Sick of absenteeism

The
first of two articles on sickness absence looks at the extent of the problem
and examines the factors associated with high levels of non-attendance.  By Anne Harriss

A
1998 Confederation of British Industry study found the cost of sickness absence
(SA) was in the region of £11bn a year1. Its latest survey suggests that SA
costs employers £434 per employee2. The Chartered Institute of Personnel and
Development, however, estimates a higher cost of £487 per employee, totalling
£12bn a year3.

These
costs do not end with those incurred through sick leave payments; they are
compounded by payments for overtime and temporary cover. A high level of SA is
disruptive and may also result in accidents due to reduced staffing levels,
employee fatigue and the employment of less experienced temporary staff.

This
article comments on the extent of the problem and discusses the effects of, and
factors associated with, high levels of non-attendance.

It
reflects on the quality of SA data, the usefulness of pre-employment health
assessment and the submission of medical certificates following SA, strategies
used in attendance management. Importantly, it considers the role of management
and the occupational health nurse in attendance management.

As
absence from work has serious implications, effective attendance management
must be a significant aspect of a manager’s role. Organisations must be
cognisant of the economic effects of absences and the legal and moral reasons
for dealing with their causes. Some causes are work related and employers must
remain aware of their general duty of care to their workforce under the Health
and Safety at Work Act 1974.

Reduced
morale, perhaps the result of poor working conditions, relationships or
management style, could conceivably be reflected in elevated absence levels. An
evolving downward spiral may then result, with increasing absenteeism further
reducing the morale among those who attend for work. Pro-active management is  essential; a high level of SA  breeds further absences.

SA
is a significant problem in all types of large undertakings4 and high levels
are prevalent in the public sector. Between 1996 and 1997, 4.6 million days of
SA were recorded as having been taken in the Civil Service, the estimated cost
being £404m, at an average of 10.4 days per employee per year5.

Financial
loss is only part of the picture: 87 per cent of prisons have problematic
levels of SA compromising their safe and effective operation. Some prisons
consistently demonstrate good or poor attendance levels, suggesting that
specific factors influence attendance. As the job requirements must be broadly
similar, management style, workplace conditions or hazards may be influencing
attendance. The Services’ Standards Audit Unit found that 56 per cent were
failing to meet statutory health and safety requirements. Disturbingly, the
most common failures were inadequate risk assessments and poor hazard
control6,7.

Workplace
factors

The
relationship between occupation and ill health has long been recognised.

Workplace
accidents, hazards and work-related stressors play their part in ill health.
Kirby comments on workplace stress experienced by NHS staff8, stating that more
than a quarter of nurses and doctors exhibit significant levels of stress.

Employers
not only have a duty of care under the Health and Safety at Work Act 1974 to
ensure the health, safety and welfare of their staff, but it is also in their
interest to reduce absences due to work-related ill health.

These
are areas in which OHNs may be able to work with interested parties –
management, workers and trade unions – to improve worker health.

Absence
from work is a complex phenomenon only partially attributable to ill health9.
Psychological, organisational and economic factors play a major role in
determining  the degree of absenteeism.

Non-attendance
may have an attitudinal component and be unrelated to health status. There
seems to be an intricate interaction between personal and workplace factors.
Ballard comments on the 2001 CIPD survey in which managers consider that
one-third of SA does not result from ill health. He considers that these
participants are implying that there is "some lead-swinging"10.  

This
attitude may result from either their failure to appreciate the effect of poor
working conditions on attendance or not wishing to acknowledge how their own
management style could precipitate poor work attendance.

Management
strategies

Employers
must minimise the drain on their resources as part of their management
strategy. In attempting to improve attendance, OHN initiatives may be expected.

Buchan
suggests that interventions can only be effective if they follow appropriate SA
data collection coupled with well-written attendance policies implemented by
management11.

Management
"owns the problem" and is responsible for managing employee
performance and attendance. Prompt, fair action by management is essential
where absence levels cause concern and detract from appropriate and efficient
service delivery.

To
be effective, management must monitor levels of attendance identifying any
consistent patterns of non-attendance. It may decide to follow a disciplinary
route terminating in the dismissal of an employee on the grounds of poor
attendance.

