Reduce Sickness Absence Research Articles

Effectiveness of an Intervention to Enhance Occupational Physicians\u2019 Guideline Adherence on Sickness Absence Duration in Workers with Common Mental Disorders: A Cluster-Randomized Controlled Trial

Purpose Evidence-based guidelines in occupational health care improve the quality of care and may reduce sickness absence duration. Notwithstanding that, guideline adherence of occupational physicians (OPs) is limited. Based on the literature on guideline implementation, an intervention was developed that was shown to effectively improve self-reported adherence in OPs. The aim of present study was to evaluate whether this intervention leads to earlier return to work (RTW) in workers with common mental disorders (CMD). Methods In a two-armed cluster randomized controlled trial, 66 OPs were randomized. The trial included 3379 workers, with 1493 in the intervention group and 1886 in the control group. The outcome measures were: time to full RTW, time to first RTW, and total hours of sickness absence. Cox regression analyses and generalized linear mixed model analyses were used for the evaluations. Results The median time to RTW was 154 days among the 3228 workers with CMD. No significant differences occurred in (time to) full RTW between intervention and control group HR 0.96 (95% CI 0.81–1.15) nor for first RTW HR 0.96 (95% CI 0.80–1.15). The mean total hours of sickness absence was 478 h in the intervention group and 483 h in the control group. Conclusions The intervention to enhance OPs’ guideline adherence did not lead to earlier RTW in workers with CMD guided by the OPs. Possible explanations are the remaining external barriers for guideline use, and that perceived guideline adherence might not represent actual guideline adherence and improved care.Trail registration: ISRCTN86605310.

Sickness absence among peer-supported drivers after occupational trauma.

Psychological first aid is a common approach for providing support after potentially traumatic events (PTEs). In Germany, a peer support model is recommended by the German Statutory Accident Insurance (DGUV) to reduce sickness absence after occupational accidents, especially in public transportation. However, data on the effectiveness of peer support are very sparse. To analyse whether peer support has an impact on sickness absence after work-related traumatic events in public transportation. An analysis was conducted in two German public transportation corporations. Due to ethical requirements, we used a historical cohort study comparing peer support by colleagues (VAG-1), peer support at supervisor level (VGF) and a non-intervention group (VAG-0). The study period was from March 2003 to December 2012. We used a negative binominal regression model to estimate the relative risk associated with the interventions and potential confounders. A total of 259 incident PTEs in employees were observed. A regression analysis identified the severity of PTE (severe and fatal events), VGF and age as significant factors in predicting duration of post-event sickness absence. In a stratified analysis, the mode of peer support (VGF) and age predicted sickness absence for less severe PTEs but this was not significant for severe PTEs. Severe and fatal PTEs had the strongest impact on sickness absence after PTEs. For less severe PTE, peer support provided by colleagues may be superior to supervisor support.

Job Maintenance through Supported Employment PLUS: A Randomized Controlled Trial.

Sickness absence from work due to experienced distress and mental health issues has continuously increased over the past years in Germany. To investigate how this alarming development can be counteracted, we conducted a randomized controlled trial evaluating a job coaching intervention to maintain the working capacity of members of staff and ultimately prevent sickness absence. Our sample included N = 99 employees who reported mental distress due to work-related problems. The intervention group (n = 58) received between 8 and 12 individual job coaching sessions in which they worked with a professional job coach to reduce their mental distress. The control group (n = 41) received a brochure about mental distress. Data were collected before the start of the study, at the end of the job coaching intervention, and at a 3-month follow-up. These data included the number of sickness absence days as the primary outcome and questionnaire measures to assess burnout indicators, life satisfaction, and work-related experiences and behaviors. Compared with the control group, the results indicated no reduction in sickness absence in the intervention group but fewer depressive symptoms, a heightened ability of the participants to distance themselves from work, more experience of work-related success, less depletion of emotional resources, and a greater satisfaction with life when participants had received the job coaching. Thus, although we could not detect a reduction in sickness absence between the groups, job coaching was shown to be a viable intervention technique to benefit employees by contributing to re-establish their mental health. We discuss the implications of the study and outline future research.

