Retorno al trabajo durante la pandemia. La perspectiva bioética.

[no disponible].

Analysis of engagement between ethics and return-to-work discourses in respective academic literature.

BACKGROUND: Return-to-work (RTW)/back-to-work (BTW) interventions that are designed to rehabilitate individuals impaired from fulfilling employment roles are facing challenges. Ethics discourses, including ethics theories, principles and concepts, are meant to give guidance on what one ought to do or not to do and RTW professionals could use them to respond to their challenges. OBJECTIVE: A scoping review was performed to investigate to what extent 33 ethics concepts, theories, and principles are employed in RTW/BTW academic literature, and to what extent RTW/BTW is engaged with in ethics linked academic journals. METHODS: Three academic databases were searched, and 147 article results were extracted from our literature review to be thematically analyzed. RESULTS: Searches with n = 11 ethics concepts and n = 4 ethics theories generated results. The content of 20 RTW/BTW article results demonstrated conceptual engagement between RTW and ethics discourses. Only one article in ethics-related journals conceptually engaged with RTW/BTW. CONCLUSION: Ethics theories and principles were not used extensively in RTW/BTW academic literature and RTW/BTW is a topic under-engaged within ethics-related journals. Our findings indicate opportunities for further research, like conducting interviews, to better understand our findings and how to respond to them.

Return-to-work success despite conflicts: an exploration of decision-making during a work rehabilitation program.

PURPOSE: Collective decision-making by stakeholders appears important to return-to-work success, yet few studies have explored the processes involved. This study aims to explore the influence of decision-making on return-to-work for workers with musculoskeletal or common mental disorders. METHOD: This study is a secondary analysis using data from three earlier multiple-case studies that documented decision-making during similar and comparable work rehabilitation programs. Individual interviews were conducted at the end of the program with stakeholders, namely, the disabled workers and representatives of health care professionals, employers, unions and insurers. Verbatims were analysed inductively. RESULTS: The 28 decision-making processes (cases) led to 115 different decisions-making instances and included the following components: subjects of the decisions, stakeholders' concerns and powers, and types of decision-making. No differences were found in decision-making processes relative to the workers' diagnoses or return-to-work status. However, overall analysis of decision-making revealed that stakeholder agreement on a return-to-work goal and acceptance of an intervention plan in which the task demands aligned with the worker's capacities were essential for return-to-work success. CONCLUSION: These results support the possibility of return-to-work success despite conflictual decision-making processes. In addition to facilitating consensual decisions, future studies should be aimed at facilitating negotiated decisions. Implications for rehabilitation Facilitating decision-making, with the aim of obtaining agreement from all stakeholders on a return-to-work goal and their acceptance of an intervention plan that respects the worker's capacities, is important for return-to-work success. Rehabilitation professionals should constantly be on the lookout for potential conflicts, which may either complicate the reach of an agreement between the stakeholders or constrain return-to-work possibilities. Rehabilitation professionals should also be constantly watching for workers' and employers' return-to-work concerns, as they may change during work rehabilitation, potentially challenging a reached agreement.

Communication and collaboration among return-to-work stakeholders.

Purpose: Workers who are injured or become ill on the job are best able to return-to-work when stakeholders involved in their case collaborate and communicate. This study examined health care providers' and case managers' engagement in rehabilitation and return-to-work following workplace injury or illness. Method: In-depth interviews were conducted with 97 health care providers and 34 case managers in four Canadian provinces about their experiences facilitating rehabilitation and return-to-work, and interacting with system stakeholders. Results: A qualitative thematic content analysis demonstrated two key findings. Firstly, stakeholders were challenged to collaborate as a result of: barriers to interdisciplinary and cross-professional communication; philosophical differences about the timing and appropriateness of return-to-work; and confusion among health care providers about the workers' compensation system. Secondly, these challenges adversely affected the co-ordination of patient care, and consequentially, injured workers often became information conduits, and effective and timely treatment and return-to-work was sometimes negatively impacted. Conclusions: Communication challenges between health care providers and case managers may negatively impact patient care and alienate treating health care providers. Discussion about role clarification, the appropriateness of early return-to-work, how paperwork shapes health care providers' role expectations, and strengthened inter-professional communication are considered. Implications for Rehabilitation Administrative and conceptual barriers in workers' compensation systems challenge collaboration and communication between health care providers and case managers. Injured workers may become conduits of incorrect information, resulting in adversarial relationships, overturned health care providers' recommendations, and their disengagement from rehabilitation and return-to-work. Stakeholders should clarify the role of health care providers during rehabilitation and return-to-work and the appropriateness of early return-to-work to mitigate recurring challenges. Communication procedures between health care specialists may disrupt these challenges, increasing the likelihood of timely and effective rehabilitation and return-to-work.

