‘Change the card, change the deck, change the game’ : approaches to case managementTrent 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

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Def. of case management - a generic term, with no single definition

……is a collaborativecollaborative process which: assesses, plans, implements, co-assesses, plans, implements, co-ordinates, monitors and evaluatesordinates, monitors and evaluates the options and services required to meet an individuals healthhealth ……… and employmentemployment 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

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Macro-environment factors shape OH services & case management

– PPolitical: BIK, UK benefits related to absence/capability

– EEconomics : economic growth, consumer confidence

– SSocietal: demographic change, diversity– TTechnological: innovation to drive down cost

of service– EEnvironmental: labour markets including OH– LLegal: risk based compliance, employment

law

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Over past decade, so six trends have emerged

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1. F2F remote2. Paper records electronic3. OHP’s OH Managers/non-health manager4. In-house out-house5. Medical labels functional capability6. “secret” “full disclosure” of records

So, how does a large retailer like Sainsbury’s manage case management?

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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

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We use a 7 R’s principles & approach

Step 1 : RReview and RRight messages

Step 2 : RRTW

Step 3 : RRehabilitation

Step 4 : RReasonable Adjustments

Step 5 : RRe-deployment

Step 6 : RRe-training

Step 7 : RReaching an employment decision

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’

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Thoughts, feedback, questions?

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Contact:

Tricia.O’Neill@sainsburys.co.uk

07788 353 835

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