Sustainable Return to Work for Workers with Mental Health and Musculoskeletal Conditions
2. Materials and Methods
2.2. Realist Evaluation Phase
2.2.1. Phase 1–Theory Gleaning
2.2.2. Phase 2–Theory Refining or Creation
2.2.3. Phase 3–Theory Consolidation
- Choices presented to line managers during the RTW process.
- Ongoing dialogue between manager and employee on specific concerns/re-negotiation processes.
- The alignment of stakeholders informs the choices presented to line managers during the re-negotiation process.
3.1. Choices Presented to Line Managers during the RTW Process
3.1.1. Good Quality RTW Process
The Alignment of Key Stakeholders around RTW Strategy
“When I came back, we had a return-to-work interview which went ok… Ok, so, I started with low level of cases and I had phased return that was suggested by Occupational Health”(015-F-40+)
“It was me feeling confident that the manager understood me as a person and understood my condition… I think it helped them understand better what support they needed to put in place.”(022-M-40+)
“….if I say, ‘my back’s bad, driving is typical, can we consider the working from home because let’s face it, you haven’t even answered me from January’ (Laughing). It will be… I will ask the service management and then I’m pretty certain the answer will be NO! So, it is kind of blocked. So, the line manager is lovely, she’ll listen to you, but they are very restricted in what they can do to help. So, 9 out of 10 times it’s blocked.”(002-F-30+)
Competent and Supportive Line Manager
“…The manager who I was working with at the time during my return was far better equipped to deal with people in my position and people with some mental health issues. The manager back where I was in my substantive role had absolutely zero ability in my opinion and I think others as well deal with that kind of situation.”(022-M-40+)
3.2. Ongoing Dialogue between Manager and Employee on Specific Concerns/Re-Negotiation Processes
3.2.1. Work Accommodation
Work Accommodation as an On-Going Dialogue/Re-Negotiation Process
“So, I came back, worked here and that didn’t work terribly well and then they said you could work from home for a few days. That really helped until I could sort out how to get to work better.”(014-F-40+, MSDs & 2 weeks absence)
“I think what was helpful was the fact that I could work shorter hours and I got to choose them. And what I mean by that was I was offered…. You know, if I was going for half a day, would I prefer to do the morning, or would I prefer to do the afternoon. Because some... for me I chose the mornings because I get up and do the school runs anyways and I found that come the afternoon I was sore… So, for me that was really helpful.”(012-F-30+, MSDs & 6 weeks absence)
“I was phased on 25% for …. I can’t really remember a 100%. 25% was for two or three weeks, and then it was 50% for about two or three weeks and then it went to 75% for a week and then full time. So, it was needed another block between 75 and 100% if that makes sense. Because that feels like a very big step, from 75% to 100. It’s not because it’s no bigger than the other steps, but it’s just when you’re coming back it feels like a big jump.”(005-F-40+)
“… It was occupational health who were obviously involved and then the colleagues that’s just sort of a subcontracted situation. But they, if I recall correctly, they… I went and spoke to them a couple of times and they made recommendations around the phase return and then my manager then took that on board. It was phased in terms of numbers of days of the week. And also, I went and worked for a different Department for a while, so that I was able to sort of break myself back into the grass roots of things because there was an awful lot of changes going on. So, it was quite important that I started to pick up on what was required and how the role had shifted.”(009-M-40+)
“I think I was off for six or seven months, so to come back in a couple of days a week to start off with you know, … I think it was a couple of days a week to start off with, and then that built over say six weeks back up to a full full-time role. It was… it made life easy… how can I describe? It meant that I didn’t feel that I was under immediate pressure to perform, to take on board everything that was going on.”(009-M-40+, CMD & 7 months)
“…it could be better simply by better communication and getting a clearer picture of what somebody can do when they come back rather than you go to occupational health, they say phased return, so your manager sits down with you and you work out the pattern of phased return and then off you go. Whereas, when you’re sitting down and talking about the phased return it needs to include ‘how are you emotionally, and physically what can you do?...”(016-F-40+)
“… I suppose it’s that reassurance and almost reiteration of it. It’s very easy to just go ‘its ok, you can do this’ and then never mention it again. So, I think that repetition of ‘it’s still ok, this is ok, I accept that, this isn’t getting done but that’s ok’. But I think probably what I didn’t do with my manager was sit down and look at the work that I’ve got on because they probably don’t know the work that I’ve got, and they trust me to do that...”(020-M-40+)
