Disability management depends on good communication. When communication problems emerge—for example, when parties have inadequate information, fail to appreciate the specific challenges of a worker’s circumstances, or are unaware of organizational practices and policies—this can contribute to return-to-work (RTW) delays, inadequate support for the worker and, not least, mistrust and ill will all around.
In large and complex organizations, communication problems tend to converge around a couple of key roles related to work disability practices. In a new study by the Institute for Work & Health (IWH), researchers found that the most common “communication bottlenecks” were those that involved disability case managers and front-line supervisors.
According to the study, published in April in the Journal of Occupational Rehabilitation (doi: 10.1007/s10926-019-09836-3), the information gaps experienced by one of these two roles can affect the work of the other, creating ripple effects throughout the entire organizational work disability management system. As such, efforts to address the communication challenges faced by case managers and front-line supervisors should be prioritized, says Dr. Arif Jetha, an IWH scientist and lead author of the study.
When looking at disability management at the organizational level—not just at its individual parts—we saw that the activities and practices of supervisors and case managers were really crucial to the smooth functioning of the whole system, says Jetha.
Case manager and supervisor communications represent leverage points that can make or break return-to-work outcomes at the organizational level.
The study was conducted via one-on-one interviews with 30 individuals working at three large municipal public services in Ontario. These were large, complex organizations with departments located across large geographic areas, many departments—each with distinct public service functions and workforce compositions—and many different collective agreements. The interviewees included disability case managers, human resource and labour relations specialists, and front-line supervisors—all with experience managing RTW cases, whether work-related or not.
The study team examined disability management at the organizational level by taking what’s called a
systems thinking approach in their data analysis.
Disability management is made up of multiple policies and practices, involving multiple internal and external stakeholders and shaped by the characteristics of different work environments and policies and program, says Jetha.
By taking a ‘systems thinking’ perspective, we can get a better sense of all the competing factors that may collectively influence return-to-work communication and have an impact on return-to-work outcomes. We can also identify the areas within the system that most need attention, he adds.
The participants spoke of several consistent features of their disability management programs. They all described communication as an essential component in the coordination of disability management efforts, at all phases of the RTW process (at the time of injury, during work reintegration and thereafter).
Participants also indicated that their organizations all had a policy of early contact with injured or ill workers, along with procedures for expedited, safe and equitable return to work. As would be expected of such large and complex organizations, participants also spoke of policies having the aim of standardizing communication and disability management practices across diverse departments and stakeholders.
Participants tended to agree that communication bottlenecks largely involved the activities of two key roles in the system: case managers and front-line supervisors. They described a number of issues.
Communication challenges involving case managers
At each participating organization, a small number of case managers were responsible for developing, implementing and evaluating RTW plans for injured or ill workers. Their work involved communicating with a broad range of stakeholders, including injured or sick workers, front-line supervisors, physicians and workers’ compensation representatives.
One set of issues described had to do with the barriers to information that case managers encountered in their interactions with health-care providers, long-term disability insurers and workers’ compensation representatives. Some described work limitation forms impeding communication about what workers were able to do. Others spoke of being out of the loop in interactions between health-care providers and insurers, or of lacking information about why claims were denied.
Case managers also spoke of the challenges navigating collective agreements and privacy legislation. Although they recognized the need to protect workers’ privacy, they also described the difficulty of providing modified work and facilitating RTW when they are restricted from having information related to workers’ health conditions.
These barriers were more noticeable when case managers had to manage health conditions with which they were less comfortable, including mental health disabilities. For example, one case manager spoke of not getting work limitation forms filled out by the treating physicians—and that was because the workers did not want to disclose that they were seeing psychologists or psychiatrists. “If we’re going to help them in the workplace, we need that information,” said the case manager.
Communication challenges involving front-line supervisors
Participants spoke of front-line supervisors as ideal employer representatives to initiate and sustain dialogue with an injured or ill worker and to obtain the information needed for absence management. However, participants also described front-line supervisors as sometimes unaware of disability management policies and unprepared to engage with injured workers in these types of conversations. Such interactions were, again, more difficult in cases involving mental health conditions and in cases where there had been a history of poor work performance.
The study found a lack of consistency across the number of front-line supervisors who had different levels of experience and competence with respect to RTW. When reflecting on the role of supervisors, one case manager noted that some supervisors were more familiar with the process while others only connected with the disability management department when it was too late. “It’s certainly not consistent across management. Sometimes, we don’t know someone is off work until the person runs out of sick time,” said the case manager.
Participants also spoke of the ripple effects across the system. When a supervisor faced difficulty communicating with an injured worker, that would impact the ability of a case manager to engage in conversations with the injured worker to support RTW. The result would be avoidable disability days.
These findings underscore the need to examine organizational disability management practices at an organizational level, says Jetha. Findings from this study highlight strategies that specifically target front-line workers and case managers and that are designed to improve communication and coordination, he adds. These might include:
- improving coordination with external stakeholders who may lack insight into the specific workplace context;
- leveraging information management systems or interventions that foster communication across diverse stakeholders in large organizations;
- promoting goodwill and trust between workers and supervisors prior to injury to facilitate information exchange following a disability absence—especially important in mental health cases;
- offering uniform training to supervisors across an organization to increase awareness regarding their roles and responsibilities in the RTW of employees and relevant communication strategies.
One takeaway message to come out of this study is that, sometimes, small changes to disability management practices can have a significant impact on communication, says Jetha.
That’s especially the case when the changes address crucial points in the systems where communication blockages tend to occur.