Promoting quality in occupational health

A conference organised by the Faculty of Occupational Medicine in London in December 2010 explored the theme: “Promoting quality in occupational health – how can we do better”. Noel O’Reilly reports.

The SEQOHS (Safe Effective Quality Occupational Health Service) accreditation scheme for occupational health providers was formally launched at a Faculty of Occupational Medicine (FOM) conference last month.

As Occupational Health went to press there were 21 applications to be assessors under the scheme and 78 services registered, including 17 single-handed providers.

Dr Paul Nicholson, associate medical director of Proctor and Gamble, who led the development of SEQOHS, said the scheme struck a balance between practicality and robustness.

“The process is designed to provide support and to arrange an external audit only when we feel confident that a service will pass,” he added. “The intention is to pass first time. We don’t want to audit and then tell people that they have failed only to arrange extra visits at additional cost. That is not our business and it is not in the interest of services.”

Improved delivery

Dr Kit Harling, former director of NHS Plus, speaking in his role as adviser to the Department of Health (DH) in occupational medicine, told delegates that he was convinced the SEQOHS scheme would improve the quality and delivery of OH services in the UK.

“SEQOHS has support from the public health White Paper, Healthy Lives, Healthy People, launched in November 2010.”

Harling told Occupational Health that the White Paper demonstrated that work and health remain part of the Government’s agenda.

“The specific section on work and health shows continuing support for the work we have been doing and sets a direction of travel,” said Harling.”There is a welcome recognition of the importance of data collection and analysis through observatory functions and a national centre of excellence which will offer an opportunity for work and health,” he added.

Harling welcomed the confirmation that the National Institute for Health Research (NIHR) will “fund research broadly in this field, given the urgent need for more and better studies of what works”.

Dr Siân Williams, clinical director of the Health and Work Development Unit (HWDU, formerly the OH Clinical Effectiveness Unit) discussed national clinical audit programmes that the HWDU had developed for NHS OH providers in England.

The HWDU is now planning to expand the audit programme, offering it to OH professionals working in other public sector and commercial settings, and lone practitioners.

Minimum standards

Williams told delegates that while the FOM’s standards for accreditation were minimum requirements for service provision, the audits could “provide a platform for improving the quality of clinical care provided by OH professionals within their consultations”.

She said that the audits were designed to lead to quality improvement activity.

“I believe audit is perceived by many as a rather dry data collection and number crunching exercise that they have to participate in. This should not be the case,” she said.

She added: “The process of clinical audit has developed from the traditional two dimensional audit cycle, to a three dimensional structure that continues to spiral upwards.

“Data collection is merely to provide a baseline, identify areas for improvement, and measure change. What is vital is the improvement activities that take place in between the rounds of data collection – these sometimes get overlooked in the excitement of reviewing the data.”

Benefits of taking part in the audits include:

  • the opportunity to participate in quality improvement spirals;
  • raising standards locally and nationally;
  • reducing variability of OH care;
  • identifying areas for development;
  • raising the profile of OH; and
  • for OH services, providing evidence for some of the domains in the new standards for accreditation.

Consultant in occupational health and Occupational Health columnist Dr Richard Preece told delegates that OH practitioners can and should attempt to measure clinical performance. Using data from audits in radiology and occupational health, Preece showed that performance variations are significant and change over time.

“We need to understand clinical performance within this background of variation,” said Preece. “We expect elite people (for example, athletes) to have good days and bad days, good seasons and bad seasons, and this is equally true of OH specialists – we are elite practitioners.”

Preece said quality improvement and accreditation needed to be approached carefully because OH practitioners often work in isolation.

“The focus of clinical performance measurement should be developmental not punitive – everyone improving for the benefit of patients,” he said.

“In our specialty most of us work pretty much on our own Although we regularly disagree with our colleagues we rarely measure what we do and directly compare it with them. We probably think our work is broadly similar. It probably isn’t.”

The SEQHOS standards are available on the Faculty of Occupational Medicine website.

While stocks last, hard copies are available from the Faculty of Occupational Medicine.

Both service providers and potential assessors can now register on the SEQOHS website.

What the paper says

What the public health White Paper, Healthy Lives, Healthy People says about SEQOHS, the new OH accreditation scheme (section 3.52):

Central government, in conjunction with the Faculty of Occupational Medicine, is developing an accreditation process for the new occupational health service standards. All employers will be encouraged to contract only those services that are fully accredited, and to seek preventive interventions. We are exploring a range of models which will help support small and medium-sized enterprises in promoting the health of their workforce, drawing on the expertise of larger companies, the NHS and the broader community, and promoting the better management of chronic conditions in the workplace.

Stages to SEQHOS accreditation

The stages to accreditation are to register for an application pack, complete the registration process and then begin to use the web-based tool. This tool enables each occupational health service to upload their evidence confidentially into a quality management system and provides access to a knowledge management system and office support. Once the service feels that it is ready to apply for accreditation (guided by a traffic-light system in the tool) they will provide the SEQOHS office with access to their evidence. If this looks suitable the service will be informed of the names of two auditors. Services can object to an auditor if they believe there is a conflict of interest (for example, someone from a direct competitor).


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