John Lewis Partnership has developed an approach to employee wellbeing that reflects the values of its founder and today’s business priorities. Nick Davison, head of partnership health services, is set to share the approach at next month’s CIPD annual conference. Here is a preview.
What is the ‘Health Hub’ model at John Lewis?
Our legacy in providing health services within John Lewis stretches back to 1929 when John Spedan Lewis, the founder of the John Lewis Partnership, first introduced them. At that time, there was no NHS and they were introduced to ensure we were able to provide the best possible customer service from fit partners.
Although public health has changed significantly since then the principle remains as relevant today and we provide a range of services to complement the NHS and positively impact partners’ health and productivity in what is a very different and much larger business.
Today’s service supports 84,000 partners across 400 sites and our services provide physiotherapy, counselling, cognitive behavioural therapy (CBT), podiatry, fitness for work advice, business travel, health surveillance and case management based on partners’ needs.
Hear Nick Davison speak at next month’s CIPD conference
Nick Davison is speaking at the CIPD annual conference on 9 November on Moving from Absence Management to a Holistic Well-being Strategy.
He joined the John Lewis Partnership in 2011 with a brief to redesign and create a health service to reflect the changing needs of this leading retailer and support the health of its 90,000 co-owning partners. Nick has driven the new shared service model service, which launched in 2013. The model blends an in-house team, who act as the integrators, with specialist providers and has resulted in better clinical outcomes for individuals, increased business productivity and a lower cost of delivery. Davison previously held roles as head of strategy, Aviva Health and general manager, occupational health, also at Aviva. He has considerable change management experience from the financial service industry. He has an MBA from Henley Business School where he majored on the impact of strategic innovation and disruptive forces.
Structurally, partnership health services sits within the wider personnel team and forms a distinct part of our partner services operational shared service function.
There are four strands to our delivery model, which blends an in-house team of occupational health advisers with our own subject matter experts and national, specialist, third party providers.
At the centre of the model is our health hub which is a central team of occupational health advisors and administrators. This is the point where all requests for help first arrive, either by telephone or online.
Annually we receive 17,000 telephone calls and handle a total of 21,000 case referrals of different sorts, 90% of which come in electronically.
Secondly, we have three regional teams of OH advisers who operate as clinical case managers and look after defined geographic areas (including John Lewis and Waitrose branches) and take responsibility for managing referred cases from end to end, working closely with the local line managers in our branch network.
The third element is our specialist third party providers who are contracted to provide national coverage for specific support such as physiotherapy, psychological support and podiatry. Finally, we manage our suppliers through a small service development team of subject matter experts who oversee their service delivery.
Our model has been developed based on what we believe we need as a business, and is therefore unique to us. It has shown the importance of working out what your organisation needs up front and then establishing a model to deliver it. It’s not as simple as choosing to outsource occupational health or retain it in-house. Establishing that clear initial picture has enabled us to drive towards a consistent set of goals and is a large part of why it has worked so well.
How does the organisation’s business model and culture influence this?
As a co-owned business it is really important that irrespective of where you work that you have access to the same range of services and support. We have therefore created a model which has extended accessibility and delivers consistently and transparently across the partnership as a whole.
In blending our own OH team with specialist providers we have retained the role of the integrator and coordinator of provision in-house. This is a key differentiator for us as we have the relationships with line managers, understand the job roles and settings, structures and culture of our business and are best placed to oversee the end-to-end partner journey.
As partners, our team also shares the same benefits and responsibilities of co-ownership and have a vested interest in wanting to make the partnership a better place – we are all in it together.
Our health team work very closely with other operational teams, particularly resourcing, policy advice, partner support (our internal employee assistance programme (EAP) and appeals. This helps Partners enjoy a more integrated experience and ensures that their health challenges are managed in the context of other organisational processes rather than as a single transaction in isolation.
How do you strike a balance between managing presenteeism and sickness absence?
