This is the first of two articles on the topic. This month's
article concentrates on defining the concept of RTW, explaining
why it's important and how to initiate a formal program,
establish goals, and explore key program elements. In Part 2, we
will cover roles and responsibilities, interventions/triggers,
outcome and success measures, and consideration for
accommodations.
Introduction
At any point in time, an estimated 4 to 10 percent of an
employer's workforce is not at work. That is a significant
number. Time away may be due to any reason including, but not
limited to, personal days, vacations, sabbaticals, jury duty,
bereavement leave, and injury or illness (both occupational and
nonoccupational). Although some absences are necessary and allow
time for recuperation and rejuvenation, employers must work to
manage absences whenever possible given their impact on
productivity, profit, and employee morale.
One way to manage time away from work is to promote—through
plans, processes, training, and communication—RTW initiatives.
Establishing an RTW program, including stay-at-work (SAW)
elements, demonstrates an organizational commitment to
employees, while also prioritizing corporate goals and
objectives.
The roots of RTW, for most firms, are linked to safety
programs and accident prevention tied to workers compensation.
The goal has consistently been to develop programs that enable
employees to return to a safer environment, as well as limit
accidents and recurring exposures to foster a SAW mentality.
Over time, the core concepts of RTW have and continue to be
leveraged for not only workers compensation but also
nonoccupational disability. Although RTW is still primarily
focused on accidents, illnesses, and injuries, employees out for
any reason (e.g., family medical leave, personal leave) benefit
from a smooth transition back to their role.
Defining RTW
In its basic form, RTW is getting employees back to their
jobs, taking into account individual circumstances, but
establishing streamlined processes to treat employees in a
similar manner. When examined in more detail, RTW is less about
the short-term gain of returning an employee to his or her
specific job and more about a sustainable culture that fosters
employees' needs and considers not what keeps them from doing
their jobs but what jobs they can accomplish and how they can be
more productive in the short and long term. Given this, programs
promoting return to employment vary based on the employer and
its culture.
Typically, an RTW program can be defined as either a formal
or an informal program. A formal RTW program is one based on
specific written and disseminated organizational policies and
practices that instruct and direct supervisors and employees in
the RTW process following a leave of absence due to an injury,
illness, or chronic disease. A formal RTW program's intent is to
expedite the individual's recovery and return to productivity
through referral, counseling, coordination of medical care, or
modifying the work space or work duties. Formal RTW programs may
include vocational rehabilitation services coupled with
transitional work to reintegrate the individual back to full
productivity. A formal RTW program may or may not be integrated
with other benefits or absence or leave management services,
although these are highly recommended. Reasons to have a formal
RTW program include reduction of lost time, it being the "right"
thing to do, statutory requirements, and protection of the
investment in the workforce.
An informal RTW program is one where there are few or no
written policies or practices to guide the management team or
the employees who are absent due to injury, illness, or chronic
disease. Any employer response is based primarily on a
case-by-case basis guided by the personal relationships,
communication, and/or local practices at the department or work
unit level. Companies often begin with an informal process and
move to a formal program to increase their success. Reasons to
have an informal RTW program include reduction of lost time,
implementation of the simplest strategy, and greater
flexibility.
RTW can be considered both a plan feature and a process. As a
plan feature, RTW coordinates with absence plan design. Within
occupational and nonoccupational disability, participation in
specific vocational rehabilitation programs that promote RTW may
be required to validate the absence by an employer or have the
absence qualified for compensability. When considering plan
design, the most important factors are program goals, roles and
responsibilities, and intervention or trigger points.
Why Is RTW Important to Companies?
The reasons for implementing either a formal or an informal
program can be as varied as the organization. As defined above,
both formal and informal programs have advantages and
disadvantages. However, research has shown that a number of
compelling factors play into the decision.
Economic Factors
Medical costs, claim incidents, and duration are all
corporate challenges. One study found that 66 percent of
companies found these to be chronic, serious, or consistent
problems.
Productivity
Saving lost workdays and protecting your human capital are
two of the most influential factors driving the decision to
implement a formal RTW program.
