The role of vocational rehabilitation in the human resources management
Riitta Seppänen-Järvelä 1
1 The Social Insurance Institution of Finland, Helsinki, Finland
Abstract
Employers increasingly develop and implement workplace disability management policies and practices. This article provides new insight into the human resource (HR) managers’ perceptions of and attitudes regarding disability management. While several studies have shed light on the important role of managers and co-workers in terms of work disability management processes, very little is known about the contribution of human resource management (HRM). The data consisted of individual interviews with selected (N=10) HR managers. Deductive orientation was adopted in the qualitative content analysis. The structure of the analysis was based on the study on disability management paradigms. The theory-based disability management paradigms have contributed remarkably to HR managers’ knowledge of workplace factors affecting disability. The disability management paradigm dominated informants’ perceptions; moreover, the emergent and strengthening pattern was the occupational wellness paradigm. The ergonomics paradigm and the worker’s right paradigm had lesser significance in the data.
Keywords
Content analysis, human resource manager, organizational management, personnel management, work disability management, work disability prevention
Introduction
In recent years, employers have launched a variety of programs and established practices to promote job retention and the return to work (RTW). Factors such as aging workforce and growing prevalence of chronic health conditions motivate employers to control work-related disability costs (Gensby et al., 2014; Reiman et al., 2017; Shaw et al., 2016; Williams & Westmorland, 2002). Nowadays, HR managers are playing an increasingly important role in the workplace health management (Haafkens et al., 2011) along with occupational health service providers who, in the past, had the main responsibility. One of the important factors behind the change is the paradigm shift from a biomedical model to a disability paradigm that considers a person’s broader situation (Loisel et al., 2001). However, there is no single shared definition of work disability. Definitions and conceptualizations vary in accordance with their purpose, the context of emergence, epistemological assumptions, and underlying paradigm (Lederer et al., 2014).
According to the holistic view of work disability (Loisel et al., 2001; Loisel et al., 2005), a wide variety of stakeholders, i.e. employee, employer, occupational or health service provider, insurance provider, and rehabilitation service provider, are involved in the work disability process. In this sense, inter-organizational and inter-professional communication, cooperation, and integration are vital components of work disability management (Liukko & Kuuva, 2016); they are both barriers and facilitators and could be understood as two sides of the same coin (Andersson et al., 2011).
Workplace disability management comprises a wide variety of activities: workplace injury prevention programs, early intervention and rehabilitation programs, and early and safe return to work for injured and disabled workers (Gensby et al., 2014; Williams & Westmorland, 2002). Research in the field has focused on three organizational challenges for employers: 1) facilitating RTW, 2) enabling one’s ability to remain working, 3) providing workplace accommodation and support for workers with disabilities (Nevala et al. 2015; Shaw et al., 2016). Active workplace involvement is a fundamental component of a successful and sustainable return to work and ability to remain working (Williams-Whitt et al., 2016). Nevertheless, because of the limitation of the data inclusion criteria, the effectiveness of workplace-based disability management programs in promoting RTW is unclear according to a review by the Campbell Collaboration. However, the review provides valuable information about the core components regarding the implementation of RTW activities. (Gensby et al., 2014.)
In general, leadership plays an important role in employee satisfaction, well-being at work, sickness absences, and disability pensions (Kuoppala et al., 2008). In RTW, supervisors’ supportive behavior has been viewed as essential: a supervisor initiates, facilitates, and manages the RTW process (Holmgren & Dahlin Ivanoff, 2007; Jensen Stochkendahl et al., 2015; MacEachen et al., 2006; Negrini et al., 2017; van Oostrom et al., 2009). To the same extent, an association has been found between lack of managerial support and poor RTW outcomes (Ahlstrom & Dellve, 2011). Supervisors experienced similar challenges, such as balancing between ethical and managerial principles and economic pressures, when conducting RTW (Jensen Stochkendahl et al., 2015) and occupational health and safety activities (Tappura et al., 2014). Leadership competencies, behaviors, communication skills, and knowledge of RTW processes enhance an employee’s return to work (Aas et al., 2008; Johnston et al., 2015). Context-related organizational factors, such as workplace social climate, co-workers’ attitudes, and social relationships, influence the RTW processes (Andersen et al., 2014; Tjulin et al., 2011). An immediate supervisor may be forced to face the conflicting goals and priorities of the stakeholders involved in the RTW process (Haafkens et al., 2011). Support from supervisors and co-workers is one of the essential factors that requires more attention in both research and practice (Williams-Whitt et al., 2016).
