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Sick leave monitoring in a 24-hour perspective

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Sick leave monitoring in a 24-hour perspective

Employees in Norway are seeking balance in their lives, and they feel that good sleep and a healthy lifestyle are very important to their working ability. Occupational Health Nurse and sleep expert Lena Drange Nesland believes we need to consider the clear signals from employees in monitoring sick leave and think in a 24-hour perspective.

“We can no longer separate occupational health and lifestyle. If we want to get more people back into work, we must increase the level of expertise about what gives people real benefit in their working lives,” Nesland stresses. She has several years’ experience from several sick leave follow-up programmes, where businesses have successfully taken a more holistic and systematic approach.

While she does believe that the term occupational health must be expanded, she stresses that this is not congruent with increased responsibility for companies. It is the approach to sick leave that needs to be modified, so it is not isolated to the workplace alone.

According to the Occupational Health Report, 33% of the workforce in Norway say that the employer to some or a great extent is responsible for enabling them to have a good balance between work and leisure.

The individual’s responsibility

“We know that balance is important for people to be content. But it’s also right to question whether this is the employer’s responsibility. Our experience shows that greater accountability and more structured follow-up at an early stage increase work attendance,” Nesland explains. But she also explains that the follow-up must take a holistic view of what influences each individual’s work ability.

“Time and time again, individual follow-up proves critical. When sick leave is not purely a physical health issue, it is usually a combination of various factors. Mental challenges can, for instance, be worsened by a less healthy lifestyle, which in turn increases the risk of muscular and skeletal distress,” she says.

To what degree do you feel it is the employer’s responsibility to help ensure that you can have a good balance between work and leisure?





To a very low degree




To a low degree








To some extent




To a very high degree




“Highlighting the individual’s absence from an early stage contributes to the sense of responsibility. In the follow-up programmes, it turned out that many employees simply had no idea of the extent of their own short-term absence,” says Nesland.“Concretising the problem also makes it easier for the employer to start discussing what kinds of measures are appropriate.”

Acknowledge me!

This time the Occupational Health Survey posed the following question: What is important for you to function well in your work? In the top three, we find “That I am seen and listened to (taken seriously by colleagues and managers)”, “That I have meaningful work tasks” and “That I enjoy going to work”.

The study shows that men and women divide the emphasis slightly differently. 60% of women say that it’s important to be seen, while the corresponding figure for men is 48%. Enjoying going to work is important for over half the women, and for men the figure is 47%.

“The sum of the factors the workers highlight says a lot about the importance of psychosocial work in preventing sick leave,” says Nesland.

Work and personal life

The research is clear. Sleep deprivation has a long list of negative consequences which are immediately noticeable, including poorer memory, lower concentration, less ability to cooperate, slower perception and reduced judgement — and above all impaired driving ability.

The Occupational Health Survey also shows that the majority of people who struggle with sleep link it to challenges both in their jobs and their private lives.

Nevertheless, it is primarily in the context of shift work that sleep has been addressed as an aspect of occupational health. But this is changing. The results of the 2017 survey have been substantiated. Eight out of ten employees feel that good sleep is important to their ability to work, but 18% of respondents say they have a good sleep pattern to a low or very low degree. 30% say they have neither a good nor a bad sleep pattern.

“When 45% of those in work fall outside of the group with a good sleep pattern, this obviously involves a major cost to society,” says Nesland. She believes it is high time that occupational health services should start working preventively on sleep issues.“Sleep is, after all, one-third of a totality,” she reminds us.

If you sleep poorly at night, to which of the following is this most often related?





Largely personal life




Largely work-related circumstances




Even division between personal life and work-related challenges




Physical ailments




None of the above – I generally sleep well









Get employees back stronger

“Holistic thinking with a 24-hour perspective on sick leave produces results,” says Lena Drange Nesland. Here, she gives some tips to get people back to work stronger.

1. Map both short-term and long-term absence. Who covers the absence in the organisation? Who is reporting absence without a doctor’s certificate (i.e. for the one-day maximum) to a high degree? Do employees ask to reduce their work hours due to workload? Do employees seem unmotivated and uncommitted at work? Mapping the absence provides an overview and reveals any patterns, while correlations are also easier to uncover.

2. Put internal structures in place. Make sure that your efforts are systematic and that there are tools for follow-up, such as timetabled discussions. Involve NAV/Norwegian Labour and Welfare Administration, the IA/Inclusive Working Life contact, and the occupational health service. Establish dialogue with the person’s GP and discuss possible measures for the employee to have some work attendance. Ideally invite the GP to dialogue meetings. Record all follow-up and establish follow-up plans. Send the records to the GP and NAV.

3. Set specific goals and measure the effect. Set goals, and establish what the planned measures should help to achieve. The goals could be a combination of overall HSE goals in the organisation and individual goals, such as improved physical and mental health, increased well-being, tools to manage stress and pressure at work, better sleep patterns or greater customer satisfaction. Evaluate whether the measures lead to goal achievement.

4. Follow up along the way. Hold regular meetings, and talk about where the challenges lie. Ask the employee if they have capacity for some hours of work. Inform the employee about what measures the company can implement so that they can come back to work on reduced hours. 

5. Consider having a separate absence phone. A separate absence line can contribute to more regular follow-up and a better overview of the absence. If needed, employees can for example get a support call or action can be taken more quickly.

6. Documentation: Be sure to document all follow-up of the employee.

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