Owner attitudes and self reported behavior towards modified work after occupational injury absence in small enterprises: a qualitative study

Differences in Modified-Return-to-Work by Immigration Characteristics Among a Cohort of Workers in British Columbia, Canada

Introduction To investigate differences in modified-return-to work (MRTW) within the first 30 days of a work-related, short-term disability injury by immigration characteristics. This question was part of a program of research investigating differences in work and health experiences among immigrant workers and explanations for longer work disability durations. Methods Workers' compensation claims, immigration records and medical registry data were linked to identify a sample of workers in British Columbia, Canada with a short-term disability claim for a work-related back strain, concussion, limb fracture or connective tissue injury occurring between 2009 and 2015. Multivariable logistic regressions, stratified by injury type, investigated the odds of MRTW, defined as at least one day within the first 30 days on claim, associated with immigration characteristics, defined as a Canadian-born worker versus a worker who immigrated via the economic, family member or refugee/other humanitarian classification. Results Immigrant workers who arrived to Canada as a family member or as a refugee/other immigrant had a reduced odds of MRTW within the first 30 days of work disability for a back strain, concussion and limb fracture, compared to Canadian-born workers. Differences in MRTW were not observed for immigrant workers who arrived to Canada via the economic classification, or for connective tissue injuries. Conclusion The persistent and consistent finding of reduced MRTW for the same injury for different immigration classifications highlights contexts (work, health, social, language) that disadvantage some immigrants upon arrival to Canada and that persist over time even after entry into the workforce, including barriers to MRTW.

Return-to-Work After Work-Related Injury in the Construction Sector: A Scoping Review

Purpose Construction remains one of the most hazardous and disabling industries worldwide. This scoping review was completed to identify barriers and facilitators related to return-to-work (RTW) after work injury in the construction industry and gaps in the literature. Methods We searched ten databases from 1990 to 2020 for academic and grey literature. Two independent reviewers screened citations for inclusion. One team member charted the data and a second team member reviewed the coding. Articles were included if they identified any barriers or facilitators to RTW in the construction industry. The findings were synthesized into overarching themes. Results Our search identified 6706 articles for screening, with 22 articles included in the final sample. Three articles used qualitative methods, while the remaining articles were quantitative. The majority of articles were from North America and published in academic journals. Overall, findings are organized under seven main themes: worker sociodemographic characteristics; injury characteristics; worker motivation; workplace goodwill; modified work and disability management; work disability systems; and access to healthcare. Some barriers and facilitators are more relevant to the construction industry compared with the general working population. Conclusions: The findings suggest that accommodations are possible for this industry but barriers still exist in identifying suitable work. More research is needed to investigate the role of union involvement, work disability management systems, gender, and organizational characteristics, such as multiple worksites, in relation to RTW in the construction industry.

Exploring Differences in Work Disability Duration by Size of Firm in Canada and Australia

Purpose To identify whether there were differences in work disability duration between injured workers employed by small, medium, large, and self-insured firms and whether these differences varied between workers' compensation jurisdictions in Canada and Australia. Methods Workers' compensation data were used to identify comparable lost-time, work-related injury and musculoskeletal disorder claims in five Canadian and five Australian jurisdictions between 2011 and 2015. Work disability duration was measured using cumulative disability days paid up to one-year post-injury. Jurisdiction-specific quantile regression models were used to estimate differences in cumulative disability days paid to claims from small (< 20 full-time equivalents (FTEs)) medium (20-199 FTEs), large (200 + FTEs) and self-insured firms at the 25th, 50th, and 70th percentiles in the disability distribution, adjusting for confounders. Results Compared to large firms, workers in small firms generally had longer work disability duration at each percentile, particularly in Saskatchewan and Alberta (Canada), Victoria and Australian Capital Territory (Australia), where an additional 31.1, 18.4, 58.5 and 37.0 days were paid at the 75th percentiles, respectively. The disability duration of workers from self-insured firms was longer than large firms in all Canadian jurisdictions but was shorter or no different in Australian jurisdictions. Smaller differences were observed between claims from large and medium-sized firms. Conclusions Workers in small firms had longer work disability duration than those in large firms in all but one of the study jurisdictions. Claims management processes need to be sensitive to the challenges that small firms face in accommodating and returning injured workers back to work.

