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  • Discussions and consultation will often bring to light facts and circumstance of which the employers were unaware and will throw new light on the problem, The employee may wish to seek medical advice on his own account which when brought to the attention of employers medical advisor could change their opinion, If employee is not consulted and given opportunity to state their case injustice may be done, ? Place of warnings in ill-health cases, but employee is entitled to know if and when their job is in jepoardy
  • Adjusting the premises, allocating some duties to another person, altering person’s hours, changing persons workplace, providing or arranging training, acquiring or modifying equipment, extent to which it is practicable for employer to take steps, financial and other costs incurred, extent to which it would disrupt any of his activities, extent of employers financial or other resources.
  • Unfair dismissal- the general framework, several exclusion criteria from ord unfair dismissal, main one is one year’s continuous service, certain types no qual period, and prinicipal reason fell within the specified category, preg, dismissal due to suspension from work on medical grounds, qual period just 1/12, Capability can be assessed by reference to skill, aptitude, health or any other physical or mental quality. Statutory reason or restriction imposed by law, some other substantial reason, of a kind to justify dismissal of employee holding that postion his status as an employee, the nature of his/her work, his/her terms and conditions of service.
  • Reasonableness; depends on the circumstances (including size and administrative resources of the organisation, Procedural issues
  • Transcript

    • 1. Absence Management, a risk management issueAbsence Management Training programme. Dr Peter Noone, Consultant Occupational Physician06/04/12
    • 2. But We’ve been here before ! “If you think you’re too small to have impact, try going to bed with a mosquito”! Anita Roddick (The Body Shop)04/06/12 Dr Peter Noone
    • 3. President Clinton It’s the Economy Stupid !04/06/12 Dr Peter Noone
    • 4. Absence Management Guiding value Keep it Positive……∗∗∗∗∗∗!04/06/12 Dr Peter Noone
    • 5. “Sickness absence should be used as an integrated measure of physical, psychological and social functioning in studies of working populations” Whitehall Study, Marmott et al 199504/06/12 Dr Peter Noone
    • 6. Topics to Cover Absence as a risk management issue, Models of Absence, Types of Absence Management, Management of Short-term Absence, Management of Long-term Absence, Pension eligibility.04/06/12 Dr Peter Noone
    • 7. Cost of Sickness absenceCBI 1998 UK, £11 billion per annum,Average cost £478 per employee, €882 IRL (IBEC - survey) 7.8 days/employee/yr,10.7 days in large companies (>250employees) €1.4 billion = the estimated cost of absence to IRLorganisations/ yrLoss of average of 3.7% of working time,Hocking el al 1994, Australian Telecoms sector,$2 billion loss from alcohol & smokingabsence alone!28% of lost work-time in Europe (Euro Foundation forImprovement of Living and Working Conditions 2000) 04/06/12 Dr Peter Noone
    • 8. Corporate Social Responsibility04/06/12 Dr Peter Noone
    • 9. Employment Risk Matrix Wage increases, Absence, Fraud, Stress,I Mortality Turnover, retention,mpa Safety, Early Retirement,ct Legal Compliance Succession Planning Improvement Potential 04/06/12 Dr Peter Noone
    • 10. Risks accept retai n transfe r mitigate preven control avoid04/06/12 t Dr Peter Noone
    • 11. Accident / Illness, Resource Loss per YearAccidents Illness300 deaths, 100,00012 million lost deaths,days/yr 200 million lost days04/06/12 Dr Peter Noone
    • 12. THE ENVIRONMENT SOCIAL POLICY Occupation Education Pollution of Employment Air/water/food Social Status Climate Wealth Infectious Agents Legislation about Housing health THE HEALTH OF THE POPULATION INDIVIDUAL GENETIC HEALTH LIFESTYLE CONSTITUTION CARE SYSTEMS Nutrition Race Smoking Heredity Prevention Exercise Predisposition Treatment Sexual Behaviour Rehabilitation04/06/12 Dr Peter Noone
    • 13. Impact of unhealthy workplace Low Employee SatisfactionLow Customer Low MoraleSatisfaction High EffortLow Commitment Low Reward Low Trust +Low Loyalty High Demand Low Retention Low ControlLow Motivation Low Creativity Trailing Edge Performance 04/06/12 Dr Peter Noone
    • 14. Taking A Holistic View04/06/12 Dr Peter Noone
    • 15. 04/06/12 Dr Peter Noone
    • 16. 04/06/12 Dr Peter Noone
    • 17. If you’re not creating community, you’re not leading, Empowering people to reach their full potential.04/06/12 Dr Peter Noone
    • 18. Managing Employee Commitment04/06/12 Dr Peter Noone
