OH Today Volume 32 Issue 1 - 2025

Spirometry : Understanding the Flow-volume loop

Also in this issue : OH Employee Empowerment | 2025 EOPH conference Policy Writing | NEBOSH | Learning strategy | Work Hardening Hearing Loss | OH Technicians | Quality Systems

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Editor LYNN PRATT Assistant Editor JANET O’NEILL Copy Editor LIBBY MORLEY Production Editor IAN GARNER Copyright © iOH 2025 Registered Charity No. 1205635 Published by iOH, The Association of Occupational Health and Wellbeing Professionals

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email: admin@ioh.org.uk

Views expressed in OH Today are those of the contributors and not necessarily those of iOH.

Nor does iOH necessarily endorse any of the products or services mentioned or advertised in the publication.

CONTENTS From the President

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Spirometry : Understanding the Flow-volume loop in Spirometry

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Employee Empowerment within the Occupational Health Sector

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Learning and connecting at the 2025 EOPH conference

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Guide to writing a meaningful policy

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Education Review : My Experience Studying with NEBOSH Through a Fully Online Platform

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Identifying responsibilities as part of a learning strategy

43

Returning to Work : Rehabilitation and Work Hardening

48

The Workplace Isn’t Listening : How Hearing Loss is Misunderstood at Work

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An opinion and proposal for OH technicians

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Opinion Piece: The Value of Quality Systems in Healthcare

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Feature Interview with Carolyna Franklin

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From the President Lynn Pratt

R

ecently, I had a conversation

The forthcoming Health & Wellbing at

with a new member of the OH

Work Conference on March 11th & 12th

community. They excitedly

at the NEC is a highlight in our calendar.

shared how their colleagues were

The iOH team are busy finalising

encouraging them to pursue formal OH

preparations for our conference

qualifications and how they were

presenters and our exhibition stand

immensely enjoying OH challenges.

located at 56B where we will be

Hearing their enthusiasm reminded me

showcasing what iOH has to offer and

of my own journey in occupational

future plans. We encourage members to

health, starting fresh as a practice nurse

book their tickets and use the discount

for an airline without any OH

code IOH15 for extra savings.

qualifications and feeling very overwhelmed. Thanks to the support and inspiration from my colleagues, I

pursued further education, which allowed me to advance into case management, advisory roles, and management positions across various industries. Each industry brought its own set of challenges and learning experiences, enriched by the guidance of remarkable role models.

Our career experiences can shape us profoundly, especially in the early

stages. The iOH team recognises that not all OH professionals receive the necessary support to flourish. Through our role modelling network of members, we can inspire the next generation to

After a busy day at the conference, why not chill out the iOH Ruth Alston Memorial Lecture and Dinner on March

11th. This year's lecture, delivered by Kevin Bampton is entitled "Occupational Health: Time for a 21st Century Upgrade?". It promises an evening of fun, networking, learning, and entertainment.

Through such initiatives, we strive to inspire all OH professionals to achieve excellence. By fostering support, and creating opportunities for growth, we can ensure that our field continues to thrive and adapt to the ever-changing demands of the workplace.

Lynn Pratt, President iOH

achieve excellence in our field, wherever they are on their journey. iOH are here to support in choosing educational providers, offering small grants for short courses to alleviate financial burdens,

providing educational materials, peer support and facilitating networking opportunities.

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Obituary Lyndsey Marchant 1979 to 2025 Lyndsey, passed away peacefully on 2nd January 2025, surrounded by her family.

As the Founder and Director of Phoenix Occupational Health Ltd, she was a devoted advocate for Occupational Health.

Lyndsey had a distinguished career, starting as a Queen Alexandra’s Royal Naval Nurse in the Royal Navy before transitioning to occupational health. Her contributions to the field were significant, and she was recognised for her dedication and leadership. Her leadership included involvement with iOH as a former iOH Board Member between 2014 and 2016. She was actively involved in various special projects and developing relationships with sponsors. Her efforts helped enhance our resources and support for occupational health professionals.

Lyndsey was also recognised for her outstanding contributions to the field, receiving a special mention and SOM Lifetime Achievement Award in 2024. Her dedication and leadership within iOH, FOHN and the broader occupational health community left a lasting impact.

She will be greatly missed. Our thoughts are with her family at this difficult time.

If anyone would like to make a charitable donation on behalf of Lyndsey, this can be made online: www.windsmillscharity.org.uk Acute bereavement support for children and young people.

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Spirometry : Understanding the Flow-volume loop

By Charlene Mhangami, V-core Senior Product Specialist, Vitalograph

T

he flow-volume loop is a graphical plot that p airflow. The graph is created during a spirome expiratory volumes. These measurements are of air that can be exhaled from the lungs from full in interpretation.

Traditionally, spirometry focused on measuring exh in lung function testing, with the focus being on enh Standardization of Spirometry. The current ATS/ERS inspiratory and expiratory measurements during sp

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provides key insights into lung function by showing the relationship between lung volume and etry test, capturing information during inhalation and exhalation to calculate inspiratory and e formed during the Forced Vital Capacity (FVC) manoeuver which measures the maximum volume nhalation. The FVC alongside the Vital Capacity (VC) manoeuvres are crucial in spirometry

halation only, with the test ending when the subject has fully exhaled as shown in figure 1. Advances hancing the precision and accuracy of spirometry results led to an update ATS/ERS 2005 S 2019 Standardization of Spirometry standards, emphasise the importance of incorporating both pirometry testing to create the flow-volume loop.

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Spirometry : Understanding the Flow-volume loop

Figure 1.

Flow-volume loop with expiration only.

Historically, some spirometers and spirometry software only measured expiration, as well as the use of one-way valve mouth pieces. As a result, many departments routinely performed exhalation-only manoeuvres. However, new insights discussed within this article suggest that measuring inspiratory flow alongside expiration can improve test quality.

Past and Present Spirometry guidelines: 2005 v 2019 The 2005 ATS/ERS spirometry standardization outlined three main steps to obtain an FVC. Firstly, maximal inspiration, followed by a strong exhalation (blast), and finally, complete exhalation. A separate test sequence was discussed briefly for inspiration, referred to as the “Maximal Expiratory Flow Volume Loop” MFVL. In this test sequence, the subject is asked to take a rapid full inspiration to total lung capacity (TLC) from room air through the mouth, insert the mouthpiece and, without hesitation, perform an expiration with maximum force until no more gas can be expelled, followed by a quick maximum inspiration. At this point, the

manoeuvre is finished, completing the loop in a single manoeuvre.

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By contrast, the 2019 guidelines prioritise both inspiration and expiration within a single FVC manoeuvre.

This is broken into four steps: 1. Maximal inspiration 2. A forceful exhalation 3. Complete exhalation and 4. An inspiratory manoeuvre back to total lung capacity (TLC).

This revised approach places greater importance on inspiration, as the 2019 ATS/ERS guidelines mention the parameter forced inspiratory vital capacity (FIVC), which is measured at end expiration with inhalation back to TLC. The guidelines state comparing the FVC and FIVC is key for assessing the technical acceptability of spirometry results. Only when both inspiratory and expiratory manoeuvres are performed can this comparison be made, ensuring accurate testing.

What does a normal flow-volume loop look like?

Figure 2. A well-formed flow-volume loop reflects healthy lung function. The curve shows the relationship between airflow (vertical axis) and lung volume (horizontal axis). For a normal result, the curve begins at TLC and features a peak during forceful exhalation, which gradually diminishes as lung volume decreases.

The loop then curves upwards as the patient inhales back to TLC. The highest flow rate occurs at the beginning of exhalation and is effort dependent. After approximately one-third of the exhale, airflow becomes less effort-dependent and more influenced by lung pressure and airway resistance.

Figure 2.

Flow-volume loop in a healthy subject with expiration and inspiratory volumes. ioh.org.uk

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What does an abnormal flow-volume loop look like?

Spirometry : Understanding the Flow-volume loop

The shape of the flow-volume loop can also reveal patterns of lung disease. For

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example, in obstructive lung diseases like asthma or COPD, there is a reduction in maximal expiratory flow which causes the characteristic “scooping” or concave shape in the loop. This occurs because the airway collapses during forceful exhalation, reducing the airflow despite maximum effort. The severity of obstruction can be assessed by depth of the scoop as shown in figure 3 and 4.

Figure 3 Flow-volume loop with mild airflow obstruction.

Figure 4 Flow-volume loop with severe airflow obstruction.

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Lung diseases that restrict lung expansion such as chest wall abnormalities or space-occupying lesions such as tumors can lead to restrictive lung disease. In these cases, the flow-volume loop will show reduced lung volumes and shorter exhalation times as shown in Figure 5.

Figure 5 Flow-volume loop with a mild restrictive defect.

Figure 6 Flow-volume loop with a severe restrictive defect.

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The importance of inspiration One of the key advantages of measuring inspiration during spirometry is the

Spirometry : Understanding the Flow-volume loop

ability to capture the FIVC. Without the inspiratory maneuver FIVC cannot be

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obtained. FIVC can be compared with FVC to assess whether the test began at TLC. According to ATS/ERS guidelines, if the FIVC exceeds the FVC by more than 0.100 L or 5% of the FVC, it indicates that the test did not start from TLC, making the result unreliable for certain measurements such as FEV1. However, the FVC may still be acceptable. Most modern spirometers have the FIVC parameter within the parameter list and some software can offer real-time feedback on this comparison, helping operators ensure the test is conducted correctly. The comparison of FIVC and FVC can also be observed on the flow-volume loop if FIVC is obtained is bigger than FVC as shown in Figure 7.

Figure 7 Flow-volume loop showing initial suboptimal inhalation before exhalation, confirmed by the second inhalation back to TLC.

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References Spirometry: Performance and Interpretation A Guide for General Practitioners. (2005). Available at: https://irishthoracicsociety.com/wp-content/uploads/2017/05/SpirometryGuidelinespdf.pdf Spirometry: Performance and Interpretation A Guide for General Practitioners. (2005). Available at: https://irishthoracicsociety.com/wp-content/uploads/2017/05/SpirometryGuidelinespdf.pdf.

