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

1. ‘Change the card, change the deck, change the game’ : approaches to case management Trent Occupational Medicine GroupOctober 2014 Tricia O’Neill RGN, MSc, MBA (Dist.) Head of Occupational Health and Wellbeing

2. 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

3. Def. of case management - a generic term, with no single definition ……is a collaborative process which: assesses, plans, implements, co-ordinates, monitors and evaluates the options and services required to meet an individuals health ……… and employmentneeds… (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

4. 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

5. Over past decade, so six trends have emerged • 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

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

7. 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

8. We use a 7 R’s principles & approach

9. Step 1 : Review and Right messages

10. Step 2 : RTW

11. Step 3 : Rehabilitation

12. Step 4 : Reasonable Adjustments

13. Step 5 : Re-deployment

14. Step 6 : Re-training

15. Step 7 : Reaching an employment decision

16. 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’

17. Thoughts, feedback, questions?

18. Contact: Tricia.O’Neill@sainsburys.co.uk 07788 353 835