health and safety executive cause and effect of sick leave dr. emilia zainal abidin department of...
TRANSCRIPT
Health and Safety Executive
Cause and effect of sick
leave
Dr. Emilia Zainal Abidin
Department of Environmental and Occupational Health
Faculty of Medicine and Health Sciences
UPM
Outline of this presentation
• The health agenda
• Understanding sickness absence
• Identifying the underlying causes
• Managing excessive sick leave
Health: the role of the workplace
• More than 50% of working age people in Malaysia are in employment and spend a high proportion of their waking hours in the workplace
• The workplace offers great scope for targeting of messages and initiatives about healthy living – with potential impact on both employees and their families
• Need to go beyond essential compliance with health and safety legislation and promote health and well-being more generally
Work and health – what we know
• Work offers opportunities to promote individual health and well-being
• Work should be recognised by all as important and beneficial, and access to, and retention of work promotes and improves the overall health of the population
• Long-term sick leave / sickness absence is a strong predictor of disability and mortality
• Work has a positive impact on health and well-being (‘good jobs’ in well managed organisations)
• Under some circumstances work can have adverse effects (‘bad jobs’)
• The key is prevention of underlying causes rather than relying just on management of outcomes (secondary & tertiary interventions)
Sources: WHO (2010). WHO Healthy Workplace Framework and Model: Background and Supporting Literature and Practices.
Sickness Absence or Sick Leave and Health
• Risk factors for sickness absence are not always the same as risk factors for disease
• An holistic approach needs to focus both on the risk factors that precede absence as well as implementation of policies & procedures for monitoring & management.
• Sickness absence data collection, analysis and interpretation methods need to reflect both aspects.
Sick leave and legislation in Malaysia
• The Employment Act 1955
• An employee is entitled to paid sick leave only under the following circumstances:– he has obtained a certificate from a registered
medical practitioner duly appointed by his employer; or
– he has obtained a certificate from a dental surgeon; or
A national study of absence
Definitions:
• Disease: is defined in terms of objective biological abnormalities in the structure and/or functions of bodily organs and systems
• Illness : is the personal subjective perception of unwellness. Therefore, if a person feels ill, they are ill
• Sickness: is derived from the concept of the “sick role”, a role that carries certain privileges (to stay away from work), as well as obligations (to seek medical help and to ‘get well’).
Ill health: A Population Study
33
235
8
3
2
1
Illness %
Disease %
Absence % >14 days
None of these 25%
Wikman et al (2005)
2% of the blue ‘sickness absence’ represents factors other than health-related ones.
So, what are they? The short answer is we are not sure! combination of reasons including coping behaviour; withdrawing from the hazard, the so-called flight response.
Sickness Absence: NHS Trust
Typical - Stress Sickness Abscence Data(n=3600, mean 27 days)
0
10
20
30
40
50
60
70
80
01-10 11-20 21-30 31-40 41-50 51-60 61-70 71-80 81-90 91-100 101-110 111-120 121-130 131-140 141-150 151+
DURATION - DAYS
No.
INC
IDEN
TS
The Individual
The biopsychosocial model: (Waddell & Burton, 2004)
Biological:
• The physical or mental health function
Psychological:
• Recognises that personal and psychological factors also influence functioning and the individual must take some responsibility for their behaviour
Social:
• Recognises the importance of the social context, pressures and constraints, on behaviour and functioning
Drivers of sickness absence
• Individual factors – personality and motivation; past behaviour; sick role
• The ‘system’ – organizational culture and tolerability, what is legitimate; sickness certification
• Non-work factors – life events and family pressures
• Work factors – absence as ‘coping’, job satisfaction, chronic adverse features of work
• Commitment and involvement
Health and Safety Executive
Work stressors: effects on
health and sickness absence
Findings from Whitehall II and other studiesFindings from Whitehall II and other studies
2
Moves to private sector practiceMoves to private sector practice
Job insecurityJob insecurity
Temporary employmentTemporary employment
Labour market stressorsLabour market stressors
Moves to private sector practice Moves to private sector practice (transfer to an executive agency)(transfer to an executive agency) effects on health and sickness absence effects on health and sickness absence (men)(men)
* adjusted for age, employment grade, marital status & health at the beginning of the follow-up period
0
0.5
1
1.5
2
2.5
systolic bp diastolic bp weight
0
