Empowering self-direction in return to work of employees with low and high levels of education: A qualitative comparative study

Abstract

BACKGROUND:

Dutch legislation encourages active participation of employees in their return-to-work (RTW) process. Empowering leadership may support employees’ self-direction in this process (i.e. by allowing and enabling their involvement in decision-making).

OBJECTIVE:

Building upon a previous study, we aimed to study (1) how representatives of a university, i.e. an employer for employees with high levels of education (EH), manage RTW, (2) the similarities and differences between the RTW management of employers (or representatives thereof) of employees with low (EL) and high levels of education, and (3) the degree to which the employers’ roles resemble empowering leadership.

METHODS:

Qualitative methodology was applied. A thematic analysis of interview transcripts (rq1) was followed by a comparison of themes (rq2) and pattern matching (rq3).

RESULTS:

(1) EH tend to engage in dialogue and accommodate their employees as much as possible. (2) EL and EH showed several similarities, such as aiming to meet legal requirements on RTW management. Compared to EL, EH tend to focus more on facilitating employees. (3) Empowering leadership seems to be more common among EH.

CONCLUSIONS:

Compared to employees with low levels of education, those with high levels of education may be granted more opportunity to self-direct their RTW. The study results provide starting points for employers for employees with both low and high levels of education who aim to enable employees’ self-direction in RTW, and help them to develop empowering leadership styles.

Keywords

Sickness absence return to work self-direction empowering leadership educational level

1 Background

Sick-listed employees express a wish to self-direct their return to work (RTW), which implies taking decisions about work resumption and especially about schedules and work tasks [1]. Employees consider self-direction to be helpful for achieving a personalized RTW-trajectory that suits their needs and preferences [1]. In a broader sense, RTW research shows that absent employees highly value being autonomous and in control. These factors play a role in the experience of RTW self-efficacy [2].

Dutch employees who are on sick leave are legally required to cooperate with their employers to achieve RTW [3]. Employers may be inclined to use their hierarchical power in shaping the employees’ RTW, which may be a barrier to employees’ self-direction [1]. As such, employers can be assumed to have an important influence on the extent to which employees are able to self-direct their RTW. More in general, there is ample research that suggests the importance of employers’ adequate role taking and support during employees’ sickness absence and RTW [4 –8].

1.1 Empowering leadership and self-direction of employees in return to work

Following the above, it can be postulated that – in order to act in line with the rationale of the legislation – Dutch employers ought to use a leadership style that involves power sharing with or empowerment of employees. Leadership styles such as transformational [9] or ethical leadership [10] meet this criterion. Empowering leadership as described by Amundsen and Martinsen particularly stands out in this regard though, given that it supports the opportunities, motivation and ability of individual employees to fulfil autonomous activities [11]. Self-direction of employees – i.e. making decisions about work resumption [1, 12] – can be considered an example of such an autonomous activity.

Empowering leadership consists of two dimensions. First, autonomy support concerns “empowering leader behaviors that theoretically influence subordinates’ opportunities and motivation in performing autonomous work-role activities through delegation, coordination and information sharing, encouragement of initiative and goal focus, efficacy support, and inspirational communication” ([11], p.506). Second, development support covers “leader behaviors that influence subordinates’ continuous learning and development through leaders’ role modelling and guidance, which also clearly have implications for their ability to cope with autonomous activities” ([11], p.506). Employers may, for instance, provide autonomy support by sharing the decision latitude regarding the employees’ RTW. Also, employers may support the development of absent employees as directors of RTW by taking an advisory role (adapted from [11]). To illustrate, many items of Amundsen and Martinsen’s scale to measure empowering leadership [11] can be applied to the context of RTW. Table 1 describes several empowering leadership behaviors that may enable absent employees to self-direct their RTW.

Table 1
Items chosen from the 18-items of Amundsen and Martinsen [11, 13] and that were applied to the management of RTW

Autonomy support - Make clear that absent employees are to take responsibility for their RTW.

- At least share decision-making regarding RTW with absent employees.

- Applaud initiative and suggestions of employees regarding their RTW.

- Encourage absent employees to take initiative and come up with suggestions regarding their RTW.

- Show concern that employees achieve their personal RTW objectives.

- Show concern that employees show effort to achieve their personal RTW objectives.

- Listen to the employees’ perspectives on their RTW.