Job demands and resources of managing directors of micro- and small enterprises: A qualitative study of the German transport industry

BACKGROUND: In many European countries, entrepreneurs have to consider psychosocial factors in the workplace risk assessment. Little is known about psychosocial working conditions in micro- and small companies. Even less is known about the entrepreneur in these settings. OBJECTIVE: The present study was conducted to develop and examine the job demands and resources of small business owners and managers, who serve as important designers of their businesses’ working characteristics. METHODS: N = 29 semi-structured interviews with a unique sample of owners and managers of the transportation sector were analysed via qualitative content analysis. RESULTS: The data suggest the presence of specific demands (time-, management-, and organisational demands) and resources (support and feedback). In particular, the variability and load of the demands indicate that the existing theoretical framework for employees is inadequate for evaluating the working characteristics of micro- and small business managers. CONCLUSION: Occupational health activities in small companies should include the working situation of the entrepreneur/manager.

Role and Responsibilities of Supervisors in the Sustainable Return to Work of Workers Following a Work-Related Musculoskeletal Disorder

Purpose Supervisors play an important role during the return to work (RTW) of injured workers. Yet little research has been done on the actions associated with this role or the contexts in which they are taken. The purpose of this study was to develop courses of action to promote supervisors' involvement in the process aimed at achieving sustainable RTW for workers following a work-related musculoskeletal disorder (MSD), and to verify their pertinence, feasibility, and applicability in practice. Methods A two-phase qualitative method was used. (1) Secondary content analysis of 46 interviews of 14 workers post-MSD and 32 other actors in the RTW process, conducted during a prior case study, yielded proposals for courses of action composed of specific actions for supervisors. (2) The pertinence, feasibility, and applicability of these courses of action and specific actions were explored, first, through a self-administered questionnaire to initiate individual reflection, and later in greater depth through focus groups to identify the different contexts in which they might be applicable. Thematic analysis was performed for each phase. Results Eight proposed courses of action, including specific concrete actions and conditions influencing supervisors' involvement, were developed by the researchers and generally perceived as pertinent and feasible by the participants. Several aspects of the organizational context appeared to influence implementation of these courses of action within the organizations. Conclusion Organizational context appears to influence the application of these courses of action, as do the conditions under which they are implemented.

Systematic review: Factors related to injuries in small- and medium-sized enterprises

The purpose of this systematic review was to identify the antecedent factors of workplace injuries in small- and medium-sized enterprises (SMEs). A customized systematic review protocol included the research question, literature search, quality appraisal, data management and extraction, and evidence synthesis. The evidence was evaluated using the Critical Appraisal Skills Programme checklists and the Cochrane Collaboration “Risk of Bias” assessment tools. A total of 1355 articles were identified before duplicate removal. Ten articles were relevant to the study objective. Of these, two articles examined antecedents related to physical injuries, three examined those related to psychological injuries, and four focused on a combination. Antecedent factors included older workers, unsafe acts, unsafe working conditions, accident type and type of work performed, trips and falls, loss in productivity, social isolation, financial stress, and lack of employer support during the return to the workplace. The findings of this systematic review support the need for increased research to identify antecedent factors associated with injury in SMEs. Research should focus on interventions to mitigate injury rates that associate employees with employers, thus promoting collaboration in augmenting health and safety in SMEs.

Psychosocial risks in small enterprises: the mediating role of perceived working conditions in the relationship between enterprise size and workers' anxious or depressive episodes

Purpose. The relationship between enterprise size and psychosocial working conditions has received little attention so far but some findings suggest that conditions are more favorable in small enterprises. This could have a positive impact on workers' mental health. The objective of this study was to test the mediating effect of perceived working conditions in the relationship between enterprise size and anxious or depressive episodes. Methods. Data from the 2010 SUMER - Surveillance Médicale des Expositions aux Risques professionnels (French periodical cross-sectional survey) were analyzed; N = 31,420 for the present study. Anxious or depressive episodes were measured with the hospital anxiety and depression scale and the perceived working conditions were psychological demand, decision latitude and social support as assessed with Karasek's job content questionnaire. The indirect effect was tested according to the method proposed by Preacher and Hayes. Results. In a multivariate logistic regression, the risk of anxious or depressive episodes was found to be lower in micro enterprises (2-9 employees). Formal tests pointed to a significant indirect effect of enterprise size on mental health through perceived working conditions, with a larger effect for psychological demand. Conclusion. This study highlights perceived working conditions as an explanation of the effects of enterprise size.