Graham, B.L., Steenbruggen, I., Miller, M.R., Barjaktarevic, I.Z., Cooper, B.G., Hall, G.L., Hallstrand, T.S., Kaminsky, D.A., McCarthy, K., McCormack, M.C., Oropez, C.E., Rosenfeld, M., Stanojevic, S., Swanney, M.P. and Thompson, B.R. (2019b). Standardization of Spirometry 2019 Update. An Official American Thoracic Society and European Respiratory Society Technical Statement. American Journal of Respiratory and Critical Care Medicine, [online] 200(8), pp.e70–e88. doi:https://doi.org/10.1164/ rccm.201908-1590st.

Vitalograph Spirotrac 6 software.

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Employee Empowerment within the Occupational Health Sector

By Jane Manders

Introduction

T

he term empowerment when used in a healthcare setting usually refers to how staff can empower their patients. This can be seen as upskilling them on their

diagnosis, so that treatment goals can be defined and allow them to take responsibility (Varekamp et al., 2009). In the occupational health (OH) setting Ekeberg et al. (1997) defines empowerment as a process whereby the OH nurse helps a person to take control over issues that affect their lives. This viewpoint is held similarly by Puetz (1988) whereby sharing power with others enables them to achieve their goals. However, this article

is focused on empowerment from a quality management perspective with reference to my own research study in 2023.

The role and benefits of employee empowerment Employee engagement is about an employee's emotional commitment and motivation towards their work and organisation, driven by leadership support and a positive culture.

Employee empowerment involves giving employees the autonomy, resources,

and authority to make decisions and take ownership of their work, enabling them to act independently and contribute to success.

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empowerment. Structural empowerment

focuses on organisational conditions such as: Access to information: Employees need relevant knowledge to perform effectively.

Support: Guidance and feedback from leaders enhance confidence and decision -making.

Resources and tools: Availability of

necessary materials and technology.

Opportunities for growth: Training, career development, and participation in decision-making.

Psychological empowerment focuses on the individual, their perception of controlling work and their motivational processes. It also includes: Meaning: Employees see their work as

valuable and aligned with personal and organisational goals.

Competence: Confidence in their skills and abilities to perform well.

Autonomy: Freedom to make decisions and solve problems independently.

Impact: Belief that their contributions Employee empowerment is crucial for quality management. By giving employees ownership, listening to their ideas, and implementing them, creativity and innovation increase, boosting organisational performance (Goetsch & Davis, 2016).

Empowered employees care about their work, leading to continuous improvement and as Hemag et al. (2022) highlight

make a difference in the organisation.

Employee empowerment impacts workplace mental health positively.

Laschinger and Havens (1997) found that nurses' perception of structural empowerment improved their mental

that empowered employees are vital to organisational success.

health and effectiveness. Laschinger et

In healthcare settings research has shown that implementing

authentic nurse leaders, highlighting

quality programmes alone is not enough. To truly enhance clinical care, it is essential to empower employees alongside these initiatives.

al. (2013) linked reduced burnout to balanced processing and self-awareness as key factors. Their study showed similar outcomes for both recent

In Maynard et al.’s (2012) literature review, they cited several

graduates and experienced nurses.

sources when defining employee empowerment with two

Senior leaders should note that self-

elements identified, namely structural and psychological

aware leaders who practice balanced processing enhance structural ioh.org.uk

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empowerment, regardless of employees' experience levels.

Measuring structural empowerment Chandler created the Conditions for Workplace Effectiveness Questionnaire (CWEQ) in 1986, based on Kanter's employee empowerment theory. It was later improved to CWEQ II , recognised as reliable and valid. CWEQ II has six subscales: Opportunity, Information, Support, Resources, Formal Power, and Informal Power (Western University Canada, 2023).

Research The CWEQII was distributed within the OH sector, yielding 92 anonymous responses. No

personal data was collected. The results showed that total structural empowerment scores range from 6 to 30; scores of 6-13 represent low empowerment, 14-22 moderate, and 23-30 high.

Figure 1 displays the total structural empowerment by profession. Operations roles had high structural empowerment, while nurses, doctors, and technicians had moderate levels.

Figure 1 Total structural empowerment by profession The CWEQII uses a global measure of empowerment as a validation index. The global empowerment score was 3.53, indicating a moderate level.

OH nurses were the largest group of respondents, with 70 completing the survey.

Additional input from other professions will be necessary for more comprehensive

results in the future. Figure 2 provides an overview of the number of respondents by sector.

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Figure 2 Respondents by sector Figure 3 shows the scores for each empowerment subscale, ranging from 1 to 5. Higher scores indicate better access.

Figure 3 OH nurse subscale

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OH nurses had moderate scores across all subscales. The highest score was in

Opportunity, indicating career development and innovation in problem-solving, while the lowest was in Support, indicating a lack of constructive feedback from managers and colleagues, which may affect their empowerment.

The Nursing and Midwifery Council (2018) states that effective nursing practice requires providing and seeking feedback from colleagues and stakeholders. Feedback is crucial for professional development, helping nurses to reflect and improve. In this survey, 36.9% of respondents said they rarely or never received specific improvement comments, while 41% indicated receiving them sometimes.

Demographics on the work sector were also captured (figure 4). It was found that

individuals working in the public sector had the lowest total structural empowerment score. In contrast, self-employed individuals or business owners had the highest empowerment scores.

Figure 4 Total empowerment score by sector

Barriers and improvements This research identified barriers to workplace empowerment, including employee readiness, contextual setting, and resistance by various groups (Goetsch & Davis, 2016).

Line managers are essential for effective empowerment, with coaching and training needed to upskill all management levels. They also play a critical role in providing employees with the necessary information to perform effectively.

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Limitations This research survey relied on self-reporting by individuals, and their responses may be influenced by their daily mood. The cross-sectional design of the survey is another limitation; a longitudinal design could address this issue. The voluntary nature of participation introduces selection bias, which may limit the ability to generalise the findings to the entire OH population. Consequently, it should not be assumed that the views of non-respondents are the same as those who participated.

Summary There are several benefits to employee empowerment including improved productivity, performance, job satisfaction, and innovation, all leading to successful organisations. In healthcare settings, similar benefits are noted, such as improved nurse performance, better clinical care, compliance to standards and job satisfaction. Better mental health, including lower burnout, is also a benefit. Line managers play a key role in employee empowerment.

This research focuses on OH nurses, but future studies should include other roles in the sector, such as physiotherapists and occupational therapists, to get a comprehensive view.

There is a decline in OH expertise (Tindle et al, 2020) and given the government's recognition of their value and importance, if OH practitioners are dissatisfied and

perform poorly due to lack of empowerment, the future of this workforce could be harmed. Targeted programs must be improved by senior leaders and management.

Jane Manders, MSc,

Jane Manders | Linkedin Jane is an Occupational Health Business Partner at Mitie. This article was based on Jane’s research for an MSc in Strategic Quality Management in 2023. Jane also holds a BA in Occupational Health Practice.

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Learning and connecting at

The 2025 EOPH conference took place in Birmingham on 14th February. Themed ’Putting Health back into Health Surveillance’ it saw over 80 delegates, speakers and exhibitors come together for a day of talks, networking and learning. Speakers covered different aspects of how occupational health professionals prevent ill health and injury through effective health surveillance in the workplace.

It was an informative and valuable day, enabling those who attended to think more broadly than the processes and towards the outcomes that all of us working in occupational health want to achieve.

For those who couldn’t attend, we’ve summarised the takeaways from each talk, along with any resources mentioned. We hope you’ll find this helpful.

Want to know more about EOPH and our courses?

Wherever you are in your career, we can support the next stage in your professional development. Visit our site for the latest training for occupational health professionals, our free knowledge hub and much more: https:// eoph.co.uk/

Join us next year The EOPH Conference will be back in 2026! Dates and programme to be announced later this year.

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t the 2025 EOPH conference

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Learning and connecting at

Quality and Effectiveness in Health Surveillance Dr Robin Cordell covered how the 2023 SEQOHS standards enable occupational health services to demonstrate how they identify occupational health needs for their client organisations. He also discussed how they ensure quality of processes and the competence of those undertaking health surveillance as required by the Health and Safety Executive (HSE).

Dr Cordell’s message was that standards are important as they give assurance that we, as OH professionals, are doing things right. And that we are also striving for better, i.e. assuring that services are ‘good enough’ and then moving from ‘good’ to ‘great’. It’s a combination of assurance, continuous quality improvement and demonstrating value.

He referred to the latest version of the SEQOHS quality standards and their emphasis on outputs and outcomes.

Providers can now demonstrate with clarity the breadth

of value they bring to commissioners/purchasers of services, to their employees, and to themselves through benchmarking. Find out more about the latest standards at: https://www.seqohs.org/CMS/Page.aspx?PageId=77 Dr Robin Cordell is in clinical practice as an accredited specialist in occupational medicine and is the current President of the Faculty of Occupational Health.

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t the 2025 EOPH conference HSE Perspectives on Health Surveillance Dr Steve Forman started his session by stating that while

the UK is one of the best countries in terms of workplace safety, we still saw 138 workers killed in work-related accidents in 2023/24 - and that’s 138 too many. What’s more, that 1.7 million people are suffering from workrelated ill health. - either new or long standing. Therefore, health surveillance and the early identification of work ill health to manage risk is of strategic importance to a fit and healthy workplace.

Dr Forman covered the regulations that require health surveillance which include the control of hazardous substances, hand-arm vibration and noise as well as those requiring an appointed doctor which include managing and working with asbestos, control of lead at work and working with ionising radiation. Guidance on all regulations are available from the HSE here: https://www.hse.gov.uk/ On a cautionary note, health surveillance can go wrong when not performed by the employer or when performed inadequately by an OH provider which may be due to poor testing or failure to recognise abnormal results amongst other issues. Poor communication between the OH provider and the employer, or the employer not acting on results are additional risks.

In summary, Dr Forman’s talk concluded that health surveillance allows early identification of work-related ill health so employers can manage risk (both at individual and group levels), it’s part of a system of health risk management an important process that needs to be performed correctly.

Dr Steve Forman leads the OH team in the Health and Work branch of the HSE.

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Learning and connecting at

Monitoring and protecting working skin Using a practical and entertaining example, based on handling goods in a ‘bath bomb’ shop, Dr Katrin Alden covered the hazards and conditions causing hand eczema relevant to skin surveillance. As she explained, skin is affected on a common basis and skin surveillance is relevant as a strategy or method to detect and assess the adverse effects of work, or workplace exposures, on the skin health of workers.