    • 19. 04/06/12 Dr Peter Noone
    • 20. 04/06/12 Dr Peter Noone
    • 21. Main Occupational Health Ethical Positions Independent impartial medical examiner/advisor to employer and employee, Traditional therapeutic doctor patient relationship and ? Advocate, Research, auditor of trends, factors in working populations.Ref “Guidance on Ethics for Occupational Physicians” FOM London 1999 04/06/12 Dr Peter Noone
    • 22. Models of Absence Deviance model- lazy, lack of commitment, McGregor’s theory X, Withdrawal- from unsatisfactory working conditions, Economic Utility- trade off leisure activities, outside interests are more valuable, Cultural- What is the norm for this organisation, state, societal attitudes.04/06/12 Dr Peter Noone
    • 23. Non-attendanceUnderlying medical condition,Problems with work colleagues or supervisor,Family, personal or domestic problems,Attitude or motivational problem,Outside interests,Response to refusal for time off for social,domestic or family crisis04/06/12 Dr Peter Noone
    • 24. Types of Absence Management Simple draconian – any rapid turnover low wage employer, Complex active – any leading multi- international, Dithering passive- the Public Sector!04/06/12 Dr Peter Noone
    • 25. 1. Simple DraconianNo sick pay for first few days of absence,Frequent short spells treated as conductand disciplinary issues,Dismissal on some other substantial reasonor medical incapacity >6/12 absence,Rapid turnover, low wage employer,depends on large pool of replacements,Lawful, - ethical, - truly cost effective?.04/06/12 Dr Peter Noone
    • 26. 2. Complex ActiveStable, high skill, well paid and productive workforce,Risk management and safety led,Strategic & project based management systems,Comprehensive health, social, welfare policies andprogrammes for employee’s and dependants,Highly, consistently and transparently managed,Preventative health programs,Early interventions for alcohol & drug misuse,Active management of medium to long-terms illness 04/06/12 Dr Peter Noone
    • 27. 3. Dithering PassiveGenerous sick pay schemes,Absence divided into “genuine” or “not genuine”,Rudimentary absence data, no analysis by CAUSE,Recurrence of preventable accidents,Cosy acceptance of short-terms absence as a safetyvalve for working in a “stressful place”,Major unaddressed workplace health risks,No clear policy on temporary modified work,rehabilitation, fast tracking for energetic treatment,Abuse of ill-health retirement procedures. 04/06/12 Dr Peter Noone
    • 28. Philosophical Position People prefer and beneficial to be at work, Only 3 absolute contra-indications to work; - imprisonment, coma, death. Absence is a multi-factorial phenomena, Best model is bio/psycho/social, Malingering does not exist04/06/12 Dr Peter Noone
    • 29. “In order that people are happy in their work, 3 things are needed; They must be fit for it, not do too much of it and must have a sense of success in it” John Ruskin 187104/06/12 Dr Peter Noone
    • 30. Why do we come to work?04/06/12 Dr Peter Noone
    • 31. Why do We Come to Work? We want to We have to, We need to?04/06/12 Dr Peter Noone
    • 32. Why come to work?04/06/12 Dr Peter Noone
    • 33. Why don’t we come to work? Medical incapacity, Social incapacity, We dislike work more than wanting to, having to or needing to.04/06/12 Dr Peter Noone
    • 34. Bio-psychosocialAbsence is behaviour,“Avoidance of workplace is the outcome ofpositive and negative medical, emotionaland social influencers”related to real & perceived conditions of work(physical & psychosocial), anticipated jobdemands, management attitudes and behaviours,social norms04/06/12 Dr Peter Noone
    • 35. “Tom had discovered a great law of human action, namely that in order to make a man covet a thing, it is only necessary tomake the thing difficult to attain.Work consists of whatever a bodyis obliged to do and play consistsof whatever a body is not obliged to do” Mark Twain, Huckleberry Finn04/06/12 Dr Peter Noone
    • 36. Factors predictive of absenceGeographical-  taxation, pension age, social attitude, social insurance, unemployment, epidemics, health services, regional culture,Organisational-  nature of business, size of unit, IR, sick pay, supervisor, working conditions, HR policies, environ hzds, OHS, labour turnover, culture & climate.Personal-  age, gender, occupation, personality, life crises, family responsibilities, job satisfaction, social activities, commute time to work, length of service, gender integration, medical, smoking, alcohol & substance misuse. 04/06/12 Dr Peter Noone
    • 37. 5 Medical factors predictive of absence Health services, Epidemics, Environmental hazards, Occupational health services, Individual health or medical conditions,04/06/12 Dr Peter Noone
