Small and Medium-Size Enterprises: Challenges for Return to Work

This study aims to describe current practices and contextualize the specific challenges faced by manufacturing small and medium‑sized enterprises (SMEs) when implementing best practices for sustainable return to work (RTW). Methods — A qualitative descriptive study was conducted in Québec, Canada. Data were collected through eight interviews with disability managers and two focus groups with 16 external stakeholders involved in rehabilitation and RTW (rehabilitation professionals, insurers, mutual insurance companies). Thematic and content analyses were performed.Results — Disability management was predominantly framed as medico‑administrative absence management, with minimal formalization of RTW procedures. Key challenges include a lack of structural and human resources, limited job diversity for temporary assignments, informal communication and decision‑making, limited access to collaborative structures, and relational proximity that may create vulnerability. Conclusion — Implementing RTW best practices in SMEs requires contextualized adaptations. Formalizing procedures and strengthening internal–external collaborative structures are essential avenues for action. Sustainable RTW depends on structured collaboration, explicit attention to functional limitations, and pragmatic, right‑sized guidance to support each stage of the RTW process.