Her example of ingredients affecting skin helped demonstrate what happens when an employer fails on the minimum legal requirement that they must do under the Management of Health and Safety at Work Regulations 1999 - i.e. to identify hazards, determine the level and severity of risks and take action to eliminate the hazard, or if not possible, to control those risks.

During her talk, Dr Alden also covered visual skin assessments and skin management using emollients and steroids. She also referred delegates to her work with SOM on the publication ‘Managing Skin Health at Work’.

Available here: https://www.som.org.uk/managing-skinhealth-work-new-som-guidance Dr Alden is an occupational health physician and speciality doctor in dermatology with an interest in work-related skin problems and lead clinician for the skin surveillance programme of a large NHS Trust.

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t the 2025 EOPH conference

An update on Occupational Lung Disease Using case studies, Professor Jo Szram outlined the common contemporary issues in occupational lung disease, focusing on the conditions and presentations that a modern day occupational health practitioner is likely to encounter.

She remarked that we are increasingly seeing cases of hypersensitivity and silicosis, with the dangers of inhalation of crystalline silica dust found in the artificial stone used in the manufacture of kitchen worktops being in the news. Discussing workplace asthma, Professor Szram shared that of the 4 million people in the UK receiving treatment for asthma, around 10% of this number is attributable to workplace conditions.

Her take home messages were that respiratory symptoms can be caused or worsened by occupational exposure, so awareness of specific workplace exposures is useful.

Taking a complete occupational history and establishing the respiratory pathology are also key. Visit www.lungsatwork.org.uk for more information and resources.

Professor Szram is a consultant in occupational lung disease and asthma based at Royal Brompton Hospital.

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Learning and connecting at Prevention and Management of Hand Arm Vibration Syndrome (HAVS) Dr Dan Ashdown and Dr CJ Grobler jointly covered an update on guidance for diagnosis and management of disorders related to hand-held vibrating tools, prevention of HAVS and best practice for health surveillance for HAVS. Dr Ashdown started with an overview of HAVS, being caused by prolonged exposure to hand-transmitted vibration (HTV) which is associated with Carpal Tunnel Syndrome and Dupuytren's Disease. It primarily affects the blood vessels, nerves, and joints of the hand, wrist,

and arm and is often associated with the use of vibrating tools in occupations such as extraction, construction and manufacturing.

Dr Ashdown mentioned the HAVS resources available from the SOM Special Interest Group, including a Delphi Study available here: https://www.som.org.uk/sites/ som.org.uk/files/ SOM_HAVS_SIG_Delphi_Study_Jan24.pdf.

Dr Grobler gave an update on health surveillance policy for HAVS and prevention of HAVS. Using the hierarchy of control measures model, Dr Grobler shared advice for employers with elimination of risk being most effective using examples of automation and remote controlled equipment. He also shared a continuous prevention model focused on health surveillance policies of Plan, Do, Check and Act. Both Dr Ashdown and Dr Grobler are members of the UK Society of Occupational Medicine’s HAVS Special Interest Group and have published research on HAVS.

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t the 2025 EOPH conference Sound Decisions: From Risk Assessment to Action Dr Finola Ryan explored the best practices in occupational hearing health surveillance. She explained how occupational health professionals can support employers in identifying noise hazards, managing exposure levels using reliable monitoring systems and recognising vulnerable worker groups.

Some of these hazards come from low frequency noise from ventilation and heavy machinery, mid-frequency noise from typical industrial processes, high-frequency noise from compressed air and metal work and impact noise which can span multiple frequencies. Understanding

these different sources helps us interpret our noise surveys more effectively. But there are a number of approaches to noise measurement, each giving different but complementary information. Dr Ryan demonstrated that measurements may tell us one thing, but health surveillance can tell us another - which is why we need to think carefully when interpreting our tests.

Her take home messages included realising there are challenges of using diagnostic tools for surveillance with different populations with different needs. We are trying

to look for pre-clinical changes and there is a need for early interventions. Some of the realities include no consensus on surveillance criteria and that threshold shifts mean that damage has already been done. Moving forward, she advised considering pattern recognition, looking at multiple frequencies, the value of early indicators and using trend analysis.

Dr Ryan is a Consultant Occupational Health Physician with a special interest in Performing Arts Medicine. She is also an Honorary lecturer at University College London.

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This guide describes simple steps to writing a meaningful policy relating to your organisational context.

Types of Policy Classifications helps to identify the different dimensions and purposes of policies within

➢ Functional (Departmental): These are

specific to different organisation functions, such as HR, finance, or marketing.

organisations and governments.

Planning = Quality

➢ Public/Government policies:

It is very easy to dive straight into improving

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Substantive (societal) policies

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Regulatory policies are formulated to impose controls and restrictions on specific activities or behaviours.

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Distributive policies enable the government to provide useful goods and services to most citizens, paid for by the

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However, take a step back and look at the strategy you will take to achieve the ultimate outcome. What is your content? What goals are you trying to achieve? Here is where

having a clear policy in place helps and involving all relevant stakeholders in policy writing is likely to bring you an increased

taxpayers

collaboration and effectiveness in your policy.

Redistributive policies reallocate wealth,

Structure

property, political or civil rights, or something else of value for the benefit of class-based groups ➢ Organisation: These are overarching

written policies that guide the overall goals and direction of an organisation. ➢ Specific e.g. Insurance: Detailed policies formulated for particular issues or scenarios.

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processes and conducting assurance activities.

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The best way to structure writing a policy is to take your reader through the learning funnel process. Starting from the wider remit narrowing it down to the relevant detail.

It is a journey, which is best illustrated when organisations are talking about ways to create effective learning materials for their staff.

Guide to writing a meaningful policy

By Victoria Tait and Hilary Winch

Figure 1 Taken from Superb Learning: The Learning Funnel, (2024) ioh.org.uk

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Write Writing your policy. What are the main

Example

points you wish to communicate?

This policy applies to all employees of {insert organisation

Use the 10 pillars approach. Ask your

name}, including contractors and casual staff.

business questions about each of the 10 areas and your policy is formed.

10 Pillars for writing a policy 1. Policy Scope

2. Policy Objective: The objective of a policy is to clearly state the purpose and

2. Policy Objective

goals that the policy aims to achieve. It provides a concise

3. Governance

explanation of why the policy exists and what it intends to accomplish. This helps ensure that everyone understands the

4. Definitions

policy’s importance and aligns their actions with its intended

5. Responsibilities

outcomes. This is the first touch point on whether the policy is

6. High-level implementation

aligned with the overall business strategy. Try to include no more than 3 key points.

guidelines 7. Communication guidelines 8. Qualifications and Training where relevant 9. Reviewing and Monitoring

Examples

10. Administration and approval

a. Health and Safety Policy:

1. Policy Scope:

Objective: To ensure a safe and healthy working

The scope of a policy defines the

mitigating potential hazards, promoting health and safety

boundaries and applicability of the policy. It outlines who and what the policy applies to, whether it is limited to certain departments, locations, or specific situations. It should come at the start. There is no point in someone reading about this policy if it does not apply to them or their job role. Clearly

environment for all employees by identifying and awareness, and complying with relevant legislation. b. Data Privacy Policy: To protect the personal data of customers and employees by implementing robust general data protection regulation

measures, ensuring compliance with UK data privacy laws, and fostering a culture of privacy within the organisation. c. Equal Employment Opportunity Policy:

defining the scope helps prevent

To promote a diverse and inclusive workplace by ensuring

confusion and ensures consistent

fair treatment in hiring, promotion, and other employment

application of the policy throughout the

practices, and by preventing discrimination based on race,

organisation. It should also be clear as

gender, age, disability, or other protected characteristics.

to who or what this policy will not cover. There has to be a clear synergy between the policy scope and objective.

d. IT Security Policy: To safeguard the organisation’s information systems and

data from unauthorized access, breaches, and other security threats by implementing comprehensive security measures and promoting cybersecurity awareness among employees.

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3. Governance

4. Definitions

What are the legislations, regulations

Acronyms and terminology may be

and standards you need to meet? These

specific to your organisation, another

are interconnected but serve different

organisation or society. It is therefore

purposes. Ask, what the risks and or

good to document which definition you

consequences of non-compliance with

have chosen to align with.

each are. Also include any details about Equality, Diversity and Inclusion in line with the Equality Act 2015 and Equality

Examples Mental health: Mental health is defined as a state of well-being in which every individual realizes his or her own

Legislation refers to laws that have been enacted by a governing body, such as a parliament. These laws are legally binding and must be followed by individuals and organisations within the jurisdiction.

Example The Health and Safety at Work Act 1974 in the UK.

Regulations are detailed rules or directives made by an authority to implement and enforce legislation.

They provide specific instructions on how the laws will be applied and enforced.

Example The UK General Data Protection Regulation (GDPR) is a regulation that

potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to contribute to her or his community.

The World Health Organization (WHO) defines mental wellbeing as a state in which an individual realises their abilities, can cope with the normal stresses of life, can work productively, and can contribute to their community.

5. Responsibilities Think about your organisation's structure. Be specific about who does what.

Include the company responsibilities, directors, managers, employees and anyone else who has a responsibility to uphold the directives in this policy.

works alongside the Data Protection Act 2018 and privacy for individuals in the UK.

Standards are established norms

or criteria that provide a basis for consistent and quality practices. They can be national or international and are often used to ensure safety, reliability, and efficiency.

Example ISO 9001 is an international standard for quality management systems.

SEQOHS is a standard for Safe Effective Quality Occupational Health Services

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6. High-level implementation guidelines

Example

This is when you tell your reader how you will implement this

Mental wellbeing

policy.

However, a policy is not a procedure. Procedures deal with the step-by-step details of “how” to follow the policy.

Aim: To create a supportive workplace culture, tackle factors that may harm mental health, and ensure managers have the right skills to support staff Policy actions:

Policy

Procedure

Organisation ‘rules’, ‘standards’, ‘principles’, ‘guidelines’ to follow

Step by step – how to follow the rules

• Give employees information on mental health issues to help raise awareness

• Deliver non-judgemental support to any staff member experiencing a

Explain why exist, when to apply and who it covers Ensure individuals aware of their responsibilities/ consequences Ensure safe / best and consistent practice is understood by the organisation

Practical details. Must be tangible, precise, exact, specific, factual, auditable Links to forms to complete

mental health issue • Consider mental health first aid training for teams, or ensure the business has mental health first aiders who can support staff with mental ill health

Visuals are often easier to understand, e.g. flowcharts, lists, screenshots, photographs

Link between organisational values, strategy and policy content

• Give all staff access to the mental health policy • Deliver a thorough induction for all new starters, providing an outline of the organisation, the policies and the role they are expected to play • Provide ways for staff to support their

This is the meatiest section in your policy. The third layer in the learning funnel as shared above.

