Summary

Every year, a large number of workers find themselves having to go on sick leave due to physical or mental health problems. Some of these workers have difficulty reintegrating into work and end up taking long-term leave. These difficulties are referred to as “work disabilities.” Given the magnitude of the human and financial costs generated by these health problems, a number of strategies have been proposed to facilitate the return to work. Several studies have shown that the presence of a return-to-work coordinator (RTWCo) helps reduce prolonged disabilities and the related costs. An RTWCo is a professional who facilitates the RTW of an employee with a work disability by working hand in hand with the various stakeholders who may be involved in the process (direct supervisor or manager, union representative, health professionals, insurer, etc.) While several scientific articles recommend coordination of the RTW process, the actual practices currently in effect in Québec remain largely unknown.

The main objective of this study was to describe the practices of the individuals responsible for coordinating the RTW in large private and public organizations in Québec. The first specific objective was to describe the individuals involved in the coordination process, as well as the organizations for which they work. The second specific objective was to describe the tasks and activities carried out by these individuals, identify the stakeholders with whom they have to collaborate, and determine the qualities and aptitudes required for the coordination task. Lastly, the third specific objective was to explore the facilitating and hindering factors associated with carrying out these tasks and activities, as well as those associated with the return to work.

Using different Web sites, a list was drawn up of potentially eligible private and public organizations, specifically, those with at least 500 employees in Québec. Of the 652 organizations identified, 471 were found to qualify following telephone contact. Of this number, 327 individuals filling the RTWCo role agreed to provide their email addresses in order to receive an invitation to complete an online survey (programmed in SurveyMonkey). All told, 195 individuals answered all the questions in the survey, which included several questions related to each of the specific objectives. Bivariate and multivariate analyses were performed using version 18 of PASW statistical software.

With regard to specific objective 1, a standard RTWCo profile was identified: female, between 35 and 54 years of age, holder of a university degree, and active in the RTW coordination field for nearly 13 years. One surprising finding was the fact that the word disability came up very infrequently in the job titles of the RTWCos, not to mention the fact that the expression return to work was totally absent. Approximately half of the surveyed organizations used the services of external firms for disability management. In addition, musculoskeletal and mental health disorders virtually tied as the main reason for sick leave, and the reported absence rate was rarely more than 10%.

Regarding specific objective 2, the results obtained revealed that the individuals with the RTWCo role in large organizations in Québec were required to perform many varied tasks and activities. Several significant associations were found between the frequency with which these tasks and activities were performed and the characteristics of the RTWCos or of their organizations. Regression analyses showed, however, that the fact of having nursing or occupational health and safety (OHS) training is one characteristic of people performing RTWCo tasks that should not be overlooked when examining the factors influencing their practices. The results obtained also showed that the RTWCos had to work on a regular basis with the worker on sick leave and his or her direct supervisor or manager, but less frequently with the human resources counsellor, health professionals and the absent worker’s co-workers. The results further indicated that the RTWCos regarded it as important that they have a broad range of qualities and aptitudes (e.g., tactfulness, creativity in problem solving, strong organizational skills) in order to perform their jobs.

Regarding specific objective 3, the results showed that, by and large, the RTWCos deemed their work environment and working conditions to be highly favourable. They also reported having much greater difficulty managing cases that involved mental health disorders than those involving musculoskeletal disorders. Several factors facilitating and hindering the return to work were considered important by the RTWCos, and many of these were associated with the attitudes and behaviours of the direct supervisors or managers, and with the contacts between them and the worker.

This study describes, for the first time in Québec, the practices of RTWCos in large organizations. These practices appear to be relatively homogenous and, for the most part, to form part of a set of more varied tasks. The study results highlight the fact that managing mental health disorders appears to be much harder than managing musculoskeletal disorders, that the role of the direct supervisor or manager is essential for promoting a smooth process, and that major efforts are required to ensure concerted action in these workplaces. Additionally, the RTWCo profile that should be recommended has yet to be evaluated in terms of its impact on sick leave duration, number of relapses and associated costs. The many challenges and needs identified by the RTWCos in this survey point to the need for additional training, for example, on mental health disorders, reintegration into the workplace and ways to ensure concerted action. It is important to remember that this study reflects practices found in organizations in good overall health, and that the RTWCO role should continue to be explored in the context of small and medium-sized businesses.