Return to work – it’s everyone’s business!


Disability and return-to-work management

Expert : 

Marie-José Durand, Centre d’action en prévention et réadaptation de l’incapacité au travail, Université de Sherbrooke, QC, Canada
Holder of the J. Armand Bombardier and Pratt & Whitney Canada Research Chair in Work Rehabilitation


Camille Roberge


Rédacteurs :

Étienne FOUQUET, research assistant, Université de Sherbrooke
Marie-Élise LABRECQUE, professional researcher, Université de Sherbrooke

This initiative was made possible through a collaboration with the Université de Sherbrooke.

Returning to work after experiencing health problems is not the same as returning to work after a tropical vacation! Each year, thousands of employees return to work after a prolonged absence. Although organizations want their employees back quickly, this is a critical time when care must be taken to ensure a sustainable return. What are the best practices to achieve this?

Looking at musculoskeletal disorders and common mental disorders, which are the most common causes of prolonged absences from work, Durand et al. (2014) suggest a six-step return-to-work process involving various stakeholders in the organization. The authors’ discoveries determine that although the causes of these disorders can vary, they all benefit from this process. Furthermore, it appears that more support provided during the return to work translates to more benefits reaped by the organization over the long term!

Defining the concepts

Common mental disorder

The term “common mental disorder” (CMD) is generally used to refer to people suffering from anxiety, depression or an adjustment disorder—the most common disorders in the active population.

Return to work

An employee is considered to be returning to work (RTW) when they resume their duties following an absence from work due to injury or a mental disorder.

Musculoskeletal disorder

Musculoskeletal disorders (MSDs) are defined as pain or other symptoms in the neck, back, or various parts of the upper or lower limbs. They affect tendons, muscles, ligaments, joint tissue or certain nerves and stem from an accumulation of injuries (INSPQ, 2019).

The six return to work (RTW) stakeholders

Senior management

Work absence manager



Union representative

RTW coordinator1


Literature review
The RTW process suggested by the authors was developed using an integrative review of the scientific literature on best RTW practices following a CMD or MSD.

1 The return to work (RTW) coordinator is a person designated by the organization to coordinate all actions related to an employee’s RTW process. This person can be an employee of the organization or from an external company. Ideally, the RTW coordinator should be a neutral party who is not connected to organizational management or union interests. RTW coordination duties can be performed part time or full time, depending on the structure and size of the organization. In France, RTW coordination tasks can be done by family doctors in partnership with social workers. In Canada, human resources advisors are generally the ones who perform these tasks.

What can organization do?

The six RTW steps are summarized here, with a focus on the primary responsibilities of each organizational stakeholder.



Specific courses of action


Time off and recovery period

Work absence manager

  • After receiving the doctor’s note, be sure to respect the employee’s recovery period and the attending physician’s recommendations;
  • Contact the RTW coordinator when the absence starts to inform them of the employee’s situation.

RTW coordinator

  • Write a letter to the employee providing contact information for resources and explaining the overall RTW process;
  • In addition to medical follow-up, provide the employee with specialized services to meet their specific clinical or social needs to support their recovery process.


Initial contact with the employee

RTW coordinator

  • Contact the employee by phone a few days or weeks after their absence starts in order to offer them support during their recovery period while also respecting the time off authorized by their attending physician;
  • Maintain the relationship between the absent employee and the workplace through good communication;
  • Explain the role of each stakeholder involved in the RTW to the employee and check whether they wish to be contacted by their manager or someone else of their choosing during their absence;
  • Plan an evaluation meeting to be held when the employee feels able to participate.


Evaluation of the employee and their work

RTW coordinator

  • Meet with the employee during their absence and jointly identify the barriers and facilitators associated with their recovery and RTW. These factors may be clinical (e.g. intensity of symptoms), social (e.g. support from coworkers) or organizational (e.g. workload) in nature;
  • Evaluate the occupational risk factors and the demands of the job together with the employee and the manager, and with clinicians if needed;
  • Include the employee in this evaluation to encourage their active participation in the RTW process by identifying problems and potential solutions. The employee’s active participation is crucial for RTW.


Development of the plan and accommodations

Senior management

  • Promote the RTW coordinator so their role is known and recognized by all members of the organization;
  • Allow managers to implement more flexible work hours, temporarily reduce departmental production requirements, permit supernumerary replacement to allow for fair redistribution of tasks without overloading certain departments or release the financial resources needed for supernumerary replacement..


  • Be aware of the employee’s capacities and limitations in order to be able to suggest appropriate work accommodations;
  • Implement a work accommodation plan agreed upon by everyone involved and serve as a liaison between the employee and the stakeholders.


  • Support the employee during their RTW.

RTW coordinator

  • Lead concerted action (i.e. pooling the resources and expertise of the various stakeholders involved in work-absence management in order to reach the shared goal of an effective, sustainable RTW);
  • Work accommodations are designed to fill the gaps between the employee’s (temporarily or permanently reduced) capacities and the requirements of the job;
  • Organize a meeting where the RTW plan can be developed by contacting the employee, manager, coworkers and—if needed—health professionals and union representatives;
  • Support the manager in their task of suggesting a RTW plan with accommodations by discussing the respective expectations of the manager and the employee regarding the RTW and, if applicable, addressing performance issues;
  • Inform coworkers of the employee’s capacities that justify work accommodations, as this reduces the likelihood of discrimination from them and encourages them to be supportive.


Work resumption

Senior management

  • Support the manager as they implement the work accommodations, such as by temporarily adjusting production requirements.


  • Prepare coworkers for the employee’s RTW to ensure a positive reception;
  • Encourage coworkers to support the employee;
  • If discrimination occurs, address it with the work group or the people involved.

Union representative

  • Support and reassure the employee during the RTW process.

RTW coordinator

  • Communicate with the stakeholders involved to determine whether the employee’s progress is following the established plan;
  • Keep in touch with the employee to monitor their progression and reassure them about the return-to-work process.


Follow-up of the RTW


  • Follow up on the work accommodations through daily contact with the employee;
  • Plan meetings with the employee to discuss the progression of the RTW and ensure that the conditions are adapted to their needs in order to help them stay at work.

RTW coordinator

  • Follow up regularly with the employee and manager to evaluate the progression of the RTW and the employee’s needs;
  • Make any necessary adjustments to the process in light of changes in the organization of the work or the employee’s health;
  • Remain available to the employee and manager as needed to discuss concerns that may arise once the employee has been performing their regular duties without any particular difficulties for a few weeks.


The results of the best practices study clearly demonstrate that a successful, effective RTW should always involve the affected employee every step of the way. The employee’s participation in the process has a positive impact and will help them stay at work over the long term. The employee must remain at the heart of the process and can become a resource, since they know their job well and can come up with innovative solutions.

The six-step process suggested in this article is applicable to cases of musculoskeletal disorders and common mental disorders, but recent research shows that it also applies perfectly to cases of RTW for cancer survivors. Thus, it is a general process that can be applied to many different health issues that lead to prolonged absences.


Durand, M.J. & Fouquet, É. (2020). Return to work – it’s everyone’s business! Global-Watch Scientific Interpretation available at


Durand, M. J., Corbière, M., Coutu, M. F., Reinharz, D., & Albert, V. (2014). A review of best work-absence management and return-to-work practices for workers with musculoskeletal or common mental disorders. Work, 48(4), 579-589.