Sustainable return to work: an integrated model. A personal example

In my previous article I shared my journey around hitting burnout, contracting a virus, and then being signed off work with Chronic Fatigue Syndrome. I then remained off work for 14 years. Four years ago, I was able to resume working again part time which has given me an interest in how such an endeavour can be sustained whilst simultaneously managing the symptoms of a long-term health condition. 

Through my role at Vitality360, I have discovered  the IGLOO model. Although initially used in the context of mental health, it has given me an interesting framework to help me reflect on my experiences of returning to work. The link provides more information about this, but the key premise is how to integrate the people and organisations that impact on you in work and non–work contexts – both personally and professionally. It also considers the knowledge, skills and abilities that are beneficial for these people to have in order to support you effectively.

IGLOO framework for integrated sustainable return to work, K, Neilson et al, 2018.

Reflecting on the IGLOO model I can see that my non-work context, individual cognitive, behavioural, and affective factors all meant that I was able to resume working. For example, I had a strategy for managing my energy levels daily and I had done many years of work psychotherapeutically.  I also found a range of things that supported me in terms of interventions such as osteopathy, dietary changes, and meditation.

In retrospect, I can see that my initial foray back into work as a receptionist in a clinical practice wasn’t done in a very realistic manner. I can see in retrospect how offering vocational support around return to work, as we do here at Vitality360, would have been helpful. What this meant was that I launched myself back in without building up more gradually. I underestimated how tiring the process of transition would be, learning a new job, and building new relationships again.  It was also thrilling to be ‘back in the world’ too and to have another focus and sense of satisfaction from meaningful activity. However, very quickly this work was not conducive to my ability to manage my symptoms.

Returning to work - without a phased return

I worked for a small business owner which created complications. For example, the fact that I was in a customer facing role in a sole capacity at any one time, meant that there was not much flexibility around adapting tasks or altering shift patterns or staffing ratios. The business owner lacked knowledge about working and fatigue, and was frustrated that I could not manage the hours I had been employed for. There were also not any HR policies in place so this meant that there was no support or guidance available and the flat structure of hierarchy meant this all had to be negotiated directly within my relationship with the owner and without mediation. During this time, my symptoms became much more acute especially around pain, and whilst I enjoyed the role, I realised that it was not sustainable or really serving me.

Reflecting on the IGLOO model, I can see that the organisational and leader and group aspects of the work context (and the knowledge, skills and attitudes needed) were not in place, which made my return to work really difficult to sustain. 

Working with a fatigue condition in a sustainable way

I then began working for Vitality360. This role immediately suited my needs much more as it involved working from home. This was crucial as it meant that I could take a flexible approach to my tasks and when I attended to them. A key change was no longer being in a customer facing role, which had a positive impact as it reduced the pressure of time commitments completely. Working from home also enabled me to control my environment very easily in terms of lighting and temperature and so on, which supports managing the fluctuating needs of a condition like CFS.  

There are still challenges. As I now work more on a computer than in my previous role, cognitive fatigue is especially challenging to manage. Some days, I can sit down to work as planned and it’s like my brain simply cannot comprehend or process the information on the screen or think in a straight line. At times like these, working at home means that I can then go and rest or do whatever else might help to restore some juice into the battery and then resume working. Often, my pattern of work is to work in the morning until lunchtime, have a rest, and then continue into the early evening. Similarly, as this recent article advocates, we all have different patterns around sleep and for me, I need lots of time to wake up and get up in the morning and not having to commute, in terms of time management, helps this too.  

The importance of a culture of wellbeing within an organisation

Having a supportive environment within the organisation has made a huge difference to how I feel my role and performance are perceived. I have, for example (pre lockdown) attended team days where I have been engaged in running a session and the owner of the company has encouraged me to stop as she could see I had reached capacity. It’s so refreshing to work in a culture of wellbeing that prioritises how its team members are, over solely maximising profit or achieving deadlines. Crucially, working within a company that is a pioneer in the rehabilitation of people with fatigue conditions is immensely supportive as my line manager is completely familiar with the challenges involved and the complexities of the condition.

Asking employers for adjustments to make work sustainable

Being able to negotiate with my immediate line manager (and colleagues) around my needs has been invaluable, as has working with our Specialist Career and Employment Consultant to help me identify those needs. As she advised me, it’s not about my ability to do the tasks involved in my role, it’s about managing my capacity to do them. This has also been a process of very much learning on the job as the role has unfolded and as my capacity and so on have changed and I have become more self-aware and knowledgeable about how my condition affects me. For example, I find any sense of time pressure very stressful which then depletes my energy, so I have discussed this with my manager and we agree that she gives me plenty of notice for tasks that have a deadline. Similarly, we are realising that I may need to pace myself by taking more regular time out of work and this is something we are discussing. 

Getting support through Access to Work Scheme

Finally, I have been encouraged to apply for an assessment with Access to work. This is a government-funded service that specialises in assessing what support a person with a disability or long-term health condition might need to be able to work more effectively. I was surprised by the expertise of the assessor I saw who spent some time exploring my condition and my role and was also well informed. As a result of this, I am now awaiting some software that will make it easier for me to use the computer (and reduce pain and fatigue) as well as a new specialist chair which will be more fit for purpose, and a mouse and keyboard. I would strongly encourage anyone in a similar position to me to see if they are eligible to apply. Obviously benefits of equipment are most effective when utilised alongside behavioural changes, such as taking a proper lunch break away from my devices and setting an alarm to remind me to move about a bit every half an hour.

Improving employers knowledge about adapting to long term health conditions

In terms of the IGLOO model, all aspects of the work and non-work contexts are aligned to make my return to work realistic, sustainable, and enjoyable. I realise that not every workplace is as well equipped to deal with supporting someone with CFS in their return to work. A lot still needs to be done to increase employers’ knowledge and awareness around fatigue and working. We regularly offer webinars for companies who are keen to hear more from an expert and from those with a personal experience like mine and other team members. Accessing support from specialists who can help to identify the potential challenges in each area and work with you and your employer to help identify solutions is imperative to success. If an employer can adopt this kind of attitude and be prepared to discuss adaptations to the role, I think you might be halfway there!

Written by Katherine Sewell, Business Support Manager & Amanda Mason, Career and Employment Consultant