    • 38. Short-term absenceBio-psychosocial model predominates,One question,  “Is there a single underlying unifying medical cause?”  either yes or no,Employer manages this as a “conduct”issue,04/06/12 Dr Peter Noone
    • 39. Long term, medical modelDisease---> loss of function--->disability,Measure loss of function,Therefore define disability in context of work,personal, social or recreational terms,We can adjust the work or the workplace.04/06/12 Dr Peter Noone
    • 40. RehabilitationRelies on medical model of disability andfunctional assessment,Uses positive influencers of bio-psychosocial model to motivate, sustain andsupport workability,Outcome - more rapid physical recovery.04/06/12 Dr Peter Noone
    • 41. A Biopsychosocial model of low back disability Social Environment Illness Behaviour Psychological Distress Attitudes & Beliefs Pain Report of a CSAG Committee On Back Pain May 199404/06/12 Dr Peter Noone
    • 42. Probability of RTW LBP04/06/12 Dr Peter Noone
    • 43. Yellow Flags, Psychological factorsIndividual cognitive, emotional, and behavioural factors.• Distress/depression• Somatisation• Fear avoidance• Passive/-ve coping?• Dysfunctional beliefs?• Pain and (re)injury 04/06/12 Dr Peter Noone
    • 44. Blue flags: perceptions about workIndividual attitudes and beliefs about:• Job dissatisfaction• No social support• Attribution (to work)• Perceptions of demand/control• Organisational culture/climate 04/06/12 Dr Peter Noone
    • 45. Black flags: not Individual perceptionsAffect all workers equally -• Sickness policy• Sick certification• RTW policy• Job content• No modified duties• Benefit systemFlags are incorporated in occupational health guidelines. 04/06/12 Dr Peter Noone
    • 46. Management Actions (medical model) Rapid recovery - no action, Permanent disability  medical advice,  redeployment, Slow recovery  medical advice,  temporary modified work,  rehabilitation 04/06/12 Dr Peter Noone
    • 47. Temporary modified work, Dr Clive Burges 2001 rehabilitation Rapid recovery Rehabilitation Slow recoveryhealth Permanent disability Death time Time gain 04/06/12 Dr Peter Noone
    • 48. Rehabilitation Team employee Fully functioning teamPerson outsick Locum 04/06/12 Dr Peter Noone
    • 49. Fitness management Line manager delivers it, Central functions (HR, OH, H&S, Risk) provide advice, monitoring data, policy and procedural support.04/06/12 Dr Peter Noone
    • 50. Referral to Occupational healthManager/HR refers using form OHS 2; frequent short term absence, concern about physical fitness to carry out duties of post, concern about mental fitness to perform duties, concern about susceptibility/vulnerability to workplace exposure(s), Statutory medical assessment, Assessment of permanent incapacity on medical grounds. 04/06/12 Dr Peter Noone
    • 51. Questions frequently asked by managers of OHWhat is the likely date of return to work?Will there be any disability at that date?If so how long will it last, will it be temporary orpermanent?,Will the employee be able to resume their fullrange of normal duties on return to work?Any implications for health, safety & welfare ofemployee or others on return to work?Is he/she likely to render regular, efficient andeffective service in future?, 04/06/12 Dr Peter Noone
    • 52. Role of Occupational health“If you have to prove your ill, you can’t getwell”,Occupational health professionals notrequired to verify reasons for absence fromwork,Protect the relationship of trust essential foropen honest and effective communicationbetween the employee and the OHprofessional 04/06/12 Dr Peter Noone
    • 53. Temporary modified work “From passive to active complex” early and continuous contact, triggers, thresholds for referral, superficial enquiry about the BPS issues, General feel for the issues,04/06/12 Dr Peter Noone
    • 54. Less capableGive modified work,tolerate decreased performance,early retirement on actuarially reduced pension,ill health retiral,otherwise dismissal route 04/06/12 Dr Peter Noone
    • 55. Decrease in performance Energetic treatment if health related, Counsel Training, Mentoring, support, Demote?, Offer old job back if successful.04/06/12 Dr Peter Noone
    • 56. Five reasons for dismissal Conduct, Capability, Redundancy, Statutory reason, e.g driving charge, Some other substantial reason.04/06/12 Dr Peter Noone
    • 57. Temporary modified work in action Organisational culture, Willingness of employee, manager, GP and Occupational health to participate, Begins with advisory medical report from OH,  indicates when full fitness likely,  indicates current restrictions,  states period over which recovery will occur,  asks manager’s decision. 04/06/12 Dr Peter Noone
