72.PubMedCrossRefGoogle Scholar
  9. 9.
    Harrison D, Martocchio J. Time for absenteeism: a 20 year review of origins, offshoots, and outcomes. J Manag. 1998;24(3):305–50.Google Scholar
  10. 10.
    Franche RL, Cullen K, Clarke J, MacEachen E, Frank J, Sinclair S, Reardon R. Workplace-based return-to work interventions: a systematic review of the quantitative and qualitative literature. Toronto: Institute for Work and Health; 2004.Google Scholar
  11. 11.
    Pransky G, Shaw WS, Franche RL, Clarke A. Disability prevention and communication among workers, physicians, employers and insurers: current models and opportunities for improvement. Disabil Rehabil. 2004;26(11):625–34.PubMedCrossRefGoogle Scholar
  12. 12.
    Muchinsky PM. Employee absenteeism: a review of the literature. J Vocat Behav. 1977;10:316–40.CrossRefGoogle Scholar
  13. 13.
    McHugh M. The absence bug: a treatable viral infection? J Manag Psychol. 2002;17(8):722–38.CrossRefGoogle Scholar
  14. 14.
    Mowlam A, Lewis, J. Exploring how general practitioners work with patients on sickness absence. Research Report, No 257. London: Department of Work and Pensions; 2005.Google Scholar
  15. 15.
    Johnson CJ, Croghan E, Crawford J. The problems and management of sickness in the NHS: considerations for nurse managers. J Nurs Manag. 2003;11:336–42.PubMedCrossRefGoogle Scholar
  16. 16.
    Robson F, Mavin S. Managing absenteeism in local government. Public Money Manag. 2011;31(2):107–14.Google Scholar
  17. 17.
    Grundemann RW, van Vuuren CV. Preventing absenteeism in the workplace. Dublin: European Foundation for the Improvement of Living and Working Conditions; 1997.Google Scholar
  18. 18.
    Alexanderson K, Norlund A. Methods used for the systematic literature search and for the review of relevance, quality, and evidence of studies. Scand J Public Health. 2004;32(63):31–5.CrossRefGoogle Scholar
  19. 19.
    Ritchie KA, Macdonald EB, Gilmour WH, Murray KJ. Analysis of sickness absence among employees of four NHS trusts. Occup Environ Med. 1999;56:702–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Blackwood B, Alderdice F, Burns KEA, Cardwell CR, Lavery G, O’Halloran P, et al. Protocolized versus non-protocolized weaning for reducing the duration of mechanical ventilation in critically ill adult patients. Cochrane database of systematic reviews 2010; 12: Issue 5. Art. No.: CD006904. doi: 10.1002/14651858.CD006904.pub2.
  21. 21.
    Pawson R, Greenhalgh T, Harvey G, Walshe K. Realist synthesis: an introduction. ESRC Research Methods Programme; 2004. Accessed 8 Feb 2012.
  22. 22.
    Pawson R, Tilley N. Realistic evaluation. London: Sage; 1997.Google Scholar
  23. 23.
    Porter S. Critical theory. In: Miller R, Brewer J, editors. The A–Z of social research. London: Sage; 2003. p. 57–60.Google Scholar
  24. 24.
    Davis P. The limits of realistic evaluation. Evaluation. 2005;11(3):275–95.CrossRefGoogle Scholar
  25. 25.
    Sheldon H. Editorial: making evidence synthesis more useful for management and policy-making. J Health Serv Res Policy. 2005;10(1):1–4.PubMedCrossRefGoogle Scholar
  26. 26.
    Greenhalgh T, Bate RP, Kyriakidou O, Macfarlane F, Peacock R. How to spread good ideas. A systematic review of the literature on diffusion, dissemination and sustainability of innovations in health service delivery and organisation. Report for the National Coordinating Centre for NHS Service Delivery and Organisation R & D (NCCSDO) 2004. Accessed 8 Feb 2012.
  27. 27.
