Return to Work for People with Common Mental Disorders: Insights into the Implementation of a Collaborative Program in a Specialized Mental Health Hospital.

Purpose Common mental disorders (CMDs) are a major cause of sick leave. Return-to-work (RTW) interventions providing mechanisms that support the participation and collaboration of the different stakeholders appear promising in these circumstances. The Therapeutic Return-to-Work (TRW) Program offers such mechanisms designed to enable affected workers to fully reintegrate into their jobs on a sustainable basis. This study evaluated the feasibility of implementing this program for workers with CMDs, within a specialized mental health hospital. Methods The study was conducted using a multiple case design and three main data sources: (1) the worker's medical file, (2) the log completed by the clinicians, and (3) individual interviews with stakeholders. Data were analyzed using a qualitative approach. Results Twelve workers between 32 and 60 years old, mostly women with complex mental health profiles working in large enterprises, participated in this study. Three main observations were made regarding the TRW Program implementation: (1) eight cases were characterized by complete or virtually complete implementation; (2) no explanatory factor could be identified for the different implementation levels; (3) eight cases achieved RTW success (RTW to the original job or another job), which appears partially attributable to the high level of program implementation. Conclusions: The TRW Program seems highly promising for supporting the return to work of workers with CMDs. However, studies identifying the factors likely to influence the implementation process in different health service contexts and specifying the scope and nature of the program's actual impact on RTW outcomes should be conducted before larger-scale implementation takes place.

Ethnocultural Minority Workers and Sustainable Return to Work Following Work Disability: A Qualitative Interpretive Description Study.

Purpose This article provides a state-of-the-art review of issues and factors associated with the sustainable return to work (S-RTW) of ethnocultural minority workers experiencing disability situations attributable to one of four major causes: musculoskeletal disorders, common mental disorders, other chronic diseases or cancer. Methods Using an interpretive description method, an integrative review was conducted of the literature on ethnocultural factors influencing S-RTW issues and factors associated with these four major work-disability causes. An initial review of the 2006-2016 literature was subsequently updated for November 2016-May 2021. To explore and contextualize the results, four focus groups were held with RTW stakeholders representing workplaces, insurers, the healthcare system and workers. Qualitative thematic analysis was performed. Results A total of 56 articles were analyzed and 35 stakeholders participated in four focus groups. Two main findings emerged. First, belonging to an ethnocultural minority group appears associated with cumulative risk factors that may contribute to vulnerability situations and compound the complexity of S-RTW. Second, cultural differences with respect to the prevailing host-country culture may generate communication and trust issues, and conflicts in values and representations, in turn possibly hindering the establishment of positive relationships among all stakeholders and the ability to meet workers' needs. Being a woman in these groups and/or having a lower level of integration into the host country's culture also appear associated with greater S-RTW challenges. Conclusions Based on our findings, we recommend several possible strategies, such as the cultural humility model, for preventing differences from exacerbating the already significant vulnerability situation of some ethnocultural minority workers.

Building a Common Language to Facilitate Discussion Among Stakeholders in Work Disability: A Consensus Group Approach.

PURPOSE: Work disability stakeholders may not share the same understanding and solutions among themselves or with researchers, causing misunderstandings and hindering collaboration regarding solutions for preventing work disability. To reduce such differences, this study sought to build a common vocabulary among stakeholders and researchers, using a transdisciplinary research framework. METHODS: A consensus method based on a constructivist approach was used. A theoretical sampling method was applied to identify researchers or stakeholders representing one of the four systems in the work disability paradigm. A preliminary set of definitions for key terms was assessed using a Web-based questionnaire. It documented participants' level of agreement with each term's inclusion and relevance in the field, and the clarity of the definition, while soliciting suggestions for other terms or clearer definitions. Disagreements were discussed at group meetings, yielding consensus on the final terms and definitions. RESULTS: Eleven stakeholders representing patients, employers, unions, healthcare professionals, and legislative and insurance systems, along with 10 multidisciplinary researchers, participated. The questionnaire yielded initial consensus on the inclusion and definitions of 49 terms, and 109 suggestions mostly for modified definitions (average = 6 suggestions/term). Two preliminary terms were excluded and three terms were added. Ultimately, 80 terms and their definitions yielded consensus. CONCLUSIONS: The process we used to build a common vocabulary was carried out within a transdisciplinary framework. It required a constructivist approach, promoting idea exchanges among participants and co-construction of generally agreed results. The results were rooted in local contexts, thus ensuring the same reference points, regardless of participants' different understandings.

How does Gender Influence Sustainable Return to Work Following Prolonged Work Disability? An Interpretive Description Study.

PURPOSE: A sustainable return to work (S-RTW) following prolonged work disability poses different challenges, depending on gender. This article provides a synthesis of gender differences in the issues and factors influencing the S-RTW of workers following such a disability. METHODS: Using an interpretive description method, an integrative review was conducted of the literature on gender differences in S-RTW issues and factors associated with four major causes of work disability. The initial review concerned the 2000-2016 literature; it was subsequently updated for November 2016-March 2020. To explore and contextualise the results, four focus groups were held with stakeholders representing the workplace, insurance, and healthcare systems and workers. Qualitative thematic analysis was performed. RESULTS: A total of 47 articles were reviewed, and 35 stakeholders participated in the focus groups. The prevailing traditional gender roles were found to have a major gender-specific influence on the attitudes, behaviours, processes and outcomes associated with S-RTW. These differences related to the (1) cumulative workload, (2) work engagement, and (3) expressed and addressed needs. CONCLUSIONS: The results highlight the importance of taking into account both professional and personal aspects when integrating gender issues into the assessment of workers' needs and subsequently into interventions.