    • 58. Temporary modified workManagers considers feasibility of restrictionson OH report,  will return on a phased basis,  can only return if adjustments made to current post,  can only return to alternative duties,  implications of partial fitness on running of department,  involvement of employee, work colleagues, external support workers, job coach,Decision - yes, no, wait a bit.04/06/12 Dr Peter Noone
    • 59. Temporary modified duties If no - OH can do no more, If wait - OH asks how long?, If yes - OH reviews employee fortnightly and monitors incremental progress to full functionality, medical restrictions in terms of hours, content, location, intensity or pace of work04/06/12 Dr Peter Noone
    • 60. Difficult topicsPregnancy & post delivery,Alcohol and drug misuse,Investigative meetings/disciplinary hearing,Conflicting opinion between OHP andpersonal physician,Premature return to work against medicaladvice.04/06/12 Dr Peter Noone
    • 61. Investigative meetingFitness to meet different from fit to RTW,Contribution of health to problem underinvestigation- mitigating factor?Make it easy for employee to attend.Cannot get on with it until closure04/06/12 Dr Peter Noone
    • 62. Pregnancy & post delivery Adjustment of work in normal pregnancy (physiological state, not an illness), Work - home life balance, Pregnancy related illness.04/06/12 Dr Peter Noone
    • 63. Alcohol & drugsReferral under the policy,  managers index of suspicion,  admission of problem,  willingness for treatment.Occupational health,  confirms extent of medical problem,  brokers treatment,  advises on success of treatment,  advises on fitness to work.04/06/12 Dr Peter Noone
    • 64. Conflicting medical opinionThe opinion of OHP usually prevails,2 questions? Did you tell OHP all health problems ? has anything changed since consultation ?Refer back to OHP to try to resolve it ornarrow down areas of conflict. 04/06/12 Dr Peter Noone
    • 65. Premature return to work Unexpected, Medical advice, Restricted employment, Suspend on pay until investigation of facts complete.04/06/12 Dr Peter Noone
    • 66. Barriers to rehabilitationLinks with disciplinary process,Litigation: work related accidents & ill-health,UK Assoc of PI Lawyers Code of Practiceon rehab linked with carer role,Absence linked with stress from disciplinaryprocess. 04/06/12 Dr Peter Noone
    • 67. The “acid test” Is everything being done that can reasonably be done by:  the individual employee themselves,  the clinical/support services of the organisation,  the employer/line-manager/HR What would you want or expect for yourself?04/06/12 Dr Peter Noone
    • 68. Medical aspects of Pension benefits - roles and responsibilities OHP – Gains evidence and advises on capabilities/ adjustments, – decides if adjustments Line manager reasonable, Line manager/HR – determine if alternative duties available, – decides if criteria met, signs Medical adviser off pension advice for probity, considers appeal04/06/12 Dr Peter Noone
    • 69. Medical aspects of pension benefits A form of dismissal NOT retirement, irrelevant if “voluntary” or “compulsory” Employer decision that “incapable of doing job”, conflict with disability ground of Employment Equality ActDDA, ? Consequence of decision.04/06/12 Dr Peter Noone
    • 70. Pension scheme criteriaIndividuals who are permanently incapable ofrendering regular, efficient and effective service inthe duties of their grade by virtue of ill health,Permanent,incapable,Duties,ill-health,Regular, efficient, effective, ? safe serviceNO suitable alternative duties available.04/06/12 Dr Peter Noone
    • 71. Pension benefits evidence Face to face assessment, Specialist reports, Evidence of failed early, energetic and effective treatment or unsuccessful adjustment(s), Full clinical recovery, coming off benefits and return to work not always contemporaneous nor synonymous, Remove the bio-psychosocial obstacles to RTW04/06/12 Dr Peter Noone
    • 72. Medical aspects of pensionRecommend IHR only;  after full investigation and consideration,  after fully exploring opportunities for recovery and rehabilitation,  Should not be made lightly,  Should not be for motivational factors (non medical reasons),  Should not be for managerial reasons (? “greater efficiency of the service”) to solve management’s problems04/06/12 Dr Peter Noone
    • 73. It’s the same each time with progress, first they ignore you, then they say you’remad, then dangerous….. Thenthere’s a pause and you can’t find anyone who disagrees with you” Tony Benn04/06/12 Dr Peter Noone
    • 74. “The difficulty lies not in new ideas but in escaping the old ones which ramify into every corner of our minds” J Maynard Keynes04/06/12 Dr Peter Noone