Those employees at risk of a delayed return to work can be identified very soon after their injury by managers who are trained in absence management. Line managers and supervisors are key to this process due to their proximity to both the employee and their ability to manage the immediate work environment. Injury flags have been used for a number of years by clinicians to determine potential non-physical barriers to successful outcomes, and employer and line managers could help improve injured employee return to work rates if they understood these barriers and and in a position to help address/reduce them.
Early contact can also be valuable for the employer to determine the outcome of the injury and to provide the individual with the support they may need to return to work. By carrying out a timely assessment using a biopsychosocial model, employers can understand who is at risk of absence and disability and why. It can also help to identify which employee needs support to return to work and also what that support might look like. Most people who fail to return to work do so because of reasons other than their health condition. We will examine these reasons by looking at the different flags, which medically speaking are markers of risk factors.
What are flags? Why do clinicians use them and what do they tell us ?
Flags can be split into two distinct categories: clinical flags and psychosocial flags:
Clinical flags are common to many areas of health. If suspected these require urgent further investigation.
- Red Flags are a sign of serious pathology. If red flags are suspected they require urgent investigation and are an alert that something could seriously be wrong – such as structural musculoskeletal damage.
- Orange flags alert to serious mental health and psychological problems e.g high levels of stress, post traumatic stress disorders or clinical depression. Orange flags alert a clinician that a referral needs to be made to a specialist in that field rather than following the normal course of management for mild anxiety for example.
Psychosocial flags have been subdivided over the years to reflect the different interactions that can affect recovery. Psychosocial flags allow us to identify aspects of the person, their problems and their social context, and how those factors affect the recovery and return to work process. Psychosocial flags provide a framework for assessment and planning, and an indication that someone may not recover as expected, and may need additional support to return to work.
- Yellow flags look at the individuals thoughts, feelings and behaviours towards the current problem which are influenced by personal factors and perceptions. They may have unhelpful beliefs about pain and as a result may have poor coping strategies. For example the individual may report extreme pain disproportionate to the condition. They may be fearful of movement and of re-injury.
- Blue flags are the injured party’s fears and misconceptions around a return to work. These are often based on their previous experiences or those of others in the organisation. They may, for example, decide not to contact work as they perceive they won’t be able to return to work until they no longer require crutches. An accommodating approach is required to provide altered duties or modified work options to facilitate an earlier return to work.
- Black flags are outside the immediate control of the injured party and those involved in a return to work. These are about the context and environment in which that person functions, which includes other people, systems and policies. For example poor or unhelpful company policies, where no policy around sickness absence management and return to work, or there is a rigid management of absence within a disciplinary policy system that does not allow sufficient flexibility to deal with genuine injury or rehabilitation needs.
- Pink Flags are facilitators of positive outcomes and can be useful in practice. These give the injured party a chance of a better outcome, these should be emphasized and created. These are individuals who enjoy their job and are keen to return to work. This is an individual who has discovered that activity actually helps them feel better, so wants to stay active at home and at work. Pink flags can be influenced by giving reassurance, educating appropriately to avoid unhelpful beliefs developing and supporting and giving confidence in the planning process. An accommodating workforce is a pink flag.
- Multiple flags- Individuals may have more than one flag at any one time.
What can be done at work to help?
A collaborative approach is advised for an effective outcome, to consider and respond to any identified flags and barriers to a timely return to work. Whether this is from a timely referral to a health professional, keeping in regular contact with the injured party and/ or having flexibility around a return to work. Having the awareness of the identified flag, acknowledging it and taking it forward in a timely and responsive manner as part of a return to work plan will be beneficial for all those involved.
Benefits of a return to work plan are:
- Early clinical support and advice to your injured employees in the first 30 days to help them manage their recovery following a work place accident as effectively as possible.
- Access to appropriate medical treatment if an employee will be off work for a prolonged period.
- Helps provide accurate and appropriate information to assist in meeting MOJ timeframes if a claim is presented.