Analysis of Managing Safety in Small Enterprises: Dual-Effects of Employee Prosocial Safety Behavior and Government Inspection

This paper aims to promote a national and international occupational health and safety (OHS) intervention for small and medium enterprises (SMEs) within internal and external resources. Based on the characteristics of small SME management, the work environment and occupational health may be positively affected by the dual-effects of employees and government. Evolutionary game theory is utilized to identify relevant interactions among the government, small enterprises, and employees. Furthermore, dynamic simulations of the evolutionary game model are used to explore stability strategies and to identify modes of equilibrium.

New Business Structures Creating Organizational Opportunities and Challenges for Work Disability Prevention

Purpose Flexible work arrangements are growing in order to develop resource-efficient production and because of advanced technologies, new societal values, changing demographics, and globalization. The article aims to illustrate the emerging challenges and opportunities for work disability prevention efforts among workers in alternate work arrangements. Methods The authors participated in a year-long collaboration that ultimately led to an invited 3-day conference, "Improving Research of Employer Practices to Prevent Disability," held October 14-16, 2015, in Hopkinton, Massachusetts, USA. The collaboration included a topical review of the literature, group conference calls to identify key areas and challenges, drafting of initial documents, review of industry publications, and a conference presentation that included feedback from peer researchers and a roundtable discussion with experts having direct employer experience. Results Both worker and employer perspectives were considered, and four common alternate work arrangements were identified: (a) temporary and contingent employment; (b) small workplaces; (c) virtual work/telework; and (d) lone workers. There was sparse available research of return-to-work (RTW) and workplace disability management strategies with regard to alternate work patterns. Limited research findings and a review of the grey literature suggested that regulations and guidelines concerning disabled workers are often ambiguous, leading to unsatisfactory protection. At the workplace level, there was a lack of research evidence on how flexible work arrangements could be handled or leveraged to support RTW and prevent disability. Potential negative consequences of this lack of organizational guidance and information are higher costs for employers and insurers and feelings of job insecurity, lack of social support and integration, or work intensification for disabled workers. Conclusions Future studies of RTW and workplace disability prevention strategies should be designed to reflect the multiple work patterns that currently exist across many working populations, and in particular, flexible work arrangements should be explored in more detail as a possible mechanism for preventing disability. Labor laws and policies need to be developed to fit flexible work arrangements.

Job Restrictions for Healthcare Workers with Musculoskeletal Disorders: Consequences from the Superior's Viewpoint

Objective Many workers suffer from musculoskeletal disorders. In France, occupational physicians are able to set job aptitude restrictions obliging employers to adapt the worker's job. The present study explored the impact of job restriction from the point of view of the employees' supervisors. Methods A qualitative study was conducted in 3 public hospitals. 12 focus groups were organized, involving 61 charge nurses and head nurses supervising 1 or more workers restricted for heavy lifting or repetitive movements. Discussions were recorded for qualitative thematic analysis. Results Charge and head nurses complained that aptitude restrictions were insufficiently precise, could not be respected and failed to mention residual capability. A context of personnel cuts, absenteeism and productivity demands entailed a need for polyvalence and reorganization threatening the permanence of adapted jobs. Job restrictions had several negative consequences for the charge and head nurses, including overwork, increased conflict, and feelings of isolation and organizational injustice. Conclusion Protecting the individual interests of workers with health issues may infringe on the interests of their supervisors and colleagues, whose perception of organizational justice may go some way to explaining the support or rejection they show toward restricted workers. This paradox should be explicitly explored and discussed.

Safety coaching: a literature review of coaching in high hazard industries

Purpose

– The purpose of this paper is to critically review the research literature on safety coaching, with a particularly focus towards work in safety critical environments such as oil and gas, manufacturing and driving.

Design/methodology/approach

– A literature review was undertaken of existing research, specifically in high-hazard industries, to assess whether safety coaching could be applied in the offshore oil and gas industry.

