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Purpose There is an absence of evidence-based guidance to support workplace stakeholders in the effective delivery of return-to-work (RTW) messages. Our study examines the specific RTW communication practices and their impact on the management of work disability. Methods Within two large and complex healthcare organizations, semi-structured interviews were conducted with workplace stakeholders (e.g., supervisors, union representatives, disability management professionals and workers’ compensation representatives) and workers who had previously experienced sickness absence related to an occupational injury or illness. For workplace stakeholders interview questions asked about their roles and responsibilities in the RTW process, and specific communication strategies and messages that were used at different phases of the RTW process. For worker participants, interview questions explored RTW experiences and the impact of communication on work re-integration. An interpretative descriptive approach was used to inductively examine themes from interviews to create ways of understanding phenomena that yielded applied findings. Results Forty participants were interviewed including workplace stakeholders and workers. Participants frequently described effective RTW communication as messages that were delivered by a workplace stakeholder that included the content required by an injured worker to navigate the organizational disability management process and utilized specific strategies to address the perceived attitudes and perceptions held by an injured worker regarding work re-integration. Workplace stakeholders described five specific communication strategies including relaying messages of support, optimizing the timing of communication, careful word choice, framing messages, and tailoring communication to the injured worker. Conclusion RTW communication is an active process that requires a strategic approach. Effective communication practices represent an important strategy for workplace stakeholders to address the barriers held by injured workers and foster early and sustained RTW.

PurposeA work disability negotiation takes place between a supervisor, the disabled employee and the occupational health service (OHS) to support the disabled employee in returning to their work, often with temporary work accommodation. The objective of this study was to define the factors of a work disability negotiation with OHS that supported or hindered supervisors in their task/role in work disability management.MethodsThe study setting comprised two parts: the creation of survey questions and the actual survey of supervisors (N = 254) from six public and private organizations in Finland. Of these, 133 (52%) had participated in one or more work disability negotiations. The responses covered about 240 work disability cases and considerably more negotiations.ResultsThe study identified four key elements that the supervisors expressed as major success factors in the negotiations. First, it was crucial that the supervisors learned about the employee’s health restrictions and understood the issues relating to their work disability. Second, the parties should aim for common solutions and conclusions through collaboration. Third, active participation of all the negotiation parties is important. The supervisors gave a high rating to OHS taking their views seriously. Last, the supervisors appreciated collaboration in a constructive atmosphere.ConclusionIn order for a negotiation to help supervisors in their challenges, it should reach solutions, conclusions and a restructured comprehension of the work disability problem in a constructive atmosphere and with active communication between stakeholders.

Purpose Within large and complex organizations work disability (WD) communication bottlenecks emerge and contribute to avoidable disability days. Our study utilized soft systems methods to better understand communication problems in WD management. Methods Semi-structured interviews were conducted with disability case managers (n = 10), frontline supervisors (n = 15) and human resource/labor relations specialists (n = 5) within three public service organizations. Interview questions asked about organizational WD system structure and communication practices. Thematic analysis was conducted to examine system structure and emergent communication bottlenecks. Results WD communication took place across a number of internal and external stakeholders. Communication bottlenecks tended to concentrate within WD case manager and frontline supervisor activities. Inconsistent communication across organizations, challenges interacting with external stakeholders, mental health disability information exchange, lack of WD communication experience and previous worker performance represented communication bottlenecks that contributed to avoidable disability days. Conclusions To strengthen communication practices, systems-focused responses towards organizational WD management are required.

BackgroundCOL4A1 gene mutations result in complex and pleiotropic phenotypes, manifesting with neurological, ophthalmic, and systemic symptoms. In particular, COL4A1-related disorders are strongly associated with intracerebral haemorrhages, ischaemic strokes, and small vessel disease.Case reportWe present the case of a middle-aged female with a history of childhood epilepsy and learning disability, who presented with tonic-clonic seizures requiring intubation and ventilation. The patient experienced rapid functional decline, becoming bed-bound, non-verbal, and dependent on gastrostomy feeding. Examination revealed fixed flexion deformities of the limbs and bilateral vision loss.Investigations showed multiple supra- and infra-tentorial haemorrhagic foci, along with severe confluent white matter changes. Cerebral angiography confirmed the presence of vasculopathy, while CSF studies and a lack of response to steroids ruled out an inflammatory process. An EEG was non-diagnostic, and further investigations excluded malignancy or embolic phenomena.Urgent genetic testing for hereditary causes of microhaemorrhages and adult-onset neurodegenerative disorders revealed a COL4A1 autosomal dominant mutation: COL4A1 c.2008G>A p.(Gly670Arg). Neurology MDT optimised the patient’s functional status before transitioning to Level 1 disability management.DiscussionThe existing literature on COL4A1-related disorders does not address the rapid functional and cognitive decline observed in this case, occurring in the absence of major trauma or head injury. We highlight the importance of early recognition and detection of genetic disorders in the differential diagnosis, as well as the need for optimising patient care through a MDT approach.lara.ali1@nhs.net

