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Assessment Telephone
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Transcript of Assessment Telephone
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Phone assessment HEALTH MAN AGEM ENT
C P DCONTINUING
PROFESSIONAL
DEVELOPMENT
Our learning for
life service helps
you use thejourna l for CPD-
related private
study. One article
in each issue is
accompanied by
a set of questions
and answers.
These have been
devised by Anne
Harriss, associate
OH professor at
London South
Bank University,
and are designed
to help you reflectin a structured
manner on what
you have learnt.
/ i *Some of the articles
in our continuing pro-
fessional development section
display a STUDY TIME logo.
The number displayed beside this is the number of hours
that we estimate reading and
reflecting on the article itself
and any recommended further
reading should contribute to-
wards your prep requirement.
Telephone hea l th
assessmen ts :good pract ice
Telephone health assessments can be a
useful way to provide a fast and effective
OH service. Cather ine Darcy-Jones
and A nne Har r is s look at good practice,
in the third and last in a series on
management reports in occupational health. O
c c u p a t i o n a lhealth as a speci-ality has had torespond to thechanging face
and demands of business, especially wi
of longterm sickness absence(LTS) impacting on businesses’financial bottom line.
There is increased pressure onagreed sickness key performanceindicators (KPIs) for OH to have
assessed the employee and giventhe advice in a written format with-in a quicker time frame.
LTS absence and its costs have ahuge impact on businesses. In2014, sickness absence equated to
an average of 2.8% of working time per year (6.5 days) per employeecosting £1116 billion.
Prevalence of sickness absencewas noted as being higher withinthe public sector than the private
sector. In 2015 alone, longtermabsence equated to £1 billion in themanufacturing sector (EEF, 2015).
O i lh l h& llb i M 2016 27
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HEALTH MANAGEMENT Phone assessment
The ski l l in carry ing out ate lep hon e a pp o in tm en t is to ga in aq u i ck r a p p o r t w i th t h e e m p l o ye e ”
This focus has gained increased
importance when it comes to the
services OH provides, as practition-
ers respond to business demands
and become more aware ofthe com-
mercial pressures placed on themto deliver added value.
One way to addre ss this increased
business pressure is to move away
from the more traditional faceto
face assessme nt typically carried
out by OH advisers to offering tele-
ph one asse ssm ents fo r advice.
It can be argued that this is a
more efficient use of an OH advis-
er’s time as it means you can
deliver more assessments over the
telephone than face to face.
Clinical information entered onto standard templates for both
clinical notes and reports reduces
the wait for a separate administra-
tor to type up a dictated report.If a facetoface assessment is
required, the telephone assessment
acts more like a triage service and
the assessm ent can be progressed
on to this, therefore more effec-
tively using the diminishing OH
adviser resource.
More than 80% of a diagnosis is
formulated from the clinical his-tory taken (Gray and Toghill,
200 0), b ut there is growing evi-
dence that this history can be
gained jus t as effectively throu gh a
telephone assessment as it canthroug h the traditional facetoface
approach (Burton et al, 2013).
There are common concerns
linked to telephone assessment
from all parties the employer, the
employee and the OH adviser but
if the telephone assessment is car-
ried out within an evidencedbased
forma t, it can successfully address
all or some of the OH needs.
How should a telephone health assessment be conducted?The O H adviser must have the skills
to enable the employee to discuss
their health symptoms and issues
with someone that they have never
met and cannot see.
Therefore, it is important that the
initial contact with the employee is
professional , with all the necessary
checks surrounding employee iden-
tification and consent carried out
as pe r NMC guidance.
Especially importan t is that the
employee is in an environment
where they feel comfortable to talk
on the telephone about confidentialhealth matters. They should be
expecting the call within a desig-
nated app ointment time frame, so
calling the employee within this
paramete r goes some way to red uc-
ing the anxiety of receiving a call.
The skill in carrying out a tele-
ph on e ap poin tm en t is to ga in a
quick rappo rt with the employee.
However, as the time for the assess-
ment will be allocated in your diary,
it is important to establish early
boundaries in regard to time alloca-
tion for the appointment.
This can be done by informing the
employee of the process the assess-
ment will follow, including the time
frame, outlining all the areas you
will cover so the employee is confi-
dent that you will be taking all the
factors into consideration.
It is the OH adviser’s role to guidethe employee throug h the assess-
ment process at a steady pace and
in an em pathic way, with the dis-
closure of personal information,
but keeping the focus on the OH
aspect of work and health. One of
the most difficult aspects of a tel-
ephone consultation is keeping the
employee on the point you are dis-cussing and to move them on when
you have gained enough clinical
information to make your decision.
