Occupational Health, Safety & Occupational Health, Safety &

Welfare within the Health Service Welfare within the Health Service

within the context of Staff within the context of Staff

GovernanceGovernance

A CEO’s viewA CEO’s view

If you don’t have healthy workforce, you If you don’t have healthy workforce, you don’t have a service,don’t have a service,

If you don’t enjoy what you do, you will not If you don’t enjoy what you do, you will not do it well,do it well,

There is no limit to what can be achieved if There is no limit to what can be achieved if the individual is engaged with the corporate the individual is engaged with the corporate culture and mission.culture and mission.

The Wider Picture- Headline issuesThe Wider Picture- Headline issues

Corporate & social responsibility,Corporate & social responsibility, Supporting quality care -governance, Supporting quality care -governance,

revalidation,revalidation, Organisational change, “Organisational change, “Quality & FairnessQuality & Fairness”” Improving working lives- Improving working lives- “APPM”.“APPM”. Recruitment & Retention- the war for talent,Recruitment & Retention- the war for talent, The Equalities agenda,The Equalities agenda, The rehabilitation agenda, The rehabilitation agenda,

Holistic Approach to Managing the individual

accept

retain

transfer

mitigate

controlpreventavoid

RisksRisks

Employment Risk Employment Risk MatrixMatrix

Early Retirement,

SuccessionPlanning

Safety,

Legal Compliance

Absence,

Stress,

Turnover/retention,Recruitment,

Wage increases,

Fraud,

MortalityImpact

Improvement Potential

Corporate Health Risk Management Corporate Health Risk Management PyramidPyramid

High impact claims - ET, PI, DDA, H&S fines, IHR,

reputation

Long Term Sickness Absence

Sub-optimal performance at work

Short term sickness absence

Well at work

Total Cost

Increases

Cost per case increases

Corporate GovernanceCorporate Governance

FinancialFinancial ClinicalClinical StaffStaff

Preventive health and well-being management Preventive health and well-being management services are proven to impact the following business services are proven to impact the following business

driversdrivers

AbsenceAbsence

StressStress

Cost of ill-healthCost of ill-health

Staff turnoverStaff turnover

Employee engagementEmployee engagement

Employee retentionEmployee retention

ProductivityProductivity

‘‘Employer of Choice’ Employer of Choice’ positioningpositioning

DecreaseDecrease

IncreaseIncrease

OH,S&W anchored in principles of OH,S&W anchored in principles of Staff GovernanceStaff Governance

Under staff governance employees entitled to Under staff governance employees entitled to be;be;

Well informed,Well informed, Appropriately trained,Appropriately trained, Involved in decisions which affect them,Involved in decisions which affect them, Treated fairly and consistently,Treated fairly and consistently, Provided with an improved safe working Provided with an improved safe working

environment.environment.

Objectives of occupational health Objectives of occupational health within the health servicewithin the health service

““promote & maintain physical, mental & social well-promote & maintain physical, mental & social well-

being” (WHO definition),being” (WHO definition),

ensure applicants are fit for & placed in appropriate ensure applicants are fit for & placed in appropriate

workwork

assist management in protecting employees from assist management in protecting employees from

hazards arising in their work or workplacehazards arising in their work or workplace

protect patients, visitors and others who may protect patients, visitors and others who may

represent a hazardrepresent a hazard

contribute to organisational effectiveness by contribute to organisational effectiveness by

enhancing performance and morale by risk reduction enhancing performance and morale by risk reduction

Minimum Standards of an Minimum Standards of an Occupational Health ServiceOccupational Health Service

Pre-placement checks of all prospective employees,Pre-placement checks of all prospective employees,

Health surveillance of in service employees,Health surveillance of in service employees,

Health promotion & education,Health promotion & education,

Comprehensive risk based immunisation program,Comprehensive risk based immunisation program,

A confidential counselling service,A confidential counselling service,

Programs for elimination of accidents causing PI, Programs for elimination of accidents causing PI,

occupational illness,occupational illness,

Education, promotion of adherence to legislationEducation, promotion of adherence to legislation

Case management of health-related absence.Case management of health-related absence.

Contact with the OHSContact with the OHS

altered work performance/conduct/safety altered work performance/conduct/safety

concernsconcerns

work affecting health, health on workwork affecting health, health on work

ability to deliver regular & effective serviceability to deliver regular & effective service

Rehabilitation/resettlement/redeploymentRehabilitation/resettlement/redeployment

potential retiral or termination of potential retiral or termination of

employment on medical grounds.employment on medical grounds.

Health assessmentsHealth assessments

Pre-placementPre-placement

statutory assessments (IR, driving, asbestos, noise, statutory assessments (IR, driving, asbestos, noise, biological agents regs)biological agents regs)

health screening, surveillancehealth screening, surveillance

immunization reviewsimmunization reviews

post sickness absence (food handlers)post sickness absence (food handlers)

health education & counsellinghealth education & counselling

rehabilitationrehabilitation

ill health retiralill health retiral

Occupational HealthOccupational Health

Work affecting Work affecting healthhealth

physicalphysical– ergonomicergonomic– chemicalchemical– radiationradiation

socialsocial– shiftsshifts

psychologicalpsychological– violenceviolence– organisationalorganisational

Health affecting Health affecting ability to workability to work

physicalphysical– heart diseaseheart disease– back painback pain– asthmaasthma

socialsocial– child / elderly carechild / elderly care

psychologicalpsychological– bereavementbereavement– mental ill healthmental ill health

