Ellen MacEachen

Health and the social relations of work : a study of the health-related experiences of employees in small workplaces

On the basis of a qualitative study of health in small enterprises, this paper attempts to theorise the social production of illness and injury in the workplace. Particular features of working life in small workplaces, especially their personalised social relations and low polarisation of employer-employee interests, shape workers’ perceptions of the employment relationship and of health in relation to work. Strained authority relations at work can form a key social context in which health and injury are constructed. In situations of conflictful supervisory relations, bodily experiences can become ‘problematised’. Meanings attributed to health conditions and the quality of the employment relationship are transformed and merged, prompting a questioning of the legitimacy of power asymmetries in the workplace and recognition of the conflicting interests of labour and capital. Bodily experiences and ill-health offer possibilities for resistance and become mediators of broader social tensions. Unheeded illness claims deepen feelings of distrust and blame, further causing labour relations to deteriorate, and re-producing the social conditions for illness.

Exploring Workplace Actors Experiences of the Social Organization of Return-to-Work

Introduction There is a limited body of research on how the actual social exchange among workplace actors influences the practice of return-to-work. The objective of this study was to explore how workplace actors experience social relations at the workplace and how organizational dynamics in workplace-based return-to-work extends before and beyond the initial return of the sick listed worker to the workplace. Method An exploratory qualitative method approach was used, consisting of individual open-ended interviews with 33 workplace actors at seven worksites that had re-entering workers. The workplace actors represented in these interviews include: re-entering workers, supervisors, co-workers, and human resource managers. Results The analysis identified three distinct phases in the return to work process: while the worker is off work, when the worker returns back to work, and once back at work during the phase of sustainability of work ability. The two prominent themes that emerged across these phases include the theme of invisibility in relation to return-to-work effort and uncertainty, particularly, about how and when to enact return-to-work. Conclusion The findings strengthen the notion that workplace-based return-to-work interventions need to take social relations amongst workplace actors into account. They also highlight the importance and relevance of the varied roles of different workplace actors during two relatively unseen or grey areas, of return-to-work: the pre-return and the post-return sustainability phase. Attention to the invisibility of return-to-work efforts of some actors and uncertainty about how and when to enact return-to-work between workplace actors can promote successful and sustainable work ability for the re-entering worker.

‘Playing it smart’ with return to work: small workplace experience under Ontario’s policy of self-reliance and early return

Abstract Although there is considerable research on the effectiveness of various approaches to promoting successful return to work after work-related injury or illness, little is known about the process in small workplaces. This paper reports on a study of the effects in small workplaces of a particular set of policies and practices in Ontario, Canada, called ‘early and safe return to work’, an approach that emphasises workplace self-reliance and return to work before complete recovery via ‘modified’ work accommodation. On the basis of qualitative analyses of documents and interviews with employers, injured workers and compensation/rehabilitation professionals, the study found that early and safe return to work can disrupt workplace norms and patterns of social interaction, and create hardship, albeit of different sorts, for both employers and workers. Employers experience conflict between their administrative role in the early and safe return-to-work process and the demands of running a small business, while injured workers find their participation governed more by the ‘discourse of abuse’ and the social dislocations of injury and modified work than by best rehabilitation practice. This situation can lead to an erosion of trust arising from what both employers and workers perceive to be the betrayal of moral understandings in the workplace, to the ‘hardening’ of co-operative intent, and to an increasing tendency to ‘play it smart’ with the system of early and safe return to work — responses that can subvert the objectives and intent of the policy, and compromise possibilities for mutually satisfactory solutions. The paper concludes with reflection on the implications of these findings for return-to-work policy and practice, particularly in relation to small workplaces.

