So bid farewell to the Eastern town
You never more will see
There's self-respect and a steady cheque
In this refinery
You will miss the green and the woods and streams
And the dust will fill your nose
But you'll be free, and just like me
An idiot, I suppose
- The Idiot, by Stan Rogers
Injured workers do better when they return to work. Beyond just being injured, which is a problem in and of itself, injured workers who are not working report personal stress, as well as physical hardship during their rehabilitation process (Kirsch & McKee, 2003). The longer someone is absent from work with an injury, the less likely they are to return to work at their previous level, or to return to work at all (Comcare, n.d.a; RACP, n.d.). If a worker is absent from work because of a psychological injury, the likelihood of return and the quality of the return to work plan is poorer yet again (Safe Work Australia, 2017). Workers take time off from work for many reasons, many of which have nothing to do with being sick. Workers may take holidays, take breaks, need to attend to sick children or relatives, and occasionally they give birth as well. Workers may take time off for injury and illness - workers are humans and occasionally get sick, get hurt, or become unable to comfortably do their jobs and so take time off. Workers can take time off for reasons unrelated to work, as well as for work-related injuries. It’s important to consider both, because even if a worker hasn’t taken time off for an injury, a serious illness, bereavement, or other major life event may introduce stress or another factor into the worker’s life and affect their ability to do their job comfortably, or return to their work following a period of absence. Return to Work isn’t just for workers who get sick or injured at work, it’s for everyone who’s needed to step away from their job, for whatever reason. That’s why it’s important to get it right.
When considering work-related injuries and illnesses, it’s important to remember that there are some absences that may be work-related but which do not become classified as claims, either because they aren’t reported as workplace illnesses, aren’t diagnosed as being related to work, the worker may not elect to pursue the claims process, or they aren’t reportable. Given that in Australia, the median hours worked per week was 38 (Australian Bureau of Statistics, 2022), where employees reported doing an average of 5.4 hours of unpaid work a week overall, (Australia Institute, 2023), it’s safe to say that work may have some contributing factor to general health and wellness, especially where overtime has a contributing factor to risk (Dembe et. al., 2005). That isn’t to say that work is the be-all and end-all of health - there’s another article somewhere that says that. This is to say that the number of reported absences from work and the statistical analysis of these data should be taken with a grain of salt, given that workers regularly push through illness instead of taking time off (Biron et. al., 2006), are less likely to take time off if they don’t have entitlements or if they are casual (Dew et. al., 2005), and for other miscellaneous and individual factors. In spite of this, for those workers who do need to take time off from their regular duties, good return to work facilitates sustainable participation, minimises friction in the workplace, and improves worker outcomes like job satisfaction, retention, and worker performance (Figueredo et. al., 2020). Organisations have a responsibility to facilitate an employee’s sustainable return to work, because the organisation serves as an important source of socio-emotional resources, such as respect, caring, and tangible benefits, like the means to access a living wage (Krishnan & Mary, 2012). By leveraging organisational resources to structure and guide a return to work program, the injured worker is brought back to a functioning level and is able to complete their duties of work with a minimum of adverse effect.
Return to Work planning is the process by which a worker is brought from a state of illness or inability to perform their regular duties, back to the point where they can do their job without assistance, accommodation, or adjustment. The distance between those two points is as large and as circuitous as their presenting injury, which may have different health impacts for different workers in different job roles. A broken ankle won’t stop someone from transcribing documents, but it puts a welder on the bench. A Return to Work process requires milestone measurements of worker capacity at the point at which they begin their rehabilitation and return to work, as well as when they achieve milestones like medical clearance or followup surgeries, when their duties of work change, and as their condition evolves, which can be measured by certification and regular communication between the worker and their employer (Papagoras et. al., 2018). These milestones and communication give the worker’s employer the guidance they need to make appropriate decisions regarding safe and sustainable return to work as well as the opportunity to communicate with the worker and their managing clinician. Returning a worker to their job is usually a clinical endeavour - workers take time off work because of accidents and illnesses and so medical professionals are often involved. In Victoria, WorkSafe as well as the Transport Accident Commission’s Certificates of Capacity offer some structure to managing this transition. However, where the workplace isn’t engaging with a worker as part of these schemes or if they don’t have a defined return to work policy, practice, or dedicated professional, the process can become complicated. Safe Work Australia reports that in 2023 the median time lost has increased from the previous reporting period - claims with 13 weeks or more time lost comprised 21.3% of all serious injury claims (Safe Work Australia, 2024). That same report finds that mental health claims, being the costliest claims in terms of compensation as well as having the median time off at 37 weeks, increased in number by 19.2% from the previous reporting period alone. Knowing that psychosocial factors can affect the resolution of physical injuries like back pain (Linton & Shaw, 2011), that injuries can cause personal and social disability that damage psychological health (Ewan et. al., 1991), that work-related factors can impact psychological health in the context of physical illness (Solidaki et. al., 2009), and that psychosocial blue flags (those related to work) are a necessary clinical consideration in return to work planning (Gray et. al., 2011), managing the psychosocial side of things is key in the return to work process.
