Award-winning strategies

With its key achievements and award-winning success, what makes the Aegon UK
occupational health team stand out from the rest? Leadership, commitment and
key initiatives are a good starting point, by Nic Paton

Too often health professionals, despite the best intentions, end up working
in grand isolation. But that is a luxury a good occupational health nurse – who
will often need to bring together many different strands of care – can ill
afford.

Angela Dunlop, occupational health and safety adviser at Aegon UK, says:
"You must have excellent communication skills and not be afraid of talking
to people. There are a lot of people out there with a lot of experience, in HR
too, so don’t be afraid to use it."

Dunlop and her team know what they are talking about. In October the Aegon
UK occupational health department was shortlisted for the prestigious Aon
Health Solutions Award for Managing Health at Work at the Personnel Today
Awards 2002, the only OH team to have been so. It has also won bronze in the
Scotland Health at Work awards, and is being considered for either a silver or
gold award.

The British Safety Council recently awarded Aegon a ‘sword of honour’ for
its approach to health and safety, an award only given to 40 companies
worldwide each year.

Aegon UK is the British subsidiary of Dutch insurer Aegon and the name
behind Scottish Equitable. It has assets of more than £43bn, making it one of
the largest companies within its sector. Within the UK it employs some 4,500
people.

OH provision at the company has been available since 1998, provided through
a contract with OH provider Corporate Health at a cost of £90,000 a year,
including the cost of providing two full-time OH nurses. It is located within
the HR department.

Dunlop helped found the department and previously worked for OH company
Salus, which provides occupational health provision for Lanarkshire Health
Board.

Initially the team only had Dunlop as a specialist OH practitioner, but in
October it expanded to include another OHN, Janette Hoffmann. It is
complemented by an OH support nurse, Joanne Cassidy, a health and safety
adviser Chris Clarke and overseen by Gareth Humphreys, group personnel manager.

"The main challenge is that I am not sitting in an occupational health
department, I am in personnel. So there is often tension around maintaining
confidentiality. It is about trying to get the right balance for the employee
and the employer," says Dunlop.

Having said that, relations with the management are ‘excellent’, she says.
"The support we have had from Aegon UK’s senior management has been second
to none."

Focus on outcomes

So, what is so special about Aegon UK? According to Dr John Cooper, head of
corporate healthcare at Unilever, who judged the Personnel Today Aon Health Solutions
Award for Managing Health at Work, it is very much the fact that the department
is not isolated.

"The thing that stood out for me was that it is very much a
multi-disciplinary effort. There was evidence of good leadership and it makes
it work. It is one thing to have a good idea, but it will not work unless there
is leadership and commitment.

"The team is also very business-oriented. They have made attempts to
measure what they are doing. They are very much focused on outcomes," he
says.

Departmental initiatives include a monthly health promotion topic, for
instance on mental health awareness, family health or safe skin. A monthly
staff needs survey is also carried out, which has been central to formulating
the department’s ongoing OH strategy.

Alternative therapists are contracted in to offer osteopathy, reflexology
and aromatherapy, and have proved so popular that there are now waiting lists.
Another element has been the implementation of an alcohol and substance misuse
policy. Staff benefits include private medical insurance, as well as permanent
health insurance for those with long-term ill health. The company’s total
benefits bill comes to £1.6m, an average cost of £408 per employee.

Innovative rehabilitation

But the main task facing the OH department has been to make it easier for
long-term absentees to return to work. Since 1998, 76 employers have used the
department’s innovative rehabilitation programme. Of these, 28 are now back at
work, 27 are receiving benefit from it and 21 are still off on long-term sick
leave. This, says Aegon, represents a long-term absence figure of just 0.67 per
cent.

Any employee who has been absent for four weeks or longer is automatically
referred to OH for an assessment. Medical, social or work-related factors are
explored in this assessment and ways of returning-to-work are discussed. An
individual return-to-work programme is also designed.

"Through liaison with the employee, their medical practitioners and
their managers, action can be taken to ensure the employee’s health is not
adversely affected by work," explains Dunlop.

Other elements of the programme include gradually building up the time an
employee can spend back at work and, where necessary, retraining them into
another position. Both approaches have been found to be very effective in
helping employees who have been absent for a significant period of time.

