Occupational health professionals fully recognise the value of multi-disciplinary working in terms of generating good outcomes. But what does “success” look like, and what are the barriers to effective inter-disciplinary working? A panel discussion at the SOM/FOM annual conference brought together experts from different disciplines to try to unpick some of these challenging questions. Nic Paton listened in.
It has long been recognised that occupational health practice is becoming ever-more multi-disciplinary and inter-disciplinary. At one level this is straightforward – it simply means different specialists from different disciplines working together, communicating and collaborating to achieve the best outcomes, both for the patient (the employee) and the client (the employer).
But effective multi-disciplinary working throws up challenges, not least around questions of competency if different skill-sets are being brought to bear at different points of an intervention and around leadership. Who leads – or should lead or direct – this collaborative/team process? And should it always be the same leader?
To try to unpick some of the difficult questions posed by this area, the Society of Occupational Medicine (SOM) and Faculty of Occupational Medicine (FOM) held a panel discussion at their Occupational Health 2019 conference in June.
The discussion, entitled “Facilitating multidisciplinary working in workplace health” saw eight leading figures from different disciplines within or related to occupational health and wellbeing come together to, explain their profession’s role, discuss the barriers to effective multi-disciplinary working and what “success” in this context might look like.
As Professor Andrew Curran, chief scientific adviser at the Health and Safety Executive, and chairing the discussion, explained: “The idea is that we talk about interdisciplinary working, and how occupational health/occupational medicine can benefit from a different kind of approach, one that perhaps make the best use of all the talents available to it.
“And I think one of the great challenges that the profession has is to make sure that all of those skills are utilised to deliver the best outcomes for everyone involved, be it employees or employers. I think there is some interesting discussion to be had around the balance those skills can deliver at the different ends of the spectrum, be it prevention or treatment.”
Each panellist was asked to make a short presentation followed by a short Q&A, with physiotherapist Miles Atkinson, head of MSK Corporate Services at Vita Health Group, first up.
He explained how the role of the physiotherapist was underpinned by a biospsychosocial approach to the management of conditions. “We are interested in functional evaluations, and an individual’s functional capacity on a day-to-day basis. We are experts at doing targeted rehab. We can underpin all of that with a biopsychosocial, biomechanical analysis of those individuals and understanding of tissue healing and also their pain physiology. That all comes together in looking at the individual as a whole.
“Not only do we see individuals on just one occasion, we get to see them at least two or three times. So we have a unique opportunity to change that person’s behaviours and help them get back on their feet,” he said.
Effective multidisciplinary working was therefore about “understanding what each individual’s scope is, understanding their skills, and that takes a bit of time and training. I think we really need to work on overcoming that.”
As well as multidisciplinary working, there needed to be a focus on tackling a silo mentality around how services are bought or procured, he contended. “When you have, say, three different providers having an inter-disciplinary approach can be really challenging,” Atkinson added.
Case manager Deborah Edwards, director and consultant at RTW Plus and chair of the Vocational Rehabilitation Association, highlighted how the recovery process, by its very nature, tends to be “totally inter-disciplinary, whether it’s physio, speech and language or whatever the injury or degree or injury is.”
She added: “And that really has to carry on through to the return to work piece. When there is case management or vocational rehabilitation involved it is vital that we are able to work with the occupational health team in place. They know the employer, they know the jobs, they know how to help with that flexibility.”
One of the key barriers in this context was education: getting the message across about the possibility or return to work as an outcome, whether for the NHS to be considering it more as a health outcome or employers recognising it may be a feasible outcome, she argued.
“Perseverance I think is a key factor. Events like these are of course preaching to the converted; we are all singing from the same hymn sheet. But when we go back to our individual areas we are often that lone voice. But together we can make returning to work the norm as opposed to abnormal.”
Occupational health nursing
Christina Butterworth, chief operating officer at the Faculty of Occupational Health Nursing (FOHN), then highlighted how OH nurses have a broad expertise across areas such as fitness for work, health risk management, health leadership, case management, risk measurement and monitoring, clinical audit and personal resilience training.
“That really puts occupational health nurses into an ideal position to determine competency; the best occupational health team to provide care, and to also provide corporate governance, to understand the organisation as well as the individual to ensure they are doing the best they can,” she argued.
“We shouldn’t be protectionist. We need to have mutual respect and recognition for each other’s skills and what we bring to that multi-disciplinary team. We need to get the best possible solutions for employees and employers.
“It is about going out and finding out what everyone can bring to the game rather than having that assumption that you know what people do. A lot of people think, ‘she’s a nurse, she deals with sick people’. I am an occupational health nurse but dealing with sick people is just one small part of what I do.”
Training and education also needed to reflect this changing landscape better, Butterworth argued. “It is not in our basic training. You are taught very much about what to do as your own profession, not how you engage with other professions. What we’re looking within the faculty at is trying to encourage higher education institutions to start to deliver occupational health nurse training on a modular basis.
“So when you are talking about musculoskeletal health, say, you do it with physiotherapists. When you’re talking about occupational medicine, you do it with physicians. When you’re talking about mental health you’re working with psychologists. And that’s how we want to see the career and the degree to be structured so that we get the right people and we’re learning about them during our initial training,” she added.
John Dobbie, president of the British Occupational Hygiene Society, then made the case for his profession. “We do a lot of training; we train the workforce in how to control hazards. Because we’re out in the field a lot, even more than our colleagues in safety, we can take the pulse of an organisation by talking to the workforce. We can gauge what is actually happening and what their mood is and that is very, very useful,” he said.
