Bouncing back

What is vocational rehabilitation (VR)? As a label, it can mean different things to different people. There is, as yet, no regulatory or professional accreditation body for the provision of vocational rehabilitation services in the UK and, perhaps because of this, the meaning of the term VR has been allowed to drift according to the needs of the person using it.

Most commonly, VR is used to describe a process whose purpose is to restore a person to their prior health, wellbeing and occupation. It can also be used preventatively, to avoid the loss of these qualities, or to minimise the extent or duration of their loss.

A more formal definition of VR is that it is a goal-oriented process that restores abilities, enabling the individual to achieve their maximum vocational potential. Where possible, it will focus on returning the individual quickly to safe, suitable employment. By restoring the workplace connection, VR preserves valuable work skills and work relationships, while minimising human and financial cost.

While different from the medical model of disability, the vocational model can work effectively side-by-side with it. In a nutshell, the medical model will diagnose illnesses that lead to work-related impairments. The vocational model takes these impairments and identifies what restrictions and limitations flow from them, and the residual functional capacity. With this information, VR specialists can identify the gaps between what the individual can do and what their job requires them to do, and can build a programme to close this gap so that the individual is able to return to work.

Information overdrive

So, how do these definitions translate into actions and processes? In the realm of workplace absences, VR encompasses the efforts of everyone involved in the task of restoring a disabled or injured person back into work. It is not what the VR specialist does to the employee to get them back to work, but rather what all the participants do in partnership to achieve that same end.

Like any good project, VR has a number of clear steps:

n The parties need to have a good understanding of what is going on. This means gathering data on the medical problem, its prognosis, and what impact this will have on the employee's ability to do the job. Also it means gathering information on the job, the workplace and relationships at work.

n A plan is needed to remove barriers to returning to work, resolve conflicts, identify solutions, and the steps to achieve those solutions.

n The plan is implemented.

At key points during the implementation, results are monitored and evaluated, and the plan adjusted accordingly. The revised plan is then implemented, and so the cycle continues.

Although the focus is often on the employer, the cost of an absence is often even greater for the employee. Employees can suffer financial loss, if the employer does not provide adequate income replacement. Even more significantly, they often suffer greater emotional distress, in addition to the physical consequences of being unwell.

Apart from the obvious moral basis for helping employees who are in difficulty, many employers will assist absent employees in the very early stages in order to prevent these difficulties from impacting on the workplace.

A more fundamental problem to resolving employee absences may be our limited understanding of how sickness impacts on the person as a whole. Illness and injury can damage not just their body, but also their relationships with others. We tend to focus on the medical issues, in preference to the less tangible social and personal issues, that either cause or are impacted by an absence. In doing so, we not only forgo a golden opportunity to encourage employees back to work, we also risk a bigger problem and a longer absence.

For many of us, our identity is closely attached to our work. That is, who we are is very much wrapped up in what we do. When we are no longer at work, we do not receive the recognition for our role, and lose the place in the world that we once had. This can be a difficult adjustment for a person who is already not feeling at their best, and can lead understandably to unhappiness, moodiness, depression and anger.

Spiral of doubt

In addition to the individual's own views about his or her situation, our society has very strong views about absence and illness. This can have a significant impact on how we respond to someone who is ill, especially if they are absent from work. Most often the initial response is sympathy. As time passes and the person does recover, contact with them will decline, and the individual may begin to feel isolated, neglected, ignored, unwanted and disconnected from the work place. If there is not an obvious compelling reason for the person to stay off work, sympathy tends to wane and be replaced by indifference or scepticism.

These increasingly negative perceptions can influence how the employer and employee interact with each other, creating a progressively negative spiral of doubt and resentments. A relationship that was initially very strong and positive can deteriorate over time. A relationship that was already troubled to begin with, is even more likely to fester and deteriorate, and to do so more quickly.

Social and personal issues are not the only ones to influence how well an employee deals with illness and absence. Financial insecurity and job insecurity can motivate employees to get back to work quickly, but they can also be a counterproductive force. People who are worried about these issues may feel they need to prove how sick they are in order to keep a hold of their job and their pay. And while a person is focusing on proving how sick they are, they are unlikely to get well.

Finding the right healthcare can be difficult too, and for the employee who is already not feeling their best, it can be hard. Most have never needed to negotiate their way through the NHS system. For those with more complex illnesses or long waiting times, the stress of not knowing how to get the service they need can distract the employee from the business of getting well and getting back to work.

For some it is the sheer uncertainty of their situation which causes them to feel vulnerable, scared, apprehensive, resentful, restless, anxious, and displaced. A successful approach to absence management should take into account these dynamics ' the physical, occupational and social environment that the employee is operating in ' when designing and implementing job retention and return to work.

Disability is a difficult subject in the workplace: medical issues are seen to be essentially private matters and management often feel uncomfortable and behave awkwardly when dealing with an employee who is disabled for whatever reason.

Few employers have the experience or have developed the personal skills to navigate through the complex mix of personal and workplace issues which might influence whether an employee is in work or not. In addition, very few employers know what help is available to them. Many are unsure as to what constitutes an appropriate intervention, and would rather do nothing than risk doing the wrong thing.

Even large employers do not always think about absence management when they are managing their personnel. Some have grown from a smaller, less formal structure where the need was not immediately obvious. Others have a traditional health and safety loss prevention model, which focuses on safe procedures rather than absence management.

As a result, few employers have sufficient procedures in place to deal with absence, and limited resources with which to build them.

Knowledge is key

The dilemma for many employers is that they feel they are in uncharted territory.

The support of experienced rehabilitation specialists can help employers address many of these concerns.

In addition to assisting with specific cases, VR specialists should also be able to help the employer build better ways of handling absence and return to work on a go-forward basis. Although there is no single blueprint of what this will involve, it would typically involve a process of understanding what it is the employer is looking for and needs, assessing their existing processes, identifying the gaps between the two, and helping the employer build a solution.

As employers become increasingly aware of the true costs of absence, and understand these are not all fixed costs, they become more willing to find solutions that will bring those costs down. However, a willingness alone will not be sufficient. Employers need skills to manage the complex medical, social, psychological and economic factors that influence the frequency and duration of absence, and the overall cost.

Employers cannot abrogate their responsibilities in this area by outsourcing the process altogether, but they can benefit from expert assistance to bring absence costs down. Although each employer will need to find their own solution to the cost of absence, there are some common principles that can be adopted. Specialists in absence management and VR can help employers manage individual absences. They can also help employers develop organisational structures and procedures that improve their overall management of absence for the future.

Joy Reymond is head of rehabilitation services at UnumProvident.