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Archive for September, 2014

The power of the personal account. How qualitative research offers important insights into the self-management of musculoskeletal conditions in the context of work. Part 2

Tuesday, September 9th, 2014

I wrote yesterday that work itself should be considered as a form of self-management . Likewise, there are numerous ways of self-managing one’s health condition at work. These were revealed by the study we published on Friday, the findings of which came from interviews with individuals living with a musculoskeletal disorder, and thus offered us unique insights..

Today, I am going to discuss another pertinent finding which revolves around the relationship between individuals with MSDs and their line managers. In order to manage their condition at work individuals sometimes needed adjustments to their job setup (e.g. changes to their workstation, alterations to responsibilities, or flexibility or changes to their hours). It was found that approaching one’s line manager to request adjustments was a complex process. For example, some participants saw it as a reciprocal exchange, whereby they could only ask for an adjustment if they had proven themselves and contributed sufficiently to the organisation.

Part of it I think is because I know that I’ve worked so hard and my employer and the one particular line manager knows how hard that I have worked.  So from that respect I know that she would always be very tolerant and that I could more or less ask her for anything [in terms of adjustments].”

Participant 2

It was found that other participants were reluctant to ask for adjustments from their line manager, citing fear of negative judgement and job loss as key contributors to this reluctance.

“I don’t know [why I haven’t asked for adjustments], I just feel that there’s a lot of people looking for work. I just don’t want to cause any waves, I’d rather have the attention away from me.”

Participant 10

These findings have implications for how support is offered to individuals, and highlights the barriers that need to be overcome in order for individuals to receive the adjustments they need: the receipt of adequate support cannot be contingent on an individual having had the opportunity to build a solid relationship with their line manager.

The report’s recommendations (pp.85-90) detail how all stakeholder groups can do more to support the self-management of chronic conditions in the workplace, a selection of which follow:

  • The government must do more to support individuals working in smaller organisations, which often do not have the resources to provide appropriate support. Increasing awareness of, and participation in, Access to Work is one way to begin increasing this support.
  • The government can also do more to incentivise healthcare professionals to consider and treat individuals with MSDs in a holistic way, including offering support and guidance around their working lives. By including work as an outcome in the CCG Outcomes indicator set steps can be made towards this goal.
  • Employers need to understand their responsibilities to people with disabilities and long term health conditions, including the provision of reasonable adjustments. Employers should also create opportunities to discuss an employee’s condition which is separate to discussions about performance, so that managing their condition is not tied up with their ability as an employee.
  • Line managers should be proactive in seeking out information about MSDs, and in asking the employee how they can be supported to do their job. Line managers should also consider the importance of supporting mental as well as physical health: living with an MSD is not restricted to managing the physical symptoms of the condition.
  • Healthcare professionals need to understand how crucial it is to provide individuals with quick diagnoses and appropriate medication regimes as quickly as possible. It is only when these are set in place that individuals can begin to learn to manage their condition, including in the context of work.

It is by conducting interviews with individuals with lived experiences of managing their MSD in work that the nuances of the challenges faced can be revealed. It is hoped that solutions will be enacted that are equally sensitive to these complexities.

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The power of the personal account. How qualitative research offers important insights into the self-management of musculoskeletal conditions in the context of work. Part 1

Tuesday, September 9th, 2014

Work itself should be considered as a form of self-management. This is the central finding of the study that The Work Foundation and Fit for Work UK launched on Friday, 5 September  entitled “Self management of chronic musculoskeletal conditions and employment”. Individuals whom we interviewed for the report found that partaking in work was an important way in which they managed several (often psychological) aspects of living with an MSD. However, the onus for managing one’s condition at work weighed far too heavily on the individual, and participants often described foregoing their home lives, social lives, and compromising their physical health to stay in work. Work as self-management was often being undermined as individuals struggled to self-manage in the context of work.

Other stakeholders have a far greater role to play in supporting self-management, and notable among those are the government, healthcare professionals, and employers. It was only through conducting an interview based study, and talking directly to individuals, that this tension between wanting to continue to work, yet often struggling to manage one’s condition successfully, could be revealed to the researchers.

Interview studies of course have their limitations. They are designed to provide depth rather than breadth meaning that statistical representativeness is foregone. The researchers are also far more ‘present’ in that they conduct and then analyse the interviews themselves meaning it is even more important that they are aware of how they may bias the results. However, this research demonstrates the power of speaking directly to individuals with lived experience of the phenomena being studied. There were some specific, very striking findings, which would be unlikely to have arisen if individuals living with chronic MSDs had not been interviewed.

Take the implications of the invisible nature of the condition, for example. Due to MSDs often not having easily visible external symptoms, individuals described how this meant others found it harder to understand their condition, and that they often were not offered support when they needed it. Some participants even described feigning alternative, more understandable, symptoms when in fact they felt unwell because of their MSD, in order to communicate to others that they were unwell.

People wouldn’t know [I had arthritis].  Sometimes that can go against me, because it’s a bit like you’re trying to do something and then you know that you’re struggling to do something.  And people go.. they don’t accept it.”

Participant 13

Sometimes I would.. if I’m not well, if things are a bit on top of me, in front of my colleagues I will say to them I have a headache, rather than go about the arthritis thing.”

