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Manager’s Guide to reviewing occupational health services

Manager’s Guide: 15 Steps – Review of Occupational Health Service Provision

Are you wondering if your occupational health service is fit for purpose? Are you finding different parts of the business have different practices? Or are you taking on a new contract and wondering if it delivers the type of service adequate for the types of health risks involved.

You may have misgivings about whether your occupational health service is doing what it should be, using evidence based strategies or at least best practice?  Is the current service providing value for money, could it do more or less? Or maybe, you don’t have any occupational health service at all and you think perhaps you should?

If these questions are troubling you, you should consider a review of your occupational health (OH) needs and service provision.

This article will take you through the steps to take to review your occupational health service provision, whether contracted out, in-house or various OH providers working in different areas/business units.

1.  Size of Organisation

The type of review you choose for your occupational health services, will depend on:

  • The size of the organisation that you work in
  • The geographical spread of your company and the contracts you work on
  • How much control you have over contracts
  • The health risks in the business or contracts
  • Other considerations, such as type of service (those for schools and hospitals say) and whether you deal with government contracts, as these are governed by statute.

2.  Who Should Do the Review of Occupational Health

It’s difficult for an OH service to review and audit themselves. The assessment is best done by an outsider with a more neutral perspective and no expectations or personal interest in the review outcome.

Unfortunately, few people outside of occupational health understand what OH services should do.  Just to make sure we all understand this, occupational health’s primary work is preventing work related ill health.

health surveillance image from HSE
Health surveillance image from HSE

For more information on this go to the HSE website at on health surveillance here

This says:

“Health surveillance allows for early identification of ill health and helps identify any corrective action needed. Health surveillance may be required by law if your employees are exposed to noise or vibration, solvents, fumes, dusts, biological agents and other substances hazardous to health, or work in compressed air.”

One way of testing understanding of OH matters, within your own organisation, prior to a full OH review,  is to survey your managers that use occupational health, and gauge their responses and expectations.

Use Surveymonkey to set your own questions, such as:

  • Is the current OH service meeting expectations?
  • Is the service adding value to your department?
  • Could managers have managed as well by using the individual’s GP?
  • Did you understand the report that OH sent you?
  • Was the response timely?
  • Satisfaction scores
  • How were problems resolved

It may be an opportunity to lead an internal workshop with some hand-picked individuals to examine the general level of awareness  of OH issues.  This is especially important where resources are tight or you’re operating on low margins. Health needs in the workplace must be based on facts that are evidence based or best practice and any health strategy must be relevant to your workers.

Limitations of the review

Competent reviewers should do the formal review especially if the current service OH has been in place for years.  Even if the general opinion is good about the OH service, it may not be doing what it should be.

I once reviewed an OH service where everyone in the company was absolutely thrilled by what the OH service did, hearing checks and lung function testing on everyone in the company, whether they worked in a hazardous area or not. Managers were worried about discrimination if they didn’t allow this for everyone.

 In fact, the company was wasting money by checking office workers who had no exposure to noise or dusts.  “Ah”,  you might say, “surely that is good not bad?”

But why is it good when the company is paying for unnecessary health checks – why not spend the money on buying quieter machinery or dust dampening process controls – that would make much more sense, and be proactive for those working in the hazardous environments?

The ability needed for the review will also depend on the types of risks you have in your company.  For example, nuclear and railways are high risk and covered by regulations that need a specialist doctor’s input; because administration and call centres are considered low risk, and may not need any health monitoring at all.

Also, if you have separate business units, the risk will vary according to the work.

One thing is absolutely clear, do not check your OH provision with those already working in your organisation, as they will have a pre-set idea of how an OH service should look.  You will need a set of fresh eyes, maybe a new start, maybe a new model of delivery.

It’s important that the reviewer is not hampered by company politics or allegiances. In fact if you choose somebody already in the organisation, you may be wasting your time and money especially if they do not understand the professional and legal issues of occupational medicine.