- Recognize strengths and weaknesses of employees in achieving their personal RTW objectives.

- Invite absent employees to make use of their strengths.

- Communicate a bright view of the employees future regarding RTW.

- Share relevant information (e.g. on forms that employers need to fill out in order to comply with the DGIA).

Development support - Adopt a mostly advisory role, allowing employees to self-direct their RTW.

- Make suggestions to employees about how to self-direct their RTW.

To our knowledge, empowering leadership as described by Amundsen and Martinsen [11] has not yet been studied in the field of sickness absence and return to work. Nevertheless, the literature concerning employees who are not on sick leave suggests that employees on sick leave will benefit from empowering leadership. For example, employees may be less dependent on empowering leaders than on transformational, directive or transactional leaders ([14, 15] as cited in [11]).

1.2 The role of employees’ educational level

Employees with low levels of education are often employed in low-skilled occupations. These jobs typically provide employees with limited job control [16]. Having a job with limited decision control declines the chance of absent employees to achieve early work resumption [17]. It can be postulated to be more challenging for these employees to self-direct their RTW. Given that all Dutch sick-listed employees are legally required to pursue RTW in cooperation with their employers [3], particularly employees with low levels of education may be in need of empowering leaders. However, findings from our previous qualitative study based on 13 semi-structured interviews with employers of employees with low levels of education show that their employers tend to take the lead in managing their RTW, for example by deciding about the planning and mode of work resumption. Table 2 provides a short overview of the main results of that study [12].

Table 2
Main themes on how employers for employees with low levels of education manage RTW (derived from the study results of Hoefsmit and Houkes [12])

Theme

- Pursue to abide by the requirements on employers set by RTW legislation (all interview participants).

- Maintain contact with absent employees (all participants).

- Make proper contact with employees, e.g. based on respect (several interview participants).

- Provide protection of some kind, e.g. support in case of financial troubles (multiple participants).

- A part of the supervisors may lack ‘equipment’ to manage RTW. Their employers should provide help (multiple interview participants).

- Employees with low levels of education would have few possibilities to resume work at their current companies, due to their presumed limited work ability and there would be few tasks or jobs at their companies that can be done by these employees (most interview participants).

- Make use of professional support, such as that of an OP (nearly all interview participants).

- Instruct absent employees about the employers’ decisions about their RTW and/or what they expect from employees and/or that both employees as well as employers are legally obliged to aim for RTW (all interview participants). Interview participants monitored and tried to control employees. According to some interview participants, a leading role of employers would be welcomed by absent employees with low levels of education.

- Pay attention to the parts that partners or (other) family members play (many participants). They may withhold absent employees from returning to work.

Employers usually appeared to play an influential role in the absent employees’ RTW. Yet, about half of them had experience with attempts to discover needs and preferences of employees. This was mostly unsuccessful though, e.g. because the employees’ preferences were considered unviable.

In some cases, employees with low levels of education still appear to self-direct the timing and/or mode of their work resumption to some extent.

Theme
- Pursue to abide by the requirements on employers set by RTW legislation (all interview participants).
- Maintain contact with absent employees (all participants).
- Make proper contact with employees, e.g. based on respect (several interview participants).
- Provide protection of some kind, e.g. support in case of financial troubles (multiple participants).
- A part of the supervisors may lack ‘equipment’ to manage RTW. Their employers should provide help (multiple interview participants).
- Employees with low levels of education would have few possibilities to resume work at their current companies, due to their presumed limited work ability and there would be few tasks or jobs at their companies that can be done by these employees (most interview participants).
- Make use of professional support, such as that of an OP (nearly all interview participants).
- Instruct absent employees about the employers’ decisions about their RTW and/or what they expect from employees and/or that both employees as well as employers are legally obliged to aim for RTW (all interview participants). Interview participants monitored and tried to control employees. According to some interview participants, a leading role of employers would be welcomed by absent employees with low levels of education.
- Pay attention to the parts that partners or (other) family members play (many participants). They may withhold absent employees from returning to work.
Employers usually appeared to play an influential role in the absent employees’ RTW. Yet, about half of them had experience with attempts to discover needs and preferences of employees. This was mostly unsuccessful though, e.g. because the employees’ preferences were considered unviable.
In some cases, employees with low levels of education still appear to self-direct the timing and/or mode of their work resumption to some extent.

