interactive workshop on job retention and return-to-work

Sustainable employment and workplace health The Europe 2020 strategy for smart, sustainable and inclusive growth sets the target of “achieving a 75% employment rate for 20–64 year olds throughout the EU”. However, about 25% of the working population in the European member countries report to suffer from a chronic illness or have long-‐standing health issues.

The “Promoting Healthy Work for Employees with Chronic Illness -‐ Public Health and Work (PH Work)” campaign, initiated by the European Network for Workplace Health Promotion (ENWHP), contributes to achieving sustainable employment. Under the slogan “Work. Adapted for all. Move Europe”, it enhances the coordination, communication, and collaboration between healthcare professionals and the workplace, and it focuses on work-‐related issues (including adaptation of the workplace, reorganisation of tasks, matching jobs to abilities, and supportive management).

The 9th ENWHP initiative (2011-‐2013) was designed to contribute to the implementation of effective workplace health practices, by stimulating activities and policies in European companies to retain and encourage return-‐to-‐work of chronic-‐ally ill employees, in order to prevent employees from moving into disability or early retirement.

www.enwhp.org/enwhp-‐initiatives.html

Working with a chronic illness Chronic conditions and diseases have a substantial impact on the labour market and working life. This urges the need for effective job retention and workplace-‐based return-‐to-‐work (RTW) strategies and interventions. The workshop presents the results of the PH Work campaign and contributes to the exchange of knowledge and improvement of cooperation among all stakeholders.

Advantages for employers, employees and society For companies, benefits of keeping people with chronic conditions in employment include: fewer sickness absences, fewer lost workdays, retaining the experience and knowledge of the employee, reducing healthcare costs and avoiding the cost of hiring and training a replacement. Job retention or a return-‐to-‐work can also do wonders for the chronically ill employee: they feel valued for their contribution and can earn their full income, which in turn leads to a better quality of life. Finally, keeping people with chronic illness at work or getting them back to work can be seen as an investment in economic productivity and social cohesion.

Interactive workshop on job retention and return-to-work of employees with chronic illness Sunday, 24 August 2014 - Frankfurt

Workplace health practices for employees

with chronic illness

Organisers Side event of XX World Congress on Safety and Health at Work 2014 www.safety2014germany.com

Programme


10.00 Welcome Prof. Dr. Karl Kuhn, co-‐chair of ENWHP

10.05 State of the art : national return-‐to-‐work policies Dr. Robert Gründemann (TNO)

10.25 PH Work : guide to good practice & recommendations Nettie Van der Auwera (Prevent)

10.35 Good practices in companies for employees with chronic illness Isabelle Burens (ANACT)

10.55 Ready to Work? Meeting the Employment and Career Aspirations

of People with Multiple Sclerosis / Working with Schizophrenia Prof. Stephen Bevan, The Work Foundation 11.15 Fit for Work Prof. Stephen Bevan, The Work Foundation

11.30 Discussion Questions from the audience / situation in different countries / obstacles? 12.00-‐14.00 ENWHP Business Meeting (restricted to ENWHP members)

Practical information When and where? Sunday, 24 August 2014 -‐ Frankfurt (Germany) Side event of the XX World Congress on Health and Safety at Work Venue Messe Frankfurt, Hall 3.C West, Room Apropos (www.messefrankfurt.com) Languages Presentations and discussions will be held in English. Unfortunately, there will not be any translation facilities available. Price Participation to the workshop is free. This includes access to the workshop,

documentation, coffee and refreshments. Registration Register online via www.amiando.com/workshopENWHP. Registration is compulsory! You don’t have to register for the World Congress to attend the workshop.

List of participants

Ingrid Bellemans Nurse ECB Medical Centre Germany Lucio Fellone Post-Graduate student in

Occupational Medicine Post-Graduate School in Occupational Medicine - University of Siena

Italy

dr. Gbezo Bernard BEG INTERACTS France Karl Kuhn co-chair ENWHP - Germany Theodor Haratau MD, Executive Director Romtens Foundation Romania Charlotte Wåhlin PhD Ergonomist / RPT Karolinska Institutet,

Implementation and intervention Unit

Sweden

Jaana Lerssi-Uskelin MSc, Head of Development FIOH Finland Nettie Van der Auwera Assistant-coordinator ENWHP Prevent-Foundation Belgium Eunice Yong Senior Research Analyst WSH Institute Singapore dr. Siok Lin Gan Executive Director, Doctor Workplace Safety and Health

Institute, Singapore Singapore

Yi Lin Neo Manager Health Promotion Board (Singapore)

Singapore

Karen Cheong Deputy Director Health Promotion Board (Singapore)

Singapore

Yoong Kang Zee Fedor Jagla ENWHP / NCO Slovakia Institute of Normal and

Pathological Physiology, Slovak Academy of Sciences

Slovakia

Jean-Michel Miller Research manager Eurofound EU dr. Sara Felszeghi Head of the Healthcare Centre University of Miskolc Hungary dr. Peter Kortesi Co-chair of the Department of