3.  Set Your Budget

A medical review is not cheap and worthwhile and cost saving money in the long-term.  Services may be streamlined, improved, and even extended if there are health risks being ignored by current provisions.  Legal costs for poor management can be really high, more importantly, workers can suffer long-term health problems because of the work.  A bespoke, relevant OH service provision can mitigate these costs and outcomes.

Costs for the review can be set by you and this will become part of the offer to the reviewer.  You may want to cut the cost of the OH service, so you need to focus on what is essential e.g. what do you legally need to offer?

4.  Priorities for the Review/Audit Process

Set your priorities for review depending on your available budget and need, such as:

  • Do you need to do health surveillance – is it a priority, are you handling dangerous chemicals or need statutory medicals?
  • Well-being programmes, are they cost-effective and relevant to the majority of the workforce?
  • Health screening – do you have safety critical workers or drivers
  • Pre Placement health screening – have you the right people doing the right job?
  • Are you losing money through high absence levels?

Or what about a preliminary internal company review by doing:

  • A strategic SWOT or gap analysis
  • Where do you want to be in 5 years and how to get there?
  • What “good” occupational health provision would look like in your company
  • Can occupational health be delivered more cost effectively or cheaper? What options do you have?

5.  Where to Go for Reviewers/Auditors

So you’ve been through all the preliminary steps of deciding that your occupational health service needs a review.  What do you do next?

Your really have two choices:

1.    SEQOHS (Safe Effective Quality Occupational Health Services)

SEQOHS (said see-qoss) is an accreditation scheme for occupational health service providers and recommended by the UK government to give consistency and compliance in occupational health service provision. It’s supported by the Faculty of Occupational Medicine. For detailed information about SEQOHS click here.  The SEQOHS  site lists all the accredited OH services in the UK.  This service is usually chosen by large corporations and those involved with government contracts.

2.    Another Service/Individual

There are other professional lists where you can find suitably competent individuals to undertake a review eg OSCHR, BOHS services or perhaps from word of mouth.  You will need to check out qualifications for this type of review and make sure it’s relevant to your service.  These are generally more relevant for small to medium-sized enterprises.

6.  How to Choose

Choose 3 – 5 OH service reviewers from the lists on the two sites above, bearing in mind the process you will be following and size of your company.

Consider telephoning each OH reviewer for a preliminary discussion,  setting out what you looking for and whether they have the ability, resources and inclination to tender.  In the process you may pick up some hints on how to be more specific in the real invitation to tender document.

When you have your preferred bidders send the tender document to them or follow legal guidance if applicable[1].

7.  Set the Process

The process of review of OH services will contain important steps usually:

  • The objectives of the review (cut costs, evidence based, better delivery etc)
  • The time-frames for delivery
  • Signposts for delivery, what is delivered when and how
  • Recommendations with costing
  • Staffing levels for any new service
  • Model of delivery e.g. in-house service, contracted services, hybrid model
  • Projections for future service
  • Terms and conditions for payment
  • Attendance on site days for workshops, interviews, presentations etc

Specify a date when the tenders should be returned and the option to ask questions if anything is unclear (answers will be sent to all potential bidders). This ensures transparency and gets you the best process for choosing the OH reviewer.

If you have a procurement team they will recommend how to do this.

8.  Appoint a Coordinator

If you’re having a thorough review and the reviewer requests interviewer with  specific people, you will need a coordinator for the review, for example, to book rooms, setting up interviews, checking on progress and trouble-shooting.

Again, procurement usually take this role in large companies.

9. Buy in and Cooperation

Co-operation and priority for the review is important, this type of project can easily get put on the “I’ll do it later pile”; so an email from senior management or even better, the Chief Executive will work wonders for co-operation of busy managers.  Without managers input the final recommendations may be academic and not meaningful, and resources wasted.