“I think they were probably a bit surprised that I came in to work with my arm in a sling and tried to work (laughing). They kept on saying to me ‘are you sure you should be at work?’ And you know, ‘can you manage?’ And I thought I could manage. And I remember telling you this and then I realised that no, you know I couldn’t drive, and I had to walk back to the station with a laptop and another bag. And I just realised that I couldn’t do that on a daily basis because it was exhausting when you’re struggling the whole time and so then they said that I could work from home and that was what made a … that made a big difference.”(014-F-40+)
Hindrances to Re-Negotiation
“But being not so integrated in the team that is something I just accept that. I find it sometimes painful, allowing me feel what I feel, but I feel like I can’t change it really…”(015-F-40+, CMDs)
“.... The flip side of that is this glass ceiling and you’re perceived to be a bit flaky. So how do you minimise that? Because you’ve had a bleep (mental break-down), that you’re a bit flaky and that you can’t do your job.”(011-F-40+, CMDs)
“It’s difficult because as I said then, going back to this previous line manager and you know after I got back last time and then dealing with this person who I could have put in a complaint with. So, it’s basically being line-managed by the person who was the problem and so I suppose it was an unusual case in that respect.”(019-M-30+, CMDs)
“In my experience with what I’ve had, it was very good. I think that it’s unique to me. I’m almost thankful for what I’ve got because I recognise that this isn’t standard and I don’t see it elsewhere within the organisation or … it’s in places, I mean there are pockets of really good behaviours. But you see other working environments, other businesses, you know your colleague work at places, and everyone is under a lot of pressure. I don’t see this across there.”(020-M-40+, CMD/MSD)
3.3. The Alignment of Key Stakeholders Informs the Choices Line Managers Are Presented with during the On-Going Re-Negotiation Process
“…it obviously depends on what your managers have to deal with if you like, …. because they have the Occupational Health and the HR and their guidance and obviously the HR team and the Wellbeing team would have dealt with a lot more situations with people’s mental health situations. I think they’re supported by the other members of the organisation, so they are able to support you. Even if they might not understand your situation that they haven’t dealt with any mental health issues themselves, I think they’re supported enough that they can be empathetic.”(021-F-40+)
3.4. Summary of Consolidated Theories
4.1. Limitations of the Study
4.2. Implications for Policy, Practice, and Research
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
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|CMO RTW Theories||Original Theme|
|1||A competent and supportive manager, working in collaboration with other health services within the organisation (context) is likely to increase their level of understanding about employee’s condition and best RTW approach to adopt, as well as be more empathic towards employees (mechanism). As a result, they can successfully implement an effective RTW strategy (mechanism) approved by senior management, thus impacting on sustainable RTW (outcome).||Good quality RTW process|
|CMO RTW Theory||Original Theme|
|2||Reassuring workers of their workload during the on-going RTW negotiation process for appropriate work accommodation(context) is effective in assuaging fear (mechanism) and assisting in easy transition back to work (outcome), which in turn impacts on successful RTW (outcome).||Workload clarity|
|CMO RTW Theory||New Theme|
|3||When employees sick listed with CMD return to toxic working environments (context) during the RTW process (mechanism), it is likely to impede the negotiation process for adequate work accommodation, thereby aggravating their condition, leading to a failed RTW (outcome)||Hindrances to re-negotiation|
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Etuknwa, A.; Daniels, K.; Nayani, R.; Eib, C. Sustainable Return to Work for Workers with Mental Health and Musculoskeletal Conditions. Int. J. Environ. Res. Public Health 2023, 20, 1057. https://doi.org/10.3390/ijerph20021057
Etuknwa A, Daniels K, Nayani R, Eib C. Sustainable Return to Work for Workers with Mental Health and Musculoskeletal Conditions. International Journal of Environmental Research and Public Health. 2023; 20(2):1057. https://doi.org/10.3390/ijerph20021057Chicago/Turabian Style
Etuknwa, Abasiama, Kevin Daniels, Rachel Nayani, and Constanze Eib. 2023. "Sustainable Return to Work for Workers with Mental Health and Musculoskeletal Conditions" International Journal of Environmental Research and Public Health 20, no. 2: 1057. https://doi.org/10.3390/ijerph20021057