Generally, HR professionals are involved in wellness and work disability management processes to the extent relevant to their own position. They master, co-ordinate, integrate, communicate, and handle a wide variety of work disability management issues from individual employee cases to issues on the strategic human resource management level (James et al., 2002). In terms of work disability management, HR managers hold a central and influential position in a particular organizational context (Haafkens et al., 2011; Seppänen-Järvelä, 2018). There is also some evidence that the processes led by the HR function are economical for the employer (Reiman et al., 2017). There is an increasing need to base the workplace disability management practices and policies, for example in RTW activities, on the knowledge of evidence-based interventions (Costa-Black, 2013). From this perspective, it is important to produce knowledge about HR managers’ experiences and perceptions, since they formulate and implement policies and strategies aimed at facilitating one’s ability to remain at work and return to work.
Disability management paradigms
While several studies have shed light on the important position of managers and co-workers within the work disability management process, very little is known about the contribution of other actors, such as HR management personnel. Within the literature on human resource management, research concerning health and disability management is practically absent (Haafkens et al., 2011; James et al., 2002). The current study provides insight into the HR managers’ perceptions and attitudes toward disability management. In essence, this article scrutinizes how the theory-based disability management paradigms (Shaw et al., 2013) have contributed to HR managers’ knowledge of workplace factors affecting disability.
Shaw et al. (2013) have classified four different paradigms that have framed the existing knowledge concerning workplace factors that influence disability. The paradigms are: 1) the disability management paradigm, 2) the ergonomics paradigm, 3) the workers’ right paradigm, and 4) occupational wellness paradigm.
The first paradigm is “the disability management paradigm”, which focuses on the assessment of organizational policies and practices as a critical workplace issue in disability management. Within this perspective, there are studies on organizational factors such as supervisor and co-worker support, job modifications efforts, and RTW programs (e.g. Gensby et al., 2014; Williams-Whitt et al., 2016). Reducing costs via effective disability management strategies (e.g. Reiman et al., 2017), such as proactive RTW programs or monitored work absences, has been an important impetus for the researchers as well as for employers. (Shaw et al., 2013.)
The second paradigm, “ergonomics”, has provided an important framework for the assessment of job characteristics that, combined with an employee’s health limitations, result in disability. This paradigm has operated on individual level and the methods of assessment have been observation, self-report of workers, and instrumented measurement. A key perspective of the research concerns environmental design and work environment (e.g. Bégat et al., 2005). For the employers, the focus has been on reducing workplace risk factors and improving the employees’ safety at work. (Shaw et al., 2013.)
“The worker’s right paradigm” has focused on challenging issues, such as stigmatization, that individuals with physical or mental disorders face in working life. Research within the paradigm has produced knowledge about workplace accommodation and assistive technologies that could support people with disabilities within the workplace (e.g. Nevala et al. 2015; Wong et al. 2021). Furthermore, policies and legislative acts regarding disability rights, which have been adopted in many countries, have influenced research and formed a significant collective imperative for employers to promote the workplace inclusion of people with disabilities. (Shaw et al., 2013.)
The implicit goals for the rising ‘occupational wellness paradigm” include improved worker ability, fitness and job satisfaction, reduced employer costs, and increased wellness culture. This paradigm has motivated many current disability management programs and practices and endorsed a broader view of disability management. Societal perspective has been the key viewpoint in the occupation wellness paradigm, and work and family conflict, worksite health promotion for example stress management (e.g. Richardson, 2017) and disease and symptom management have been the potential sample factors. (Shaw et al., 2013.)
Data and methods
The analysis conducted in the present study was based on the data collated in the evaluation research of an innovative vocational rehabilitation program[1] (TK2) conducted in 2012-2014 in Finland (Seppänen-Järvelä et al., 2015a; Seppänen-Järvelä et al., 2015b). Close collaboration with employers (N=27), employees (N=233), occupational health services (N=27), and rehabilitation service providers (N=5) was expressed as one of the key elements in the work-related rehabilitation program. In addition, the rehabilitation should be flexible and correctly timed in accordance with both the individual’s and employer’s needs.