10
20
30
40
50
60
physical ill-health*
longstanding illness*
sickness absence
mental ill-health
Ferrie et al. J Occup. Health Psychology 20013
rela
tive
incr
ease
in c
ardi
ovas
cula
r ri
sk f
acto
rs
com
pare
d to
men
not
tran
sfer
red
to a
genc
ies*
% e
xces
s il
l-he
alth
com
pare
d to
men
no
t tra
nsfe
rred
to a
genc
ies*
Job insecurity and health in womenJob insecurity and health in women
60
80
100
120
140
160
180
200
220
240
260
poor physical health poor mental health depression longstanding illness
Incr
ease
in il
l-hea
lth*
remained securegained job securitylost job securitychronic job insecurity
*adjusted for age, employment grade & health at the beginning of follow-up
Ferrie et al. J. Epidemiology Community Health 20024
Ferrie et al. Am. J. Public Health 1998
Job insecurity and coronary artery diseaseJob insecurity and coronary artery disease
*adjusted for age, grade and CAD before the threat of privatisation
5
Job insecurity and sickness absenceJob insecurity and sickness absence
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
1.1
Women Men
Secure (Controls) Insecure - Short spells Insecure - Long spells
Od
ds
Rat
ios*
*adjusted for age, employment grade and health status
Ferrie et al 2001 J. Occup. Health Psychol6
Temporary employment and sickness absence
0
0.5
1
Baseline Follow-up
Permanent Temp - Perm Temporary
Rat
e R
atio
s*
*adjusted for age, sex, income, and number of contracted days
Virtanen et al 2003 Occup Environ Med7
Temporary employment and early death
0
0.5
1
1.5
2
Women Men
Permanent Temp - Perm Temporary
Haz
ard
Rat
ios*
*adjusted for age, occupational status and income
Virtanen et al 2003 Am. J. Epidemiol8
Organisational JusticeOrganisational Justice
Procedural componentProcedural component decision-making procedures include input from affected parties, are consistently applied, open and ethical
Relational componentRelational component respectful and considerate treatment of employees by supervisors
21
refers to the extent to which employees are treated with refers to the extent to which employees are treated with fairness and justice at their workplacefairness and justice at their workplace
Organisational Justice Organisational Justice (relational component)(relational component) and sickness absence in womenand sickness absence in women
0.8
0.9
1
1.1
1.2
1.3
1.4
Short-spells Long spells
Low Intermediate High
Od
ds
Rat
ios*
*adjusted for age, employment grade and health status
Head et al 2007 J. Psychosomatic Research23
Estimated incidence rates of self-reported work-related illness, for people working in the last 12 months
0
500
1000
1500
2000
2500
All illnesses Musculoskeletal disorders Stress, depression or anxiety Other illnesses
Inc
ide
nc
e r
ate
(p
er
10
0 0
00
)
2001/02 2003/04 2004/05 2005/06 2006/07 2007/08 95% confidence interval
Health and safety statistics 2007/08
Managing sickness absence
Introducing sickness absence management• Do you have a procedure?
• Is your existing procedure contractual?
• You will require employee agreement to vary
existing terms
• No procedure
• Engage employees to introduce a new policy
• Explain your business reasons
• Explain the changes/new procedure to
employees
Introducing sickness absence management
• Make your attendance policy part of your
induction process
• Make it part of your appraisal process
• Make line managers accountable
Introducing sickness absence management
• Keep accurate records of absence
• Record all absence
• Measure the cost of absence in all departments
• Employees to complete self certification forms
• Carry out return to work interviews
• Train line managers
Introducing sickness absence management
• Cautions not warnings
• Non contractual
• Develop triggers
• Calling in and keeping in touch
• Eligibility for company sick pay
• Consistent treatment
Tools for tackling short term absence
• Rigorous notification procedure
• Return to work interviews
• Should all short term absences be counted?
• Medical evidence?
• Withholding sick pay
• Employee health initiatives
Tools for tackling long term absence
• Keep in touch
• Early intervention 4-6 weeks
• Consider temporary adjustments
• Be proactive in asking for medical advice
• Preferably Occupational Health Practitioner
Designing ‘good’ jobs
• Promote ‘healthy’ workplaces
• Prevention and management of common health problems
• Job content, job context and organizational arrangements critical
• Move from a less desirable (‘bad jobs) to a more desirable state (‘good jobs’)
• HSE Management Standards can help in prevention and management
Summary
• The workplace offers the opportunity to promote and improve the health of employees and their families
• The drivers for ill-health are not always the same as the drivers for absence
• We need a better understanding of the causes of sickness absence so these can be managed in a proactive manner
• Current attendance management practice and policy is based on convention rather than evidence (IES, 2007)
Thank you