The Effect of Cold Showering on Health and Work: A Randomized Controlled Trial.

PurposeThe aim of this study was to determine the cumulative effect of a routine (hot-to-) cold shower on sickness, quality of life and work productivity.MethodsBetween January and March 2015, 3018 participants between 18 and 65 years without severe comorbidity and no routine experience of cold showering were randomized (1:1:1:1) to a (hot-to-) cold shower for 30, 60, 90 seconds or a control group during 30 consecutive days followed by 60 days of showering cold at their own discretion for the intervention groups. The primary outcome was illness days and related sickness absence from work. Secondary outcomes were quality of life, work productivity, anxiety, thermal sensation and adverse reactions.Results79% of participants in the interventions groups completed the 30 consecutive days protocol. A negative binomial regression model showed a 29% reduction in sickness absence for (hot-to-) cold shower regimen compared to the control group (incident rate ratio: 0.71, P = 0.003). For illness days there was no significant group effect. No related serious advents events were reported.ConclusionA routine (hot-to-) cold shower resulted in a statistical reduction of self-reported sickness absence but not illness days in adults without severe comorbidity.Trial RegistrationNetherlands National Trial Register NTR5183

Work-related medical rehabilitation in patients with musculoskeletal disorders: the protocol of a propensity score matched effectiveness study (EVA-WMR, DRKS00009780).

BackgroundMusculoskeletal disorders are one of the most important causes of work disability. Various rehabilitation services and return-to-work programs have been developed in order to reduce sickness absence and increase sustainable return-to-work. As the effects of conventional medical rehabilitation programs on sickness absence duration were shown to be slight, work-related medical rehabilitation programs have been developed and tested. While such studies proved the efficacy of work-related medical rehabilitation compared with conventional medical rehabilitation in well-conducted randomized controlled trials, its effectiveness under real-life conditions has yet to be proved.Methods/DesignThe cohort study will be performed under real-life conditions with two parallel groups. Participants will receive either a conventional or a work-related medical rehabilitation program. Propensity score matching will be used to identify controls that are comparable to treated work-related medical rehabilitation patients. Over a period of three months, about 18,000 insured patients with permission to undergo a musculoskeletal rehabilitation program will be contacted. Of these, 15,000 will receive a conventional and 3,000 a work-related medical rehabilitation. We expect a participation rate of 40 % at baseline. Patients will be aged 18 to 65 years and have chronic musculoskeletal disorders, usually back pain. The control group will receive a conventional medical rehabilitation program without any explicit focus on work, work ability and return to work in diagnostics and therapy. The intervention group will receive a work-related medical rehabilitation program that in addition to common rehabilitation treatments contains 11 to 25 h of work-related treatment modules. Follow-up data will be assessed three and ten months after patients’ discharge from the rehabilitation center. Additionally, department characteristics will be assessed and administrative data records used. The primary outcomes are sick leave duration, stable return to work and subjective work ability. Secondary outcomes cover several dimensions of health, functioning and coping strategies.DiscussionThis study will determine the relative effectiveness of a complex, newly implemented work-related rehabilitation strategy for patients with musculoskeletal disorders.Trial registrationGerman Clinical Trials Register (DRKS00009780, February 10, 2016).

The role of qualitative research in adding value to a randomised controlled trial: lessons from a pilot study of a guided e-learning intervention for managers to improve employee wellbeing and reduce sickness absence.