For some employees, talking dur-
ing a telephone assessment can becathartic so it is the role of the prac-
titioner to make them feel listened
to while directing them on to the
next set of questions. It mayb e ben-eficial to time check with the
employee half way through the
appointment, informing them of
the time left for the assessment.
This will assist with keeping the
discussions and answers focused.
What tools are there to help?Occupational health, unlike o ther
forms of diagnosis, relies 100% on
assessing an employee’s functional
capability with regards to the
impact of work on health and healthon work.
As with any OH assessment, it is
good practice in telephone consul-
tations to use a set o f evidenced
based tools against which you con-
duct your assessment. These should
cover both musculoskeletal and
mental health tools an d include a
system, such as the flag system, toeasily identify any causes fo r con-
cern. There are plenty of evidence based too ls to use (Anderson and
Cocchiarella, 2009; AmericanMedical Association, 2011). The
Patient Health Quest ionnaire
(PHQ9) is p articularly useful for
assessing depression.
Such tools allow the OH adviser
to make a judgement call as to
whether or not they can continue
to assess the employee over the tele-
ph one, or if the case needs to be
progressed to a fac etoface ap -
po intment or moved to an appoint-
ment w ith an occupational physi-
cian. Whichever situation arises,
that means the telephone method
is not adequate to assess the
employee further, consent for this
forward assessment should begained during the telephone con-
versation and clearly documented
in the clinical notes.The style of questioning is key to
obtaining the most appropriate
information from the employee to
make your clinical decision. There
should be a mixture of closed and
open questions.
There is caution attached to the
open style of questioning as this may
allow employees to talk at length,
and although you want to gain as
much information, it is advisable to
bring the employee back to the nextquestion once you feel sufficient
information has been gained.This bounda ry is easier in a mus-
culoskeletal case than a mental
health case, but the skill is to rec-
ognise within a mental health case
if counselling is a more appropriate
forum for the employee to talk and
pr og re ss to th is . Th e te leph one
assessment in this way can be
viewed as a signpost to en sure theemployee is progressed to and re-
ceives the most app ropriate inputfor their health situation.
What are the advantages and disadvantages of telephone assessments?As with any system of work, thereare advantages and disadvantages
to be considered on different levels,
from the OH practitioner’s perspec-
tive, and the employer and the
employee’s point o f view.
For the OH p ractitioner, a tele-
ph one assessment could be seen as
advantageous, bringing an element
of convenience to the role. This
could include working from home,
although an efficient IT system and
clinical backup to check decisionmaking is a necessity.
Systems such as writing straight
into templated clinical records and
reports will ease the administrative
side of telephone assessments fora company and ensure a standard
assessment approach for the cus-
tomer. If this is used, there needs
to be a robu st IT system that allows
safe transfer of data un der the Data
Protection Act 1998 to enable the
clinical report to be sent securely
to the employee’s manager.
Working in this way would incur
less travel costs to the company and
is therefore m ore cost effective from
a business perspective.
One could also argue that the
nature of telephone health assess-
ments would enhance an OH
prac titioner’s comm unication and
questioning skills when talking
with a client to enable all the rele-
vant information to be obtained
during the assessment.
However, working in this way can
be lonely and isola ting for the prac-titioner. It is essential the appropri-
ate clinical support is in place if
assistance is needed on a decision
to be made or to discuss a clinical position with anothe r colleague.
Employers using telephone
assessments may find there is a
quicker turna roun d in delivering
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Phone assessment HEALTH MANAGEMENT
clinical reports to the customer,
herefore meeting o r even exceed-
ng expectations of the agreed OH
ervice. This enhances customer
atisfaction with a quicker turna-ound for the KPIs and less waiting
ime for the OH appointments.
It also means th at if the employee
s not at their home address then an
OH assessment can still take place
and th e timely advice can be sent to
he referring manager.
The q uicker delivery of an OH
service will have a knockon effect
on the customer’s budget as they
are able to implement the OH
advice quicker because they have
received the clinical report on the
day of the ap pointment and theycan reduce the financial cost o f LTSon their bo ttom line.
Where the OH referral has been
made on a proactive basis, it canalso be more cost effective for the
employer as the employee does nothave to have time away from work
o gain OH advice. The employee
can take a call during work time if
they can talk in a quiet confidential
environment. Working in this way
means tha t OH is being apprecia-
tive of and responsive to changing business needs.