Conflictos bioéticos en la relación sanitaria derivada de las bajas laborales / Bioethical conflicts in the healthcare relation derived from work leaves

El presente artículo realiza una reflexión sobre los conflictos bioéticos que surgen en la relación médico paciente cuando un trabajador presenta un problema de salud que deriva en una baja laboral. Se limita a aquellos casos de origen común, es decir, cuando el problema de salud no tiene una relación directa con el trabajo. Asimismo se centra específicamente en los trabajadores por cuenta ajena cuyo régimen integra la seguridad social y reciben una prestación económica mientras dura el proceso a través de la Mutua Colaboradora con la Seguridad Social (en adelante Mutua) a la que su empresa este afiliado. Aunque el trabajador acude al médico por un problema de salud, la relación no es únicamente asistencial, sino que también incluye una valoración de la capacidad laboral, ya que en caso de verse disminuida, se emitirá un certificado de incapacidad temporal. A través de dicho certificado se activan mecanismos que ponen en marcha la participación de otros sanitarios, en éste caso de la Mutua, con el objetivo de gestionar dicho proceso. Por tanto, hablamos de una relación más amplia, compleja, que va más allá de la asistencia sanitaria, y que en ocasiones puede generar conflicto de intereses (AU)

This paper reflects on the bioethical conflicts derived from the physician-patient relation when a worker presents a health condition that results in a work leave. The paper only deals with those cases that have a common origin, i.e., the health condition is not directly related to the individual’s work activity. Furthermore, it is specifically focused on employed workers whose labor regime is part of the social welfare system and receives an economic benefit for the duration of the process through a health insurance company (hereinafter, Mutua), which the worker’s firm is affiliated to. Although the worker visits the doctor due to a health condition, the relation is not limited only to receiving healthcare, but also includes an assessment of the labor capability, because, in the event that this is undermined, a temporary certificate of incapacity will be issued. This certificate will activate some mechanisms that result in the involvement of other entities related to the healthcare system, in this case the Mutua, that will manage said process. Therefore, this relation is broader and more complex and goes beyond mere healthcarerelated matters and, sometimes, may give rise to conflicts of interests (AU)

Return to work or job transition? Employer dilemmas in taking social responsibility for return to work in local workplace practice.

PURPOSE: The aim was to analyze the role and activities of employers with regard to return to work (RTW), in local workplace practice. METHOD: Semi-structured interviews were conducted with sick-listed workers and their supervisors in 18 workplaces (n = 36). The analytical approach to study the role of employers in RTW was based on the three-domain model of social corporate responsibility. The model illustrates the linkage between corporations and their social environment, and consists of three areas of corporate responsibility: economic, legal and ethical. RESULTS: Employers had difficulties in taking social responsibility for RTW, in that economic considerations regarding their business took precedence over legal and ethical considerations. Employers engaged in either "RTW activities" or "transition activities" that were applied differently depending on how valued sick-listed workers were considered to be to their business, and on the nature of the job (e.g., availability of suitable work adjustments). CONCLUSIONS: This study suggests that Swedish legislation and policies does not always adequately prompt employers to engage in RTW. There is a need for further attention to the organizational conditions for employers to take social responsibility for RTW in the context of business pressure and work intensification. IMPLICATIONS FOR REHABILITATION: Employers may have difficulties in taking social responsibility for RTW when economic considerations regarding their business take precedence over legal and ethical considerations. Rehabilitation professionals should be aware of that outcomes of an RTW process can be influenced by the worker's value to the employer and the nature of the job (e.g., availability of suitable work adjustments). "Low-value" workers at workplaces with limited possibilities to offer workplace adjustments may run a high risk of dismissal. Swedish legislation and policies may need reforms to put more pressure on employers to promote RTW.

