Background
Methodology
Design
Data Analysis
Results
Stakeholder group | N | Type of industry |
---|---|---|
Human resources | ||
Public sector (large±) | 2 | Service |
Voluntary sector (large) | 1 | Service |
Occupational health advisers | ||
Physician—private sector, in-house (large) | 1 | Manufacturing |
Nurse—public sector, in-house (large) | 1 | Service |
Nurse—private sector, in-house (large) | 1 | Manufacturing |
Nurse—nationwide private provider | 1 | Various |
Owners of small businesses (micro) | 3 | Service |
Managers | ||
Managing Director—private sector (medium) | 1 | Engineering |
Manager—voluntary sector (micro) | 1 | Service |
Line manager/supervisor—public sector (large) | 2 | Service |
Line manager/supervisor—private sector (medium) | 2 | Engineering |
Line manager/supervisor—private sector (small) | 1 | Service |
Disability adviser (voluntary sector) | 1 | Service |
Interview Findings
The impact of stroke on the employer |
The emotional response |
Employers’ concerns |
Characteristics of employees returning to work after stroke |
Personal characteristics |
How employers perceive the effect of stroke on the individual employee |
Motivational factors |
Awareness/acceptance of limitations |
Communication |
Asking for help |
Consent and confidentiality |
Communication between healthcare and the workplace |
Knowledge and information |
Employers’ understanding of stroke |
How employers gain knowledge about stroke |
Awareness of disability management |
Awareness of existing support services |
Experiences and perceptions of other stakeholders |
GPs/physicians |
Occupational health (OH) |
Management (Human Resources (HR), line manager/supervisor) |
Integrating healthcare in return to work |
Content and delivery |
Who might pay? |
The Impact of Stroke on the Employer
The Emotional Response
It was devastating at the time, just the things that happened….it was horrendous. (Participant 11, business owner)
we both got upset and had a hug because we’ve known each other for so long and she’s a really good worker, she loved her job….(Participant 5, line manager)You never see something like that coming…….it’s a period that I’ll never forget…………but should I have gone and found out myself [about how to help the employee stay at work] that’s what I question? (Participant 11, business owner)
Well, for me personally, it’s been, this sounds all wrong, but it’s been an enjoyable experience because it’s been really interesting, trying to understand what happened to [the employee] and how it affects him and how it affects his response time. (Participant 7, line manager)
Employers’ Concerns
Unfortunately we have had somebody die on the premises of a heart attack and so we knew the effect that that could have, you know, emotionally on people around and took a long time for people to forget - and the consequences of him having a stroke at work and the people around him and how that affects them and, you know, that was just a huge problem. (Participant 8, managing director)
She (the employee’s colleague) would have her concerns just the way that (the employee) would look some days or behave. Memory loss things and just not looking well. And there was one particular day where a client did have to go downstairs and get (another staff member) because (the employee) came over all funny.(Participant 11, business owner)
That was the main concern; that we didn’t cause another accident in any way. We’ve got moving machinery, rollers running fabric that can pull a person into the machine…..nobody wants that now or wanted it at any stage in the process; we were all really concerned about having to face that eventuality (that the employee might not be considered safe to return). (Participant 7, line manager)
Characteristics of Employees Returning to Work After Stroke
Personal Characteristics
But he’s a very enthusiastic employee and it’s been fairly simple actually because he’s been very enthusiastic and wanting to come back so it’s been fairly easy to make adjustments for him. (Participant 10, occupational health manager)
How Employers Perceive the Effect of Stroke on the Individual Employee
What she was telling me was that, like I’d have a communications meeting every week, she’d come to the communications meeting, she’d hear the first sentence, and then she wouldn’t hear any of it for the rest of the hour. (Participant 5, line manager)
I suspect most of them would look at the physical stuff, the – you know, potential that the arm or the leg doesn’t work…… I doubt that they think about cognitive – and obviously I doubt they think about the fatigue and of course the other one is, is that people are often a bit more emotional and a bit easier to cry. (Participant 15, disability adviser)
Motivational Factors
I wouldn’t necessarily call them disabilities, in that respect I would say there are actually normal aspects of being out of work and of being ill such as effects on confidence and self-esteem……. Again it gets back to - you cannot ignore the psycho-social factors. (Participant17, occupational health physician)
