Sickness Absence or Sick Leave and Health

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Cause and effect of sick leaveDr. Emilia Zainal Abidin Department of Environmental and Occupational Health Faculty of Medicine and Health Sciences UPM

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Outline of this presentationThe health agenda Understanding sickness absence Identifying the underlying causes Managing excessive sick leave

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Health: the role of the workplace More than 50% of working age people in Malaysia are in employment and spend a high proportion of their waking hours in the workplace The workplace offers great scope for targeting of messages and initiatives about healthy living – with potential impact on both employees and their families Need to go beyond essential compliance with health and safety legislation and promote health and well-being more generally

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Work and health – what we know Work offers opportunities to promote individual health and well-being Work should be recognised by all as important and beneficial, and access to, and retention of work promotes and improves the overall health of the population Long-term sick leave / sickness absence is a strong predictor of disability and mortality Work has a positive impact on health and well-being (‘good jobs’ in well managed organisations) Under some circumstances work can have adverse effects (‘bad jobs’) The key is prevention of underlying causes rather than relying just on management of outcomes (secondary & tertiary interventions)

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Sources: WHO (2010). WHO Healthy Workplace Framework and Model: Background and Supporting Literature and Practices.

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Sickness Absence or Sick Leave and HealthRisk factors for sickness absence are not always the same as risk factors for disease An holistic approach needs to focus both on the risk factors that precede absence as well as implementation of policies & procedures for monitoring & management. Sickness absence data collection, analysis and interpretation methods need to reflect both aspects.

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Sick leave and legislation in MalaysiaThe Employment Act 1955 An employee is entitled to paid sick leave only under the following circumstances: he has obtained a certificate from a registered medical practitioner duly appointed by his employer; or he has obtained a certificate from a dental surgeon; or

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A national study of absenceDefinitions: Disease: is defined in terms of objective biological abnormalities in the structure and/or functions of bodily organs and systems Illness : is the personal subjective perception of unwellness. Therefore, if a person feels ill, they are ill Sickness: is derived from the concept of the “sick role”, a role that carries certain privileges (to stay away from work), as well as obligations (to seek medical help and to ‘get well’).

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Ill health: A Population Study332358321Illness %Disease %Absence % >14 daysNone of these 25%Wikman et al (2005)2% of the blue ‘sickness absence’ represents factors other than health-related ones.So, what are they? The short answer is we are not sure! combination of reasons including coping behaviour; withdrawing from the hazard, the so-called flight response.

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Sickness Absence: NHS Trust

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The IndividualThe biopsychosocial model: (Waddell & Burton, 2004) Biological: The physical or mental health function Psychological: Recognises that personal and psychological factors also influence functioning and the individual must take some responsibility for their behaviour Social: Recognises the importance of the social context, pressures and constraints, on behaviour and functioning

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Drivers of sickness absenceIndividual factors – personality and motivation; past behaviour; sick role The ‘system’ – organizational culture and tolerability, what is legitimate; sickness certification Non-work factors – life events and family pressures Work factors – absence as ‘coping’, job satisfaction, chronic adverse features of work Commitment and involvement

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Work stressors: effects on health and sickness absence Findings from Whitehall II and other studies

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2 Moves to private sector practice Job insecurity Temporary employmentLabour market stressors

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Moves to private sector practice (transfer to an executive agency) effects on health and sickness absence (men)* adjusted for age, employment grade, marital status & health at the beginning of the follow-up periodFerrie et al. J Occup. Health Psychology 20013relative increase in cardiovascular risk factors compared to men not transferred to agencies*% excess ill-health compared to men not transferred to agencies*

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Job insecurity and health in women*adjusted for age, employment grade & health at the beginning of follow-upFerrie et al. J. Epidemiology Community Health 20024

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Ferrie et al. Am. J. Public Health 1998Job insecurity and coronary artery disease*adjusted for age, grade and CAD before the threat of privatisation5

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Job insecurity and sickness absenceOdds Ratios**adjusted for age, employment grade and health statusFerrie et al 2001 J. Occup. Health Psychol6

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Temporary employment and sickness absenceRate Ratios**adjusted for age, sex, income, and number of contracted daysVirtanen et al 2003 Occup Environ Med7

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Temporary employment and early deathHazard Ratios**adjusted for age, occupational status and incomeVirtanen et al 2003 Am. J. Epidemiol8

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Organisational JusticeProcedural component decision-making procedures include input from affected parties, are consistently applied, open and ethical Relational component respectful and considerate treatment of employees by supervisors21refers to the extent to which employees are treated with fairness and justice at their workplace

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Organisational Justice (relational component) and sickness absence in womenOdds Ratios**adjusted for age, employment grade and health statusHead et al 2007 J. Psychosomatic Research23

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Health and safety statistics 2007/08

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Managing sickness absence

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Introducing sickness absence managementDo you have a procedure? Is your existing procedure contractual? You will require employee agreement to vary existing terms No procedure Engage employees to introduce a new policy Explain your business reasons Explain the changes/new procedure to employees

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Introducing sickness absence managementMake your attendance policy part of your induction process Make it part of your appraisal process Make line managers accountable

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Last Updated: 8th March 2018

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