Absence essentials: return-to-work interviews

In the first of a series of practical features on attendance management, we put the spotlight on return-to-work interviews, including the handling of sensitive health issues.

We put the spotlight - in the first of a series of articles on essential aspects of attendance management - on return-to-work (RTW) interviews, and at ways of persuading line managers to feel more confident about conducting them, particularly when sensitive issues are raised.

Many new policies place line managers at the heart of absence management, yet research suggests that this group is less than enthusiastic about this particular aspect of their management role.

At the same time, evidence is growing that human and behavioural factors - including management style and organisational culture - constitute an important set of determinants of work-related ill health, particularly in the case of mental health and stress-related conditions.

The onus is on personnel and human resources departments to demonstrate that implementing an absence management policy need not be an onerous addition to hard-pressed managers' daily lives. Line managers need convincing that effective absence management adds value to the organisation, by preventing the disruption to teams caused by irregular attendance, by cutting the amount of a departmental budget spent on replacement staff, and by helping to support and retain valued team members.

Flavour of the month

RTW interviews have been flavour of the month lately, and growing numbers of employers have incorporated them into revised absence management policies and procedures. A 2004 survey of absence by the Chartered Institute of Personnel and Development (CIPD) finds that 50% of employers have introduced RTW interviews as part of the changes to attendance management policies they have introduced in the past two years.

Many policies now recommend that managers conduct RTW interviews after every absence, regardless of duration - the CIPD finds that 81% of the employers it surveyed in 2004 use the tool to manage short-term absence. The proportion using interviews in long-term absence cases is only slightly less, at 77%, and RTW interviews have overtaken the provision of absence information to managers as the most commonly used tool for managing this type of absence, the 2004 CIPD survey also finds.

RTW interviews are considered to be highly effective in reducing the absence of both manual and non-manual employees, according to the managers taking part in the latest absence survey conducted by the Confederation of British Industry (CBI). The managers polled for this survey considered RTW interviews to be more effective than either disciplinary procedures, or formal notification of absence policies.

This perception is borne out by the facts - a performance gap of 2.8 days in average absence levels for manual workers exists between those organisations using and not using RTW interviews, according to the CBI survey. The CIPD research finds that 63% of managers across all sectors also view RTW interviews as the most effective tool in their armoury for tackling short-term absence.

RTW interviews have a number of purposes, depending on the individual employee and the type of absence. For example, an interview can be used to explore the underlying reasons for a worker's persistent short-term absence, and to make the employee aware that the manager is keeping tabs on their attendance record.

An interview can also point out the consequences of poor attendance to an employee with intermittent attendance, including the use of disciplinary procedures if appropriate.

In longer-term absence cases, interviews can be the first point at which an employee and manager start to develop an RTW plan, and might include an early discussion about whether or not any adjustments or alterations to the job are needed.

But, in all situations, RTW interviews need to be carried out sensitively - employees resent them if badly handled and, in some cases, RTW chats might even increase the duration of an employee's next absence.

Two-stage model

Line managers responsible for conducting RTW interviews should be encouraged to view them as a two-stage process. The first step is taken on an employee's immediate return to work, where an informal discussion is held. The second stage involves a more formal meeting that can be convened some days later during the individual's first week back at work.

During the informal talk, managers should be encouraged to ask after the wellbeing of an employee, demonstrate how valued the individual is at work, and to enquire whether the organisation can do anything to help. This meeting should be very positive - for example, managers should be discouraged from highlighting the pile of work that has built up in the employee's absence. HR departments should stress to managers that such discussions are part of the normal manager/ employee relationship.

A formal discussion to review any performance or disciplinary issues arising from the absence should be held later in the first week back at work. This should look at the impact of the absence from a production or service perspective, and should explore the reasons for the absence in more detail. For example, a discussion of wider occupational health and safety issues, such as workload, role clarity and relationships with other team members, should take place.

In effect, managers should be encouraged to use basic risk assessment techniques to explore what work-related factors might be affecting the employee's attendance, particularly in the psychosocial arena (see the case study of Somerset County Council, for example, in box 1 ).

In this way, managers and the organisation are fulfilling the duty to assess risks to health at work - albeit in a reactive fashion - and are also providing opportunities for employees to disclose work-related problems that are affecting their health.

