Employers still have to turn the corner in the management of sickness absence, with the latest figures showing absence rates rising despite the higher priority of the issue in recent years.
The Chartered Institute of Personnel and Development (CIPD)’s 2007 survey has found that 8.4 days per employee were lost to sickness in the past year, an increase of 0.2% to 3.7%. Respondents reported annual costs of £659 – an increase of £61 on 2006. The private sector has the lowest level of absence, with manufacturing the only sector which reported a reduction.
But the good news for OH professionals is that there is a growing body of evidence available on how to tackle the problem. New tools have also been developed which take this information into account. Essentially, the current thinking is that sickness absence is not solely a health issue. Organisations such as the CIPD and manufacturing employers’ body the EEF are assessing the bio-psycho-social causes of taking prolonged or frequent time off work, and looking at a range of issues, including motivation and job engagement.
In recent months, research and guidelines have become available from publisher IRS, employers’ body the CBI, health insurer AXA PPP Healthcare, the CIPD and the EEF. All these organisations have compiled information about what employers are doing, and evidence about what works best.
For example, ‘” href=”http://www.personneltodayccpadminlive.rbi.web.internal/editor/'” target=_blank>IRS research has found that when employers make a concerted effort to manage workforce attendance and absence effectively, absence levels can be significantly reduced. However, employers need to spend time on such initiatives, and take a multi-faceted approach. Typically, the organisations surveyed by IRS cut absence levels by more than 25% if they pursued a policy of this kind.
Line management role
Organisations surveyed highlighted the role of line managers in managing the absence of team members, and stressed that they need training and support to perform this role. Managers also needed a clear, carefully drafted corporate absence policy to support their efforts – clarity on this issue is essential.
Many employers see absence recording as a weak area, and are working to address this. Reporting and recording are being overhauled by many organisations. They also want to see facts and figures, including the costs of absence to the business, supplied regularly to line managers.
Key findings from IRS include:
Initiatives to control absences typically involve more than eight different measures. These include: return-to-work interviews actions to involve line managers more fully in absence management improved reporting systems and cultural and policy changes.
The most effective measures are:
Targeting individuals with poor attendance records
Training line managers in absence management
Making sure that line managers are committed to managing absence
Ensuring that absences are recorded and monitored effectively.
Employers should be prepared for an apparent increase in absences when they begin to manage them more effectively. This is likely to be caused by improved absence-recording systems.
Meanwhile, the <A href="http://www.personneltodayccpadminlive.rbi.web.internal/editor/”>CBI-AXA 2007 survey found that return-to-work interviews were the most effective absence management tool, and are used by more than 90% of employers. Disciplinary procedures and the provision of absence data to managers were even more commonly used. OH provision was seen as the third most effective way of managing absence by employers.
Carrot and stick approach
This third-place ranking – which puts occupational health behind disciplinary procedures when it comes to tackling absence – led the CBI to suggest that a ‘carrot and stick’ approach may be the most successful. Almost 90% of employers provide rehabilitation services to staff returning from sick leave, although the CBI could not say how many provided a comprehensive service. This number has tripled since 2001.
Another useful finding was that employers providing private medical or surgical treatment (20% of the total) had the lowest average absence levels: 6.6 days per employee per year, suggesting that timely access to medical advice can make a crucial difference.
Dr Mark Simpson, director of AXA-PPP OH Services, says: “There is a need for greater corporate investment in simple treatments. Problems such as mild anxiety and depression can be worsened if they are left untreated. But fast-track treatments are often effective. Fast-track counselling and physio will make a huge difference to this group. Private treatment at an early stage is important.”
Employers are progressing, says Simpson, but there are still areas which need attention. “Companies still record absence badly. And it’s worse in the knowledge economy than in the service industries. It’s harder to track whether knowledge workers are actually working. If they are homeworkers, they can log on, do some e-mailing, and then go back to bed.”
With this in mind, AXA-PPP has developed a sickness management tool in collaboration with BT. Sickness Absence Management records all absences using voice-activated software, which is simple to use. Staff members record their own sickness, and the system automatically informs whoever needs to know about their absence. Those who need extra support are easily identified, and overall absence patterns are monitored.
Simpson also sees mediation and vocational rehabilitation as potential growth areas. “Vocational rehabilitation involves in-depth counselling and support, and counsellors help negotiate with the employer on behalf of the employee. They find out what the employee is capable of doing, and find work which they can still do which is useful to the organisation.”
But while he sees a place for advocacy of this kind, Simpson believes OH staff should be clear that their ultimate allegiance is to the organisation. “We are a commercial outsourced OH provider, and companies pay our wages. I am not comfortable when OH staff say: ‘I am an advocate of the employee.’ There is a balance needed.”
Another survey, <A href="http://www.personneltodayccpadminlive.rbi.web.internal/editor/”>Sickness absence and rehabilitation, was published by the EEF in July. The EEF surveyed more than 600 organisations and found that absence rates had fallen for the second year in a row. While the improvement rate seemed small – 0.6 % since 2004 – this represents an extra 1.3 million working days.
Professor Sayeed Khan, chief medical adviser to the EEF, puts the emphasis on the positive benefits of good absence management. “OH practitioners need to be even more proactive,” he stresses. “A lot of my colleagues really aren’t. And line managers need training in handling sickness absence. Training isn’t a ‘nice to have’ – it’s essential.”