Moreover, based on research findings [1, 12], employers of employees with low levels of education can be postulated to play a more steering, directive role, compared to employers of employees with various educational levels. This assumption suggests a relative inequality in self-direction, where employees with higher levels of education are given more opportunities to self-direct their RTW.

2 Study objective

The objective was threefold, namely to study (1) how representatives of a university (i.e. an employer for employees with high levels of education), manage RTW, (2) the similarities and differences between the RTW management of employers (or representatives thereof) of employees with low and high levels of education, and (3) the degree to which the employers’ roles resemble empowering leadership.

This study adds to existing knowledge on the employers’ role in return to work. We built upon the results of earlier studies [1, 12], to make an explicit comparison between the RTW management practices for employees with low levels of education versus RTW practices for employees at a university. Hereby, we acquired in-depth understanding of the assumed relative inequalities in the RTW management of employees with low levels of education and that of employees at a university who have high levels of education. Despite the fact that a considerable part of the EU labor population has a low level of education (i.e. 27.5 percent in 2018, [18]), the RTW management of this group has received little attention in research [12].

More in general, our study results will benefit employers for employees with both low and high levels of education who aim to support employees’ self-direction in RTW [1, 12], and help them to develop more empowering leadership styles.

3 Methods

3.1 Study design

This qualitative study was based on semi-structured, in-depth interviews. To achieve rigor, we addressed several criteria of the COREQ-checklist for qualitative studies. This concerns, among other things, the methods of sampling and approaching interview participants, the number of interviewees, the topic list, and how themes were obtained from the interviews. The results section covers quotations and clear descriptions of themes that comply with the data [19].

3.2 Study context

The interviews were conducted in the Netherlands in 2018 and 2019. The Dutch Gatekeeper Improvement Act (DGIA) stipulates that both absent employees and their employers should work together to achieve the employees’ RTW. This involves composing and monitoring an action plan for RTW. During maximally two years, the employer pays at least 70% of the absent employees’ income [3 , 20]. Moreover, employers are obliged to provide absent employees with work that fits with their abilities. This can concern work with the employees’ current or different employers [3, 20].

3.3 Population and procedure

Two samples were used. The first sample included representatives of a university [21]. The second sample included representatives of employers for employees with low levels of education [12]. Below, we describe the study population and procedures for both samples.

3.3.1 Study sample 1

An existing research sample and transcripts from a study by BP were used to study how representatives of a university manage RTW [21]. In the context of this study, a university is considered to be exemplary for an employer with employees who have high levels of education [22]. The FHML Research Ethics Committee of Maastricht University gave ethical approval (correspondence 25 March 2019, ethical license number: FHML/WHC/2019/01). The sample included Human Resource (HR) professionals and supervisors who had experience of RTW management [21]. Participants were recruited purposively [23] by email, and with help of an HR professional. BP aimed for variety in the sample with regard to department [21]. Snowball sampling [23] was used as well. The final sample consisted of 10 participants. This sample covered both supervisors (4) and professionals in the broader field of HR management (6). Further, the sample consisted of 8 women and 2 men. Nine participants worked at an organizational support service such as the HR department, and 1 participant worked in a faculty [21]. Interviews were conducted by BP at the workplaces of the study participants. On average, these interviews took about three quarters of an hour. He used a topic list consisting of several sections. The first section was aimed at mutual introductions, providing information, and obtaining informed consent. Second, background information about the interviewees was acquired (e.g. their jobs). Three sections of the middle part of the topic list were relevant to this study. The first of these sections covered a range of topics about sickness absence and return to work. Examples were: how employers manage sickness absence and return to work, organizational return to work policies, the participants’ experiences with self-direction. Second, the list included a section concerning the relationship between absent employees and the employers (e.g. how they cooperate for achieving the employees’ return to work). The third section that was used for this study concerned common barriers for return to work [21]. During the interviews, participants were given the opportunity to mention additional information that could be relevant. All interviews were held at the workplaces of the study participants. One interview was conducted with two study participants simultaneously. Further, all interviews were audio-recorded except for one of which notes were taken. Data saturation was achieved after the eighth interview [21].

