Safety and Return-to-Work

In the past, employers often took the approach that unless injured employees were “whole,” they were of no use and should stay home. This has been changing over the last several years and most employers recognize that there are numerous benefits for both the employer and employee to return an employee, temporarily disabled due to an injury or non-infectious illness, to the workplace. Two of the most important reasons include the retention of a valued, experienced employee and demonstrating to employees that they are an important part of the “team.” RTW programs also help relieve employee fears of financial uncertainty, family security and employment future. Not only are there cost benefits for the agency, staffing concerns are also addressed. Employees tend to heal faster when returned to work as soon as possible, so RTW should not be limited to workplace incidents. 

One of the keys to a successful, comprehensive RTW program is working closely with the employee’s health care provider to determine “appropriate work duties” that will allow the employee to safely return to and remain at the workplace during the recovery period. To do this, it is important that an employee’s functional abilities in relation to his/her current condition are identified. A job description or employee work profile (EWP) with accurate physical requirements should be provided to aid the physician in accurately assessing the needs of the employer and the abilities of the employee, along with a form that the physician can use to easily list restrictions and functional abilities. This can help the physician consider the RTW process as part of the overall treatment plan. A simple slip from the physician indicating “return to light duty” is no longer acceptable. An example form, “Patient’s Restrictions and Capabilities” is available through the Commonwealth of Virginia Workers’ Compensation Program website.

It is important that the physical requirements listed on the job description or EWP be as accurate as possible. Ask yourself how these figures were determined. In many cases, they are a “best guess” and not based on any true physical measurements. In fact, many such descriptions may actually contribute to an increased risk of injury. Devices designed for testing such loads, such as an exertional scale, can provide accurate measurements. As an alternative, tasks can often be assessed within an acceptable range by using simple, economical measuring devices, such as a bathroom or floor scale (lifting) and a scale used for weighing fish (push/pull). In addition, occupational health organizations can often provide assistance with task evaluations.

After functional capabilities are determined, a RTW plan including a temporary job description should be developed, focusing on what the employee can do and not what they cannot do. Try to keep the employee doing as much of his/her normal duties as possible, with modifications as required by their restrictions. However, if this is not possible, the next step is to assemble a list of productive tasks that the employee can do safely. These tasks can be in the employee’s own department or throughout the facility. For short-term positions, a special project may be the ideal solution. Whatever the method, it is critical that the duties are discussed with and approved by the treating physician.

Every attempt should be made to make the temporary duties progressive. Not restricting the employee to one department provides the flexibility that may be needed to establish appropriate progressive duties. This process can be compared to preseason conditioning for athletes before the regular season (full duty). This requires that the physician approve an appropriate sequence of progressive duties, building to full duty. Assigning progressive duties can reduce the chance of re-injury because it allows for a reconditioning period before a return to full duty. A timeline, including periodic reassessments, should be part of the process to make sure the employee is not moved up to more demanding duties before it is safe to do so. There may be pain associated with increased activity; however, this may not indicate re-injury but rather the need for additional medical treatment.

Another important part of an effective RTW program is the role of the manager or supervisor. It is important that the supervisor have a clear understanding as to why injured or disabled employees are returned to work as soon as possible, and that they have a critical role in the process. In addition to thoroughly explaining the program to the employee, it is the supervisor’s job to oversee the employee’s activities so that he/she does not attempt to do more than allowed under the RTW plan. The supervisor also provides feedback to the RTW coordinator as to the employee’s performance and any problems that may arise. They are a vital part of the communication chain that also includes the RTW coordinator, the treating physician, and of course, the employee.

In summary, employees are less likely to re-injure themselves or prolong their absence when in a supervised transitional duty program, rather than sitting at home unsupervised, where there may be an increased risk that they will perform a task, such as mowing the lawn or lifting groceries, which could delay their recovery. If presented properly, employees will view RTW as an additional benefit and get a true sense of security from their employer. Employees who feel secure in their employment tend to be more efficient and productive employees.