What is the best model for tackling absence? Personnel Today rounded up a panel of experts to compare notes.
Focus on engagement
Adrian Chojnacki, vice-president, employee health management, GlaxoSmithKline.
Ideally, we should focus on attendance and engagement of employees with their work rather than absence – focusing on measures of performance, not who is absent. Attendance has to be a management responsibility, focusing on short-term absence, with health professionals supporting longer term cases.
Fundamental to this is developing the right culture at work, developing methods and programmes to improve personal and business performance through the enhancement of all dimensions of health (physical, emotional, mental and the spiritual). We need to connect the personal values of employees with the values of the organisation to achieve maximum positive effect. But we know line managers are busy and they need help in managing attendance.
At GSK, we follow the model below:
- Managers must own attendance and employees going absent must make contact with their line manager on day one and establish an ongoing dialogue.
- Managers should refer to employee health professionals as early as practicable, especially for ‘red flag’ conditions such as musculoskeletal disorders or mental illness. Early identification and onward referral for rehabilitation support is the key. This may include physical rehabilitation programmes, direct referral to cognitive behavioural therapy, the use of private medical insurance, counselling or an array of non-medical advice service available through an employee assistance programme.
Standardise your case management of absentees, and ensure you use trained personnel to do this who are caring and empathetic but have a firm rehabilitation policy. They should be sending out a ‘work is good for you’ message. Bend over backwards to adapt the workplace to facilitate the return to work. Communicate early and in a standard way with GPs.
For long-term sickness, have key milestones in your process and stick to a process. Gather all evidence for a final case conference at 28 weeks, including a consultant’s report, then help the line manager to reach one of four decisions at 30 weeks: return to work, leave employment, offer long-term disability (continue pay for up to one year provided their return in one year is medically guaranteed), or progress to ill-health retirement. Finally, ensure that someone keeps records of these decisions and any medical notes for consistency.
Create a supportive work culture
Nick Jones, managing director, Grosvenor Health, and chairman, Commercial Occupational Health Providers Association
Absence management is rarely a problem in small companies, but only rarely is it not a problem for large employers.
What do small companies do better?
- They don’t have expensive day-one reporting systems
- They know their staff personally
- They don’t tend to have employment contracts that encourage absence
- They don’t have HR departments, so line managers have to do what they are paid for and manage their staff
- They use specialist external occupational health help when they need it.
If we look at the bigger companies that successfully manage absence, we see the same things, and independent research supports the basic principles.
The single most significant factor in predicting absence is the perceived lack of an encouraging and supporting culture in the work unit, and research by John Treble at Swansea University suggests that certain aspects of contractual arrangements may actually influence worker absence levels.
Neither of the above findings are new or surprising, yet they remain practical issues in many organisations, and severely limit and frustrate the efforts of HR and occupational health teams alike.
Other reasons for high absence are where an organisation is inconsistent in the application of its absence policies, and where the organisation is not prepared to act on the advice given to it by its occupational health specialists.
To be successful an organisation must help managers understand the importance of their role in avoiding and managing absence. A starting point might be to ask the occupational health team who the good and poor managers are.
Providing clear and appropriate information and advice and support to the line management on what to do when, and how to do it, will give managers the confidence and authority to act, but they also need to know that the organisation will support them in the difficult disciplinary issues that will inevitably occur with any malingering employees.
Manage attendance, not absence
Richard Preece, independent specialist in occupational medicine
Most workers are in reasonably good health, attending work and performing satisfactorily, most of the time. There are inevitably bigger rewards to be gained from supporting, developing, and encouraging the 95% that are at work, so keep absence in perspective.
There is limited evidence to support the sometimes impressive claims for one intervention or another. Large surveys may claim to identify best practice, but in reality they only identify common practice (good or bad) and the latest fads – first-day reporting, wellness programmes, employee assistance programmes and the like. Read these reports with healthy scepticism – is there really a sustained improvement in attendance and performance? Usually the ‘evidence’, just like the workers, is noticeable by its absence – some organisations recurrently report their impressive improvements in attendance, yet why was the absence rate poor in these cases to start with? And has the improvement been sustained?
Most of the key issues are common sense:
- Make it clear that the expectation is 100% attendance: most people will maintain this most of the time
- Measure and report attendance: what gets measured gets done
- Intervene quickly: why make those who need support wait?
- Communicate regularly and sensitively – both employer and employee should keep in touch
- Be prepared to pay to keep employees working: there may be a business case for supporting rapid intervention
- Seek advice – don’t settle for an interested non-specialist. Invest in robust expert occupational health advice from registered specialist nurses and doctors (and insist they deliver this whether in-house or outsourced)
Watch this space: the government’s response to Dame Carol Black’s Working for a Healthier Tomorrow review is due soon.
Train line managers to manage absence
Dr Sayeed Khan, co-author of the EEF’s Managing Sickness Absence toolkit, overall winner of the Occupational Health Awards 2007
I am firmly of the view that the line manager has the most important role to play in getting an employee back to work from either long- or short-term absence.
EEF’s experience in advising member companies shows that employers have the greatest success in creating and sustaining a high attendance culture if the whole chain of management takes day-to-day responsibility – and is accountable for – meeting attendance goals.
Research carried out by EEF reveals that the single biggest influence on reducing long-term absence is a line manager’s willingness to consider temporary adjustments, such as reduced hours. But managers can only be receptive if they are trained to understand what is possible and how to manage an employee in a rehabilitation situation. Companies can do much to support managers by getting early and pragmatic medical advice on ‘fitness to work’ rather than a simple diagnosis or prognosis of an employee’s condition.
A manager’s role is crucial and should not become too diluted by bureaucratic policies and procedures.
The line manager also plays a pivotal role in managing short-term, frequent absence. There is significantly less absence when employees have to notify their own manager rather than someone more remote. The line manager performs a central role in monitoring absence patterns in their department, and in holding return-to-work interviews and attendance reviews.
If a company outsources responsibility for fundamental roles such as notification, keeping in touch with absent employees and discussing possible early return, its chances of achieving a high attendance culture are weaker.
Tackle absence on day one
Ingolv Urnes, chief executive, Active Health Partners
Active Health Partners (AHP) introduced nurse-led absence management from the first day of absence four years ago. A number of successful implementations in the private and public sectors have translated into absence reductions of up to 40% and positive feedback from employees.
We believe it works because:
- Medical advice from nurses speeds up recovery and having a formal process deters unnecessary absence
- Consistent processes and management information highlights ‘trouble spots’ and drive accountability of both employees and managers
- Integrating absence management into web systems ensures compliance with HR policies – in particular completion of return-to-work interviews and trigger point reviews
- Early intervention and proactive management of ‘difficult’ cases such as stress reduces long-term absence and litigation risk.
We advocate that employees report all absence from the first day to a call centre staffed 24/7 with qualified nurses trained in occupational health. The nurse provides immediate medical advice, while a web-based software application ensures managers know immediately and have easy access to the absence data.
Line managers are under great pressure to do their day job. What’s more, greater litigation risk and mental health issues are increasing the burden. The ‘day one’ approach provides much needed support for the line manager, less administration and accessible management information online, and increased accountability with integrated monitoring of compliance, including completing return-to-work interviews.