1.3.19 Reintegration after incapacity for work

Goal and purpose

Regulations for reintegration into the operational processes of medical patient care after a longer period of incapacity for work. By means of reintegration, the doctor is to be gently but continuously reintroduced to the stresses and strains of his or her workplace on an individual basis, i.e. depending on the illness and previous period of incapacity for work, without jeopardising his or her own health or the health of third parties. Ensuring that the reintegration process is transparent for all parties involved.

Application

All doctors who are involved in the inpatient and outpatient treatment of patients in hospital as part of their official duties. In the event of incapacity for work due to illness lasting longer than eight weeks or if the illness is severe enough.

Description of the process

Procedure for reintegration

If reintegration is intended after a longer period of illness, the following procedure applies:

Registration for the company medical examination Prior to the decision - to be taken by the Medical Director - on reintegration, the doctor must undergo a medical examination by the company medical examination centre. For this purpose, the Human Resources Department shall register the doctor with the company medical examination centre, with the prior consent of the person concerned, the Medical Director, the attending physician and the company physician.

Medical report and its content In addition to the circumstances triggering the assessment (e.g. prolonged serious illness, obviously reduced performance due to illness), the company medical report forms the basis for the Medical Director's assessment of whether the doctor is unfit for work. The assessment of a possible reintegration through the medical examination is not solely based on the doctor's personality. Rather, the decisive factor is the impact of the illness on the ability to fulfil the duties of the functional office. In order to do justice to the special circumstances of the individual case, the underlying medical report must then contain statements on rehabilitation measures to restore fitness for duty. These include information on the duration of the measures, including the scope of daily or weekly working hours, the type and scope of possible activities and information on the date of a follow-up examination.

Assessment and decision on reintegration The Medical Director (or his/her representative in office) is responsible for deciding on the reintegration of the doctor. He decides on the basis of the company medical report whether and to what extent specific measures for gradual reintegration are to be taken. He may obtain additional or supplementary reports. The Medical Director is authorised, but not obliged, to allow the doctor who is still incapacitated to work in the context of such a rehabilitation measure with a restricted function. When making this decision, he/she must take into account the specific circumstances of the individual case and ensure that there is no potential risk to the patient's health.

Creation of an action plan Under the direction of the Medical Director, an individualised action plan is drawn up with the doctor and his/her supervisor. This plan is based on the information provided in the medical report(s) and is intended to gently but continuously reintroduce the doctor to the stresses and strains of the workplace, depending on the illness and the period of incapacity for work to date, while avoiding any risks to the patient. The reintegration action plan should contain at least the following information:

• Planned overall time frame for reintegration
• Planned daily / weekly working hours
• Location and area of application
• Information on the type of individual activities to be carried out in relation to the employee's skills profile and the requirements profile of the job
• Information on the scope of the individual activities to be carried out in detail
• Date of the medical re-examination (follow-up examination) at the company medical examination centre
• Regular reporting obligation of the line manager on the progress of reintegration to the Medical Director
• If necessary, jointly agree on a mentor who will accompany the doctor during the reintegration measures

The action plan must be documented in writing prior to reintegration and confirmed by the signature of all parties involved in the process.

Implementation of the action plan The supervisor is responsible for the implementation of and compliance with the action plan for reintegration. If the incapacitated doctor is the director of the department, clinic or institute, the medical director is responsible for the implementation of and compliance with the action plan. If this has been agreed in advance (see action plan), the director of the department may delegate this task to the mentor. In this case, the mentor is obliged to report to his/her superior.

Should circumstances arise during the reintegration process that necessitate changes to the action plan or its premature cancellation, the supervisor will inform the Medical Director immediately. The reasons for this will be discussed together and, with the involvement of the doctor and, if necessary, the mentor, an adjustment to the action plan will be made or its premature cancellation decided. This must be documented in writing, stating the reasons, and confirmed by the signatures of all parties involved.

Finalisation of the action plan Once the action plan has been completed, the supervisor shall draw up a final report for the Medical Director, which - with regard to the objective of the reintegration measure carried out - provides a professional assessment of the doctor's fitness for duty. The doctor shall also undergo a follow-up medical examination by the company medical examination centre at the end of the reintegration. The result of the assessment by the superior and the follow-up medical examination, including any supplementary reports, shall form the basis for the Medical Director's decision on how to proceed with the doctor's further deployment. The HR department will be informed of this in order to initiate the necessary measures.

Responsibility, qualification

Determination of medical suitability for reintegration: Company doctor. Registration of the doctor for the medical examination: HR department. Decision on "whether and how" to reintegrate the doctor: Medical Director Deployment of the doctor in the context of reintegration in the clinic: Supervisors of the department/clinic/institute.edit

Documentation

Written documentation of the reintegration based on the preparation of the action plan including changes and professional judgement after completion of the reintegration. Written documentation in the event of premature cancellation of the action plan.

Notes and comments

Individual recommendations of the medical associations were not taken into account.

Guideline of the Association of German Company and Works Doctors

Applicable documents

Hamburg Civil Service Act (HmbBG) General Collective Agreement for Salaried Employees (MTV Angestellte) Social Security Code V - Law on Statutory Health Insurance (SGB V) Administrative Order on the Regulation of Management Tasks in the Public Health Sector dated 17.04.1978 (MAN02.03) Version 02 dated 02.03.2001 Procedural Instruction on Notification and Verification Obligations in the Event of Illness (Per05.30) Version 01 dated 10.10.2001

Terms

Inability to work

A person is unfit for work if, as a result of an illness, they can no longer carry out their work or can only do so at the risk of the illness worsening.edit

"Prolonged" incapacity for work

A "prolonged" incapacity for work within the meaning of these procedural instructions exists if the doctor has been unable to perform his/her duties for at least eight weeks due to the incapacity for work. If the doctor applies for reinstatement to his/her medical duties after the expiry of this period if the incapacity for work persists, the procedure in Section 3.2 applies accordingly.

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