Governmental Regulations
Federal, state, and local regulations and subsequent
compliance are a source of possible influence, especially if
employers are required to have a program in place.
Inclusiveness
An aging workforce leads to more attention to strategies to
keep workers at work and making sure that all lost time is
connected.
Proactive Stance
Managing lost time benefits society through longer-term
positive effects on labor force participation.
RTW Works
There is a substantial body of knowledge that illustrates the
effectiveness of RTW "best practices" if applied in a timely and
appropriate manner.
Developing a Formal RTW Program
Any concerned supervisor and motivated employee can engage in
RTW; no formal process is required. These ad hoc initiatives are
beneficial for all parties involved, but they can create some
inconsistencies in processes, which may be frustrating to
employees and perhaps result in noncompliant interactions with
employees or even legal implications. Without support, managers
and supervisors cannot be expected to be aware of all federal
and state requirements, and, therefore, they may innocently ask
questions that may be inappropriate or forget to track cases in
line with regulatory standards (e.g., state disability, family
medical leave, etc.).
By developing a more structured program with an RTW focus, an
organization can better manage its features. Expectations will
be communicated, and all core parties (employees, supervisors,
physicians, etc.) will know what is expected of them. Also, a
formal process usually includes a provision for supplying
physicians with details surrounding job requirements. This may
translate into a greater comfort level for returning an employee
to work with modifications or in a limited capacity. Additional
gains in process include:
- Streamlined communications to all core
stakeholders
- Training for managers to equip them with the
appropriate tools to remain compliant
- Formal triggers for RTW
- Established modifications for job categories
- Creative options for both internal and
external jobs (e.g., job banks)
- Ability to track against established
processes and monitor outcomes
- Financial and cost savings
- A competitive advantage
Implementing an RTW program from scratch may be challenging
because many organizations have not
rigorously analyzed their causes and costs related to absence.
Absent an established baseline, predicting or demonstrating
savings can be difficult. Employers should study the experiences
of industry peers or competitors to appreciate that their
companies can replicate successes by other organizations if
they install appropriate plans and processes. It is imperative
that when considering implementing an RTW program, tracking is
part of the overall solution. It is only through tracking the
plans, processes, and outcomes (qualitative and quantitative)
that results can be monitored and changes can be made to improve
on the program over time.
Program Goals
Employers engage in an RTW program for many different
reasons, including better management of the costs of benefits
offered by their organization, creating a more employee-centric
process, and supporting managers toward optimal productivity.
The core RTW goals should be clearly defined at the outset,
reassessing them on a regular basis. In some cases, they may be
attained, and, therefore, more aggressive standards should be
set. In other circumstances, goals may need to be modified if
they no longer correspond to corporate need or if they have been
set too high and require adjusting.
Although all program goals are important, the most common
objective is reduced spending. Savings can be achieved through
various mechanisms and incentives to establish and maintain an
RTW program. At the outset, these may be difficult to quantify,
but organizations achieve savings through:
- Reduction in cost of absence (disability,
workers compensation, etc.)
- Decrease in replacement worker expenses
(training, recruitment, team worker effect,
etc.)
- Decline in medical claim costs
- Reduction in litigation costs
- Earlier identification of fraudulent cases
- Increased awareness of injury prevention and
safety protocols
- Improved employee morale, which may
contribute to decreased turnover
If thoughtfully established, processes and plans represent a
mutually beneficial solution for employees and employers. For
employees, participating in an RTW program may assist in their
recoveries. It typically allows them to begin working as they
recover, which frequently translates into a feeling of physical
and emotional growth. Absent employees, depending on their
circumstances, may become disengaged from the workplace. At
times, physical ailments may transition into emotional
deterioration, resulting in longer recovery time.