Analysis of the Institute of Mathematics

University of Miskolc Hungary


Workplace health practices for employees

with chronic illness

Organisers Side event of XX World Congress on Safety and Health at Work 2014 www.safety2014germany.com

Sandie Brown Information Researcher United Kingdom Dominique Baradat Chargée de mission Aract Aquitaine France Michael Goetz Directeur Aract Aquitaine France dr. Ulrich Jansen START Zeitarbeit NRW GmbH Germany Philippe Reumont Physical therapist, ostéopathes,

diététician, nutritionnist MEDISPORT Belgium

Maria Dolores Solé Occupational physician INSHT Spain Nicolas Buidin Ergonome AWIPH (Agence Wallonne pour

l'Intégration des Personnes Handicapées)

Belgium

Karsten Knoche Referent for european networking

BKK umbrella organization Germany

Sarah Copsey Project manager European Agency for Safety and Health at Work (EU-OSHA)

Spain

Steven Bell Director of Healthy Working Lives

NHS Health Scotland Scotland, UK

Vladimira Lipsova MD, Occupational Medicine Specialist

National Institute of Public Health, Prague

Czech Republic

Katya Vangelova Scientist, PhD National Center of public Health and Analyses

Bulgaria

Tanja Vidmar Diogo Dias MD, occupational health Bosch Portugal Eleni Grana Occupational Health Nurse Cosmote Telecommunication SA Greece Alkinoi Krikella Occupational physician Cosmote Telecommunication SA Greece Marija Zavalic Director, M.D.Ph.D.,

occupational medicine specialist Croatian Institute for Health Protection and Safety at Work

Croatia

Ana Bogadi Šare Head of Departement for Education and Information, M.D.Ph.D., occupational medicine specialist

Croatian Institute for Health Protection and Safety at Work

Croatia

dr. Mariana Dumitriu Transcarpathian Limited United Kingdom Rob Gründemann Senior researcher / adviser TNO Nederland Isabelle Burens Project manager ANACT France Beate von Devivere CEO, owner bvd CONSULT Germany Isabel Moreira-Silva PhD CIAFEL, Faculty of Sport -

University of Porto Portugal

Prof. Jorge Mota Full Professor CIAFEL, Faculty of Sport - University of Porto

Portugal

Veronique De Broeck Coordinator ENWHP Prevent-Foundation Belgium Ana-Maria Chiorean United Kingdom Dinu-Aurel Ortan United Kingdom Prof. Giuseppe Masanotti Researcher University of Perugia Italy

Karl Kuhn, Chairman of ENWHP XX World Congress on nSafety and Health at Work

2014

Workshop on job retention, Frankfort 24.8.2014 1

Premature Mortality

Sick leave

Work incapacity

Lost employment years in Germany Million Years

Women Men


21,9%: Injury, poisoning and certain other consequences

of external causes

16,1%:Mental and behavioral disorders

12,2,%: Neoplasms

11%: Diseases of the musculoskeletal system and

connective tissue:

9,4%: Diseases of the circulatory system

6,0%: Diseases of the respiratory system

4,9%:Diseases of the digestive system

4,8%: Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified

13,7%: Others

Lost employment years by specific diseases Source : National statistical office of Germany Health cost accounting, reference year 2006


Lost Gross value added for Germany

  4 Million lost employment years  Gross value added per worker: 63 000€  Preventive potential: Lost value creation:

4 Million years X 63 000 € = 252 Billion €


Background: Promo8ng Healthy Work for Employees with

Chronic Illness (PHWork)

  The main objective of PHWork – project is/was to promote healthy work for those suffering the consequences of a chronic illness -‐ either through enabling job retention or by supporting their return-‐to-‐work (RTW).


The specific objec8ves are to:   Identify good practice on job retention / early intervention / RTW workplace health strategies and interventions;

 Provide guidance to enterprises / employers;  Establish cross-‐border knowledge transfer between experts and stakeholders;

 Make recommendations for stakeholders on strategies for workplace health promotion targeted to job retention / RTW for employees with chronic illness.


Methods and Means   Good workplace health practices with regard to job retention and return-‐to-‐work targeted to chronic illnesses were gathered through interviews.

  Qualitative data were gathered in 11 different countries using a centrally developed data gathering approach.

  The survey results were brought together and analyzed in order to make recommendations for the guidelines.

  During the analysis, factors like cultural differences, labour market differences and social security differences have been taken into account.


Strategic relevance and EU added value   The strategic relevance of this project derives from the opportunity to establish public health – private sector partnerships, and to strengthen the general case for investing in workplace health.

  This process allows for developing exemplary approaches to enhance job retention and RTW, and to encourage other sectors to improve their respective practices.

  The project relates to one of the general objectives of the 2nd Health Programme, promoting health and preventing disease by addressing health determinants across all policies and activities.


