Impediments to Disability Accommodation

The results of a qualitative field investigation exploring how tripartite relationships affect disability accommodations are reported. Arbitration cases, in-depth interviews and other documentation are analyzed using grounded theory techniques. Four key categories emerge as contributors to difficult accommodations. The first category suggests that managerial reluctance and bias may stem from added workload or from questions about disability credibility. It further demonstrates how trust issues spill over to affect future accommodations. The second category, employee involvement, indicates that excluding the disabled employee from accommodation planning occurs frequently and has a negative affect on communication patterns, again damaging trust. The third category, ineffective investigation, highlights the difficulty managers have balancing confidentiality requirements: over-investigating illness legitimacy and under-investigating accommodation options. The final category, union-management climate, looks at union roles in accommodation and suggests that while unions often play a unique and positive role, substantial union-management animosity taints return-to-work efforts.L’accommodement en milieu de travail dans les cas d’incapacité peut semer la confusion et apparaître compliqué. Il y a rarement des solutions toutes faites car chaque situation présente un ensemble unique de circonstances. Quand un salarié est frappé d’une incapacité, on exige de l’employeur et du syndicat qu’ils fassent tous les efforts raisonnables pour arriver à un accommodement. Parfois chacun en sort content, le salarié retourne à son travail et progresse d’un emploi adapté à sa condition vers un retour à ses pleines responsabilités ou bien on lui trouve un travail adapté à son incapacité avec assez de facilité. Dans d’autres situations, cependant, le processus d’accommodement est semé d’embûches et peut donner lieu à un litige.Alors, on doit se demander qu’est-ce qui fait la différence entre ces deux scénarios ? Y a-t-il quelque chose que les employeurs ou les syndicats font qui puisse diminuer les chances de succès de l’accommodement raisonnable en milieu de travail ?Nous avons examiné soixante-douze décisions arbitrales (qui représentent plus de 1500 pages de texte) et effectué vingt-trois entrevues en profondeur. Nous avons ensuite analysé toutes ces informations à l’aide de techniques de codage appuyées sur des méthodes d’analyses théoriques pour tenter d’identifier les facteurs qui, dans une relation tripartite, peuvent affecter négativement le retour au travail. Quatre catégories de facteurs contribuant à rendre l’accommodement plus difficile se sont dégagées de l’analyse de données : 1) l’attitude de l’employeur, 2) l’implication du salarié, 3) une enquête inefficace, 4) le climat des relations du travail.Dans la première catégorie, celle de l’attitude de l’employeur, la recherche montre que les employés ayant besoin d’un accommodement perçoivent fréquemment des préjugés ou des actions prises à leur égard à contrecoeur. Les données nous suggèrent que dans plusieurs occasions ces perceptions peuvent être exactes. La latitude de l’employeur dans le choix des mesures d’accommodement peut aussi permettre l’exercice de traitements privilégiés. Ainsi, dans certains cas, des travailleurs peuvent récolter les avantages d’un accommodement exceptionnel, alors que d’autres peuvent être forcés d’accepter des offres rigides et défavorables imposées par des supérieurs moins sympathiques.Les données tirées des cas indiquent que des préjugés peuvent aussi survenir du fardeau additionnel que placent sur les employeurs les exigences de l’accommodement compte tenu du peu de récompense pour leurs efforts. D’autres préjugés peuvent aussi apparaître si les employeurs mettent en doute la crédibilité des salariés au sujet de la légitimité de leur incapacité ou des restrictions prescrites. Ceci se traduit parfois dans des accommodements qui visent à punir les salariés handicapés. La résistance des employeurs, quelle soit perçue ou authentique, est importante parce que : a) elle accentue le conflit et la mauvaise communication; b) elle diminue la qualité de l’accommodement offert; c) elle diminue l’engagement du salarié impliqué à l’endroit de l’organisation et du processus de retour au travail. De plus, il existe une certaine preuve à l’effet que l’expression d’enthousiasme de la part de l’employeur à l’endroit des mesures d’accommodement et du retour de l’employé a été observée et imitée par des collègues de travail, ce qui peut en avoir amplifié les effets.Le deuxième thème qui s’est dégagé de l’analyse a été l’exclusion de la personne atteinte de l’incapacité dans la planification de l’accommodement en vue de son retour au travail. Cette exclusion n’est pas nécessairement voulue. Cependant, la preuve laisse croire que, si elle n’est pas explicitement intégrée aux responsabilités et aux rôles des employeurs, il est fort probable qu’on n’y porte pas attention. L’étude de cas démontre que le fait d’exclure ainsi les employés concernés peut résulter en une incompréhension à l’égard des aptitudes de ces salariés, de leur volonté de