Returning to work after serious injury – part two

Supporting someone to return to work after a serious injury or illness can be a difficult process when there have been many health professionals involved in their care, and many opinions on whether and when they may be fit to return to work.

Returning to work is not only of economic significance to the individual and the wider social economy, but is also an important part of recovery from injury or illness, being known to have a therapeutic benefit in the short to medium term and health protecting effects in the long term. Effective return to work planning for those with more complex conditions or social situations often requires a collaborative team approach of the individual, the health care advisors, employment support advisors and their employer (where applicable) but this is not always easy to co-ordinate.

Heather Watson is a Physiotherapist who has spent over 20 years specialising in supporting people to return to work after physical injury and illness, and has set up award winning return to work services that have catered for conditions from minor musculoskeletal disorders through to serious trauma and illness. In part one of her bl;og last week, Heather emphasised the importance of timing and getting the team in place. 

Think about the work tasks:

• If the person has a job to go back to –carry out a simple “job demands analysis” together: list all the physical and cognitive tasks involved in the job role, (including travel needs).
• Now, split that list into “primary” tasks – the things that are critical to the specific job role, and “secondary” tasks (all the other things to be done – calls, emails, paperwork etc)
• Take the primary list first, discuss each task in turn, and next to each task agree what the person needs to be able to do to complete it – e.g. drive for 10 minutes, stand for 30 minutes, concentrate for 40 minutes and then next to that give it a tick if they think they can do it, or a cross if they are sure they can’t, or a question mark if they just don’t know. Do the same for the secondary list.
• This simple process will give you both an idea of what needs to be worked on, or where support will be needed most, and whether some tasks may need modifying in the short term to enable a return to work. It can also help the person focus on specific work related goals with their therapists.
• If the person does not have a job to go to, this bit is a little bit trickier, but start by encouraging the person to think about what they CAN do, and what sort of work they would be interested in doing, and what therefore what the options might be.

Planning return to work (RTW)
Planning is critical to the success of returning to work – it gives everyone a structure to work within, and an agreed target. The final RTW plan, where possible should be “owned” by the individual, with them having spoken to each of the people in the support team (especially if the team cannot easily meet) and been actively involved in the planing process.

•  It often helps for the individual to go to their workplace manager with suggestions of ways that might support them to return to work rather than going with a list the problems and expecting them to solve it. Taking the job demands analysis and some ideas can form the basis for a positive discussion and demonstrates willingness to find a solution from the individual.
•  Encourage the person to be as open as possible about how their health may affect their work, especially if they have symptoms that cannot be seen, so that their managers can understand the situation
• Aim for long term sustainability – avoid very fast return to work plans if the person has had a serious injury or illness – pushing too much too soon can lead to set backs which disappoints everyone, and dents the confidence of the person who then may be reluctant to try again.
• Help the individual create a simple week by week schedule, using a combination of graded hours and modified duties – for example, starting with tasks they know they can do, for limited periods of time.
• Factor in some “set backs” – it won’t all be plain sailing and there needs to be room for modifications along the way, and discuss how they can be managed. For example, if they struggle to cope with the hours one week, then next week “hold” at the same hours rather than increase them as may have been planned, or if necessary, drop the hours back down to the level they were at the previous week, BUT wherever possible aim to avoid the person going off sick again.

Most importantly, wherever possible, encourage and support the person to take control of the process and the planning, take a positive approach to problem solving and look for ways to overcome obstacles. You are in a great position to help them with this by providing reassurance and working through some of these strategies with them and bringing experiences of what has worked for others in a similar position.  Finally, remind the individual that anyone considering a return to work has already overcome many obstacles, is learning how to cope positively with their health condition – and most people can successfully get back to work with the right support and encouragement.