The American College of Occupational and Environmental Medicine (ACOEM) guidance statement on Preventing Needless Work Disability by Helping People Stay Employed discusses 16 specific areas to promote work stability. In brief, they are:
1. Increase awareness of how rarely disability is medically required.
(Refer to Table 1.)
2. Urgency is required because prolonged time away from work is harmful.
Shift the focus from “managing” disability to “preventing” it and shorten the response time.
3. Acknowledge and deal with normal human reactions.
Encourage all participants to expand their Stay at Work/Return to Work (SAW/RTW) model to include appropriate handling of emotional reactions that accompany temporary disability to prevent it from becoming permanent.
4. Investigate and address social and workplace realities.
Understand workplace and social realities; establish better communication among SAW/RTW parties; develop and disseminate screening instruments that flag issues for investigation; conduct pilot programs to discover the effectiveness of various interventions.
5. Effectively address psychiatric conditions.
Adopt effective means to acknowledge and treat psychiatric co-morbidities.
6. Reduce distortion of the medical treatment process by hidden financial agendas.
Develop best practices; educate providers and employers about financial aspects that could distort the process.
7. Pay physicians for disability prevention work to increase their professional commitment.
Compensate physicians for the cognitive work and time spent evaluating patients and providing information needed to resolve SAW/RTW issues.
8. Support patient advocacy by getting treating physicians out of a loyalties bind.
Recognize the treating physician’s allegiance; reinforce the primary commitment to the patient/employee’s health and safety; avoid putting the treating physician in a conflict-of-interest situation.
9. Increase “real-time” availability of on-the-job recovery, transitional work programs and permanent job modifications.
Encourage/require employers to adopt policies and procedures that hold supervisors accountable for the cost of benefits if temporary transitional work is not available.
10. Be rigorous, yet fair, to reduce minor abuses and cynicism.
Encourage programs that allow employees to take time off without requiring a medical excuse. Be fair and kind to workers in the SAW/RTW process.
11. Devise better strategies to deal with bad-faith behavior.
Devote more effort to correcting employers or insurers who use SAW/RTW efforts unfairly.
12. Educate physicians on “why” and “how” to play a role in preventing disability.
Educate all treating physicians in basic disability prevention/management and their role in the SAW/RTW process.
13. Disseminate medical evidence on recovery benefits associated with staying at work and being active.
Undertake large-scale educational efforts so activity recommendations become a routine part of medical treatment plans and clinicians prescribe inactivity only when medically required.
14. Simplify and standardize information exchange among employers/payers and medical offices.
Encourage employers, insurers and benefits administrators to use communication methods that respect physicians’ time; highlight key information so physicians can quickly spot the most important issues.
15. Improve/standardize methods that provide data for SAW-RTW decisions.
Standardize information and processes and encourage the use of accurate functional job descriptions.
16. Increase the study of and knowledge about SAW/RTW.
Complete and distribute a description of the SAW/RTW process with recommendations on how best to achieve desired results in disability outcomes. Develop screening tools to accurately predict relative risk of long-term functional disability and provide a basis for therapeutic interventions.
Source: Preventing Needless Work Disability by Helping People Stay Employed ©2006 American College of Occupational and Environmental Medicine, published in the Journal of Occupational and Environmental Medicine, September 2006.