Participant 10

These findings regarding the invisibility of the condition led the report to make several recommendations, including the need to employers and line managers to be more proactive in providing support, as sometimes individuals would be unwilling to come forward and identify their MSD as being the source of their problems. In my next blog, I’m going to explore the report further by discussing a subsequent set of findings related to the self-management of chronic conditions in the context of work – the crucial, yet often overlooked, relationship between workers and line-managers.

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People with chronic MSDs compromising their health to keep their jobs, new report reveals

Friday, September 5th, 2014

The government, the NHS, and employers are failing to provide the necessary support for people with chronic MSDs (musculoskeletal disorders)* to stay in work. This is according to a new report released today (Friday 5th September) by Lancaster University’s Work Foundation and the Fit for Work UK Coalition. The findings also indicate that some patients are putting their health at risk to hold on to their jobs.

Update: Commenting on the report, Sue Browning, deputy chief executive of the CSP, said: “Physiotherapists are experts at keeping people healthy in work, or facilitating a return after sickness absence, and it is very important that employers provide staff with fast access to occupational health services (…) The NHS should also make self-referral to physiotherapy available across the country”. Read the full statement of Sue Browning on the Chartered Society of Physiotherapy website.

Professor Stephen Bevan, director of the Centre for Workforce Effectiveness at The Work Foundation and founding president of Fit for Work UK, said: “Workers with MSDs often find themselves fighting a lonely battle to remain in work. The government, employers and clinicians should make it a priority to support them to remain in employment after diagnosis”.

Currently, Britain is losing 30.5 million working days a year to MSDs, which are the leading cause of sickness absence, according to the Office for National Statistics (ONS)**. Today’s paper shows that employers, in particular small organisations, have little knowledge about government schemes such as “Access to Work” and are insufficiently prepared to manage chronic conditions in the workplace. Many workers admit to being reluctant to ask for help from their line managers for fear of stigma, negative judgement and job loss. Others said they had to involve their union to get the necessary support or move into self-employment.

The interviews conducted for the report released today highlight that, unless action is taken, individuals’ health conditions and quality of life will continue to be damaged by work, with some leaving the labour market prematurely. The consequence of the status quo is an increase in productivity loss, sickness absence and, ultimately, the welfare bill.

One employee interviewed in the report said: “Last year, the team were very understaffed some individuals went off sick. I think the pressure to try and do other people’s jobs as well as your own just got too much for me. It was a very stressful time to me and that made my illness a lot worse”. Another explained: “It’s a bit rule by fear in this department these days. They’ll try and get rid of you if you’ve been off too long with your health”.

Kate Summers, research officer at The Work Foundation, commented: “Individuals with chronic MSDs will go to great lengths to remain in work. They will give up aspects of their family and social life, and they will even take roles below their skill set. This is because work can bring many benefits – be they financial, psychological or social. These benefits are undermined if individuals are working in a environment that is not good for their health”.

The report makes four recommendations:
1. The government should increase participation to initiatives like “Access to Work” and should provide extra assistance for employees working in small and medium enterprises;
2. The government should also ensure that work is viewed as a “clinical outcome” by clinicians and invest in more “specialist nurse” roles;
3. Employers should consider all necessary workplace adjustments and offer career development opportunities for people with chronic MSDs;
4. Clinicians should view it as part of their role to ask patients about their work lives.

The authors of the paper also added that they welcome the government’s new Health and Work Service in England and Wales, but that it needs to focus on sustained return to work outcomes.

The report is being previewed on Friday at the conference “Self care & resilience: How we can care?” organised by the College of Medicine at the King’s College, in London

– ENDS –

Notes to the Editors:

1. Kate Summers, research officer, is available for interviews, briefings and written comment.
3. The paper is part of a national campaign led by Fit for Work UK, informing the public debate on dealing with the growing burden of MSDs and calling for coordinated action across all main political parties in the UK.
4. *Musculoskeletal disorders (MSDs) cover around 200 disorders that affect the joints, bones, muscles and connective tissues. MSDs include back pain, arthritis, osteoarthritis, ankylosing spondylitis, injuries caused by trauma, such as fractures, and other conditions that are the result of genetic or developmental abnormalities, as well as bone and soft tissue cancer.
5. ** The “Sickness Absence in the Labour Market” report.
6. The Fit for Work UK Coalition is an active partnership of healthcare professionals, policymakers, employers and advocacy groups founded in 2007. It supports people with long-term conditions, particularly musculoskeletal conditions. Their members are: AbbVie, the Arthritis and Musculoskeletal Alliance (ARMA), BT Group, Capita, the Chartered Society of Physiotherapy (CSP), National Ankylosing Spondylitis Society (NASS), National Rheumatoid Arthritis Society (NRAS), The Work Foundation, and the Royal College of General Practitioners (RCGP).
7. Lancaster University’s Work Foundation transforms people’s experience of work and the labour market through high quality applied research that empowers individuals and influences public policies and organisational practices. The Work Foundation is part of Lancaster University – an alliance that enables both organisations to further enhance their impact.

Media enquiries:

Ioana Piscociu,, 020 7976 3526, for urgent out-of-hours enquiries: 0755 178 14 06.

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