    Franche R, Baril R, Shaw W, Nicholas M, Loisel P. Work based return to work interventions: optimising the role of stakeholders in implementation and research. J Occup Rehabil. 2005;15(4):525–54.PubMedCrossRefGoogle Scholar
  28. 28.
    Farrell C, Nice K, Lewis J, Sainsbury R. Experiences of the job retention and rehabilitation pilot. Research Report No 339. London: Department of Work and Pensions; 2006.Google Scholar
  29. 29.
    Waddell G, Burton AK, Kendall NA. Vocational rehabilitation: what works, for whom, and when? report for the vocational rehabilitation task group. London: The Stationery Office; 2008.Google Scholar
  30. 30.
    Yassi A, Tate R, Khorhar JB. Early intervention for back injured nurses at a large Canadian tertiary care hospital; an evaluation of the effectiveness and cost benefits of a 2 year pilot project. Occup Med. 1995;45:209–14.CrossRefGoogle Scholar
  31. 31.
    Loisel P, Abenhaim L, Durand P, Esdaile JM, Suissa S, Gosselin L. A population based, randomized clinical trial on back pain management. Spine. 1997;22(24):2911–8.PubMedCrossRefGoogle Scholar
  32. 32.
    Foreman P, Murphy G, Swerissen H. Barriers and facilitators to return to work: a literature review. Melbourne: Australian Institute for Primary Care, La Trobe University; 2006.Google Scholar
  33. 33.
    Frank J, Sinclair S, Hogg-Johnson S, Shannon H, Bombardier C, Beaton D, Cole D. Preventing disability form work-related low-back pain: New evidence gives hope: if we can just get all the players onside. Can Med Assoc J. 1998;158(12):1625–31.Google Scholar
  34. 34.
    MacEachen E, Clarke J, Franche IE. Systematic review of the qualitative literature on return to work after injury. Scand J Work Environ Health. 2006;32(4):257–69.PubMedCrossRefGoogle Scholar
  35. 35.
    Franche RL, Severin CN, Hogg-Johnson S, Cote P, Vidmar M, Lee H. The impact of early workplace-based return to work strategies on work absence duration: a 6-month longitudinal study following an occupational musculoskeletal injury. J Occup Environ Med. 2007;49(9):960–74.PubMedCrossRefGoogle Scholar
  36. 36.
    Friesen MN, Yassi A, Cooper J. Return to work: the importance of human interactions and organizational structures. Work. 2001;17:11–22.PubMedGoogle Scholar
  37. 37.
    de Boer AGM, van Beek J, Durinck J, Verbeek JHAM, van Dijk FJH. An occupational health intervention programme for workers at risk for early retirement; a randomised controlled trial. Occup Environ Med. 2004;61(11):924–9.PubMedCrossRefGoogle Scholar
  38. 38.
    Heymans MW, de Vet HCW, Bongers PM, Koes BW, van Mechelen W. The effectiveness of high-intensity versus low-intensity back schools in an occupational setting: a pragmatic randomized-controlled trial. Spine. 2006;31(10):1075–82.PubMedCrossRefGoogle Scholar
  39. 39.
    Spurgeon P, Mazelan P, Barwell F, Flanagan H. New directions in managing employee absence: an evidence-based approach. London: Chartered Institute of Personnel Development; 2007.Google Scholar
  40. 40.
    Baril R, Clarke J, Friesen M, Stock S, Cole D. Management of return-to-work programs for workers with musculoskeletal disorders: a qualitative study in three Canadian provinces. Soc Sci Med. 2003;57:2101–211.PubMedCrossRefGoogle Scholar
  41. 41.
    Nieuwenhuijsen K, Verbeek JHAM, de Boer AGM, Blonk RWB, van Dijk FJH. Supervisory behaviour as a predictor of return to work in employee absent from work due to mental health problems. Occup Environ Med. 2004;61(10):817–23.PubMedCrossRefGoogle Scholar
  42. 42.