The data collated in the above-mentioned evaluation research consisted of HR managers’ interviews focusing on their experiences with work-related rehabilitation in the program and perceptions on job retention and work disability management. A prior analysis of the HR specialists’ views on vocational rehabilitation as a part of workplace disability management brought out that when rehabilitation was expected to be a work community-based and work-related activity, the importance of the interaction between a supervisor and an employee was underlined. An individual employee’s agency and responsibility in terms of maintaining one’s work ability was highlighted. (Seppänen-Järvelä, 2018). In the present study, the interview data was revisited to shed light on the HR managers’ perceptions of disability management by applying the classification of disability management in the analysis.
The data consisted of individual interviews with selected (N=10) HR managers involved in the project. In the organizations, they were tasked with job retention and work disability management processes. In addition, they were the employer’s designated contact persons for the project. In this sense, the data were dictated by the project context. The strategy for the selection of the informants was information-oriented selection (Flyvberg, 2015): the selection criterion was to incorporate a wide variety of organizations in the data. Half of the interviewees were from public organizations (municipalities) and half were from the private sector, representing construction and maintenance, banking, transportation, and trading. All of the organizations employed more than 300 people.
There were eight female and two male interviewees, who all gave informed consent. Prior to the interviews, written information about the study was distributed to the informants. The ethical board of the Social Insurance Institution of Finland carried out the ethical review.
Because the interviews were harnessed primarily to the evaluation of the program, they focused on themes like “necessity and individuality of rehabilitation” and “benefit and effect”. The informants, however, talked broadly about their experiences of work-related rehabilitation and perceptions of job retention and work disability management. Thematic interviews remained open-ended and assumed a conversational manner (Rubin & Rubin, 2005). Each of the interviews lasted approximately 40 min. The author conducted all of the interviews, and a professional transcriptionist transcribed them. The data comprised 80 single-spaced pages of transcribed text.
The manifest content of the data was analyzed using the Atlas.ti qualitative analysis program (Atlas-ti). The data were reviewed several times during the analysis process in order to gain a deeper understanding and to confirm the coding consistency. The deductive content analysis (Elo & Kyngäs, 2007; Hsieh & Shannon, 2005) supplemented with the inductive analysis was founded on the classification of the disability management paradigms (Shaw et al., 2013).
[1] The foundation of the current KIILA vocational rehabilitation service provided by Kela is based on the knowledge produced in the TK2 program.
Results
As a result of the analysis, three workplace disability management paradigms (Shaw et al., 2013) were identified in the data: 1) disability management paradigm, 2) ergonomics paradigm, and 3) occupational wellness paradigm. They were classified into subcategories according to their content.
Disability management paradigm. The most important goal of disability management is to support work ability and reduce discomforts for individual workers. A strong preventive tone was apparent in the significance the interviewed HR managers assigned to disability management. For instance, they typically preferred to use the term work ability instead of work disability. The informants mentioned reducing disability costs as an implicit target for the disability management. On the one hand, they talked about reducing the costs; on the other hand, they highlighted the employer’s social responsibility rather than economic incentives as a motivating factor for disability management. As expressed in the following quote, the ability to act in a socially responsible way is based on corporate values:
“We want to act responsively. One aspect of our corporate values is that we care about people.” (P10)
All of the informants described a variety of disability management procedures used in their organizations. Within the data, it was characteristic for the interviewees to talk about both organization-level procedures and individual worker-level issues. Often, the two levels were interwoven.
