‘Change the card, change the
deck, change the game’ :
approaches to case management
Trent Occupational Medicine Group October 2014
Tricia O’Neill RGN, MSc, MBA (Dist.)
Head of Occupational Health and Wellbeing
Sainsbury’s landscape
• 161k employees
• 1200 stores, 22 logistics
centres, 3 support
centres and 1 bank
• Presence in Asia
• Conservative cost of
absence in the £m’s –
including presenteesim & medical
dismissal costs
• MSD’s, mental health and
chronic conditions main
reasons for absence
2
Def. of case management - a generic term, with no single
definition
……is a collaborative process which: assesses, plans, implements, coordinates, monitors and evaluates the options and services required to
meet an individuals health ……… and employment needs… (CMSUK,
2014)
•Can be sector, condition or service specific
•
•
•
•
Insurance – reduction or mitigation of claim costs
Legal – defence/prosecution
NHS – preventing hospital admission
Rehabilitation eg life changing injuries
• In workplace terms, generally means a referral for
occupational health opinion on fitness for work.
– Managed by occupational health professionals who may/may not
seek other medical/health professional opinions
3
Macro-environment factors shape OH services & case
management
– Political: BIK, UK benefits related to
absence/capability
– Economics : economic growth, consumer
confidence
– Societal: demographic change, diversity
– Technological: innovation to drive down cost
of service
– Environmental: labour markets including OH
– Legal: risk based compliance, employment
law
4
Over past decade, so six trends have emerged
1.
2.
3.
4.
5.
6.
F2F remote
Paper records electronic
OHP’s OH Managers/non-health manager
In-house out-house
Medical labels functional capability
“secret” “full disclosure” of records
5
So, how does a large retailer like
Sainsbury’s manage case management?
6
Our approach
•Occupational health team
– Service hub in Manchester
– 3 OHA’s , 3 admin (and 7 Safety Direct team)
– 5 field based OH & Wellbeing partners
•Remote case management – c. 4000 referrals/pa
•Referral at week 6 of absence but maybe longer
•Average case duration c. < 75 days
– Dependant on medical reports required
– C. 60% return to substantive role +/- temp or permanent adjustments
• Support resources
• Contracted Occ Physician & access to a network of OP’s
• EAP
• Physiotherapy in logistic sites
7
We use a 7 R’s principles & approach
Step 1
Review &
Right
messages
Step 7
Step 7
Reaching an
Step 2
employment
decision an
employment
decision
RTW
Colleague in
work
Step 6
Step 3
Retraining
Rehabilitation
Step 5
Step 4
Redeployment
Reasonable
Adjustments
Step 1 : Review and Right messages
Criteria : ALL absent colleagues
Key points
Resources
• We want you back
• Regular tel contact/weekly
• Monthly F2F, in-store/on site
• Use TLC approach to conversations
• Consider OH referral at week 6
• Remind colleague of Validium EAP
• Health@Work directory,
• OH referral – ‘how to call card’
• Colleague leaflet - ‘What I need to know about my OH referral’
• Validium EAP: 0800 027 77 77
• Connect
Step 2 : RTW
Criteria : ALL colleagues
Key points
• Fix date and time for 1:1
• Complete RTW form
• Provide HWB advice/signpost
• Review RTW plan within the week
Resources
• Health@Work directory
• RTW form
• Review notes
• Connect
Step 3 : Rehabilitation
Criteria : only for colleagues who are returning after > 4
weeks absence, not always necessary and is
discretionary
Key points
Resources
• Consider adjusting hours/days, shifts and tasks
• Time bound has review and end date, no more than 4-6 weeks
• Has the GP recommended any adjustments?
• As before, and :
• Rehabilitation guidance notes
• Fit note guidance notes
• Access to work support
Step 4 : Reasonable Adjustments
Criteria: For any colleague who has a condition that
disadvantages them from meeting the requirements of
their job due to symptoms and/or condition.
Key points
• Short term – define length and review date
• Long term – maybe necessary under the Equality Act, 2010,
may need to consider contractual changes
• Trial of work option
Resources
• As before, and:
• ‘Little book of diversity’
• Reasonable Adjustment guidance
Step 5 : Re-deployment
Criteria : when adjustments are exhausted,
unsuccessful or substantive role no longer viable
Key points
• Map available roles against colleague capability
• Consider functional assessment vs. roles
• Don’t have to create a role
Resources
• As before, and:
• Trial of work
• Access to work and Remploy
Step 6 : Re-training
Criteria: Only when colleague has capability to work or reasonable
adjustment are not sufficient and there are no suitable roles available
Key points
Resources
• Option to retain talent/skill in business
• A business decision not medical opinion
• Internal move
• Access to work or Remploy
Step 7 : Reaching an employment decision
Criteria : all previous considerations have been explored, have been
unsuccessful (from a capability not a colleague perspective) and no suitable
alternative roles available
Key points – IHER
Key points – Medical
dismissal
Key points - capability
•Criteria : In pension scheme
•All treatment options exhausted
•Clinical specialist report on record
•Colleague requests
• Criteria: Not in Pension scheme
• GP report on record, treatment options exhausted
• Functional capability assessment supports contention not fit for any role
• Unlikely to RTW in forseeable future, 3-6 months
• Sufficient funds available
•Criteria : Medical condition known and can do some work but none available in JS that
matches capability
•Unlikely to RTW in forseeable future, 3-6 months
•Colleague refuses adjustments, rehabilitation, redeployment or retraining
In summary……
•Success of case management depends upon:
– The OH delivery model
– Organisational model of people management,
including robust policies
– Supporting interventions available i.e physio, EAP
– Specialist resource available with right skill set
– Number of non clinical flags – yellow, blue, black (Kendall
& Burton, 2009)
– And ultimately employees desire to return to work
•However, case management is ‘horses for
courses’ and ‘one size does not fit all’
16
Thoughts, feedback, questions?
17
Contact:
Tricia.O’Neill@sainsburys.co.uk
07788 353 835
18