253 General discussion including their work ability. These legal rules and regulations may force OHPs to take the role of the expert and mainly provide advice on their work functioning and work-related problems. Consequently, less emphasis may be on adequately solving problems that lay outside the workplace, and this makes it difficult for OHPs to take on the role of the process leader, as was expected of them in the Grip on Health intervention. Being a process leader was perceived as challenging by OHPs in this thesis, as in the intervention they needed to remain in a neutral position, withhold themselves from giving advice and let the worker and employer come up with solutions. Considering their obligations to give advice and mostly on work-related problems, we could question whether an OHP, and especially an OP, is the best person to act as a process leader. The role of supervisors in the complexity of systems The results of this thesis also indicated that supervisors could play an essential role in the sustainable employability of workers in a vulnerable position. The extent to which they can fulfill this role is also dependent on the organizational and socio-political context in occupational health practice. In this thesis supervisors were considered important for the early identification of workers at risk to dropout of the labor market. They might be the first person to notice whether a worker is at risk and could refer workers timely to an OHP. However, in the Netherlands, supervisors are not allowed to discuss health related problems (28). Supervisors discussing health-related problems could therefore violate privacy regulations. Moreover, in case workers discuss their health-related problems with their supervisors may contain negative consequences for their employment contract. For instance, a study on the choices of employers regarding employment indicated that employers less often hire or extend contracts of workers with health complaints (29). According to the same study, employers also tend to invest more in workers with fixed contracts, as opposed to workers with temporary contracts (29). Temporary or flexible contracts are more prevalent among workers in a vulnerable position, and laws- and regulations regarding employment contracts are more focused on protecting workers with a fixed contract (30). As a result, workers in a vulnerable position are once again negatively affected by factors on a system level. Privacy regulations have been established to protect the worker, because of hierarchical relationships between a worker and supervisor. This could play an even bigger role among workers with a lower SEP and/or with a work disability. Whether workers discus their health-related problems with supervisors is strongly dependent on the relationship with their supervisor (31). Having a positive and supportive relationship with your supervisor was identified as one of the most important factors for the disclosure of a disability (31). Moreover, not discussing their health-related problems may hamper the ability of employers to provide 8
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