Implementation of a checklist to assess factors relevant for work ability assessments of employees on long-term sick leave

Abstract

Objective

To implement the use of a checklist with factors relevant for work ability assessments of employees on long-term sick leave in daily practice of Dutch insurance physicians (IPs).

Subjects/design

Two hundred and twenty IPs were asked to participate in a nationwide implementation study.

Methods

A context analysis identified the barriers and promoting factors for the implementation. Then, participants were asked to assess, identify and report the factors that hinder or promote return to work (RTW) of employees on long-term sick leave using the checklist during six work ability assessments in daily practice. The outcome measure was the percentage of IPs that used the checklist in at least three of six work ability assessments. The use of the checklist was defined as the assessment of at least one of nine factors from the checklist. A frequency analysis was performed. Official work ability assessment records were analysed to determine whether the IPs reported the assessed factors.

Results

Most identified barriers and facilitators were related to the potential users, the work environment and the characteristics of the checklist. The implementation goal was achieved. A total of 79 IPs participated. Almost all the IPs (96 %) assessed at least one factor; 89 % used the checklist in at least 3 work ability assessments. An analysis of 474 official work ability assessment records indicated that 90 % of the IPs reported at least one of the factors.

Conclusions

The implementation of a checklist to assess barriers and facilitators for RTW of long-term sick-listed employees was successful.

Appendix: Checklist of factors relevant to return to work (RTW): a checklist for use in the identification of factors liable to promote or inhibit RTW of long-term sick-listed employees

Introduction

This checklist is intended to help IPs making work ability assessments to identify and record factors that are liable to promote or inhibit the RTW of long-term sick-listed employees. Information about such factors can promote evidence-based decision-making and transparent insurance-medical reporting.

A recent nationwide study of 102 IPs found that 80 % of them regarded consideration of the following factors as important for workforce participation and that more than 50 % of the physicians regarded consideration of the factors relevant to their work ability assessments:

• Factors liable to inhibit RTW:

  • 1. Inefficient coping style

  • 2. Inability to accept limitations

  • 3. Negative illness perceptions

  • 4. Secondary gain of illness

  • 5. Cognitions and/or behaviour that hinder RTW

  • 6. Sickness behaviour-promoting attitude and/or inappropriate advice from treating physicians regarding RTW.

• Factors liable to promote RTW:

  • 1. Positive attitude of sick-listed employee towards resuming work

  • 2. Motivation of sick-listed employee to RTW

  • 3. RTW vocational rehabilitation provided from an early stage.

How to use this checklist

• The checklist of factors relevant to work reintegration lists the nine factors referred to in the introduction. A definition of each factor is provided beneath its listing.

• To establish whether a given factor is present in a particular case, you may start by posing a question. A suitable question for starting your consideration of each factor is provided in the checklist below the factor’s definition. The question is designed to help you determine the extent to which the factor is relevant to a particular client’s circumstances.

• In the column to the right of the starting question are a number of statements relevant to the factor. The statements reflect the latest medical insights and knowledge concerning the factor.

• Establishing whether the statements are valid in the client’s case will yield information to help you to answer the starting question.

• The observation that an inhibiting factor is present can be the starting point for specific advice aimed at its elimination or mitigation.

• The observation that a promoting factor is present facilitates the identification/reinforcement of things that promote work reintegration.

• The factors present in a given case can be identified in your evaluation, where you can also indicate how they have been reflected in your assessment.

