With a total of 168 million working days being lost to absence last year at a cost of £12.1bn to the UK’s employers, it is no surprise that they are focusing more attention on reducing the costs associated with sickness absence .1
Musculoskeletal disorders are still the predominant occupational health problem in most industries, accounting for 20% to 30% of all workers’ compensation claims, and up to 50% of direct compensation.2
To stem the growing costs to the UK workforce, the Health and Safety Executive (HSE) has produced a six-point guide to help employers manage sickness absence by offering practical advice and suggestions.3 The Faculty of Occupational Medicine’s guidelines for the occupational health management of back pain also proposes an active approach to return to work.4 Both provide OH professionals with evidence-based methods of rehabilitation and advice for staff to use within their own companies.
There is also a growing body of knowledge from research studies, which have attempted to identify the most effective ways of providing support to employees and employers to optimise early return to work following sickness absence.5, 6
Within industry itself, there is also growing evidence that employers are recruiting more occupational health advisers (OHAs) to take on the role of case managers to help reduce absence at work by providing advice and support to employees and rehabilitating them back to work. There is now even an established Case Management Society, which held its own conference earlier this year to discuss the best approaches to managing attendance.
Employee Health Management
Employee Health Management (EHM) is the name given to the internal occupational health service within GlaxoSmithKline (GSK). The title reflects the fact that the group not only provides an expert OH service, but goes far beyond the traditional role of this service to prevent ill health and promote the health needs of employees.
EHM is part of corporate human resources (HR) and provides a shared service model by providing advice and support on employee health issues across 21 sites in the UK. There are currently about 19,000 staff in the UK, and they are based at the company’s global manufacturing supply, research and development and commercial sites.
Each site has OHAs and occupational health physicians (OHPs) that provide support. Further support is also provided by site health support and resilience project Leaders so that a proactive and comprehensive service can be provided.
The benefits of an active case management model in GSK are:
- An efficient and effective model that reduces the direct and indirect costs of absence within the business.
- Providing HR and line managers with an operationally excellent model to manage attendance by undertaking a systematic and consistent approach.
- Improving the case management knowledge and skills of EHM staff across the UK by using evidence-based methods and resources.
- Improving standards of record keeping, legal compliance and alignment to the company’s UK Attendance Management Policy.
About two years ago, EHM began a review of its role in sickness absence management, and how it could support the business more actively. Although GSK has a relatively low prevalence of sickness absence, averaging at approximately 3%, the associated cost was still significant, and was deemed to be wasteful in terms of a world-class business that promotes operational excellence.
Case management toolkit
Through consultation with company OHAs and OHPs and external benchmarking, it was decided to enhance the skills of its team and establish a more structured approach to case management.
The findings from an internal audit programme carried out by EHM also revealed a need to standardise the approach of case management, allowing for different ways of working across the UK operation. The aim was to assemble tools and information that reflected best practice in this area, and that this information would be used as a working document and a source of reference.
A draft version of the case management toolkit was devised in March 2004 by a core team of EHM professionals for use on all sites in the UK. The rationale behind the toolkit was to enable OHAs and OHPs to consistently manage cases of illness and injury of GSK staff to a high standard, and to ensure that employees, managers and the human resources (HR) department were actively involved. EHM obtained advice from experienced case managers in the UK, the US and other countries.
The toolkit was devised following feedback from various staff on what they saw as key tools and resources, which would support them in their role as case managers.
The toolkit consisted of:
- roles and responsibilities for EHM, HR and line managers
- letter templates for use with staff, line managers and employees’ GPs on the types of support available within EHM and the company as a whole
- legal advice for EHM staff regarding the Disability Discrimination Act and the issuing of medical certificates
- advice on rehabilitation and workplace modifications.
The toolkit was then sent out on a trial basis for use on all sites in March 2004. The objective of this trial was for all OHAs and OHPs to use the resources for several months. The content of the toolkit would then be reviewed at a case management training event.
Case management training
In November 2004, a one-day training event was held for all of GSK’s OHAs and OHPs in the UK, which was run by the vice-president, Adnan Chosnacki, and Robert Manson, operations manager for EHM in the UK. It was recognised that most OHAs and OHPs already had previous experience and knowledge in case management, but the level of experience and knowledge varied across the different sites within the UK. The training course was designed to provide further knowledge and skills for the team, but also to be interactive in enabling staff to provide input into the design of the toolkit. Current cases were also brought to the session, and were peer reviewed to identify both the strengths of how they were being managed, and the areas for development. Specific tools and techniques were discussed and agreement was made to standardise the implementation of these to the mutual benefit of EHM and the employees.
In February 2005, the toolkit was revised and streamlined following feedback from the case management training event. All new staff are now provided with case management training and taken through the toolkit, which is now available on the EHM community website. This means that any EHM staff worldwide can gain access to support their own case management programmes.
EHM has been very active in devising and attending EHM and HR network meetings within GSK’s manufacturing, research and development and commercial sites to review and improve site attendance management programmes.
An analysis was undertaken to identify any gaps in knowledge by mapping out the process of when employees initially notify their manager of any planned or unplanned absence. An action plan is then devised on improved ways of working, which is continually reviewed and monitored for progress.
These meetings have been very successful: roles and responsibilities have been clarified and improved ways of working have now been established on those sites.
