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 on 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 Scotland (NBS) and has been 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 to develop 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 referred to the government’s introduction of the NHS Plus OH service in 2001 along with initiatives such as Workplace Health Connection in 2006 (Paton 2007 p 21). This was an attempt by then Health Secretary Alan Millburn to expand and develop the current 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 comes from small and medium-sized companies (less than 50 employees and less than 250 employees), this being the market to be addressed (Paton 2007).

O’Reilly (2006) identifies three large groups of OS vendors

1. NHS consultancies, which employ OH doctors and their team.

2. Internal OH departments are typically staffed 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 like 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 (Kennaugh 1997, p 49)

A structured needs assessment should be conducted to identify the actual versus perceived needs of the business (Harrington p. 336). This will act as a guide in planning how to implement the service.

Things to consider:

• Company Profile i.e. 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 upon. This could range from a multi-staffed in-house department specifically designed to serve thousands of employees, to a day-a-week/month absence management or a one-time screening programme. 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 in-house 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.
• Greater 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

Soft spot

• Could be a high cost of running the department 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 as needed through an occupational health agency, which may be once a week or month or full-time on a short- or long-term basis.

Strengths

• Cost-effective, best for small and medium businesses
• Greater autonomy for the OR nurse.
• More flexible to meet business needs

Soft spot

• 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 implement changes quickly

opportunities

• To build a well-managed evidence-based service.
• Establish relationships with local doctors, physical therapists, etc.

threats

• Could lack presence in the company
• It is difficult to express the most important role of OH
• May lose company commitment if not seen to meet 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 different models need to be addressed first for successful occupational health intervention.

References.

McBain M (2006) This year’s model? Occupational health. 58(3) p16-19

Chang PJ (1994) Factors influencing nursing practice in occupational health. 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) Establishing Occupational Health Services.’ At Oakley. k Occupational Health Nursing. London. buzz P49

Harrington JM (1998) Occupational Health. 4th ed. London: Blackwell.