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University of California at San Francisco Case Study

Medical students working on computer

Comprehensive Approach to Sustained Health and Productivity

The University of California at San Francisco (UCSF) is ranked among the world's leading centers in providing health care, graduate and professional study in the health sciences, and pioneering medical research. Research discoveries of UCSF scientists have led to the creation of many biotechnology companies and partnerships with industry for collaborative studies and clinical trials. The campus includes the Medical School and Medical Center, Pharmacy School, Dentistry School, and Nursing School, and more than 20,000 graduate students, postdoctoral fellows, faculty and staff.

Thirty years ago, the University of California (UC) system responded creatively to the affirmative action requirements of the Rehabilitation Act for reasonable accommodation of disability. Mr. Larry Hickey, Assistant Director of Human Resources, explained that the UC system developed an Employee Rehabilitation Program to uphold these federal regulations and because they recognized that preventing unnecessary disability retirements was the fiscally responsible thing to do. Over the years, managers at the UCSF campus have expanded the program into a comprehensive approach to sustain the health and productivity of their employees and retain them in employment when they incur injuries or develop health-related conditions.

"Our approach is based on our desire to retain the highly skilled employees who work here," Hickey explains. "We acknowledged the reality that sooner or later, all of our employees will experience some type of health problem, and we have attempted to incorporate this reality as part of the regular way we do things as an organization and as an employer." Hickey quotes Nick Plezbert, one of the UCSF Disability Management Analysts who says, The health of our workforce is an immensely valuable asset - one that we must foster, not just preserve."

The UCSF Approach

In order to achieve their goal of supporting the health and productivity of employees and their retention in employment, a comprehensive approach was required. The specific functions needed for this approach are organized into 3 tiers:

  1. Primary Initiative: keeping people healthy, by fostering wellness and safety.


  2. Secondary Initiative: keeping people working, by providing temporary transitional work for conditions that are expected to be temporary. A written transitional work plan is developed, based on communications among the employee, the treating physician and work place personnel.


  3. Tertiary Initiative: providing reasonable accommodation when conditions are chronic or permanent and render the person unable to do their former job. A comprehensive and interactive process for providing reasonable accommodations is initiated. When necessary, a system for preferential placement (Special Selection) in a new, vacant position is used.

Medical students working in a lab

HR is not able to independently address all the aspects of the employment relationship that are required to achieve these goals. So, their approach relies on a coordinated system of working partnerships to carry out these functions. This partnership approach relies on support from management and departmental administrators and supervisors and is sustained by a commitment to ongoing dialogue. The program functions are supported by clearly written polices and guidelines, which were developed in partnership with the departments involved in their implementation. These policies and guidelines can be easily accessed by all parties on the HR website,

The program functions are also supported by staff services from HR. In addition, three rehabilitation professionals staff a Disability Management Services Unit. These professional Disability Management (DM) Analysts are assigned as partners to serve individual business units on-site. They serve as a single point of contact for employees and as a knowledgeable resource to assist the business unit in addressing and resolving disability related employment needs. "By serving as a consultant to a specific business unit, these DM Analysts are dedicated to the department and their people", says Hickey. "They know the business of that department and they really help the supervisor and the employee work out accommodation solutions that work. We attempt to provide the employee with good information from a neutral professional source, so that employees are well informed and can make good decisions along the way."

A Comprehensive Process for Reasonable Accommodations

Transitional Work allows employees with temporary restrictions to work in a modified, alternative or reduced-hours capacity while recuperating using a clear plan for a defined period of time that has been developed with the supervisor and employee. "We want to make dealing with transitional work just a regular part of what supervisors do day-to-day, just as they deal with vacation and sick leave", says Hickey. "All employees experience these needs from time to time. Return-to-work programs arent effective when they take this responsibility away from the supervisory process and assign it to one designated staff person. So our goal is to make accommodation of these temporary restrictions an integrated part of the way we all do things here", explains Hickey.

Reasonable Accommodation assures employees with prolonged or permanent disabilities, which impair job performance, that an effort will be made to provide accommodation to enable work in a modified capacity or in a more suitable position. DM analysts are called upon to facilitate this as an interactive process between the supervisor and employee. "This reasonable accommodation analysis is the single most important thing an employer can do to retain injured or ill employees and to reduce risk", explains to Bob Gilmore, Disability Management Analyst. The rights and limits in the process are clearly spelled out, and access to the Special Selection process is provided when it is not possible to reasonably accommodate the employee.

Special Selection provides access to a preferential employment process when employees are medically precluded from returning to their regular position, but may participate in a search for alternate work. Typically, this process takes about 30 to 60 days. Hiring managers are required to seriously consider these candidates first, for positions for which they are qualified, and to document the required functions that any disqualified candidate has failed to meet. DM analysts assist employees in preparing for the search and selection process. Even when medical separation or disability retirement has occurred, eligibility for this preferential hiring process extends from 1 to 3 years. However, special selection does not provide a guaranteed right to re-employment. This reasonable accommodation analyses is the single most important thing a employer can do to retain injured or ill employees and to reduce risk.


For the past three decades, the UC system has developed and sustained positive attitudes toward accommodation of disability in its organizational culture and among its managers and supervisors. The UCSF approach has built upon this heritage and evolved from an employee rehabilitation program to a comprehensive absence management program of prevention, disability management and productive job retention that utilizes the principles of reasonable accommodation as an everyday part of their operations.

Results are visible in lower frequency of lost time claims, medical costs, and costs of temporary disability. Results are also visible in the sustained and successful coordination of the interdepartmental partnerships needed to achieve this comprehensive approach, in reduced litigation of claims, and in
customer satisfaction survey results. "We do not have it all perfected", Hickey admits, "but we strive to be flexible and continually search for innovations to address challenges such as health care financing. We look for meaningful ways to measure our performance and to integrate our functions in the organization. We are committed to continually improving our performance and we have learned that sustaining real and working partnerships works."

For information regarding this Case Study contact:
Larry Hickey, Assistant Director, Human Resources

McMahon, B., Wehman, P., Brooke, V., Habeck, R., Green, H., and Fraser, R. (2004). Business, Disability and Employment: Corporate Models of Success. A Collection of Successful Approaches Reported from 20 Employers. Richmond: Virginia Commonwealth University, Rehabilitation Research and Training Center on Workplace Supports and Job Retention.

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