PHWork State of the art: national return-to‐work policies

Interactive workshop on job retention and return-to-work of employees with chronic illness

Frankfurt: 24 August 2014

Rob Gründemann, TNO Hoofddorp

HU University of Applied Sciences Utrecht

Structure of the presentation

!  Background of the study

! Addressing the target group

! Defining disability and chronic illness

!  Stakeholders

! Key Succesfactors

! Role of Public Health

!  Changes in RTW policies

! Conclusions

2

Background of the study !  Topics

• The importance of the target group of workers with chronic illness • Legal approaches to the issue • Institutional stakeholders and the nature of their involvement • Policy developments in the area • The orientation of employers towards the issue • The role of the Public health care system

!  12 Participating countries • Austria • Belgium • Denmark • France • Germany • Ireland • Netherlands • Norway • Romania • Scotland • Slovenia • Slovakia

3

Adressing the target group Type of initiative Examples Legislation for all (all workers); anti-discrimination and anti-exclusion

Austria, Netherlands, Norway, Scotland, Denmark, Germany, Ireland

Specified target group (disabled persons) Slovenia, Slovakia, Romania, France, Ireland

Chronic disease, e.g. heart disease, arthritis, mental illness.

France, Germany

Integrated legislation (focus on RTW for all) Netherlands, Norway, Belgium, Scotland, Austria, Denmark

Social partners (policies, pilots, national involvement)

Ireland, France, (Netherlands), Norway

Increasing employers responsibilities Netherlands, Scotland, Germany, Ireland, Norway

Patient organisation initiatives France, Ireland, Belgium

Quota for disabled persons Austria, France, Slovenia, Ireland (Netherlands)

Definitions of disability and chronic illness

!  Multiple definitions for disability – all countries

!  These include access to benefits, access to services and access

to employment

!  Only some definitions are based on the ICF classification, e.g.

Slovenia, Germany, Ireland, Norway

!  Chronic illness is rarely defined separately

!  Only in Germany and France chronic illness is formally defined.

!  In Denmark informally defined

!  In some countries, e.g. Belgium, Ireland, Scotland, it is part of the

disability definition

5

Most important policy for employment of workers with chronic illness

!  Most current legislation and related systems are c0ncerned either with employing people with disabilities or with managing absence and preventing it from becoming long term

!  Not specifically concerned with chronic illness !  Varying emphasis on absence management in practice !  Most countries have a strong emphasis on integration of people with

disabilities !  Public health is concerned with illness and not with employment !  Most public health systems are focused on treatment, not on

(disability) prevention

6

New developments in policy and practice

!  Some countries are currently updating legislation and systems, e.g. Romania, Slovenia, Slovakia

!  Many countries are focused on updating efficiency of systems, e.g. Austria, Belgium, Netherlands, Norway

!  Some countries are making no changes e.g. Germany, Slovakia !  Many projects based changes, e.g. Belgium, France, Ireland, Romania,

Scotland !  The financial economic crisis has a negative influence on the

employment (projects) of disabled persons, e.g Romania, Ireland

7

Has the issue of employment of people with chronic illness and disability had much attention within companies?

Country Yes/no Austria No

Belgium No

Denmark No

France Yes

Germany Some

Ireland Some

Netherlands Some

Norway Yes

Romania No

Scotland Some

Slovenia No

Slovakia No

8

Most important stakeholders in each country

Policy measure

Aus

tria

Bel

gium

Den

mar

k

Fran

ce

Ger

man

y

Irela

nd

Net

herla

nds

Nor

way

Rom

ania

Scot

land

Slov

akia

Slov

enia

Employer organisations X X X X X X X X

Individual employers X X X X X X X x

Labour unions or employee reps. X X X X X X

Patient/consumer organisations X X X X X

Social security agencies X x X X X X

Insurance companies X X X

Health care X X

Public health sector X X X

OSH-professionals X X X X

Professional organisations X X Vocational rehabilitation X X X X X X

Social services X X X

Municipalities/local government X X X X

Central government X X X X X x

Social assistance X X

Other X X

9

Key factors for success for good practice within companies

Consensus between countries:

Strong integrated policy and strategy

Disability management approach

Flexible implementation Management commitment

Social responsibility Information systems, monitoring and evaluation

Trained staff An RTW ‘mentality’

Early intervention (RTW) Good assessment methods

Case management (integrated care)

Incentives

10

The role of Public Health

Country Nature Austria Know how, process consulting and evaluation Belgium Some initiatives, but uncoordinated Denmark Changes to sick note system France General social and health services and ‘Local Houses’ Germany None Ireland Some patient organisations are active, poor links with GPs

Netherlands No focus on work, nor time nor skills. Rehab agencies are involved

Norway PH can assess working conditions Romania Soled focus is on health Scotland Lobbying role, Rehab, focus on abilities Slovenia Medical and certification Slovakia Awareness raising

