OH&W Awards – ‘Occupational health has to be a combination of a clinical and a leadership role’

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As Occupational Health & Wellbeing gears up for the launch of its 2020 Occupational Health & Wellbeing Awards next month (May), we are profiling the winning teams from last year’s awards. Here, we dive beneath the surface with the in-house OH team at Thames Water, winner of “Best mental health initiative” in the 2019 awards.

“It is just about recognition for your hard work. For nurses and medical professionals especially, you don’t go into our profession if you don’t want to care for people. We do it because we have a duty of care to the individual; it is what we’re trained to do. But at the same time, when you go in and do your job every day, it is nice to get thanked or recognised for what you’re doing.”

So says Aimee Cain, occupational health and wellbeing manager at Thames Water and one of the winners of last year’s Occupational Health & Wellbeing Awards, about why entering awards as a team or an individual – why opening yourself up to peer scrutiny – can be a great thing to do.

To begin the countdown to the launch next month of the 2020 Occupational Health & Wellbeing Awards, we will over the next few months be profiling the teams, the dedication, and the innovation that set last year’s six category winners apart.

Totally passionate about occupational health

Could you be one of them this year? Certainly, suggests Aimee, who, it is clear, is totally passionate about OH and OH nursing as a specialty.

“I think it is really important for the employees of your business to recognise that what their organisation has in place in terms of OH is leading, is cutting edge,” she tells Occupational Health & Wellbeing. “Being able to say you’re an award-winner can help to make them proud of where they work; they will be proud to talk to their friends and colleagues about what’s available to them in terms of health and wellbeing and occupational health,” she adds.

Thames Water’s in-house OH team won last year’s “Best mental health initiative” category for its innovative use of virtual reality (VR) technology as a way to raise awareness of and understanding about mental ill health (and see the panels below for more on this).

But, more widely, winning an award in this way was recognition of just how the team has evolved in recent years, Aimee highlights.

“Up until about five years ago, occ health at Thames Water was predominantly reactive; we were dealing largely with health surveillance and very much focused on safety. That’s still there, but there has been a big change in the culture. We’ve become much more proactive; we now have much more of a platform to introduce wellbeing initiatives,” she explains.

“Being an in-house team also allows us to pick up trends in the cases we’re seeing and react quickly. My team is heavily clinical, which I think it is a benefit. When you’re working outside of a medical setting, without any doctors nearby, you have to have autonomy in your decision-making. So I won’t employ anyone unless they are training to be, or have already got the qualification they need to be an occupational health nurse.

“We are also able to support our managers in generating conversations around health, around mental health and around wellbeing, and ensure they are picking up these things early and referring to occupational health while people are still in work. Most other organisations, they would still be waiting for someone to be off four weeks before they even refer into the team. By then in some cases it is too late; it is a big challenge to get someone back to work after four weeks,” says Aimee.

Musculoskeletal complaints and ‘physical resilience’

Musculoskeletal complaints are, naturally, a big part of her team’s caseload, especially for the those who are out on the road dealing with physical issues such as burst pipes or water and mains’ infrastructure.

“Managers can refer to our physiotherapy service direct; they don’t have to come through us, and they can refer for non-work as well as work health-related issues. If you injure your foot playing football, coming into work is still going to cause you pain and discomfort. So we see it as a preventative approach and, again, a wellbeing approach for our employees that we can offer this,” explains Aimee.

“In addition, we offer things like ergonomic van assessments, for those who work in our vans, and complex desk assessments for those who have got particularly complex needs. We have got an extremely good manual handling programme, too, which limits the risk to people.

“We also have a ‘physical resilience programme’, which helps people to build their resilience against suffering from an injury. For example, even if you follow the right manual handling practices if you’ve sat in a van for three hours and then failed to stretch out before going out to try and lift a manhole, there will be a much greater chance of doing yourself some damage. So it is about learning how to manage musculoskeletal health in a positive way. We also run programmes around how to minimise musculoskeletal risk in specific roles,” says Aimee.

“The OH team also facilitates all employees to undergo a free confidential personal medical assessment (PMA) every year. Ultimately our people at Thames Water are our biggest asset and the key to our wider OH and wellbeing programme – the PMA helps to detect any potential health issues early to keep our people healthy,” she adds.

