Why case management is an effective tool for health in the workplace
Why should employers be concerned around health challenges in the workplace?
The art and science of occupational health (OH) is to explore the relationship between health and work. The two are often inseparable – if someone is unwell, they cannot attend work and/or perform as effectively if they would if they were fit. Employees are an organisation’s greatest asset and looking after their health and wellbeing should be a business imperative.
The effect of sickness absence on the economy, as well as attending work while unwell (presenteeism), has been the subject of extensive research and is documented in a number of published reviews, most notably Dame Carol Black’s ‘Working for a Healthier Tomorrow’, and the Boorman Report on health and wellbeing in the NHS. While a healthy and motivated employee is a productive employee, unwell staff attending work can represent a risk. This risk could be to the employee themselves and their employment as they may not perform optimally. In addition in some industries that risk could have major organisational repercussions, including productivity, revenues, damage to reputations or accidents with severe consequences.
There is a need for an interface to ensure that an employee can attend work and perform to the required standards, with reasonable adjustments to their work arrangements or environment if necessary.
Employers must manage their workforce’s capability to undertake their duties through appropriate policies and procedures but should take any health issues interfering with this into account or risk breaching health and safety and disability discrimination regulations.
What role can occupational health play?
OH was born of the recognition that people may suffer from health problems specifically related to their line of work. It has a dual responsibility – to employer and employee– and positions itself as a provider of independent specialist medical advice.
An OH clinician can advise the employer based on their knowledge of how the workplace may affect the employee’s health, where a GP maybe more aligned to the individual’s health concern. The employee who has an illness which is preventing them from fulfilling their duties welcomes the opportunity to speak to a clinician who can advise their employer on this subject without discussing private medical details.
Occupational health offers independent advice on how health conditions may interact with an employee’s capability and provides practical and helpful advice to support the employee in continuing at work – for example, through adjusting their work arrangement to make it suitable to their needs or provide information the employer feels is needed before deciding how to move the case forward and explore available options regarding the employment process. People managers crave clear and definitive OH information that can be used to make informed business decisions.
Occupational health clinicians also have specialist knowledge in employment and health and safety legislation and can provide appropriate guidance to help employers fulfil their obligations under such legislation.
What are the benefits of a case management approach?
Case management can be considered as occupational health plus. As usual, the process starts when the employee is referred to OH with the thought that there may be a health issue that affects an individual’s ability to undertake their duties. However, when case management is included in the service agreement with the employer, OH support may extend beyond offering the standard advice to explore how the employee can be supported through their ill health journey.
This could include expediting access to therapy or relevant specialist assessments, communicating with the GP and specialists, regularly updating the employer on the progress of the case and then guidance on rehabilitation and return to work. This could include advising on the need for ergonomic assessments and specialised equipment which could help maximise employee’s effectiveness at work while managing their health condition. The support may also involve dealing with the psychological element of the health condition through referrals to an EAP, formal psychotherapy or advice on eligibility for income protection schemes: often a cause of anxiety for the employee. Occupational health becomes the ‘Clinical Hub’, acting as a central point and offering a coordinated approach to an employee’s health as part of an effort to secure a successful work/health relationship, with the employee placed at the heart of all decisions.
The case manager can help support the process by recognising that the employee’s problem often extends beyond the health condition itself. AXA PPP healthcare has adopted a biopsychosocial model: the clinician looks into factors which could be contributing to an employee’s ‘functioning’ and influence their return and recovery – for example, relationship problems, financial difficulties or legal constraints. The clinical case manager explores available support avenues and provides a realistic estimated return date. This helps the employee tackle these factors and improve their chances of making a lasting improvement in their recovery and, if off work, a safe and sustainable return, whilst the employer has better clarity and quality of management information.
Other services which could be advised upon as part of employee wellbeing approach include dental treatment and access to private GPs for advice and private prescription. This could help them avoid delays in accessing appropriate therapy.
The case manager will continue to be involved until both employer and employee are satisfied that the employee has either regained capability to undertake their role or has reached maximum improvement – at which point it is the responsibility of the employer to decide how to move their situation forward.
It can be hard to work out just which rules, regulations and remedies apply to the health of employees and gain the advice you need to fit around your timescales. Where a manager has lots of questions surrounding making a referral, at AXA PPP healthcare we have found the provision of a supportive management telephone helpline where guidance from clinicians can be gained to be a real benefit in the process.
Adopting case management and placing OH as a central hub providing timely, evidence based and appropriate specialist delivered medical care, to complement the appropriate guidance on fitness for work and the support that could be offered by the employer, secures the best outcome when approaching ill health at work. Employers must ensure their providers can provide access to the required resources which deliver seamless communications and effective links between OH and various services such as private medical insurance, private GPs, physiotherapy and beyond.
What about the costs involved?
Contracting a health and wellbeing service will have to come at a cost. However, employers should look beyond the immediate costs when they are investing in the health and wellbeing of their employees as the return from this investment will be evident with time through maintained staff productivity, reduced sickness absence and staff retention. An important factor to consider is that, according to the ONS, over the next decade the changing age profile of the workforce will be the most significant development in the UK labour market, as a third of employees will be over 50 by 2020. As employers are facing the prospect of an ageing workforce, it will become increasingly likely that illnesses associated with old age which are often chronic and difficult to manage will pose workforce challenges. Having an effective approach to supporting employees through their ill health could provide the answers to such challenges.
What is the future for OH and case management?
We see an increased role for proactive programmes complementing an employer’s provision of occupational health, helping organisations proactively manage the health of their employees and design an organisational environment more conducive to health – equipping today’s modern workforce with the awareness, understanding and necessary behaviour changes to thrive in today’s modern workplace.
For organisations without an OH service, Fit for Work is a welcome step in terms of increasing employer interest in the management of potential long-term absence, and employee health in its broadest sense. However, it is not a replacement for well developed, focussed and comprehensive OH support programme.
Organisations and people managers are demanding more clarity and quicker access to information. Evidence shows biopsychosocial factors play a significant part in recovery and a lasting return to work. Taking account of them allows us to adjust return to work times, tailor advice and consider important barriers to health and productivity. Data, technology, services and clinical expertise need to come together and result in a simple coherent occupational health service from a reputable and reliable provider. Management information can enable organisations to identify trends and make informed decision around health and wellbeing investment. We have invested time, technical expertise and systems capability to deliver this depth of reporting, UK wide.
Ten Top Tips
1. Encourage early referral to OH, particularly in areas of musculoskeletal and mental health.
2. Ensure that your employees have clarity of the role of OH and what to expect from an assessment
3. Centrally position OH in your policies, to interface with other services
4. Insist that your employees are assessed by qualified and experienced OH clinicians.
5. Ask how you can better support your employee through their illness.
6. Expect clear and unambiguous assessments of an employee’s state of health and fitness for work.
7. Expect a clear and realistic timeframe for their return to health and work which incorporates biopsychosocial factors that may influence their return to work.
8. Ensure your managers are supported and have access to timely and appropriate advice.
9. Utilise technology to collect timely information about absence causes and ensure that it’s secure and compliant.
10. Have consistent case information drive management information which can help you determine where to spend your health and wellbeing investment.