11

Role of public health

!  No country reported a major role for public health in relation to RTW

!  In Germany and Romania public health policy and practise confines

itself to ilness issues and not to employment

!  In Scotland one-stop-shops have been created for workplace health,

with actively liase with public health services when a worker goes

absent

!  In all countries medical services are involved in certification of illness

12

Expanding integration policy: More responsibilities or obligations for companies, more

support or obligations for workers in return-to-work programmes

Policy measure

Aus

tria

Bel

gium

Den

mar

k

Fran

ce

Ger

man

y

Irela

nd

Net

herla

nds

Nor

way

Rom

ania

Scot

land

Slov

akia

Slov

enia

Anti-discrimination legislation to enforce equal opportunities in employing people with chronic illness

3 2-3 3 1 3 3 0 2 0-2 3 3 2

Modification of employment quotas 3 2-3 0 2 2 0-1 0 0 0 0 ? 3

Stronger employer incentives: it is in the employer’s financial interest to retain workers with a chronic condition

2 2 2 3 1 0 3 2 0 0 0-1 2

Earlier vocational rehabilitation 3 1 1 2 1 1 3 2 0 1 0-1 2

Individual placement and support, vocational rehabilitation

2 2-3 3 2 2 1 2 2 0-2 2 0-1 2

Improving sheltered or special employment schemes

3 2-3 3 1 1 1 3 2 0 1 1 1

Improving wage subsidies in the case of permanent disability

1 2-3 3 2 0 1 3 3 0 1 0 2

13

Policy integration summary

!  Netherlands, Austria, Denmark and Belgium have highest levels of

relevant policy

!  Most common policies are :

!  Anti discrimination legislation

!  Strengthening employer incentives

!  Improving wage subsidies

!  Employment quotas relatively little important

14

Improving institutional setup: change in structure of systems and service provision

Policy measure

Aus

tria

Bel

gium

Den

mar

k

Fran

ce

Ger

man

y

Irela

nd

Net

herla

nds

Nor

way

Rom

ania

Scot

land

Slov

akia

Slov

enia

More efficient and integrated service provision, public and private

2 1-2 2 2 1 1 1-2 3 0-2 2 ? 1

Incentives for public agencies/authorities

2 0 2 ? 0 0 3 3 0 1 1 1

Outcome-based funding of services

2 0 0 1 0 0 0 2 0 2 ? 0

More options for clients to choose from

3 0 0 0 0 0 3 2 2 1 1 1

Improving skills and awareness of medical professionals about rehabilitation and return to work

3 1 2 2 1 0 2-3 3 1 3 2 2

15

Improving institutional setup summary

!  Few activities

!  Austria, the Netherlands and Norway have highest levels of

institutional setup changes

!  Most common is improving skills and awareness of medical

professionals about rehabilitation and return to work

!  Some incentives for public agencies/authorities and more options for

clients to choose from

!  Least common is outcome based funding of services

16

Tightening compensation policy Changes in benefit systems to make it more difficult to obtain a long-term disability benefit

Policy measure

Aus

tria

Bel

gium

Den

mar

k

Fran

ce

Ger

man

y

Irela

nd

Net

herla

nds

Nor

way

Rom

ania

Scot

land

Slov

akia

Slov

enia

More objective medical criteria 3 0 2 1 0 0 3 1 2 2 0 2

More stringent vocational criteria, better assessment of work capacity

2 1 3 2 2 0 3 2 2 2 2 1

Changes in benefit payments 1 1 2 2 0 1 3 2 1 2 ? 2

Stronger work incentives 2 2-3 1 1 1 1 3 1 0 2 0-1 2

Stricter sickness absence monitoring

1 2 2 ? 2 2 0 2 0 2 3 0

17

Tightening compensation policy - summary

!  The Netherlands has tightened the compensation policies most

consistently

!  Most common element is:

!  More stringent vocational criteria

!  Most discussed, but least implemented element is:

!  Stronger work incentives

!  Most controversial element is:

!  More objective medical criteria

18

Conclusions

! Clear differences in emphasis on the importance of RTW on the policy agenda between countries

!  The role of public health services and approaches on job retention and RTW are of low importance

!  Few countries have a legal definition on chronic illness. Most

disability is legally defined. !  Company level interest in job retention and RTW is generally low

!  In most countries a wide range of stakeholders are involved in job retention and RTW, including patient organisations

!  Job retention and RTW are becoming more important in many

countries

19

Thank you for your attention

Prof. Dr. Rob Gründemann TNO Sustainable Productivity & Employment P.O. Box 3005 2301 DA Leiden HU University of Applied Sciences Utrecht T 06 2350 5536 E-mail: [email protected] Website: www.robgrundemann.nl

PH Work : guide to good practice & recommendations

Nettie Van der Auwera

Instruments

Research report on national return-to-work policies Selection of Models of Good Practice (MOGP)

Guide to good practice (guidelines) &

Recommendations for national and European policy

Guide to good practice

“Promoting healthy work for workers with chronic illness:

A guide to good practice”


  Guidelines to set up comprehensive workplace health strategies and interventions.