An action must accompany each objective. When you map your

thought process of what is achievable, you can then tidy up your objectives section accordingly. Choose policy actions that suit your workplace and make them SMART (Specific, Measurable, Achievable, Realistic, Time-specific). High-level steps, stages, or

own mental wellbeing, for example through stress-buster activities, lunchtime activities and social events • Offer employees flexible working hours • Set realistic targets and deadlines for staff to prevent long working hours • Deal with any conflict quickly and

gateways that are recognisable within the evidence or process,

make sure the workplace is free from

and in use anywhere the scope is covered, must be evident.

bullying, harassment, racism or

If you are implementing a specific policy i.e. not a business-wide company policy, follow the same approach but narrow the funnel down further.

discrimination • Ensure all staff have clear job descriptions, objectives and responsibilities, as well as the training to do their job well • Ensure good communication between managers, staff and teams

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If you have timeframes associated with some of the implementations, then surface them, especially if they are

key to the outcome delivered. Here is a diagram that illustrates all these pillars.

7. Communication Guidelines If your policy does not have any information to communicate with stakeholders, you have an ill-fitting policy. You need to go back to the drawing board. Remember, a solid governance framework operates in line with an organisation's context. This

Example 1. All employees will be made aware of the {insert policy name} policy and the resources that are available to them.

2. The {insert policy name} policy will be included in the employee handbook.

3. Employees receive a copy of this policy during the induction process 4. This policy is easily accessible by all members of the

context has to be at the front of your

organisation will be available to download from the staff

policy’s output and outcome.

intranet or shared drives and servers.

What will I communicate, with who, and when do they need this information by?

If you answer the question above and

consider all your stakeholders, you have got your section populated.

5. Employees are informed when a particular activity aligns with this policy 6. Employees are empowered to actively contribute and provide feedback to this policy 7. Employees are notified of all changes to this policy.

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8. Qualifications and Training

9. Reviewing and Monitoring

This section is an optional one, used

needs to? Is it easily understood? Get a peer to review it.

only where applicable and commonly seen in policies that are skill-specific.

For example, a policy on audit will include a section that explains who is authorised to conduct the work and what training or qualifications they require.

Put yourself in the reader's shoes. Is it communicating what it Involve people in the development process, get ideas and feedback and the workplace talking about the policy details. The commitment and participation of your employees is essential to creating a supportive, responsive and productive working environment that benefits everyone. Regular reviews and monitoring are important for checking the effectiveness.

10. Administration and approval The document should contain a document title, a unique document identifier, version number, Issue Date, Review Date, Author and Review/Approved with names and job titles (and e-signature). ISO has guidance on creating and updating policies: ISO-ts-9002-2016

Document Title

Privacy Policy

Document Identifier

QOH-01

Version

001

Issue Date

04 Jun 2024

Author

Review date Mickey Mouse

June 2027 Senior OHA

Reviewed and approved by

Minnie Mouse

Clinical Director

Your policy should now be at a stage to be reviewed for final sign-off. Once you have finalised your policy and it has been approved by senior management, ensure a communication strategy is in place, circulate the approved policy to all current employees, provide any training required on the policy and incorporate the policy into any new employee induction processes. Ensure any procedural documents or tool kits associated with the policy are ready to launch as well.

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In conclusion, remember, a policy is a position statement and the “who”, the “what” and the “why” needs to be

clear. A clear decision starts a good policy. Remember the reader, meet their needs and enhance understanding, keep it short and without jargon. Be transparent in communicating and ensure clarity i.e. Write in an active voice vs a passive, e.g. all employees must adhere to these steps. And last of all remember, a policy is not a procedure.

Victoria Tait | Linkedin Victoria Tait, CQP FCQI is a Chartered Quality Professional and a Fellow of the Chartered Quality Institute working as a Quality Assurance Specialist in the field of Occupational Health (QualitaitTM)

Hilary Winch | Linkedin Hilary is the past Chair of NHS Health at Work Network. Associate Director- Workplace Health, Safety & Wellbeing, Norfolk & Norwich University Hospitals NHS Foundation Trust

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Education Review My Experience Studying with NEBOSH Through a Fully Online Platform

By Michelle Moorst

A

s an occupational health specialist

Among their respected offerings, the NEBOSH

nurse, I was looking to find a course

National General Certificate in Occupational

to further enhance my skills in

Health and Safety delivers practical insights

health, safety and the environment. My

for effectively managing workplace health and

preference for a flexible, self-paced learning

safety. This comprehensive course covers

approach led me to research various

critical areas such as risk assessment,

providers before enrolling in The National

recognising common workplace hazards,

Examination Board in Occupational Safety

implementing control measures, and ensuring

and Health (NEBOSH) Certificate. NEBOSH

legal compliance.

stands as a global leader in providing health, safety, and environmental qualifications.

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The NEBOSH qualification journey can be both challenging and immensely rewarding. I

embarked on this path in October 2024, opting

The course has significantly enhanced my role

for a full self-study online course. The chosen

as an occupational health advisor. It has

platform was intuitive and well-structured,

equipped me to better identify and address

making it easy to navigate through the course

workplace hazards, ensuring compliance and

materials. The resources provided were clear

reducing risks. Moreover, the qualification has

and concise, featuring video tutorials,

improved my ability to manage cases, provide

interactive exercises, and practice assessments

advice on work-related health issues, and

that reinforced key concepts. The advantage of

educate others on health and safety practices,

studying at my own pace was particularly

all of which contribute to creating a safer work

beneficial. I scheduled my examinations

environment.

through the provider, with the examination

dates available on the NEBOSH website. The exams comprised two parts: an open-book written examination and a risk assessment submission. Additionally, the provider offered webinars to support exam preparation closer to the exam dates. While the course materials on the platform were thorough, I supplemented them with an extra textbook from NEBOSH to deepen my understanding of the subject matter.

I highly recommend the NEBOSH qualification,

particularly through an online platform provider if you value the flexibility of studying at your own pace. Overall, it is a practical and worthwhile course that has equipped me with invaluable skills for my daily work. If you are considering a similar path, my advice is to go for it—make sure to choose the right course provider, gather the necessary resources, and develop a solid plan to maximize your selfstudy experience.

Michelle Moorst | Linkedin Michelle is an Occupational Health Specialist Nurse.

iOH offers small educational grants to iOH members subject to criteria. Log onto the members area for more information on applying for an iOH Educational Grant

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Identifying responsibilities as part of a learning strategy

T

he ageing population of

What is a Responsibility Matrix

Occupational Health Advisors

A responsibility matrix outlines roles to ensure

(OHAs) and a historical lack of

that L&D are optimised. Effective L&D

investment in their training have led to a

programs help develop the skills and

skills shortage and wage inflation in the

knowledge necessary for delivering high-

sector (DWP, 2021). To address this, many

quality OH services, thereby contributing to

Occupational Health (OH) organisations

the organisation's success. Good quality L&D

have developed in-house training programs.

inspires employees to perform at their best,

For these programs to be effective, it is

enhancing their contributions to

crucial to clearly define roles and

organisational goals. In times of talent scarcity,

responsibilities within the organisation

developing existing employees is more cost-

through a Learning and Development (L&D)

effective (Organization Development: A

responsibility matrix.

Practitioner's Guide). To ensure success, learning responsibilities must be clearly allocated among the employer, employee, and the L&D department.

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Learning and Development Goals

(Source: Adapted from Nick van Dam, 25 Best Practices in Learning & Talent Development, 2nd edition, Lulu Press, 2008)

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Role of the Individual

smoothly into their new roles.

Seek and reflect on feedback.

Collaborate with the L & D department

Assess personal skills and knowledge to identify areas for improvement.

Actively pursue opportunities to address skill and knowledge gaps.

Apply new knowledge in practice.

Share learning and insights with the team to foster continuous improvement.

Role of Line Managers Role model a learning culture by actively

and Clinical Governance (CG) when onboarding new services to identify and plan how L&D needs will be met.

Conducting a learning needs analysis (LNA) with the L&D department when gaps are identified ensures the learning environment, processes and procedures are considered when

Role of the L&D Department

engaging in their own learning and

Collaborate with operations and CG

development.

when onboarding new clients or services

Set clear expectations and goals for their

to identify and plan training needs.

team. Including defining job

Conduct an LNA to determine skills and

responsibilities, performance targets,

knowledge gaps.

and the skills and behaviours needed to

Differentiate between learning, process,

achieve them.

and environmental needs to design

Provide constructive feedback and

appropriate training solutions.

coaching to foster both individual and

Set clear learning objectives and use

team growth. Contribute to the team’s understanding of how they contribute to the organisation’s goals.

Through regular performance reviews and 1-1s actively support development by identifying skills gaps and facilitating personalised learning opportunities.

This includes arranging observation sessions, mentoring and competency checking, with formal training.

Integrate learning into daily work activities by encouraging problem-

evidence-based practices to develop training programs.

Deliver training through various methods, including remote, in-person, e -learning, and blended approaches.

Conduct learning transfer analysis posttraining to assess the effectiveness of learning outcomes.

Report on L&D functions to senior management to ensure alignment with organisational goals.

solving and sharing of best practices.

Role of the Organisation

Observe and document behaviour

Recognise that the quality of service is

change following training to feedback to the L&D department. This data is essential to assess learning transfer and identify areas for improvement.

Plan and review induction programmes

determined primarily through clinician efforts.

Emphasise core values and behaviours during regular appraisals.

to help new employees integrate

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Facilitate access to training and development through in-house and external training.

Support apprenticeships where feasible.

Consider financial support for higher education or professional qualifications.

This article provides a comprehensive overview of the roles and responsibilities necessary for an effective L&D strategy within an organisation. By clearly defining these roles, OH organisations can ensure that their L&D programs are successful and contribute to overall business goals.

Not all organisations have separate L&D, CG and operational departments; however, this can be a good guide to map within organisations.

This article was provided by PAM Academy, the L&D department of PAM Group.

