Researching Complex and Multi-Level Workplace Factors Affecting Disability and Prolonged Sickness Absence

Workplace disability arising from injury and illness on the job is costly for employers who are typically held responsible for affected employees’ return to work. Thus, employer discussion on workplace disability has focused on prevention of injury, illness and hazardous exposure. In contrast, research in this area has centred on the psychosocial and environmental factors influencing disability outcomes.

The goal of this article, by Vicki L. Kristman, William S. Shaw, Cécile R. L. Boot, George L. Delclos, Michael J. Sullivan, and Mark G. Ehrhart of the Hopkinton Conference Working Group on Workplace Disability Prevention, is to recommend future directions in research on workplace disability that better reflect employer priorities, with a view to reducing its incidence and impact.

This paper presents the results of a year-long collaboration that involved a review of the differences between research studies and the employer-directed “grey” literature (case studies, success stories, management surveys, best practice guides) in their respective examination of factors that contribute to workplace disability.

Workplace Disability Factors: Research versus “Grey” Literatures

In the research literature, studies have been guided by a more “psychosocial” framework, whereby the focus is on the social and psychological factors contributing to disability outcomes. Employees experiencing musculoskeletal (MSK) disorders, particularly back pain, in large organizations were the most frequently studied population, though more recently there is a widening focus on mental health. Predominant factors contributing to disability outcomes that have been identified in research studies can be categorized as:

  • Physical job demands;
  • Psychosocial job demands, particularly job strain and lack of worker control;
  • Work organization and support factors such as a lack of social and supervisory support and, to a lesser extent, part-time work and poor leadership; and
  • Workplace beliefs and attitudes, particularly low job satisfaction.

In contrast, the grey literature reflects a high degree of employer reliance on a strict “biomedical” model directed at prevention. According to this model, work disability is explained by the severity of the condition, the effectiveness of the clinical treatment and the employer’s disability management process. Thus, in addressing disability in their firms, employers tend to focus on:

  • Defining roles and responsibilities: having the commitment and funding support of senior management; granting frontline supervisors more autonomy, training and support to improve job modification; identifying and training an in-house return-to-work (RTW) coordinator or disability manager.
  • Standardizing management tools and procedures: using administrative data to monitor, evaluate and analyze disability outcomes and trends; having clear disability management guidelines that are developed in coordination with affected workers and integrated with other corporate policies; having ergonomic assessments; distributing employee educational packets.
  • Being prompt and proactive: providing offers of job modification and accommodation that are tailored to individual specifications; implementing workforce education and outreach to publicize benefits and policies; adopting early, proactive RTW measures with medical treatment and rehabilitation.
  • Attending to individualized needs of workers: recognizing social and behavioral influences relating to individual, group and job characteristics that might affect RTW, such as family lifestyle and culture, job tenure and experience, worker motivation and readiness, prior disability absences, views on compensation and other regulatory and benefit structures.

The authors identified differences between the research and employer-directed grey literatures in three ways, which come down to the difference between the organizational and the individual.

  1. Perspective: the grey literature takes a managerial viewpoint, whereas the research literature tends to focus on the individual worker.
  2. Outcomes: the grey literature tends to focus on factors at the organizational level (e.g., lower cost, higher productivity), whereas in the research literature they are at the worker level (changes in behaviour, stress levels, and attitudes, modified by worker characteristics).
  3. Type of disability emphasis: the grey literature is more focused on general disability management policies and issues applicable across disabilities, whereas the research literature is more likely to differentiate types of disabilities and RTW issues unique to specific disabilities.

Recommendations for Conducting Research That is Relevant to Employers 

To develop an overall conceptual research framework that enables employers gain a better understanding of the factors contributing to disability outcomes, the authors identify three research principles:

  1. Identify barriers to work re-entry: e.g., lack information about how to proceed, concerns about ability to effectively meet the demands of employment, inaccurate information about the safety of returning to work.
  2. Identify negative workplace factors: physical elements of the work environment (e.g., noise, temperature, pace, smell), and social/ interpersonal elements (e.g., disrespect, aggression).
  3. Identify positive workplace factors: physical elements (e.g., comfort, flexibility, financial reward), or social/interpersonal elements (e.g., social contact, identity, autonomy, control).

The authors conclude with three recommendations for future research into workplace disability factors that would make it more relevant to employers:

  1. Incorporate more advanced approaches to analysis, including conducting multi-level assessment, i.e. from the perspectives of workers, the workforce overall, supervisors, and managers;
  2. Include small and medium sized enterprises, because most research to date has been in large organizations and therefore is not generalizable to all firms; and
  3. Consider workplace factors from all relevant domains, including supervisory and working group support, because most research to date has focused on physical demands and working style.

This paper would be of great interest to employers interested in reducing disability incidence and costs, as well as researchers and policy makers interested in developing employer-acceptable policies that will reduce injury and disease in the workplace.