1. Tugman-Swanson, Kristin MS, CRC, LPC
  2. Brimrose, Heidi CRC, CEBS, ALHC

Article Content

A total of 125 million Americans live with a chronic disease, and the United States loses nearly $234 billion a year as a result of the associated lost productivity (Lerner et al., 2001). An effective way to mitigate these losses is through early intervention and transitional return-to-work programs, but myths refuting their effectiveness continue to exist in the workplace and these misconceptions often prevent their effective application. One prevalent myth related to transitional return-to-work is that it encourages light duty work that is not productive for an employer. Structured programs are becoming more important because of changes to the Americans with Disabilities Act, as well as the ongoing risk surrounding the Family and Medical Leave Act (Ring, 2010). Transitional return-to-work programs are very different from long-term job accommodations and they can have a positive impact on an employer's bottom line.


A mistake employers often make is failing to have an accurate sense of the physical requirements needed to successfully perform job functions (Gosner & Archibald, 2010). To make a distinction between transitional work and long-term Americans with Disabilities Act considerations, employers must have a clear understanding of the essential functions, as well as the physical requirements of each position. This will help to identify areas where the job function may be able to be modified for return to work.


Behavioral predictors should also be taken into account when planning for return to work. A significant correlation exists between return to work and social support, work attitude, and willingness to expend effort in the return-to-work initiative (Brouwer et al., 2009).


Transitional Return to Work and Its Value

According to Bose (2009), individuals out of work for 6 months are 50% less likely to return to work, and the likelihood of a return to productivity decreases by another 25% as the leave approaches 1 year. As a result, early intervention, transitional return to work is defined as a modified transition back to full duty over a short period of time (Secord, 2009). The method is designed to capitalize on incremental recovery whereby producing a safe and timely return to work that reduces costs for the employer. Specifically, direct benefit payments for nonoccupational and occupational injuries and illnesses create hardship to a company's bottom line. Indirect costs such as lost productivity, overtime, hiring, and training, however, can far outweigh the cost of direct benefit payments. Early intervention return-to-work strategies can mitigate the associated cost of these long-term absences by 20%-40% (Bose, 2009).


Unum Saved Lost Work Days

Ultimately, transitional return to work is an important and effective strategy for employers, as it reduces disability days, which in turn improves productivity and the employer's bottom line. Unum, the world's leading disability insurance provider, routinely assists employers in their effort to implement early intervention transitional return-to-work programs through its health and productivity consulting team. In tracking the results of these programs, Unum identifies saved lost workdays associated with individual transitional return-to-work plans. Saved lost workdays are defined as days of productivity the employer gained as a direct result of the early return to work associated with the transitional return-to-work plan. In an effort to determine the effectiveness of transitional return-to-work programs, Unum studied its 2009 short-term disability data among 3,967 return-to-work outcomes.


The hypothesis noted for the study was that employers who have a structured transitional return-to-work program will experience significantly higher saved lost workdays than employers without a program. A structured transitional return-to-work program is defined as having transitional return-to-work job modification options, with a defined timeframe for a return to full capacity within one's own occupation. In addition, diagnosis, age, gender, and industry were thought to be mitigating factors related to saved lost workday success.


The results of the study found that employers with structured return-towork programs experienced 151% greater mean saved lost workdays than those without transitional programs. This workplace flexibility was noted as the most significant variable within the study. Age, gender, and diagnosis were not statistically significant factors. Tenure, on the other hand, was statistically significant in that employees with more than 2 years of service demonstrated more saved lost workdays than those with fewer than 2 years of service. This can be plan-design driven, however, in that some employers may not cover employees for short-term disability during the first 1-2 years of employment. Finally, the Standard Industry Classification of the government sector demonstrated significant saved lost workdays associated with transitional return to work, suggesting particular success in this arena.


The Unum study concluded that workplace flexibility associated with a transitional return-to-work program was the single most influential factor in employers experiencing saved lost workdays and increased productivity associated with their return-to-work efforts. A structured program will not only enable employers to remain compliant from a legal perspective but also increase their productivity and increase their saved lost workdays associated with these efforts.


The Process for Implementation

The first step in implementing a program is for employers to understand the physical requirements of each position and the necessary output for an employee to be productive, while understanding the essential physical tasks necessary to achieve that output (Gosner & Archibald, 2010). This knowledge will allow employers to know where tasks can be removed or modified so someone can come back to work and remain productive. As a result, Unum recommends that employers predetermine job modification options in advance of an employee going out on disability and that employers and managers clearly define the essential work product and tasks needed to accomplish that output. In addition, transitions must be time limited and are most effective at less than 6 weeks in duration (Secord, 2009). Managers should also offer time limits for standard transitions so that they are comfortable with the length and its possible impact to surrounding employees.


The longer an employee is out of the work, the less likely he or she is to return to work. Therefore, it is important for a successful program to offer early intervention strategies. These strategies help to identify psychosocial flags that may be present and acting as barriers to return to work. These barriers are often things such as faulty thinking about the disability circumstance, job dissatisfaction, and social isolation with the disability experience. With early intervention and planning, these situations can be recognized and adequately addressed (Watson, 2010).


Ultimately, implementing a transitional return-to-work program through manager engagement and well-defined structure allows for early intervention, as well as the ability to address work attitude, self-efficacy, and social support (Brouwer et al., 2009). In a structured, transitional return-to-work program with predetermined transitional work options and time frames, return-to-work planners can engage in the planning process with employees and physicians on day 1 of absence, allowing for the identification of barriers or flags prohibiting more timely return to work. Furthermore, the program should be seen as a benefit for employees, one that creates a social support within the workplace. An employee's willingness to expend effort is likely to increase if he is aware of the specific tasks he will be performing throughout his transitional work plan, and this process allows the employee to feel more prepared for the return to work (Brouwer et al., 2009).



The costs of both disability and chronic disease are continuing to rise in the United States and transitional return to work is one way to mitigate the cost of employee absences. There are many myths and mistakes employers make associated with transitional return to work, and many employers do not understand the benefit of transitional work versus a 100% full-duty policy. In the end, transitional return to work is an important tool in an employer's effort to reduce the direct and indirect costs associated with employee absence.


Unum performed a study that found that employers with a structured return-to-work program had 151% more saved lost workdays than employers without a transitional return-towork program. While these programs are effective, there are considerations when implementing this process. Specifically, it is important to understand the nature of behavior change for individuals, and early intervention is important in an effort to avoid or address the flags that create barriers to return to work (Watson, 2010).


An effective return-to-work program allows for early intervention in that it engages managers in the development of the program. Specifically, job modifications are identified in advance of a disabling event, allowing immediate planning with employees and physicians on day 1 of a disability. This process will allow employees to address psychosocial issues, as well as establish improved work attitudes and a sense of preparedness for return to work. Ultimately, transitional return-to-work programs can have a significant impact on an employer's bottom line when the employee, the physician, and the manager work together on proactive early intervention.




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