A Model of Supervisor Decision-Making in the Accommodation of Workers with Low Back Pain

Abstract

PURPOSE-To explore supervisors' perspectives and decision-making processes in the accommodation of back injured workers.METHODS-Twenty-three semi-structured, in-depth interviews were conducted with supervisors from eleven Canadian organizations about their role in providing job accommodations. Supervisors were identified through an on-line survey and interviews were recorded, transcribed and entered into NVivo software. The initial analyses identified common units of meaning, which were used to develop a coding guide. Interviews were coded, and a model of supervisor decisionmaking was developed based on the themes, categories and connecting ideas identified in the data. RESULTS-The decision-making model includes a process element that is described as iterative "trial and error" decision-making. Medical restrictions are compared to job demands, employee abilities and available alternatives. A feasible modification is identified through brainstorming and then implemented by the supervisor. Resources used for brainstorming include information, supervisor experience and autonomy, and organizational supports. The model also incorporates the experience of accommodation as a job demand that causes strain for the supervisor. CIHR Author ManuscriptCIHR Author Manuscript CIHR Author Manuscript accommodation decision complexity, which in turn affects the quality of the accommodation option selected. If the employee is unable to complete the tasks or is reinjured during the accommodation, the decision cycle repeats. More frequent iteration through the trial and error process reduces the likelihood of return to work success.CONCLUSIONS-A series of propositions is developed to illustrate the relationships among categories in the model. The model and propositions show: a) the iterative, problem solving nature of the RTW process; b) decision resources necessary for accommodation planning, and c) the impact accommodation demands may have on supervisors and RTW quality.

Obstacles to returning to work with chronic pain: in-depth interviews with people who are off work due to chronic pain and employers

“…Similar to previous research, employers felt larger organisations would be more able to make appropriate work accommodations and enable redeployment [22, 23]. On the other hand there was also a perception that small, family-run businesses may be more accommodating due to a stronger and more considerate relationship with employees.…”

“…Employers in previous studies complained that they were provided with insufficient detail and clarity about activity restrictions by occupational health staff and that unrealistic recommendations were difficult to implement, [21, 23] echoed in our findings. On the other hand, other research suggests that occupational health can be seen by employees with low back pain as being on the side of the organisation rather than the employee [31].…”

The work of return to work. Challenges of returning to work when you have chronic pain: a meta-ethnography

“…Managers’ attitudes and efforts,46 combined with effective routine methods of regular communication of changes made to colleagues,49 were seen as ways of improving the success of workplace adjustments. Managers did not always have the resources or know what options would be available for making these adjustments and saw the planning of these accommodations as an additional demand on their time 46. Managers also felt that information about work restrictions from occupational health was not always realistic in the work setting and therefore difficult to implement 47…”

“…Some struggled in their interaction with employers and tended to be passive, not believing their views were listened to, or valued, which led to difficulties in sustaining work return 12. Unsympathetic employer attitude and a lack of understanding of the person’s experience of pain were seen as major obstacles to work return,13 31 32 43 44 but those employers with personal experience of pain were perceived as more sympathetic and empathic 45 46…”

“…People with chronic pain often felt they were not consulted or involved in the decision making about workplace redeployment or adjustment, and when desired modifications were not possible they could not return to work 43–45 48. Managers’ attitudes and efforts,46 combined with effective routine methods of regular communication of changes made to colleagues,49 were seen as ways of improving the success of workplace adjustments. Managers did not always have the resources or know what options would be available for making these adjustments and saw the planning of these accommodations as an additional demand on their time 46.…”