3.3.2 Study sample 2

With respect to the second sample, approval was obtained from the ethics committee of the Open University of the Netherlands (correspondence 8 May 2018, registration number: U2018/03287/HVM) [12]. This sample was earlier used in our study on self-direction of RTW among employees with low levels of education [12]. Purposive sampling [23] was applied to recruit study participants in different occupational sectors and geographic locations in the Netherlands. They were mainly recruited via email and some by phone [12].

The sample consisted of 13 employer representatives (i.e. RTW and HR professionals) who had experience of guiding sick-listed (>6 weeks) employees with low levels of education. Twelve study participants were female. The participants were employed in organizations with 1000 employees or less (5) and over 1000 employees (8), and in a diversity of vocational sectors, i.e. retail (3), production (3), the health sector (3), the cleaning industry (2), transportation (1), and a sector that is not disclosed for anonymity purposes (1) [12]. In The Netherlands, low levels of education concern primary education, years 1–3 of senior general secondary education (in Dutch: HAVO; 5 years in total) or pre-university education (VWO; 6 years in total), pre-vocational secondary education (VMBO), or level 1 senior secondary vocational education / assistant training (MBO level 1) ([22] as cited in [12]). NH conducted semi-structured, audio-taped interviews that on average took about three quarters of an hour each (face-to-face, mostly at the workplaces of the participants: 9, telephonic: 3, please note that two participants were interviewed simultaneously). Prior to the interview, each participant signed an informed consent form. NH used a topic list of which the first section was aimed at mutual introductions, providing information, and obtaining informed consent. Second, background information about the interviewees was acquired (i.e., their jobs, professional roles in and experience with supporting absent employees with low levels of education). The central section of the topic list covered questions about the course of sickness absence and return to work, including the contact employer representatives have with absent employees, the occupational physician (OP), other health care professionals, stakeholders in the employees’ home environments, colleagues and the social insurance office. As the participants told about their experiences, NH asked further questions about several topics such as the behaviors of employees targeted at shaping or influencing their return to work [1, 12]. Data saturation was achieved after eight to ten interviews. More information about the data collection is described in the methods section of Hoefsmit and Houkes [12].

3.4 Data analyses

Study sample 1 [21] was used to analyze how representatives of a university manage RTW (study objective 1). The data were analyzed thematically in NVivo 12 [24], building on a part of/several themes of and simultaneously with the data analyses for the study concerning the RTW management of employees with low levels of education [12]. The following steps – that were inspired by Braun and Clarke’s thematic analysis [25] – were taken: NH read the transcripts to develop preliminary ideas about how representatives of the university manage RTW. Upon that, she performed multiple cycles of coding and reviewing until she created an initial thematic map that was relevant to the study objective, covered a significant part of the dataset, and was meaningfully organized. Then, BP and IH carefully inspected the NVivo file to check the quality of coding. When all researchers agreed on the coding structure, NH described the study results. During the writing process, she kept on refining the coding. BP and IH provided feedback on the written study results.

To compare the RTW management of employees with low levels of education versus that of employees at a university, i.e. an employer for employees with high levels of education (study objective 2), we used the written results regarding study aim 1 on the RTW management at a university. In addition, we used the main themes - that were described in Table 1 and derived from the study results of Hoefsmit and Houkes [12] - on how employers for employees with low levels of education manage RTW. NH compared both collections of themes and made an overview of similarities and differences (see Table 3). BP and IH provided feedback on the written version of the study results.

Table 3
Similarities and differences that EL and EH show in their RTW management

Similarities¹

- Pursue to meet legal requirements on RTW management

- Establish connectedness with absent employees

- Take an activating stance on absent employees

- Make use of the services of healthcare or RTW professionals

- Supervisors differ in their ability to manage RTW. Employers should provide support.

