Measuring how well the NHS looks after its own staff: Methodology of the first national clinical audits of occupational health services in the NHS

Journal of Evaluation in Clinical Practice (Impact Factor: 1.08). 03/2012; 18(2):283 - 289. DOI: 10.1111/j.1365-2753.2010.01574.x


Rationale, aims and objectives Little is known about the quality of occupational health care provided to National Health Service (NHS) staff. We designed the first national clinical audits of occupational health care in England. We chose to audit depression and back pain as health care workers have high levels of both conditions compared with other employment sectors. The aim of the audits was to drive up quality of care for staff with these conditions. The object of this paper is to describe how we developed an audit methodology and overcame challenges presented by the organization and delivery of occupational health care for NHS staff.Methods We designed two retrospective case note audits which ran simultaneously. Sites submitted up to 40 cases for each audit. We used duplicate case entry to test inter-rater reliability and performed selection bias checks. Participants received their site's audit results, benchmarked against the national average, within 4 months of the end of the data entry period. We used electronic voting at a results dissemination conference to inform implementation activities.Results Occupational Health departments providing services to 278 (83%) trusts in England participated in one or both audits. Median kappa scores were above 0.7 for both pilot and full audits, indicating ‘good’ levels of inter-rater reliability.In total, 79% of participants at a dissemination conference said that they had changed their clinical practice either during data collection (52%) or following receipt of their audit results (27%).Conclusions Clinical audit can be conducted successfully in the occupational health setting. We obtained meaningful data that have stimulated local and national quality improvement activities. Our methodology would be transferable to occupational health settings outside the NHS and in other countries.

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    ABSTRACT: Dealing with work related stress is a declared priority of European Union mental health policy. A particularly under-researched sector in this regard is the community vocational support sector for people with mental health and intellectual disability problems. To report on the organisational profile of the vocational support and rehabilitation sector for people with mental health and intellectual disabilities as this relates to occupational stress, in five European countries (Austria, Ireland, Italy, Romania and UK). A sector profile questionnaire was distributed to representative organisations in five countries and a short face-to-face survey was conducted with 25 local managers (five from each country) to draw up a profile and facilitate a comparative description and analysis. It was found that there is no national and European data collected at any level in this sector upon which to base effective policy interventions to combat occupational stress specific to professionals working in this sector. Results indicate that the sector in a number of the countries sampled does not have effective mechanisms in place to deal with occupational stress. Developing effective transnational occupational stress management policy that supports staff working in this sector and measuring its success is greatly impaired by a failure to effectively define the purpose of the sector and collect and collate national data to support it.
    Full-text · Article · Apr 2011 · Journal of Mental Health