Return-to-work success despite conflicts: an exploration of decision-making during a work rehabilitation program^*

* This study was part of Marie-Michelle postdoctoral fellow at CAPRIT. Since February 2017, she is affiliated to the École de gestion, Département de management et gestion des ressources humaines, Université de Sherbrooke, Longueuil, Canada.

Abstract

Purpose: Collective decision-making by stakeholders appears important to return-to-work success, yet few studies have explored the processes involved. This study aims to explore the influence of decision-making on return-to-work for workers with musculoskeletal or common mental disorders.

Method: This study is a secondary analysis using data from three earlier multiple-case studies that documented decision-making during similar and comparable work rehabilitation programs. Individual interviews were conducted at the end of the program with stakeholders, namely, the disabled workers and representatives of health care professionals, employers, unions and insurers. Verbatims were analysed inductively.

Results: The 28 decision-making processes (cases) led to 115 different decisions-making instances and included the following components: subjects of the decisions, stakeholders’ concerns and powers, and types of decision-making. No differences were found in decision-making processes relative to the workers’ diagnoses or return-to-work status. However, overall analysis of decision-making revealed that stakeholder agreement on a return-to-work goal and acceptance of an intervention plan in which the task demands aligned with the worker’s capacities were essential for return-to-work success.

Conclusion: These results support the possibility of return-to-work success despite conflictual decision-making processes. In addition to facilitating consensual decisions, future studies should be aimed at facilitating negotiated decisions.

Implications for rehabilitation

• Facilitating decision-making, with the aim of obtaining agreement from all stakeholders on a return-to-work goal and their acceptance of an intervention plan that respects the worker’s capacities, is important for return-to-work success.

• Rehabilitation professionals should constantly be on the lookout for potential conflicts, which may either complicate the reach of an agreement between the stakeholders or constrain return-to-work possibilities.

• Rehabilitation professionals should also be constantly watching for workers’ and employers’ return-to-work concerns, as they may change during work rehabilitation, potentially challenging a reached agreement.

Keywords:

• Decision-making
• concerted action
• negotiation
• return-to-work program
• musculoskeletal disorder
• common mental disorder

Disclosure statement

The authors declare no conflicts of interest.

Additional information

Funding

The initial study on MSDs was supported by a grant from the Quebec Health Research Fund (FRQS) in the traumatology research consortium program, and a grant from the Institut de recherche Robert-Sauvé en santé et sécurité du travail (IRSST) (Grant no. 00–99-8320). The study on CMDs was funded by the participating government agency and the IRSST, for the development of the methodology. This study was part of MMG’s postdoctoral fellowship at the Centre for Work Disability Prevention and Rehabilitation (CAPRIT), which was granted by the IRSST and the Interdisciplinary Research Team on the Prevention and Reduction of Work Disability, funded by the FRQS (Grant no. 0000022065). MJD holds a Research Chair in Work Disability Prevention. MFC is an FRQS scholar, specifically, in the traumatology research consortium program.