Devil’s advocate: We alone must guarantee high standards

According to the 2008 CIPD absence survey the most effective intervention in the management of long-term absence is ­involvement of an occupational health service. It is the only intervention considered one of the most effective by most HR specialists. It seems most HR specialists think occupational health is fairly useful.

In fact, only about half of the 811 CIPD members who responded said occupational health advice was among the top three interventions for long-term absence. Fewer than 100 said occupational health advice was among the top three interventions for short-term absence. These numbers haven’t changed in five years. It seems that most HR specialists think occupational health is fairly useless.

I draw three main conclusions. First, statistics can be very misleading. Second, if virtually no HR specialists think OH advice is even in the top three interventions for short-term absence why do they keep getting managers to refer these people.

Finally, and most importantly, health at work is our core purpose, so why do 49% of HR specialists think that occupational health is not even in the top three interventions for long-term sickness absence.

The theoretical evidence of effectiveness for occupational health in the management of long-term absence is reasonably persuasive. In theory we should be top of the list. If our colleagues in HR don’t think we’re effective then it reflects our delivery.

Let’s assume occupational health attracts its fair share of good, poor and average ­performers. Let’s say about a qua­rter are good, a quarter are poor, and about half in the middle – a fairly “normal” distribution. The chances of each of the doctors and nurses in an OH service being good are 1 in 4.

Often services have only one OH physician or one nurse. Three-quarters of these services will be poor or mediocre. In services with more than one doctor and more than one nurse it is likely that the most able rise to lead the service, but still three-quarters of the clinicians will be poor or mediocre. The good leaders will be hard pressed to raise the bar. The chance of having a good doctor and good nurse leading clinical delivery together is very unlikely.

This is a particular problem for OH because our speciality is characterised by small teams. In most clinical specialities there are relatively large teams of co-located doctors and nurses and they have substantial peer pressure and support to raise their game. In OH we operate in relative isolation, at liberty to deliver a poor service without being measured against meaningful benchmarks.

Occupational health is structurally destined to deliver a poor service and have a poor reputation. Even most HR specialists think we aren’t very effective. This is not an argument for large providers. It is an argument for better standards, better benchmarking, and the need for OH to work much harder to earn a better reputation.

Dr Richard Preece is a consultant occupational physician

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