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Returning to Work: Rehabilitation and Work Hardening By Claire Glynn

Introduction Returning to work (RTW) after a prolonged absence due to illness or injury can be challenging.

Rehabilitation and work hardening programmes are essential to ensure a safe and effective reintegration into the workplace. This article guides the consideration and implementation of measures or processes, emphasising the importance of individualised plans and the role of biopsychosocial factors.

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Return to work is defined as the process

rehabilitation, reduces the need for long-term m

of helping employees transition back to

These activities help physical recovery and addre

their job role(s) after an absence due to illness, injury, or other reasons (Office for Equality and Opportunity (OEO), 2023).

Measures can be considered in all circumstances, not only returning following sickness absence, but after career breaks or maternity leave, for example.

What is Rehabilitation or Work Hardening?

Work hardening is a specific rehabilitation programme tailored to the needs of both the employee and the job, assisting individuals in returning to work after an illness or injury, or other absence. Interventions are carefully planned and have clear goals to ensure individuals regain their strength, confidence, and ability to perform tasks safely and effectively.

Generally, rehabilitation and work hardening involve increasing an individual's work duties, hours, and pacing to their maximal capacity. The goal is to facilitate the workplace reintegration of individuals who have experienced a reduction in work capacity or capability.

Incorporating work-based activities into rehabilitation plans and health and wellbeing strategies offers several key benefits. This approach aligns with the biopsychosocial model of rehabilitation, which has been shown to lead to more comprehensive recovery outcomes.

Research indicates that addressing the

whole person, including psychological barriers like anxiety and fear of reinjury, and integrating psychological and social support with physical

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There is much to consider when designing a RTW

may be ideally suited to plan and support. The n

required of the day and is commensurate with th commuting to work, possible homeworking and

medical care and improves return-to-work rates, (Bae, M., 2024, International Association for the Study of Pain, 2010).

ess psychological and social aspects, contributing to a holistic rehabilitation process.

W plan. Use of specialists within a multi-disciplinary Occupational Health (OH) or Vocational Rehabilitation (VR) teams

number of hours and days to initiate as the starting point of the RTW is determined by the physical and mental demands

he length and/or reasons for absence. Consideration of the type of shift pattern and work is also essential. The effects of hybrid working should also be considered.

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Assess and Plan

confidence or self-esteem. Simple

1. Physical/Functional Conditioning:

town, building up general exercise for

Work hardening programmes focus on improving strength, endurance, flexibility, and coordination. They often include simulation of jobspecific tasks to replicate and increase capacity to meet the physical demands of the workplace.

Establishing the individual's current

physical condition and job demands is the starting point.

prepare the individual for returning to work. Social prescribing is an innovative approach in healthcare that connects people to non-medical services and activities within their community to improve their overall health and wellbeing. Social prescribing recognises

that health is influenced by a range of social, economic, and environmental factors and aims to address these by

hardening should address any

connecting individuals to community

psychological aspects of returning to

resources. Link workers spend time

work, such as confidence building

understanding what matters to and

and/or managing anxiety related to

individual and assist them in accessing

re-injury.

relevant community services, such as

hardening programmes can be

designed by a team of healthcare professionals, including OH nurses trained in rehabilitation, physiotherapists, occupational therapists, Vocational rehabilitation and mental health specialists.

4. Emotional State: The psychological

activities including volunteering, arts and crafts, group learning, gardening,

befriending, cookery classes, physical activities, and more. Social prescribing is particularly beneficial for people with long-term conditions, those needing support with mental health issues, individuals who are lonely or isolated, and those with complex social needs, particularly those who may be anxious

impact of their condition and

about returning to a working

readiness to return to work will

environment with any of these issues,

determine whether a rapid or gradual

(NHS England, 2023, Gov.uk, 2022,

return is more appropriate.

Buck, D. and Ewbank, L, 2020)

5. Symptoms and Conditions: Symptoms and any aggravating factors will affect their ability to work. Research promotes a return to work despite symptoms, but specific tasks that may cause aggravation should be cautiously integrated.

Pre-Return to Work Desensitisation may be required if an absence has been prolonged, and the individual has a significant loss of self-

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stamina, and socialising can help

2. Psychological Support: Work

3. Multidisciplinary Approach: Work-

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activities such as shopping in a busy

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Gradual Reintegration 1. Increasing Hours of Work: Increasing work hours from the initial start can be completed by increasing the number of days in a week worked or increasing the number of hours in a day. With each increment all biopsychosocial and workplace factors need to be considered.

Included needs to be the response to the previous increment and the

magnitude of the next increment.

Evaluation can help determine these

This can help them adjust, ensures

modifications. Temporary

they do not overexert themselves and

redeployment to alternate roles may

therefore help ensure a smooth

also be considered.

transition back to full duties.

2. Endurance Capacity: The ability to handle the physical and mental demands of their job must be considered. Some individuals may perform better at different times of the day.

3. Reduced Days of Work: Normal rehabilitation may involve returning to normal shift durations at an agreed point but providing a bigger break than normal between work periods to allow for better recovery.

This strategy is useful for roles where shorter working hours cannot be accommodated and helps build confidence, stamina, and resilience.

4. Incremental Increases in Duties: The initiation of RTW depends on the length of absence and extent of incapacity. A staged approach can help ensure a smooth transition, with regular reviews and adjustments to the plan to ensure its effectiveness.

Support and Resources 1. Work Task Redesign: If the employer or OH service has access to a specialist ergonomic team, they can work with the employee and manager to redesign tasks or advise on

alternate techniques for task performance. This can help employees undertake tasks with less risk to their underlying health issues and regain physical stamina.

2. Targets and Supernumerary Roles: Setting measurable targets and reducing these can be as effective as a phased return in hours.

Supernumerary roles, where the

employee is accompanied by a colleague, can help build tolerance, confidence, and stamina.

3. Compliance with Treatment: Those receiving or nearing the end of interventions are likely to make a more successful and efficient RTW.

The duration of stages can be advised

4. Financial Considerations: The

by appropriate OH professionals. The

financial implications for the

overall duration of a phased return to

individual, including pay during a

work can range from a few weeks to a

phased return can affect progress.

couple of months, depending on the

Consider government schemes like

individual’s progress and the

Employment Support Allowance

complexity of their job.

(ESA) for those returning after a

5. Temporary Restrictions: Some aspects of the role may need to be

prolonged absence.

5. Home Working: Home working and

avoided, mitigated, or reduced if the

hybrid working can help avoid travel

employee has a temporary

fatigue and provide flexibility.

incapability or reduced capacity to

However, it is essential to ensure

undertake certain tasks. A Physical/

workstations are set up appropriately

Functional Capacity Assessment/

and that the employee remains integrated into the workplace.

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Communicate and Coordinate 1. Job Role: The specific requirements and duties of the job need to be clear to all parties. Discussions with managers and colleagues can help address barriers to RTW. 2. Hours of Work: Understanding and agreeing on the feasibility and expectation of the individual's work hours, including shifts and overtime. Financial situations may also influence the ability to work overtime.

3. Psychosocial Flags: psychosocial factors play a significant role in the success of RTW programmes. These factors are categorised into yellow, blue, and black flags: (Gray, 2011; Shaw, 2009; Nicholas, 2002

4. Commuting and Access to Work: For some employees, concerns around commuting during peak hours may need to be addressed. Advice regarding travel outside peak hours can help alleviate fears of re-injury and anxiety. Consider "Access to Work" for transport support and assistance from colleagues or management.

Monitor and Evaluate 1. Progression: Regularly reviewing the employee’s progress and adjusting the return-to-work plan as needed is crucial.

2. Planning: Setting clear objectives and agreeing on actions with

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adjustments to the plan may be necessary to ensure its effectiveness.

Justification for Work Hardening & Rehabilitation Programmes

anticipated timescales is crucial

The primary purpose of a person-

(Agimal, 2022). The RTW plan should

centred RTW or work hardening

be flexible and adaptable to the

programme is to facilitate a smooth and

individual's progress and the needs

successful transition back to work,

of the business. Regular reviews and

ensuring that the individual is fully

Volume 32 Issue 1

prepared to safely meet the demands of

their job, without risking relapse or injury, and improving the overall quality

References and further reading

of life, (NHS England, 2025). These

ACC, (2004). New Zealand Acute Low

programmes aim to restore the

Back Pain Guide: incorporating the Guide

employee to 100% of their role unless

to Assessing Psychosocial Yellow Flags in

otherwise agreed.

Acute Low Back Pain. Wellington, New

Evidence shows that supporting

Zealand: ACC.

temporary modifications to work roles,

Equality Act, (2010). Chapter 15.

duties, or hours can be effective and cost

Available:

-efficient when goal oriented. Such adjustments, often temporary, can facilitate staying at or returning to work and are typically easy to implement with little or no additional cost to employers, (Council for Work & Health, 2019).

Substantial evidence supports the efficacy of physical conditioning programmes that incorporate a cognitive-behavioural approach and intensive physical training, supervised by appropriate healthcare professionals or a multidisciplinary team. These programmes, which deliver a biopsychosocial model of healthcare, significantly enhance vitality, improve

http://www.legislation.gov.uk/ ukpga/2010/15/pdfs/ ukpga_20100015_en.pdf. Last accessed 20th February 2017 Carvalho, A, (2007). How useful are flags for identifying the origins of pain and barriers to rehabilitation? Frontline. 13 (17).

International Association for the Study of Pain, (2010). Evidence-Based

Biopsychosocial Treatment of Chronic Musculoskeletal Pain. (2010). Available at: https://aped-dor.org/images/ FactSheets/DorMusculoEsqueletica/en/ Biopsychosocial.pdf [Accessed 26 Feb.

overall health outcomes, and reduce the

2025].

number of sick days lost, (Jakobsen et al,

IOSH, (2015). A healthy return. Good

2017; Miki et al, 2021; Ibrahim et al,

practice guide to rehabilitating people at

2019).

work. IOSH: Leicestershire.

Conclusion

Kendall, NAS, Burton AK, Main CJ,

Rehabilitation and work hardening programmes are vital for the successful reintegration of employees into the workplace. By considering the individual's physical, emotional, and psychosocial needs, and by setting clear, achievable goals, these programmes can help employees return to work safely and effectively.