Workplace Health Understandings and Processes in Small Businesses: A Systematic Review of the Qualitative Literature

Introduction Small businesses (SBs) play an important role in global economies, employ half of all workers, and pose distinct workplace health problems. This systematic review of qualitative peer-reviewed literature was carried out to identify and synthesize research findings about how SB workplace parties understand and enact processes related to occupational health and safety (OHS). Methods The review was conducted as part of a larger mixed-method review and in consultation with stakeholders. A comprehensive literature search identified 5067 studies. After screening for relevance, 20 qualitative articles were identified. Quality assessment led to 14 articles of sufficient quality to be included in the meta-ethnographic findings synthesis. Results This review finds that SBs have distinctive social relations of work, apprehensions of workplace risk, and legislative requirements. Eight themes were identified that consolidate knowledge on how SB workplace parties understand OHS hazards, how they manage risk and health problems, and how broader structures, policies and systems shape the practice of workplace health in SBs. The themes contribute to ‘layers of evidence’ that address SB work and health phenomena at the micro (e.g. employer or worker behavior), meso (e.g. organizational dynamics) and macro (e.g. state policy) levels. Conclusions This synthesis details the unique qualities and conditions of SBs that merit particular attention from planners and occupational health policy makers. In particular, the informal workplace social relations can limit workers’ and employers’ apprehension of risk, and policy and complex contractual conditions in which SBs are often engaged (such as chains of subcontracting) can complicate occupational health responsibilities. This review questions the utility of SB exemptions from OHS regulations and suggests a legislative focus on the particular needs of SBs. It considers ways that workers might activate their own workplace health concerns, and suggests that more qualitative research on OHS solutions is needed. It suggests that answers to the SB OHS problems identified in this review might lie in third party interventions and improved worker representation.

The Role of Health Care Providers in Long Term and Complicated Workers’ Compensation Claims

Introduction: Health care providers (HCPs) play a central role in workers’ compensation systems. In most systems, they are involved in the legitimization of work-related injury, are required to provide information to workers’ compensation boards about the nature and extent of the injury, give recommendations about return-to-work capability and provide treatment for injury or illness. This study identifies problems that occur at the interface between the health care system, injured workers, and workers’ compensation boards (WCBs) that may complicate and extend workers’ compensation claims and the mechanisms that underlie the development of these problems. Methods: Interviews were sought with injured workers, peer helpers and service providers from a variety of geographic locations in order to get a broad picture of return to work problems and concerns. This analysis includes data from total of 34 interviews with injured workers who had long term and complicated claims. Interviews were also conducted with 14 peer helpers and 21 service providers. Results: We identified four domains related to injured workers’ interface with the health care system that played a key role in complicating and prolonging compensation claims. These problems, related to health care access, conflicting or imperfect medical knowledge, limited understanding of compensation system requirements and confusion about decision-making authority, resulted in frustration, financial difficulties and mental health problems for injured workers. Conclusion: Recommendations are made about how compensation system parties can find better ways to serve injured worker health care needs and facilitate a smooth relationship between the compensation board and HCPs.

The social interaction of return-to-work explored from co-workers experinces.

Purpose. The objective was to explore the role and contribution of co-workers in the return-to-work process. The social interaction of co-workers in the return-to-work process are analysed within the framework of the Swedish national and local employer organisational return-to-work policies. Methods. An exploratory qualitative method was used, consisting of open-ended interviews with 33 workplace actors across seven work units. Organisational return-to-work policies were collected from the three public sector employers. Results. The key findings that emerged during analysis showed that some co-workers have a more work-task oriented approach towards the return-to-work process, whilst others had a more social relational approach. In both situations, the social relations worked hand in hand with job tasks (how task were allocated, and how returning workers were supported by others) and could make or break the return-to-work process. Conclusion. A suggestion for improvement of return-to-work models and policies is the need to take into account the social relations amongst workplace actors, especially involving co-workers when planning for return-to-work interventions. Otherwise the proper attention to work arrangements, social communication and the role of co-workers in the return-to-work process might not be seen.

Bearing the brunt: co-workers' experiences of work reintegration processes.

Purpose Work disability research has found co-worker support to be a significant but under-recognised aspect of work reintegration (WR) processes. Although co-workers work alongside returning workers, their practical contribution to WR success or failure is often invisible to others. This study aimed to gain further insight into the role and contribution of co-workers in WR interventions. Method An exploratory qualitative pilot study was conducted in Toronto, Canada in 2011. Three focus groups were conducted with 13 co-workers, recruited for their direct experience of ‘working alongside’ a returning worker. An iterative data gathering and analysis process occurred. Themes were generated from categories in open-ended interview questions and new issues arising from the data. Findings The findings detail co-workers’ practical experiences of WR processes and their reflections on social and work conditions that impacted their participation. Co-workers’ capacity to support returning workers was related to the quality of the WR arrangements, the relationship with the returning worker, work culture, and the duration of the required support. Workplace privacy and confidentiality requirements were identified as a key challenge for co-worker participation. The effects on co-workers of WR processes ranged from the opportunity to learn new skills to disillusionment and withdrawal from the workplace. In worst case scenarios, ‘ripple effects’ including emotional distress, physical injury and termination of co-workers’ employment had occurred. Conclusion Co-workers are not a neutral party in WR procedures. Formalizing the co-worker role to include communication, consideration and recognition might improve co-workers’ WR experiences.