Carolyn Didsbury, vice-president of HR at GSK’s Stockley Park site says: “EHM has great expertise, and there is a willingness to work together to continuously improve our absence process.”
The success of adopting a structured approach to attendance management also depends on the involvement of the employees’ GPs in the community and other health care providers outside of GSK. It is paramount that workers and their healthcare providers are aware of the support available within GSK from EHM in providing health support and rehabilitation methods. Letters have been provided to employees and their GPs to explain the support available. On some sites, local GPs have been invited in to meet EHM, so they can see for themselves the kind of support that their patients will be receiving.
Medical Disability Adviser
EHM has also provided each site with an online version of the Medical Disability Adviser. This is an up-to-date medical reference source that not only provides optimal return-to-work dates, but also advises on a range of medical conditions that may cause medical disability and any workplace adaptations to consider. This has been highly effective in providing EHM, line managers and employees with guidance on the different types of tasks that staff can perform, and how soon they would likely to be able to return to performing their job role.
Employees’ GPs are now following advice from EHM and staff, which has resulted in up to 40% of medical certificates not being used for their full duration, saving many weeks of lost time.
The case management model adopted by EHM has been recognised externally as a best practice model in reducing absence. Manson has been interviewed by the Financial Times about GSK’s approach. In April, he was asked to present at an annual sickness absence conference held by Working Families – a campaigning charity which helps to promote work-life balance – which was attended by government officials and leading companies in the UK. The feedback from many companies was very positive. As Claire Green, director of Working Families, says: “EHM takes a very pro-active approach to supporting their employees in GSK.” And only last month, EHM was awarded the PMI Health Group Award for Managing Health at Work in the Personnel Today Awards 2005.
Positive cost benefit
The case management toolkit was designed at zero cost, as it was devised and compiled using expertise within the group. The main cost was the time allocated to providing information and resources to the EHM team.
The impact on GSK in the UK has been an 11% reduction of long-term absence days lost, and a 20% reduction of days lost due to mental health conditions from 2003 to 2004. The number of occupational illness cases due to mental ill health has also fallen by 29%, and the number of days lost due to this condition has been reduced by 60% in the same period (see graphs on pages 27 and 28).
On some sites, absence rates have been morethan halved falling from 7% to less than 3%. On one site, this resulted in savings of about 1.5m in one year alone, taking into consideration both direct and indirect costs, such as overtime and staff replacements.
Employees are returning to work more quickly by using the medical disability adviser in conjunction with the employee and healthcare provider. In some cases, they are returning to work three times more quickly through effective case management – a result much appreciated by GSK’s senior managers.
GSK believes it has made sustainable achievements by adopting this case management approach. This model has been taken to all sites in the UK and has shown value in eliminating waste and boosting productivity. In this way, it supports GSK in adopting an operational excellence approach to optimising human capital.
It has found that by using the medical disability adviser and building up relationships with local GPs, employees are not being ‘signed off’ for longer than required. And by discussing particular medical conditions and the modifications available, staff are better informed about their specific conditions, and therefore feel more supported.
GSK has continued to use the internal EHM audit process to evaluate the impact of the case management toolkit. It is finding that EHM staff are much more informed on how to practise case management and utilise the tools and techniques much more effectively in a standardised way.
GSK will continue to monitor and review its attendance management programme and more focus will be placed on collating metrics to measure the impact of our performance on attendance. For instance, the active case management programme has helped to reduce absence due to mental ill health, and the company intends to provide further programmes to reduce the number of days lost due to musculoskeletal conditions. Although the company has reduced musculoskeletal disorders significantly in the past two years, it is aiming to reduce it even further.
GSK is working in partnership with other leading research bodies and the HSE in a bid to continually improve its programme and become one of the leaders in case management within the pharmaceuticals industry. It is also taking part in an HSE study run by ergonomics consultancy Hu-Tech.7
The purpose of this study is to identify and develop models for active case management and rehabilitation for those suffering from MSDs, which can then be applied across all industries.
Robert Manson MSc, MIOSH, is operations manager for EHM at GSK, and is responsible for the OHAs across 20 sites in the UK. He has been in this role for the past three years, and has a BSc in Occupational Health, an MSc in Ergonomics and a diploma in Environment Health and Safety
1. Confederation of British Industry (2005) Who Cares Wins: Absence and Labour Turnover, CBI, London
2. Clinical Standards Advisory Group (1994 ) Epidemiology Review: the Epidemiology and Cost of Back Pain, HMSO, London
3. Health and Safety Executive (2004) An Employers’ and Managers’ Guide (HSG249)
4. Carter JT, Birrell LN (2000) Occupational Health Guidelines for the Management of Low Back Pain at Work – Principal Recommendations, Faculty of Occupational Medicine, London
5. Kendall NAS, Linton SJ, Main CJ (1997) Guide to Assessing Psychosocial Yellow Flags in Acute Low Back Pain: Risk Factors for Long Term Disability and Work Loss, (Accident Rehabilitation and Compensation Insurance Corporation of New Zealand and the National Health Committee, Wellington NZ)
6. Main CJ, Burton AK (2000) Economic and Occupational Influences on Pain and Disability: Pain Management. An Interdisciplinary Approach, Churchill Livingstone, Edinburgh, pp63-87
7. Go to www.hu-tech.co.uk