BackgroundDespite the growing popularity of mixed-methods studies and considerable emphasis on the potential value of qualitative research to the trial endeavour, there remains a dearth of published studies reporting on actual contribution. This paper presents a critically reflective account of our experience of the actual value of undertaking qualitative research alongside a pilot cluster randomised controlled trial of a guided e-learning intervention for managers in an NHS Mental Health Trust to improve employee wellbeing and reduce sickness absence.For the qualitative study we undertook 36 in-depth interviews with key informants, managers and employees. We observed and took in-depth field notes of 10 meetings involving managers and employees at the Trust, and the two qualitative researchers acted as participant observers at steering committee and monthly research team meetings. We adopted a narrative methodological orientation alongside a thematic approach to data analysis, eliciting a rich account of the complexities of managing stress at work.ResultsWe identified two key overarching roles played by the qualitative research: ‘problematising’ and ‘contextualising’. Specifically, the qualitative data revealed and challenged assumptions embedded in the trial about the nature of the learning process, and exposed the slippery and contested nature of abstracted variables, on which a trial depends. The qualitative data challenged the trial’s logic model, and provided a rich understanding of the context within which the trial and intervention took place.ConclusionsWhile acknowledging the ever-present tension in mixed-methods research between the requirements of quantitative research to represent the social world as abstracted variables, and the goal of qualitative research to explore and document the complexity of social phenomena, we adopted a pragmatic position that enabled us to engage with this tension in a productive and partially integrative way. Our critically reflective account of the praxis of integration illuminated opportunities and challenges for maximising the value of qualitative research to a trial. This paper sets out tangible illustrative lessons for other mixed-methods researchers endeavouring to get the most from qualitative research.Trial registrationThis study is registered as ISRCTN58661009. Registration was submitted on 22 April 2013 and completed on 17 June 2013.

Evaluating an Organizational-Level Occupational Health Intervention in a Combined Regression Discontinuity and Randomized Control Design.

Organizational-level occupational health interventions have great potential to improve employees' health and well-being. However, they often compare unfavourably to individual-level interventions. This calls for improving methods for designing, implementing and evaluating organizational interventions. This paper presents and discusses the regression discontinuity design because, like the randomized control trial, it is a strong summative experimental design, but it typically fits organizational-level interventions better. The paper explores advantages and disadvantages of a regression discontinuity design with an embedded randomized control trial. It provides an example from an intervention study focusing on reducing sickness absence in 196 preschools. The paper demonstrates that such a design fits the organizational context, because it allows management to focus on organizations or workgroups with the most salient problems. In addition, organizations may accept an embedded randomized design because the organizations or groups with most salient needs receive obligatory treatment as part of the regression discontinuity design. Copyright © 2016 John Wiley & Sons, Ltd.

Effectiveness of educational materials to prevent occupational low back pain.

Low back pain (LBP) in association with occupation is well documented. A subpopulation of workers can be defined as 'non-heavy' manual workers with either light or sedentary roles who may be at risk of LBP due to insufficient physical activity. Educational materials are a potential intervention, which are cost-effective and easily targeted at this population. To investigate the evidence for using information material among 'non-heavy' manual workers and the effect on their sickness absence. A search investigating the effect of educational material on LBP in non-heavy manual workers. Electronic databases were searched and selected references were reviewed. Specific key terms were used including: 'worker', 'non-heavy manual', 'booklet', 'leaflet', 'advice', 'sickness', 'absenteeism', 'prevention' and 'low back pain'. Methodological quality was assessed by predefined criteria. Four studies were identified: one guideline review, one prospective study and two randomized controlled trials. Methodological quality was deemed moderate to high. There was insufficient evidence to show written education altered sickness absence. There was evidence that information given to workers can help change attitudes and beliefs about LBP. Educational materials alone do not appear to reduce sickness absence for LBP in the 'non-heavy' manual working population. However, they can facilitate behavioural change and modify health beliefs and attitudes. Educational materials may be a useful medium to engage workers, provide information regarding practical modifications to their work environment and activities and potentially reduce psychological distress regarding ill-health at work.

A multi-faceted workplace intervention targeting low back pain was effective for physical work demands and maladaptive pain behaviours, but not for work ability and sickness absence: Stepped wedge cluster randomised trial.

