Summary

Musculoskeletal disorders (MSDs) remain a major occupational health problem in industrialized countries. The consequences of work disability place a heavy burden not only on workers and their families, but also on organizations. While a number of studies on work disability underscore the important role of supervisors in various return-to-work (RTW) programs, few have focused specifically on their roles, responsibilities, and actions in facilitating the reintegration of workers who have sustained a work-related musculoskeletal injury.

The general objective of this study was to propose possible courses of action for supervisors during the process aimed at the sustainable RTW of workers following a work-related MSD, and to verify their applicability in various organizational contexts and industry sectors in Québec. The specific objectives were to (1) describe the concrete actions taken by supervisors during the process aimed at achieving sustainable RTW, the different problems they face, and the problem-solving strategies they use; (2) study the conditions favourable and unfavourable to supervisors’ involvement in work disability prevention; (3) develop possible courses of action for harmonizing the role and responsibilities of supervisors regarding sustainable RTW with their other roles in the organization (e.g. in production or accident prevention) and with the responsibilities of other organizational actors seeking to prevent work disability; and (4) verify the pertinence, feasibility, and applicability of these courses of action in various organizational contexts and industry sectors in Québec.

A three-part qualitative sequential design was used to achieve these objectives. In part 1, a literature review was performed, starting with a systematic search of three specialized databases. It served to document the international evidence available on the role and responsibilities of supervisors and their involvement in activities essential to the process aimed at achieving a sustainable RTW (objectives 1 and 2 – “international context” component). These essential activities were as follows: (1) contacting the absent worker; (2) evaluating the worker and his¹ work situation; (3) offering, planning, and implementing the RTW solution; (4) welcoming the worker back, and implementing and adjusting the RTW solution; (5) doing follow-up of the RTW solution; (6) establishing communication among the actors (e.g. supervisor and worker post-RTW); (7) promoting collaboration within the work team and support for the worker; (8) coordinating with the other actors in the RTW process; (9) formalizing policies and procedures; and (10) acquiring knowledge and focusing on experience and skills in order to facilitate a sustainable RTW. Descriptive content analyses of the different publications were performed to complete part 1. In part 2, a secondary analysis was conducted of data obtained from a Québec case study carried out in four large companies operating in two different industry sectors. The aim was to describe supervisors’ involvement in these essential activities from the various perspectives present in Québec workplaces: workers, supervisors, managers, and union representatives (objectives 1 and 2 – “Québec context” component). Content analyses of interviews were performed for this component. A synthesis of the results of parts 1 and 2 was used to develop possible courses of action and the specific actions associated with them. The essential activities and actions identified in the literature review therefore served as the starting point, and were then adapted in light of the secondary analysis of the workplace interviews (objective 3 – “development of courses of action” component). Lastly, part 3 consisted of verifying the pertinence, feasibility, clarity of the wording, and applicability of these courses of action in various contexts and industry sectors in Québec (objective 4 – “applicability” component). A questionnaire was administered for this purpose, and the frequencies of the “yes” answers to the various questions were compiled. The respondents’ suggestions were then re-examined to encourage an exchange of ideas among these same actors, both within focus groups and in individual interviews. Content analyses of the participants’ comments collected for each course of action produced findings regarding their feasibility and applicability, and made it possible to propose an operational model for supervisors.

Results: For the “international” component (objectives 1 and 2), the literature review yielded 788 documents. After eliminating duplicates and applying selection criteria, 16 documents were retained. Three others that were identified in the reference sections of the selected documents were added to these. The literature review revealed a total of 10 essential activities and 22 actions for supervisors associated with the process aimed at achieving sustainable RTW. It also highlighted the types of problems encountered by supervisors and their problem-solving strategies, on the one hand, and the conditions favourable to their involvement in this process, on the other.

For the “Québec context” component (objectives 1 and 2), as a whole, the concrete RTW actions mentioned by the supervisors pertained to the role and responsibilities they were assigned in their organizations and corresponded to the actions identified in the literature review. The actions, problems, and strategies cited concerned mainly evaluation or planning, and in particular, information sharing between supervisors and the head of human resources (HR). The supervisors reported having difficulty reconciling their role and responsibilities regarding production objectives with those regarding sustainable RTW. In addition, they appeared more knowledgeable about prevention actions, particularly the need to document accident circumstances, than about actions facilitating sustainable reintegration into work. Two types of favourable or unfavourable conditions emerged in connection with supervisors’ ability to perform their roles and responsibilities in the four organizations. The first type concerned the importance of managing interpersonal problems and of supporting the worker, whether in his relationships with fellow team members or to ensure that he only does what his capacities allow him to do. This type of condition was mentioned by both the supervisors and other actors interviewed (manager, human resources advisor, person responsible for the RTW, worker, and fellow team member). The second type of condition concerned the organizational culture: an atmosphere favourable to sustainable RTW, available resources, clear and unambiguous procedures regarding the responsibilities of supervisors and other actors, sufficient leeway in choosing and implementing adjustments and accommodations during the RTW, and training (for supervisors and other actors). For example, the participating supervisors appeared to greatly appreciate having discussion opportunities and greater decision latitude for problem solving when these were permitted by their organization.

The synthesis of the essential activities and concrete actions identified in the literature review and the results of the secondary data analysis pointed to eight courses of action and 23 specific actions (objective 3).

For the “applicability” component (objective 4), 19 participants (4 supervisors and 15 other actors) from 19 Québec organizations operating in six different industry sectors completed the questionnaire. Eleven of them (1 supervisor and 10 other actors) also participated in the focus groups. Generally speaking, the 19 respondents found the courses of action to be pertinent, worded appropriately and comprehensively, and applicable in Québec in favourable organizational contexts. These favourable contexts referred to formalized roles and responsibilities for supervisors regarding sustainable RTW, a prevention-minded organizational culture, available organizational resources, decision latitude given to supervisors to make temporary modifications to the organization of work, and the possibility of supervisor training on the actions requested in the context of a worker’s reintegration. The comments collected also revealed specific factors influencing applicability that are related to the organizations’ intrinsic characteristics: size, location, union presence or absence, prevalence of sick leave cases, and nature of the work.

This study resulted in a clearer identification of the role and responsibilities of supervisors in the process aimed at achieving sustainable RTW in various organizational contexts in Québec. In particular, it detailed the actions taken by supervisors, problems they encountered, and strategies they used to overcome these problems, as well as the conditions favourable to their involvement in the process. The study also led to the development of courses of action to be implemented by organizations and supervisors themselves to facilitate the sustainable RTW of workers following a work-related MSD. The participants considered these courses of action to be pertinent, feasible, and applicable. Based on our findings about (1) the need to clarify the supervisor’s roles and those of other actors in the process aimed at achieving sustainable RTW and (2) the pertinence and feasibility of the courses of action, two recommendations were put forward for organizations. An operational model was proposed to guide the process of harmonizing the roles and responsibilities of supervisors with those of the other actors in the process, as part of the formalization of procedures aimed at facilitating sustainable RTW.

¹ The masculine form is used throughout this text solely in the interests of readability, with no gender discrimination intended.