Poor recommendations for phased returns are far too common in occupational health reports. When they’re done well, phased returns benefit employees and employers and reduce the chance someone will quickly go back on sick leave after they return to work. Done badly, they drag out a period of illness, slow down recovery and are impossible to put into place.
A phased return (also known as a ramp-back, or graduated return) is a workplace adjustment for an employee who has been off sick for a long time. Phased returns assist by helping the employee regain physical and psychological stamina after a long period of sickness absence. For an employee who’s apprehensive about returning to work, throwing them in at the deep end, working full hours after 6 months off sick would be little use to anyone. It takes time to adjust to a new routine, and supporting this well gives the best chance of a successful, sustained return to work.
Common mistakes
Too often, occupational clinicians recommend phased returns as a knee-jerk reaction to almost any period of sickness absence. Phased returns are very rarely necessary when someone has been away from work for just a few weeks – the employee is unlikely to have embedded themselves into a routine where being at work is abnormal and something they need to get used to again. Most of the time, people know how to be at work, and unnecessary fiddling with getting back into a routine can be disruptive in itself. Of course, it’s important to discuss with the employee what they feel they are able to do, and to look at the referral or other provided information to establish what the employer is able to accommodate.
Excessively long phased returns are also a problem - phased returns over 4 weeks’ duration are almost never appropriate. A phased return should be thought of as a route to the employee’s return to their normal role and hours when they are fit for the full range of duties associated with their role. If the employee isn’t fully fit for their job for a few months – perhaps while their doctor tweaks their medical treatment – this needs to be made clear and a plan suggested to help the employee and employer find a workable solution.
Someone returning to work while recovering from cancer, for example, may need far longer than 4 weeks to get back to work after surgery, radiotherapy and chemotherapy. A phased return may not be appropriate if they are not yet fit for their full duties and hours but still want to get back to work. In supporting the employee back to work, it’s important to acknowledge that they are still recovering, even if they are eventually expected to recover fully. In this case, a careful discussion is needed around how the employee’s current and anticipated function fits in with the requirements of their job over the course of their recovery. They may need a longer-term adjustment to their role or hours, possibly with a review after a month or two to check their progress against expectations, and revise the plan as needed.
Another very frequent mistake is the excessively prescriptive phased return recommendation. This looks something like this:
I recommend a 4-week phased return as follows:
Week 1 – 4 hours per day
Week 2 – 5 hours per day
Week 3 – 6 hours per day
Week 4 – 7 hours per day
After week 4, they can return to their normal hours.
This approach is unfortunately taught to many occupational clinicians in training, but there are several problems with it. First, it turns into a target to recover on a slow schedule rather than providing a flexible framework for success. It has a hidden message – “you’re not well and you won’t be fully well for at least 4 weeks.” If the employee is feeling great after two weeks, their manager may feel apprehensive about a return to normal hours in week 3, even if they want to. Although from the occupational clinician’s perspective, their reports are recommendations only and it’s for managers to decide what’s reasonable (indeed many reports put a disclaimer like this at the end), this is incongruent with a prescriptive table like the one seen above. Going against a recommendation like this, which looks more like an order, is quite difficult for many employers.
Second, it isn’t clear what this is actually trying to achieve. As noted above, the purpose of the phased return is to allow the employee to gain physical and psychological stamina after a long period of absence. Imagine in this example that we’re two days into week 4, with the employee working 7 hours a day. Is it really likely that there’s a medical reason they are able to work 7 hours but not their normal 8? If the person is likely to be fit to work 8 hours per day, halfway through week 4, as they almost certainly will be, why do we have an ongoing unnecessary restriction? Neither the employee or the employer benefits here.
Third, it’s often incredibly difficult to implement this sort of schedule. Messing about with individual hours in rostered roles causes huge headaches for managers while not medically benefitting the employee. If a train driver’s route takes 5.5 hours for a run, they can’t very well stop the train 4 hours in. They may have to go to work and sit in the depot, bored, until week 3 when they are ‘allowed’ (according to this schedule) to work 6 hours. This achieves nothing. In non-rostered roles, most people don’t clock on and off exactly on the minute – if extreme rigidity around hours isn’t the workplace norm, it’s hardly constructive to introduce this inflexibility into a normally somewhat-flexible environment.
Occasionally, employers do want a prescriptive phased return recommendation like this. It’s worth exploring with them what they are trying to achieve with this, but if that’s the way they wish to manage, so be it. But you’re not there to tell managers how to do their jobs as an occupational clinician, so this is something to be minimized or avoided wherever possible.
Phased returns done well
The best phased return recommendations encourage employees and employers to discuss what works for them both, illuminated as they are by the wisdom and clarity of your report. The details of any functional restriction you include in your report will give a framework, so the employer understands the challenges the employee has, and both understand the expected timeline for recovery.
You should mention where appropriate that the employee is fit for the full range of duties associated with their role. The ‘baseline’ phased return plan should be extremely simple:
“I suggest a short phased return to help the employee gain physical and psychological stamina after the period of sickness absence”
…is ideal if the employer is comfortable with implementing adjustments in the workplace. This applies to the majority of employers.
If the employer is less comfortable (for example if they have a small HR function or if managers prefer more guidance), a little more detail may be helpful:
“I suggest a phased return of up to 2 weeks to help the employee gain physical and psychological stamina after the period of sickness absence.”
Getting back into work is often therapeutic and energizing. “Up to” two weeks allows for the employee who’s feeling great after a week to go back to normal hours and get back to normal. For an employee who has been off a very long time or needs further support, changing this suggestion to “2-4 weeks” may be appropriate. As discussed above, longer than this suggests a need to consider other, longer-term adjustments that are better tailored to the employee and the employer’s needs.
This article refers to occupational health practice in in England.