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LAS VEGAS — Employees' expectations and fears about returning to work better predict how long they'll be out of work than other factors, including a clinical diagnosis.
An employee's “return to work doesn't actually happen until somebody decides to return to work,” said Jason Parker, president and senior disability management consultant at CentriX Disability Management Services Inc. in Vancouver, British Columbia. “A medical diagnosis does not tell you how long (an employee) will be off work.”
If it did, Mr. Parker said, there wouldn't be cases in which one employee asks for transitional work or other accommodations to return to the job, while a second, similarly injured worker ends up on disability. In this example, the only difference between the workers is motivation, he said.
“We label people as being unmotivated, and that may not necessarily be the case,” Mr. Parker said. “Motivation is a little bit more complex than an on/off switch. People can appear unmotivated, not because they're not motivated but because something is in the way. And until we uncover that, to assume that they're not motivated is falling a little bit short.”
When workers are engaged in the process, he said, they're more likely to open up about their concerns and eventually return to the job.
The idea that return-to-work and disability issues aren't solely clinical matters was a major focus of last week's annual Disability Management Employer Coalition conference in Las Vegas, where Mr. Parker spoke during a general session.
Kristin Tugman, assistant vice president of health and productivity at disability insurer Unum Group in Portland, Maine, said “there's a psychology component in any return-to-work effort,” but it's even more challenging when dealing with behavioral health.
“If we don't intervene, the anxiety is going to creep in and it's … going to feel like that person is not motivated,” Ms. Tugman said in an interview.
Mr. Parker said return-to-work expectations are the greatest predictor of how long an employee will be off the job, with fear and avoidance of dealing with that fear being the second-greatest predictor.
When “expectations are low and fear and avoidance are high,” injured employees “may want to come back to work; they just don't know how to,” he said.
“Anytime a person is fearful of anything, they'll avoid it,” Mr. Parker said. “If people are fearful of reinjury, fearful of their supervisor not being supportive, fearful of possibly being fired or let go … they're going to delay until that concern is addressed or it's not an issue anymore.”
“We need the medical treatment, but it's also about mindset,” Ms. Tugman said. “But at the same time, the person can't necessarily control it … They feel that anxiety and they're concerned that, 'I'm going to fail,' or, 'I feel guilty; I can't face my co-workers because I know they've been covering for me,' or, 'Clearly my co-workers are mad at me because they haven't reached out to me.' We need to be able to understand what are those barriers, and then talk about them and figure out a way to overcome them.”
Darrell Bruga, CEO of consultant LifeTeam Health in Sacramento, California, said “symptoms only account for a small percentage of why people don't return to work.”
“Psychosocial factors are much more important when determining who will return to work,” he said.
Catastrophic thinking — where a worker constantly worries about their condition — and a sense of injustice if, for example, a claim was not accepted immediately, are “risk factors that can be reduced,” he said. “People want to feel listened to.”
Experts say it's important for managers to ask open-ended questions, be good listeners and stay connected with injured employees who are off the job.
“Without that,” Ms. Tugman said, “the employee is not going to feel like they owe you anything. They're not going to feel like you care about them, and that's extremely important.”