Investing in occupational health not only helps in managing absenteeism and cutting costs but also ensures businesses fulfil their legal and moral obligations. Ultimately, as Elaine Kerr writes, employers need to recognise – and be reminded – that OH services play a pivotal role in safeguarding the health, safety, and wellbeing of employees.
Occupational health (OH) providers, as OH professionals will be well aware, support businesses in understanding the relationship between work and health (Nicholson 2022).
This article will identify and analyse the strategies required to manage an OH service, appraise the use of quality and audit management systems and discuss the impact of policies and laws on OH services.
The introduction of OH services to a large supermarket, Linton’s, will be explored within the article. The author, recently appointed as OH manager, will address the implementation of OH services, their role in mitigating the high staff turnover at the supermarket, and strategies to support employees with chronic health conditions.
These OH services will be provided externally from ‘s supermarket, encompassing onsite and remote support to enhance business operations.
Strategies to manage OH services
When implementing an OH service within this large supermarket, much of the literature advises that a business case should focus on three main factors.
These include the financial, moral, and legal benefits of OH services to a business (Nicholson 2022). Society of Occupational Medicine (SOM 2022) concurs that a business case should provide stakeholders with valid, transparent, and compelling reasons for investing in OH services.
They can help a company manage absence and reduce costs, businesses have a legal duty of care to their employees and a moral obligation to help improve employee health and well-being (SOM 2022).
Nicholson (2022) suggests that OH can add value to a business by reducing costs by managing and preventing absenteeism. SOM (2022) highlights that sickness absence can cost UK businesses in the region of £28.8bn per year and work-related ill health affects 1.3 billion workers in the UK.
SOM (2022) further suggests that investing in OH services is the most efficient and effective way to manage long-term sickness absence. Nicholson (2022) suggests that organisations should consider the cost of OH provision in the light of the broad value that OH provides to a company, including supporting a faster return to work, health promotion, keeping workers healthy and compliance with their legal responsibilities.
NHS Employers (2023) define OH as a specialist service focused on improving the productivity of an organisation by investing in the health and well-being of their employees. The World Health Organization (WHO 2002) advocates that implementing effective OH services requires planning, good management, strategy, and vision.
This helps to guarantee services are balanced, needs and priorities are met, and financial sustainability assured. Facilitating a strategy helps foster accountability, focus, and better results for a business.
While this reference is dated, Gilbey (2014) agrees that a strategy needs to include identifying the problem to be solved, how big the problem is, what research is provided to back this up and what return on investment this will provide.
Concerning Linton’s, the problems identified are a high turnover of staff and employees with chronic health conditions. Therefore, implementing an OH service will support employees in managing long-term health conditions by providing health promotion and advising reasonable adjustments or recommendations which may allow them to remain or return to work (Work and Health Unit (WHU) 2019b).
Smaller OH providers can lack a depth of knowledge and struggle with clinical governance. Outsourced services have a larger pool of staff to cover absences and to provide a wider range of skills and knowledge but have less awareness about local hazards and risks, and may lack continuity of provision.”
When preparing a business case, stakeholder analysis should be conducted, starting with the OH board representative, usually an HR director, as ultimately, they are the main stakeholder requiring evidence to support implementing OH services (Gilbey 2014).
The author successfully acquired Linton’s supermarket as a client to provide OH services by bidding during the tendering process. According to the government’s Work and Health Unit (WHU 2019a), 63% of OH providers conducted some form of marketing; however, targeted marketing was rare and found mainly in sectors requiring legal requirements, such as engineering industries.
WHU (2019a) also found that 37% of OH providers did not conduct any form of marketing, citing they had enough business without the need for this; however, these results were limited to 103 participants and are therefore not representative of all OH providers in the UK.
Carnall (2014) suggests that market research can assist in understanding the needs and aspirations of customers. Tjalvin and Moen (2019) explain two main models of OH delivery: internal and external OH services.
An internal service is delivered by personnel employed directly by the company and remains onsite at the business. This approach allows the OH practitioner to gain valuable information on the work environment and to build relationships with employees. It can be difficult to implement workplace change, and internal OH providers must ensure they keep their integrity.
Alternatively, an external OH service is managed by an outside company, such as the author’s OH service which will be implemented for Linton’s supermarket.
Higher Educational Occupational Physicians/Practitioners (HEOPS 2016) believe that the different models of OH services can present advantages and disadvantages; in-house services can have a better understanding and knowledge of an organisation, allowing for open dialogue.