“We support our occupational health advisers by helping on health surveillance techniques. We can help with doing the monitoring to assist the exposures and the workplace parameters. We do epidemiology studies and emergency response planning, too, among other areas.
“What stops us working separately together? Silos. It is silos. Traditionally the health disciplines have been siloed. We haven’t even tried to mix. We’ve never even thought about each other’s view. Or in some cases people thought they knew what we did but actually they don’t.
“If you look at our customers, they think about health, and they think we’re all the same. That we basically know everything about each other’s disciplines. So if they come to one person in health, they will get the ‘right’ answer. Sadly that isn’t always the case,” Dobbie added.
Making the case for occupational medicine then was Dr Richard Heron, vice president, health and chief medical officer at BP, who focused very much on the leadership role an occupational physician could take.
“I have one foot in our multi-disciplinary team, which is multiple disciplines across the spectrum. But my other foot is in the multi-disciplinary team that is everyone else at BP. I think that is probably my most important role – aligning what we do with what makes the company more successful.
“It is about maintaining the health disciplines across the piece and connecting that to the organisation. I think my multi-disciplinary is much more about every executive; it is around our relationship with HR, benefits, reward; it is about behaviours; I am getting much involved in those sorts of conversations,” he explained.
Ergonomist Dr Richard Graveling, registrar of the Chartered Institute of Ergonomics and Human Factors, conceded that, in some respects, because ergonomists are often called in to trouble-shoot and sort out a particular problem there was often less scope for working in a multi-disciplinary way.
But that didn’t mean interdisciplinary working wasn’t important, quite the contrary in fact. “We may work with occupational physicians and occupational health advisers. But we also work with safety engineers, production engineers, designers, which means we do have to be able to communicate and talk to them in their language and understand their role and how they work. Prevention is always the best approach but unfortunately is not always an opportunity,” he said.
“I would say the number one success factor is commitment. You have to get buy-in to the need to change and recognition for the need to change from all levels of management as well as the individual.
“Communication is the second. We have been talking quite a bit about communicating between ourselves, between different disciplines. But we also need to communicate with others in the workforce we are dealing with, whether that is, again, managers right down to those on the shopfloor. If you are going to want people to change the way they work, they are going to have to accept that. It is also about understanding roles and understanding of where you’re coming from and why you’re suggesting you should do something,” Dr Graveling emphasised.
Occupational psychologist Dr Roxane Gervais highlighted her specialty’s focus on an holistic whole-person and whole-organisation approach. “Everything has to connect. We don’t evaluate one particular thing; we have to evaluate the entire process. We have to understand how people work as well as why they work. We also have to think about the whole workplace approach.
“You have to respect the knowledge and competencies that each other has. And that means not stepping on other people’s toes. Respect and trusted colleagues play to each other’s strengths and support each other. I think it’s also important to look at how we’re different as much as how we’re similar. If we work together we have a stronger output at the end,” she said.
The final panellist was occupational therapist Alison Biggs, chair of the Royal College of Occupational Therapists Specialist Section Work, who took delegates through a short history of the specialty (going back to the Arts and Crafts Movement) as well as the key roles, remits and responsibilities within the profession.
Within this OT within occupational health was a relatively new area, she highlighted, although she conceded the OT was not necessarily seen as a core member of the OH team. “We can deliver complex problem-solving or prioritisation, and quite often occupational therapists may also be in case management roles. Good communication is needed between the multi-disciplinary team and all the stakeholders, whether that is verbally or written reports.
“We can take the time to hear the story, look into the health issue but also perhaps discuss the work issue, issues perhaps around personality clashes, poor management and organisational issues that are going on,” she added.
Peer support and respect was a key element of effective multi-disciplinary working, she contended. “We need more learning opportunities together and, as a profession; we have got a lot of OTs who want to move into this field [occupational health] and we need to offer training options,” she said.
As the discussion drew to a close, Sue Carty, registrar at FOHN, highlighted how, for her, Biggs’ presentation had “sold” occupational therapy to her as a complementary skill-set to OH. “And in a way for me it really sums it up because we all need to sell more what we do,” she added.
Professor Curran then brought the session to a conclusion. “One of the things from this conversation that has been really important for me is understanding what everybody brings to the party. Because I think that is the only way we will work out how those circles overlap – to deliver something that is achieving value and delivering good work and good jobs for people, which is one of the key things that occupational health can deliver within organisations,” he highlighted.
“That understanding piece is really important. Because then that will help share knowledge and information. And by sharing that knowledge and information, hopefully, every bit of that incredible jigsaw will become much more efficient and effective,” he added.
- Miles Atkinson, chartered physiotherapist, head of MSK Corporate Services, Vita Health Group
- Alison Biggs, occupational therapist, director, Healthywork, chair, Royal College of Occupational Therapists Specialist Section Work
- Christina Butterworth, chief operating officer, Faculty of Occupational Health Nursing (FOHN)
- Professor Andrew Curran, chief scientific adviser, Health and Safety Executive (HSE) (chair)
- John Dobbie, president, British Occupational Hygiene Society (BOHS)
- Deborah Edwards, director, consultant and case manager, RTW Plus, chair, the Vocational Rehabilitation Association
- Dr Roxane Gervais, chartered psychologist, HCPC-registered occupational psychologist
- Dr Richard Graveling, chartered ergonomist and human factors expert, registrar of the Chartered Institute of Ergonomics and Human Factors (CIEHF)
- Dr Richard Heron, vice president, health, and chief medical officer, BP