PurposeThis paper aims to illustrate an example of how to set up a work injury database: the Smart Work Injury Management (SWIM) system. It is a secure and centralized cloud platform containing a set of management tools for data storage, data analytics, and machine learning. It employs artificial intelligence to perform in-depth analysis via text-mining techniques in order to extract both dynamic and static data from work injury case files. When it is fully developed, this system can provide a more accurate prediction model for cost of work injuries. It can also predict return-to-work (RTW) trajectory and provide advice on medical care and RTW interventions to all RTW stakeholders. The project will comprise three stages. Stage one: to identify human factors in terms of both facilitators and barriers RTW through face-to-face interviews and focus group discussions with different RTW stakeholders in order to collect opinions related to facilitators, barriers, and essential interventions for RTW of injured workers; Stage two: to develop a machine learning model which employs artificial intelligence to perform in-depth analysis. The technologies used will include: 1. Text-mining techniques including English and Chinese work segmentation as well as N-Gram to extract both dynamic and static data from free-style text as well as sociodemographic information from work injury case files; 2. Principle component/independent component analysis to identify features of significant relationships with RTW outcomes or combine raw features into new features; 3. A machine learning model that combines Variational Autoencoder, Long and Short Term Memory, and Neural Turning Machines. Stage two will also include the development of an interactive dashboard and website to query the trained machine learning model. Stage three: to field test the SWIM system.ConclusionSWIM ia secure and centralized cloud platform containing a set of management tools for data storage, data analytics, and machine learning. When it is fully developed, SWIM can provide a more accurate prediction model for the cost of work injuries and advice on medical care and RTW interventions to all RTW stakeholders.EthicsThe project has been approved by the Ethics Committee for Human Subjects at the Hong Kong Polytechnic University and is funded by the Innovation and Technology Commission (Grant # ITS/249/18FX).

This article explores the efficiency in the administration of social grants for adult persons with disabilities (PWDs) in the Northern Cape province of South Africa. The focus, in particular, is on explaining why, despite a gatekeeping element, adult PWDs presenting with the same medical condition, with mild or no verifiable impairment, keep returning and are allowed through the system, only to be rejected again, citing the same reasons as before. Administrative gatekeeping, as illustrated in the 2011 Social Grants Disability Management Model, does not extend beyond (i) verifying the correctness of supporting documents and (ii) checking documented proof of medical history to ascertain that applicants of social grants for adult PWDs are not booked for medical assessments within three months of their last assessment. This points to a weakness in the system, as the screening officials cannot turn away applicants of social grants for adult PWDs for any other reason once the documents are verified as correct. Here, we report the findings from responses to structured telephone interviews and structured face-to-face interviews with applicants of social grants for adult PWDs who are residents of the Northern Cape province of South Africa. We conclude that socio-economic circumstances, rather than impairment, are the main drivers for adult PWDs to keep on applying for social grants for adult PWDs and we offer some strategies for addressing this predicament to contribute to a sustainable and an efficient, effective, and economical administration process.

Purpose Despite increased attention towards workplace disability in global and local development agenda, mainstream inclusion of persons with disability continues to be a challenge for most organizations. This paper aims to explore how organizations can be facilitated for adapting to the need and responsibility for change, towards evolving into disability inclusive workplaces. Design/methodology/approach This paper uses an inter-domain approach by linking organization change and development models to Indian indigenous disability management literature. Findings This review indicates that in comparison with the other dimensions of diversity, disability brings unique challenges that need a differentiated management approach. Further, it finds a strong base for organizations to approach disability management as a strategic and transformative change initiative, aligning with some of the proven change and organization development (OD) interventions. Research limitations/implications This paper draws implications for disability management and highlights the need for a practice perspective towards disability management and OD. Originality/value This paper provides an integrated view of critical factors influencing workplace disability management and OD.