However, smaller OH providers can lack a depth of knowledge and struggle with clinical governance. Outsourced services have a larger pool of staff to cover absences and to provide a wider range of skills and knowledge but have less awareness about local hazards and risks, and may lack continuity of provision (HEOPS 2016).
Impact of law and policies on OH services
Kloss (2020) defines OH services as both a therapeutic and preventative branch of medicine, where the OH professional has a duty of care to the employee and the employer while meeting standards set by their governing bodies such as the Nursing and Midwifery Council (NMC), or the General Medical Council (GMC).
Oakley (2008) recognises that OH professionals must manage their practice by considering their professional duties and responsibilities. OH nurses are governed by the NMC 2018 Code, which holds nurses to a professional standard and identifies that nurses should adhere to relevant laws and policies to safeguard those they care for (NMC 2018).
Furthermore, Schultz (2018) agrees that governance is a process by which organisations are controlled, directed, and held to account. Implementing governance in the workplace allows for confidence from stakeholders, allows organisations to perform to a high standard and ensures that organisations can cope with changes.
Kloss (2020) suggests that the role of an OH clinician involves the development of policies, cultures, and practices within organisations to maintain and promote the health and well-being of workers.
The requirements of Health and Safety at Work etc. Act 1974 is the primary legislation that underpins the management of workplace OH and safety within the United Kingdom (HSE 2024).
Maintaining records is essential to OH practice, as these records capture baseline health information of employees and facilitate the identification of patterns in the factors contributing to ill health.”
OH clinicians will use this legislation to provide appropriate advice and recommendations to employers in managing ill health in the workplace (Oakley 2008). Furthermore, SOM (2017) reflect that OH services can help businesses manage their health and safety within work to meet the regulatory requirements set out by the Management of Health & Safety at Work Regulations 1999, which requires that a competent person should be in place to implement health and safety in workplaces.
While this regulation does not stipulate that a competent person is a clinician, the OH provider can be required to help manage and support work-related health problems and support the competent person in managing health and safety in the workplace (SOM 2017).
The Chartered Institute of Personnel and Development (CIPD 2024c) defines HR policies as guidance documents formulated to manage a range of issues which may arise within an organisation.
Policies ensure that organisations are fair, inclusive and support trust between employees and employers. Some HR policies are necessary to ensure companies comply with laws, for example, a business with more than five employees must provide a written health and safety policy for their organisation (CIPD 2024c). Furthermore, Nicholson (2019) states that absenteeism and work-related ill health management are more easily managed with the support of OH services and clearly defined HR policies.
Maintaining records is essential to OH practice, as these records capture baseline health information of employees and facilitate the identification of patterns in the factors contributing to ill health (Oakley 2008).
The NMC (2018) states that all nursing professionals must ensure that data, including medical records, are kept securely and that all clinical records are clear and accurate. The Information Commissioners’ Office (ICO 2024) highlights that. under the UK GDPR (2018) legislation, data must only be collected for legitimate purposes and held confidentially.
Oakley (2008) explains that OH records belong to the OH company that holds them. The OH record belongs to the clinician who makes these records, this is referred to as a data controller. The data controller has a responsibility to keep these records confidential on behalf of the employee (Oakley 2008).
The use of audit and quality management systems within OH
To provide a robust, safe, evidence-based and effective OH service, quality management systems and audits are vital.
The purpose of monitoring quality and conducting audits is to assess need, measure quality and identify gaps in knowledge. Any audit should be used as a tool to improve practice and should be measured based on a set of standards or criteria (Thornbory and Everton 2018).
Nicholson (2018) concurs that quality clinical audits are essential for quality management, recognising that clinical audits help to identify strengths, areas to improve, and promote best practices. Quality improvement tools are fundamental for those in leadership or management roles to achieve high standards of clinical practice.
Leaders play a role in implementing quality improvement and promoting individuals to be engaged in developing their clinical practice (NHS Education for Scotland 2024). Thornbory and Everton (2018) observe that one weakness of clinical audit is that it can become a meaningless exercise if the methods or standards used to assess the work are not relevant to practice.
The NHS (2024) formulated a benchmark tool to aid with auditing clinical practice within OH services. Management of Health at Work Knowledge (MoHaWK) is a web-based tool developed to improve clinical practice in OH. This tool can be used by NHS and external OH providers and strives to ensure the quality of OH services. This tool allows areas of improvement to be identified and ultimately improves the quality of clinical practices in OH.
SOM (2019) recommends that, when implementing an OH service to a new company, the OH provider should provide the client with regular monitoring, quality, performance, and statistical information to help measure and define the progress of operational goals.