The aims of this study were to test whether a multi-faceted intervention effective for low back pain was effective for physical capacity, work demands, maladaptive pain behaviours, work ability and sickness absence due to low back pain. A stepped wedge cluster randomised, controlled trial with 594 nurses' aides was conducted. The intervention lasted 12 weeks and consisted of physical training (12 sessions), cognitive behavioural training (two sessions) and participatory ergonomics (five sessions). Occupational lifting, fear avoidance, physical exertion, muscle strength, support from management, work ability and sickness absence due to low back pain were measured every 3 months. Before and after the intervention we measured physical capacity, kinesiophobia and need for recovery. Linear mixed models adjusted for baseline values of the outcome were used to estimate the effect. Significant reduction in occupational lifting (-0.35 (95% confidence interval -0.61 to -0.08)), and improvement in two measures of fear avoidance ((-0.75 (95% confidence interval -1.05 to -0.45) and -0.45 (95% confidence interval -0.80 to -0.11)) were found for the intervention group compared to the control. There were no significant effects on physical exertion, muscle strength, support from management, work ability or sickness absence due to low back pain. After the intervention, significant increased physical capacity and improvements in kinesiophobia were found, but no change in need for recovery. CONCLUSIONS THE INTERVENTION WAS SIGNIFICANTLY EFFECTIVE FOR PHYSICAL WORK DEMANDS AND MALADAPTIVE PAIN BEHAVIOURS, BUT NOT FOR WORK ABILITY AND SICKNESS ABSENCE DUE TO LOW BACK PAIN TO IMPROVE WORK ABILITY OR REDUCE SICKNESS ABSENCE DUE TO LOW BACK PAIN MORE SPECIFIC INTERVENTIONS SHOULD PROBABLY BE DEVELOPED.

Effectiveness of very early workplace interventions to reduce sickness absence: a systematic review of the literature and meta-analysis.

The aim of this review was to investigate the effectiveness of workplace return-to-work (RTW) interventions delivered at very early stages (<15 days) of sickness absence (SA). A systematic literature search was conducted in PubMed, Health Management Information Consortium (HMIC), Cochrane library database, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsychInfo and Embase. Using pre-established criteria, independent pairs of researchers carried out the study selection, quality appraisal and data extraction. Workplace interventions before day 15 of SA, were included. Primary outcome measures included rates of and time until RTW, productivity loss, and recurrences of SA. We found limited available evidence on the benefits of "very early" workplace interventions in terms of RTW after a SA episode compared to usual care. Only three randomized controlled trials classed as high or intermediate quality were identified. Early part-time sick leave together with appropriate job modifications led to a reduction in the duration and recurrence of SA. There is evidence of benefit of intervening during the first two weeks of SA for musculoskeletal disorders. Our review has identified a lack of evidence from the literature at this time point to support "very early" intervention compared to usual care. The methodological design of the studies, notably the extent and timing of usual care provided and variable compliance/crossover between groups could however explain the lack of demonstrated benefit. Consensus is required on the definition of "early" and "very early" interventions, and further research is recommended to improve understanding of the factors influencing when and how best to intervene for maximum gain.

Changes in Leisure-Time Physical Activity and Subsequent Sickness Absence Due to Any Cause, Musculoskeletal, and Mental Causes.

The association between changes in physical activity and sickness absence is poorly understood. The aim of this study was to examine the association between changes in leisure-time physical activity and long-term sickness absence due to any cause and musculoskeletal and mental causes. We measured physical activity at baseline in 2000-2002 (response rate 67%) and at follow-up in 2007 (response rate 83%) among middle-aged employees of the City of Helsinki, Finland. The survey data were linked to the Finnish Social Insurance Institute's register data on sickness benefit periods > 9 days, including diagnoses (ICD-10; International Statistical Classification of Diseases and Related Health Problems, 10th revision) (mean follow-up 2.3 years). We used a negative binomial model to calculate rate ratios. The analyses included 4010 respondents (81% women). Those who were persistently vigorously active and those whose physical activity level changed from low to moderate or vigorous, from moderate to vigorous, or from vigorous to moderate were at lower risk for sickness absence than were the persistently low-activity group. For sickness absence due to musculoskeletal causes, vigorous activity showed stronger associations, whereas mental causes showed no such associations. To reduce sickness absence due to both musculoskeletal and mental causes, middle-aged and aging employees should be encouraged to engage in physical activity.