  Target group: everyone, but specifically – employers   Type of guide: European   Content:

- Basic info - Six-step action plan - Checklist on manager support


  Basic info on workplace health promotion, chronic illness and return-to-work, why should employers care?

  Six-step action plan – crucial steps to be taken when an

employee suffers from a chronic illness   Checklist on manager support – tool listing desirable

conduct of employers and managers towards employees with a chronic illness

A six-step action plan

1.  Identify who needs help

2.  Get in touch

3.  Initial meeting

4.  Case review

5.  “Get back to work” programme

6.  Keep the plan under review

Checklist

Recommendations - for employers -

-  Promote trusting communication and sincerity -  Assess the needs of the affected person -  Create an individual return-to-work plan embedded in

integrated Disability Management Programmes -  Improve co-ordination and co-operation -  Identify and define the role of each party -  Ensure transparency -  Ensure continuity and sustainability of services -  Monitor the programmes -  Evaluate the programmes

Recommendations

“Recommenda*ons from ENWHP’s ninth ini*a*ve”

Recommendations

  on strategies for workplace health promotion targeted to job retention / return-to-work for employees with chronic illness.

  Target group: stakeholders at national and European level   Type: policy recommendations   Format:

- Recommendation paper - Leaflet listing the recommendations

Recommendations

1.  Focus on the prevention of chronic diseases in the workplace

2.  Detect chronic diseases at an early stage 3.  The perspective should move from reduced performance

to remaining working ability 4.  Address discrimination against persons with

chronic diseases 5.  Raise the importance and priority of return-to-work

on the policy agenda

PH Work

6.  Work must reward 7.  Systematic cooperation of all relevant players and

stakeholders 8.  Raise Health Literacy and Empowerment 9.  Fill the gap in existing knowledge, and extend and

maintain evidence and experience based interventions

PH Work

More?

www.enwhp.org/enwhp-initiatives/9th-initiative-ph-work.html

www.workadaptedforall.eu

[email protected] Twitter @ENWHP

©!

GOOD PRACTICES IN COMPANIES FOR EMPLOYEES WITH CHRONIC ILLNESS

"

Isabelle Burens and Dominique Baradat, members of ENWHP network" and project managers at "

the French Agency for Improving Working Conditions Network"www.anact.fr - www.maladie-chronique-travail.eu !

"

Interactive workshop on job retention and!return-to-work of employees with chronic illness!

Sunday, 24 August 2014 - Frankfurt!

2!ANACT – ENWHP Worshop 24 August 2014! ©!

"Good practices from 16 countries : "

!Austria , Belgium, Denmark, Finland, France, Germany, !

Greece, Hungary ,Ireland, Netherlands, Norway, !Poland, Romania, Slovakia, Slovenia, United Kingdom"

Project «Public Health at Work » 2011- 2013 !


Criteria for good practices "

  A company, service provider or an organisation initiative"  A current case "  A collective or a communication action."  Early detection - intervention / case-management (coordination)"  Involvement of the employee with chronic illness."  Project management"  Awareness - training for managers and executive"  Process and outcome data available "  Cooperation between various stakeholders, link between public health and

Occupational Safety and Health. "


34 good practices : overview"

PRIVATE COMPANIES" PUBLIC SECTOR"GOV. INSTITUTIONS"

not-for-profit organisations"

INSURANCES "SERVICE PROVIDERS"

Drukkerij Wedding, Netherlands!Delpeyrat, France!Naravni Park, Slovenia!Cosmote Telecom, Greece!Telenor, Norway!Argyll Housing Association, UK!Thomas Tunnock Ltd,UK!Ford Werke, Germany!Salzgitter AG,Germany!Sparkasse, Austria!Železiarne Podbrezová, Slovakia!DARS, Slovenia!Abbott, Ireland!John Lewis Partnership, UK!Unilever ,Romania!ISS Palvelut ,Finland!Grundfos Group, Denmark!Monsanto ,Netherlands!

Campus Herk-de-stad, Belgium!City of Pori ,Finland!University of Miskolc, Hungary!Frisk Bris, Norway!!NRCWE Denmark!NIOM, Poland!!"Close to You" Foundation, Romania!Huset Venture, Denmark!Aract Aquitaine ,France ! !!!!!

OÖGKK, Austria !D.Rentenversicherung , Germany!"Hellas, Greece!Headway Ireland !Centrum Chronisch Ziek en Werk ,Netherlands !!!

Fit2work, Austria !

Prevent, Belgium!!


3 selected examples :Dars - Slovenia !(cooperation, Human Resources)Drukkerij Wedding - Netherlands !(management)Hellas - Greece !(case management, engagement)!

Opera&on and maintenance of motorways in Slovenia Monitoring and traffic management Toll collec&on Organisa&on and construc&on of new motorways

Employees : 1240

+ Chronic disease and disability

Onset of disability

Workers in administra&on

Workers in opera&on

Average seniority when disability appears.