Watson, PJ, (2009). Tackling Musculoskeletal Problems: A Guide for Clinic and Workplace – Identifying Obstacles Using the Psychosocial Flags Framework. London: The Stationery Office.

Kendall, NAS, Linton, SJ and Main, CJ, (1997). Guide to Assessing Psycho-social Yellow Flags in Acute Low Back Pain:

Risk Factors for Long-Term Disability and Work Loss. Accident Compensation Corporation and the New Zealand Guidelines Group, Wellington, New

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Zealand. (Oct, 2004 Edition).

Lechner DE, (1994). Work Hardening and Work Conditioning Interventions: Do They Affect Disability? Physical Therapy. 74 (5). p471-493.

The Cochrane Collaboration, (2009).

Work conditioning, work hardening and functional restoration for workers with back and neck pain (Review). John Wiley

The European Agency of Safety and

Health at Work, (2016). Rehabilitation and return to work: analysis report on EU policies, strategies and programmes.

Luxembourg: Publications Office of the European Union. p3.

Waddell G and Burton AK, (2006). Is work good for your health and wellbeing?

Norwich: The Stationery Office.

& Sons, Ltd.

Claire Glynn | Linkedin Claire is the Operations Manager for the ‘Project Your Health’ initiative at the University of Central Lancashire.

This project supports students in delivering quality preventative healthcare services to local community

employers. Claire has 15 years of experience as a specialist occupational health clinician, specialising in occupational health and ergonomics, and over 20 years of experience in the field of physiotherapy. She is also a qualified teacher.

Claire is a member of several professional organisations, including the CSP, HCPC, ACPOHE, VRA, iOH, and SOM. Claire is passionate about supporting workplaces to help their colleagues and staff achieve an enhanced quality of life and improved health goals. She believes that a healthy workforce is the foundation of a productive and thriving

organisation. Through her work, Claire focuses on implementing effective health and wellness programmes, ergonomic solutions, and preventative measures to reduce workplace injuries and promote overall wellbeing. She is dedicated to educating and empowering employees to take charge of their health, fostering a culture of wellness within the workplace.

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The Workplace Isn’t Lis How Hearing Loss is Misunder

By Dan Williams, Visualise Training an 58

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stening: rstood at Work

nd Development

H

earing loss can affect every aspect of a person’s life, but it’s particularly challenging in the

workplace. Whether it’s missing out on important information in meetings or struggling with phone calls, hearing loss can create barriers that hinder both professional growth and day-to-day productivity.

The Invisible Barrier What many people don’t realise is that hearing loss is often invisible. While someone might have difficulty hearing, they may not show any obvious signs.

This can lead to misunderstandings, especially when colleagues or managers don’t acknowledge the challenges faced by people with hearing loss. The assumption may be that hearing loss doesn’t impact work unless it’s extremely severe, but even mild to moderate hearing loss can create significant difficulties.

Workplace Communication Struggles Meetings are often where hearing loss

becomes most apparent. Imagine sitting in a room full of colleagues discussing strategies and objectives, but the discussion becomes muffled or hard to follow. The challenge is that people with hearing loss might not always speak up to ask for clarification, especially if they fear being judged or interrupting the flow of conversation.

This can lead to the perception that they

aren’t contributing or engaging with the

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conversation when, in fact, they’re

judgment is key to making sure everyone

struggling to keep up. A few simple

has an equal opportunity to succeed.

workplace adjustments, like using a microphone in meetings or providing meeting agendas and summaries, can make a significant difference in ensuring clear communication and reducing misunderstandings.

The Importance of Support and Adjustments Employers have a legal and moral responsibility to accommodate employees with hearing loss. This could mean offering assistive technology like

“Hearing Loss Myths That Need to Be Left Behind” There are many misconceptions about hearing loss that have persisted for years, often preventing people from seeking the support they need or perpetuating stigma. Let’s bust some of these myths and look at the truths behind them.

Myth 1: “Hearing Loss Only Affects Old People”

captioning services or ensuring that

While age-related hearing loss is

meetings are accessible with written

common, hearing loss can affect people

follow-ups. But it also requires a cultural

of all ages; more than 5% of the world’s

shift within the workplace, where the

population—approximately 430 million

value of inclusive communication and

people—suffer from hearing loss. Causes

the understanding of hearing loss are

can range from genetics and injury to

prioritised.

exposure to loud noises or certain

What Needs to Change?

medical conditions. So, don’t assume that hearing loss only happens in later

• Awareness: Employers and colleagues

life. It can occur at any stage.

need to be educated about the

Myth 2: “Hearing Aids Solve Everything”

challenges faced by employees with hearing loss and understand that it’s not just a “personal” issue; it impacts

Hearing aids can help amplify sound,

performance, morale, and success.

but they’re not a magical fix-all. They

• Flexibility: Allowing employees to have access to meetings in formats that work for them—whether it’s through captions, transcripts, or sign language interpreters—creates a more inclusive environment. culture where people are encouraged to discuss their challenges without fear of

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and may not work equally well for everyone. Many people with hearing loss also struggle with background noise, distorted sounds, or hearing in difficult environments, which hearing aids alone can’t always solve. People with hearing

• Compassion: Creating a workplace

60

don’t restore hearing to normal levels

Volume 32 Issue 1

loss might also need additional support,

Employers have a responsibility to a employees with h

a legal and moral accommodate hearing loss.

like captioning, lip reading coaching, or

are drowning out the voices. For people

assistive listening devices.

with hearing loss, this is an all-too-

Myth 3: “People with Hearing Loss Can’t Participate in Conversations” It’s easy to assume that someone with hearing loss is disconnected from social situations, but many people with hearing loss are perfectly capable of engaging in conversations. With the

right tools and strategies, like lip reading or assistive technology, they can follow along and actively participate.

The key is communication—finding ways to ensure that the person with hearing loss feels included and understood.

Myth 4: “People with Hearing Loss Are Just Being Rude When They Ask You to Repeat Yourself” People with hearing loss are often afraid to ask others to repeat themselves because it can feel awkward or frustrating. However, it’s not about being rude; it’s about the need for

familiar frustration.

The Struggle of Watching TV with Hearing Loss TV shows and movies are created with sound as a vital part of the experience, but for those with hearing loss, that’s often where the problem begins.

Whether it’s the booming action sequences that overpower dialogue or the unclear speech due to poor sound mixing, watching TV can be a battle of frustration.

Subtitles Are Not Always the Solution While subtitles are a helpful tool, they’re

not always available or perfectly accurate. Often, they’re delayed, missing, or simply don’t capture the nuances of conversations. For people who rely on subtitles, a poorly synced or incomplete version can make a show or

clarity. People with hearing loss may

film feel unwatchable.

find it difficult to understand speech in

Improving Accessibility for All

noisy environments or when there’s background chatter. Instead of feeling

impatient, be patient and supportive

The good news is that the entertainment

when someone asks for repetition or

industry is beginning to recognise the

clarification.

importance of accessibility for people

“Turn It Up! The Frustration of Watching TV When You Can’t Hear It”

with hearing loss. Streaming services

We’ve all been there—sitting down to

accessibility in mind, offering clearer

watch your favourite show after a long day, but something’s just not right. The dialogue’s unclear, the background music is too loud, or the sound effects

like Netflix, Amazon Prime, and Disney+ have made huge strides in offering highquality closed captions and even options for descriptive audio. Some new TV shows and films are even created with audio mixes that make speech more prominent.

For the home setup, many people with hearing loss invest in technologies like ioh.org.uk

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hearing aid-compatible TV speakers, or even

can be overcome with better access to

smart speakers that allow for clearer sound.

information, such as captioning in media,

Simple changes, like using subtitles, adjusting

better public announcement systems, or more

the volume, or investing in specialised tech,

inclusive social spaces. The Social Model

can drastically improve the TV-watching

stresses that the problem lies in the design of

experience.

our environments, not the people who

“The Social Model of Hearing Loss: Why It’s Not Just About Your Ears”

navigate them.

Hearing loss isn’t just about “bad ears.” It’s

The key to an inclusive society is making small

about the barriers created by society that make it harder for people with hearing loss to engage fully in life. This is where the Social Model of Disability comes in. Instead of seeing hearing loss as a personal deficiency, this model views it as a result of the way society is structured.

What is the Social Model of Disability?

The Social Model of Disability focuses on changing the environment rather than “fixing” the individual. It emphasises the idea that people with hearing loss are disabled not because of their condition, but because of how society doesn’t accommodate them. In this context, hearing loss is not the problem—the problem is the lack of accessible communication, spaces, and services.

Breaking Down Social Barriers In a world where spoken communication is dominant, people with hearing loss face unique challenges. However, these challenges

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Moving Towards an Inclusive Society changes that benefit everyone. For example, having captions at public events, offering sign language interpreters at conferences, and ensuring workplaces have appropriate accommodations can level the playing field for those with hearing loss. As we move towards a more accessible world, the Social Model of Disability helps shift focus away from what individuals can’t do to what society can do to help everyone thrive.

Find out more To find out more about making your organisation more accessible for deaf colleagues and those with hearing loss, visit https:// visualisetrainingandconsultancy.com/ workplace-assessments/hearing-lossworkplace-assessment To ensure your team is equipped to interact confidently and respectfully with colleagues and individuals who have hearing impairments, visit https:// visualisetrainingandconsultancy.com/training/ deaf-and-hearing-loss-awareness-e-learning

L

ast year, a colleague saved a life

at work. It was a routine day of audiometry, spirometry, and

skin surveillance on a customer’s site.

My colleague “Jim”, carefully explained to an employee/client that the blue trace represented the left ear and the

Due to debate and di has been moved to a possible to

red the right; the top of the trace was quiet, like a leaf blowing in the wind

while the bottom of the trace was loud like a jet engine; the left side of the

trace is like the low notes of a piano and the right side of the trace, the high

notes of the piano that the client had heard.

Jim noted that whilst the client’s right

ear was as expected for his age, his left ear was not. Jim emphasised that although this was a screening audiometry test rather than a diagnostic test, the results required further

investigation. Jim strongly recommended that the client take his audiometry trace along with a standardised letter to his GP, who would likely refer him for specialist assessments at the hospital.

An opinion a View the p for OH tec

Jim later found out from the Health and

Author: An

Safety Manager that the client had been diagnosed with a brain tumour. Surgery to remove it had been successful, but

without the audiometry test, the tumour might not have been detected until it was too late. The Health and Safety Manager confirmed the client’s comments that without Jim’s clear explanation of the results, they would not have sought medical advice at all.

