Make it your business to make the business case

In February 2004, the Health & Safety Commission (HSC) – never an organisation to miss an opportunity for raising its profile – published a series of case studies setting out the business case for good health and safety management.

The information was specifically designed to coincide with a conference promoting the benefits of corporate social responsibility (CSR). But, looking down the list of 19 case studies, the lesson for occupational health professionals wanting to learn a trick or two about how to make the business case for OH could not be clearer.

Among other things, the case studies gave examples of how one firm had saved 11m by reducing sickness absence, another had achieved a 40 per cent reduction in reportable injuries, a third had cut its health insurance bill by 200,000 a year, and a fourth had achieved a 50 per cent reduction in civil claims. Another company showed how, in financial terms, the benefits of a new rehabilitation scheme had outweighed costs by a whopping 12:1.

Traditionally, OH has not been renowned for blowing its own trumpet. OH practitioners come from a medical background where the satisfaction comes from a good outcome. Whether or not the chief executive and all and sundry are aware of the achievement is neither here nor there.

Yet, as Dr Olivia Carlton, head of OH at London Underground, pointed out in Occupational Health (September 2003), that if OH really wants to effect change, it has to work with managers at an organisational level.

OH, she argued, needs to go beyond being a box ticked off by management, and become something that is there early on in the decision-making process, with a profile and credibility to be taken seriously from the outset.

In many ways, argues Clive Pinder managing director of health and well-being organisation Vielife, OH mirrors human resources (HR). For a number of years now, HR has been battling to shake-off its image as a transactional, administrative function that does little more than send out pay cheques and make sure the organisation’s not breaking the latest employment rules.

HR professionals in many organisations are now considered strategic business partners, are sometimes represented on or are even on the board themselves and are a key cog in the decision-making process. OH, on the other hand, is rarely as enmeshed in the business framework.
One of the problems, then, for OH is that it is often viewed by management as a strictly administrative function – where people are sent to be made better – rather than a strategic partner, Vielife has a track record of working with big organisations such as Unilever and Standard Life Healthcare, but, suggests Pinder, all too often employee well-being is not seen as a critical, strategic part of the business. “It needs to be part of the business mix, not just a knee-jerk response to legislation or supply issues,” he says.

One sector where the message does appear to be getting through is the construction industry. The death toll and injury rate for the sector, particularly in areas such as falls from height, has kept organisations such as the Health & Safety Executive (HSE) deeply worried.

The HSE is now working to develop an industry-wide OH scheme which firms can tap into and gain advice from.

In many ways, though, it’s not whether you’re public or private sector that matters, or whether you’re working in a particular industry. The most important thing, argues Anne Harriss, director of the OH course at London’s South Bank University, is to make sure that what you are doing as an OH practitioner is simply what the organisation requires.

That may sound self-evident, but too often functions such as OH, HR or IT can end up working in glorious isolation, pursuing their own agendas at the expense of the wider business priorities of that organisation.

The difficulty with this argument, though, is that sometimes OH will find itself in the invidious position of knowing an organisation needs something, or needs to be addressing an issue, before the senior management have realised it is something they need to be worrying about.

This may be a hazard that’s been identified on the horizon or even a particular piece of equipment that’s either being, or not being used.

In this sort of situation it’s vital to be able to get management to understand the issue in their own language. In other words, you need to be able to warn that this is something that’s going to cost money if it’s not addressed or, better still, will save money or even create income, if it is.

“You have to prove that what you are doing is cost-effective. But the organisation needs to be open to the suggestions that you make,” says Harriss.

As more and more OH departments are becoming nurse-led, it is becoming increasingly beholden on the lead nurse to be able to argue their corner, to make the business case, she argues.

“You have to be able to demonstrate that you are not just a cost, that you are bringing some added value,” Harriss adds.

What this means, says stress consultant Carole Spiers, is that OH practitioners, however reluctantly, simply must learn how to speak the language of the board.

OH, because of the nature of what it does, can sometimes fall into the mistake of being too ‘touchy-feely’ in its language and not bottom-line focused enough, Spiers argues.

While there’s nothing particularly wrong in this in itself, it’s not going to make the boardroom sit up, listen and take notice. “Management too often uses OH as a dumping ground because they do not have the skills to manage their own people,” she says.

“OH needs to raise its head above the parapet, it has to be talking and speaking to management, it has to be in tune with management and the way it is thinking,” she adds. “It has to be campaigning and putting forward the business case, and that does not necessarily sit comfortably with OH professionals.”

Having a higher profile and credibility will naturally allow an OH department to function more effectively and gain a bigger slice of the financial cake.