The email from the CEO will also show the importance of the subject and helps with the recommendations after…

10. Review of Tenders

The completed tenders will need reviewing in a scientific way, that is, more quantitive (scoring) than qualitative (personal feeling), due to the misconceptions about how OH should be delivered.  This is where a workshop before is helpful.  A system of points for elements of service can be agreed early on for scoring the bids.  For many companies now, managers have to prove why and how they chose a certain service; fairness and transparency are key issues.

I know this will vary from company to company but I have mostly used five categories of scoring:

  1. Has not met any of the objectives
  2. Met some of the objectives
  3. Met all objectives
  4. Over delivered on objectives
  5. Gone beyond the objectives and aims to deliver a comprehensive response

Also considered is the cost, or cost savings of each recommendations made.  Companies will have their own view of how cost (quality versus quantity)  impacts on awarding contracts. Many go with the lowest price.  But that is not always the best way forward for health services and one would look at the quality of the processes described too (e.g. response time, reports, IT services, economies of scale, facilities) for a full picture.

You need to decide what is important to you, your workers and your work, when scoring the responses.

The higher the score on each objective the better the answer.  Adding up the scores will give a comparator and bids can be ranked in order of acceptability to you.

11.  Scoring The Tenders

For best results, it’s important that a number of reviewers score the tenders, and they work independently of each other.  Remember the loudest voice or the most senior manager may not have much insight into OH services. And it’s sometime difficult to argue against these.

Each reviewer takes away a scoring card and sets a score using their professional skills against each  objective. Hopefully everyone will come to the same conclusion and there will be an outright winner. However with health, it is difficult to do; people have different expectations of what is right in terms of occupational health provision in the workplace.

This is where the importance of the workshop comes into play, making sure everyone understands what occupational health is all about. And this serves a number of purposes; not only does it give scorers and stakeholders tools to be able to critically analyse the tenders, it also improves the overall understanding of occupational health and influences good OH in the company going forward. For example, many believe occupational health is about health and well-being (checking blood pressures and measuring cholesterol); but it’s not really.  So it’s important that scorers understand that it is non-essential occupational health work, and already available on the NHS.  Without the understanding of OH in the workplace the scoring could be skewed and irrelevant.

12.  Decision Made

If there are two or even three bidders who are close in terms of quality and price, ask these to present their findings to key stakeholders before making a final decision.

Ask the winning tender service to go ahead with the OH review/investigation.

13.  The Review/Investigation

In order to get a full picture of what’s happening across the company (and especially in multi-national and cost centred companies) try any or all the following:

  • Workshops where occupational health services and requirements are discussed and analysed. The first part of the workshop needs to explore what OH is so that the outcome is realistic and people understand what occupational health is before making recommendations. The second part would be based on your company’s needs and requirements.
  • A list of key stakeholders (important people) in the company for interview, and could include
    • Managers
    • Directors
    • Finance
    • HR
    • Safety
    • The current occupational health provider
    • Trade unions
  • Health risk profile of work undertaken
  • Relevant health legislation to your work e.g. COSHH. Asbestos, Noise
  • Site visits
  • Review of current services, quality and costs
  • Review of policies and procedures
  • Review of integration
  • How OH is coordinated and consistency across the business
  • Value for money
  • Past history of occupational disease, absence, accidents and incidents linked to health – prioritise what is most important in your company

14. Results from the Review of OH Services

The final report should contain the information you need and have an executive summary setting out at least 3 options for your OH provision:

  1. The “do nothing” option (leave things as they are) – pros and cons
  2. Preferred option and why this is the best way forward for your company
  3. An option (or options) that addresses the pros and cons of issues arising in 1 and 2 above, or considers another approach entirely.

15.  Conclusion

From the final review of occupational health services, with recommendations and options, you will be able to decide if your current occupational health service fits your needs or whether you need to reconsider and reorganise.

And, most importantly, from the workshops, interviews and the process itself, you will have increased awareness  and understanding of occupational health issues in your company.

[1] The outline of procurement for Government projects: click here

 

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