Making well-being a team effort

The OH team at Merrill Lynch explains how it has managed to put a preventative healthcare programme in place for all employees, by Sara Bean

The ideal scenario for anyone working in occupational health is to offer a preventative healthcare programme for employees, rather than cope with a treatment-based, continuous fire-fighting role that is so often the reality for OH professionals.

The Bupa Wellness occupational health team based at Merrill Lynch, in the City of London, is in that enviable position. It has managed to put a system in place that enables occupational health to deliver a fully-integrated and proactive preventative health system.

Merrill Lynch, the global finance and advisory company, has the headquarters for its Middle East, European and African operations based in London. From here, the 18-strong Bupa Wellness occupational health team looks after the healthcare needs of about 7,000 Merrill Lynch staff across five sites in London.

The team comprises an OH manager, a part-time OH physician, three OH advisers, an OH practice nurse, five physiotherapists, two part-time GPs, two administrators, a dentist, a dental assistant and a hygienist. Services include physiotherapy, an Employee Assistance Programme (EAP) counselling service, an on-site private GP service and, of course, a comprehensive occupational health service.

Val Hughes, the occupational health manager, explains: "As the main service provider for healthcare at Merrill Lynch, our multidisciplinary team works closely with HR to manage attendance.

"Through our integrated approach to healthcare, our OHAs can facilitate prompt referral to our on-site team of specialists, who provide fast-track treatment, resulting in early intervention and shorter rehabilitation.

"In many cases, through a holistic approach to healthcare management, we successfully instigate an earlier return to work for the employee. This, in some cases, may involve advising management on changes to working practices or a phased return to work for the employee."

Tackling causes of ill health

Recent figures from the Health and Safety Commission (HSC) show the two greatest causes of days lost to illness in 2002 were stress and musculoskeletal problems.1

At Merrill Lynch, preventative procedures are in place to specially target these two areas. For stress-related conditions, a confidential EAP scheme enables employees to self-refer if they feel they require counselling. They can also go through one of the OHAs, the on-site private GP or the OH physician.

Hughes is at pains to point out that when someone is referred for counselling through a member of the OH team, although OH is given feedback on how they are progressing, information is limited and feedback is kept within the bounds of confidentiality.

Since September 11, a special 'trauma support programme' has also been put in place, which can be activated by senior management in the event of an emergency, with OH in a supporting role in providing trauma support.

A similarly proactive scenario applies to dealing with musculoskeletal complaints. Although health and safety is taken care of by an in-house Merrill Lynch team, it works closely with OH and the physiotherapy department on both the prevention and treatment of back and muscular pain.

Employees can complete a computer-generated questionnaire that, using a scoring system, will flag up potential musculoskeletal problems and feed them back to the health and safety department. Depending on the score, the department may carry out a workstation audit or refer the client for physiotherapy.

Hughes says: "Our main aim is to minimise the number of days off work due to back and other musculoskeletal problems. I believe people can be kept fit and healthy at work with a properly integrated approach."

The physiotherapy department is open five days a week, and, says physiotherapist Steven McLaren, the type of problems experienced tend to be "neck and shoulders, postural dysfunctions and a lot of sports injuries, as we do have a young, dynamic workforce".

He adds: "Since the introduction of on-site physiotherapy by Bupa last November, I've seen more people with chronic problems who haven't wanted to take time out before to seek treatment. Referrals come via the OHAs, OH physician, private GP and the health and safety team, or even through outside GPs, and people can usually get an appointment on the same day."

The physiotherapy team operates an accelerated injury management programme, which as well as getting people seen quickly, aims to promote a quick recovery. So if the physiotherapist sees no improvement in a client after three sessions, the patient will be referred to specialist rehabilitation consultants and there will be a case conference held by all those involved in their care.

In most cases however, the OH department will work with the physiotherapist and the health and safety team to manage the problem. A client's working conditions may be assessed and advice given on:

- Restricting keyboarding

- Temporary reduced hours of work

- Modification to job role and responsibilities

- One-to-one instructions on postural exercises.

And because they're on site, the physiotherapist and the health and safety team can go into the client's office to make postural adjustments.

Taking the initiative

As well as managing the two main causes of workplace absence, the OH team at Merrill Lynch runs a comprehensive series of healthcare initiatives.