[Temporary disability and its legal implications]. / La incapacidad temporal y sus implicaciones legales.

Temporary disability is the condition that workers face when, as the result of illness (common or professional) or accident (work-related or not), they are temporarily prevented from performing their work and require health care. The management of temporary disability is a medical act that involves (in addition to a complex clinical assessment) obvious social, occupational and financial connotations and requires continuing medical follow-up from doctors, as well as responses to medical-legal conflicts. The regulatory framework on the subject is extensive in the Spanish setting and highly diverse in the European setting. Beyond the regulatory framework, the repercussions of temporary disability are self-evident at all levels. Although determining temporary disability is a common medical act for practicing physicians, it is not exempt from risks or difficulties arising from the assessment itself and the characteristics of practicing medical care. Established medical-legal conflicts include the processing of health data and the requirements for transferring information related to workers' temporary disability to their company's medical services. The interest and usefulness demonstrated by the data obtained from forensic medicine for public health require the incorporation of these data into general healthcare information, as it could be essential to the surveillance of worker health. The recommendations established by medical societies, as good practice guidelines, are especially useful in this type of conflict.

La incapacidad temporal y sus implicaciones legales / Temporary disability and its legal implications

La incapacidad temporal es la situación en la que se encuentra un trabajador que, a consecuencia de una enfermedad (común o profesional) o accidente (sea o no de trabajo), está impedido para desempeñar temporalmente su trabajo y requiere asistencia sanitaria. La gestión de la incapacidad temporal es un acto médico que implica, al margen de una compleja valoración clínica, evidentes connotaciones sociales, laborales y económicas, exigiendo al médico un seguimiento clínico continuo y dar respuesta a conflictos medicolegales. El marco regulatorio en la materia es extenso en el ámbito español y muy diverso en el europeo. Más allá del marco normativo, la repercusión de las incapacidades temporales es indiscutible a todos niveles. Aunque la determinación de una incapacidad temporal es un acto médico muy frecuente para los médicos asistenciales, no está exento de riesgos ni de dificultades derivados de la propia valoración y de las características del ejercicio de la medicina asistencial. Algunos conflictos medicolegales planteados son el tratamiento de los datos de salud o la obligatoriedad de trasladar a los servicios médicos de empresa la información relacionada con la incapacidad temporal del trabajador. El interés y utilidad que han demostrado los datos obtenidos desde la medicina forense para la salud pública obligan a incorporar a estos al común de la información sanitaria, pudiendo ser clave en la vigilancia de la salud de los trabajadores. Las recomendaciones establecidas por sociedades médicas, como códigos de buenas prácticas, son especialmente útiles en este tipo de conflictos (AU)

Temporary disability is the condition that workers face when, as the result of illness (common or professional) or accident (work-related or not), they are temporarily prevented from performing their work and require health care. The management of temporary disability is a medical act that involves (in addition to a complex clinical assessment) obvious social, occupational and financial connotations and requires continuing medical follow-up from doctors, as well as responses to medical-legal conflicts. The regulatory framework on the subject is extensive in the Spanish setting and highly diverse in the European setting. Beyond the regulatory framework, the repercussions of temporary disability are self-evident at all levels. Although determining temporary disability is a common medical act for practicing physicians, it is not exempt from risks or difficulties arising from the assessment itself and the characteristics of practicing medical care. Established medical-legal conflicts include the processing of health data and the requirements for transferring information related to workers’ temporary disability to their company’s medical services. The interest and usefulness demonstrated by the data obtained from forensic medicine for public health require the incorporation of these data into general healthcare information, as it could be essential to the surveillance of worker health. The recommendations established by medical societies, as good practice guidelines, are especially useful in this type of conflicto (AU)