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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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 .

Assessment Telephone

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