OHS&W Supports Safe Working inOHS&W Supports Safe Working in a Contractual Relationshipa Contractual Relationship

Work on HealthWork on Health Health & Safety agendaHealth & Safety agenda hazardshazards risk assessmentrisk assessment fitness in safety critical fitness in safety critical

rolesroles human factorshuman factors health surveillancehealth surveillance

Health on workHealth on work HR agendaHR agenda Increase productivityIncrease productivity human capitalhuman capital attendance managementattendance management rehabilitationrehabilitation employee supportemployee support healthy worker effecthealthy worker effect

Different managers may want different things

OHS&W Supports Safe Working inOHS&W Supports Safe Working in a Contractual Relationshipa Contractual Relationship

The relationship is essentially between the ‘client’ The relationship is essentially between the ‘client’ and the ‘organisation’and the ‘organisation’

Which manager?Which manager? Not clinical care in OM?Not clinical care in OM? Health and safety issuesHealth and safety issues Contractual and employment issuesContractual and employment issues Disability issues and fitness to workDisability issues and fitness to work Managers need results to stay in business Managers need results to stay in business Employees also have a duty of careEmployees also have a duty of care OHP duty of care to bothOHP duty of care to both Complex ethics and law means scope for conflictComplex ethics and law means scope for conflict

What are the Priorities for OHP’s from What are the Priorities for OHP’s from Employers?Employers?

Advice on Law and EthicsAdvice on Law and Ethics Assessment of Occupational HazardsAssessment of Occupational Hazards Assessment of Disability and Fitness to WorkAssessment of Disability and Fitness to Work CommunicationCommunication Assessment of Environmental Exposures to Assessment of Environmental Exposures to

HealthHealth Research MethodsResearch Methods Health PromotionHealth Promotion ManagementManagement

Competencies of Occupational Physicians – the Customer PerspectiveRetoo KN, MacDonald EB, Harrington JM HSE Contract Research cr247 2004

Characteristics High Performance Characteristics High Performance CulturesCultures

Good ManagementGood workOptimal risk takingAlignmentDistributed leadershipMeasurement,

reportingIntegration of effortClear Goals

Time basedResourcing the medium

termBias for actionLearning focus

Link between Staff Governance and Patient care

Michie S, West M, Measuring Staff Management and HRM in the NHS

Analysing key issuesAnalysing key issues

Health protection Health protection at workat work

Rehabilitation Rehabilitation after ill healthafter ill health

Sickness absence Sickness absence controlcontrol

Extending Extending services to the services to the wider communitywider community

Motivating healthy Motivating healthy lifestyleslifestyles

Protecting Protecting patientspatients

Fitness for Fitness for recruitmentrecruitment

Fast access to Fast access to treatmenttreatment

Redeployment Redeployment adviceadvice

Barriers to progressBarriers to progress

Complex management structureComplex management structure Immunity from regulatory legislationImmunity from regulatory legislation Absence of a “Health and Safety” cultureAbsence of a “Health and Safety” culture Litigation raised by employees - Litigation raised by employees -

relatively infrequentrelatively infrequent

Stimulus for changeStimulus for change

Loss of Legal ImmunityLoss of Legal Immunity Chief Executives appointedChief Executives appointed Pressure from insurersPressure from insurers Quality standardsQuality standards Parliamentary questionsParliamentary questions Financial awarenessFinancial awareness

Financial AwarenessFinancial Awareness

Litigation costsLitigation costs Absence from work costsAbsence from work costs Occupational Injury and Ill HealthOccupational Injury and Ill Health Hidden costs of accidentsHidden costs of accidents

Towards a Safer Healthier Towards a Safer Healthier WorkplaceWorkplace

Strategy Document Strategy Document Best Practice documentsBest Practice documents Minimum DatasetMinimum Dataset Standards, Audit and BenchmarkingStandards, Audit and Benchmarking Research ProgrammeResearch Programme Extension of OHSS to General Medical Extension of OHSS to General Medical

and Dental Practitioners and their staff and Dental Practitioners and their staff

An effective occupational healthAn effective occupational healthand safety management and safety management

programmeprogramme

Setting policiesSetting policies Organising for health and safetyOrganising for health and safety Planning and implementingPlanning and implementing Measuring performanceMeasuring performance Reviewing performanceReviewing performance Auditing and feedback loopAuditing and feedback loop

Bridging the Gaps to Bridging the Gaps to

Workability &Workability &WellbeingWellbeing

Health Risk Management Health Risk Management ProcessProcess

EducationEducation

PromotionPromotion

Risk Risk AssessmenAssessmentt

Risk Risk ControlControl

Primary CarePrimary Care

ScreeningScreening

SurveillanceSurveillance

Secondary CareSecondary Care RehabilitationRehabilitation RehabilitatioRehabilitationn

ScreeningScreening

SurveillanceSurveillance

DisabilityDisability

DeathDeath

Cost dispersed and not calculated or recognised: E.T. – DDA, unfair dismissalPersonal injuryHSE notice or fineAbsenceSub Optimal PerformanceIll Health Retirement

Benefits include:Retain trained staffImprove performance

HSA/ Safety Department in Organisation Health Service Executive

DSFA / insurer / pension fund

Occupational Health Service - end to end process management in a job

Gap

Gap

K Holland-ElliottK Holland Elliott 2004