For the employee, the impact of
a telephone assessment would
mean less travel to OH appoint-
ments, either in or out of work time.
Although some employers may offer
transport to assist employees
attending OH appointments, on the
whole, many employees have to
organise this themselves, and there
may also be the cost factor of attend-
ing the appointments while on sick
pay that affects at tendance.
Employees will find that it is
often more convenient to choose
and fit an OH appointment into
their day around existing medical
appointments or when they are
functioning best in the day.
They are more likely to attend if
they have a mobility issue or have
a workplace stress issue restricting
their perceived ability to cross the
workplace threshold.
When would you not use a telephone assessment?There are situations where the tele-
phone is not the mo st appropriate
form of assessment. These couldinclude where there is the need for
a physical examination or if there
is a difficulty in understanding the
employee over the telephone. The
employee may also need an inter-
pre te r or a sig ne r to assist thei runderstanding of the assessment.
It could be tha t consent for thetelephone assessment is refused at
the outset of the appointment or at
the po int of referral by the man-ager. It mu st be remembered that
if consent is refused, the employee
may be happy to attend a faceto
face assessment instead.
One of the m ain clinical reasons
a telephone assessment would not
be appropriate would be where there
is an inconsistency in the clinical
reporting from the employee. As anOH practitioner you are aware of
many of the causes, as well as treat-
ment and recovery, of clinically
treated conditions.
During any assessment, there is
an unconscious reference between
the employee’s treatm ent for their
presenting symptoms and recovery
and the standard treatment and
recovery of such conditions.
If during the telephone assess-
ment it becomes apparent the re isa vast difference between th e two
then it would be necessary to meet
in person to allow an OH adviser toassess with sight as well.
A telephone assessment is only
as good as the ques tions asked, and
if the appropriate information
cannot be gained to give a sound
clinical decision, then the further
medium of visually assessing how
someone is walking, sitting or
standing mayb e required.
There is a place for telephone
assessments, as in other areas of
health care such as cognitive behav-
iour therapy, GP appointments,
and physiotherapy assessments,
where it is being increasingly used
more widely. Research conducted
by the DWP in 2013 concluded that
telephone assessments can be as
effective as the facetoface method
if conducted app ropriately for the
right conditions (such musculo-
skeletal or mental health). How-
ever, the research highlights the
importance of strong telephone and
clinical skills, supported by focused
training and the use of standardised
pro toco ls to refer to.Used effectively and with the cor-
rect case types, telephone assess-
ments can be a safe and efficient
way of providing OH advice to busi-
nesses in a timely fashion.
OH advisers are able to add
additiona l value to businesses and
the increased dem ands of business
efficiency with th e advantages it br ings. Ho wever, th e ap proa ch
should be chosen as the preferred
assessment type with the restric-
tions of the service in mind so the
correct level of service can be
secured for both the employee and
the business.
Catherine Darcy-Jones MSc,
BSc (Hons) Nursing, BSc (Hons)
Occupational Health Nursing,
RGN is an occupational health
adviser at OH Assist. Anne
Harriss MSc, BEd, RGN, OHNC,
RSCPHN, NTFHEA, PFHEA,
CMIOSH is associate professor
occupational health and reader
in educational development at
London South Bank University.
References>American Medical Association
(2011). American Medical
Association Guide to the Evaluation
of Work Ability and Return to Work.
Chicago: American Medical
Association.
>Burton K, Kendall N, McCluskey S,
Dibben P (2013). "Telephonicsupport to facilitate return to work:
what works, how, and when?"
London: DWP.
>Anderson GBJ, Cocchiarella L
(2009). Guides to the Evaluation of
permanent impairment, 6th edition.
Chicago: American Medical
Association 2001.
>Gray D and Toghill P (Editors)
(2000). Introduction to the
Symptoms and Signs of Clinical
Medicine: A Hands-on Guide to
Developing Core Skills. London:
Hodder.>Sickness Absence Survey 2015.
Sponsored by Jelf.
>Sickness absence rates revealed
in UK’s largest survey. Occupational
Health & Wellbeing. Available online
at www.personneltoday.com/hr/
sickness-absence-rates-and-costs-
revealed-in-uks-largest-survey
The impact of the telephone
assessment would mean less
travel time to OH appointments”
O i lh l h& llb i M 2016 29
http://www.personneltoday.com/hr/http://www.personneltoday.com/hr/
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HEALTH MANAGEMENT Phone assessments
C P D activity: Cond ucting telep hone health assess m en tsLifelong learning and continuing professional deve lopment (CPD) are the processes by which professionals, such as nurses, developand improve their practice.
