Please handle with care: A qualitative analysis on gradual return to work in Germany

Abstract Background Gradual return to work (GRTW) is a well-known work accommodation that helps employees reintegrate sustainably into the workplace after long-term sickness absence. This qualitative study examines the current implementation of GRTW in Germany, identifying challenges and improvement needs, particularly from the perspectives of returning employees and organisational stakeholders. Methods Qualitative data were collected through six structured group discussions across three organisations. Each organisation hosted two discussions: one with employees returning after long-term sickness absence and GRTW participation, and one with key organisational stakeholders (e.g., organisational integration managers, supervisors). Each discussion comprised 3-5 participants. Data were analysed using the Documentary Method of Interpretation (R. Bohnsack). Results Although GRTW is essential for recovery, implementation often failed to match employees’ individual abilities. Participants reported that both internal and external pressures to return quickly-along with the mental health challenges of long-term illness-were often underestimated. Employees frequently experienced anxiety and concerns about their work capabilities and colleagues’ reactions. Organisational resource shortages, workplace pressure, and lack of support hindered successful GRTW implementation, leading to feelings of overwhelm. Conclusions GRTW plays a vital role in facilitating a sustainable return to work process. However, supportive working conditions must extend beyond the GRTW period to strengthen implementation. A more flexible, needs-based approach is required-one that genuinely considers employees’ limitations, recovery trajectories, and available resources. Key messages • Long-term illness disrupts professional life and is often accompanied by self-doubt. • Gradual RTW must sustain employees’ recovery and promote long-term work ability and health.