title: A Model of Supervisor Decision-Making in the Accommodation of Workers with Low Back Pain.
abstract: Purpose To explore supervisors' perspectives and decision-making processes in the accommodation of back injured workers. Methods Twenty-three semi-structured, in-depth interviews were conducted with supervisors from eleven Canadian organizations about their role in providing job accommodations. Supervisors were identified through an on-line survey and interviews were recorded, transcribed and entered into NVivo software. The initial analyses identified common units of meaning, which were used to develop a coding guide. Interviews were coded, and a model of supervisor decision-making was developed based on the themes, categories and connecting ideas identified in the data. Results The decision-making model includes a process element that is described as iterative "trial and error" decision-making. Medical restrictions are compared to job demands, employee abilities and available alternatives. A feasible modification is identified through brainstorming and then implemented by the supervisor. Resources used for brainstorming include information, supervisor experience and autonomy, and organizational supports. The model also incorporates the experience of accommodation as a job demand that causes strain for the supervisor. Accommodation demands affect the supervisor's attitude, brainstorming and monitoring effort, and communication with returning employees. Resources and demands have a combined effect on accommodation decision complexity, which in turn affects the quality of the accommodation option selected. If the employee is unable to complete the tasks or is reinjured during the accommodation, the decision cycle repeats. More frequent iteration through the trial and error process reduces the likelihood of return to work success. Conclusion A series of propositions is developed to illustrate the relationships among categories in the model. The model and propositions show: (a) the iterative, problem solving nature of the RTW process; (b) decision resources necessary for accommodation planning, and
authors.affiliation: Faculty of Management, University of Lethbridge, Calgary Campus, Suite S6032, 345 - 6th Avenue SE, Calgary, AB, T2G 4V1, Canada. kelly.williams@uleth.ca.
authors.forename: Kelly
authors.initials: K
authors.lastname: Williams-Whitt
authors.affiliation: Department of Health Sciences, Lakehead University, Thunder Bay, ON, Canada.|Institute for Work and Health, Toronto, ON, Canada.|Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.|Northern Ontario School of Medicine, Lakehead University, Thunder Bay, ON, Canada.
authors.forename: Vicki
authors.initials: V
authors.lastname: Kristman
authors.affiliation: Center for Disability Research, Liberty Mutual Research Institute for Safety, Hopkinton, MA, USA.
authors.forename: William S
authors.initials: WS
authors.lastname: Shaw
authors.affiliation: Centre for Addiction and Mental Health, Toronto, ON, Canada.|Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
authors.forename: Sophie
authors.initials: S
authors.lastname: Soklaridis
authors.affiliation: Department of Health Sciences, Lakehead University, Thunder Bay, ON, Canada.
authors.forename: Paula
authors.initials: P
authors.lastname: Reguly
mesh_terms: D003657:Decision Making; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D008297:Male; D017146:Models, Organizational; D009934:Organization and Administration / Q000592:standards; D010559:Personnel Management / Q000379:methods* / Q000592:standards; D062707:Return to Work
keywords: Decision-making; Job accommodation; Qualitative methods; Return-to-work; Supervisor
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