The EEF found that setting up a gradual or phased return to work was one of the most effective elements in cutting absence rates. The favoured methods were:
Altering pre-absence working hours or arrangements to allow a phased return to work
Changing or modifying previous tasks to allow a phased return to work
Maintaining contact with the employee during absence
Allowing time off to attend essential appointments, post-return
Medical examination or review of medical records to assess fitness for work
Advice for employers
The EEF and AXA PPP have also drawn up a detailed document for OH and employers, <A href="http://www.personneltodayccpadminlive.rbi.web.internal/editor/”>Managing Sickness Absence – A toolkit for changing work culture and improving business performance. This includes practical, business-focused tools and templates, such as model policy documents and letters developed by HR, employment law and occupational health specialists.
With the aim of giving employers the information they need to create a high attendance culture, the kit includes sections on a wide range of issues including leadership, employee engagement, return-to-work interviews, preventing the drift into long-term absence, developing guidelines, home visits, confidentiality, difficult cases and dealing with stress, anxiety and depression.
Khan believes that OH really has to raise its game when it comes to communicating with GPs about staff whose fitness to work is in doubt, and the guidelines should help them do that. For example, a model letter asks the GP to explain what is wrong with the employee in layman’s terms, and to explain what is preventing them from returning to work.
Expecting GPs to make an overall assessment of fitness to work is a mistake. What they should do is give a medical opinion about what is wrong with the person, and what they are capable of in physical terms.
“We want OH people to stop asking GPs if someone is fit to work,” says Khan. “The OH professional is the person who should make this assessment, based on the GP’s report on the person’s condition. It’s like a cardiologist asking a GP if someone should have open heart surgery or not.
“The sort of information the GP can give is can the person sit, stand, walk? Information you can use when making an assessment about their fitness to work.”
Khan points out that often GPs have no idea about simple workplace adjustments that can be made. “The most they do is sometimes suggest that someone returns to work and carries out ‘light duties’.”
Clarity is also needed when assessing the likely period of time that an employee will need to recover from illnesses such as stroke or heart attack, or surgery. GPs have been given guidelines on this by the government, but it helps OH staff to have a meaningful discussion with doctors if they know what the parameters are themselves. For instance, it may be useful to know that a woman recovering from a hysterectomy operation will need about seven weeks off work, while the average recovery time for a hip replacement operation is 26 weeks.
Another way forward for absence management is putting the onus on employees to take the initiative, rather than wait passively to be signed off work for the duration.
“It’s a simple matter for a GP to say to someone – do you have an OH service?” says Khan. “We know from our research that organisations with more than 500 employees will have OH provision of some kind. If the GP gives a person a sicknote for a couple of weeks, then tells them to see OH at the end of that time, it is simple and puts the responsibility on the employee to do something themselves.”
Other organisations have also developed new tools geared to tackle the absence problem. WorkMatters, an Unum Group company, has launched the Absence Tracker service as part of a wider initiative to help manage workplace absence. This follows Unum’s research, which asked employees in full-time work whether they thought their colleagues would have fewer sick days if there was a stricter reporting procedure in place – about 30% thought that it would.
With this in mind, WorkMatters developed the AbsenceTracker tool, which provides the first point of contact for all absent staff. It’s a software package that enables people to contact a dedicated absence line and give details about why they are unable to come to work. The relevant details are recorded, and an e-mail or text is sent to the line manager immediately.
This leaves a clear ‘audit trail’ for both employee and employer, and is cheap to maintain. The aim is to give organisations a better understanding of the causes of absenteeism, the regional or divisional hotspots and the real impact it is having on an organisation.
Another absence management system has been developed by Bupa. Its 360-degree <A href="http://www.personneltodayccpadminlive.rbi.web.internal/editor/”>Health Risk Management is a case management service covering health risk management issues. It co-ordinates and manages treatments, clinical support and advice on a range of medical, psychological, social and lifestyle issues.
Graham Johnson, Bupa operations manager, occupational health, Manchester, says the tool has been designed in this way because the causes of workplace absence are complex and multi-faceted. “We have realised from personal experience that when people don’t return to work, the cause is often not medical,” he says. “It may be a lack of communication from the employer – someone may be off work for three months, and hear nothing. They don’t feel valued or cared for. Or maybe the real reason for their absence is anxiety or depression, or it may be something unconnected with work, such as caring for a sick relative, which they don’t want to disclose.”
Passing the buck
A system like this can help prevent line managers from passing the buck to OH, says Johnson. “There may be nothing medically wrong with an employee, but the problem is medicalised by the manager, so it is no longer their responsibility, and has to be picked up by OH.”
As a general principle, Johnson believes that involving managers from the outset is the most successful way of handling absence. “The way that people respond to a call from their manager if they are off sick depends on the way that the sickness absence policy is sold to them at the outset. The policy should be explained to all staff as part of the induction process.”
And the same applies to handling individual cases – managing absence should be seen as an essential management skill.
“One of the keys to success is involving line managers from the outset,” says Johnson. “They should be part of the process throughout. There shouldn’t be an element of surprise when someone comes back to work – this should be a planned event, which has been thought about from day one.”
The EEF toolkit Managing Sickness Absence – A toolkit for changing work culture and improving business performance is available to buy, price £90.
The Health and Safety Executive (HSE) and the Institute of Occupational Medicine (IOSH) have compiled a resources list Survey of Tools and Resources Available to Employers to Manage, Record and Monitor Sickness Absence, prepared in 2006 and available on the HSE website, reference Research Report 483
Relevant training courses on sickness absence include an MA in case management for health and employment at the University of Brighton
Unum has launched a new training programme formulated in conjunction with the National Institute of Disability Management and Research (NIDMAR).
The University of Nottingham is launching a new MSc in Workplace Health in January 2008.