travailler ou bien à l’égard du désir de l’employeur de les voir réintégrer le travail. À moins que l’employeur invite le salarié à assister aux discussions sur la planification du retour au travail, ce dernier ne sera probablement pas renseigné sur les options envisagées, les considérations inhérentes à la production ou encore les limites dans l’établissement des horaires de travail, qui peuvent exercer une influence sur l’offre finale d’accommodement. Cela peut par inadvertance soulever des questions, même dans l’esprit des employés qui jouissent d’excellentes mesures d’accommodement eu égard à l’effort ou à la qualité de l’accommodement.Le troisième thème qui est ressorti des données est la confusion tant chez les employeurs que chez les salariés au sujet de l’équilibre à conserver entre une enquête suffisante sur l’incapacité et le harcèlement des employés. Dans 64 % des cas où les griefs ont été maintenus, les arbitres ont statué que l’échec des employeurs face à une investigation correcte permettait de conclure que l’obligation d’accommodement n’avait pas été rencontrée. Les employeurs ne réussissaient pas à colliger suffisamment d’information eu égard à l’ampleur de la maladie de l’employé, à sa capacité fonctionnelle ou aux ajustements possibles à ses tâches qui faciliteraient l’accommodement. Dans d’autres circonstances, les employeurs ont outrepassé les liens de confidentialité ou bien ils ont harcelé les employés lorsqu’ils ne croyaient pas à l’authenticité de leur incapacité ou de leurs limitations.La dernière catégorie, celle qui concerne le climat des relations patronales-syndicales, montre que les syndicats ont un rôle unique et positif à jouer pour faciliter le retour au travail des employés. Les rôles qui nous ont été décrits en entrevue et qui ont contribué à des accommodements réussis incluaient : a) l’assistance aux employés frappés d’une incapacité auprès des organismes publics d’indemnisation des travailleurs ou auprès des assureurs privés; b) l’offre d’un support psychologique et d’aide dans le labyrinthe des processus administratifs de retour au travail; c) le maintien d’un lien avec les salariés absents de leur travail pendant leur convalescence et, enfin, d) l’insistance auprès des employeurs pour qu’ils regardent de plus près lorsqu’une solution convenable n’apparaît pas immédiatement évidente.Par contre, de mauvaises relations patronales-syndicales jouent parfois un rôle très destructeur en brouillant les communications et en interférant au moment de l’identification des options d’accommodation. Dans ces entreprises, les syndicats sont perçus par les employeurs comme des institutions politiques démontrant peu de considération pour le bien-être de leurs membres. Les dirigeants syndicaux ont été accusés d’obstruction à des tentatives d’accommodement en refusant des croisements de groupes de salariés ou en avisant les employés de ne pas divulguer de l’information médicale. Une méfiance à l’endroit des motifs du syndicat était constamment manifestée par les dirigeants qui soutenaient qu’un raisonnement propre au monde des affaires pouvait être retenu comme une manière d’expliquer l’approche plutôt prudente mise de l’avant par le syndicat face au processus de retour au travail. Les attitudes négatives ont même été observées par des travailleurs du secteur de la santé, qui considéraient l’environnement de travail empoisonné, ralentissant le processus d’accommodement et interférant avec la confiance entre le personnel médical et les employés handicapés.En conclusion, nous soulignons les apports uniques de cette recherche et nous recommandons des avenues potentiellement fructueuses pour d’autres travaux sur le sujet.Se presenta aquí los resultados de un estudio cualitativo de terreno que explora cómo las relaciones tripartitas afectan la acomodación de discapacitados. Utilizando las técnicas de la teoría enraizada, se analizaron casos de arbitraje, entrevistas en profundidad y otros documentos. Cuatro categorías claves emergen como elementos que dificultan las acomodaciones. La primera categoría sugiere que la falta de interés y suspicacia de parte de los directivos pueden provenir de la carga de trabajo agregada o de cuestiones relativas a la credibilidad de la invalidez. Se demuestra, más adelante, cómo estas cuestiones de confianza desbordan afectando las acomodaciones futuras. La segunda categoría, la implicación de los empleados, indica que el empleado discapacitado es frecuentemente excluido de la planificación de la acomodación y que esto tiene un efecto negativo en el modelo de comunicación, dañando una vez más la confianza. La tercera categoría, la investigación ineficaz, resalta la dificultad que los directivos experimentan para equilibrar los requerimientos de confidencialidad: investigación excesiva sobre la legitimidad de la enfermedad e investigación insuficiente de las opciones de acomodación. La última categoría, el clima de las relaciones patronal-sindicales, señala el rol de los sindicatos en la acomodación y sugiere que mientras los sindicatos juegan con frecuencia un rolo único y positivo, la animosidad sustancial de las relaciones patronal-sindicales empañan los esfuerzos de retorno al trabajo

