Working together in close partnership

Three
occupational health professionals, working in vastly different settings,
discuss the pros and cons of working within a multidisciplinary team, by Jane
Downey

The
past 10 years have proved to be a very exciting, if not challenging, time for
occupational health professionals.

Not
only have we played a major role in the implementation of radical legislation,
such as the ‘six pack’ Health and Safety Regulations and Disability
Discrimination Act, we have also witnessed the election of a Government that
has pledged its commitment, at least on paper, to improving workplace health
and have put in place strategy statements to help achieve this.

The
setting up of primary care trusts has provided an excellent opportunity for OH
practitioners to influence policy and ensure the prevention and management of
work-related ill health does not remain the domain of a few enlightened
employers. OH has, at long last, been given the prominence it deserves.

However,
all this change has not only impacted on what we do, but how we do it. The old
traditional reactive service, which was mostly based purely on the medical
model, is now often insufficient to deal with the many demands and needs placed
on us by 21st century organisations.

To
be truly proactive, we now need to engage with a whole host of people from a
wide range of disciplines. I asked occupational health nurses (OHNs) working in
three different settings what it meant for them to work within a
multidisciplinary team, how it had redefined their practice and the challenges
it presented.

The
company director

In
1995, Alison Persson decided to take the plunge and set up as an independent OH
and safety consultant. This was after gaining 15 years of knowledge and
experience working as an OHN based mainly at British Gas.

In
2001, she became the director of her own OH and safety company, Catalyst. She
now manages a team of nine practitioners – three safety practitioners, four
OHNs, one OH physician and a change coach.

Her
involvement with the multidisciplinary element definitely increased when she
became an independent practitioner. “With some contracts, I found I did not
have enough knowledge, so I found other practitioners who had the knowledge,
and then I really started to appreciate the benefits of working in a
multidisciplinary team,” she says.

This
experience has changed her involvement with, and perception of, team working.
“Ten years ago, my view of the multidisciplinary team was very different to
what it is now. The team was then the OH physician and OH nurse practitioner.
Now I feel it should comprise safety practitioners, ergonomists, counsellors,
and change management specialists. However, this is not an exhaustive list.”

Although
the practitioners have many core skills in common, their different backgrounds
often result in them approaching a problem from a different angle. Persson
believes this can be beneficial if you are working as a team, but can cause
problems if you are working on the same problem independently.

“If
you are working separately, you are not doing the best for the workforce as you
may be overlapping,” she says.

“Managers
get confused as to whom to listen to. They hear the same problem but from a
different slant.

“While
working as a team, you are looking at who is best to take on a particular role.
You do this with the practitioner, bearing in mind their qualifications and
experience, and then you decide who is right for the role.”

Persson
is a firm believer that “joint thinking unleashes creativity and leads to more
effective solutions”, and judging by her company’s ever-increasing workload, it
would appear the clients agree.

The
senior manager

After
gaining her stripes working as an OH nurse and manager in a number of settings,
including the Civil Service, the NHS and the Metropolitan Police, Judy Cook,
head of occupational health services (OHS) at British Airways, now manages a
large team of nurses.

Team
members are based at either BA’s Waterside HQ or at Gatwick airport, providing
OHS to all UK-based BA employees.

OHS
is part of the larger organisation, British Airways Health Services (BAHS),
headed by the director Dr Sandra Mooney. Other sections are occupational and
aviation medicine, BA travel clinics, business support, dental, food safety and
environmental health and passenger medical clearance unit.

The
director has influenced and supported the many changes in core OH provision
that have taken place since Cook took the helm four years ago.

Within
her team, Cook has both OHAs and OH practice nurses. The latter are mostly
based at health centres at Waterside or Gatwick, performing screening for
fitness for role, providing health advice and immunisation for overseas travel,
advising and supporting first aiders and generally promoting health.

A
large component of the OHA’s role is providing specialist advice to managers in
their allocated business areas to help them manage attendance, advising on
fitness for role, providing health and safety advice and again, generally
promoting health in the workplace.

Although
Corporate Safety Services lead on developing safety policies and procedures,
Cook has encouraged collaborative working and states “we are always looking for
opportunities to work more closely together”. She fosters and also enjoys a
good working relationship with colleagues in other BAHS groups.