Australian Employee Perspectives on Disability Management in Relation to Job Satisfaction, Physical and Mental Health, Workplace Morale and Reduced Sickness Absence

Disability management is now recognised as an effective means of managing the increasing global costs of injury and disability. However, research on disability management particularly employee perceptions of its value, are sparse. This paper reports on the Australian findings of a large international project that included Canada, China, Switzerland and Australia, which examined employee perspectives of disability management related to job satisfaction, physical and mental health, workplace morale and reduced sickness absence. Data was collected from 365 employees in 10 large private and public companies using an online survey tool that focused on three components of a disability management program — disability prevention (DP), stay at work (SAW) and return to work (RTW) programs — in relation to the dependent variables of job satisfaction, physical and mental health, workplace morale, sickness absence. Multivariate regression was used to predict disability management's influence on the dependent variables. Results demonstrated positive perceptions regarding the perceived benefits of disability management to both individual employees and their perceptions of coworkers. It was apparent that each component of a disability management program (DP, SAW, and RTW) is positively related to job satisfaction, physical and mental health, workplace morale and reduced sickness absence Disability management programs were perceived as more beneficial in private, as opposed to public, workplaces; however, no differences were evident according to union status or gender of the respondent. It is possible disability management may impact on organisational productivity via variables associated with workplace culture, as well as through the direct benefits flowing from preventing and managing injury. Given the significant costs associated with absenteeism, an outcome of interest to many employers was the finding that employees perceived SAW programs as the most beneficial in terms of reducing absenteeism for both themselves and their coworkers.

Physical exercise, sickness absence and subjective employability: An 8-year longitudinal observational study among musculoskeletal patients

Physical exercise recommendations become particularly effective when embedded into medical rehabilitation. However, little is known about long-term behaviour maintenance and its effect on sickness absence and subjective employability. The current longitudinal observational study investigated self-reported physical exercise, sickness absence and subjective employability over a period of 8 years. A total of 601 (T0) outpatients (mean age 45.14 years; standard deviation 10.73 years, age range 18-65 years) with different orthopaedic disorders were recruited during their 3-week medical rehabilitation in Germany. Of these, 61.7% (n = 371) were female. Follow-ups were carried out at 6 months (T1, n = 495), 12 months (T2, n = 340), 3 years (T3, n = 296) and 8 years (T4, n = 142) after baseline. Patient characteristics, exercise status, social-cognitive variables, sickness absence and subjective employability were obtained via self-report questionnaires. SPSS hierarchical regression models were used for data analysis, controlling for baseline measures and sociodemographic variables. Physical exercise status 6 months after rehabilitation treatment (T1) predicted sickness absence at 12 months (T2). Inactive people were 3.28 times more likely to be on sick leave at T2. In addition, physical exercise at T1 predicted subjective employability 12 months (T2) and 3 years (T3) later. Those who met the recommendations to be physically active for at least 40 min a week were more likely to feel able to work. Exercise appears to play an important role in reducing sickness absence and subjective employability and should be promoted within and after rehabilitation treatment.

Reduced Sickness Absence after a Physical Activity Intervention among Health Care Workers: One-Year Follow-Up of a Randomised Controlled Trial

Background: Health care workers frequently suffer from complaints of musculoskeletal disorders and they are prone to long-term sick leave, as their work involves considerable physical demands. Objective: To follow-up and evaluate longer term effects measured one year after baseline of “Tailored Physical Activity” (TPA) versus a reference group (REF) in reducing number of self-reported sickness absence days for health care workers. Methods: In this randomised controlled trial, health care workers (n=54) with musculoskeletal pain in the back or upper body were included and randomised to TPA or REF. All participants participated in individual health counselling (1.5 hours). TPA consisted of both aerobic fitness training and strengthening exercises (three times 50- minute/week during 10 weeks). REF received only health guidance. At baseline and after the intervention period the participants were assessed with a questionnaire and health-related measures. Results: In the longer term, the TPA showed a significant effect compared to REF in the ability to reduce sickness absence related to troubles in the musculoskeletal system. In TPA 81.5% reported no sickness absence within the last three months compared to 59.3% in REF. Significant improvements were also seen for kinesiophobia (p<0.01) and pain (p<0.01) from baseline to follow-up. Conclusion: Results indicate that physical activity interventions can encourage health care workers to be more active and achieve improvements in kinesiophobia and pain intensity, thereby preventing sickness absence.

