Research and analysis

Summary: Innovation and knowledge development amongst providers of occupational health

Published 20 July 2021

Angus Tindle, Lorna Adams, Isabel Kearney, Rachel Keeble, Sarah Coburn, Libby Eastwood and Sam Stroud, IFF Research

1.1 Overview

This report presents the findings from a set of qualitative interviews with occupational health (OH) providers. The research explored provider’s attitudes towards and examples of innovative practice in OH, and their approaches to developing and maintaining OH knowledge.

1.2 Research Context

The Work and Health Unit (WHU) is a UK government unit which brings together officials from the Department for Work and Pensions (DWP) and the Department of Health and Social Care (DHSC) to lead the Government’s strategy supporting working age disabled people, and people with long term health conditions enter, and stay in, employment. To enable this, the government aims for more individuals to have access to appropriate and timely OH advice.

Recent research with private providers of occupational health has provided evidence to fill some knowledge gaps about the functioning of the occupational health market, however the government is concerned that low demand for OH services to date, combined with a marketplace where purchasers are often less informed, may also have driven underinvestment in innovation in the market. To explore this, the WHU commissioned research into OH provider approaches to innovating and maintaining knowledge.

1.3 Methodology

A total of 15 qualitative interviews with OH providers (13 with private providers, and two with NHS providers that sell OH services commercially) were completed in two phases between February and May 2020, with the final six interviews taking place during the COVID-19 pandemic. Those interviewed were either owners of the business, or senior members of staff.

Interviews were completed with a range of sizes of provider that broadly reflected the fact that most OH providers are small-scale employers: 9 micro businesses, 4 small businesses and 1 large business were interviewed.

1.4 Findings

1.4.1 Approaches to innovation

OH providers tended to focus on innovation in four main areas, with a view to improving their internal processes, and client services and outcomes:

• software development; for example, updating in-house IT systems, remote services such as online assessments, and app development;
• policy and procedure development; for example, updating procedures for supporting people with chronic pain or women going through menopause; and reasonable adjustment passports that clients’ employees could take with them when moving to new positions or departments;
• preventative measures; for example, workplace coaches, wellness training and steps to improve stress management and emotional resilience;
• enhancing employer knowledge of and engagement with OH; for example, educating employers about the potential cost of OH inaction.

The most common triggers for innovation centred on introducing efficiencies (either to the provider’s own processes or those of clients) to streamline costs and maintain competitive pricing in the OH market; as well as providing better outcomes to clients. The COVID-19 pandemic did impact innovation somewhat in terms of increasing demand for existing innovative work that was already on offer to employers, such as remote services. However, there was no evidence of it being a trigger for innovation in itself, so far. There appeared to be minimal focus on innovation activity intended to facilitate access to OH services among SMEs and the self-employed, as providers did not consider this a priority or felt unable to increase uptake of services amongst these groups without further government support. Nevertheless, there were some innovations that providers felt SMEs or the self-employed could benefit from.

Most providers approached innovation on an ad-hoc basis, according to staff or business interests or simply when ‘good ideas’ occurred, rather than having specific innovation structures or procedures in place. There was, however, some evidence of providers using defined processes and procedures after a possible innovation had been identified, such as the formation of working groups or the development of business cases. Collaboration when innovating and external (and indeed, internal) evaluations of innovations were rare, due to providers not giving these priority, or due to them lacking the resources to do so.

1.4.2 Challenges and barriers to innovation

Capacity and cost to the business were commonly identified as the main barriers to OH providers innovating, specifically the difficulty of balancing time spent innovating with delivering their day-to-day services – with this sometimes being exacerbated by a shortage of skilled clinicians. The way the OH market operates also fed into this, with some providers referencing competitive pricing and limited customer spends, resulting in an environment in which providers have little capacity to innovate. Few providers viewed management of intellectual property as a barrier to pursuing innovation, as they recognised the benefit of information sharing within their close-knit sector.

While many OH providers shared similar barriers, there was no consensus about the best way to tackle these barriers. Attempts to demonstrate the benefits of investment in innovation, to enable providers to justify time and resource dedicated to innovation, were relatively common. Some providers ‘absorbed’ the indirect costs by working on innovations in their own time. Those perceiving a lack of demand for OH from (usually SME) employers had tried various approaches to increasing employer knowledge of the benefits of OH, but felt that collective effort in this area, between government, providers and trade bodies, was still required.

Those not innovating were split between those that would like to but faced barriers, and those that felt innovation was not necessary – either because they were satisfied with their existing services, or because they felt their customers were not yet ready for innovative services.

Providers generally struggled to see how external guidance on how to innovate or how to support innovative practice could be helpful in solving the challenges they faced; but a few suggested either funding, or work to address the wider challenges facing the OH sector.

1.4.3 Approaches to developing and maintaining OH knowledge

The most common methods OH providers used to develop and maintain knowledge were training, attending conferences and events, accessing journals and research papers, and informal networking and knowledge sharing. Many providers had a genuine motivation and felt a responsibility to stay up to date in the field, viewing this as a necessary part of providing a high-quality service.

Few providers had specific systems for developing and maintaining knowledge; most just pointed to regular attendance at conferences, keeping up with journals and guidance, and seeking to develop their knowledge as and when needs arose. A few providers referred to clinical staff keeping up to date with their continuing professional development (CPD) requirements, although this was managed by the individuals themselves.

Engagement with the wider OH sector was commonplace, with a general recognition that keeping in touch with other providers was a valuable practice. This mostly tended to be on an informal basis, likely facilitated by the relatively small size of the OH sector.

1.4.4 Challenges and barriers to developing and maintaining knowledge

Similar to innovation, the main challenge providers faced in developing and maintaining knowledge was balancing this with day-to-day service delivery. This was particularly notable in relation to attending conferences, events and external training as these not only required time away from core activities, but also usually cost money for attendance and travel (the frequency of these events taking place in London causing additional strain for providers based some distance from the capital). A few providers also cited as a barrier the focus within the sector on learning for staff with clinical backgrounds, leaving non-clinical staff with fewer networks and resources to tap into.

Few providers had identified specific ways of overcoming these challenges and barriers. There was a sense that such barriers were inevitable and hard to overcome, although one provider had found it effective to schedule dedicated time for knowledge development into monthly workloads; while another had reduced the expense of conference attendance by offering to speak at them.

Again, providers felt that solutions to the wider challenges facing the OH industry, such as addressing the lack of qualified OH professionals, would be most helpful in overcoming barriers to knowledge development. Providers also suggested financial grants for training and knowledge development; and an opening up of existing networks to non-clinical staff. They noted that regional or local networks and events may be of some benefit too, but these were not without their own challenges.