Workplace Interventions to Prevent Disability from Both the Scientific and Practice Perspectives: A Comparison of Scientific Literature, Grey Literature and Stakeholder Observations

Purpose The significant individual and societal burden of work disability could be reduced if supportive workplace strategies could be added to evidence-based clinical treatment and rehabilitation to improve return-to-work (RTW) and other disability outcomes. The goal of this article is to summarize existing research on workplace interventions to prevent disability, relate these to employer disability management practices, and recommend future research priorities. Methods The authors participated in a year-long collaboration that ultimately led to an invited 3-day conference, Improving Research of Employer Practices to Prevent Disability, held October 14?16, 2015, in Hopkinton, Massachusetts, USA. The collaboration included a topical review of the literature, group conference calls to identify key areas and challenges, drafting of initial documents, review of industry publications, and a conference presentation that included feedback from peer researchers and a question/answer session with an expert panel with direct employer experience. Results Evidence from randomized trials and other research designs has shown general support for job modification, RTW coordination, and organizational support, but evidence is still lacking for interventions at a more granular level. Grey literature reports focused mainly on job re-design and work organization. Panel feedback focused on organizational readiness and the beliefs and values of senior managers as critical factors in facilitating changes to disability management practices. While the scientific literature is focused on facilitating improved coping and reducing discomforts for individual workers, the employer-directed grey literature is focused on making group-level changes to policies and procedures. Conclusions Future research might better target employer practices by tying interventions to positive workplace influences and determinants, by developing more participatory interventions and research designs, and by designing interventions that address factors of organizational change. Electronic supplementary material The online version of this article (doi:10.1007/s10926-016-9664-z) contains supplementary material, which is available to authorized users

The Job Accommodation Scale (JAS): Psychometric Evaluation of a New Measure of Employer Support for Temporary Job Modifications

