Producing the Perfect Management Report
I was asked to give a talk to my peers on ‘Producing the Perfect Management Report,’ and looking at my audience, I realised this would be more than the presentation of a template letter and explanation of each section. This was a tough crowd: doctors, nurses, academics and observers. How could I engage them all in what, on the surface seemed a pretty dry subject? In short, how to produce the perfect presentation on producing the perfect management report.
At the time, I was reading a philosophy book, and for the first time discovered Wittgenstein’s beetle analogy, which I could use as my icebreaker.
Wittgenstein asks us to imagine that everyone has a closed box in which they keep a beetle. No one can look in anyone else’s box, only in their own. So no one knows what the beetle looks like. Over time, people talk about what is in their boxes and the word “beetle” comes to stand for what is in everyone’s box. But, Wittgenstein argued, if no one can see everyone’s beetle – the box contents might all be different.
I might have stag beetle in my box – you could have Paul McCartney.
This video from the BBC explains it better:
So, this is my way of letting you see my beetle, that is, what’s in my perfect management report box and hoping yours looks something like mine.
Communication between medical professionals and patients has changed, with all official correspondence now available online. We need to take more care than ever over how we communicate a medical issue. The results will form a permanent digital record and often have to stand alone as an explanation or interpretation of a patient’s health. There is no room for error or ambiguity.
What does the Manager want?
As part of my research, I asked managers what they wanted from a report – one said:
“What I really want to know, most of the time, is that the person is safe and we are not harming them. I don’t want them to sit on the fence, they (OH professionals) need to make decisions and tell me how and why they came to that decision. So many times, I get reports back that tell me what I already know and it is just a complete waste of time.”
And this one:
“We have the same report back from our management referrals every time, the reports look great to start with, four pages long, wow! But after a while, I realised it is just a standard letter sent out for each person seen. I have to look through to find the relevant few sentences that apply to my worker. The rest are disclaimers and template phrases.”
Who else might see the OH Management Report?
It’s not just the referrer who sees a medical report, they can be shared too:
- Colleagues at work
- Clinical supervisor
Occupational Health Potential Role
Managers delegate OH to help them do their job, that is, keeping workers safe and well whilst at work. This might be:
- Health/Medical Surveillance(H/S) e.g., lung function testing, hearing tests, skin checks
They might ask us to check workers are able to do their job, by doing:
Or to give a health opinion on other related matters, such as:
- Psycho-social issues
- Investigations of health matters in the workplace
- Litigation by individual or HSE
- Suspected ill health
- Improving attendance or advice on absence
We have to document everything, even though most managers prefer a conversation. Nowadays there may be:
- Legal challenges
- Subsequent illness/accidents
- Unavailability of manager
- Mixed messages or misunderstanding
- Professional requirement
- The need for a chronological record of interventions
The report gives 4 basic conclusions about the worker. They are:
- Fit with restrictions/recommendations
- On hold (see GP, workplace assessment)
- Unfit (after health/medical surveillance programmes e.g., lead workers, retirement)
However, the number of recommendations and types of restrictions are myriad.
Types of Occupational Health Services
There is no law to say that a business must have an occupational health service, or which health issues to deal with. However, in my experience, the smaller the organisation, the less we are asked to help, which is probably due to cost of services, but also, employers don’t understand health risks and legal responsibility under the Health and Safety at Work Act.
Other factors that influence whether a OH service is required:
- Types of health risks involved, for example, asbestos is known to be deadly
- The culture of the company – how much the organisation values its workers
- The business itself, health care companies tend to be more health conscious
- Male dominated professions tend to be less risk averse
There are different models of OH services. The biggest are:
- National OH providers, such as Duradiamond, Health Management, Bupa, Express Medicals.
- In house OH services, such as the NHS, local government, multinationals.
- Lone practitioners
They will have different ways of communicating and business objectives, such as:
- Legal challenges – the bigger the company, the more you have to consider negative feedback/possibility of being sued
- Knowledge of the workplace – in house services tend to know more about the work, culture and workers
- Familiarity with managers, again in house services win here
- Resources for producing reports, some reports have taken me days to write and rewrite.
How Much to Write
Take the example of an employment tribunal on disability; an OH service provider could be asked to write a report detailing their involvement.
- The national OH provider covers every possible issue, as they may not know the details of the claim, they will need to produce all the documents (with a court order provided) and findings, telephone calls, conversations and research into the health problem, plus reasons why they may have decided a particular pathway and their service level agreement. The report will an executive summary, discussion, and appendices.
- The in-house OH service will respond as part of a company response, therefore their evidence (reports) will sit alongside managers, safety and HR.
- A lone practitioner will produce a report with the facts of the case and some discussion, and conclusions.
The point is, that the more complex the situation, the complex the report.
Most OH services use a template to write their report in a company style guidelines, that cover,
- Branding (fonts, colours, and logos)
- Size and type of font – see the Dyslexia Style Guide for optimal accessible reading layout
- Headings (see below for examples)
Report writing should:
- Be objective – write in the third person
- Limit use of adverbs (not, he ran very quickly, but, he sprinted), use strong verbs to make the meaning crisp and clear
- Follow Plain English guidelines
- Have research based medical solutions, research health issues – things change
- Be timely
- Be as short as possible without losing meaning, beware the long template letter
- Decide and give recommendations
- Predict the probability of success
- Discuss the resources required to put recommendations in place e.g. time, money, helpers, risk assessment, supervision
Headings in an OH report
Divide long reports into headed sections to make details easier to find, such as:
- Introduction – face to face, by telephone, date seen, how referred (self referral, management referral)
- Method (discussion, observation, examination, received reports, questionnaire, procedures such as health surveillance)
- Health issues
- Work issues
- Fitness for current role/conclusions
- Answer questions asked
- Recommendations – in order of importance
- Has the worker seen or have a copy of the report?