Ongoing monitoring for health risks and absences and the importance of early intervention were commonly discussed. HR managers were knowledgeable about the potential disability risks of the personnel; bigger employers applied various HR databases in monitoring staff performance, engagement and development. Despite the use of the data produced by the HR information systems, the HR managers stated that they used a lot of informal information on disability management as well. For example, in order to define the target group and to select the participants for the rehabilitation program, the interviewed HR managers either worked actively in close cooperation with occupational service providers or cooperated dynamically within the work organization, especially with supervisors. Furthermore, they underlined the vital role of the supervisors in disability management implementation. The information and knowledge exchange with supervisors was seen as being particularly important for the HR managers:
“It’s the supervisor who knows the staff. Here in the HR department, we don’t know when there has been a warning signal or when early intervention might be needed.” (P10)
Symptom management, along with work accommodations, were closely related to the disability management procedures and could be understood as one aspect of those procedures. The focus of symptom management was on prevalent chronic diseases such as musculoskeletal, mental, and cardiovascular conditions. However, the informants recognized work disability as a social phenomenon rather than a biomedical condition causing impairment and, thereby, challenging the work performance. This point of view cropped out in the informants’ comprehensive view of work disability; they talked about contextual factors and social characteristics associated with health problems and disabilities:
“— there are concrete modifications that can be done within the workplace, for example, individual adjustments to a job or flexibility in working hours. Often, these modifications also extend to the employee’s personal life.” (P7)
In terms of vocational rehabilitation, HR managers expressed the significance of preventive actions. Generally, they thought that early intervention might decrease sick leaves and prevent chronic problems. One interviewee described a situation where the condition of a relatively young worker had become so bad that rehabilitation was no longer an option. The person was not able to work any longer and retirement was inevitable. This was a loss for the worker and the employer as well as for society at large. The informant summed up the case in the following quotation:
“We must react in time before people reach the point at which they can no longer continue in working life…. otherwise we face a lot of unnecessary early retirements.” (P1)
According to the informants, the employer’s intentions for disability management are to support, or even to empower, employees. Rehabilitation was understood as an employee benefit and a means to stand one in good stead. However, the interviewees recognized that it was also in the employers’ interest, albeit primarily economical.
The ergonomics paradigm. The HR managers who represented areas of industry that involve physical job demands often raised issues concerning the physical work environment and ergonomics. Typically, ergonomics referred to a broader organizational health and safety policy or an individual employee’s workplace accommodation. The informants expressed the importance of early intervention and supportive workplace practices, especially in terms of the supervisors’ active involvement: It was essential that each supervisor had sufficient knowledge about ergonomics, job re-design, and the importance of supporting workers.
When the interviewed HR managers spoke about ergonomics issues concerning the physical work environment, they scrutinized them in the broader context by relating an individual worker’s case to the organizational milieu:
‘How should one ensure good ergonomics and, for example, a safe work posture for a mechanic who fixes things in a challenging location or position – – but then we have to consider the big picture in terms of the organization as well, because the organization has the ability to affect an individual employee’s job and the management culture as well as to affect changes in the working methods.’ (P6)
The occupational wellness paradigm. Many of the interviewed HR managers talked about health promotion and the need to increase the wellness culture as a preventive measure. The significance of the different aspects of the occupational wellness paradigm discussed by the informants placed focus on a way of thinking: the significant statements related to this paradigm were tinged with a positive and proactive tone.
Many interviewees gave practical examples related to exercise programs and weight management. Furthermore, they underlined an individual employee’s own role and responsibility in terms of maintaining one’s work ability and fitness:
‘No one can do the exercises but the person herself. When motivation is created, the person understands to carry on with the exercises after the program as well.’ (P6)
‘We strive to ensure that an employee’s work ability and career remain on track. We want individuals to stay at work and be able to manage their workload – to have the tools for self-management and well-being. It also calls for more effort and commitment on the part of the individual.’ (P9)
Several informants argued that interventions intended to enhance work ability should be incorporated in the work and the work community. Some of them described a typical situation, where workers had attended a rehabilitation program but the positive effects had only lasted a short period because relevant job modifications were not carried out. In this sense, the HR managers underlined that supervisors should be actively involved with disability management and overall occupational wellness promotion activities because they are knowledgeable about the personnel, the work practices, and the work environment.
On the one hand, the interviewees underlined the workers’ own responsibility for their work ability. On the other hand, they expressed the importance of the greater work community. Some of them considered support and understanding from co-workers and an inclusive organizational culture to be key factors. A workplace-based and work community-centered work disability management effort might benefit the whole community. One informant supported this idea in the quote below:
‘The entire work community benefits when it’s [rehabilitation] put into practice within and throughout the workplace.’ (P5)
Discussion
The aim of the study was to analyze how the theory-based disability management paradigms (Shaw et al., 2013) have contributed to HR managers’ knowledge of workplace factors affecting disability. The limitation of the analysis was the very nature of the data: The informants attended the work-related rehabilitation program, and the data were initially collected for the evaluation of the rehabilitation intervention. It is possible that HR managers working in other contexts, for example, in small-scale organizations, would have focused on different aspects, since the organizational characteristics, managerial style, and culture are the factors that shape the work climate and orientation toward employees, and, therefore, may affect disability prevention intervention (Amick et al., 2000).