Rise of mental health and wellbeing

Just as in many other organisations, mental health is the other ‘biggie’ alongside musculoskeletal in terms of health and wellbeing, as seen also of course in the award-winning VR initiative.

“We’ve certainly seen an increase in mental health-related referrals,” agrees Aimee. “That is partly down to the fact we have trained managers; we have made managers more aware of the signs and symptoms to look out for. We have also created a culture whereby people aren’t afraid to talk about their mental health. People will ring in sick now saying they are suffering from stress rather than saying they have got a cold. We’ve allowed people to talk openly.

“You can’t just do one thing. For me, a lot of organisations do lots of small things – mental health first aiders, mental health awareness, engagement stuff – but unless you have the whole lot built into a wider strategy, you are never going to change the culture. And it has to be a continuous push,” she adds.

Secret to a successful, winning OH team?

What, to Aimee’s mind, therefore, makes a successful – even an award-winning – occupational health team?

“Teamwork’s essential. You need to be able to share workload and be able to make the roles varied. As an occ health adviser or nurse, you need to be able to do all of it, and having a mixture of work to do is important,” says Aimee.

“An additional thing, and this is not just with my team but anyone, is having flexibility and autonomy around your workload; that makes a massive difference. If you are forcing people to work in a certain office between 8am and 4pm that can be a challenge. I allow my team to work from home; they are very flexible; they can plan their diaries; they can go to different sites. They engage in wellbeing initiatives as well as doing their core casework, and they are involved in wider team meetings.

“Occ health is often an entity on its own within an organisation. It may sit with HR or health and safety but, regardless of where it sits organisationally, it is important you feel valued within that wider team. For example, as a team we sit within health and safety and so I encourage all my advisers to go to their relative health and safety meetings to ensure they feel part of the wider team and, also, so they can show their impact,” says Aimee.

This brings us neatly to the ongoing debate within OH around the extent to which an OH nurse can have, or needs to carve out, a leadership role within their organisation; the extent to which OH nurses have an opportunity to be the pivot around which multi-disciplinary health and wellbeing intervention is led, managed and delivered.

“Occ health nurses will make decisions and make recommendations, and people will challenge you on it. If you have an occ health team where the leader isn’t clinical, I don’t know where you get the respect you need?” agrees Aimee.

“My team, for example, escalate cases to me that they can’t manage or which they feel they’re getting to the point where they can’t manage. To me, that’s where a clinical leader is really, really important.

“It is giving your team confidence to know they can escalate if need be and they have got someone in a senior position who will support their clinical decision. Occupational health has to be a combination of a clinical and a leadership role; you have to be a clinical leader,” Aimee adds.

The Thames Water team in a nutshell

  • An in-house team, led by occupational health and wellbeing manager Aimee Cain, including three OH nurses and one mental health nurse currently training for her SCPHN qualification.
  • Serves approximately 5,000 employees.
  • Can make more complex case referrals to an occupational health physician, who works on site one day a week.
  • Can refer physiotherapy cases to a contracted fast-track physiotherapy service provided by occupational health provider IPRS, which offers access to a network of clinics.
  • Receives some 100 clinical referrals a month.
  • The OH service is complemented by access to more than 1,000 employees who are trained mental health first aiders (with a ratio of 1:10 across the business), an EAP, an internal mental health group and various other benefits.

How Thames Water was an OH&W winner

Thames Water won “Best mental health initiative” in the 2019 Occupational Health & Wellbeing Awards.

Its entry focused on the development of a virtual reality (VR) film as part of its “Time to talk” mental health strategy. The VR placed the user in the position of someone who was suffering from severe depression and encouraged them to think about how they might have acted in similar situations and how they had potentially been ignoring warning signs in the past.

The VR training and other mental health initiatives led to an increase in occupational health referrals for those recognising their symptoms and seeking support, while discussion around mental health also grew across the business.

The organisation’s mental health first aiders reported an average of 30 contacts every month, five times the number of physical first aid contacts recorded. There had also been an 18% increase in EAP uptake and some 350 people had joined the company’s internal mental health group.

Our judges praised the innovative use of VR technology in particular, saying: “The videos are also an excellent way to reach a diverse workforce” and “an excellent submission…there is clear evidence of documenting business impacts and the use of VR is truly innovative and distinguishes the approach”.

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