Although
this may be acceptable, it is well advised to ensure its actions are beyond
reproach. Management may be required to demonstrate to an industrial tribunal
that it has acted fairly and responsibly, and respected the employee’s rights
under current employment legislation.

Pre-employment
screening

Organisations
may seek reassurance by requiring pre-employment health screening (PES),
believing that this protects them from repeated future absence. The premise is that
the exclusion of candidates with pre-existing health problems will improve
their attendance statistics.

This
screening should not be designed as a process to weed out employees with
existing health problems. The aim should be to bar applicants with a health
problem from employment; however, it gives an opportunity to match the
requirements of the post to workers’ health status and their physical and
mental capabilities. PES has a place, particularly in attempting to ensure that
the proposed employment will not adversely affect the health of the candidate.
It may identify existing health conditions that could interfere with work
performance and is the starting point for ongoing health surveillance. This
surveillance may identify early symptoms of occupational disease such as
asthma.

Early
interventions may then be initiated, which might reduce possible future
health-related absences.

Quality
of record keeping

A
person’s decision to withdraw from work may be influenced by whether their
absences are noticed by management. The compilation of accurate data is the
first step in promoting attendance.

The
CBI study of 1993 indicated that organisations using manual systems for
recording absences have a 16 per cent higher rate of absences than those with
computerised record systems12. Furthermore, organisations with no records for
SA have a 30 per cent higher level than those with computerised systems13. This
suggests that computerised records allow trends to be recognised. "Action
triggers", such as the frequency or length of absences, allow problem
areas to be targeted. Prompt, early interventions are key to improving
attendance.

An
Industrial Relations Services study found that although 73 per cent of
organisations nationally utilised triggers, there was no preferred system14.
Silcox reports on its later survey, revealing that 61 per cent of organisations
utilise a trigger system based on length or number of spells of absence or a
combination of both in order to review an individual’s attendance or initiate a
referral to OH. She asserts that attendance management has now begun to move up
the organisational agenda11.

Harriss
found that ineffective utilisation of comprehensive data seems to be a
recurring feature of attendance management16. The true extent of SA is, quite
frankly, unknown. Without recognising and acknowledging the extent and causes
of non-attendance the negative impact of SA on the organisation cannot be
significantly reduced.

Medical
certificates

Just
as PES cannot foresee future attendance, management may erroneously rely on
medical certificates submitted by employees following SA to justify a period of
ill-health and assess fitness to return to work. Although a requirement for
payments of statutory sick pay, they are probably not helpful in deciding
whether employees are able to fulfil the requirements of their post. Howard
considers them unreliable indicators of capacity for work or indeed of
morbidity17.

The
omission of a diagnosis, or the diagnosis of "debility", may hide the
socially less acceptable diagnosis of "mental ill health". Employees
may be absenting themselves as a "coping strategy" in response to
stressors and workplace hazard exposure.

There
is the possibility of role conflict on the part of their GP who recognises that
a protracted absence may jeopardise the continuing employment of the patient.
However, a medical report obtained with the employee’s consent, and interpreted
by the OHN, can be useful provided appropriate questions are asked of the GP.
The implications, but not the content, of such reports relating to employees’
ability to perform the requirements of their post can then be explained to
their managers.

Occupational
health strategies

Management
is responsible for dealing with attendance but OHNs play a part. Their role is
separate from that of management – they give confidential, impartial and
objective advice to both parties. They should not monitor or "police"
absence levels nor should a referral to the OHN form part of the disciplinary
process. These are management responsibilities.

OHNs
can advise management on the formulation of robust SA policies which include
trigger points for management actions, including referrals to the OHN.

The
objective of such referrals is to ascertain whether employees are suffering
from a significant health problem affecting their ability to perform the
requirements of their post. The outcome of these consultations may be that, in
conjunction with management, the OHN recommends and co-ordinates
"rehabilitation" programmes for employees. This may precipitate a
workplace risk assessment and initiate a phased return-to-work programme. Such
assessments are important if hazards are to be recognised and controlled.

The
health, safety and welfare of staff can then be assured, allowing consideration
of the impact of both work practices on employee health status and of health
status on work performance. Such an assessment may identify previously
unrecognised hazards and culminate in changes to work materials, work processes
or equipment to protect the workforce. It may be pertinent to consider the
re-deployment of an employee who is suffering from a work-related ill-health
condition.