Insights into the Sustainable Return to Work of Aging Workers with a Work Disability: An Interpretative Description Study.

Purpose A sustainable return to work (S-RTW) following prolonged work disability poses particular challenges as workers age. This article provides a synthesis of the factors and issues involved in a S-RTW process for aging workers following such a disability. Methods Using interpretive description methods, a critical review was conducted of the literature specifying return-to-work factors and issues for aging workers with regard to four major causes of work disability (musculoskeletal disorders, common mental disorders, cancer or other chronic diseases). The initial review concerned the 2000-2016 literature, and was subsequently updated for November 2016-December 2018. To further explore and contextualise the results of this literature review, four focus groups were held with stakeholders, representing the workplace, insurance, and healthcare systems and workers. Qualitative thematic analysis was performed. Results Fifty-five articles were reviewed and 35 stakeholders participated in the focus groups. Returning to work and staying at work appear to be particularly challenging for aging workers, who face notable issues and stigma concerning their ability to meet work demands, as well as their mobilisation and engagement in these processes. Such findings echo in many ways the main assertions of the literature on aging at work, except those regarding the transformation of capacities with aging, which is not mentioned in relation to workers with a work disability. The influence of healthcare and compensation systems on the S-RTW of aging work-disabled workers has also received little attention to date. Conclusions The results underscore that aging workers with a disability are frequently vulnerable in terms of their health or their jobs. Intersectoral efforts are needed to remedy this situation to keep them at work.

Professional Role Identity: At the Heart of Medical Collaboration Across Organisational Boundaries.

PURPOSE: The purpose of this paper was to help answer two persistent calls in the literature: the first asks to strengthen the understanding of medical collaboration across levels of healthcare delivery; the second one requests paying more attention to the individual experience of different forms of professional work. Accordingly, the study was guided by the following research question: How do family physicians and specialists working at different levels of healthcare delivery enact their professional identity when interacting in their situated clinical contexts? METHODOLOGY: This was a multiple interpretive case study in which, based on Giddens' ideas, professional identity was viewed as a dynamic structural element of social life recursively related to professionals' collaborative actions through sensemaking processes. The study involved 57 participants. Face-to-face individual semi-structured interviews and organizational documents were the main sources of data. Deductive-inductive thematic analysis was adopted as strategy for data analysis. FINDINGS: Three prevailing physicians' identity roles were elicited: medical expert, care coordinator, and team member. These professional identities, not mutually exclusive, were instantiated in three specific modalities of collaboration: quasi-inexistent, restrained, and extended. The entanglement of a particular identity role and a specific collaborative practice became meaningful through a complex net of organizational and institutional features, and patients' nosological profiles.

Understanding the emergence and development of medical collaboration across organizational boundaries: A longitudinal case study.

Our goal in this investigation was to help shed light on the very difficult process of collaboration between family physicians and specialists working at different levels of healthcare delivery. More precisely, and grounded on Giddens' structuration theory, our investigation aims to understand how medical collaboration emerges and develops around chronic patients. This was a longitudinal interpretive case study, the "case" being a continuum-of-care for patients suffering from diabetes, put in place in an urban health center in the Canadian province of Quebec. The study shows how the application of rules of signification and of legitimation, combined with domination resources, have supported the emergence of new forms of collaborative practices. Our analysis reveals, however, that new collaborative practices at the administrative level do not necessarily entail greater shared decision-making in patient management and the mobilization of knowledge across boundaries. The study also corroborates the mutual recursive influence of practices and structures. Our study's most important contribution concerns the impact of knowledge dynamics, that is, individual and collective learning, on the development of medical collaboration across levels of care.

[Using telemedicine to improve chronic disease monitoring]. / L'utilisation des télésoins à domicile pour un meilleur suivi des maladies chroniques.

AIM: The purpose of this study was to understand how home telecare technologies can be used to improve services for people with chronic diseases. METHODS: Canadian elders with at least one of the targeted chronic diseases (COPD, heart failure, hypertension, diabetes) were asked to use telehomecare equipment. The data needed to assess the implementation process and to monitor outcomes were collected through participatory observation, documentary analysis and interviews. RESULTS: The study found that the technology has a number of benefits for patients, particularly in terms of access to health services. By enabling patients to access more information about their health, the use of the technology, combined with an educational program, contributes to increasing their capacity for self-management. The results also indicate that the telehomecare equipment had a positive impact on clinical decision-making. By facilitating health professionals' access to information and expertise, it was found to promote interprofessional practice. The study found that telehomecare technology has an organizational impact on practice and requires organizational adaptation, the form of which will depend on local organizational and clinical settings. CONCLUSION: The results suggest that telehomecare technology helps to create conditions that need to be met by health care organizations in order to improve service delivery to people with chronic diseases, particularly with regard to interprofessional collaboration, health professionals' access to information and expertise and active patient participation. However, the successful implementation of the technology requires a detailed analysis of the settings in which it is used.