Based on the analysis, most of the sub-categories were gathered into the disability management paradigm. For example, diversity management referred to sensitivity to the employees’ varying cultural backgrounds when conducting disability management practices and activities intended to promote a culture of wellness. The significance placed on the data that could be referred to as part of the ergonomics paradigm was typically also closely related to the disability management practices. It is possible that, due to the Nordic welfare state as a broader study context, disability management was understood more as a part of the socially responsible human resource policy (Barrena-Martinez et al., 2017) than a worker’s rights issue. However, employers take the goal of social legitimacy into consideration, and they are expected to act within the legal regime (Boxall & Burcell, 2003). For example, employer policies and practices are based on legislation referring to employers’ rehabilitation responsibility (Holmgren & Dahlin Ivanoff, 2007).
The significance derived from the data that referred to the disability management paradigm was very consistent with the components of disability management as defined by Williams and Westmorland (2002). Due to the nature of the data, the use of incentives in benefit design, cost accounting, and performance evaluation, as intended to encourage the participation of the employees and supervisors as well as to monitor the benefit use and outcomes, did not come out explicitly, contrary to James et al. (2002) and Williams and Westmorland (2002) studies. Based on the data, disability management consisted of a variety of actions and procedures. For example, rehabilitation was “one tool in the toolbox” used for managing the personnel’s work ability.
The data showed that the HR managers were aware of the condition of the personnel in terms of work disability, as the organizations had different information and management systems that keep track of their personnel. Despite the information systems, face-to-face interaction and communication were the themes that inherently overlapped with the data. The importance of open and positive communication as a necessary ingredient for a successful RTW has been discussed in several other studies (Williams & Westmorland, 2002; Williams-Whitt et al., 2016). In the present study, the HR managers identified communication and collaboration with supervisors and occupational health providers as being fundamental. A previous study found that supervisors expected support from the HR function in order to conduct occupational health and safety management (Tappura et al., 2014) but supervisors tended to handle disability management on their own without requesting support from the HR function or occupational health service. The present study underlined the supervisors’ sufficient knowledge and readiness regarding disability management and confirmed the findings found in other studies that have examined the crucial role of supervisors and the occupational health service (Haafkens et al., 2011; Holmgren & Dahlin Ivanoff, 2007; James et al., 2002; Jensen Stochkendahl et al., 2015; Negrini et al., 2017) in implementing disability management. Generally, line managers are considered the key players in implementing HR practices (Seppänen-Järvelä, 2018; Sikora & Ferris, 2014).
The way work disability concept is defined has important implications for research, compensation, and rehabilitation (Lederer et al., 2014). The informants in this study discussed the comprehensive concept of work disability as a context-related social phenomenon. Despite the broader organization-wide perspective of the interviewed HR managers, they still seemed to view disability management as a process-like, employee-centered activity.
Disability management processes and programs that are centered in and around people are part of human resource management (James et al., 2002; Trullen et al., 2016). HR professionals meet the needs of both employees and employers. However, there are new expectations for HR. The uncertainty and urgency of working life, the temporary nature of work, and multi-tasking all affect the mental strain and well-being perceived by employees (Guest, 2017). Moreover, HR involves strategic direction and measurements in order to demonstrate their worth (Boxall & Burcell, 2008). This could be an opportunity to visualize and validate the benefit and the utility of disability management efforts.
Conclusion
This study provides insight into the HR managers’ perceptions of and attitudes towards disability management. The theory-based disability management paradigms have contributed remarkably to HR managers’ knowledge of workplace factors affecting disability. The disability management paradigm dominated the informants’ perceptions. The occupational wellness paradigm was an emergent and strengthening pattern. The ergonomics paradigm and the worker’s right paradigm had lesser significance in the data.
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