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Roberts L1,2, Corbett W1, Ewings S2, Liniker H2, Smedley J3,4, Walker-Bone K4,5
1University Hospital Southampton NHS Foundation Trust, Therapy Services, Southampton, United Kingdom, 2University of Southampton, School of Health Sciences, Southampton, United Kingdom, 3University Hospital Southampton NHS Foundation Trust, Occupational Health, Southampton, United Kingdom, 4Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, Southampton, United Kingdom, 5University Hospital Southampton NHS Foundation Trust, Occupational Rheumatology, Southampton, United Kingdom
Background: Sickness absence among healthcare workers reduces productivity and increases pressure on staffing. At the inception of this project in 2014, average sickness rates for healthcare workers in England were high (4.4%) compared with the private (1.8%) and public sectors (2.9%). High patient mortality in hospitals is associated with high patient: staff ratios, therefore minimising sickness absence is vital for maintaining safe staffing levels and patient safety. In 2014, musculoskeletal symptoms accounted for 17.5% of sickness absence in our hospital Trust.
Purpose: To design, deliver and evaluate a new self-referral service offering 11 500 healthcare workers free, on-site physiotherapy for musculoskeletal symptoms.
Methods: This physiotherapy-led, quality improvement initiative with a nested qualitative study included a 6-month pilot with 4 clinics per week to measure demand, test delivery logistics and collect data to support future funding. The new service allowed healthcare workers to access an individual 45-minute consultation (comprising assessment, advice and treatment) with further appointments if required. Following the pilot, 8 half-day clinics per week were deemed necessary to meet demand. Service-users completed a questionnaire providing demographic details, symptom history, perceived impact on their ability to do their job (presenteeism), sickness absence, healthcare utilisation, and impressions of the Trust as an employer. The nested qualitative study was undertaken with 14 purposively sampled service-users. Semi-structured interviews were conducted exploring their perceptions and experiences of the self-referral service and their musculoskeletal symptoms. Data were analysed thematically and managed using a Framework approach comprising transcription, coding, developing a framework matrix and interpretation of the data.
Results: From September 2015 - July 2018, 1514 staff attended the service and the questionnaire response rate was 95.2% (n=1441). Presenteeism was evident as 765 staff (54%) reported their symptoms impacted upon their ability to do their job, although 82% (n=1114) reported not taking time off work. For those with long-term absence due to back pain, there was a reduction of 10.5 days in the median absence following introduction of the new service.
The majority of service-users (n=1281, 95%) considered that this service would prevent them needing to make future visits to their doctor or other healthcare professionals. Nearly all staff (n=1376, 98%) reported that the service improved their impression of the Trust as an employer, with 790 (58%) rating it in the top 10% of employers.
The qualitative study identified 6 themes and 40 sub-themes and showed the service was highly valued by service-users. Key findings included health and work impacts: return to normal activities and hobbies; enhanced injury awareness and self-management; improved employer-employee relationships; and prevention of sickness absence.
Conclusion(s): On-site, direct access to physiotherapy was highly valued by hospital workers, helped reduce presenteeism, sickness absence for musculoskeletal symptoms, demand and time out for doctors' appointments. This service highlights the ability of physiotherapists to influence attitudes, behaviours, health and well-being.
Implications: Broad implementation of physiotherapy self-referral services for healthcare workers could enhance employer-employee relationships and significantly reduce sickness absence due to musculoskeletal disorders, thereby maintaining staffing levels and patient safety.
Keywords: Musculoskeletal disorders, self-referral, sickness absence
Funding acknowledgements: NHS England Healthy Workforce Programme and UHS. LR is supported by a National Institute for Health Research senior clinical lectureship.
Purpose: To design, deliver and evaluate a new self-referral service offering 11 500 healthcare workers free, on-site physiotherapy for musculoskeletal symptoms.
Methods: This physiotherapy-led, quality improvement initiative with a nested qualitative study included a 6-month pilot with 4 clinics per week to measure demand, test delivery logistics and collect data to support future funding. The new service allowed healthcare workers to access an individual 45-minute consultation (comprising assessment, advice and treatment) with further appointments if required. Following the pilot, 8 half-day clinics per week were deemed necessary to meet demand. Service-users completed a questionnaire providing demographic details, symptom history, perceived impact on their ability to do their job (presenteeism), sickness absence, healthcare utilisation, and impressions of the Trust as an employer. The nested qualitative study was undertaken with 14 purposively sampled service-users. Semi-structured interviews were conducted exploring their perceptions and experiences of the self-referral service and their musculoskeletal symptoms. Data were analysed thematically and managed using a Framework approach comprising transcription, coding, developing a framework matrix and interpretation of the data.
Results: From September 2015 - July 2018, 1514 staff attended the service and the questionnaire response rate was 95.2% (n=1441). Presenteeism was evident as 765 staff (54%) reported their symptoms impacted upon their ability to do their job, although 82% (n=1114) reported not taking time off work. For those with long-term absence due to back pain, there was a reduction of 10.5 days in the median absence following introduction of the new service.
The majority of service-users (n=1281, 95%) considered that this service would prevent them needing to make future visits to their doctor or other healthcare professionals. Nearly all staff (n=1376, 98%) reported that the service improved their impression of the Trust as an employer, with 790 (58%) rating it in the top 10% of employers.
The qualitative study identified 6 themes and 40 sub-themes and showed the service was highly valued by service-users. Key findings included health and work impacts: return to normal activities and hobbies; enhanced injury awareness and self-management; improved employer-employee relationships; and prevention of sickness absence.
Conclusion(s): On-site, direct access to physiotherapy was highly valued by hospital workers, helped reduce presenteeism, sickness absence for musculoskeletal symptoms, demand and time out for doctors' appointments. This service highlights the ability of physiotherapists to influence attitudes, behaviours, health and well-being.
Implications: Broad implementation of physiotherapy self-referral services for healthcare workers could enhance employer-employee relationships and significantly reduce sickness absence due to musculoskeletal disorders, thereby maintaining staffing levels and patient safety.
Keywords: Musculoskeletal disorders, self-referral, sickness absence
Funding acknowledgements: NHS England Healthy Workforce Programme and UHS. LR is supported by a National Institute for Health Research senior clinical lectureship.
Topic: Musculoskeletal; Occupational health & ergonomics; Service delivery/emerging roles
Ethics approval required: Yes
Institution: University of Southampton
Ethics committee: Faculty of Health Sciences
Ethics number: 26393
All authors, affiliations and abstracts have been published as submitted.
