Summary

The sustainable return to work (SRTW) of workers following an employment injury or occupational disease poses specific challenges for small and medium-sized enterprises (SMEs). While studies on SMEs have increased over the past 30 years, with some leading to new occupational health and safety (OHS) concepts and theories, little is still known about what can be done in these smaller companies to improve the management of sick leaves caused by work-related injuries. There is a clear lack of knowledge about SRTW practices in SMEs and how they relate to the various characteristics of these companies (size, industry sector, type of work, unionization status). The aim of this study was therefore to identify, in the literature on OHS management in such companies, strategies and aspects of implementation (resources, structures, activities) that could be transferred to and applied in the SRTW process in various SME contexts in Québec.

A scoping review was conducted of the literature on OHS management in SMEs. The research question was “What are the strategies and aspects of implementation (resources, structures, activities) of OHS management that could improve SRTW practices and conceivably be applied in Québec?”. The methodology involved several steps carried out in a reflective, iterative, and collaborative manner. Scientific databases (e.g., SCOPUS and ProQuest) and non-scientific databases (e.g., NHSE and NIOSH) were consulted, with the assistance of a specialized librarian, to identify relevant studies dating from the year 2000 on. The search strategy for relevant publications involved using different combinations of keywords related to the research question. The inclusion criteria applied to the studies identified were as follows: (1) examines OHS empirically (study of workplace interventions), (2) examines SMEs in a general or specific context, and (3) examines strategies or aspects of implementation used to manage employment injuries and occupational diseases. Two evaluators selected articles, extracted information, and analyzed data using a consensus-based approach. Based on their analyses, they first described the articles and then the different strategies, resources, structures, and activities promoting OHS management in SMEs. They produced a synthesis document, which served as the basis for consultation with stakeholder representatives in the context of an IRSST thematic committee on rehabilitation and RTW. The purpose of the consultation was to assess the potential of these various strategies and aspects of implementation for use in SMEs in Québec.

Overall, four main strategies for improving OHS management in SMEs were identified: distributing, disseminating, and exchanging information on OHS; acquiring knowledge, skills, and know-how related to OHS; using a collaborative or participatory approach; and adapting OHS management to the SME context (legislation, company size, industry sector, etc.). These strategies are applied at various levels at which action can be taken by the different stakeholders involved in promoting OHS in SMEs (process initiator, intermediary, SME). Different resources, structures, and activities are associated with implementing any one of these strategies, and involve interactions among the various actors or groups of actors working in OHS management within SMEs.

The SRTW process is not often very included among strategies for promoting OHS in SMEs. In fact, few resources, structures, or activities related to work disability and SRTW practices are mentioned in the literature consulted. However, a number of the strategies and aspects of implementation described regarding OHS management share common ground with disability and SRTW management. According to several authors, the challenges of applying disability and SRTW management practices in SMEs could be related to employers’ beliefs about the major costs associated with implementing the appropriate resources and structures. Focussed on production, they may not see the issue of disability prevention as having a positive impact on the company’s productivity and as forming part of the company’s principal activity in the same way as sales, planning, or finance.

When applying these strategies to improve disability and SRTW management in SMEs, reinforcing the lines of communication could promote interactions among the different actors as this appears to facilitate information circulation and promote the support available to SME employers. Intermediaries in fact appear to be at the centre of the dynamics of these interactions. Through their collaboration with process initiators and the constant support they offer to SMEs, they may provide coherence in a shared vision of how to mobilize resources, structures, and activities in order to distribute and disseminate information and to exchange and ensure uptake of OHS knowledge and know-how in SMEs. The complementary nature of concerns about prevention and SRTW would allow intermediaries to focus on all SME workers, including those who have sustained a work-related injury. In this type of company, activities such as accident investigations, assessments of risks in the workplace, and offering or requesting organizational and physical changes to work stations – all requiring the support of intermediaries – would give SMEs a degree of flexibility and workforce fluidity.

Indeed, given the emergence of advanced technologies, new societal values, demographic evolution, and globalization, new company structures now allow for more flexible work arrangements (temporary employment, remote work, telework, etc.). These arrangements provide opportunities for developing effective SRTW practices and for resolving the labour shortage problem now being faced by a number of industry sectors in Québec, all while maintaining good productivity. The results of the consultation with stakeholder representatives highlighted the importance of seizing these opportunities for retaining the workforce and of considering the potentially favourable impact of certain provisions of the Act to modernize the occupational health and safety regime (SQ 2021, c 27) on SRTW practices in SMEs.

This study pointed to the need for continued research on the specific levers for managing sick leaves and the SRTW process, in order to provide greater insight into the SRTW experiences of SMEs, intermediaries, and process initiators. More studies are also needed on increasingly integrated management strategies that allow intermediaries working in SMEs to develop and pass on their knowledge about SRTW in collaboration with other OHS stakeholders.