This is the second part of two articles on the topic of return-to-work (RTW) best practices. This month's article completes the basic framework that should be considered when establishing and implementing an RTW program: setting roles and responsibilities, defining interventions and triggers, measuring outcomes and success, and formulating considerations for accommodation.
Defining detailed roles and responsibilities is arguably the most important step in defining an RTW program and in ensuring success. Without clearly set roles and responsibilities, the processes and programs established will remain unused. Also, by setting firm roles, an organization can track against those roles to reward employees and supervisors for following appropriate protocols even if the ultimate goal—RTW—is not achieved by every employee.
Most successful programs give each team member an incentive to participate in the program. If a culture of RTW is already established, the incentive can be relatively small. In firms where a culture of RTW does not exist, some team members will need to be motivated through more vigorous means. Some firms use a "carrot" approach of tracking progress and rewarding key team members based on favorable results. Other firms use a "stick" method that penalizes team members for not accommodating employees. This is often managed through financial means where managers or lines of businesses incur an additional cost if employees are not accommodated compared with managers and lines of business that make accommodations and directly support initiatives toward partial duty RTW.
Because most employers coordinate some portion of their absence program with an insurance company, third-party administrator (TPA), or specialty provider, it makes sense to engage vendor partners in RTW initiatives. In some cases, these providers will work with employers to establish, expand, or refine RTW programs on behalf of their employer client(s). Collaboration of this kind benefits all stakeholders since it allows employers to leverage subject matter experts within their vendor community. Regardless of how knowledgeable or helpful vendor partners are, employers cannot completely outsource their RTW program or process—they have to own it and be committed to achieve success. Further, the relationship between the employer and employee can never be a substitute for a vendor relationship. This is partially due to potentially conflicting goals but also due to the knowledge employers (and specifically supervisors) have about the job requirements and the individual employee.
Depending on the relationship, vendor partners may not have the same direct goals as their employer customers. For example, an insurance company will administer the plans and policies based on the contract provisions. This is appropriate but may or may not foster the best RTW opportunity. Given this potential conflict, employers must be continually engaged in the process.
When considering roles in RTW programs, organizations must think beyond their core stakeholders and consider pivotal resources from the employees' perspective. Although every organization is different and titles and programs vary from company to company, the following groups should be included:
Primary care physician
Employee assistance program (EAP)
Disease management program
Workers compensation insurer/TPA
Figure 1: Stakeholder Categories
Intervention or Trigger Points
Although lost time is the typical trigger for RTW initiatives, savvy employers recognize the value of intervention even before an absence begins. For example, an ergonomic assessment for an employee experiencing neck pain may not be a lost time event, but it certainly does pertain to RTW philosophies and best practices. Regardless of the terminology used, proactive processes may be effective in reducing overall spending, even though the savings may initially be difficult to implement and track. Documenting all trigger points is important so they can be easily transferred from a plan feature into a process.
Figure 2: RTW Process
Complexities expand when employers, employees, and their vendor partners begin to change existing core processes to achieve the best opportunities for RTW even if full time, full duty is not an option. Adjusting existing habits and simple methods will likely translate into a more comprehensive RTW program and more significant gains. Constant program monitoring, analysis, and attention to detail are important. As noted earlier, every RTW process is different, but see Figure 3 for a summary of the core RTW process considerations.
Figure 3: Core RTW Process Considerations
The entire process is important. However, when establishing a core plan or revising a current RTW program, consider the following as high priority:
An initial care plan
Documenting the expected treatment protocol and aligning it with employee, supervisor, attending physician, and case manager expectations contributes to the team accountability.
Communication among stakeholders
Clear communication is imperative for success.
Stakeholders will vary as previously noted; Figure 1 highlights the stakeholder categories.
Protocols addressing acceptable accommodations and variation by business unit and job type
When employees are not able to return to work full time, full duty, all accommodations and modification should be considered. Any that are safe for the employee and supported by the organization should be considered. Modifications can vary, but the most common modifications tie to the job itself (e.g., lifting no more than 25 pounds) or the location (e.g., sitting at equipment instead of standing). Simple changes can often yield significant results.
Integration with other benefits and employer programs
Consideration of and referral into another employer program such as EAPs, disease management, wellness, etc., can have a positive impact on the process and overall level of employee engagement. Underlying comorbidities often impact both recovery and RTW.
Setting standards and tracking
Tracking RTW protocols and results is imperative for success. Having information regarding peer groups or current states assists employers in understanding the need for RTW initiatives. From there, appropriate tracking will demonstrate improvements over time as well as where additional value can be added.