There is a regular travel-health clinic for both business and leisure travellers, which, says OHA Michelle Davis, is very well attended. The clinics provide advice on travel, including access to information from an online database on the particular travel health risks for each destination. The OHAs will also take a vaccine history and administer vaccines and anti-malaria pills as prescribed by the doctor.

Davis explains that the company also supports Tommy's Campaign - the charity that promotes research into the causes of miscarriage, premature birth and stillbirth. The OH department conducts pregnancy risk assessments, gives information and booklets on healthy pregnancy and ensures there are rest areas available for pregnant employees.

And as the OH team's remit is preventative, not treatment based, it has a well co-ordinated first aid programme in place, managed by OHN Michaela Longmore.

She says: "I do not solely work as an occupational health practice nurse, but rather to co-ordinate the provision of first aid, maintain the first aid database and ensure that all first aiders are trained to the correct level and regularly updated.

"In a low-risk environment such as this, we need about one first aider for every 50 to 100 employees, so in all we've got about 140 first aiders. I provide the introduction on how to become a first aider, then I work with security to ensure first aid boxes are kept up-to-date and available, and I also work closely with health and safety. My role is one of managing health. Like the rest of the team here, I'm a great believer in preventative care."

As well as being involved with first aid audits, management referrals and the travel health clinics, OHA Tracy Barker is working with the management at Merrill Lynch to help promote a healthier work-life balance among its hard-working staff.

She says: "I'm currently working with a focus group to look at ways of implementing a healthier work-life balance for Merrill Lynch employees. It will be called 'Managing the Pace'. The management wants feedback and is committed to improving the service."

Promoting healthcare services

Aside from physiotherapy and OH clinics, the occupational health department also hosts a range of other healthcare services, including a dentist and dental hygienist, and for those willing to pay, appointments with a private on-site GP.

Alison Baggett, one of the administrators for the department, organises appointments and meets and greets those attending the OH department or one of the clinics.

"I do have to explain on occasion to people who walk in that we're not here to offer treatment. I am a first aider though, so if it is a first aid matter, I'm always willing to help," she says.

So how does the Bupa Wellness team get the OH message through to Merrill Lynch staff? Aside from a 10-minute presentation to all new staff on induction, occupational health services are listed for staff on the company intranet and the Bupa Wellness team will soon be launching its own intranet site highlighting OH services.

In addition to this, says Hughes, the OH team organises a number of health promotion events, from no-smoking days to stroke awareness. "We also work with both the company gym and the in-house cafeteria, which, although managed by the corporate services division of Merrill Lynch, liaise closely with us to promote healthy eating and taking regular exercise. The gym took an active role in helping to develop the very successful Wellness Fair we organised at the end of last year."

The fully-equipped gym, which offers fitness advice to staff, organises up to 28 exercise classes a day, teaches pilates and yoga, and offers a range of complementary therapies including reflexology, chair massage and sports massage. Physiotherapists will occasionally refer clients to a therapist and vice versa.

Although Bupa has provided an OH service to Merrill Lynch for some years, the new integrated structure has only been in place since last autumn - and, according to Hughes, is already showing some success.

Reference:

1. HSC Health and safety statistics highlights 2001/02, www.hse.gov.uk/statistics

www.bupa.com

Wellness Fair

One of the greatest successes for the OH department has been the Wellness Fair, which took place last November. OHN Michaela Longmore says: "Last February, we decided to hold the fair after staff research revealed that alcohol, stress, dietary problems and smoking were the most notable problems experienced by Merrill Lynch staff."

The challenge for the team was to help co-ordinate all the major disciplines that took part on the day. The OH department worked with the gym and restaurant over a period of nine months - planning the structure of the day and estimating the costs involved.

After presenting the idea to Merrill Lynch, who agreed to provide funding, the team worked hard to get the day organised and a variety of departments, including HR and marketing, helped to devise logos and other promotional tools.

Highlights of the fair included:

- Walks around the city for staff to do during their lunchtimes

- A look at how the body works

- Mini health checks

- Demonstrations of yoga and pilates

- Breast awareness

- Alcohol consumption tests

- Prizes of hampers, gym membership and a medical directory

Attendance was impressive, with about 817 people attending on the day, although the team had only printed 370 feedback forms.

Longmore says: "The day was real team success, and helped us create closer liaisons within Merrill Lynch.

"It was an informal and fun event, and feedback was very positive, with 97 per cent of those attending asking for an annual event," she adds.