Experiences of sickness absence among NHS staff: A grounded theory analysis

Abstract

Reducing sickness absence and speeding up return to work following absence is usually beneficial for employees and organisations. However, current theory on sickness absence is not sophisticated enough to meaningfully inform policies which adequately promote employee wellbeing. This research aimed to explore employees’ decisions about taking sickness absence and returning to work and to identify factors which help employees to remain in or return to work. Two studies are presented. Study 1 was a systematic review evaluating the evidence that cognitive-behavioural (CBT) pain management improves work outcomes (return to work, sickness absence and hours worked) in employees with chronic pain. Fifteen studies were reviewed. A meta-analysis of a subgroup of four good or adequate quality studies showed no effect of intervention. Other high and adequate quality studies found no effect of intervention, with one exception. Lower quality studies lacked appropriate control groups, therefore conclusions could not be drawn about their effectiveness. Overall, insufficient evidence was found that CBT pain management improves vocational outcomes. Complex interventions, which target workplace and health issues, may be required. Study 2 was a grounded theory study of sickness absence among NHS staff in South Wales. Face-to-face interviews were conducted with 18 employees. Interviews were transcribed verbatim and analysed using Charmaz’s (2006) approach to grounded theory. A new process model of sickness absence is presented which goes beyond established theories. The establishment of the legitimacy of absence and its negotiation with others, particularly health professionals and managers, were core to the model. The absence process was complex, with different factors becoming important at different points in time, including the type and severity of illness; the work context; the employees’ beliefs about illness and work; their values and support. Line managers had a key role in managing absence but may require additional support and training. Health psychologists should now turn their attention to understanding the specific beliefs which are relevant to absence from work in order to further develop theories of sickness absence