Why Fitness for Work Is More Important Now Than Ever Before

Why Fitness for Work Is More Important Now Than Ever Before

The pandemic’s impact on workers is highlighting the importance of the fitness for work test and process.
Michael Lacroix, Medical Director, The Hartford
Michael Lacroix, Medical Director, The Hartford
Adam L. Seidner, Chief Medical Officer, The Hartford
Adam L. Seidner, MD, MPH, Chief Medical Officer, The Hartford
Fitness for work has long been critical to whether a company ran a safe workplace. Now, the pandemic and its lasting impacts on workers has highlighted the need even more for employers across many industries to pay attention to fitness for work.
“When it comes to fitness for work, there’s three areas that really need to be addressed,” said The Hartford’s Chief Medical Officer Dr. Adam L. Seidner. “The opioid epidemic has actually gotten worse during the COVID-19 pandemic, and it’s also had an impact on workers from a behavior and psychological perspective. The workforce is also aging, which is a component that should be looked at.”
Although there’s not a simple solution, medical experts at The Hartford believe employers need to focus on fitness for work now to help ensure their employees are safe and healthy while doing their jobs.

Why Is Fitness for Work Important?

For employers, knowing when and how to assess an employee’s fitness for work is vital to maintaining a safe, healthy work environment. A number of factors can reduce a worker’s ability to properly perform their duties, such as:
  • Use and misuse of prescription or over-the-counter drugs
  • Illegal drug use
  • Mental health conditions
Under Occupational Safety and Health Administration (OSHA) rules, employers have a federal mandate to address impaired workers who contribute to unsafe work environments.
The best way for employers to follow this mandate is to create a clear, comprehensive, written policy about substance use and impairment. This should include guidelines for fitness-for-work evaluations and workplace drug testing.
Be sure your policy is consistent with federal and state laws and conform to union contracts when applicable. This is especially important for employers in safety-sensitive positions.
Determining Fitness for Work

The Pandemic and the Opioid Epidemic

Opioid use and overdose deaths due to opiates increased since the start of the pandemic, according to Seidner. It’s a staggering trend that needs to be focused on and addressed.
When it comes to fitness for work, employees who misuse opioids or prescription drugs can put themselves and their colleagues at risk of injury or even death. So, it’s important to know how to address this issue and help workers who may be struggling with misuse or addiction, as well as creating a stigma-free workplace culture.
Recognizing the importance of this issue, The Hartford continues to develop partnerships with nationally leading experts to help address the ongoing opioid epidemic. The Hartford recently announced it will partner with Yale School of Medicine to put together a pilot training program that will help treat Connecticut injured workers and aim to curb the ongoing opioid crisis.
“We’re going to collaborate and put together a training program for physicians to be able to identify behavioral health issues and substance use disorders,” Seidner explained. “We want to take the stigma off of having any of those diagnoses.”

Behavioral and Psychological Impacts and Fitness for Work

There’s no question the pandemic had a negative effect on people’s mental health. In fact, nearly half of adults continue to report negative mental health impacts related to worry or stress from the pandemic.1
“It’s not just opioids, but we’re seeing massive increases in depression and other conditions,” said Dr. Michael Lacroix, medical director at The Hartford. “There’s a need to have a better structure and better process to evaluate folks.”
What does this look like? Both Lacroix and Seidner said they believe the scope of safety-sensitive positions will expand. A “safety-sensitive” job means the position involves a risk of injury to the employee, fellow workers or general public. These jobs can be dangerous if the employee is working while impaired.
Seidner added that before the pandemic, fitness for work assessments typically looked at the physical aspects of an employee and were “very little focused on the cognitive or behavioral factors.” The pandemic highlighted the need to change this approach.

Aging Workforce

The pandemic brought on a phenomenon called, “The Great Resignation.” It started in Spring 2021, where millions of U.S. workers quit their jobs. In fact, there were 10.6 million job openings on the last business day of November 2021, according to the most recent data from the U.S. Bureau of Labor Statistics.2
An analysis from Harvard Business Review showed resignation rates were highest among mid-career employees.3 And the rates fell for employees in the 60- to 70-year-old age group.4 With an aging workforce, it’s a good idea for employers to provide flexible working policies and a focus on occupational health.
Before the pandemic, the trend was more employees retiring earlier. This posed a potential problem for employers, who would have to hire younger workers with less experience.
“New workers and younger workers are more prone to injuries and accidents. And the severity is higher in that group as well,” Seidner explained.
A younger, less experienced workforce means it’s essential for employers to have proper training policies in place. Part of the training process should include fitness for work evaluations to determine if the employee can do the specific job, Seidner said.