Causal inference in multi-state models-sickness absence and work for 1145 participants after work rehabilitation.

BackgroundMulti-state models, as an extension of traditional models in survival analysis, have proved to be a flexible framework for analysing the transitions between various states of sickness absence and work over time. In this paper we study a cohort of work rehabilitation participants and analyse their subsequent sickness absence using Norwegian registry data on sickness benefits. Our aim is to study how detailed individual covariate information from questionnaires explain differences in sickness absence and work, and to use methods from causal inference to assess the effect of interventions to reduce sickness absence. Examples of the latter are to evaluate the use of partial versus full time sick leave and to estimate the effect of a cooperation agreement on a more inclusive working life.MethodsCovariate adjusted transition intensities are estimated using Cox proportional hazards and Aalen additive hazards models, while the effect of interventions are assessed using methods of inverse probability weighting and G-computation.ResultsResults from covariate adjusted analyses show great differences in sickness absence and work for patients with assumed high risk and low risk covariate characteristics, for example based on age, type of work, income, health score and type of diagnosis. Causal analyses show small effects of partial versus full time sick leave and a positive effect of having a cooperation agreement, with about 5 percent points higher probability of returning to work.ConclusionsDetailed covariate information is important for explaining transitions between different states of sickness absence and work, also for patient specific cohorts. Methods for causal inference can provide the needed tools for going from covariate specific estimates to population average effects in multi-state models, and identify causal parameters with a straightforward interpretation based on interventions.

Effectiveness of legislative changes obligating notification of prolonged sickness absence and assessment of remaining work ability on return to work and work participation: a natural experiment in Finland

ObjectivesPolicies have been introduced to reduce sickness absence, but their effectiveness is largely unknown. In a natural experiment, we examined effects of legislative changes on return to work and work...

Pilot study of a cluster randomised trial of a guided e-learning health promotion intervention for managers based on management standards for the improvement of employee well-being and reduction of sickness absence: GEM Study.

ObjectivesTo investigate the feasibility of recruitment, adherence and likely effectiveness of an e-learning intervention for managers to improve employees’ well-being and reduce sickness absence.MethodsThe GEM Study (guided e-learning for managers) was a mixed methods pilot cluster randomised trial. Employees were recruited from four mental health services prior to randomising three services to the intervention and one to no-intervention control. Intervention managers received a facilitated e-learning programme on work-related stress. Main outcomes were Warwick Edinburgh Mental Wellbeing Scale (WEMWBS), 12-item GHQ and sickness absence <21 days from human resources. 35 in-depth interviews were undertaken with key informants, managers and employees, and additional observational data collected.Results424 of 649 (65%) employees approached consented, of whom 350 provided WEMWBS at baseline and 284 at follow-up; 41 managers out of 49 were recruited from the three intervention clusters and 21 adhered to the intervention. WEMWBS scores fell from 50.4–49.0 in the control (n=59) and 51.0–49.9 in the intervention (n=225), giving an intervention effect of 0.5 (95% CI −3.2 to 4.2). 120/225 intervention employees had a manager who was adherent to the intervention. HR data on sickness absence (n=393) showed no evidence of effect. There were no effects on GHQ score or work characteristics. Online quiz knowledge scores increased across the study in adherent managers. Qualitative data provided a rich picture of the context within which the intervention took place and managers’ and employees’ experiences of it.ConclusionsA small benefit from the intervention on well-being was explained by the mixed methods approach, implicating a low intervention uptake by managers and suggesting that education alone may be insufficient. A full trial of the guided e-learning intervention and economic evaluation is feasible. Future research should include more active encouragement of manager motivation, reflection and behaviour change.Trial Registration numberISRCTN58661009.