For me this is a key question. It is very easy to lose sight of the fact that the vast majority of people are at work and not off sick, but being at work doesn’t mean you are well and firing on all cylinders.
It shouldn’t be a binary choice between looking after those off sick or those at work. We should be supporting both. We have worked hard with line managers to get earlier intervention as we know it leads to earlier recovery.
This leads to proportionately higher referral levels for partners still at work but with lower levels of severity of condition, as we are involved sooner. We know that work, generally, is good for us, so to be able to support somebody’s recovery while they remain working is a good thing and in turn leads to better health and increased productivity over a shorter time period, which is good for everyone concerned.
To illustrate this we have established that it is five times cheaper to provide that support for a partner needing counselling or CBT who is still working, rather than do so when they have gone off sick as their condition deteriorates.
What is the stepped care model for mental health at John Lewis and how is it delivered?
We have created a stepped care model designed to support mild to moderate mental health conditions through the provision of counselling and cognitive behavioural therapy (CBT). We recognise that complex and severe conditions require more specialist interventions, which are already well established in the NHS and private sector.
This does mean that we cannot meaningfully help everybody for everything but have been able to make a positive difference to those in the mild to moderate condition range, which is most common.
The principle underpinning the model is that we select the most effective delivery channel and therapeutic approach based on the severity of the condition, which is assessed up front.
All referrals are initially triaged by our in-house OH advisors who are CBT trained. Where their assessment indicates referring a partner would benefit from counselling or CBT a referral is made to our psychological service provider, Rehab Works, which arranges and delivers the therapy sessions.
We measure partner psychological wellbeing, levels of anxiety and depression at the point of entry and again at discharge, which allows us to measure improvement. Typically, two thirds of partners are treated at the milder end: level one, using telephone based brief therapy counselling and self-help workbooks.
Just under a third of partners referred are supported at level two by telephone based CBT with a small minority of moderate level cases provided with face to face CBT at level three. We routinely track the outcomes and have seen a 26% improvement in psychological wellbeing for level one conditions and over 90% average improvement for anxiety and depression in level two and three.
How are line managers supported in managing mental health issues?
Line managers have access to a range of online information about mental health but our feedback suggests the thing they value most is the ability to talk to an expert. Our health hub and regional clinical case managers (OH advisers) provide that expertise and advice.
In addition, they provide onsite training for management teams on mental health awareness, signposting support. The recent introduction of wellbeing actions plans (provided by charity MIND and adapted by ourselves) has provided a proactive discussion tool for partners and line managers to use together to discuss physical and mental wellbeing in the workplace. It’s early days but the feedback is really positive.
How do you measure the health and business outcomes of wellbeing interventions?
Employee wellbeing is an interesting concept for us, in that it isn’t really yet in our language but is very much part of who and what we are about. We provide a wide range of opportunities for partners to participate in leisure, arts and sports activities through over 40 clubs, which the partnership subsidises.
We measure the success of these through our partner engagement and feedback. In the health arena, more specifically, we have deliberately focused on tangible, measurable outcomes such as personal productivity improvement, working days saved, improvement in return to work following treatment.
These resonate within the business and have a commercial impact. To illustrate this, we saved the business over 70,000 working days last year from our physiotherapy service (delivered by Physio Med) through a combination of fast track access and productivity improvement.
It is important that we are able to demonstrate our value to the business in both human and financial terms. That financial value significantly exceeds the cost of the services we deliver which helps justify what we do and how we do it.
What plans do you have for the future?
Our future emphasis will build on the preventative agenda and the ways in which we can help partners help themselves, develop resilience, enhance productivity and ultimately mitigate future demands.
I would expect technology to play a role in that but also expect people to be at the heart of it – a combination of human and digital. Finally, Spedan Lewis, in establishing his social experiment, which is the partnership, set out to create a better kind of business. It is incumbent on us to live up to that aspiration and constantly strive for something better.
Nick Davison is head of partnership health services at John Lewis Partnership.