30 years 22 years

Average age when disability appears. 52 years 43 years

Number of disabled per 100 employees 1 4

50% of DARS employees suffer from chronic illnesses. Due to limita&ons in health status, there are 10 transfers of workers to other occupa&ons every year.

"Healthy, Safer, BeRer" Project ‘s objec&ve: to reduce the scope of employees with altered working ability to improve employees well-‐being and health

+ Project ac&vi&es and “Strategy for dealing with employees whose ability to work has changed”

 Direct presence of human resource specialists once per month at 9 geographically dispersed work loca&ons -‐ enters into contact with the workers with altered working abili&es.

 Ac&ve coopera&on with occupa&onal physicians – managers – social partners -‐ safety engineer -‐ and other professionals in finding appropriate solu&ons for these workers.

 Adap&ng the current work environment and jobs to employees whose ability has changed.

  Training for employees and top management

 Carrying out workplace health promo&on ac&vi&es among employees to maintain and enhance their health : periodic ac&vity -‐ weight managing…

+ Effects of the "Healthy, Safer, BeRer" Project

Item 2009 2010 2011 2012

% of sick leave 5,09 4,63 4,86 4,73

Number of persons with disabili&es 47 48 46 43

Number of invalidity procedures 16 17 17 12


“Prac&ce what you preach : Ac&ve health policy in a Dutch prin&ng company”

Company founded in 1844, 14 employees Produce brochures, leaflets, envelops, labels, papers and books, but also digital products such as websites, e-‐books and newsle@ers.


An inclusive way of management"

Drukkerij Wedding deliberately creates and invests in a diverse workforce (including people with distance from the labour market, and people with disabiliFes).

4 strong principles :

  « We are all disabled » : chronic illnesses, life accidents, work injuries, divorce …

  Work Organiza&on as a facilitator : flexible, self-‐supporFng, allowing and learning from mistakes, building rules and links between people (ask for support, for quesFons), autonomy.

  Openness is the key : if you don’t understand , you don’t want this kind of people to work with you , telling colleagues about chronic diseases, dare to say.

  Focussing on skills and possibili&es : starFng point is always what a person can do.


HELLAS Employee Assistance Programs Ltd (EAP) , 25 employees, brings services of behavioural managed care and rehabilitaFon mental health services.

EAP Disability Management is a holisFc workplace approach focusing on a conFnuum of support that reflects a strong emphasis on keeping an employee at work and supporFng early, safe and sustainable return to work.

This pracFce concerns employees who were diagnosed with and suffer from chronic illness due to physical/mental health problems, injuries and/or accidents.


A 4 steps program "

1.  Establish management commitment and support

2.  Develop a manual of Policies & Procedures on Disability Management

3.  CommunicaFon and awareness-‐raising

  Training & orientations for: a) managers b) employees c) unions!  Promotional material!  Relevant articles and a publication promoting the program via the intranet!  Wellness campaigns & presentations


On-‐going case management based on the individual’s needs and abili&es

4.  Case management :   The case is referred by the return-‐to-‐work coordinator to the EAP “case manager”.   Assessment of the employee’s problems and needs : the employee signs the Intake

Form, the Consent Form   Re-‐evaluaFon of the exisFng stakeholders and selecFon of addiFonal ones   Psychosocial and/ or psychometric evaluaFon.   Defining goals and design a personal recovery plan with the employee.

ImplementaFon.   Job tasks analysis. Fitness For Duty EvaluaFon.   PreparaFon of the work environment (supervisor and colleagues)   RecommendaFons based on the progress of the iniFal rehabilitaFon plan and the

goals accomplished.   EvaluaFon of the program -‐ Follow-‐up of the case by EAP a^er 3 and 6 months


Evalua&on of EAP Disability Management Service

During 2006 -‐2013, 7 companies from various sectors, 91closed cases served (Physical & Mental Health Issues).   Results from HR / Managers / Health & Safety Department saFsfacFon quesFonnaires:

• 97,3% absence of relapse within 1 year upon return to work • 97,8% saFsfacFon about work performance

  Results from served employee saFsfacFon quesFonnaires: • 98% declared the intervenFon resulted in quick rehabilitaFon and safe return to work • 86% declared improvement in relaFon to their emoFonal well-‐being

  GAF (Global Assessment of FuncFoning) : a numeric scale (0-‐100) used to rate subjecFvely the social, occupaFonal and psychological funcFoning of adults.

!


Thank you for your attention !"

All good practices are available "… on ENWHP website under the 9th initiative. "

www.enwhp.org"

©The Work Foundation

Stephen Bevan Director, Centre for Workforce Effectiveness The Work Foundation & Honorary Professor Lancaster University

Ready to Work Meeting the employment & career aspirations of people with MS & Schizophrenia

The Work Foundation

•  Focus on improving the quality of working life for people living with chronic conditions

•  Have researched the impact of a range of conditions on labour market participation

•  Translate research findings into accessible recommendations for doctors, employers, policy-makers and individuals

•  Looked at MS in a major study in 2011 (UK) and Schizophrenia in 2013/14 (UK & Germany)


Multiple Sclerosis & Work: The Numbers


37



75


85 in 15


30


44 vs 35


57


18

Interventions

•  Traditional treatments

•  Fatigue management

•  Workplace adjustments

•  MS Specialist Nurses

•  ‘Work’ as an outcome of treatment?