    Hazard R, Reid S, Haugh L, McFarlane G. A controlled trial of an educational pamphlet to prevent disability after occupational low back injury. Spine. 2000;25(11):1419–23.PubMedCrossRefGoogle Scholar
  43. 43.
    IRS. Rehabilitation: A case for management. IRS Employment Review; 747:44–46.Google Scholar
  44. 44.
    Kenny D. Barriers to occupational rehabilitation: an exploratory study of long term injured workers. J Occup Health Saf Aust NZ. 1995;11(3):249–56.Google Scholar
  45. 45.
    Irvine A. Managing mental health and employment. Research report No 537. London: Department of Work and Pensions; 2008.Google Scholar
  46. 46.
    Krause N, Dasinger LK, Neuhauser F. Modified work and return to work: a review of the literature. J Occup Rehabil. 1998;8(2):113–39.CrossRefGoogle Scholar
  47. 47.
    Nicholson N. Management sanctions and absence control. Human Relat. 1976;29(2):39–151.CrossRefGoogle Scholar
  48. 48.
    Nicholson N, Johns G. The absence culture and the psychological contract: who’s in control of absence? The Acad Manag Rev. 1985;10(3):397–407.Google Scholar
  49. 49.
    Baum JF. Effectiveness of an attendance control policy on reducing chronic absenteeism. Pers Psychol. 1978;31:71–81.CrossRefGoogle Scholar
  50. 50.
    Virtanen P, Nakari R, Ahonan H, Valitera J, Peritti J. Locality and habitus: the origins of sickness absence practices. Soc Sci Med. 2000;50(1):27–39.PubMedCrossRefGoogle Scholar
  51. 51.
    Loisel P, Durand M, Baril R, Gervais J, Falardeau M. Interorganizational collaboration in occupational rehabilitation: perceptions of an interdisciplinary rehab team. J Occup Rehabil. 2005;15(4):581–90.PubMedCrossRefGoogle Scholar
  52. 52.
    Jansson I, Bjorklund A. The experience of returning to work. Work. 2007;28:121–34.PubMedGoogle Scholar
  53. 53.
    Clayton S, Bambra C, Gosling R, Povall S, Misso K, Whitehead M. Assembling the evidence jigsaw: insights from a systematic review of UK studies of individual-focused return to work initiatives for disabled and long-term ill people. BMC Public Health. 2011;11:170–82. doi: 10.1186/1471-2458-11-170.PubMedCrossRefGoogle Scholar
  54. 54.
    von Knorring M, Sunderberg L, Lifgren A, Alexanderson K. Problems in sickness certification of patients: a Qualitative study on views of 26 physicians in Sweden. Scand J Prim Health Care. 2008;26:22–8.CrossRefGoogle Scholar
  55. 55.
    Beaumont DG. The interaction between general practitioners and occupational health professionals in relation to rehabilitation for work: a Delphi study. Occup Med. 2003;53:249–53.CrossRefGoogle Scholar
  56. 56.
    Nice K, Thornton P. Job retention and rehabilitation pilot: employers’ management of long-term absence. Research report No 227. London: Department of Work and Pensions; 2004.Google Scholar
  57. 57.
    Schonstein E, Verbeek JH. Occupational health systematic reviews: an overview. Work. 2006;26:255–8.PubMedGoogle Scholar
  58. 58.
    Anema JR, Jettinghoff K, Houtman ILD, Schoemaker CG, Buijs PC, van den Berg R. Medical care of employees long-term sick listed due to mental health problems: a cohort study to describe and compare the care of the occupational physician and the general practitioner. J Occup Rehabil. 2006;16(1):41–51.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Angela Higgins
    • 1
  • Peter O’Halloran
    • 1
  • Sam Porter
    • 1
  1. 1.School of Nursing and Midwifery, Medical Biology CentreQueen’s University BelfastBelfastNorthern Ireland, UK

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