If it’s evidence you want that training line managers in absence management really makes a difference, you don’t have to look much further than the Heart of England NHS Foundation Trust. Back in June 2007, absence at the trust was running at around 4.47% a month. By June last year this had fallen to 4.25%, and by June this year it was down to 4.18%, explains Sara Brown, the trust’s interim head of organisational development.
While this decline cannot be solely attributed to improvements in how managers manage absence and sickness, the fact that the trust began a significant training programme for line managers from spring 2008 has definitely played an important part in this turnaround, suggests Brown.
“Our training now looks at, if you do have absence, how to deal with things such as return-to-work interviews,” she says.
“It is less about policy and more about principles. We do want them, of course, to understand the policy, the triggers and the targets, but we also want to look at when you need to get HR involved, how to recognise signs of stress and what to do to try and prevent absence when you have a more complex case,” she adds.
Black Review on line managers and absence
National director for health and work Dame Carol Black made it very clear in her ground-breaking Working for a A Healthier Tomorrow review of workplace health that the role of the line manager was key in tackling absence and ill health.
“Good line management can lead to good health, wellbeing and improved performance,” she said. “Line managers also have a role in identifying and supporting people with health conditions to help them to carry on with their responsibilities, or adjust responsibilities where necessary.”
Line managers also had an important role in ensuring the workplace was a setting that promoted good health and wellbeing, she emphasised.
“Line managers should be supported to understand that the health and wellbeing of employees is their responsibility, and should be willing to take action when health and wellbeing are at risk,” Black said. “This ranges from identification of the potential risks, hazards and causes, to support for people who have, or are at risk of developing, health conditions. Support may mean adjusting or adapting working practices, patterns or job roles where appropriate to do so.”
And she was clear that training was an absolutely essential prerequisite to making this happen in reality.
“Line managers may need training in how best to regularly contact absent staff to stay in touch, offer support, and suggest back-to-work plans. It is important that line managers feel equipped and confident about approaching sensitive or difficult areas of conversation,” she recommended.
The importance of ensuring line managers had the right skills to play their part was also highlighted by the government in its response to the Black report.
“Creating the right environment for health and wellbeing to thrive depends upon the knowledge and skills of managers and the backing of employers/owners,” it said.
“We know that line managers have a direct impact on the health, safety and overall wellbeing of their staff through their behaviours. That is why it is so important that they have the necessary competencies and skills to be effective,” it added.
“We want to ensure that all businesses, regardless of size or sector, understand the necessity of good management skills and practices that will promote positive behaviours and create healthy workplaces.
“We want to disseminate (in partnership with others) the basic principles of good line management: how to actively encourage worker participation; motivate the workforce; manage staff who have long-term health conditions or impairments, address short- and long-term sickness absence, and encourage better worker engagement,” it recommended.
Line manager role
In many respects, while it has also proved something of a seminal document for occupational health (OH) practitioners, national director for health and work Dame Carol Black’s Working for a A Healthier Tomorrow, the 2008 review of workplace health, put the role of the line manager at the heart of its agenda for change (see box, right). And line managers can only become more effective at managing absence, sickness and wellbeing if they have the right training, she recognised.
It’s not only Black, of course, who has highlighted the importance of the line managers taking at least some “ownership” of absence issues. HR body the Chartered Institute of Personnel and Development (CIPD) has also consistently emphasised the importance of this, most recently in its 2009 absence management survey, published in July.
While the average level of employee absence had fallen to 7.4 days per employee per year from eight days (with public sector absence still sharply higher), the role of the line manager, along with access to OH expertise, was vitally important, it said. For example, return-to-work interviews were the most highly rated approach to managing short-term absence, with almost two-thirds of those polled citing them as one of the three most effective measures.
Intriguingly, given the continuing disparity between public and private sector absence, it was public sector employers that were more likely to have adopted best practice approaches to managing absence, including training line managers in absence-handling, it added.
In fact, this issue is considered of such importance – not least against the backdrop of swine flu potentially becoming a much more serious threat this autumn – that the CIPD is involved in a joint research project with the British Occupational Health Research Foundation, exploring the role of the line manager in supporting employees in making effective and lasting returns to work after long-term absence. As part of this research, this year’s survey asked the HR practitioners polled to suggest the most important things line managers could be doing (and be taught to do) to support employees back to work. These were:
- remaining in contact with absent staff
- understanding the nature of the employee’s illness and how their symptoms might affect their return to work
- discuss possible adjustments to work with the returning employee
- have regular one-to-one meetings to discuss progress
- set realistic objectives to help the employee get back up to speed
- provide flexibility over working hours
- find ways of welcoming the employee back into the team.
Of course, none of this is exactly rocket science and it should probably be common sense to most competent managers. But, as CIPD adviser Ben Willmott points out, reiterating the point and validating managers’ own instincts through formal training can be valuable.
“Sometime managers do shy away from communicating with people who are off sick, often because they feel they do not want to intrude. But that can, in fact, make the situation worse,” he says.
