It is important to clarify what is meant by ‘model’ as there are many different definitions. One of the most useful definitions is
“A way for nurses to organize their thinking about nursing and then transfer it to practice with order and efficiency” McBain (2006)
Chang’s (1994) critical work on OH models states:
“All of them 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 role of the OH nurse; and lack empirical evidence”
The most recent models are the Center for Nursing Practice Research and Development (CeNPraD) model which emerged from a national survey funded by the National Board of Nursing and Midwifery in Scotland (NBS) and was revised and updated as a model. OH from CeNPraD 2005 (McBain 2006). The Hanasaari model was also developed to allow flexibility in occupational health nursing practice. It was devised during a workshop in Hanasaari, Finland (1989) and has been used as a framework for developing the occupational health nursing curriculum. 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, one of the main contributors to the model published in 2001.
A large body of writing concerned the government’s introduction of the NHS Plus OH service in 2001 along with initiatives such as the Workplace Health Connection in 2006 (Paton 2007 p 21). This was an attempt by then health secretary Alan Millburn to expand and develop existing 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% that currently do not access OS services come from small and medium-sized companies (less than 50 employees and less than 250 employees), this being the market to address (Paton 2007).
O’Reilly (2006) identifies three large groups of OS providers
1. NHS Consultancies, which employ OH doctors and their team.
2. Internal OH departments are typically run by nurses with ties to a multidisciplinary team.
3. Independent private sector.
The latter group ranges from independent specialist firms like myself, to large operators such as Capita, Bupa, Atos Origin and Aviva.
A structured approach is essential when establishing 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 (Kennaaugh 1997, p 49).
A structured needs assessment should be conducted to identify the actual needs of the business as opposed to the perceived ones (Harrington p. 336). This will act as a guide in planning how to implement the service.
Things to consider:
- Company profile, ie manufacturing, blue collar, public sector, construction. what dangers
- How many employees, type of management structure. Who are the main stakeholders/decision makers?
- Internal/external forces, who do they employ? Permanent/seasonal staff?
- Existing services. What provision have you had in the past? Is it a new venture?
- What is your understanding of OH? What are absenteeism rates not? Litigation costs?
- Where does the company want the OH department to be in 5 years?
This is by no means conclusive, but it will give an idea of what form of delivery would be suitable and what level of service can be agreed. This could range from a multi-staffed in-house department designed specifically to serve thousands of employees, to one day a week/month of absence management, or a unique screening program. There are a multitude of variations between these extremes. This should be tailored to the individual needs of the company.
Now I would like to look at the Strengths, Weaknesses, Opportunities and Threats (SWOT analysis) of the different delivery models, namely internal and purchased models.
The in-house service is carried out within the company and is somewhat self-managed, made up of OH professionals and contracted specialties.
Strengths
- On site to monitor ongoing issues daily if needed.
- Increased continuity of care, building relationships with employees.
- Better understanding of how the company works and its priorities.
- Better exchange of information within the company.
- Greater presence of OH
Weakness
- Could be a high cost of running the apartment if not used efficiently
- It could be isolated from evidence-based practice.
Opportunities
- Ability to develop a varied multidisciplinary team within the OH department.
- Increased ability to build stronger links with the broader management team.
- It is easier to plan long-term goals and strategies.
threats
- If not done, it could be outsourced.
Ad-hoc service when necessary through an occupational health agency, which can be once a week or a month or full time in the short or long term.
Strengths
- Cost effective, best for small and medium businesses
- Greater autonomy for the OR nurse.
- More flexible to meet business needs
Weakness
- Isolation of shared knowledge within an OH team.
- Reduced continuity of care if not seen regularly.
- Difficult to plan rehabilitation programs for individuals.
- Unable to monitor issues or quickly implement changes
Opportunities
- To build a well-managed evidence-based service.
- Establish relationships with local doctors, physiotherapists, etc.
threats
- There could be a lack of presence in the company
- It is difficult to express the most important role of OH
- You may lose the company’s commitment if you are not seen to meet the needs
- OH can be considered to cover health and safety legislation. Quick fix.
By no means does this exercise demonstrate the full scope of the issues highlighted, although it is first necessary to address different models for the success of the occupational health intervention.
References.
McBain M (2006) Model of this year? Occupational health. 58(3) p16-19
Chang PJ (1994) Factors influencing occupational health nursing practice. Occupational health 58 (3) p17
HSE (2005) Applying health models to the occupational needs of the 21st century. Buxton.HSL
Paton, N (2007) A picture of health? Occupational health. Flight 58; No. 6. page 21
O’Reilly (2006) Access for all. Occupational health. Vol 58, No 8 page 20
Kennaugh A (1997) Establishment of occupational health services.’ At Oakley. what Occupational Health Nursing. London. buzz P49
Harrington JM (1998) Occupational Health. 4th ed. London: Blackwell