What Should the Stakeholders Do?


Working with Schizophrenia


Schizophrenia and Employment

•  About one in a hundred people in the UK have schizophrenia •  Only 8% of people with schizophrenia are in employment,

compared to 71% of the general population •  Being diagnosed with schizophrenia at an early age impedes

effective transition between education and the labour market •  Periods of absence lead to poor job retention and hamper

career prospects •  Benefits of work* include financial gain and improved general

and mental health and wellbeing •  Those in paid employment are over five times more likely to

achieve functional remission than those who are unemployed or in unpaid employment1

*Work can include paid employment, self-employment, work in the home, volunteering etc

1. Haro et al. Br J Psychiatry. 2011;199:194–201

Economic Implications of Schizophrenia (England)

•  Average annual cost of schizophrenia per person estimated at £55,000

•  Estimated total societal costs for schizophrenia in England was £6.7 billion in 2004–2005

•  Over 70% of costs attributable to lost productivity

Mangalore & Knapp. J Ment Health Policy Econ 2007;10:23–41

Treatment 4,14%

Informal care and private expenditure 12,73%

Lost produc=vity

(unemployment, absence from

work and premature mortality) 70,36%

Lost produc=vity for family carers

0,66%

Criminal jus=ce 0.1% Social

security benefits 11,80%

Administra=on of benefits

0.2%

Schizophrenia costs for England

Research Questions

•  What are the barriers to employment and remaining in work for people living with schizophrenia?

•  What are the most important factors that influence the ability to work or remain in work for people living with schizophrenia?

•  What interventions help people living with schizophrenia enter or remain in (competitive) employment?

•  What can policy makers and key stakeholders do to reduce the barriers to employment for people living with schizophrenia?

S Bevan, personal communication

Other factors:  Housing  Co-morbid health

conditions  Alcohol/drug use

What factors influence the ability to work?

Symptoms

Job history

Attitudes

Self-stigma + public stigma related to negative attitudes of: •  Clinicians •  Family members •  Employers •  Society

•  Self-efficacy •  Sustained

attendance •  Spells of

sickness absence

•  High quit rate

•  Positive •  Negative

What kind of employment?

•  Voluntary? •  Sheltered? •  Supported? •  Competitive?

There is good evidence that traditional step-wise structured rehabilitation, sort of Boston model, doesn’t get them into work. So to some extent the idea that people with schizophrenia learn the tasks and then cope with sheltered work and then go into open employment, I think the evidence is fairly strongly against it.

Academic Psychiatrist


Stigma, Self Stigma and Low Expectations

“I’ve come across people who have low expectations of themselves because they’ve been told ‘you’ll never work’ or ‘you’re going to have a life of taking medication and you’re not going to be able to live life to the full’. So I think there are low expectations on people by others as well as by themselves.”

Clinician

Bevan et al. Working with Schizophrenia: Pathways to Employment, Recovery and Inclusion available at: http://www.theworkfoundation.com/Reports/330/Working-with-Schizophrenia-Pathways-to-employment-recovery-and-inclusion, accessed March 2014

The Disclosure Conundrum

•  Benefits and risks of disclosure to employers and co-workers

•  Perverse consequences of non-disclosure

•  Employers can do more here to create cultures where disclosure and support are more possible than now

•  “People living with schizophrenia often suffer more from the diagnosis than from the symptoms of the illness”


What Interventions Work?

•  Pharmaceutical (in the form of antipsychotics)

•  Psychotherapeutic (e.g. CBT, family therapy)

•  Early Intervention Teams (first episode of psychosis)

•  Vocational Support (IPS – ‘Place then Train’)

•  Anti-stigma campaigns (early evidence of cost effectiveness)


CBT, cognitive behavioural therapy; IPS, Individual Placement and Support

Cost savings of early intervention

Vs

•  Early intervention services (EIS) found to have potential

cost saving of 35%

•  Difference maintained for 3 years

•  Mainly due to lower hospital readmission rate for EIS

Cost of early intervention

service

£9,422

Cost of standard service

£14,394

McCrone et al. Early Interv Psychiatry 2009;3:266–273

Challenges for Policy and Practice

Implications for policy and practice

•  Healthcare professionals –  Should focus also on personal goals including work not only

on symptom reduction –  Ensure staff have the appropriate competencies to deliver

interventions and are provided with good supervision –  Include Peer Support workers in teams

•  Policymakers –  Invest in supported employment so it is accessible to all –  Continue to invest in early intervention –  Make employment a clinical outcome