Differences

EL: coordinate RTW¹

- Consider that employees with low levels of education would have few possibilities to resume work at their current companies

- Provide protection of some kind, e.g. support in case of financial troubles

- Decide, instruct, monitor and try to control employees’ behavior

- Pay attention to the parts that partners or (other) family members play

EH: facilitate RTW

- Consider employees capable of self-directing their RTW and career paths

- Trust absent employees and use conversation as a means to identify what employees need to return to work

- Accommodate the needs and preferences of their employees as much as possible

- Develop tools for and provide training to supervisors

Similarities¹
- Pursue to meet legal requirements on RTW management
- Establish connectedness with absent employees
- Take an activating stance on absent employees
- Make use of the services of healthcare or RTW professionals
- Supervisors differ in their ability to manage RTW. Employers should provide support.
Differences
EL: coordinate RTW¹
- Consider that employees with low levels of education would have few possibilities to resume work at their current companies
- Provide protection of some kind, e.g. support in case of financial troubles
- Decide, instruct, monitor and try to control employees’ behavior
- Pay attention to the parts that partners or (other) family members play
EH: facilitate RTW
- Consider employees capable of self-directing their RTW and career paths
- Trust absent employees and use conversation as a means to identify what employees need to return to work
- Accommodate the needs and preferences of their employees as much as possible
- Develop tools for and provide training to supervisors

¹Please note that the information in this table on the RTW management of employees with low levels of education is derived from [12]. Note. This table does not describe any nuances, which are included in Table 1 and in paragraph 4.1.

Both study samples [12, 21] were used to analyze the degree to which the roles of employers for employees with low levels of education versus that of the representatives of the university resemble empowering leadership (study objective 3). Elements of pattern matching [26] were applied in a similar manner as reported in an earlier study [27]. Regarding employers for employees with low levels of education, the expected degree of empowering leadership (both the dimensions of autonomy support and development support) was estimated as low. A moderate degree of empowering leadership was expected among the representatives of the university ([26] as cited in [27]). These estimations were based on the background of this study (particularly studies [1, 12]). Upon that, the interview transcripts were read in order to rate the actual degrees of autonomy support and development support for each individual interview participant. Afterwards, all ratings were taken into account into an overall average score (low, moderate or high) for autonomy support and development support among employers for employees with low levels of education and representatives of the university separately. Finally and for each sample separately, a comparison was made between the expected and actual degrees of autonomy support and development support ([26] as cited in [27]). NH conducted the pattern matching procedure. To support peer validity, BP and IH reviewed the results of this procedure.

4 Results

4.1 RTW management of employees at a university (study objective 1)

Interview participants with the university, i.e. representatives of an employer for employees with high levels of education (EH) generally appeared to trust their absent employees. One interviewee noted: “ ⋯ the boss makes a phone call ⋯ not to monitor. We know our people too well for that ⋯ everybody is committed ⋯ we contact [absent employees] by phone to show interest.” (EH5)

EH generally considered their employees capable of self-directing their RTW and career paths. “Employees are responsible for their jobs, employability, careers, sickness absence ⋯ ” (EH1) Another interviewee mentioned: “you are to self-direct your own career development ⋯ it fits with the spirit of our times.” (EH5) The EH generally respected their employees as quite independent and motivated professionals. Please note that employees’ responsibility for their own career development is part of a new HR policy at the university (HR Manager university, personal communication, September 2019).

All EH reported to take an activating stance on absent employees. “[despite a health injury] You may still want to return to work ⋯ ” (EH3). These interviewees aimed to identify and utilize the employees’ work abilities. To enhance their employability, if needed, professionals such as “ ⋯ an employability coach ⋯ ” (EH3) were asked to support absent employees.

EH appear to use conversation as a means to identify what employees need to return to work. “I think the solution can be obtained from the employee. He knows best what has to be done first.” (EH5) Another interviewee reported to aim for sustainable RTW: “I don’t want someone to return to work after a month and call in sick two weeks later. That doesn’t seem like a good plan to me.” (EH8) Many EH seemed to accommodate the needs and preferences of their employees as much as possible. “As employer, you particularly need to facilitate [your employees].” (EH4) Another interviewee mentioned: “Not everybody returns to their own jobs, not everybody wants that.” (EH8) Some EH reported difficulty for employees to return to work at another department. “ ⋯ the employee has to apply for this job ⋯ ” (EH4)

Moreover, supervisors differ in their ability to manage RTW. For example, an interviewee mentioned: “It depends on mutual trust [employee-supervisor]. You need to show warm and business-like behavior ⋯ You must show empathy, yet it shouldn’t prevail. This [quality] is partly inherent in a person.” (EH2)

According to multiple EH, employers should prepare their supervisors to carry out RTW management tasks. Most interviewees wished to use tools for and training of supervisors to get a grip on the basics of RTW management and to achieve efficiency as a RTW manager. For example, an interviewee noted: “I am going to help them [supervisors]. As an organization, you have to facilitate. You need to give a lot ⋯ I think they [supervisors] would like to have [an administrative ICT system to support RTW management] and [a guideline for the supervisors’ responsibilities]. They are busy, busy, busy.” (EH3) Please note that most tools were still in development at the time of the interviews, and there also was disagreement among interviewees about the specific tools they preferred to use. Also, training on RTW management was implemented. A part of the EH had already received training.