Findings

– The paper suggests that coaching may offer some potential in helping support learning, behaviour change and is consistent with feedback and development approaches used in behavioural-based safety.

Research limitations/implications

– Further research would be needed to test the value of coaching to this new environment.

Practical implications

– The paper informs practice on the development of coach training for safety coaching offshore.

Originality/value

– The paper offers a new understanding of the potential of safety coaching in a new area of practice.

A theoretical model of co-worker responses to work reintegration processes

PURPOSE

Emerging research has shown that co-workers have a significant influence on the return-to-work outcomes of partially fit ill or injured employees. By drawing on theoretical findings from the human resource and wider behavioral sciences literatures, our goal was to formulate a theoretical model of the influences on and outcomes of co-worker responses within work reintegration.

METHODS

From a search of 15 data bases covering the social sciences, business and medicine, we identified articles containing models of the factors that influence co-workers' responses to disability accommodations; and, the nature and impact of co-workers' behaviors on employee outcomes. To meet our goal, we combined identified models to form a comprehensive model of the relevant factors and relationships. Internal consistency and externally validity were assessed.

RESULTS

The combined model illustrates four key findings: (1) co-workers' behaviors towards an accommodated employee are influenced by attributes of that employee, the illness or injury, the co-worker themselves, and the work environment; (2) the influences-behaviour relationship is mediated by perceptions of the fairness of the accommodation; (3) co-workers' behaviors affect all work reintegration outcomes; and (4) co-workers' behaviours can vary from support to antagonism and are moderated by type of support required, the social intensity of the job, and the level of antagonism.

CONCLUSIONS

Theoretical models from the wider literature are useful for understanding the impact of co-workers on the work reintegration process. To achieve optimal outcomes, co-workers need to perceive the arrangements as fair. Perceptions of fairness might be supported by co-workers' collaborative engagement in the planning, monitoring and review of work reintegration activities.

Bearing the brunt: co-workers' experiences of work reintegration processes

PURPOSE

Work disability research has found co-worker support to be a significant but under-recognised aspect of work reintegration (WR) processes. Although co-workers work alongside returning workers, their practical contribution to WR success or failure is often invisible to others. This study aimed to gain further insight into the role and contribution of co-workers in WR interventions.

METHOD

An exploratory qualitative pilot study was conducted in Toronto, Canada in 2011. Three focus groups were conducted with 13 co-workers, recruited for their direct experience of 'working alongside' a returning worker. An iterative data gathering and analysis process occurred. Themes were generated from categories in open-ended interview questions and new issues arising from the data.

FINDINGS

The findings detail co-workers' practical experiences of WR processes and their reflections on social and work conditions that impacted their participation. Co-workers' capacity to support returning workers was related to the quality of the WR arrangements, the relationship with the returning worker, work culture, and the duration of the required support. Workplace privacy and confidentiality requirements were identified as a key challenge for co-worker participation. The effects on co-workers of WR processes ranged from the opportunity to learn new skills to disillusionment and withdrawal from the workplace. In worst case scenarios, 'ripple effects' including emotional distress, physical injury and termination of co-workers' employment had occurred.

CONCLUSION

Co-workers are not a neutral party in WR procedures. Formalizing the co-worker role to include communication, consideration and recognition might improve co-workers' WR experiences.

The return-to-work coordinator role: qualitative insights for nursing

Introduction Few studies have examined the role of RTW Coordination from the perspective of RTW Coordinator's. Furthermore there is little health specific literature on returning injured nurses to work despite the critical workforce shortages of these professionals. The study aimed to examine barriers and facilitators identified by the RTW Coordinator to returning injured nurses to work and influences on specific health sector or geographic location. The study sought to gain insights into the professional backgrounds and everyday work practices of RTW Coordinators. METHOD Five focus groups were conducted in metropolitan and rural areas of NSW, Australia. Twenty-five RTW Coordinators from 14 different organisations participated in the study. The focus groups included participants representing different health sectors (aged, disability, public and private hospital and community health). RESULTS The data analysis identified information pertaining to the qualifications and backgrounds of RTW Coordinators; the role of RTW Coordinators' within organisational structures; a range of technical knowledge and personal qualities for RTW Coordination and important elements of the case management style used to facilitate RTW. CONCLUSIONS The findings identified a wide range of professional backgrounds that RTW Coordinators bring to the role and the impact of organisational structures on the ability to effectively undertake RTW responsibilities. The study found that interpersonal skills of RTW Coordinators may be more important to facilitate RTW than a healthcare background. A collaborative case management style was also highlighted and the difficulties associated with juggling conflicts of interest, multiple organisational roles and the emotional impact of the work.