The structure of a formal RTW interview will vary according to the circumstances prompting it, for example, the type and length of absence. However, managers should broadly seek to:

Line managers might be advised to cover an additional range of issues during RTW interviews if the absence is, or is suspected to be, stress-related. For example, employees at one local authority are invited to describe the causes of stress and to indicate whether these are work-related when returning from stress-related absence. Line managers at the authority will also ask such employees whether there is anything they can do to help, and will take any reasonable steps necessary to provide this support. Line managers also explore the need for stress counselling with the worker, and are required to keep notes of work-related stress-related incidents or reports made by employees during RTW interviews.

Any follow-up action suggested by either the informal or formal RTW interview should be agreed between the manager and the employee. This could include a referral to occupational health support, or signposting to other appropriate services, for example external support agencies or the employer's own employee assistance programme. It might be appropriate to develop this follow-up work into an action plan for the next two or three months, with a further discussion scheduled to review progress.

Health is always a sensitive issue

Any discussion of an employee's health is potentially sensitive, which explains why many managers do not feel confident about conducting RTW interviews, particularly in cases where the absence might be related to mental ill health, or to domestic or personal issues, such as drug or alcohol dependency.

Personnel and HR professionals need to convince managers that the basis for handling sensitive issues lies in their day-to-day management style and is not a special technique to be applied when a problem arises. People in teams need to know that their input is appreciated and they will receive support during a crisis. It is this everyday development of a supportive organisational culture that ultimately aids the management of sensitive health issues when they arise.

A Scandinavian study¹ of leadership highlights the vital role that managers' behaviour has in reducing team members' work-related stress, and presents the following checklist for a stress-alleviating management style:

show genuine concern by valuing contributions and developing people's strengths;

Behaviours to avoid in building this positive, supportive work environment include:

Most of this advice represents basic good people management practice, and is likely to be covered in the management development programmes of many organisations. But it is important to ensure that line managers make the link between these aspects of their management style and workplace health and wellbeing.

Disclosing mental health problems

The mental ill health of an employee is a particularly sensitive area to cover in RTW interviews and is often complicated by a reluctance or fear on the part of the worker to disclose their problems to a manager. However, it is very difficult for line managers to support an employee with mental health problems, including retaining them in the job, unless and until the worker chooses to disclose problems. It is useful therefore to make line managers aware of the factors and behaviours that encourage disclosure so that they can develop them.

Researchers at Nottingham University² report that one in three line managers manages a team member with a chronic illness, and that decisions to disclose chronic illness by employees are influenced strongly by three key factors. These involve workers' perceptions of expected discrimination from colleagues and managers, the illness's visibility and the adaptations it might require for the employee to continue in work.

A case study of a further education employer by the researchers shows that 26% of workers with any chronic illness disclosed it to their managers, but that those with certain mental ill health problems (depression and anxiety) were more likely to disclose. The expectation that they would receive support from colleagues and line managers is the factor most likely to trigger a disclosure of illness, followed by a person's own experience of the condition. Again, here is evidence that a supportive management style is crucial to the effective use of RTW interviews, particularly in cases of mental ill health.

Substance misuse

A second set of health-related issues commanding special attention during RTW interviews relates to substance dependency and, in particular, addiction linked to mental ill health or other conditions. Managers need to ensure that the symptoms they observe at work that appear to relate to substance abuse, and which they are seeking to explore in formal RTW interviews, are not directly due to an illness, for example, hypertension in the case of slurred speech.

It is generally advisable to treat dependency issues as health ones, particularly if connected to poor attendance, as the dependency could itself be a symptom of mental ill health, such as depression, meaning that the employee could be covered by disability legislation.

This is a legal minefield, and HR and personnel professionals need to ensure that managers take appropriate medical and legal advice if they suspect dependency issues as a result of a RTW discussion. Managers should still consider alternative employment and adaptations to jobs and duties in dependency cases, especially if there is evidence that work pressures are contributing to stress, which in turn is inhibiting a person's ability to tackle their dependency.

Two-way process

RTW interviews should be a two-way process - managers need to ensure that they gather as much information as possible from the employee by adopting good listening skills and effective, but not interrogatory, questioning.

But employees also need to be clear about where they stand, and managers must communicate what happens next at the end of the interview, perhaps in the form of an action plan. HR professionals should encourage managers to use RTW interviews to seek common ground between their needs as supervisors and the needs of employees - which should focus on restoring health to enable employees to perform at work.

¹"The transformational leadership questionnaire", Leadership and Organisation Development Journal, vol. 21 no.6, pp.280-296.

²Short report to Society of Occupational Medicine annual scientific meeting by Dr Jehimidah Munir, summer 2004.

This article was written by Sarah Silcox, a freelance writer and trainer on employee health issues, sarahsilcox@waitrose.com.