Workplace culture that promotes health and wellbeing for all: an imperative for health care managers and others.

In 1996, the Nuffield Provincial Hospitals Trust published a report on protecting and promoting doctors' health and the work environment.1 In the light of the seriousness of the evidence of ill health among doctors, other reports on the health of those working in the National Health Service (NHS) and the profound implications for individuals, communities and the nation at large, the Trust established a Partnership on the Health of the NHS Workforce. Many reports had been published on the health of those working in the NHS, but none was sufficiently extensive or robust to draw general conclusions for action and none covered all staff groups working in the NHS. The Nuffield Trust convened a Partnership of the key organisations with a stake holding in the NHS to assess all available evidence and make recommendations for action. The importance of addressing the challenge lay not just in the concern for the welfare of the staff of the NHS but also in the implications for the quality of patient care and the findings revealing the important influence of management culture, style and skills. The Partnership report2 contained a submission to the Secretary of State stating 'these very uncomfortable findings about the health of the NHS workforce will create challenges for all of us but the next stage must be a matter for those responsible for the NHS workforce'. Following publication of the report and its acceptance by Government, significant progress was made over the years in implementing its recommendations in the NHS.The publication in June 2015 by National Institute of Clinical and Health Excellence (NICE)3 brings the issue once more to the fore about what managers need to do to create a happy and healthy workplace. Simon Stevens, NHS England's CEO, said on the publication of the report, 'health-promoting workplaces are obviously good for millions of employees and ultimately for taxpayers too, so the time is right for all employers - including the NHS - to raise our game'.Work and the quality of work experience are key determinants of health. We spend about one-third of our life at work, and the quality of the workplace experience is key to our health and wellbeing and that of the employing organisation. In the UK, 27 million workdays are lost each year to work-related illness. The cost to the UK economy is around £13 billion per annum.The new NICE guidance proposes that promoting health and wellbeing is recognised as an essential management and organisational competence.A healthy workplace results in multiple benefits such as reducing sickness absence and presentism (being ill but not taking time at home to recover), increased safety and work satisfaction, greater loyalty to the organisation and enhanced reputation - all associated with greater productivity.People are any organisation's most valuable asset, and employers have a duty to look after and effectively care about the wellbeing of their employees. This is as, and arguably more, important in times of recession as well as boom periods. This is especially important given the increasingly less stable and secure nature of work for many in our society.Organisations' are essentially abstract entities; it's the people and the relationships between them that define the nature and culture of the organisation and its health and thus productivity and sustainability.NICE have produced (June 2015) generic guidance for the first time on workplace policy and management practices to improve the health and wellbeing of employees. The guidance confirms what good leaders and managers already know and what many may describe as self-evident truths. The guidance provides the underpinning evidence base and solid recommendations for practical leadership and management action at all levels of the organisation. …

Effectiveness of psychoeducation in reducing sickness absence and improving mental health in individuals at risk of having a mental disorder: a randomised controlled trial.

BackgroundThe aim of this study was to evaluate the effect of psychoeducation on return to work as an adjunct to standard case management in individuals on sick leave at risk of having a mental disorder. The participants could have different diagnoses but were all at risk of having a mental disorder.MethodsBetween 2012 and 2014, 430 participants on sick leave were randomly allocated to either an intervention or control group. The psychoeducation consisted of 2-h sessions once a week for 6 weeks. The sessions focused on stress and work life and was based on problem-solving techniques and coping strategies. The main outcome, the relative risk (RR) of a full return to work based on register data from the job centres, was determined during the first 3 and 6 months after participation in the psychoeducation programme. At baseline and at 3 and 6 months after the intervention, the participants received a questionnaire on psychological symptoms, mental health-related quality of life, and locus of control.ResultsDuring the first 6 months after inclusion, the two groups had almost the same RR of a full return to work (RR:0.97, 95 % CI: 0.78;1.21), but during the first 3 months, the individuals in the intervention group had a significantly higher risk of not having fully returned to work (RR:0.68, 95 % CI:0.47;0.98). The individuals in the intervention group who had participated in at least four of the six psychoeducational sessions returned to work considerably slower at both time points than did the control group. The intervention did not decrease the level of psychological symptoms or improve mental health-related quality of life; however, individuals in the intervention group improved their scores on internal locus of control at both 3 and 6 months.ConclusionOffering psychoeducation to individuals on sick leave at risk of having a mental disorder had no influence on the chance of a full return to work during the first 6 months; however, it did result in a higher relative risk of not returning to work after 3 months. Therefore, we do not recommend offering psychoeducation in this form to facilitate return to work.Trial registrationClinical Trial.gov NCT01637363. Registered 6 July 2012.