Staff will maintain regular contact with the OH department during any
rehabilitation programme, and progress reports are sent to the HR department
and their GP. "A major contributory factor in the success of the programme
is regular communication with all relevant parties to work in partnership, as
well as the ability to adapt to changes when needed," Dunlop said in the
department’s entry to the award.

Absence figures overall have reduced to 4.3 days per employee per year, down
from six days in 1998, with the added benefit of the company spending less
money on temporary staff to cover absences.

Staff turnover is currently 12.32 per cent, significantly better than its
rivals in the sector, at 17-19 per cent. In the past year (from March 2001 to
March 2002) the turnover rate fell from 14 per cent to the current 12 per cent.
The company also points to improved productivity since the absence and turnover
rates fell, and improved morale.

Success stories

Dunlop is particularly proud of her success in turning around the long-term
sickness absence rate at a nearby rival organisation, GRE, which was taken over
by Aegon. After the takeover, Dunlop was called in to instigate a health
promotion programme and suggested the company tackle long-term absence.

"I met with employees and looked at why they were off sick and what we
could do to get them back to work. It had just not been managed properly
before," she says.

A total of 90 per cent of the long-term absentees are now back at work and
the company’s executors have said they want to bring in their own nurse.

Another key area of the department’s work is stress management. "We see
a lot of stress cases but not all is work-related. Most employees live in
Edinburgh, which is now really expensive, so many have financial worries too.
This means there are various different kinds of stress," says Dunlop.

"There is the odd case of bullying and harassment, but no more than
anywhere else. Because the average age of our employees is mostly late 20s to
early 30s, they tend to be quite a sporty bunch, so we do see a number of
musculoskeletal injuries, pulled muscles and that sort of thing," she
says.

A health needs survey of staff in 2000 – conducted as part of the
department’s three-year health promotion strategy – found that two-thirds of
respondents felt their life was very or quite stressful, with time pressures at
work and money worries the two most common problems. A third of people took
work home with them, 64 per cent worked long hours to get through their work
and 60 per cent felt they were always trying to catch up.

More than half – 57 per cent – found getting enough physical exercise in a
typical week difficult, but more than a third took exercise at least three
times a week.

One of the key achievements any good OH department must have is trust –
trust among employees that you are going to maintain confidentiality and look
after them, and trust from management that you are going to work successfully
for the company.

"You have to build up that trust. Employees must know you are not going
to go back and tell their employer everything. It is about getting the consent of
the employee to divulge appropriate information.

"You get a feel for what you can or cannot tell them, and a lot of the
time it will be something they have already told their line manager
anyway," explains Dunlop.

Open communication

A key facet of this approach is the department’s attitude to working with
other health professionals and management. Dunlop says she tries very hard to
keep communication channels open as widely as possible and will often be found
to be working closely with local GPs, consultants, psychiatrists and the HR
team.

"Our main advantage has been working within the company, not separate
to it. We are the link people, we bring everyone together," she says.

As to the future, Dunlop envisages there will be more work on stress, as the
company is working its way through a number of redundancies. Other initiatives
include a review of the absence management programme and the alcohol and drug
misuse strategy.

"We are going to have to look very closely at stress. I would like to
do a survey specifically on stress during February," she says, adding that
she will then do another one in February 2004 to provide a comparison.

And the close working relationship with health colleagues will also
continue. In some cases, consultants and GPs are now actively advising Aegon
employees to approach the OH department if they have an appropriate problem.

"GPs and local health practitioners are more supportive of allowing
their patients to return to work sooner than anticipated, safe in the knowledge
they will be closely monitored for adverse effects and appropriate action taken
promptly. This has the added advantage of an increase in the likelihood of the
return to work being successful," said Dunlop in her Awards entry.

"So often you see good activities, but they are not able to show you
any results," explains Unilever’s Dr Cooper, summing up what made the
Aegon department stand out. "This was a more business-like approach to OH.
It is very easy for a nurse or doctor to go to a manager and present a proposal.
But too often that proposal is not measured or linked to outcomes."

The team

– Angela Dunlop, occupational health
and safety adviser

– Gareth Humphreys, group personnel manager

– Joanne Cassidy, occupational health support nurse

– Chris Clarke, health and safety adviser

– Janette Hoffmann, occupational health and safety administrator

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