You will often hear or read occupational health (OH) professional people saying “It’s not a health issue, it’s a management issue – steer well clear”.
But what exactly does that mean? This question was on my website this week.
I’ve had many inappropriate cases referred to me in my time. Sometimes it’s accidental, sometimes deliberate; usually by inexperienced or untrained managers.
In my early days as an OH practitioner, I didn’t know the difference and accepted everything – I was just trying to help m’lud.
But so often, trying to sort out managerial issues left me holding the can.
This article explains my take on the difference between health and management issues and why it’s imperative to understand how to deal with each. Otherwise, legal problems and frustration from the worker, manager and especially for OH occur.
The victim of the argument becomes the confused employee, caught in the middle.
Occupational Health Services
The thing an occupational health service does well, and why it’s there, is for health issues at work.
Managers cannot be expected to know anything except the basics about worker’s health condition or treatments, whereas OH are specialists. Not just in health; they know about the job, the type of duties and what options are available in each workplace. By working together, OH and the manager can usually accommodate most types of health issues.
If unable to change the work or the worker’s job, then the decision of employment rests with the employer. And that, is a fancy way of saying whether a worker gets dismissed or not.
At the heart of the collaboration between OH and a manager, is the referral system.
Just as a GP sends a patient off to the specialist, so the manager sends the worker with a known or suspected health problem to their OH service.
The OH service assesses the medical issues and, after discussing and agreeing on the facts and solutions with the worker, sends the advice (I call them recommendations) of how to deal with the situation back to the manager for action.
OH assumes all is done and dusted, after all, if there are any problems the manager will contact OH for a discussion, wouldn’t they? And the case is discharged. Sorted! What could be simpler?
The worker’s health is affecting their performance at work or work is affecting a worker’s health.In the workplace, typical health or medical issues are:
- Short-term repeated absences due to health
- Long term health issues or absence
- Return to work programmes after illness
- Fitness for the job
- Health issues caused by work
- Health problems that can affect work or the product e.g., food handlers, safety critical
Occupational health can do any of the following:
- Investigations e.g. discussions and questionnaires
- Letters to GP’s and health specialists
- Suggest rehabilitation programmes
- Suggest changes to work to help a worker with a health problem
- Occasionally the job may be unsuitable for the health problem and recommend other work
Clearly, these are all health and health-related topics.
The Management Issue
I divide the management issue into ‘before’ and ‘after’ referral because they are significantly different:
Before Referral to OH
In companies with no policy, managers each set their rules for a referral to OH.
Here are some typical inappropriate reasons for referrals:
- The worker has vaguely mentioned an illness during an absence discussion, grievance or disciplinary meeting. Managers do not want to get into the detail and so send them to OH. Thus adding a couple of weeks to the process, increasing everyone’s stress levels while waiting for a response.
- Worker has high level of absence so sent to OH as a punishment
- A company policy specifies a set circumstance where workers MUST be referred to OH; I call this the ‘tick in the box’ referral
- The worker is not performing at work, and the manager wants to rule out a medical reason before discussions with worker
- A manager does not want to deal with a situation and tags it as a ‘medical’ problem. Full stop.
For an experienced OH practitioner, these cases are easy to spot. They are quickly dealt with, and a report comes back to the manager explaining how best to handle it – the ball is back in the manager’s hands. However, a lot of time and effort is wasted, running around this circle.
After Referral to OH
Once the report is back with management most problems occur, mainly because there is no follow-up meeting with the worker for discusscions and implementation of the OH report.
This has two outcomes:
1. Health Issue Not Dealt With
The manager ignores the health report and everything stays the same; except, the employee waits for action. As nothing happens, resentment builds up in the employee, whose behaviour and motivation are negatively affected, that is, they get ticked off with both the manager and OH.
In some cases such as repeated absence, the worker believes they have outwitted the manager and usually tells others, fostering a sense of unfairness and poor management. If outcomes such as this occur frequently, it spreads through the company affecting overall absence levels and culture.
OH too is often perceived as ineffective.
2. Confusion about Responsibility
In many businesses, employees and even some managers believe that the OH services run the show.
What they recommend stands, and occupational health has some managerial power in the workplace. Power and authority to change working condition or to reprimand a manager if they ignore or the report.
This is not the case.
In law, it is clear under the Health and Safety at Work Act that the employer is responsible for looking after the health and safety of employees.Nowhere in the Act does it talk about occupational health being in charge.
Occupational health advises managers (who are ‘the employer’) on how to deal with a situation. They give options. If these options are unworkable, then there should be a suggestion to contact OH to discuss other options.
The OH service works with managers to guide them through the employer’s legal requirements of health issues at work.
- Legal implications, e.g., data protection, health discrimination
- Writing and advising on policy, e.g., health supervision, surveillance and screening
- Referral processes and questions to ask of OH
- Training for managers/employers, e.g., absence management, referral processes, and,
- Individual worker advice
The final report should contain all the information needed to deal with the worker’s health issue.
When a Health Issue Turns Into a Management Issue
What often happens with busy, poorly trained or inexperienced managers and OH services too, is they miss or omit the last step.
For OH, it is to check that the report has reached the manager and they understand it and have a clear way forward. And managers must manage their employee’s health and expectations. They have the information now.
But, in so many cases, nothing changes. The report from OH gets filed in a drawer. The manager read the recommendations but is unable to grasp what s/he needs to do next. OH, not hearing anything back from the manager assumes all is well and files the notes away.
But the worker is left, waiting for a new chair, modified shifts, or perhaps with a bad back, with no adjustments or a discussion to say that the manager can’t afford the chair or even ‘It ain’t gonna happen’. You now have a disgruntled worker blaming the lack of action on either the manager or OH and sometimes both.
The health problem continues and after a few months, the manager sends the worker to the OH service again. Hoping, I suppose for a different approach or solution. OH gets fed up now, and sends back the same report, albeit strongly worded.
The barriers are coming up.
Again we get the same problem, same recommendations, no action.
And this is the classic management issue.
Because there has been no manager picking up the results from the report and acting on it. And, the OH service hasn’t checked to make sure the case was resolved.
No one is a winner here. And yet everyone tried.
How to tell the Difference between Health and Management issues?
Individual health problems are complicated. There are times when even the simplest health issue turns into a management issue just because a manager doesn’t understand what to do next or OH hasn’t checked to see if the report is helpful or practical.
As a note, I should like to point out that some special health problems always have the potential to become management issues at some stage, no matter what you try. These are:
- Work-related ill health (especially stress)
- Bullying and harassment
- Disability likely to be covered by the Equality Act
- Dismissal due to ill health
- Fitness for work especially at pre-employment stage
As you can see the difference between health and management issues in the workplace is not a black or white matter.
Health problems need identifying and, once identified, need managing.
Managers and OH both have key roles to play for the benefit of the individual, and each helps the other.
To avoid problems both must take the final step of the process – managers must manage the health issue and OH must check the worker’s health issues have been addressed.
In my experience, if there are clear health and management policies, guidance, training, collaboration and trust, plus the final steps of the processess are completed, the question rarely arises.