“Provided the contact is appropriate it will normally be welcome. Managers need to keep dialogue open when people go off long-term.”
But there is a problem here in the current economic climate, concedes Dr Les Smith, managing director of consultancy Health and Wellbeing UK, which offers just this sort of training.
“Often OH is being delivered on a contract basis where the contracts have been agreed and signed and there is not any extra money put aside for training,” he says. “OH services will often be paid to deliver a casualty, treatment and compliance service.
“With the recession, training budgets have been slashed anyway. So what has to be achieved is a way of negotiating an investment in health training,” he adds.
“There is no easy answer in terms of how OH practitioners can influence line manager behaviour,” agrees Willmott. “The important thing is that the message around the role of line managers in supporting employee wellbeing is communicated and is supported by senior management.” And, as Brown has found, grasping this particular nettle can make a big difference.
The catalyst for putting the training programme in place was the merger of Heart of England with the Good Hope Hospital back in April 2007 – a process that inevitably created challenges around communication, integration and developing a new, merged identity.
“One of the major issues that was felt could come out of the merger was potentially a major increase in sickness absence, although in fact there wasn’t,” says Brown.
From relatively small beginnings with the senior management team, a programme was put in place to ensure that managers now get around two to three hours’ education on absence management, as well as coaching from HR, with sickness management incorporated into the performance management appraisal process.
A key part of this has been the development of an e-learning package that complements the face-to-face learning, including providing examples of case studies and when to refer forward.
“We emphasise how important it is to involve OH and get their advice and support. In some cases, historically, managers refer to OH and then do nothing themselves or, even worse, do not refer until it is all last-minute and they have missed many opportunities to refer staff at an earlier point,” concedes Brown.
“Long-term sickness can also sometimes be an issue, with managers feeling they have little choice but to leave people at home to rot. So it is about creating a much more joined-up management approach, and we have really seen some positive changes,” she adds.
At its most basic, often simply just explaining to line managers what OH does can make a big difference, explains Mark Holt-Rogers, managing director of consultancy Wellbeing4business who, along with Smith, developed the Heart of England programme.
“They may not understand what the role of OH is or whether to refer, when to refer, and how to get a balance. So it is all learning the roles and responsibilities. It can also be about specific things, such as how do you actually conduct a return-to-work interview or do a medical,” he explains.
“In most organisations, the majority of what OH does is just management referrals, but often the two sides do not work as well together as they could. Managers tend to think OH just says no all the time and OH tends to think managers ask too much of them or try to push them across boundaries where they won’t or can’t go. So it is about learning why OH sometimes has to say no and what it can do. It is also about showing managers what they can ask,” he adds.
Of course, an added bonus of this is that is makes OH departments more visible with managers.
Modules should probably cover areas such as legal issues and compliance, stress, return to work, competency assessments and wellbeing – but whatever you cover, the key is to ensure that the training is relevant to your organisation’s day-to-day reality.
To this end, off-the-shelf training may not necessarily be the best answer, because the more you can tailor it to the experiences of those individual managers – for example, with ‘real-life’ case studies from the organisation – inevitably the more it is going to engage them.
“An organisation can put its own policies in there which, of course, makes it much more relevant to the manager,” adds Holt-Rogers. “We can look at what the triggers for a referral to OH should be, and so on.”
Similarly, the role of e-learning, particularly if yours is a large organisation with thousands of managers, can be crucial in helping to disseminate these messages.
Within all this, it is important to outline why OH operates in the way it does and makes the decisions it does, stresses Smith.
“A lot of managers do not understand the boundaries and strictures that OH professionals work under,” he points out. “They do not understand, for example, that OH is not only covered by the laws of land, but also the corporate governance laws of their organisation and, most importantly, the laws of professional accountability and of their professional bodies. So it is about explaining how health professionals get struck off, what that means, and so on,” he adds.
Explaining what we mean by vocational rehabilitation and case management (and current thinking) can also often lead to the scales falling away from the eyes of many line managers. Similarly, explaining that it is not just those who are absent that you need to be thinking about should be an important part of the training, Smith advises.
“You should be covering things such as the biopsychosocial models and the obstacles that can stop people coming into work” he recommends. “You can also look at prevention, education and early intervention as well as wellbeing training. So it can have a focus on the preventative aspects of health in the workplace.
“Managers need to develop a strategy for their teams to enhance and improve their health in the future. It is about trying to change it from casualty treatment and compliance model into a wellbeing and enhancement model,” he adds.
At a practical level, it is important to ensure the sessions are not too long or ‘academic’, says Brown.
“You need to keep your sessions fairly short,” she says. “If you are doing a whole -day session the chances are that people will not be able to commit the time to come along. You also need to focus on key principles rather than just policy. As well as being short, you need to make [the training] as interactive as possible, involving real-life situations that they are likely to come across. It should not just be lectures.
“You just need to try and keep the issue burning and flagging it up through coaching and by going through cases,” she adds. “It is about getting [line managers] to work more closely with HR and OH, rather than just passing it all over to them.”