- Next steps (discharge or review)
- Availability of author to discuss any points – suggest time frame and give contact details, especially if an external OH service
Organising the report into sections
Your job is to make it easy for the readers to find the information. Short reports of one or two pages are easy. With a ‘long’ report (more than four or five pages), you need to take care in how you organise the information.
The discussion part forms the body of the report. It is likely to be the longest section, containing all the details of the work organised under headings and sub-headings. Few readers read every word of this section. Start with the most important issue and follow it with the next most important, and so on. The conclusions are your main findings. Keep them brief. They should say what options or actions you consider to be best.
Order of presentation
You won’t always need all these sections, especially those in brackets.
Long medical reports
- Title or title page
- (Contents list)
- (Abstract/Executive Summary)
- Summary and conclusions
- Sign off, date and contact details
After writing all the sections, read and revise them. Rewrite sections if necessary.
Planning the writing
To help plan a long or complex report, use one of these methods:
- Write every fact, idea, observation down in a random way (post it notes, paper or whiteboard) as fast as possible
- Organise, group, and assess each for strength, relevance, and their place in the report (use headings such as introduction, conclusion etc.,) using lines and arrows to link related points. This will become the structure of your report.
- If you have time, leave overnight and review with fresh ideas and points.
- Erase anything that is irrelevant or mere padding.
- Put the topic in a box in the middle of the page or App (see image)
- Draw lines to branch out from it with your main ideas as above, it is easy to add new information and to make links between the main ideas. Order and organisation will take care of themselves.
- Export or use main boxes as headings for your report
Reports can take hours to write. I have sometimes spent days considering what to say and how to say it whilst trying to be objective. Time vanishes as you research, write to GP’s and do the workplace visits. There are so many ways to help make your report easier to write and better to read.
Here are my favourites (no affiliations with any mentioned):
- Parts to speech/predictive text, available in Microsoft word (see video above of how to do it). Once set up you will have your own set of useful phrases and common sentences to use
- Speech to text apps, available on all modern smart phones, look for the little icon of a microphone on your keyboard; or use a Chrome extension
- Hemingway Editor (free on web). Cut and paste your completed management report in here to find adverbs, long sentences and difficult to read passages
- Grammarly (free version available) and ProWriting Aid – both check for grammar issues but the latter has many innovative tools; see the word cloud image above I made from this article
- Dictating and transcribing services (Apps and services available) e.g., Rev – but it can work out expensive
- If you use Microsoft Word, you can check accessibility by pressing the Review tab/Check Accessibility tab
The medical information is the keystone of an OH report and consider including the the following:
- Advise on the employee’s current health status
- Can you indicate when a condition is likely to resolve or the person can return to full duties or otherwise?
- Advise on the current functional ability in terms of work e.g., cannot lift boxes at the end of the packing line.
- If work duties are affected, provide advice on whether any impairment is likely to be short term, long term or permanent
- Details of a specific rehabilitation plan and advice on adjustments, if appropriate, with clear timescales
- Advice to the organisation regarding disability in accordance with relevant legislation, in the UK, this is the Equality Act
- Advise if ill health retirement is a consideration.
Definition of an ‘underlying condition’
‘Underlying condition’ means an unnamed condition that may be contributing to sickness absence. These illnesses may be different. For example:
- Asthma or another respiratory condition may be an underlying factor in absences due to respiratory infections. But respiratory infections do not always mean that there is an underlying condition
- Anxiety may be an underlying reason for absences due to headaches or ‘debility’
- An underlying condition is not necessarily serious or life threatening. Underlying conditions are relevant because issues that would be relevant under the UK Disability legislation may have to be considered in managing the attendance.
It is important that the referrer understand what is meant by the presence or absence of an ‘underlying condition,’ and the action needed if this is the outcome e.g., consider making ‘reasonable adjustments’ to the work, or, in the case of repeated short term absence, setting attendance targets.
Occupational Health cannot:
- Reveal a health condition that employer does not already know about.
- Predict absence patterns
- Definitively say whether or any UK Disability legislation would apply (this is subject to a legal test), although they can advise if it is likely or not that it would apply
- Say whether an adjustment is reasonable (this is subject to a legal test which takes account of the specific business needs, cost and working environment) or advise the manager that they must make adjustments. However, they can suggest what potentially reasonable adjustments may assist the worker
- Predict an exact number of days absence for any given condition or combination of conditions.
Ten Tips for Writing Perfect Management Reports
- Think of your audience, their level of understanding, their language skills and what they need to know.
- Don’t try to impress people by using your language to show off: keep it as straightforward as possible. Imagine you are speaking to someone and write that way.
- Use short sentences (15 – 20 words). If you have to go longer don’t have more than three items of information.
- Explain any technical language and write out acronyms in full the first time you use them.
- Use active verbs not ‘passive’ ones where you can.
- Don’t underline, use capitals or bold in the body of the text
- Put complex information into bullet points
- Follow a logical or time sequence when you write
- Use everyday words
- Use paragraphs to break up long tracts of text.
To recap – The Perfect Management Report
The extent of the management report depends on the reason for writing the report, what sort of role you have in the organisation and the nature of the health problem. However, there are general principles to follow which will make the finished article professional and fit for purpose. These range from formatting, using templates correctly, setting out with plenty of white spaces, to, putting the most important points at the beginning of any paragraph or recommendation. You must always answer the questions the requester asks and label them as such. And give referrers/workers the opportunity to discuss any outstanding issue or to renegotiate the way forward.
And so I ended my presentation, which is included for you to see. I showed the audience what was in my box, did my beetle look like theirs or yours? I hope so…