Rehabilitation

Work
attendance may have attitudinal components. These seem to be linked to repeated
short-term rather than those of long-term duration. It is unlikely that the OH
nurse will have much impact on absences with an attitudinal component, but it
remains an issue that must be dealt with by the manager. Long term, SA is more
likely to be associated with chronic ill-health18 and the OH nurse may be able
to make a positive contribution.

Initiating
a phased return to work should be an important aspect of the role of OHNs. They
have knowledge of both employee health status and their job requirements. They
are well advised to make effective links with a range of practitioners, such as
occupational therapists and disability advisers, in order that they can give
the best possible advice to both worker and manager.

Although
an employee may be fit to undertake work of some description, a multitude of
factors, not least continuing health problems may preclude them from returning
to their previous post. Re-deployment may be possible and should be
investigated.

Ethical
issues

Kloss
notes the OHN’s dual duty of care to the employer and the workforce19. Some
OHNs may feel uneasy undertaking a role in attendance management, feeling
coerced into enforcing policies with which they do not agree or validating the
reasons underpinning an individual’s SA rather than having a "caring"
role. They must decide for themselves the ethical boundaries for their
practice.

Conclusion

In
summary, OHNs have a unique nursing function, advising both employees and
management on issues relating to health, safety and welfare at work. In this
respect they are supporting the government’s initiative to improve the health
of the population encompassed within the White Paper – Saving Lives: Our
Healthier Nation20. They undertake a range of interventions in relation to
attendance management which are both reactive and proactive.

Anne
Harriss is OH nursing council director at RCN Development Centre at South Bank
University

References

1.
CBI (1998) Missing out: 1998 absence and labour turnover survey. London: CBI.

2.
CBI and PPPHealthcare (2001) Pulling together 2001 – absence and labour
turnover survey. London: CBI.

3.
CIPD (2001) Employee absence – a survey of management policy and practice.
London: CIPD.

4.
Confederation of British Industry (1995) Managing absence: 1995 CBI/Centre-file
survey results. London: CBI.

5.
Occupational Health Review (1999) Education and Employment Department takes
lead from Savings. Occupational Health Review, 78, 5.

6.
National Audit Office (1999) Managing sickness absence in the prison service.
London: Stationery Office.

7.
Occupational Health Review (1999) 
Sickness absence hits prison service. Occupational Health Review, 80, 8.

8.
Kirby A (2001) Pressure points. Occupational Health 53 (6): 26.

9.
Eyal, A. Carel RS, Goldsmith JR (1994) Factors affecting long-term sick leave
in an industrial population. International Archives of Occupational and
Environmental Health. 66: 279-282.

10.
Ballard (2001) Who bears the burden? Occupational Health Review 92: 1.

11.
Buchan J (1994) Attendance management. 
Nursing Management 1: 18-19.

12.
Confederation of British Industry (1993) Too much time out? London: CBI Percom.

13.
Confederation of British Industry (1994) Managing absence – in sickness and in
health, London: CBI.   

14.
Industrial Relations Services (1994) Industrial relations review and report 569.

15.
Silcox S (1999) Sickness absence survey. Occupational Health Review, 77, 19.

16.
Harriss A (2001)  Attending to sickness
absence. The experience of OH nursing degree students. Occupational Health
Review 92: 24-27.

17.
Howard G (1997). Getting sick of the away days. Occupational Health 49: 178-180.

18.
Watts-Davies R (1989) Absenteeism. London: Industrial Society.

19.
Kloss D (1999) Occupational health professionals: their duty of care.
Occupational Health Review 79: 35-36.

20.
Department of Health (1999) Saving lives: Our healthier nation. London:
Stationery Office.

The
role of the OHN

The
role of the OHN is:


To advise on workplace hazards and preventative strategies


To recommend adaptations to the tasks, work process or environment
matching  worker capabilities


To facilitate a return to work following SA


To identify work-related ill health conditions

OHNs
can and should play a valuable part in an attendance management strategy16.
However, they must carefully define and clarify their role as there is the
potential for conflict between their responsibility to management and their
role as employee advocate. The time is now right for research into the
strategies used by both OHNs and management to identify those that have a
significant impact on improving attendance

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