Canadian Occupational Safety

April 2013 21 • having labour and management work together as partners in returning injured workers. Organizational policies and prac- tices also matter in another way when it comes to return to work. ey appear to predict the likelihood of injured workers returning and, more impor- tantly, if these workers will function well once back in their jobs, according to a 2011 research from IWH associate scientific director Ben Amick. Research results indicate workers who gave their organizations high marks in terms of policies and practices were 2.3 times more likely to be back at work and functioning well at six months, and 2.2 times more likely at 12 months than those who gave their organizations low marks. e policies and practices in question promoted a people-oriented, trusting and co-oper- ative work culture, a safe work environment, ergonomically designed jobs and strong disability management practices. Some types of workplace-based RTW programs seem to be particu- larly effective. IWH scientist Ivan Steenstra found that workplace-based programs in which workers and supervisors jointly identify and solve return-to-work barriers help workers with low-back pain return to their jobs more quickly. ese workers returned 30 days earlier, on average, than those who received usual-care, and at only a slightly higher cost. ese programs are based on the "Sherbrooke model," which refers to a program developed in Canada by Patrick Loisel and his fellow research- ers at Quebec's Sherbrooke University. The programs involve the worker and supervisor, with the help of an occupational health professional or ergonomist, identifying and solving RTW barriers, and then implementing the solutions in the workplace. What hinders? In the 2009 publication, Red Flags, Green Lights: A Guide to Identifying and Solving Return-to-Work Prob- lems, IWH's MacEachen and her team describe the problems that can com- plicate recovery and return to work, including problems related to the workplace: • a worker returning to work too early, before being well enough to manage modified work • a worker's injury complicating his or her commute, even though modified work may be available • a worker doing modified work not suited to her physical restrictions or where the danger that caused the injury continues to exist • a worker's workstation, health-care needs or injury not being sufficiently accommodated • a worker doing "embarrassing" modi- fied work of little productive value. For each potential work problem, the guide points to warning signs and helpful practices. It does the same in the areas of vocational rehabilitation, health-care and claims processing. More recent research also looked at the key role of co-workers in the RTW process. It turns out co-workers are not a neutral party when it comes to injured workers' RTW. ey can make all the difference to the success — or failure — of a return, yet can also be negatively affected by the challenges involved. is was made clear in two recent qualitative studies both published within the last year. One study was led by Debra Dunstan of the Univer- sity of New England in Australia, who co-authored the study with IWH's MacEachen. e other study was led by former IWH scientist Agnieszka Kosny, now a research fellow at Aus- tralia's Monash University. ese studies found co-workers can be barriers to a colleague's return to work when: • they don't already have a good rela- tionship with the returning worker • the work culture is competitive, has little modified work available, is char- acterized by poor com munications and precarious work and/or offers little job security • the returning worker requires support for too long — because worker good- will can wear thin over time. e researchers suggest commu- nicating effectively so co-workers understand the injury, are consulted about RTW plans and receive guidance on how to assist. If possible, hire replacement staff to ease the workload on co-workers. Acknowledge and recognize the con- tribution of co-workers, via monetary or in-kind payments such as extra holidays. Is it worth it? RTW is beneficial for both workers and the workplace. Getting back to work aer an injury or illness can improve the health of workers, according to a 2012 systematic review conducted by researchers, including IWH presi- dent Cameron Mustard, at the Health Research Initiatives at the Ontario HIV Treatment Network. e review found a significant improvement in health aer re-employment and a significant decline in health attributed to contin- ued unemployment. A systematic review published in 2008 by IWH's Amick found strong evidence RTW programs have a positive effect on workers' compensa- tion claims costs and on the frequency and severity of injuries and illnesses. Visit www.iwh.on.ca/return-to- work-practices for more RTW data. Cindy Moser (cmoser@iwh.on.ca) is the communications manager at the Institute for Work and Health in Toronto. 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