The final publication is available at Springer via http://dx.doi.org/10.1007/s10926-014-9508-7An employer offer of temporary job modification is a key strategy for facilitating return-to-work for musculoskeletal conditions, but there are no validated scales to assess the level of support for temporary job modifications across a range of job types and organizations. Objective To pilot test a new 21-item self-report measure [the Job Accommodation Scale (JAS)] to assess its applicability, internal consistency, factor structure, and relation to physical job demands. Methods Supervisors (N = 804, 72.8 % male, mean age = 46) were recruited from 19 employment settings in the USA and Canada and completed a 30-min online survey regarding job modification practices. As part of the survey, supervisors nominated and described a job position they supervised and completed the JAS for a hypothetical worker (in that position) with an episode of low back pain. Job characteristics were derived from the occupational informational network job classification database. Results The full response range (1–4) was utilized on all 21 items, with no ceiling or floor effects. Avoiding awkward postures was the most feasible accommodation and moving the employee to a different site or location was the least feasible. An exploratory factor analysis suggested five underlying factors (Modify physical workload; Modify work environment; Modify work schedule; Find alternate work; and Arrange for assistance), and there was an acceptable goodness-of-fit for the five parceled sub-factor scores as a single latent construct in a measurement model (structural equation model). Job accommodations were less feasible for more physical jobs and for heavier industries. Conclusions The pilot administration of the JAS with respect to a hypothetical worker with low back pain showed initial support for its applicability, reliability, and validity when administered to supervisors. Future studies should assess its validity for use in actual disability cases, for a range of health conditions, and to assess different stakeholder opinions about the feasibility of job accommodation strategies.This research was supported by CIHR Grant MOP-102571, Supervisors’ perspectives on accommodating back injured workers: a mixed-methods study (PI: V Kristman) and by intramural research funding (Project LMRIS 09-01) of the Liberty Mutual Research Institute for Safety (PI: W Shaw).http://dx.doi.org/10.1007/s10926-014-9508-

Physical activity and exercise interventions in the workplace impacting work outcomes: a stakeholder-centered best evidence synthesis of systematic reviews

Open access article. Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0) appliesBackground: The prevention of work disability is beneficial to employees and employers,, and mitigates unnecessary societal costs associated with social welfare. Many service providers and employers have initiated workplace interventions designed to reduce unnecessary work disability. Objective: To conduct a best-evidence synthesis of systematic reviews on workplace interventions that address physical activities or exercise and their impact on workplace absence, work productivity or financial outcomes. Methods: Using a participatory research approach, academics and stakeholders identified inclusion and exclusion criteria, built an abstraction table, evaluated systematic review quality and relevance, and interpreted the combined findings. A minimum of two scientists participated in a methodological review of the literature followed by a consensus process. Results: Stakeholders and researchers participated as a collaborative team. 3363 unique records were identified, 115 full text articles and 46 systematic reviews were included, 18 assessed the impact of physical fitness or exercise interventions. 11 focused on general workers rather than workers who were absent from work at baseline; 16 of the reviews assessed work absence, 4 assessed productivity and 6 assessed financial impacts. Conclusion: The strongest evidence supports the use of short, simple exercise or fitness programs for both workers at work and those absent from work at baseline. For workers at work, simple exercise programs (1–2 modal components) appear to provide similar benefits to those using more complex multimodal interventions. For workers off-work with subacute low back pain, there is evidence that some complex exercise programs may be more effective than simple exercise interventions, especially if they involve workplace stakeholder engagement, communication and coordination with employers and other stakeholders. The development and utilization of standardized definitions, methods and measures and blinded evaluation would improve research quality and strengthen stakeholder-centered guidance.Ye

Job demand and control interventions: a stakeholder-centered best-evidence synthesis of systematic reviews on workplace disability

Open access article. Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0) appliesBackground: Physical and psychological job demands in combination with the degree of control a worker has over task completion, play an important role in reducing stress. Occupational stress is an important, modifiable factor affecting work disability. However, the effectiveness of reducing job demands or increasing job control remains unclear, particularly for outcomes of interest to employers, such as absenteeism or productivity. Objective: This systematic review reports on job demand and control interventions that impact absenteeism, productivity and financial outcomes. Methods: A stakeholder-centered best-evidence synthesis was conducted with researcher and stakeholder collaboration throughout. Databases and grey literature were searched for systematic reviews between 2000 and 2012: Medline, EMBASE, the Cochrane Database of Systematic Reviews, DARE, CINAHL, PsycINFO, TRIP, health-evidence.ca, Rehab+, National Rehabilitation Information Center (NARIC), and Institute for Work and Health. Articles were assessed independently by two researchers for inclusion criteria and methodological quality. Differences were resolved through consensus. Results: The search resulted in 3363 unique titles. After review of abstracts, 115 articles were retained for full-text review. 11 articles finally met the inclusion criteria and are summarized in this synthesis. The best level of evidence we found indicates that multimodal job demand reductions for either at-work or off-work workers will reduce disability-related absenteeism. Conclusion: In general, the impacts of interventions that aim to reduce job demands or increase job control can be positive for the organization in terms of reducing absenteeism, increasing productivity and cost-effectiveness. However, more high quality research is needed to further assess the relationships and quantify effect sizes for the interventions and outcomes reviewed in this study.Ye