They highlight that key performance indicators (KPIs) are required, KPIs should focus on aspects of the OH services provided, such as the time between referral and consultation, presenteeism figures, customer satisfaction and sickness absence figures.
Moreover, service level agreements (SLAs) should also be defined and agreed upon between the OH provider and the client as to what service provisions are required. SLAs will be used to measure the performance of the OH service; however, they will remain flexible initially and may change as the contract grows.
SLAs may include managing referrals, timescales for arranging appointments and when cases are closed. NHS Employers (2023) agree that organisations must ensure that what is expected of the OH service is clear and that regular monitoring is undertaken. KPIs and SLAs are critical for the success of OH services, and facilitating these allows for the contract to run smoothly as both parties understand the requirements to support the organisation (Paton 2012).
An action plan specific to the organisation can be a helpful tool when commissioning an OH service. Action plans are good practice and allow the employer and OH provider to agree on what is required to support business goals (Paton 2012).
Governance, collaboration, and change
To provide a high-quality OH service, governance must be implemented; this allows for an honest and open organisational culture which is led by leaders who are compassionate and inclusive.
Leaders should ensure that in supporting staff to provide high-quality OH services, they remain transparent about decision-making by promoting a positive team culture, acting as role models, and championing workplace diversity and equality issues (NHS Education for Scotland 2024).
Craig and McKeon (2015) agree that great organisations are formed when team dynamics are positive, and teams are most productive when they feel supported and understand their purpose. Furthermore, teamwork takes constant work and attention, using good communication and ensuring the individual wellbeing of each team member.
Ronquillo, Ellis and Toney-Butler (2023) suggest that a leadership style involving a collaborative, dynamic and multifaceted approach has been proven to be the most effective way to successfully manage a team.
Transformational leaders typically inspire shared vision, encourage innovation and creativity, fostering an environment of trust and lead by example. Appointing a new OH provider is a change for Linton’s and their staff that may be accepted positively. However, some staff members may find this challenging.
CIPD (2024a) suggests that when implementing change, this is best achieved by positive social interactions and negotiations rather than by authority and control.
Furthermore, change management is a process critical for a business; change can be difficult, and consideration should be given to the use of change models; these models can help organisations coordinate and structure any changes to meet the organisation’s vision (Ovington 2023).
CIPD (2024a) also recognises that organisations will benefit from using techniques such as change models to implement organisational changes; these changes will be effectively implemented by positive leaders who are committed and supportive of their team.
Making changes in organisations can meet some resistance; however, managing communication and considering change management should avoid significant resistance from employees (James and Lewis, 2020).
Craig and McKeon (2015) support that leaders should combine their leadership skills with organisational policies and practices, this ensures teams feel supported, perform better and promote open communication.
Johnson (2017) suggests leaders must approach and manage any crisis effectively and quickly. Mikusova and Horvathova (2019) describe crisis management as when a disruptive or unexpected event happens which can threaten to harm an organisation. OH professionals will have the clinical knowledge to support organisations navigating crisis and can develop an action plan to support and inform businesses (Nicholson 2020)
CIPD (2024b) found in a recent study that one-third of employees had experienced some form of conflict within the workplace. In a supermarket such as Linton’s workplace, conflict is likely to arise. A large part of people’s life is spent at work, and conflict can occur due to various factors, including behaviour, harassment, or bullying.
While not all conflicts are negative, they can fester; therefore, they should be resolved as early as possible (CIPD 2024b). HR policies should be used to manage equality, diversity, bullying and harassment; these policies are important and should remain visible across the business to promote respect and positive attitudes (CIPD 2024b).
Furthermore, Thornbory and Everton (2018) suggest that companies should have clear, accurate policies and protocols to manage workplace conflict. OH practitioners have a unique opportunity to work alongside line managers and HR to help facilitate policies to manage workplace issues (Oakley 2008).
Conclusion
In conclusion, this article has explored the strategies essential for effectively managing an OH service. It has explored the introduction of OH services at Linton’s supermarket, emphasising the advantages they offer to the business.
Moreover, it has highlighted that investing in OH services not only aids in managing absenteeism and cutting costs but also ensures businesses fulfil their legal and moral obligations.
Ultimately, this article highlights the pivotal role OH services play in safeguarding the health, safety, and wellbeing of employees in the workplace. By implementing efficient OH systems and strategies, businesses not only save costs but also demonstrate their commitment to their employees’ health and wellbeing.
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