Work resumption at the price of distrust: a qualitative study on return to work legislation in the Netherlands

Abstract

BackgroundReturn to work (RTW) after sick leave is considered necessary to support the employees’ health. Cooperation between employees and employers may encourage employees’ RTW, but is hampered by bottlenecks that we do not completely understand. Dutch legislation means to support this cooperation and allows trying RTW during two years. The Resource Dependence Institutional Cooperation (RDIC) model has been developed for studying cooperation in public health. Study aims were to get insight into the degree of cooperation between Dutch sick-listed employees and employers, how this (lack of) cooperation can be understood, and how valid the RDIC model is for understanding this (lack of) cooperation.MethodsThis qualitative study was based on in-depth interviews with 8 employees and 8 employers. Employees reported sick for 1.5-20 months for various reasons. Interviews were analysed using an interpretative approach and pattern matching.ResultsCooperation was lacking early during sick leave. Later on there were regular meetings, but employers decided about RTW without consulting the employees. Particularly employers were motivated to cooperate during the first year, while employees were especially motivated during the second. This could be understood by experienced dependence; employees (first year) and employers (second year) did not consider cooperation to be important for achieving medical recovery (employees) or RTW (employers). These divergent goals may be understood by personal norms about the timing of medical recovery and RTW. Legislation was particularly effective regarding employer behaviour in year 1 and employee behaviour in year 2. Employees distrusted their employers during the first year, while employers reported to distrust the employees during the second year. Besides, employees and employers experienced a moderate ability to cooperate. This could be understood particularly by having moderate knowledge about legislation. The RDIC model appeared to be valid to understand the cases studied, but the additional factor distrust also played a role.ConclusionsLegislation appeared to support cooperation, but awareness of a mutual dependence, trust, knowledge about the legislation and personal norms regarding recovery and RTW are also important. Professionals such as occupational physicians should support this to attain a degree of cooperation that is necessary for effective RTW.

“Dis-able bodied” or “dis-able minded”: stakeholders’ return-to-work experiences compared between physical and mental health conditions

“…Previous research also showed how employers in the Netherlands used the legislation to force meetings with the sick-listed employee out of distrust regarding the employee's (in)ability to work. [10] These observations nuance earlier quantitative findings suggesting that the Dutch legislation promotes the RTW of long-term sick-listed employees more than the Danish legislation, [40] since statistics remain rather silent on how workplace actors actually experience the RTW process. [41] It may be assumed that negative experiences, such as feelings of being pushed, impair (the sustainability of) the RTW and damage the employment relationship.…”

“…Several studies demonstrated that employers appear to have the upper hand in decisions about RTW issues, for example about work(place) adjustments or the timing and speed of the RTW. [9][10][11][12] In making these decisions, employers seem to base their approach, inter alia, on their perceptions of the sick-listed employee's image, attitude, personality and openness about the illness and the RTW. [13,14] Moreover, employers' actions appear influenced by the value and the replaceability of the sick-listed employee, and by the presence of goodwill and trust.…”

“…[6,9,11,12,15,16,18] As a result, the limited available research has proven inconclusive so far: While some literature reviews suggest the existence of similarities between RTW experiences in physical (here, musculoskeletal) and mental health conditions, [23] such as the importance of work adjustments, [4,25] qualitative studies noted differences in RTW experiences between both health conditions. For instance, with regard to early contact, Tjulin et al [26] found that supervisors and coworkers felt that the timing of the RTW should vary between physical and mental illnesses, and Hoefsmit et al [10] observed that in mental cases, supervisors and employees tended to not have early contact, compared to physical cases. The inconclusiveness of evidence leaves a significant gap in the existing literature, since understanding how the RTW process can be tailored (or might not need to be tailored) to the needs of the physically or mentally sick-listed employee may promote an earlier RTW, and in so doing create a "win-win situation" [17,26] for all parties involved.…”

“…Since legislation has been shown to affect workplace stakeholders' RTW behavior, [10,27] for instance by giving actors their "teeth" to act, [28] this research examined actual RTW processes in two countries to take this influence into account: the Netherlands and Denmark. These countries are viewed as frontrunners in the "activation" of sick-listed employees to RTW early, [29,30] yet differ regarding the degree to which workplaces are given a statutory role in this process.…”

Theoretical perspectives upon the return to work of cancer patients: The difficult path of integration in the organization

“…At the same time, in an Australian organizational setting, McKay, Knott and Delfabbro (2013) found also there is a lack of knowledge among managers concerning the procedures and attitudes imposed by RTW and cancer patients. Moreover Hoefsmit, de Rijk and Houkes (2013) observed that even if the legislation supports the idea of cooperation between employer and employee in the case of RTW and illness recovery, there are low levels of information, knowledge, trust and motivation to cooperate among the two sides.…”