The Royal Australian College of Physicians with the Australasian Faculty of Environmental and Occupational Medicine recommend communicating return to work options to the patient, as well as providing sufficient consultation time to address patient issues and concerns and advise patients about the history of their conditions (RACP, n.d.). These are recognised psychosocial interventions, but they are directed at the patient, and not the workplace. Psychosocial yellow flags refer to factors that have their locus in the patient like belief and behaviour. Blue flags have to do with work, being work and health concerns. Black flags are those structural and systemic inhibitors and facilitators of patient outcomes, such as workplace policies, systems and professional contacts (Watson, 2010). Can a Return to Work plan necessarily engage with occupational factors outside of the patient? Best practice suggests that it should. A comprehensive return to work plan doesn’t just engage with the patient and the professional role, but the contextual factors around those two points that make the ground between the two shakier or more sturdy. Return to Work programs for patients injured at work are opportunities to develop good work design practices around that person’s work and for the organisation to evaluate the policies, procedures,and practices that may have led to that situation having arisen in the first place (Safe Work Australia, 2015). Work Safe Victoria has a page that reads, in bold writing, that Work is good for health and wellbeing (Work Safe Victoria, 2022) but not all work is good work, not all work is dignified work, and not all work can make someone healthy. Work is made to be good work when it is designed to be good work, where the human is placed at the heart of the process and the needs of the worker are considered first. Occupational and organisational Black Flags are barriers that are baked into the system either by incidental operation or by design in the service of another goal. Facilitation of good return to work requires cooperation between the worker and the workplace and the accommodation of the latter to support the dignity of the former. Safe Work Victoria provides a return to work arrangement template for convenient use (2023) but this template doesn’t go into the impact, adjustment adaptability, or sustainability of return to work arrangements that require things an organisation can’t provide. What happens if a company is too small to offer anything reasonable, where the worker’s decision latitude and work autonomy are restricted as a consequence of their being asked to complete a role they might not be comfortable with, trained for, or experienced in?
Safe Work Australia provides a guide for returning to work that recommends consultation with workers, matching the job to the worker’s needs, providing a supportive workplace, and responding to changes in the worker’s health and their ability to do their job (Safe Work Australia, 2023). Those aren’t principles of successful return to work, they’re principles of successful work, full stop. If every workplace worked according to those four basic principles, then Work Safe Victoria really could paint the words Work is good for health and wellbeing on their website. Comcare’s 2015 Return to Work survey reported that some of the problems employees reported when returning to work was a negative attitude to those on workers’ compensation, the unavailability of suitable duties, and a lack of supervisor support (Comcare, n.d.b). Supportive relationships at work between a worker and their supervisor, their peers, and their broader workplace are essential in increasing workability and return to work - in fact, the most important factor in return to work is the relationship of an employee with their supervisor (Young, 2010; Awang et. al., 2016). If the workplace is the source of tangible and intangible benefit, as noted by Krishnan and Mary, then what happens if the supervisor or institutional architecture stand as gatekeepers and guardians in front of the worker’s ability to access what may be reasonable entitlements and accommodations? Supervisors, when surveyed, noted that their ability to engage with worker re-enablement needed to be balanced with their obligations toward their business. Again, an outcome driven by business and workplace policy. Where worker return to work is successful, it is facilitated by work adjustments, fulfilling relationships with supervisors, and adequate occupational health guidance (Joosen et. al., 2022), which may lend themselves to enhancing and accommodating for worker volitional deficit (Strømstad et. al., 2024).
An employee returning to work is the person best situated to articulate their understanding about the demands of work. An employee returning to work is the person best situated to articulate their needs for accommodation and adjustment to support their sustainable and safe participation in their job roles. Two people might be doing the same job, but owing to their different capacities, characteristics, and contexts, may go about their work in their own ways and experience stressors differently. Work should be tailored to the individual in a returning and regular context as much as can be done (Thrive at Work, n.d.). All of the action areas in the Australian Government’s National Return to Work Strategy 2020-2030 are interventional points of development where by providing information, training, instruction, and support, workplace cultures and leadership, employers, stakeholders and the worker themselves are empowered to optimise the worker’s recovery and capacity to work, and centralise the role good work plays in achieving this (SWA, 2019). This is especially important in those cases where a worker does not take time off work, but elects to remain at work and undertake their recovery and rehabilitation while still meeting what job demands they can, where if a worker doesn’t return to work fully recovered, they may jeopardise their longterm health (Galizzi et. al., 2016).
Everyone needs to trade the time in their lives for a living wage. Sometimes, in that trade, a person is injured, exhausted, or otherwise rendered unable to do their duties of work safely and successfully. For workers who are injured on the job, and for people whose injuries may not be work-related but which affect their ability to participate in their occupations, workplaces, workspaces, and businesses have the opportunity to leverage organisational resources to assist, accelerate and achieve a successful return to work that supports the health, wellbeing, and sustainable participation of the worker, no matter who they are, and no matter what their duties may be.
None of this information constitutes medical, legal, occupational health and safety, best guidance, standard, or other guidance, instruction, or prescription.
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