Dr Nerys Williams looks at how setting key performance indicators can help occupational health service providers stay at the top of their game.
Over the last few decades, the position of OH provision has changed considerably, with the growth of outsourced services driven by the need for businesses to control costs in a challenging economic environment. In the future, it looks as if cost pressures will continue and be even more unrelenting, while at the same time there is increasing pressure for services to demonstrate their efficiency and effectiveness. One mechanism that businesses have introduced to help manage services is to set key performance indicators (KPIs).
Who sets these KPIs varies from business to business – sometimes they are set by the people commissioning the service, sometimes by those delivering the service or sometimes by both parties. The reality is that indicators described as KPIs are often more like performance indicators, which are reviewed monthly or quarterly, unlike true KPIs, which are so fundamental to business survival that they are reviewed daily or weekly.
In some organisations KPIs are entirely activity related – the aim of the KPIs is to set targets for the time taken for the OH service to complete specific tasks around referral and response. Rarely do KPIs consider the quality of how those tasks are undertaken or the impact that completion of the task has on the business.
A clear understanding of which KPIs are important to set and what they actually mean in demonstrating the value of the service is necessary for both sides of the business relationship if conflict and dissatisfaction are to be avoided.
While the temptation is to set KPIs for those aspects of the service that can be easily measured and to avoid the more difficult areas of indicators around quality, it is the latter that truly demonstrates the value of OH and is of prime importance for users of the service.
Activity-related KPIs are the most commonly set for OH service performance, and in some organisations time-dependent KPIs may be the only indicators set.
A survey of predominantly OH advisers attending a central England OH conference in mid-2012 gave a snapshot of the types of KPIs that OH services have signed up to and for which they are being held accountable.
The most common of these time-dependent KPIs were those relating to the time taken from:
- referral to offer of appointment – for example, for pre-employment checks or sickness absence reviews;
- referral to actual appointment time;
- referral to receipt of the final report by the line manager; and
- referral to a specific appointment time with other health professionals, such as physiotherapists.
Most KPIs are set with a requirement for 90% to 95% of cases to be compliant with the respective time interval, but no indication as to how long a response was to be expected from the 5% to 10% of cases that fell outside this range. This may cause problems, as it is the more complex and difficult cases that can take longer in order to give an opinion.
While the temptation is to set KPIs for those aspects of the service that can be easily measured and to avoid the more difficult areas of indicators around quality, it is the latter that truly demonstrates the value of OH and is of prime importance for users of the service.”
Having “major” – for example, 90% to 95% – targets is useful as it keeps the process moving, and service providers pay particular attention to goals if there are penalties to not meeting them, but this is only part of the story.
Commissioners of services may need to consider setting dual KPIs, with exception reporting where cases fall outside the control of the OH professional to deliver on time – for example, when non-arrival of an essential medical report from a treating consultant delays treatment.
Determining KPIs for quality is more difficult, but not impossible.
Quality OH reports
If the purpose of the OH referral is to provide the line manager with an opinion to aid the decision-making process, then a simple enquiry with each report to see if the requirement is met is one indictor that the report is fit for purpose.
While referrals for pre-employment checks are brief, employers have common complaints regarding OH reports with regards to sickness absence. These complaints seem to have remained the same over the years, but it is not clear that every manager knows what a good OH report looks like.
To be of quality, the report should try to avoid:
- reiterating what the employee says;
- sitting on the fence and avoiding giving an opinion;
- acting as an employee advocate and not being independent; and
- concentrating on medical details and treatment without reference to the functional impact of the condition on what the person can and cannot do.
- As well as avoiding some of the above features, a good report will:
- contain a clear statement as to the worker’s fitness at the time of the assessment;
- provide a guide as to when they maybe fit for work if necessary;
- provide useful, forward-looking advice on adjustments that would aid return to work and to usual duties;
- signpost to other services provided by the employer such as physiotherapy or psychological support, to maximise the range of support available to staff; and
- provide useful advice on what action can be taken to prevent a recurrence, such as absence (if relevant).
The OH consultation is not only an opportunity for the manager to receive expert guidance on fitness for work, but also to find out about the resources that are available to assist the employee in feeling confident that they can return successfully.
Dr Nerys Williams MSc FRCP FFOM MRCGP (1988) DDAM is a consultant occupational physician