Objective To examine the impact of the social workplace system on sustained return-to-work (SRTW). Methods A random sample of workers’ compensation claimants was recruited to complete a survey following claim acceptance (baseline), and 6 months later (time 2). SRTW, at baseline and time 2, was classified as those reporting being back at work for >28 days. Co-worker and supervisor support were assessed using five and seven items, respectively, and total scores were produced. A list of potential supervisory and co-worker reactions were presented to participants who were asked whether the reaction applied to them; response were coded as positive or non-positive. Demographic and injury characteristics, and work context factors were collected. Baseline and at time 2 multivariable models were conducted to examine the impact of supervisory and coworker support and injury reaction on SRTW. Results 551 (baseline) and 403 (time 2) participants from the overall cohort met study eligibility criteria. At baseline, 59% of all participants indicated SRTW; 70% reported SRTW at time 2. Participants reported moderate support from their supervisor (mean = 8.5 ± 3.9; median = 8.2; range = 5–15) and co-workers (mean = 10.2 ± 4.5; median = 10.3; range = 5–25). Over half reported a positive supervisor (59%) or co-worker injury reaction (71%). Multivariable models found that a positive supervisor injury reaction was significantly associated with SRTW at baseline (OR 2.3; 95% CI 1.4–3.9) and time 2 (OR 1.6; 95% CI 1.1–2.3). Conclusions Promoting supervisor positivity towards an injured worker is an important organizational work disability management strategy.

Background Return-to-work (RTW) within a complex organizational system can be associated with suboptimal outcomes. Purpose To apply a sociotechnical systems perspective to investigate complexity in RTW; to utilize system dynamics modeling (SDM) to examine how feedback relationships between individual, psychosocial, and organizational factors make up the work disability system and influence RTW. Methods SDMs were developed within two companies. Thirty stakeholders including senior managers, and frontline supervisors and workers participated in model building sessions. Participants were asked questions that elicited information about the structure of the work disability system and were translated into feedback loops. To parameterize the model, participants were asked to estimate the shape and magnitude of the relationship between key model components. Data from published literature were also accessed to supplement participant estimates. Data were entered into a model created in the software program Vensim. Simulations were conducted to examine how financial incentives and light duty work disability-related policies, utilized by the participating companies, influenced RTW likelihood and preparedness. Results The SDMs were multidimensional, including individual attitudinal characteristics, health factors, and organizational components. Among the causal pathways uncovered, psychosocial components including workplace social support, supervisor and co-worker pressure, and supervisor-frontline worker communication impacted RTW likelihood and preparedness. Interestingly, SDM simulations showed that work disability-related policies in both companies resulted in a diminishing or opposing impact on RTW preparedness and likelihood. Conclusion SDM provides a novel systems view of RTW. Policy and psychosocial component relationships within the system have important implications for RTW, and may contribute to unanticipated outcomes.

Introduction We present the results of a systematic literature review of disability management interventions to answer the question: “what is the credible evidence that incremental investment in disability management interventions is worth undertaking?” Methods We identified studies through searches in journal databases and requests to content experts. After assessing the quality of studies that met content requirements, we employed a best-evidence synthesis approach. Studies were stratified across several dimensions for evidence synthesis, with industry as the core stratification criterion. Results We identified 17 disability management interventions with economic analyses, of which eight were of high or medium quality. We found strong evidence supporting the economic merits of multi-sector disability management interventions, but could not make a positive statement about the remaining five industry clusters with studies. For stratification by intervention components, we found moderate evidence for interventions that included an education component, moderate evidence for those with physiotherapy, limited evidence for those with a behavioural component, and moderate evidence for those with a work/vocational rehabilitation component. For stratification by intervention features, we found moderate evidence for interventions that included a work accommodation offer, contact between health care provider and workplace, early contact with worker by workplace, ergonomic work site visits, and interventions with a return-to-work coordinator. Conclusions We found credible evidence supporting the financial benefits of disability management interventions for one industry cluster and several intervention components and features.