The longer employees are absent, the less likely they are to
return to their original jobs. In some ways, this is simply a
function of more complex conditions that necessitate
long-duration absences, but industry experts agree there is a
culture of absence that can cause employees to remain out simply
due to the fact that they are not engaged in the workforce. They
may realize the benefits of not working, or they may simply
become detached from their prior identities and, over time, lose
the drive to become productive in the workforce. This is not
necessarily fraudulent behavior, as many employees are not
purposefully remaining out of work, but they lack the desire to
return, which can exacerbate their circumstances and translate
into emotional or physical ailments.
RTW is not always about returning an employee to his or her
specific job, although that is the ideal state. RTW also
encompasses engaging employees in alternative jobs as
stepping-stones toward full time, full duty, or a way for an
employee to remain engaged during his or her period of
disability.
Program Elements
Successful RTW programs are reported to have the following
essential program characteristics.
Commitment of an Internal Champion
A culture of RTW begins though an internal champion (or group
of supporters) who values the employees and truly wants them to
regain useful employment. The champion's intentions are not
based solely on costs or productivity, although he or she knows
both are affected by positive RTW. Instead, the champion's
personal commitment to employees is demonstrated in his or her
ability to work with them in a proactive manner to achieve
positive outcomes for all parties.
Establishment of Credible Evidence
RTW programs (and "best practices" of effective programs)
need to match the goals of the employer. This is done through
the following.
- Attention to the implementation process,
which emphasizes:
- Consistency with organizational values
- Adequate human and financial resources
- Development/motivation/empowerment of an
internal program champion
- Education and communication with all
stakeholder groups (specifically supervisors
and physicians)
- Simplicity, accessibility, and
flexibility in program design
- Professionalism and accountability on
the part of those assigned to manage the
program
- Accessibility to all individuals with all
types of impairments
- Monitoring by an evaluation system that uses
multiple outcome measures, occurs periodically
(quarterly), and demonstrates value to the
employer; in addition, employers need
information on how to design and implement
concrete steps to gather and interpret
appropriate RTW data.
- Support by incentives from the disability
insurer or third-party administrator to support implementation and
maintenance of an RTW program
- Integration and coordination with all
stakeholders to avoid a silo mentality yet
maintain an employee-centric focus. Many
organizations silo their various benefits
programs into various operational categories to
include environmental health and safety, health
promotion, employee assistance programs,
disability, RTW, group health, workers
compensation, and other programs. The advocated
approach integrates RTW with worker health,
safety, and productivity as an overall business
strategy. When organizations operate their
benefit programs semi-independently and
piecemeal, dysfunction and inefficiency
eventually ensues. An integrated approach to RTW
is recommended as a best practice, and this
coordination will foster an effective culture of
RTW over time.
- Endorsement by upper management is essential, as it is certain that
RTW must command senior management support.
Conclusion
Not all employees will be able to return to work, and every
situation is unique, but best-in-class programs have an
underlying culture that fosters RTW. Establishing a culture of
RTW may be challenging and take time for some organizations yet
prove relatively easy for others. Establishing a formal RTW
program ensures consistent application, lowers risk and legal
exposure, documents cost savings, increases productivity and
morale, and supports a cohesive and integrated disability and
absence management approach.
References:
Disability Management Employer Coalition (DMEC),
Foundation for Optimal
Productivity: The Complete Return to Work Program Manual (2012).
U.S. Department of Labor, Bureau of Labor Statistics, Current
Population Survey: Circadian Information, Shiftwork Practices
(Washington, DC: GPO, 2005).
Centers for Disease Control and Prevention, National
Institute for Occupational Safety and Health, Steps to a
Healthier U.S. Workforce Symposium, "Examining the Value of
Integrating Occupational Health, Safety and Productivity
Management Programs in the Workplace" (2004).
Syracuse University, Burton Blatt Institute, "Final
Report: Corporate RTW Policies & Practices: A National Study" (2012).
Marcia Carruthers, MBA, ARM, CPDM, is
cofounder and chairman of the Disability Management Employer Coalition
(DMEC), a San Diego-based nonprofit trade association providing educational
resources to employers in the area of disability, absence, health, and
productivity. For information, visit
www.dmec.org or email Ms.
Carruthers at .