Work and Health Research Lab

Work disability policy and systems

The Science and Politics of Work Disability Policy: International Contexts

This book focuses on the science and politics of work disability systems. It addresses how and why, despite the mounting scientific evidence base and law and policy changes, the problem ofwork disability remains. Authors from 13 countries consider social security system changes to stem ‘work disability’ in their jurisdiction: their ideals, what worked and what didn’t work and why. They not only consider research evidence, but also realities of implementation, budgets, and political favour. The book is edited by Ellen MacEachen and was published by Routledge in September 2018.

Click here for access to the table of contents and book ordering information.

Study Team: Ellen MacEachen (Editor) with editing and layout support from Dr. Margaret Oldfield, Julia Goyal and Sonja Senthanar.



Return to Work Coordinators and Mental Health

This study (Jan 2018 – May 2020) tapped the rich and grounded knowledge of Canadian return to work (RTW) coordinators to understand their strategies for managing return to work among clients with common mental health disorders associated with work absence.

Study page
Return to Work and Mental Health Guide

Study Team: Ellen MacEachen PhD (Principal Investigator), Elena Neiterman, PhD (Co-Investigator), Cindy Malachowski PhD (Co-Investigator), Katya McKnight MA (Project Coordinator), Meghan Crouch MSc (PhD Candidate), Sharanya Varatharajan (PhD Candidate), Pamela Hopwood (MSc Student), Erica McDonald, Nada Dali, Emily Giau, and Megan Dol (Research Assistants).

What is fair? International perspectives on equality in work and health

This course, a first of its kind at UWaterloo, is an international on-line graduate partnership between UWaterloo and international universities. The objective of this course and partnership is to provide unique learning opportunities for students to work with their international peers on course work and group activities while learning about international systems and policy in relation to health, work and equity.

Study team:  Asa Tjulin (Mid-Sweden University), Ellen MacEachen (University of Waterloo), John Selander, (Mid-Sweden University), Phil Bigelow University of Waterloo), Stig Vinberg (Mid-Sweden University), and Robert Larsson (Malardalen University).

Scoping Review of Work Disability Policy

This scoping review provides an overview of international peer review literature on gaps and challenges in the design and delivery of work disability policy and programs.

The scoping review database is available here.

Centre for Research on Work Disability Policy

Ellen MacEachen co-founded this research centre, funded through a 7-year SSHRC partnership grant (2013 to 2020). The Center brings together 60+ researchers and 60+ partners from across Canada to identify how people with disabilities can be better retained and integrated into the Canadian labour market. The Center provides funding to graduate students to engage with work disability policy. This initiative is a transdisciplinary inquiry into the future of work disability policy and labour-market engagement.

See the CRWDP website here.

See a YouTube presentation here.

International studies of return to work

In Finland, early return to work policies are only recently emerging. We conducted research to gauge opinions and experiences of occupational health physicians in Finland in relation to appropriate return to work policy for Finland.

Read the findings about occupational physician reasoning, temporary work modifications  and a related editorial.

In Sweden, early return to work policy has focused on persuasion and advice to workplace parties rather than fixed rules or policy. Studies of how return to work is carried out in workplaces have shown how informal interaction in workplaces can foster or hinder the reintegration of workers following a workplace injury or illness.

Read the findings about employer dilemmas, work intensification, early contact with sick listed workers, co-worker experiences and social organisation of return to work.

Critical Review of Experience-Rating in Workers’ Compensation Systems

Workers’ compensation systems build in financial incentives to encourage employers to maintain safe workplaces. We investigated peer-review literature on these incentives, called experience-rated premiums, to examine intended and unintended behavioural effects and health effects.

Read the critical review here.

Vocational Rehabilitation for Injured Workers: The Labour Market Re-Entry Program

When workers cannot return to their original employment because of the nature of their injury or because their employers cannot offer them continued work they, workers’ compensation systems provide retraining for a new career. We examined how Ontario’s Labour Market Re-Entry (LMR) program is carried out and identified areas of possibility, and of concern, for the re-integration of injured workers to the workforce.

Impact: This study prompted significant redesign and rebranding of the Workplace Safety and Insurance Board’s LMR program (now called Work Reintegration).

Read findings about the ‘ability paradigm’ and about models of consumer choice.

Long-Term, Complex Workers’ Compensation Claims

A small percentage of workers’ compensation claims account for a disproportionate amount of system resources. Only a vague picture existed of why some claims become complex and costly while others do not. This study identified determinants of complex claims experiences in the context of health care, employment, return to work, and retraining experience.  We found idealist return to work policies help to set the stage for these problems.

Read findings about the toxic dose of system problems and about health care providers and complex chains. Read the full report “How systemic problems can prolong workers’ compensation claims’.

Using the complex claims findings as a platform, we held stakeholder workshops and developed a toolkit, called “Red Flags/Green Lights: A Guide to Identifying and Managing Return-To-Work Problems”. This guides stakeholder decision-makers on how to manage processes, situations and problems of workers with long-term workers’ compensation claims. We also conducted an evaluation of how the guide is useful to different kinds of stakeholders.

The Red Flags/Green Lights Guide can be found here.  Read the evaluation of the guide here.

Reviews of Literature on Return to Work after Illness or Injury

Because return to work often includes early return before full recovery while a person is undergoing rehabilitation treatment, physical recovery is embedded in complicated ways with workplace processes and practices and social organization. We conducted a systematic review of international qualitative research literature on return to work considered the dimensions, processes, and practices of return to work. This systematic review formed part of a mixed-method review of return to work literature and provided a foundation for the stakeholder tool, Seven “Principles” for Successful Return to Work.

Read the systematic review of return to work research and an editorial commentary of the review. Read the full mixed methods review.

Download the Seven “Principles” for Successful Return to Work.

Since the 1990’s, workers’ compensation authorities have promoted policies of early return to work before full recovery. We examined evidence sources touted by authorities and provide a critique of policies.

Read the ‘hurt versus harm’ article.

Frontline Staff at the Ontario Workers’ Compensation Board

We characterized and explained the nature, logic and social relations of front-line service work at Ontario’s Workplace Safety and Insurance Board (WSIB). We found that front-line work is a “professional assembly line” where judgment and flexibility are required within a highly standardized process. Strategic discursive (language/talk) and strategic discretionary practices enable staff to “keep things moving,” solve problems, manage clients, and handle conflicting expectations. Work with small businesses has distinctive challenges within an administrative and policy system designed for larger organizations, and is affected by the marginal, oft-changing status of small business within the WSIB.

See the ‘logic of practice’ findings report.

See the presentation here.

Injured Workers’ Self Help Groups

An in-depth study was conducted of an Ontario injured worker peer support network.  Four dimensions of peer support were identified: worker experience of being misunderstood by system providers, need for advocates, social support, help with procedural complexities of the workers’ compensation, and health care systems. Peer support constitutes a partial return-to-work solution for workers with injuries, but injured workers encounter an uneven playing field. Injured worker peer support group needs and activities show us that sensitivity to structural and social issues may lead to better return-to-work outcomes.

Read the ‘unexpected barriers’ paper here.