Absence management: Beyond the quick fix

Any company wishing to review its absence management services must be overwhelmed by the number of products on offer. Managing people back to work has become an industry in itself, and there is a risk that organisations that are under pressure to reduce absence levels will turn to high-profile ‘quick fixes’.

What organisations lack is real guidance in identifying where the gaps are in their internal absence management processes before they buy in additional resources. Even with successful external absence management or occupational health providers, long-term gains cannot be realised without a strong in-house absence management service.

Supermarket giant Tesco made headlines when it stopped pay for the first three days of sick leave, but there was less publicity about other initiatives, including the rolling programme of manager training, which underpinned the whole process. However, in time, it will be the manager training that will have the greater impact.

Occupational health (OH) practitioners come from a background where the first focus of absence management is on rehabilitation and support, but they also realise that where people cannot (or do not wish to) return to work, the needs of the business should take precedent. This balance between managing the individual and supporting the company is unique to OH.

This means that OH professionals are in an ideal position to lead the way in guiding managers and the human resources (HR) function to manage absence fairly, whether OH is provided in-house or externally. The profession must do more to help managers and HR to understand the OH approach and use it in practice.

Two decades ago, OH advisers would not have seen themselves as fundamental to a company’s absence management needs. Today, organisations rely on OH to help improve absence statistics and, furthermore, expect OH to justify its role by demonstrating a return on investment for the service.

For OH, this is a real step-change. Approaches designed to prevent ill health have, in part, given way to more of a focus on absence reduction, where savings can be demonstrated and greater numbers of people returned to work.

HR has taken much of the lead on this, rather than OH. This is because OH professionals do not see themselves as integral to the absence management process; are not always involved in absence policy; and, quite often, do not hold the budget to help shape how people are managed, either in or out of work, due to sickness.

However, the management of absence cannot be successfully ‘owned’ by one entity – all those involved need to come together to consider approaches, design training programmes and, most importantly, share skills.

The top two causes of absence in the UK at present are musculoskeletal conditions and stress-related illness. Both conditions are fairly protracted and difficult to manage. Certainly with back pain (and quite likely stress, too) it is known that an approach that includes all those involved in the process is the key to success.

However, what tends to happen in practice is an approach to managing the individual’s absence via two different routes: the management or HR route on the one hand, and the OH or medical one on the other. Quite often, the latter dominates. When faced with a sickness absence record, most organisations will intervene using the traditional medical or OH model.

There are many drawbacks in not only choosing this model first, but also relying on it to provide a solely medical rehabilitation route for the employee. Firstly, if the underlying cause of absence is to do with lack of training in the role or worries about personal finances, for example, it is the line manager who should be involved first in assisting the individual. And if managers are not trained to make the right interventions, the OH adviser identifying the cause of absence as work related and reporting it to the line manager or HR will be of no use.

Additional training

Only after the business has done what it can to support the employee – for example, by arranging additional training – should the individual be sent to OH, or referred to the employee assistance programme.

This is not to say that the medical approach is wrong in the rehabilitation process, but that it is currently used in isolation. Managers, HR and OH, regardless of background and skillsets, must work to the same criteria and towards the same goal – a true case management, or vocational rehabilitation approach.

This partnership approach applies as much to outsourced OH or absence management services as internal ones. It may make more sense to improve a management information system than to introduce a new OH service, which may merely duplicate what a company’s internal OH team should be doing in-house.

For the past five years at the retail-banking arm of HBOS, we have been building the skillset of HR and managers to understand this concept of rehabilitation. It has been quite a challenge, as it has meant that HR has taken on some activities that OH services would usually have carried out.

How can people who are not health professionals understand the link between health and work, create reduced hours plans and determine whether an individual’s responsibilities should be changed to help them back to work?

Our answer was to provide robust training that developed the skills of HR to understand how to question colleagues on the reason for their absence, be it health, work or social. Training was also provided to help HR support managers in formulating return-to-work plans for their teams.

Another advantage of this approach is that it can be used in a shared service environment where HR is contacted by telephone in a central service. As well as providing rehabilitation advice, HBOS’s HR advice team use a health broker to access treatment for colleagues based on previous experience with the NHS and medical advice.

HBOS does use OH support, but very much within a consultative framework, where an occupational health opinion on two opposing medical views is used as a means of arbitration, or where a very complex case of absence needs OH expertise. However, this is by no means a solution for all cases of long-term absence.

The real eye-opener is how far OH professionals can really go in supporting companies in managing absence – not by directly managing the process, but by being educators in the process.

This is to the benefit of the organisation, as HR professionals can be the makers or breakers of whether an absence case is managed through the disciplinary route or rehabilitation.

Unless a company is operating huge health surveillance programmes, it will see this as the most cost-effective route in which to provide support services.

The job satisfaction for those OH people caught up in this change will depend on their ability to engage with their HR colleagues and shape the shared service arrangements of tomorrow.

Case managers with a working knowledge and application of both HR and OH skills will be the most successful in the new world as they embrace the change.

It may not be easy for all OH practitioners to see themselves as part of this environment, but they should rethink their role and consider becoming educators of HR and line managers.

Mary McFadzean is a member of the Royal College of Nursing’s occupational health manager’s steering committee, and currently works for HBOS as its retail wellbeing manager. She is soon to set up MMC Attendance and Health Management as an independent consultant.

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