With respect to legislation, EH appeared to consider it self-evident to abide by requirements on RTW management. For example, most interviewees mentioned to ensure regular contact with absent employees, over and above legal requirements: “Someone shouldn’t be at home for three weeks without any contact [with the employer]. Work sort of drifts away.” (EH1) Some interviewees mentioned to consult the OP when they were legally obliged to do so, and/or when they needed advice. “The supervisor and the employee are to self-direct as much as possible. The OP is your remote medical advisor.” (EH4) Please note that the new RTW policy at the university emphasizes the primary responsibility of employees, and secondarily that of supervisors (HR Manager university, personal communication, September 2019).

In sum, our results describe that EH focus on meeting legal requirements on RTW management, and on identifying, enhancing and utilizing the absent employees’ work abilities. Even more apparently, EH usually seem to play a facilitating role in the absent employees’ RTW processes. Yet, these findings should be interpreted with caution. It appears from the data that some interviewees had experience of deciding how the employees’ sickness absence or return to work should unfold. To illustrate: “At first, we arranged temporary replacement. But the employee interpreted it as an attack ⋯ The employee hadn’t mentioned to want any rest.” (EH5) The end of this quote suggests that this interviewee has learnt from this experience, now knowing not to decide for employees to stay at home.

4.2 Similarities and differences (study objective 2)

Our comparative analysis reveals multiple similarities that employers for employees with low levels of education (EL) and EH show in their RTW management. These are: pursuing to meet legal requirements on RTW management, establishing connectedness with absent employees, taking an activating stance on absent employees and making use of the services of healthcare or RTW professionals. Among both EL and EH, supervisors differ in their ability to manage RTW, and employers would need to provide support to them [12].

Our analysis also reveals a fundamental-yet-nuanced difference. EL considered that employees with low levels of education would have limited work ability and there would be few tasks or jobs at their companies that can be done by these employees. They decided individually about the employees’ RTW. Correspondingly, EL instructed, monitored and tried to control the behavior of employees in the direction of RTW [12]. In contrast, EH generally considered their employees capable of self-directing their RTW and career paths. EH seemed to use conversation as a means to identify what employees need to return to work, and many EH appeared to facilitate employees as much as possible.

Table 3 gives a complete overview of all similarities and differences that EL and EH show.

Yet, these results should be interpreted with caution (see Table 1 and paragraph 4.1).

4.3 Empowering leadership (study objective 3)

Table 4 shows the expected and observed degrees of empowering leadership.

Table 4
Results of the pattern matching procedure

Employer Degree Autonomy support Development support

EL Expected – –

Observed in each case –(10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 21), –(10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 21),

+- (20) +- (20)

Observed overall mean – –

EH Expected +- +-

Observed in each case –(2, 7), +- (5, 8), + (1, 3, 4, 9) –(2, 7, 8), +- (5), + (1, 3, 4, 9)

Observed overall mean +- +-

Employer	Degree	Autonomy support	Development support
EL	Expected	–	–
	Observed in each case	–(10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 21),	–(10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 21),
		+- (20)	+- (20)
	Observed overall mean	–	–
EH	Expected	+-	+-
	Observed in each case	–(2, 7), +- (5, 8), + (1, 3, 4, 9)	–(2, 7, 8), +- (5), + (1, 3, 4, 9)
	Observed overall mean	+-	+-

Note. - = low, +- = moderate, + = high. Note. EH6 is not included in the table. The notes taken from this interview did not allow for the pattern matching procedure to be conducted. The table and procedure are adapted from [27].

Almost all EL scored ‘low’ on autonomy and development support. These observed scores match with our expectations. Only one EL scored ‘moderate’ on both dimensions.

Further, one EH scored ‘moderate’ on both dimensions of empowering leadership. This case fits with our expectations. However, multiple EH scored ‘high’ on both dimensions– which exceeds our expectation –, and only some scored ‘low’ on one or both dimensions of empowering leadership.

