It is important to clarify what is meant by a ‘model’ as there are many different definitions. One of the most useful definitions is
“A way for nurses to organise their thinking about nursing and then to transfer that thinking into practice with order and effectiveness” McBain (2006)
Chang’s (1994) critical work on OH models states:
“They all provide a framework or conceptual model of OH nursing. But there are common weaknesses in that they lack clarity in the scope of OH nursing practice; lack a clear definition of the OH nurse role; and lack empirical evidence”
More recent models are the Centre for Nurse Practice Research and Development’s (CeNPRaD) model which emerged from a national survey funded by the National Board for Nursing and Midwifery in Scotland (NBS) and was revised and updated as CeNPRaD’s OH model 2005( McBain 2006). Also the Hanasaari model developed to allow for flexibility in occupational health nursing practice. It was devised during a workshop at Hanasaari, Finland (1989) and has been used as a framework to develop the Occupational Health Nursing Syllabus. It combines three fundamental concepts: total environment; human, work and health; and occupational health nursing interaction (HSE 2005). This model was largely attributed to Ruth Alston a major contributor to the published model in 2001.
A great deal of writings concerned the governments introduction of NHS Plus OH service in 2001 along with initiatives such as Workplace Health Connection in 2006 (Paton 2007 p 21). This was an attempt by the then health secretary Alan Millburn to extend and develop current NHS occupational health departments to reach out to employers in their communities, to address the lack of OH provision identified by the HSE in 2000, which estimated that only 3% of UK employers have access to occupational health services (O’Reilly 2006). The other 97% not currently accessing OH services come from the small and medium-sized businesses (less than 50 employees and less than 250 employees) this being the market to be addressed (Paton 2007).
O’Reilly (2006) identifies three broad groups of OH providers
1. NHS consultancies, which employ OH physicians and their team.
2. In-house OH departments normally nurse lead with links to a multi-disciplinary teams.
3. Private independent sector.
The last group ranges from independent specialist firms like myself, to major operators such as Capita, Bupa, Atos Origin and Aviva.
A structured approach is essential when setting up a new service or changing the focus of an existing service. Therefore the nursing process of assessment, planning, implementation and evaluation is a good tool to achieve success (Kennaugh 1997,p 49)
A structured needs assessment should be conducted to identify the actual as opposed to perceived needs of the company (Harrington p336). This will act as a guide in planning how to implement the service.
Things to consider:
- Company profile i.e. manufacturing, blue-collar, public sector, construction. What hazards
- How many employees, type of management structure. Who are the key stakeholders/decision makers?
- Internal/external forces, who do they employ? Permanent/seasonal staff?
- Existing services. What provision have they had in the past? Is it a new venture?
- What is their understanding of OH? What are past absence rate? Litigation costs?
- Where does the company want OH department to be in 5 years time?
This is by no means conclusive, but will give an idea of which form of delivery would be appropriate and to what service level can be agreed. This could range from an in-house multi-staffed, purpose-built department servicing thousands of employees, to one day a week/month absence management or a one-off screening programme. There are a multitude of variations between these extremes. This should be tailored to the company’s individual needs.
I would now like to look at the strengths, weakness, opportunities and threats (swot analysis) of differing delivery models, namely in-house and bought in models.
In house service is run within the company and is somewhat self-managed, made up of OH professionals and contracted specialties.
- On site to monitor ongoing issues daily if needed.
- Greater continuity of care, relationship building with employees
- Better understanding of how the company runs and their priorities.
- Better sharing of information within company.
- Greater OH presence
- Could be high department running cost if not used efficiently
- Could be isolated from evidence-based practice.
- Ability to develop a varied multi-disciplinary team within the OH department.
- Greater ability to build stronger links with the wider management team.
- Easier to plan long-term goals and strategies.
- If not performing could be outsourced.
Ad-hoc service as and when needed though an occupational health agency, which could be once a week or a month or short or long-term full-time.
- Cost affective, better for small to medium companies
- Greater autonomy for the OH nurse.
- More flexible to meet companies needs
- Isolating from shared knowledge within a OH team.
- Reduced continuity of care if not seen regular.
- Hard to plan rehabilitation programs for individuals
- Unable to monitor issues or implement changes quickly
- To build a well-managed evidence based service.
- Build relations with local GP’s, physiotherapists, etc.
- Could lack presence in the company
- Hard to express the larger role of OH
- May loose commitment from company if not seen to meet needs
- OH may just be seen as covering H & S legislation. Quick fix.
By no means does this exercise demonstrate the full scope of issues highlighted although differing models do need to be address first for the success of the occupational health intervention.
McBain M (2006) This Years Model? Occupational Health. 58(3) p16-19
Chang P.J.(1994) Factors Influencing Occupational Health Nursing Practice. Occupational Health 58 (3) p17
HSE(2005) Applyomh Health Models to 21st Century Occupational Needs. Buxton.HSL
Paton, N (2007) A Picture Of Health? Occupational Health. Vol 58; No 6. page 21
O’Reilly (2006) Access for all. Occupational Health. Vol 58;No 8 page 20
Kennaugh A (1997) Setting up occupational health services.’ In Oakley. K. Occupational Health Nursing. London. Whurr. P49
Harrington J.M.(1998) Occupational Health. 4th edn. London: Blackwell