FACTORS LIABLE TO INHIBIT RETURN TO WORK

1. INEFFICIENT COPING STYLE REGARDING RTW	• Client is focused on disease/treatment, rather than on work reintegration
(Failure to cope with limitations in a way conducive to work reintegration)	• Client does not seek social support or help with problems during work reintegration
Does the client use inefficient coping strategies that hinder RTW?	• Client cannot find any suitable way of working with his/her disease
	• Client is waiting to see what will happen, not attempting to steer events, not seeking solutions
	• Client appears to avoid problematic situations by withdrawing from obligations/working arrangements
	• Client is daunted by work reintegration, is preoccupied by the difficulties of reintegration, is withdrawn, is worried often and is negative about work reintegration
	• Client has a passive/dependent attitude where reintegration is concerned, does not take the initiative and waits for others to take the lead of his/her work reintegration
	• Client puts responsibility for his/her work reintegration outside himself/herself
2. INABILITY TO ACCEPT LIMITATIONS	• Client cannot cope with the problems associated with his/her disease
(Problems accepting the physical or mental limitations associated with illness or disability)	• Client hasn’t learnt to live with the limitations associated with his/her disease
Does the client have difficulty accepting his/her disease and the associated limitations?	• Client has not learnt to accept the limitations associated with his/her disease
	• Client appears not to have accepted the limitations associated with his/her disease and finds it hard to talk about (the consequences of) the disease/is resentful about what has happened
	• Client does not believe him/herself able to cope with the limitations associated with his/her disease and lacks confidence in own abilities
	• Client appears to see his/her life as dominated by his/her disease
3. NEGATIVE ILLNESS PERCEPTIONS	• Client believes that his/her disease affects his/her life so much that working is impossible
(Negative perceptions of the disease, that hinder work reintegration)	• Client appears preoccupied with his/her disease
Does the client have negative illness perceptions that hinder RTW?	• Client does not expect treatment to yield significant improvements
	• The disease has a negative effect on the client’s mood
	• Client believes that he/she cannot go back to work until the symptoms of his/her disease have gone
	• Client thinks that he/she should not go back to work because work has made his/her problems worse
	• Client appears more focused on his/her disease/limitations than on activities that might promote RTW
4. SECONDARY GAIN OF ILLNESS (Looking for the external benefits of one’s present disease)	• There are inconsistencies in the information yielded by the examination, and there are signs that external advantages may play a role in the perpetuation of the client’s problems. The limitations described by the client are not in proportion to the seriousness of his/her disease
Is RTW hindered by secondary gain of illness?	• Client expects advantages in delaying RTW and consequently does not take advantage of reintegration opportunities, despite being medically able to do so
	• Client is awaiting outcome of a compensation claim
	• Client has asked the treating physician to help him/her secure an external benefit from a third party (e.g. benefit payments, disabled aids, work dispensation, disability accommodation, and personal health budget)
5. COGNITION AND/OR BEHAVIOUR THAT HINDER RTW	• Client believes that his/her health problems will worsen if he/she goes back to work
(Ideas/behaviour that interfere with the reintegration process)	• Client believes that working could damage his/her health
Is RTW hindered by work inhibiting behaviour and/or work inhibiting beliefs?	• Client believes that he/she should not have to work with his/her present health problems
	• Client believes that he/she is not able to work with his/her present health problems
	• Client believes that he/she cannot work until his/her health problems have been treated
	• Client believes that rest is vital to his/her recovery
6. SICKNESS BEHAVIOUR-PROMOTING ATTITUDE AND/OR INAPPROPRIATE ADVICE FROM TREATING PHYSICIANS REGARDING RTW	• Client has been advised by a treating physician not to go back to work until his/her health problems have been resolved or brought under control
(Advice from treating physicians that interferes with RTW)	• Client has been advised by a treating physician not to resume his/her previous work
Has the client been given advice by his/her treating physicians that can hinder RTW?	• Client has been advised by a treating physician not to go back to work until his/her treatment is complete
	• Client has been advised by a treating physician to rest, without receiving further information about reactivation or work reintegration

FACTORS LIABLE TO PROMOTE RTW

1. POSITIVE ATTITUDE TOWARDS RTW (Positive attitude towards returning to previous work or doing other work)	• Having a job is important to the client, and in the last 6 months, client has tried to return to work/applied for jobs/actively sought reintegration (e.g. looked for information, made contact with vocational rehabilitation counsellors, employer, and occupational physician)
Does the client have a positive attitude towards RTW?	• Work means much to the client (besides income), and client performs actions that are likely to facilitate reintegration (training, internships, work experience, etc.)
	• Client considers it likely that he/she can return to work, and client is reasonably positive about reintegration
	• Client is convinced that he/she can go back to his/her old job or do other work, and client is very confident about work reintegration
2. RTW VOCATIONAL REHABILITATION PROVIDED FROM AN EARLY STAGE	• Reintegration programme is proceeding adequately and reintegration is in sight
	• Client has made sufficient use of reintegration opportunities
(Reintegration activities start as soon as the client’s health allows)	• Client began seeing vocational rehabilitation counsellors at an early stage
Has appropriate RTW action been taken to promote work reintegration?	• Reactivation began promptly and is making steady progress
3. MOTIVATION OF SICK-LISTED EMPLOYEE TO RTW (Client’s behaviour, views or actions demonstrate motivation)	• In the last 6 months, client has performed actions aimed at reintegration (e.g. taken training, consulted occupational physician, vocational rehabilitation counsellors/job coach)
Is the client motivated about going back to work?	• Client is planning to go back to/seek work in the coming months
	• Client is ready to make concessions to return to work (accept different work, longer commuting times, accept a lower-ranking post/lower pay, etc.)
	• Client says he/she often misses work