There is nothing in a caterpillar that tells you it’s going to be a butterfly (Buckminster-Fuller, 2014)

Better together – Occupational Therapy (OT) augmenting Occupational Health (OH) – a perfect match too long in the making? With the problems being faced by the NHS can a working partnership be developed to bring about a WHS (Workplace Health Service)?

The purpose of this article is to provoke, hopefully create, drive, more positive action in exploring how we can best design workplace health services that are truly effective for 2023 and beyond.  It is an attempt to bring an objective and evidenced rationale as to the benefits of a multidisciplinary, vocational rehabilitation, illness and injury management model to the workplace.  One that will benefit all.  Employers, employees, colleagues, families, insurance companies, service providers and government (society in general).

As OH practitioners are being urged to ‘go upstream’ and develop more educative and preventative solutions; working more closely with OTs would appear to be a very progressive and valuable step.  Especially as the impact of adverse health outcomes is preventative health which leads to decreased cost burdens.  Within an integrated workplace health proposition OH can use the evidence demonstrating the value of working with OT to nurture innovative workplace health system changes.

The workplace is naturally an ideal setting in which to promote health and wellbeing and has been recognised by The World Health Organisation (WHO), as ‘one of the priority settings for health promotion into the 21st century’ as it ‘directly influences the physical, mental, economic and social well-being of workers and in turn the health of their families, communities and society’. (Innstrand & Christensen, 2015)

Our world is so different now; we need to reflect this in our changed practices; practices that are capable of following and supporting the new shape of work.  Economic, social, technical, and political drivers are fundamentally changing the nature of work and work environments, with profound implications for the field of OH.

“Nevertheless, researchers and practitioners entering the field are largely being trained to assess and control exposures using approaches developed under old models of work and risks.” (Peckham, et al., 2017)

We need to better align with the current realities of work and health and to prepare practitioners for the changing array of workplace health challenges.

Innovative ways of looking at employee health and wellbeing can be seen in such initiatives as the Growing Occupational Health and Wellbeing Together programme developed by the (NHS, 2022) and further afield in the Total Worker Health programme (National Institute for Occupational Safety and Health (NIOSH), 2022).

A WHS could be the platform from which to develop an innovative, transformative, workplace setting approach to the management of injury, illness and rehabilitation.

Dr Richard Heron was recently quoted saying “It is ok to challenge the status quo; especially in workplace environments that have ever changing business needs.” (Make a Difference Media, 2023)

Time to become the change maker, a boundary pushing change maker.  Time to creatively transform OH.  We have been talking about this and evidencing the need for long enough now.  As can be seen in the online guide Talking Work (The Council for Work and Health, 2019); Health and work: what physicians need to know (Walker-Bone & Hollick, 2021)and Supporting ill or disabled individuals in (to) work (Frank, 2016).

Whilst a trustee for the Vocational Rehabilitation Association (VRA) I had the fortune to meet and discuss with Dame Professor Carol Black, as she worked on “Working for a Healthier Tomorrow”, (Black, 2008) the ‘state’ of OH and the need to reset the lens on a more multidisciplinary approach; that was over 15 years ago.  More recently I saw her quoted as saying:

“OH featured prominently in 2008. My review recommendations pointed to an expanded role for OH and its place within a broader collaborative and multidisciplinary service.  Ultimately I believe that such a service should be available to all, whether they are entering work, seeking to stay in work, or trying to return in the wake of injury or illness. The OH community moved too slowly for my liking after 2008, but COVID-19 could be a great opportunity for development, not entirely an enemy.” (The At Work Partnership, 2020)

Much has been, and continues to be, talked about the need for a strong collective voice  (The At Work Partnership, 2015) that embraces a multidisciplinary ethos; with various professional groups working closely together to influence and deliver better employee and organisational health more effectively.  The voice/voices now need to be turned into action.  Dr Steven Boorman CBE was recently quoted as saying “OH needs to become genuinely proactive and accept the necessity to change and adapt.” And Professor Almuth McDowall, Birkbeck University of London as saying, “OH has to get better at rehabilitation.”  (Health and Wellbeing @ Work, 2023)

Hazards affecting today’s workplaces are not just physical that impact on employees physical health, they are, amongst others, to do with poor relationships, insecurity (financial and/or job), the working environment or a mismatch between an employee’s sense of purpose and that of the employer.  They demand OH professionals change their narrative and create a multidisciplinary vocational rehabilitation perspective; starting with the OH professional’s relationship with Occupational Therapy (OT).

Establishing the value of such a relationship – Why start with OT?  Quite simply because OT is a client-centred health profession concerned with promoting health and well-being through occupation.

OT was founded upon principles related to the benefits of work and supporting people with health conditions to gain or return to paid employment. As the only healthcare profession to work across physical and mental health, with a focus on occupation (people’s everyday activities), There is now a serious call being made for every OH team to include an occupational therapist. (Royal College of Occupational Therapists, 2020)

The primary goal of OT is to enable people to participate in the activities of everyday life. Occupational therapists achieve this outcome by working with people and communities to enhance their ability to engage in the occupations they want to, need to, or are expected to do, or by modifying the occupation or the environment to better support their occupational engagement. (World Federation of Occupational Therapy, 2012)

It is perhaps a tale of a story so far not well told …………..Work is integral to the ethos of OT.  An OT offers advice and support at a range of levels; Universal – advice on work for people with health conditions; Targeted – developing vocational services that support people to return to/remain in work and Specialist – working with OH departments to support the health and wellbeing of employees. (Royal College of Occupational Therapists, 2019).