5 Discussion

Our objectives were to study (1) how representatives of an university, i.e. representatives of an employer for employees with high levels of education, manage RTW, (2) the similarities and differences between the RTW management of EL and EH, and (3) the degree to which the employers’ roles resemble empowering leadership.

The results show that (1) EH tend to engage in dialogue and accommodate their employees as much as possible. (2) EL and EH showed several similarities, such as aiming to meet legal requirements on RTW management [12]. Compared to EL, EH tend to focus more on facilitating employees. (3) Empowering leadership seems to be more common among EH.

5.1 Discussion of content

It appears that both EL [12] and EH consider it to be their task to activate and enable absent employees to return to work. This task would require them to communicate in an empathic, yet expedient manner. Further, they stressed the importance of ‘strategic RTW know-how’, for example with respect to when and how to make use of professional RTW or healthcare services (see also [12]). Such social norms about an employer’s role suit their own financial interests to limit the costs of sickness absence, and appear to coincide with many of the standards set by the DGIA [3, 20].

Our findings also show clear differences between EL and EH. As mentioned in [12], EL appear to have a tendency to use their power over absent employees. EH tend to engage in dialogue more often. Empowering leadership seems to be more common among EH. This suggests that compared to employees with low levels of education, those with high levels of education may be granted more opportunity to self-direct their RTW. This, in turn, raises the question of why EL and EH differ in terms of the degrees of empowering leadership that they show. Our results point at three possible reasons, which comprise the roles of goals (1), power distance (2), organization policy and training (3). Below, we discuss each of these factors.

5.1.1 Goals

Distrust against absent employees appeared to be common among EL [12], whereas EH generally respected their absent employees as independent and motivated professionals who aim for RTW. These experiences are in line with the idea that workers would consider welfare benefits to be acquired rights that they are authorized to make optimum use of. Members of the middle class would be relatively disinclined to exploit welfare benefits ([28] as cited in [29]). As mentioned by Hoefsmit and Houkes [12], it is important to consider that rather than a lack of RTW motivation, employees with low levels of education may have limited abilities to engage in work – usually in jobs with relatively heavy physical demands – while they have impaired health ([30 –33] as cited in [12]).

The above suggests that EL, and not so much the EH, experience incongruent goals: a part of the employees would wish to stay on sick leave while at the same time their employers preferred them to return to work already [12]. More in general and according to Amundsen and Martinsen, dissimilar task objectives of employees and their supervisors may thwart the effectiveness of delegation ([34] as cited in [11]), which is considered to be fundamental to empowering leadership [11]. As such, EL may have negative outcome expectations of delegating decision-making about RTW to absent employees. In the eyes of EL, delegation of this task might not at all result in the employees’ early RTW. As a consequence, they may decide individually about RTW [12]. Such behavior is incompatible with empowering leadership. In contrast, EH may assume to share their objective – RTW – with absent employees. Therefore, they might have positive outcome expectations of delegating decision-making, and behave accordingly.

5.1.2 Power distance

In our previous study, we found that some EL mentioned that employees with low levels of education would wish them to take a leading role in their RTW processes [12]. EH generally considered their employees capable of self-directing their RTW and career paths. Our findings seem to reflect a difference in power distance between employers on the one hand and employees with low versus high levels of education on the other hand. In general, EL may experience relatively much power over their absent employees [12], compared to EH who seem to experience a limited power difference. Sharma and Kirkman [35] argue that those leaders, who have a lower power distance orientation, tend to consider power as something “expendable” ([36, 37] as cited in [35]). As such, and in line with Sharma and Kirkman [35], EH may be more likely to engage in empowering leadership as part of RTW management as compared to EL.

5.1.3 Organizational policy and training

At the time of the data collection, a new HR policy was implemented at the university. This policy addresses employees’ sickness absence and RTW as part of career management. It also emphasizes that employees should take more responsibility for their own career development. Both supervisors and employees received training regarding how absent employees are to take responsibility for their own RTW, and how supervisors may allow and enable them to do this. Please note that the idea of permitting and assisting employees to take responsibility for their RTW shows some resemblance with empowering leadership. It is possible that EH who already received training, use more empowering leadership behavior. Sharma and Kirkman assume that leaders who show empowering leadership will be modelled and imitated by other supervisors [35, 38]. This might facilitate the implementation of empowering leadership among EH. In contrast, EL did not report any experiences of policies and training that may support the implementation of empowering leadership practices [12].