Effectiveness of health and safety in small enterprises: a systematic review of quantitative evaluations of interventions.

Introduction This systematic review was conducted to identify effective occupational health and safety interventions for small businesses. Methods The review focused on peer-reviewed intervention studies conducted in small businesses with 100 or fewer employees, that were published in English and several other languages, and that were not limited by publication date. Multidisciplinary members of the review team identified relevant articles and assessed their quality. Studies assessed as medium or high quality had data extracted, which was then synthesized. Results Five studies were deemed of medium or high quality, and proceeded to data extraction and evidence synthesis. The types of interventions identified: a combination of training and safety audits; and a combination of engineering, training, safety audits, and a motivational component, showed a limited amount of evidence in improving safety outcomes. Overall, this evidence synthesis found a moderate level of evidence for intervention effectiveness, and found no evidence that any intervention had adverse effects. Conclusions Even though there were few studies that adequately evaluated small business intervention, several studies demonstrate that well-designed evaluations are possible with small businesses. While stronger levels of evidence are required to make recommendations, these interventions noted above were associated with positive changes in safety-related attitudes and beliefs and workplace parties should be aware of them.

Exploring the meaning of early contact in return-to-work from workplace actors' perspective.

Purpose. The objective of this article was to explore the meaning of early contact in return-to-work, and how social relational actions and conditions can facilitate or impede early contact among actors in the workplace. Method. An exploratory qualitative method was used, consisting of individual open-ended interviews with 33 workplace actors at seven worksites across three public employers in Sweden. The workplace actors represented in these interviews included re-entering workers, supervisors, co-workers and human resources managers. Organisational policies on return-to-work were collected from the three employers. Results. The analysis indicated that early contact is a complex return-to-work measure with shifting incentives among workplace actors for making contact. For instance, the findings indicated obligation and responsibilities as incentives, incentives through social relations, and the need to acknowledge and balance the individual needs in relation to early contact. Conclusion. The findings strengthen the importance of early contact as a concept with a social relational context that comprises more than just an activity carried out (or not) by the employer, and suggest that early contact with a sick-listed worker is not always the best approach for a return-to-work situation. This study provides a starting point for a more articulated conceptualisation of early contact.

A Theoretical Model of Co-worker Responses to Work Reintegration Processes

Purpose Emerging research has shown that co-workers have a significant influence on the return-to-work outcomes of partially fit ill or injured employees. By drawing on theoretical findings from the human resource and wider behavioral sciences literatures, our goal was to formulate a theoretical model of the influences on and outcomes of co-worker responses within work reintegration. Methods From a search of 15 data bases covering the social sciences, business and medicine, we identified articles containing models of the factors that influence co-workers’ responses to disability accommodations; and, the nature and impact of co-workers’ behaviors on employee outcomes. To meet our goal, we combined identified models to form a comprehensive model of the relevant factors and relationships. Internal consistency and externally validity were assessed. Results The combined model illustrates four key findings: (1) co-workers’ behaviors towards an accommodated employee are influenced by attributes of that employee, the illness or injury, the co-worker themselves, and the work environment; (2) the influences–behaviour relationship is mediated by perceptions of the fairness of the accommodation; (3) co-workers’ behaviors affect all work reintegration outcomes; and (4) co-workers’ behaviours can vary from support to antagonism and are moderated by type of support required, the social intensity of the job, and the level of antagonism. Conclusions Theoretical models from the wider literature are useful for understanding the impact of co-workers on the work reintegration process. To achieve optimal outcomes, co-workers need to perceive the arrangements as fair. Perceptions of fairness might be supported by co-workers’ collaborative engagement in the planning, monitoring and review of work reintegration activities.