Implications for policy and practice

•  Employers –  Make reasonable adjustments for people at work

–  The big companies need to focus on job retention and return to work

–  Try to see what an individual can offer rather than what they can’t

•  Individuals with schizophrenia

–  Learn how to manage condition –  Use the support networks available to you

–  Learn how to recognise early warning signs of becoming ill


Prioritising Work as a Clinical Outcome

•  Educating and incentivising Primary Care physicians – new CCG Outcome Indicator

•  Investing in early intervention teams

•  Investing in Vocational Rehabilitation programmes

•  Delivering the IPS model with more joined-up resources

•  Increase employment rate to 25% within a decade


CCG, Clinical Commissioning Groups; IPS, Individual Placement and Support

www.theworkfoundation.com

[email protected]

@StephenBevan

Musculoskeletal Disorders & Work -‐ The Fit for Work Project -‐

Stephen Bevan Director, Centre for Workforce Effec7veness, The Work Founda7on (UK)

Honorary Professor, Lancaster University, UK Founding President, Fit for Work Europe Coali7on


Global Burden of MSDs

2nd greatest cause of

disability in all regions of the

world

Disability due to MSDs increased by 45% from 1990 to 2010

1.7bn Affected: Back pain 632m Neck pain 332m OA knee 251m Other MSD 561m

MSDs and Disability

•  Ranking of major causes of death and disability (% DALYs)

•  Cardiovascular and circulatory diseases 11.8% •  All neoplasms 7.6% •  Mental and behavioural disorders 7.4% • Musculoskeletal disorders 6.8%

•  Yet MSDs not considered a priority non-‐communicable disease….

•  …high on morbidity but low on mortality

Musculoskeletal Disorders in the EU Workforce

Early Interven7on

•  Be4er treatment. The quicker an individual receives a diagnosis, the more rapidly they can get access to appropriate treatment which can stabilise or control their symptoms;

•  Reducing the risk of developing co-‐morbid condi>ons. For many people with chronic condi7ons issues like pain, fa7gue, depression or anxiety can become a significant issue which can increase healthcare costs and reduces func7onal capacity;

•  Aiding a return to ac>vi>es of daily living. Early interven7on can ensure people with chronic condi7ons can become more self-‐reliant and rely less on health and social care services;

•  Staying in or returning to work. People whose health condi7ons are being well-‐managed are more likely to remain economically ac7ve, con7nue to pay taxes and be less reliant on welfare payments


Madrid: Early Interven7on for MSDs

7

  Early Interven7on Clinic1 in Madrid – ager 5 days 1Abasolo, L et al, (2005) A Health System Program To Reduce Work Disability Related to Musculoskeletal Disorders, Annals of Internal Medicine, 143:404-‐414.

 Reduce the dura7on of temporary disability by 39%  Reduce the incidence of permanent disability by 50%  Reduce the u7liza7on of health care resources by 40%   The analysis showed that $1 invested in the early interven7on program yielded $11 of benefit

If replicated across the EU this interven>on would allow 1m addi>onal workers to a4end work each day


Early Referral

Job Design

Line Management

Voca7onal Rehabilita7on

Workplace adjustments

Examples

Messages (1)

•  Good Work is Good for Health •  Focus on ‘Capacity’ not ‘Incapacity’ •  Early interven7on is cost effec7ve: Primary care, workplaces, secondary care all play a part

•  Work should be regarded as a clinical outcome of care

•  Up to 30% of workers with MSDs also have mental health problems – interven7ons need to take this into account

Messages (2)

•  By 2030 a high % of the ageing EU workforce will have a long-‐term or chronic health condi7on which will affect their produc7vity

•  Are we just going to wait for them all to get ill & leave work so we can then spend millions on expensive care & rehabilita7on?

•  Joined-‐up, coordinated, cross-‐government ac7on with a preventa7ve focus and an ‘Investment’ mind-‐set is desperately needed

•  ‘Every Minister is a Health Minister’

Fit for Work Project

•  Reports in 35 Countries (EU, Asia Pacific, North America, Brazil, Turkey, Israel etc)

•  Coali7ons in many countries promo7ng: •  Early Interven7on & economic benefits •  Work as a Clinical Outcome of healthcare •  Job reten7on, Return to Work, Voca7onal Rehabilita7on

•  Policy interven7ons (Healthy Ageing; Troika Presidency countries; seminars/events)

•  Working closely with businesses, pa7ent organisa7ons, clinicians & AHPs

www.fiqorworkeurope.eu

www.theworkfounda7on.com

[email protected]

@StephenBevan

European Network for Workplace Health Promotion

Secretariat: Prevent-Foundation Kolonel Begaultlaan 1A 3012 Leuven/Louvain +32 16 910 910 [email protected] www.enwhp.org

_____________________________________

This article has received funding from the European Union in the framework of the Health Programme (2008-2013). The content of this article represents the views of the author and it is his sole responsibility; it can in no way be taken to reflect the views of the European Commission and/or the Executive Agency do(es) not accept responsibility for any use that may be made of the information it contains.

interactive workshop on job retention and return-to-work

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