Determining Fitness for Work

Fitness for work is commonly defined as “the assessment of the individual’s capacity to work without risk to their own or others’ health and safety.” Available scientific evidence, however, tells us that fitness for work is mainly determined by the safety and physical demands of the job – rather than the medical condition of the employee.
In other words, assessments of fitness for work that are focused on the job requirements appear to be better predictors of future health outcomes and costs than those focused solely on medical diagnoses. Because of this, fitness for work should include objective measurements and not rely solely on a supervisor’s or medical provider’s judgment.
Determining Fitness for Work
Fitness for work assessment criteria should include:
  • Worker health and safety risk
  • Third-party health and safety risk
  • Predicted performance
Fitness for work determination criteria should include:
  • Worker physical and cognitive capacity
  • Risk in relation to work environment
Outcomes from fitness for work assessments can range from “fit” to “unfit.” Employees can, however, be fit to work with work modifications or “fit with restrictions.”

How Can Employers Identify a Potential Problem?

Ongoing performance problems that don’t respond to normal supervisory actions may be signs of addiction or other personal problems that could require further intervention. For example, the potential consequence of opioid use in the workplace includes the risk and cost of adverse events, as well as productivity loss.
How Can Employers Identify a Potential Problem?
It’s not just opioids and other prescription medication that can influence a worker’s ability to do their job. Over-the-counter medicine for colds, sleep and allergies can cause drowsiness and impede an employee’s ability to perceive and react to hazards.
Employers can look for a number of indicators of addiction, such as:
  • Poor attendance
  • Mistakes or missed deadlines
  • Tardiness
  • Coworker or customer complaints

Fitness for Work Policy: Employee Support

Fitness for work assessment and determination criteria are just one part of a successful policy. Employers should also determine the type of assistance they’ll offer employees who need help.
If an employee is deemed unfit for work, a return-to-work agreement that outlines when they can safely return should be made available to the employee within a reasonable timeframe.
The first step that managers and supervisors can take to assist an employee exhibiting a performance or impairment issue is to start a conversation.
“It’s really the employer driving a change in fitness for work structure and process,” Lacroix explained. “Supervisors should identify any issues early and get the referral to any resources they have, like an employee assistance program (EAP), HR or the employee’s primary care doctor.”
Employers and employees can also use community organizations such as the National Alliance on Mental Illnesses (NAMI), the nation's largest grassroots mental health organization dedicated to building better lives for the millions of Americans affected by mental illness.as a resource.

Protecting Confidentiality and Other Workplace Protections

Discrimination is prohibited in any facet of employment. So, employers should develop confidential policies to help protect employees from unfair treatment.
If an EAP service is available, employers should inform employees that records are separate from their personnel file. Importantly, workers should know that EAP records can only be accessed with a signed release from the employee.
Be aware that decisions that affect a worker’s employment and earning capacity are complex and have legal and ethical responsibilities. Employers should work with legal counsel in decision-making processes to best understand employee rights and employer liabilities.

Guidance on Reviewing Workplace Policy

A Workplace Policy Statement outlines an organization’s policies, procedures and programs that address employee substance use and impairment in the workplace, explaining the support offered to workers. Ideally, this policy gets signed and dated by company leaders.
Guidance on Reviewing Workplace Policy
Workplace policies are most effective when they’re clearly communicated and fairly enforced. Employers can demonstrate their commitment to employees and to a healthy workplace by inviting workers to participate in the development, implementation and improvement of the workplace policy and program.
As part of this review and development process, employers should include:
  • Legal counsel
  • Gerencia
  • HR
  • Medical review officer
  • Other occupational health professionals
Remember, workplace policies and procedures require constant evaluation and updating. Train supervisors and regularly communicate with employees about what’s expected in the workplace. This will ensure knowledge and the proper implementation of programs. Another benefit? It’ll help employers attract and retain their most valuable asset: their employees.
1 Kaiser Family Foundation, “Mental Health Impact of the COVID-19 Pandemic: An Update”
2 U.S. Bureau of Labor Statistics, “Job Openings and Labor Turnover Summary – November – 2021”
3, 4 Harvard Business Review, “Who Is Driving the Great Resignation?”
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