But beyond that, OH also has an unusual function within an organisation in that, because of the issue of patient confidentiality, it is at one level part of the business, but at the same time independent of that organisation. This can sometimes create tensions between, say, HR and OH.
By being, in effect, a voice of the employee as well a service to the employer it has an integral role within the organisation, argues Spiers. Yet, too often, OH fails to use this pivotal position to its advantage.

Too few OH practitioners write articles or make presentations, whether in-house or for public consumption, or spend time networking with other OH professionals and peers, she asserts.

“OH has to raise its game, not so much in terms of medical skills, but in terms of management skills. If OH does not feel confident in putting forward the business case then it needs to get some support,” she argues.

Training in areas such as presentation, public speaking, leadership and general management skills would often not go amiss.

“OH cannot afford to wait for things to happen. It has to be proactive, getting a voice and presenting the business case,” Spiers stresses. “For instance, when was the last time an OH practitioner wrote for the Institute of Directors’ magazine, which the managers are reading?”

It’s not enough just to be good at your job, agrees Diane Grainger, OH manager for East Riding and Yorkshire Council.

“We have to work really hard from day one to bring our profile to the forefront of the authority,” she says.

Her OH department, which employs four OH nurses, two administrators and a part-time doctor, serves around 17,000 employees and has been running since 1996.

Winning this year’s Royal Society for the Prevention of Accidents’ Astor Trophy for the best managed OH programme has certainly helped to raise its profile and drive home the message that OH matters and can make a difference. But it has been just as important over time to make it clear, and to make people understand, that OH is completely linked into the aims of the authority, she explains.

“We have a very clear communications pathway. We can raise issues with the corporate management team. We have meetings with the directors of the authority, get involved in lots of training and, before inductions, we hold case conferences with all the relevant managers,” she says.

“We are trying to make sure that people know what we are and where we are. We have our own intranet site, we write articles for the in-house journal and regularly write management reports,” she adds.

“We also work very closely with the safety services unit. This tends to give us strength in numbers because we are quite a small unit,” she says.
Grainger admits she’s helped by the fact that the corporate management team are pro-OH anyway, but says “that does not mean we have an easy life”.

“You just have to keep chivvying away. You can do as much health promotion as you like, but if you cannot really justify that you are having a real impact, then it is very hard.”

Health and well-being, says Vielife’s Pinder, is now rapidly moving up the business agenda. So much so, he predicts, that it could become the issue pensions started to become 10 years ago.

“Today, more than ever, OH has the opportunity to insert itself as a critical business partner. But just because the opportunity is there does not necessarily mean people are taking advantage of it,” he says.

Managers are beginning to wake up to the idea that being proactive on health is not just something to keep you out of court, but is, in effect, “risk management for the mind”. Making links, therefore, that will make managers wake up and take notice is vital, he suggests. After all, the managers need to have good reason to invest in something and, indeed, need to be able to justify their investment to their managers further up the line.

A good example is the fact that Vielife is currently working on a pilot project with around five employers, all of which have 3,000 to 5,000 staff, looking at how good health can directly be correlated to better productivity.

The health and well-being of employees is measured at the start of the programme, then at six months and again after a year.

Interventions are then put in place and the productivity of the employees monitored to see if there is any correlation between their health and their productivity.

The initial findings suggest that people with good health can be 20 per cent more productive than their less healthy colleagues, enthuses Pinder.

“There is now evidence that health has a direct impact on productivity. If you can improve the health and wellness of your employees, you can improve their performance at work,” he says.

If you can make the case, crunch the numbers and show that something either already has had, or has the potential to have, a positive impact on the bottom line, then it also makes it much harder for the management not to invest in OH, he adds.

What this means in practice is that, if OH is to be taken seriously, it has to start understanding how best to present itself.

Just as the HSC case studies focused on the tangible business benefits that came from OH programmes, so OH practitioners need to look beyond the simple merit of what they’re doing and ask, how can I show this is benefiting the business and adding value?

“OH cannot wait to be asked to come to the boardroom table,” says Pinder, “it has to be demanding a place. If you can make the link between health and productivity, you will find very quickly that your organisation takes you more seriously.”

– Don’t wait for the board to find you, make it your job to make your presence felt and ensure that people know who you are, where you are and what it is you do

– Learn to speak the language of the board, through training if necessary, and always make sure you relate initiatives back to business outcomes

-Appreciate that what you do has to mesh with the core business priorities of your organisation

-Relate initiatives to outcomes or the bottom line, such as increased productivity, lower health insurance bills, fewer reportable injuries or civil claims or so on

-Try to get involved at an organisational rather than just an administrative level, but you’ll need to be able to explain why you should be there

-Link up, where you can, with other departments, such as HR or health and safety, as there’s strength in numbers

-Try to raise your profile generally, through articles in in-house or external publications – particularly publications you know your management will read – by entering awards, or using a website/company intranet, and so on

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