Obviously he wanted to do more, well because he’s …. I shouldn’t say this, this is a bit.… but he’s Scottish, he’s a man, he didn’t want to feel as if he was not capable anymore and he wanted to do more.(Participant 13, line manager)
Awareness/Acceptance of Limitations
And I think maybe coming back to work helped her realise that as well because I think that’s a bit more where she is now and her words to me was, I need to put this job behind me now and move on and do what I am capable of doing, rather than trying to do what I used to do. (Participant 5, line manager)
Communication
Asking for Help
She’s just not honest about how she probably is feeling. But I can see it in her face. And in fact someone sometimes, the rest of the team will say gosh, she looks really tired today. And I’ll think yeah, you know, she does. And that’s when she needs to be saying. (Participant 3, line manager)
Consent and Confidentiality
And the other thing that’s quite difficult is the other staff because if you’re managing the team and you have to make a load of adjustments for this person who’s coming back to work, as much as people can see ‘oh she’s had a stroke blah blah she’s got to come back’ the resentment always happens so you’ve got, ‘well why isn’t she taking the notes up to x floor, why am I?’ – and they [line managers] get a bit worried about that …but they can’t tell everybody why that decision’s been made because obviously that’s confidential to that person. (Participant 16, Human Resources manager)
Sometimes you can get the patient on your side and you can say, “Look, when you see your physio next, or whoever, can you ask them, can they put anything in writing?” and sometimes the physios will do that. (Participant 12, Occupational health nurse)
Communication Between Healthcare and the Workplace
This is no kind of criticism but I cannot actually remember a situation, in this type of arena, whereby a kind of therapeutic from a rehabilitative kind of position, has come to us you know, this is where we are, what can you do to help? I mean its seventy-six thousand employees we have.(Participant 17, Occupational health physician)
Knowledge and Information
Employers’ Understanding of Stroke
Twenty-seven years in production management and this is the first time I’ve really had to deal with such a severe medical case – disability as you say, so my knowledge is very lacking on it. (Participant 7, line manager)
How Employers Gain Knowledge About Stroke
I did a lot of research through the internet, it’s not hard now to find out exactly what dysphasia is and what the effect is. (Participant 5, line manager)
Awareness of Disability Management
I don’t know what my legal requirements are, can I just – can I get rid of them? Can I just ask them to leave because it’s not working out? I don’t know. (Participant 1, managing director)
Awareness of Existing Support Services
I know they’re there, but I wouldn’t know how to even start looking for them and that sort of thing. It just seems like too much hard work for me to sort it out…. there’s too much red tape and it’s just easier for us to actually sort something else out. (Participant 10, occupational health manager)
Experiences and Perceptions of Other Stakeholders
GPs/Physicians
Occupational Health (OH)
I don’t think they [occupational health] tend to examine them as such themselves. And a lot of it is done by enquiry of the GP and/or the consultant. So a report will go off to the GP, you know, in order to answer some of the queries so that - I mean obviously we would always take what our occupational health unit say to us in terms of their fitness or otherwise for work. But obviously they need to go to GPs and consultants to gauge the level of ability that person’s got. (Participant 4, Human Resources manager)
Management (Human Resources and Line Managers/Supervisors)
I think the ones HR are looking for are the ones that maybe they think ‘they’re spinning this one out a bit’. (Participant 3, line manager)
A lot of the time – and this is always the issue – it’s about the competence of the line manager…….I mean, myself and HR, we are still advisers to the business or to the organisation, so it is ultimately the line manager’s responsibility for making sure all the steps are followed and the contacts kept. (Participant 12, occupational health nurse)
Integrating Healthcare in Return to Work
Content and Delivery
Having your own occupational health advisor working or trying to work with the NHS is near on impossible. It just doesn’t work. (Participant 8, managing director)
She actually came out and visited the premises and walked the production line with me, looking at what may cause him a problem. I’m not sure how important it was for [the employee’s] overall rehabilitation but regarding my understanding of how to judge what [the employee] was doing was massive. (Participant 7, line manager)
Who Might Pay?
I think it has to be the government, it has to come from outside simply because they want to get people back, re-employment, what do they call it, people that have got a disability and stuff and getting them back to work. Yes it’s alright for your big companies, but the smaller companies obviously would like to get these people in, obviously can’t afford it. (Participant 2, line manager)