OT practitioners are distinctly qualified to analyse the relationship between the person, environment, and occupation in order to promote participation in everyday life.  They use a combination of “detailed occupational analyses; activities graded to meet personal needs; explicit time for planning to encourage balanced participation; education to provide individuals with the information about their occupational situations, with which to empower an individual to effect change; focused efforts to capitalise on strengths and build skills; and consultation and environmental modification to secure the best match between the person and the occupation in which she or he is seeking to participate” (Krupa, et al., 2009)

OT is client centred “OT practitioners work collaboratively with people in a manner that helps to foster hope, motivation, and empowerment, as well as system change”  (American Occupational Therapy Association, 2016).

Occupational therapists are experts in advising on future care and rehabilitation needs.  Depending on the type and severity of the injury or illness, an employee may require time in terms of ongoing medical care, OT, physiotherapy, community care, or psychological therapy.

Occupational therapists are well placed to provide input on the extent of care received, the future care needs of an employee, future costs, and the likelihood of recovery and return to/remain in work.  Invaluable in assisting businesses to make informed decisions on planning return to work pathways.  Structured OT interventions have delivered better functional and economic outcomes. (Rahja, et al., 2018)

Occupational therapists are used to designing, justifying, and creating detailed cost estimates.  OT is cost effective (Rexe, et al., 2013) and has been proven to be so in a number of settings (American Occupational Therapy Association, 2016), the NHS, (Julia Scott, 2017); (Alison Keir, 2020); and social care in the UK and wider evidence is provided from a global perspective. Replicating such effectiveness in the workplace would add significantly to the overall value proposition of an integrated OH service.  A WHS.

OT specialises in the area of adaptive equipment and home modifications.  This is hugely important when looking at the modern work environment in respect of employer responsibility/liability, workplace adjustments and assistive technology alongside the demands for hybrid, remote and flexible working.

Occupational therapists are well-versed in assessing and determining the capacity of an employee to return to work. In some cases, an occupational therapist may conclude that an employee is unlikely to be able to return to their previous occupation following an injury or illness. If so, they will be able to explain in detail how the loss of physical and mental functioning is likely to prevent their return to work; even helping them find alternative work.

An OH/OT led WHS would see vocational rehabilitation (VR) in action.  It focuses attention on the sustainable return to/remain in work – the lowest common denominator shared by employers and employees.

VR is an enormous topic, not widely understood, that embraces a large number of skills.  Its principles are used in a wide variety of ways in virtually all medical situations where the worlds of work and health/ability coincide.

“It is whatever helps someone with a health problem to stay at, return to and remain in work. It is an idea and an approach as much as an intervention or a service.” (Waddell, et al., 2008).

VR takes three forms: preparing those with a disability, physical or mental health condition for the world of work, job retention for those in work and assisting those out of work into new work. (Frank, 2016)  It is a multidisciplinary intervention offered to those with physical, psychological and/or social difficulties enabling a return to work or preventing loss of work.  Techniques used can include:

• assessment, appraisal, programme evaluation and research.
• goal setting and intervention planning.
• provision of health advice and promotion, in support of returning to work.
• support for self-management of health conditions.
• making adjustments to the medical and psychological impact of a disability.
• case management, referral, and service co-ordination.
• psychosocial interventions.
• career counselling, job analysis, job development, and placement services.
• functional and work capacity evaluations.

We need to look toward the management of illness and injury through a VR lens; early intervention only works when it is immediately supported by focused/appropriate therapeutic assessment of function (physical and cognitive) and interventions that set a return-to-work prognosis within appropriate, specific and consensual (sustainable) remain in/return to work pathways.

Currently, too little is really understood about just how effective a multidisciplinary (Momsen, et al., 2012)  VR approach is; especially when integrated within a return to/remain in work philosophy that accelerates the introduction of therapeutic interventions, assessment and implementation of workplace adjustments and the use of assistive technology.

This acceleration enables earlier informed decision making and reduction in overall costs.

The approach will also enhance an organisations Equality, Diversity and Inclusion, and Corporate and Social Responsibility programmes.

In conclusion; OH needs to expand its therapy led programmes and educate organisations and employees on the value of a vocational rehabilitation model that will help prove the cost effectiveness of their involvement.

• VR is realised through partnership.
• OT spans the health care continuum from prevention to intervention, from rehabilitation to recovery.
• Occupational therapists support employees and the employer during the transition back into an employment role after an injury or illness.
• Occupational therapists facilitate realistic, cost effective and proactive return to work planning that considers all of the factors that impact success – work and social determinants.
• OT is a relevant part of the whole rehabilitation programme. (Cole & Tufano, 2008).
• The trend of organisations reviewing their workplace health and wellbeing strategies has been evident in recent times. It is now ever more important that we drive the conversation around how a focused, targeted, integrated WHS might be structured.  It is my conjecture that OH and OT,with evidenced and proven value-based outcomes, ^{(Desiron, et al., 2011)} working more closely together should be the starting point.

Mark Howard MSc, PVRA

Developing Markets Consultant at Krysalis Consultancy Limited

Mark.Howard@krysalisconsultancy.co.uk

07966 092224

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