Social support and supervisory quality interventions in the workplace: a stakeholder-centered best-evidence synthesis of systematic reviews on work outcomes

Open access article. Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0) appliesBackground: There is controversy surrounding the impact of workplace interventions aimed at improving social support and supervisory quality on absenteeism, productivity and financial outcomes. Objective: To determine the value of social support interventions for work outcomes. Methods: Databases were searched for systematic reviews between 2000 and 2012 to complete a synthesis of systematic reviews guided by the PRISMA statement and the IOM guidelines for systematic reviews. Assessment of articles for inclusion and methodological quality was conducted independently by at least two researchers, with differences resolved by consensus. Results: The search resulted in 3363 titles of which 3248 were excluded following title/ abstract review, leaving 115 articles that were retrieved and underwent full article review. 10 articles met the set inclusion criteria, with 7 focusing on social support, 2 on supervisory quality and 1 on both. We found moderate and limited evidence, respectively, that social support and supervisory quality interventions positively impact workplace outcomes. Conclusion: There is moderate evidence that social support and limited evidence that supervisory quality interventions have a positive effect on work outcomes.Ye

Mental health interventions in the workplace and work outcomes: a best-evidence synthesis of systematic reviews

Open access article. Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0) appliesBackground: Mental health issues in the workplace are a growing concern among organizations and policymakers, but it remains unclear what interventions are effective in preventing mental health problems and their associated organizational consequences. This synthesis reports on workplace mental health interventions that impact absenteeism, productivity and financial outcomes. Objective: To determine the level of evidence supporting mental health interventions as valuable to work outcomes. Methods: Databases were searched for systematic reviews between 2000 and 2012: Medline, EMBASE, the Cochrane Database of Systematic Reviews, DARE, CINAHL, PsycINFO and TRIP. Grey literature searches included health-evidence.ca, Rehab+, National Rehabilitation Information Center (NARIC), and Institute for Work and Health. The assessment of articles for inclusion criteria and methodological quality was conducted independently by two or more researchers, with differences resolved through consensus. Results: The search resulted in 3363 titles, of which 3248 were excluded following title/abstract review, with 115 articles retrieved for full-text review. 14 articles finally met the inclusion criteria and are summarized in this synthesis. Conclusion: There is moderate evidence for the effectiveness of workplace mental health interventions on improved workplace outcomes. Certain types of programs, such as those incorporating both mental and physical health interventions, multicomponent mental health and/or psychosocial interventions, and exposure in vivo containing interventions for particular anxiety disorders had a greater level of research evidence to support their effectiveness.Ye

The twilight of the Liberal Social Contract? On the Reception of Rawlsian Political Liberalism

This chapter discusses the Rawlsian project of public reason, or public justification-based 'political' liberalism, and its reception. After a brief philosophical rather than philological reconstruction of the project, the chapter revolves around a distinction between idealist and realist responses to it. Focusing on political liberalism’s critical reception illuminates an overarching question: was Rawls’s revival of a contractualist approach to liberal legitimacy a fruitful move for liberalism and/or the social contract tradition? The last section contains a largely negative answer to that question. Nonetheless the chapter's conclusion shows that the research programme of political liberalism provided and continues to provide illuminating insights into the limitations of liberal contractualism, especially under conditions of persistent and radical diversity. The programme is, however, less receptive to challenges to do with the relative decline of the power of modern states

Constitutivism

A brief explanation and overview of constitutivism

Philosophy of action

The philosophical study of human action begins with Plato and Aristotle. Their influence in late antiquity and the Middle Ages yielded sophisticated theories of action and motivation, notably in the works of Augustine and Aquinas.1 But the ideas that were dominant in 1945 have their roots in the early modern period, when advances in physics and mathematics reshaped philosophy