The social interaction of return to work explored from co-workers experiences

PURPOSE

The objective was to explore the role and contribution of co-workers in the return-to-work process. The social interaction of co-workers in the return-to-work process are analysed within the framework of the Swedish national and local employer organisational return-to-work policies.

METHODS

An exploratory qualitative method was used, consisting of open-ended interviews with 33 workplace actors across seven work units. Organisational return-to-work policies were collected from the three public sector employers.

RESULTS

The key findings that emerged during analysis showed that some co-workers have a more work-task oriented approach towards the return-to-work process, whilst others had a more social relational approach. In both situations, the social relations worked hand in hand with job tasks (how task were allocated, and how returning workers were supported by others) and could make or break the return-to-work process.

CONCLUSION

A suggestion for improvement of return-to-work models and policies is the need to take into account the social relations amongst workplace actors, especially involving co-workers when planning for return-to-work interventions. Otherwise the proper attention to work arrangements, social communication and the role of co-workers in the return-to-work process might not be seen.

Workplace health understandings and processes in small businesses: a systematic review of the qualitative literature

INTRODUCTION

Small businesses (SBs) play an important role in global economies, employ half of all workers, and pose distinct workplace health problems. This systematic review of qualitative peer-reviewed literature was carried out to identify and synthesize research findings about how SB workplace parties understand and enact processes related to occupational health and safety (OHS).

METHODS

The review was conducted as part of a larger mixed-method review and in consultation with stakeholders. A comprehensive literature search identified 5067 studies. After screening for relevance, 20 qualitative articles were identified. Quality assessment led to 14 articles of sufficient quality to be included in the meta-ethnographic findings synthesis.

RESULTS

This review finds that SBs have distinctive social relations of work, apprehensions of workplace risk, and legislative requirements. Eight themes were identified that consolidate knowledge on how SB workplace parties understand OHS hazards, how they manage risk and health problems, and how broader structures, policies and systems shape the practice of workplace health in SBs. The themes contribute to 'layers of evidence' that address SB work and health phenomena at the micro (e.g. employer or worker behavior), meso (e.g. organizational dynamics) and macro (e.g. state policy) levels.

CONCLUSIONS

This synthesis details the unique qualities and conditions of SBs that merit particular attention from planners and occupational health policy makers. In particular, the informal workplace social relations can limit workers' and employers' apprehension of risk, and policy and complex contractual conditions in which SBs are often engaged (such as chains of subcontracting) can complicate occupational health responsibilities. This review questions the utility of SB exemptions from OHS regulations and suggests a legislative focus on the particular needs of SBs. It considers ways that workers might activate their own workplace health concerns, and suggests that more qualitative research on OHS solutions is needed. It suggests that answers to the SB OHS problems identified in this review might lie in third party interventions and improved worker representation.

A multivariate analysis of factors associated with early offer and acceptance of a work accommodation following an occupational musculoskeletal injury

OBJECTIVE

To identify factors associated with offer and acceptance of work accommodation.

METHODS

In 401 claimants with musculoskeletal injuries, two logistic regressions identified individual and workplace factors associated with work accommodation offer and acceptance.

RESULTS

Unionized status, strong disability management policies and practices, low supervisor support, and pink collar occupation were associated with work accommodation offer. Job tenure over 1 year and lighter physical work were associated with acceptance. Younger age and more repetitive physical work demands were positively associated with both outcomes. Pink-collar status was positively associated with offers, but negatively with acceptance. Gender, mental health, pain, job satisfaction, firm size, people-oriented culture, safety climate, and ergonomic practices were not significant predictors.

CONCLUSIONS

One month post-injury, workplace factors and age are determinants of offer and acceptance of work accommodation, while individual health factors play no significant role.