5.2 Methodological reflections

Strengths of this study include the use of semi-structured interviews to collect in-depth information about the perspectives of employers [12, 21]. In addition, we analyzed the data in a structured manner. For example, we used pattern matching to grade the degrees of empowering leadership among EL and EH separately. Multiple researchers worked on all aspects of this study. Nevertheless, a number of study limitations must be mentioned as well.

First and as mentioned by Hoefsmit and Houkes [12], we only interviewed employers [12, 21], and therefore lack information about the perspectives of employees. As such, we do not know if and how they have experienced their employers to show any valuable empowering leadership behavior during their RTW trajectories.

Second, we used interviews with mostly HR and RTW professionals and only few supervisors [12, 21]. These professionals may have relatively negative views on employees’ motivation and ability to return to work, as they might have – more than supervisors – experience of stagnant RTW trajectories [12].

Third, many EH elaborated on RTW practices that seem to be part of the university’s new HR policy. It is not always clear, though, exactly whether EH always behaved in line with this policy.

Fourth, only one employer for employees with high levels of education, i.e., a university participated in this study. We do not know whether our results are representative of other employers for employees with high levels of education as well.

Despite these shortcomings, our study results appear to be the first to provide a comparison of the RTW management and empowering leadership at EL versus at a university.

5.3 Implications for research

Further qualitative research should focus on gathering an in-depth understanding of the perspectives of employees [12] on empowering leadership in RTW management. These insights will help to understand whether and how empowering leadership may be valuable to support employees’ self-direction in RTW. In case employees indeed attach value to empowering leadership, a measurement scale – for empowering RTW management to support absent employees’ self-direction – can be developed and studied. Upon that, quantitative and longitudinal studies should focus on the possible effects of such leadership on employees’ self-direction in RTW, and their actual RTW status. These studies can be conducted among groups of employees with both low and high levels of education who are employed at several different types of organizations. In case empowering leadership is effective, interventions to support the use of this style in RTW management can be developed and evaluated.

5.4 Implications for practice

The study results provide some starting points that might help employers who want to enable employees’ self-direction in RTW, and who wish to develop more empowering leadership styles. More specifically, our study results suggest that these employers need to invest in finding shared RTW objectives together with their absent employees. Also, employers may include empowering leadership in their RTW management policies (see also [12]) and training of supervisors.

Ethical approval

Approval was obtained from the FHML Research Ethics Committee of Maastricht University (correspondence 25 March 2019, ethical license number: FHML/WHC/2019/01) and from the ethics committee of the Open University of the Netherlands (correspondence 8 May 2018, registration number: U2018/03287/HVM).

Informed consent

Informed consent was obtained from all study participants.

Conflict of interest

The authors report no conflicts of interest.

Footnotes

Acknowledgments

The authors thank the participants for sharing their experiences and perspectives during the interviews.

Author contributions

NH was involved in the design, data analysis, and writing the manuscript. BP was involved in the study design and writing of earlier drafts of the introduction and methods sections. BP participated in the data analysis, the peer review process and provided feedback on later drafts of the manuscript. IH was involved in the design of this study, the data analysis and the peer review process. Moreover, she commented on drafts of this manuscript.

Funding

Not applicable.

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Autonomy support	- Make clear that absent employees are to take responsibility for their RTW.
	- At least share decision-making regarding RTW with absent employees.
	- Applaud initiative and suggestions of employees regarding their RTW.
	- Encourage absent employees to take initiative and come up with suggestions regarding their RTW.
	- Show concern that employees achieve their personal RTW objectives.
	- Show concern that employees show effort to achieve their personal RTW objectives.
	- Listen to the employees’ perspectives on their RTW.
	- Recognize strengths and weaknesses of employees in achieving their personal RTW objectives.
	- Invite absent employees to make use of their strengths.
	- Communicate a bright view of the employees future regarding RTW.
	- Share relevant information (e.g. on forms that employers need to fill out in order to comply with the DGIA).
Development support	- Adopt a mostly advisory role, allowing employees to self-direct their RTW.
	- Make suggestions to employees about how to self-direct their RTW.