Pilot study of a randomised trial of a guided e-learning health promotion intervention for managers based on management standards for the improvement of employee well-being and reduction of sickness absence: the GEM (Guided E-learning for Managers) study

BackgroundPsychosocial work environments influence employee well-being. There is a need for an evaluation of organisational-level interventions to modify psychosocial working conditions and hence employee well-being.ObjectiveTo test the acceptability of the trial and the intervention, the feasibility of recruitment and adherence to and likely effectiveness of the intervention within separate clusters of an organisation.DesignMixed methods: pilot cluster randomised controlled trial and qualitative study (in-depth interviews, focus group and observation).ParticipantsEmployees and managers of a NHS trust. Inclusion criteria were the availability of sickness absence data and work internet access. Employees on long-term sick leave and short-term contracts and those with a notified pregnancy were excluded.InterventionE-learning program for managers based on management standards over 10 weeks, guided by a facilitator and accompanied by face-to-face meetings. Three clusters were randomly allocated to receive the guided e-learning intervention; a fourth cluster acted as a control.Main outcome measuresRecruitment and participation of employees and managers; acceptability of the intervention and trial; employee subjective well-being using the Warwick–Edinburgh Mental Wellbeing Scale (WEMWBS); and feasibility of collecting sickness absence data.ResultsIn total, 424 employees out of 649 approached were recruited and 41 managers out of 49 were recruited from the three intervention clusters. Of those consenting, 350 [83%, 95% confidence interval (CI) 79% to 86%] employees completed the baseline assessment and 291 (69%, 95% CI 64% to 73%) completed the follow-up questionnaires. Sickness absence data were available from human resources for 393 (93%, 95% CI 90% to 95%) consenting employees. In total, 21 managers adhered to the intervention, completing at least three of the six modules. WEMWBS scores fell slightly in all groups, from 50.4 to 49.0 in the control group and from 51.0 to 49.9 in the intervention group. The overall intervention effect was 0.5 (95% CI –3.2 to 4.2). The fall in WEMWBS score was significantly less among employees whose managers adhered to the intervention than among those employees whose managers did not (–0.7 vs. 1.6, with an adjusted difference of 1.6, 95% CI 0.1 to 3.2). The intervention and trial were acceptable to managers, although our study raises questions about the widely used concept of ‘acceptability’. Managers reported insufficient time to engage with the intervention and lack of senior management ‘buy-in’. It was thought that the intervention needed better integration into organisational processes and practice.ConclusionsThe mixed-methods approach proved valuable in illuminating reasons for the trial findings, for unpacking processes of implementation and for understanding the influence of study context. We conclude from the results of our pilot study that further mixed-methods research evaluating the intervention and study design is needed. We found that it is feasible to carry out an economic evaluation of the intervention. We plan a further mixed-methods study to re-evaluate the intervention boosted with additional elements to encourage manager engagement and behaviour change in private and public sector organisations with greater organisational commitment.Study registrationCurrent Controlled Trials ISRCTN58661009.FundingThis project was funded by the NIHR Public Health Research programme and will be published in full inPublic Health Research; Vol. 3, No. 9. See the NIHR Journals Library website for further project information.