There are two ways to address your CPD: formally, by attending courses, stu dy days and wo rkshops ; o r informally, through privatestudy and reflection.
Reading articles in professional jou rnals is a good way o f keeping up to date with what is going on in the field of practice, but reflectingon what you have learnt from the articles is not always easy.
These questions are designed to help you identify wha t you have learnt from studying the article on the previous three pages. They
will also help you to clarify w hat you can apply in practice and wh at you need to explore further.
1>According to EEF, in 2015 long-term
absence in the manu fac tu r ing sec to r
equa ted to :
a) £1 million
b) £1.5 million
c) £1 billion
d) £1.5 billion
2) Wh a t pe rcen tage o f a d iagnos is i s
fo rmu la ted f rom the c l i n i ca l h i s to ry?a) More than 80%
b) Less than 65%
c) More than 75%
d) Approximately 50%
3) Wh ich o f the fo l l ow ing w r i te rs
h igh l i gh t ev idence tha t te lephon e
h is to ry tak ing can be as e f fec t i ve as
t rad i t i on a l face - to -face approaches?
a) Black et al
b) Kloss et al
c) Burton et al
d) Dady et al
4>For some people , te lephone
assessm ent pose d i f f i cu l t i es to the
OH prac t i t i on e r as som e c l ien ts :
a) Find it cathartic - it is challenging for the
practitioner ensure the client feels listened too
while gaining a robust history
b) find it cathectic - they are very suspicious of
the motives of the OH adviser - the practitioner
will find it difficult to gain a satisfactory history
c) Are reluctant to give as full a health history
by telephone as they would if they could see
the practitioner
d) Believe that the OH provider prefers to
conduct a telephone interview as the Data
Protection Act 1998 does not apply.
5>Which o f the fo l l ow ing op t ions
app ly shou ld a te lephone assessm ent
be inadequate in assessing the
employee:
a) A second-stage appointment must always
be undertaken by an occupational physician,
but no further consent is required if this takes
place within 15 working days
b) A second-stage appointment must always
be undertaken by an occupational physician
and consent is required irrespective of the
timing of that appointment
c) A further second-stage assessment may be
undertaken by either a physician or a nurse.
Consent should be gained and clearly
documented in the clinical notes
d) A second-stage face-to-face interview is
planned, which does not require the formal
consent of the client. The OH adviser
must gain the client’s consent to request
a report from the client’s GP prior thisface-to-face interview.
6>Telephone assessments are an
e f f i c ien t and cos t -ef fec t i ve approach
to ga in ing heal th in format ion, as:
a) The employee does not have to travel to OH
appointments either in or out of work time
b) There is a quicker turnaround in delivering
clinical reports
c) There is less waiting time, enabling the OH
provider to achieve or exceed their service
level agreement
d) All of the above
7 ) A n p a r t i cu l a r l y i m p o r ta n t sk i ll
wh ich i s un ique to ca r ry ing ou t a
te lephone in te rv iew i s the ab i l i t y to:
a) Adapt quickly to a range of IT technology
b) Gain a rapid rapport with the employee
without the opportunity to gain feedback from
body language
c) Base the employee’s history on
evidence-based practice
d) Conduct a telephone interview, complete
the report template and then submit the
management response within 15 minutes
8>Of pa r t i cu la r imp or tance wh en
und er tak ing a te lepho ne consu l ta t ion
i s that :
a) The client is able to undertake this within
their own office
b) The employee is not expecting the call,
in order that they can be caught off guard
c) The client agrees for a specific time to take
the call as this is both courteous and goes
some way to reducing any anxiety
d) None of the above is of importance
o
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© 2 0 1 6 , O c c u p a t i o n a l H e a l t h , R e e d B u s i n e s s I n f o r m a t i o n L t d A l l R i g h t s R e s e r v e d . C o p y r i g h t
o f O c c u p a t i o n a l H e a l t h i s t h e p r o p e r t y o f R e e d B u s i n e s s I n f o r m a t i o n L t d a n d i t s c o n t e n t m a y
n o t b e c o p i e d , p u b l i s h e d o r e m a i l e d t o m u l t i p l e s i t e s o r p o s t e d t o a l i s t s e r v w i t h o u t t h e
c o p y r i g h t h o l d e r ' s e x p r e s s w r i t t e n p e r m i s s i o n . H o w e v e r , u s e r s m a y p r i n t , d o w n l o a d , o r e m a i l
a r t i c l e s f o r i n d i v i d u a l a n d p e r s o n a l u s e .