Work, organisational practices, and margin of manoeuver during work reintegration

Abstract

Background: Many individuals of working age experience cardiovascular disease and are disabled from work as a result. The majority of research in cardiac work disability has focused on individual biological and psychological factors influencing work disability despite evidence of the importance of social context in work disability. In this article, the focus is on work and organisational features influencing the leeway (margin of manoeuvre) workers are afforded during work reintegration.

Methods: A qualitative method was used. A large auto manufacturing plant was selected owing to work, organisational, and worker characteristics. Workplace context was assessed through site visits and meetings with stakeholders including occupational health, human resources and union personnel and a review of collective agreement provisions relating to seniority, benefits and accommodation. Worker experience was assessed using a series of in-depth interviews with workers (n = 12) returning to work at the plant following disabling cardiac illness. Data was analysed using qualitative content analysis.

Results: Workers demonstrated variable levels of adjustment to the workplace that could be related to production expectations and work design. Policies and practices around electronic rate monitoring, seniority and accommodation, and disability management practices affected the buffer available to workers to adjust to the workplace.

Conclusions: Work qualities and organisational resources establish a margin of manoeuver for work reintegration efforts. Practitioners need to inform themselves of the constraints on work accommodation imposed by work organisation and collective agreements. Organisations and labour need to reconsider policies and practices that creates unequal accommodation conditions for disabled workers.

Implications for rehabilitation

• Margin of manoeuvre offers a framework for evaluating and structuring work reintegration programmes.

• Assessing initial conditions for productivity expectations, context and ways and means to support work reintegration can be integrated with worker perceptions of work ability and possibilities for adaptation to structure and then monitor work reintegration programmes. Margin of manoeuvre can be used to evaluate sustainability of work at the end of rehabilitation.

• Cause-based workers’ compensation schemes, collective agreement provisions, and organisational approaches to non-compensable disability create two tiers of disabled workers and make certain workers more vulnerable to occupational disability.

Keywords:

• Sickness absence
• accommodation
• cardiac illness
• return-to-work
• disability management

Acknowledgements

Author thanks ST for his support of the project and PB for her helpful comments on a previous draft of the manuscript. FO would like to thank the Research Action Alliance on the Consequences of Work Injury for financial support during the preparation of this manuscript as well as the Canadian Institutes for Health Research Strategic Training Initiative in Work Disability Prevention for educational support during the design of the project. He would like to acknowledge the anonymous involvement of the workers and company personnel involved in the study, whose generous gift of their time and experience made this work possible. He would also like to thank DM for his able assistance in negotiating access and managing logistical issues at the research site.

Ethics

Ethics approval was obtained from the University of Toronto Research Ethics Board prior to proceeding with this study.

Disclosure statement

No potential conflict of interest was reported by the author.