It may seem unusual to get job satisfaction from a client’s traumatic experience, but Jim did because he knew that he had made a difference. As his manager, I was even more proud of not only Jim’s actions that day but also, the level of knowledge, skills, and 66

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behaviours he consistently demonstrates at work.

Jim is an Occupational Health Technician (OHT). He has a Degree in Sports and Exercise Science, is on the Perform and Interpret Spirometry Register with the Association of Respiratory Technology and Physiology (ARTP), and has successfully completed the British Society of Audiology’s (BSA) Screening Audiometry course, designed to enable attendees to ‘Interpret results and findings’ (British Society of Audiology, 2023). In addition, he has

workplace to promote compliance with

prescribed asthma medication and support escalation processes in respiratory surveillance demonstrates not only his technical competence but also his commitment to improving occupational health practice.

iscussion, this article blog, as this makes it comment.

Despite his expertise and being an enhanced technician, Jim has been told he is not competent to interpret and report on health surveillance results.

Following comments from the HSE and recent HSE improvement notices, it is felt he cannot use face-to-face interactions with clients to motivate them to take proactive actions to promote their health, safety and wellbeing. This decision has undermined his

and proposal post here chnicians

self-worth and removed his career

nonymous

long I will stay in Occupational Health

completed 3 months of direct

pathway. How long we can retain such a talented, passionate professional in

Occupational Health, as a result, is now uncertain.

As for me, a SCPHN(OH), spending 4 hours per day reviewing health surveillance results which have a 100% accuracy rate is also demoralising. How under these conditions is also unknown.

Approximate Calculations

supervision, a portfolio of evidence of

No one can tell how many workers

his knowledge, and a final assessment by

require health surveillance per year in

a Registered Nurse, SCPHN(OH), and

the UK. To calculate approximate

Practice Teacher to confirm that he has

numbers, figures from the Office of

met the required standards of skills,

National Statistics (ONS, 2024) were

knowledge and behaviours of an

used.

Occupational Health Technician. He has also worked with a GORD Specialist to understand OASYS scores, create referral criteria, and interpret serial peak flow readings. His proposal to introduce FeNO testing into the

The number of workers in Agriculture, Forestry and Fishing; Mining, Energy

and Water Supply; and Manufacturing; Construction total 2,813,985,000 workers. This includes office and management workers who may not be exposed to health hazards at work and ioh.org.uk

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admin, travel, cleaning, and calibration),

the direct cost of OHT time at £179 per day would amount to £71.96 billion per year.

A qualified OHA reviewing this work adds another £6.73 billion (£45,000 annual salary + employer costs =

Due to debate and di has been moved to a possible to £54,000 per OHA per annum) to the

those not requiring health surveillance but does not include

those that do from other industries, suggesting that the figures

may equal out. Based on organisational clinical standards, which

annual bill. Nearly 3 times the MOD’s

cost of operations and peacekeeping in 2023/2024 (Ministry of Defence, 2024)

require one hour per worker to perform and explain audiometry,

and a significant cost to UK industry.

spirometry, skin and HAVS2 surveillance, as well as provide

Competency

health, safety, and wellbeing advice, the total health

surveillance time for all these workers equates to 401,997,857

‘Competence is the ability for every

workdays per year. This does not include driver’s medicals,

director, manager and worker to

safety-critical medicals, drugs and alcohol tests, DNA rates, or

recognise the risks in operational

escalation processes etc.

activities and then apply the right

The Society of Occupational Medicine’s OH Workforce Paper (Society of Occupational Medicine, 2018) informs us that we

have: • 571 Specialists in Occupational Health (FFOM, MFOM, AFOM, DOccMeds)

measures to control and manage those risks.' Judith Hackitt, HSE Chair cited in (Health and Safety Executive, N.D.).

View the p

The risk to life from a lack of competent health surveillance is recognised.

However, restricting the interpretation

• 216 Training Registrars

of health surveillance solely to

• 3200 SCPHN (OH) accredited OH nurses (data from 2015)

Registered Nurses with qualifications in

Additional from a freedom of information request from 2023, we have 2941 NMC accredited OH nurses (73% over the age of 50; and 23% over the age of 60) If it takes 4 minutes per employee to review health surveillance activities check results, and release reports to employers, it will take those qualified OH nurses 26,799,858 days to complete the annual health surveillance checks. Practically speaking, that’s an additional 6172 qualified OHAs needed to review the required health surveillance. This assumes that qualified OH nurses are full-time and assuming recruitment into a profession which requires long hours checking test results of competent Occupational Health Technicians.

Consideration of training and salary would be an essential consideration and may preclude providers from delivering this type of service.

Occupational Health also creates a significant workforce and service capacity gap.

The lack of a sufficient workforce, both

in terms of number and mix of skills will impact on service capacity, and worker safety, and hinder our ability to transform occupational health, safety and wellbeing. This will limit efforts to eliminate or minimise work-related ill health, reduce days lost costs, and mitigate the negative impact on the UK economy.

The Health and Safety Executive states

that “Competence can be described as the combination of training, skills, experience

Competent Occupational Health Technicians (OHTs) delivering

and knowledge that a person has and their

these services would take 42 weeks per year (allowing for annual

ability to apply them to perform a task

leave and downtime), based on 4 days per week (to account for

safely. Other factors, such as attitude and

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physical ability, can also affect someone's competence.” (‘What is

competencies within Occupational

Competence’ (Health and Safety Executive, N.D.))

Health. This will help create long-term

I suggest that in the context of health surveillance (to loosely reference the HSE’s definition of competency ‘Training and Competence’ (Health and Safety Executive, N.D.)), competence involves the ability to undertake responsibilities and perform activities to a recognised standard regularly by someone who is

health surveillance competency standards for Occupational Physicians, Qualified OH Advisors, Screening Nurses, OH Technicians, OH Nursing Associates and OH Assistant

iscussion, this article blog, as this makes it o comment. not only in the possession of necessary skills and knowledge but

Practitioners.

also capable of consistently applying these attributes to

To address short to medium term

maintain clinical (and safety) standards.

challenges, my pragmatic proposal is

Given the approximate calculations above, we need, as Amanda

Pritchard, Chief Executive of NHS England, states (NHS England,

that we seek a compromise and agree

that:

2024), “a robust and effective plan to ensure that we have the right

• Competency can be demonstrated

number of people, with the right skills and support in place to be

through training and robust

able to deliver the kind of care people need’”.

assessment of skills, knowledge, and

I propose that the HSE, Faculty of Occupational Health Nursing, Faculty of Occupational Medicine, Society of Occupational

Medicine and the National School of Occupational Health have a responsibility to work collaboratively to establish a strategic

behaviours and the individual’s ability to consistently apply them to the identified clinical standards.

• It should be the responsibility of the

direction for the long-term competency standards of

supervising Specialist Occupational

Occupational Health, as well as a concrete and pragmatic action

Physician or Occupational Health

in the short to medium term to address the current challenge

Nurse specialist to ensure that their

created by representatives of the HSE when declaring that only

workforce is competent. This

OPs and OHAs with specific qualifications can interpret and

includes working within a defined

provide feedback health surveillance.

clinical framework and undergoing

post here

The HSE’s ‘Training and Competence’ (Health and Safety Executive, N.D.) outlines Key Principles of Competence. By applying these key principles we can create a competency

regular audits to ensure consistency of accurate application.

• Individuals/companies undertaking

framework that reassures all stakeholders that once achieved,

health surveillance without being

Occupational Health Technicians will be capable of performing

able to robustly demonstrate

and interpreting health surveillance, reinforcing health and

competency of staff should be

safety messages, and providing valuable health-related self-

managed by the HSE Inspectorate

management advice to workers - ultimately saving lives., This will allow us to secure ‘the right number of people with the right skills and support’.

• Companies offering ‘HSE Approved’ Audiometry through the posting of equipment to the site for workers to

The NHS and Department for Health and Social Care workforce

sit in front of a computer screen and

crisis has led to the development of several key initiatives,

press buttons without being seen by

including the ‘Care Certificate’ (Department of Health and Social

an occupational health care

Care, 2013), Codes of Conduct for Healthcare Support Workers

professional (competent or not)

(Skills for Health, n.d.), NHS Health Check Competency

should be managed by the HSE

Framework (Public Health England, 2020) and the ‘Grow Your

Inspectorate.

Own’ workforce strategy (NHS England, n.d.).

Someone needs to take positive action,

These established standards for developing a support workforce

around a table, with a focus on

need to be leveraged to map job roles, clinical standards, and

competency, pragmatism and ioh.org.uk

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compromise. Without it, we are likely

Available at: https://www.hee.nhs.uk/our-work/allied-health-

to see the death of the Occupational

professions/education-employment/future-proofing-podiatry-

Health Technician and an even bigger

workforce/case-change-developing-new-ways-working

workforce and service capacity gap.

[Accessed 12 02 2025].

References

ONS, 2024. EMP13: Employment by industry dataset. [Online]

British Society of Audiology, 2023.

Available at: https://www.ons.gov.uk/

Due to debate and discussion, this article has been moved to a blog, as this makes it possible to comment.

Minimum Training Guidelines -

Surveillance Audiometry. [Online]

Available at: https://www.thebsa.org.uk/ wp-content/uploads/2023/10/OD104-

127-Minimum-Training-GuidelineSurveillance-Audiometry.pdf [Accessed 12 02 2025].

Department of Health and Social Care,

2013. Care Certificate Handbook. [Online] Available at: www.gov.uk/government/

publications/care-certificate-handbook [Accessed 12 2 2025].

Health and Safety Executive, N.D..

Training and competence. [Online] Available at: www.hse.gov.uk/

humanfactors/topics/competence.htm [Accessed 11 02 2025].

Health and Safety Executive, N.D.. What is competence?. [Online]

employmentandlabourmarket/peopleinwork/ employmentandemployeetypes/datasets/ employmentbyindustryemp13 [Accessed 11 02 2025].

Public Health England, 2020. NHS Health Check Competency Framework. [Online]

Available at: www.healthcheck.nhs.uk/seecmsfile/%3Fid% 3D1508

[Accessed 12 02 2025].