Best-in-class RTW programs are constantly being reviewed and modified to keep pace with peer groups, as well as changing best practices and capabilities in the market. As medical and system advances occur, additional RTW opportunities exist. Once employers have implemented programs, they must establish a process to monitor their programs and prioritize changes that will assist them in attaining the goals of the programs.
Where should organizations focus their attention? Should it be the individual worker, the organization, or society as a whole? According to the National Institutes of Health, the answer is "all of the above," but in a thoughtful and coordinated fashion. The advocated approach integrates RTW with worker health, safety, and productivity as an overall business strategy.
Outcomes and Success Measures
The purpose of an RTW program is to find ways to get employees back into the workplace, performing within their abilities, and staying at work as productive employees over time. Thus, it follows that for an RTW program to be successful, the primary outcome is to return absent workers in a timely and safe manner for both work-related and non-work-related situations.
To achieve this over the long term, RTW program effectiveness must be measured with critical resources, understanding the need for measurement and benchmarks at all stages of program development and post-implementation. Data can assist in the evolution of an RTW program tracking the organization as well as the employee experience.
Measurement and benchmarking are tools used by managers in all disciplines to look for trends, identify areas of success, look for problem areas, and document results, savings, and return on investment (ROI) for the organization. Measuring the ability to return employees back to work assists RTW coordinators to support and document their assumptions, theories, and progress. Aligning the measurements to show the effect on important key company values will allow the RTW coordinator to place a more precise value on the RTW program's services and contributions to the organization's success as well.
Some important factors to keep in mind when establishing a set of metrics:
Collect both qualitative as well as quantitative measures.
Include both direct and indirect costs.
Compare results to the goals of the program.
Analyze data and look at trends and outcomes that will help the organization leverage the positive findings while making adjustments and changes to improve others.
Key elements include:
Absence frequency (also called incidence) under all plans (short-term disability, long-term disability, and workers compensation)
Average duration of absence
Claim severity or plan costs
Targeted solutions to improve employee absence, productivity, and bottom line
Further fine-tuning of an existing RTW program can be accomplished through benchmarking. In its simplest form, benchmarking can be defined as a way to find and implement best practices to accomplish the goals of the program or function of interest. Benchmarking compares one program's results, outcomes, or trends to other divisions or time periods. It can be both internal (company) and external (industry), and it is a process not only of measuring results but also of improving results over time. Benchmarking is important because it identifies needed operational and process improvements, gives statistical means to measure progress, and makes a business case for necessary changes.
Successful programs can be described by a number of measures. Fundamentally, knowing you've achieved your desired results is the most obvious. According to a 2012 report from the Burton Blatt Institute at Syracuse University, major employers reported the following as indicators of program success:
Persuading management to move to a formal RTW program—utilizing evidence that RTW made a difference, complying with state or federal regulations, empowering an internal champion who motivated others, and changing senior management priorities
Significant positive RTW outcomes including reduced lost time duration for short-term disability and workers compensation, as well as reduced medical costs
Achievement of an ROI between 2:1 to 10:1
Engagement of the right people with the right solutions
Measurable RTW dividend—direct and indirect savings, decreased costs, and increased productivity
Program flexibility and simplicity
Emphasis on the "big health and productivity picture" by investing in employees' health and well-being
Consideration for Accommodations
An overview on RTW would not be complete without a word on accommodation. Effective RTW strategies include offering the opportunity to work part time or telecommute, modifying work duties, and implementing reasonable accommodations to provide employees with the tools and resources they need to carry out their responsibilities. Efforts such as these can help employees return to work sooner, even while still recovering. This allows the employee to protect his or her earning power, while at the same time boosting the organization's productivity. Furthermore, in many instances, the ability to return to work after injury or illness plays an important role in the employee's actual recovery process.
Accommodations for employees returning to work are highly cost effective, with most incurring little or no expense at all. Data collected by the Job Accommodation Network over the years reveal that more than half of accommodations cost employers nothing. Of those that do cost, the typical one-time expenditure is $600. Add to this the fact that 74 percent of employers that implemented accommodations rated them as either "very effective" or "extremely effective," and you have a strong case for including accommodations to your RTW program.
Whether you are just starting out or intend to upgrade a long-standing program, following proven best practice methods can ensure your success. Characteristics of best-in-class programs include an integrated approach, operating on a formal basis, defining program goals and elements, matching the goals of the employer with the program, outlining the roles and responsibilities, identifying triggers and key intervention points, defining necessary and achievable outcomes and success measures, and incorporating accommodation opportunities to assist in retaining or returning employees to productive work.
Disability Management Employer Coalition (DMEC), Tools of the Trade: A Compilation of Programs and Processes for the Absence, Disability, Health, and Productivity Professional (2009).
US 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 (Dec. 3, 2004).
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 [email protected].
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