Higgins Angela, O'Halloran Peter, Porter Sam
Occupational Health, Northern Health and Social Care Trust, Antrim Hospital, Antrim, BT41 2RL, Northern Ireland, UK,
J Occup Rehabil. 2015 Sep;25(3):451-70. doi: 10.1007/s10926-014-9553-2.
The success of measures to reduce long-term sickness absence (LTSA) in public sector organisations is contingent on organisational context. This realist evaluation investigates how interventions interact with context to influence successful management of LTSA.
Multi-method case study in three Health and Social Care Trusts in Northern Ireland comprising realist literature review, semi-structured interviews (61 participants), Process-Mapping and feedback meetings (59 participants), observation of training, analysis of documents.
Important activities included early intervention; workplace-based occupational rehabilitation; robust sickness absence policies with clear trigger points for action. Used appropriately, in a context of good interpersonal and interdepartmental communication and shared goals, these are able to increase the motivation of staff to return to work. Line managers are encouraged to take a proactive approach when senior managers provide support and accountability. Hindering factors: delayed intervention; inconsistent implementation of policy and procedure; lack of resources; organisational complexity; stakeholders misunderstanding each other's goals and motives.
Different mechanisms have the potential to encourage common motivations for earlier return from LTSA, such as employees feeling that they have the support of their line manager to return to work and having the confidence to do so. Line managers' proactively engage when they have confidence in the support of seniors and in their own ability to address LTSA. Fostering these motivations calls for a thoughtful, diagnostic process, taking into account the contextual factors (and whether they can be modified) and considering how a given intervention can be used to trigger the appropriate mechanisms.
公共部门组织中减少长期病假（LTSA）措施的成功与否取决于组织背景。这项现实主义评估研究了干预措施如何与背景相互作用，以影响LTSA的成功管理。
在北爱尔兰的三个卫生和社会护理信托基金中进行多方法案例研究，包括现实主义文献综述、半结构化访谈（61名参与者）、流程映射和反馈会议（59名参与者）、培训观察、文件分析。
重要活动包括早期干预；基于工作场所的职业康复；具有明确行动触发点的强有力的病假政策。在良好的人际和部门间沟通以及共同目标的背景下适当使用这些措施，能够提高员工重返工作岗位的积极性。当高级管理人员提供支持和问责时，鼓励直线经理采取积极主动的方法。阻碍因素包括：干预延迟；政策和程序执行不一致；资源缺乏；组织复杂性；利益相关者相互误解彼此的目标和动机。
不同的机制有可能激发促使员工更早从长期病假中返回工作岗位的共同动机，比如员工感到他们得到直线经理的支持并对重返工作有信心。当直线经理对上级的支持以及自己解决长期病假问题的能力有信心时，他们会积极参与。培养这些动机需要一个深思熟虑的诊断过程，要考虑到背景因素（以及它们是否可以改变），并思考如何利用特定的干预措施来触发适当的机制。