Skills for Health, n.d.. Code of Conduct for Healthcare Support Workers and Adult Social Care Workers. [Online]

Available at: https://www.skillsforhealth.org.uk/resources/codeof-conduct-for-healthcare-support-workers-and-adult-socialcare-workers/

[Accessed 12 02 2025].

Society of Occupational Medicine, 2018. The Future of Occupational Health Workforce, s.l.: Society of Occupational Medicine.

View the post here

Available at: https://www.hse.gov.uk/

competence/what-is-competence.htm [Accessed 11 02 2025].

Ministry of Defence, 2024. MOD

Departmental Resources 2024. [Online] Available at: https://www.gov.uk/ government/statistics/defencedepartmental-resources-2024/moddepartmental-resources-2024 [Accessed 12 02 2025].

NHS England, 2024. NHS Long Term Workforce Plan. [Online] Available at: www.england.nhs.uk/longread/nhs-long-term-workforce-plan-2/

[Accessed 11 02 2025].

NHS England, n.d.. The Case for Change and developing new ways of working.

[Online] 70

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Upcoming iOH Webinar

Click for more details ioh.org.uk

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71

Opinion The Value of Quality S

By Lynda M Bruce, Direct

I

n 2005, I established a small, nurse-led

Occupational Health Service) and ISO

Occupational Health company. By

standards have a role to play, depending on an

2017/18, it became clear that my

organisation's specific needs.

organisation would benefit from a structured quality system. After researching available

Implementing ISO 9001

options and seeking advice from colleagues in

ISO 9001 was well-suited to our requirements,

the Quality Management field, I chose to implement International Organisation for Standardisation (ISO) 9001 (Quality Management System). This standard has since been supplanted by ISO 7101, which is specifically tailored for the unique needs of healthcare quality management.

I recognise that different drivers influence the choice of quality systems in Occupational Health. Both SEQOHS (Safe, Effective, Quality

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allowing us to build our procedures and policies around our business model. Had ISO 7101 been available at the time, transitioning to it would have been even more seamless, requiring minimal additional input.

The core principles of ISO 9001 and ISO 7101

are quite similar, though ISO 9001 is broader in scope. Implementing ISO 9001 was a straightforward process, involving organising and standardizing our existing systems,

n Piece: Systems in Healthcare

tor of Clinical Support iOH

policies, and forms. It also provided an

expertise across multiple ISO standards,

excellent framework for managing tender

including:

exercises and associated documentation.

The cost was very reasonable, a crucial factor for me as a cost-conscious Aberdonian! Once

• ISO 7101 (Healthcare Quality Management) • ISO 9001 (Quality Management)

the system was in place, we had two options:

• ISO 45001 (Occupational Health & Safety)

pursue full certification with external

• ISO 14001 (Environmental Management)

assessment or simply ensure that all organisations we worked with were aware of our ISO 9001 compliance. We chose the latter, as it met our business needs effectively.

The Role of Expert Guidance My colleague, Maxine Sharp, played a pivotal role in this process. A Certified Lead Implementer Professional, Maxine has

• ISO 27001 (Information Security Management) • ISO/IEC 17025 (Testing & Calibration Laboratories) • BS10012/UK GDPR (Data Protection) With over 30 years of experience, Maxine has worked across industries to implement and

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certify quality management systems. Her deep

understanding of healthcare challenges— ranging from data security to resource allocation—makes her a strong advocate for ISO 7101 as a tool for improving healthcare

SEQOHS • Scope: A UK-specific accreditation for occupational health services • Focus: Ensures that occupational health providers meet high standards of safety and

delivery.

Why ISO 7101 Matters in Healthcare?

ISO 7101 is specifically designed for healthcare organisations, offering a structured approach

to quality improvement. Key benefits include: • Enhancing patient safety and care quality • Promoting cost efficiency and operational effectiveness • Strengthening an organisation’s reputation and market reach • Ensuring compliance with risk management and safety protocols

This standard does not replace legal obligations but instead supports organisations in establishing transparent, efficient, and high -quality care processes without adding

quality • Application: Primarily relevant for organisations delivering occupational health services While ISO 7101 provides a broad framework applicable to various healthcare settings, SEQOHS is more specialized, ensuring that occupational health services adhere to best practices within the UK.

The Power of a Strong Management System An effective quality management system is more than just a certification—it fosters a

culture of continuous improvement. By maintaining well-referenced, regularly reviewed, and audited documents, organisations ensure consistency, compliance,

excessive administrative burdens.

and high standards of care.

SEQOHS vs. ISO 7101: Understanding the Differences

Conclusion

Both ISO 7101 and SEQOHS aim to enhance

of ensuring high standards in workplace health

healthcare quality, but they serve different purposes:

Good processes and clear communication drive quality outcomes. Employers and Occupational Health professionals share the responsibility services. When used effectively, quality systems like ISO 7101 and SEQOHS can make a

ISO 7101:2023

significant difference in people's working lives

• Scope: A global standard for healthcare

care.

organization management systems • Focus: Comprehensive healthcare quality management, including safety, efficiency, and patient-centred care

• Application: Suitable for any healthcare

74

by promoting safe, efficient, and high-quality As healthcare evolves, organisations should consider adopting structured quality management systems that align with their specific needs. Whether through ISO 7101 or

SEQOHS, investing in quality management is

entity seeking to improve patient

an investment in better outcomes for both

experience and operational efficiency

patients and professionals.

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Lynda is an experienced Occupational Health Nurse and food hygienist with extensive experience across various industries, including whisky, fish, oil and gas, manufacturing, education, and third sector organizations.

Since the 1990s, she has held senior positions and previously managed a nurse-led Occupational Health company, which she sold in 2021.

Lynda has also been part of the academic team at Robert Gordon University, contributing to the delivery of the BSc in Occupational Health. Currently, she is in the process of establishing a new occupational health business while serving as a clinical associate in occupational health.

Additionally, Lynda holds the roles of Trustee and Director of Clinical Support at iOH and Director of Grampian Housing Association.

Further information about Maxine Sharp can be found at: https://maxi-mizeqa.com/

The Interview Feature Interview with Carolyna Franklin iOH Equity, Diversity, and Inclusion (EDI) Director

By Lynn Pratt, President iOH

I recently had the opportunity to speak with Carolyna about her interests and aspirations in her new voluntary EDI role and her recent article on challenges faced by racially minoritised groups.

Can you tell us a bit about your background?

I graduated as an occupational therapist in 1998. I have worked extensively across diverse sectors, including the NHS, charities, local government, and the private sector. This has encompassed work in acute hospitals, community rehabilitation teams, and a driving mobility service. Adult Social Care was another interesting area which encompassed housing adaptations, safeguarding, mental capacity, and manual handling assessments.

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How has your background influenced your EDI perspective on healthcare?

I am a white woman from southern England and acknowledge my position of privilege and the systemic barriers faced by racially minoritised colleagues and patients. Though I have not experienced these challenges personally, I have witnessed disparities in healthcare and education, and I feel compelled to advocate for change. My believe is that individuals, regardless of

their background or circumstances, should have access to opportunities that enable them to thrive. My passion for EDI is rooted in my work with diverse populations, including neurodiverse individuals, those with long-term health conditions, and people navigating complex challenges such as brain injury and mental health conditions.

What type of issues do you see?

Studies such as the annual NHS 2023 Staff Survey, consistently show that professionals from Black, Asian, and minority ethnic backgrounds experience higher levels of discrimination and bullying at work compared to white colleagues. Ethnic minority NHS staff are less likely to be shortlisted for promotions or receive career development. Research by The Guardian in 2023 revealed that Black and racially marginalised doctors in the NHS are more likely to be in lower pay bands despite having comparable qualifications and experience to their white colleagues

Allyship is a term often used in healthcare. What is it, and how do you practice it?

Allyship in healthcare, particularly in occupational health, means leveraging my privilege to challenge inequities, amplify marginalised voices, and promote inclusion. In my role on the iOH board and in practice, I

support mentorship, safe spaces, transparent hiring, and cultural competence training. My goal is to help foster a more inclusive environment for racially minoritised healthcare professionals.

Another commonly used term is privilege. How do you define privilege, and what is your understanding of white privilege?

people has, usually because of their position or

because they are rich. White privilege, specifically, is the implicit societal advantages afforded to White people relative to those who experience racism. It is an institutional set of benefits granted to those who resemble the people who dominate powerful positions in our institutions.

What about microaggressions? Can you share an example of how microaggressions manifest in the workplace?

Microaggressions are subtle, often unintentional, comments or behaviours that convey bias, stereotypes, or exclusion toward individuals from racially marginalised groups.

For instance, microinsults might include indirect comments that demean someone’s identity, such as saying, "You’re so articulate," which implies surprise at a person's intelligence.

We know that racially minoritised healthcare professionals often work in agency roles. Why is this?

Agency roles often provide healthcare professionals with flexibility and autonomy,

better pay, avoidance of hostile environments, and broader exposure to different trusts, wards, or care settings. This mobility can be particularly appealing for those who feel undervalued in their substantive NHS roles.

What steps can be taken to promote diversity and inclusion within the occupational health sector?

Promoting diversity and inclusion requires self

Privilege refers to an unearned advantage or

-reflection and education on unconscious bias,

entitlement that only one person or group of

systemic racism, and cultural competency. It

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also involves being an ally, building safe

be discussed openly and constructively. I urge

spaces, and supporting diverse hiring and

everyone to engage in conversations about

mentorship. Additionally, organisations

racial bias and systemic inequities to drive

should enforce anti-racism policies, provide

awareness and change. Establishing an

mental health support, and regularly assess

anonymous forum for racially marginalised

diversity initiatives through staff feedback and

staff to report and discuss experiences without

data on representation, progression, and

fear of retaliation is one step towards this goal.

retention.

What is your call to action for addressing racism in healthcare?

Finally, how can iOH members practically help: Speaking up against discrimination, supporting diversity, and advocating for fair

Addressing racism in healthcare requires more

policies is essential. Encouraging diverse

than acknowledgment—it demands action. We

hiring and mentorship is also crucial. I will be

must foster a culture where discrimination can

open to confidentially discussing with people from minority ethnic groups about their experiences in OH and healthcare settings.

If you would like to link with Carolyna, you can connect by email: carolyna.franklin@ioh.org.uk or Linke dIn Read Carolyna’s article: Challenges Faced by Racially Minoritised Groups

Carolyna with Juno & Indie

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