In
fact, at every level of the business, she takes the utmost care to work with
the person rather than against and expects her team to do the same.

However,
she admits that sometimes, even with the best intentions, things can occasionally
go awry.

“As
the business climate changes and jobs become less secure, you can see many
groups competing for the same work, resulting in overlap rather than synergy,”
she says.

Currently,
BAHS does not employ OH technicians, but Cook would not be opposed to such a
move in the future – if she believed it was right for the organisation. In
fact, it would be fair to say that she has a very open mind and weighs up the
pros and cons of every argument.

She
does not believe in “putting labels on groups”, but instead feels we should be
“moving towards generic skills and knowledge”.

She
is even prepared to ask the question that many of her peers may find
unpalatable: “Do you need to be a registered nurse to deliver good occupational
healthcare?”

Many
of us may vehemently believe that ‘yes’ is the only answer to that question.
But whatever your stance, you cannot but admire Cook’s ability to ask the
difficult question, irrespective of whether it is popular or not, because it is
not based on the need for control but the vision to look pragmatically at where
OH is today and decide how it can move forward in the future.

The
lone OH adviser

Mary
Clarke is an occupational health adviser (OHA) for Avecia, and manages its OH
needs for the Grangemouth site in Scotland.

Avecia
is a global speciality chemicals company and Grangemouth is its largest UK
site, employing about 600 employees. It has a manufacturing range including
pharmaceutical products and biotechnology advanced medicines.

Clarke
has been an OHN for 12 years; nine of which has been with Avecia. Prior to
this, she worked in the NHS, where she found the OH culture very different.

“With
the NHS, you get the back-up and automatically belong to a team,” she says.
“Here, because you are isolated, you soon learn that if you want to be
effective, you have to make the effort to network with other disciplines as
well as other OHNs.”

Clarke
works closely with her HR colleagues on health policy development and also with
the company’s hygienist and safety manager, ensuring OH is regularly consulted
on any issues that require its input. Clarke has a full-time OH technician and
an OH physician, who visits one day a week.

The
OH technician role was already in place when she started at Avecia. It was this
issue that caused such controversy when she gave a presentation on the role of
the OH technician at the Scottish Occupational Health forum last April.

Some
delegates felt it was totally “inappropriate” and accused her of “doing nurses
out of a job”. However, she strongly denies this.

“The
OH technician position was already in place when I started working at the
company. He has received the necessary training, is on an ongoing training
programme and is closely supervised with strict procedures and protocols with
which he must comply.

“Regarding
screening nurses, well, anyone out there who has tried to employ a screening
nurse will know how difficult it is – there are so few of them about. With the
OH technician, I have someone who is keen and enjoys his job, and I get the
opportunity to get out on site and be proactive,” she says.

During
her presentation at the conference, her last slide stated: “Health surveillance
by a non-OH professional is NO replacement for a qualified occupational health
adviser”.

Carol
Bannister, the RCN OH adviser, explains why she takes a similar approach. “I do
not have a problem with OH technicians as long as they are not doing the
specialist practitioner’s role, have attained the necessary levels of competency
and accountability and are adequately supervised.

“With
the present shortage of OH nurses, we need to delegate if we are going to
provide a modern OH service. Other healthcare practitioners are going down this
route and there is no reason why we should not follow suit,” she says.

So
maybe that is why each of these practitioners are so successful in their
particular sphere of work. In the pursuit of best practice, they choose
collaboration over isolation; question the status quo and do not accept tradition
purely for tradition’s sake. This is what makes them not just leaders, but
excellent team players.

Jane
Downey RGN, RM, OHND, OND obtained her diploma in OH nursing in 1994, while
working for GPT, part of the GEC telecommunications group, based in Nottingham.
After spending four years there, she completed an 18-month stint in the NHS,
gaining a NEBOSH certificate before moving down to London to work for Barbican
Health, which then became Bupa Wellness. During her time at Bupa, she obtained
a diploma in counselling but left in 2000 after taking maternity leave. She now
works from home as an independent OH practitioner

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