Writing a good Occupational Health (OH) report is an essential skill of any OH professional. It is our product that we sell and therefore needs to look professional and be useful. Every OH report, whether we like it or not, reflects the OH profession so writing a poorly constructed and written report with no added value gives the customer a poor view of the usefulness of Occupational Health. Whether an in-house provider or an external provider, all OH professionals have a customer and that is the individual who commissions the report.
We always advocate that an OH report is only as good as the referral; however, there are some basics that we should always get right. As a profession which is prefaced with qualifications such as a nurse; doctor; physiotherapist; psychotherapist etc. as well as a specific Occupational Health qualification; there will always be expectations that need to be met due to our qualifications. Points such as these aid the impression of professionalism: –
- spelling and grammar;
- professional language;
- avoiding medical terms that the manager cannot understand;
- presentation with a unified font; equal spacing; titled paragraphs
- succinct and to the point
- not copy and pasting into the report
- signed with full name and qualifications
- answering the manager’s questions
The employer is paying for the report either indirectly or directly and as such the report should always add value. Although we aim to provide information to the manager; our goal is also to break down barriers to work and support an individual to return or remain in work.
It is essential to read the referral and understand what it is that the manager wants to know. Always keep the referral information and questions in front of you when undertaking the referral to understand the direction the consultation needs to go in. An example is a referral of an individual recovering from a cardiac arrest asking if they would be at risk of COVID; the report in return advises on the individual’s fitness to return to work and does not address the COVID risk.
An OH professional (OHP) needs to understand their own bias and ensure this not brought into the report. Our role is to be independent of both employer and employee and therefore evident judgement of either party would be detrimental to both and OH would lose credibility. For example, if the OHP reflected in the report that the individual had been poorly treated at work whilst only receiving this information from the employee; the report would be biased towards the employee. However, if the clinician indicated that the individual felt they were badly treated then it would provide information to the employer and support for the employee (with consent of course).
If the individual has had poor clinical care via the NHS then it is very useful for the employer to know this. If the individual could be making several changes to improve their health and therefore workability, don’t say this in the report as they are likely to withdraw consent. If you signpost to validated resources for self-help or make suggestions on how they can improve their health then by mentioning this in the report, you will be demonstrating your added value as a clinician and will be allowing the manager to follow up with the individual.
The report needs to justify the advice to management. It is not helpful to advise that an individual is not fit for work or requires a phased return without substantiating this. It is not good enough for us to say that managers need to understand that we are the experts. Human nature means that we need to understand why we are being asked to do something and we are more likely to do so if we understand. An example is an HR manager who sent instructions to managers based on the OH report without providing the report – not surprisingly the managers never made the adjustments. As soon as they obtained permission to send the report to the manager; the adjustments were made.
The advice in the report must be relevant to the organisation to make it practical and useful and needs to answer the employer’s questions
The report needs to be evidence-based. For example, if we say that an individual is not fit to attend a work-related meeting then we must base this on the FOM evidence. If we state that their health condition will impact on their ability to concentrate or work night shifts then we need to back this up with the evidence. Reports can be used in tribunals with or without our knowledge and therefore will be scrutinised. A thought to hold in our heads when writing a report is what impact it may have on the individual’s job. It may be that the employee is wholly unmotivated to return to work during your consultation but in a week or two they may change their mind. Never hesitate to state (should the circumstances fit) that although you feel someone could return to work; they disagree and do not feel a return to work is feasible. That way, if they change their mind, your report stands.
Always ensure that your report is bespoke to the individual. Reports providing generic information about a condition makes it look like the report is being padded out and doesn’t help either the individual or the manager. It can be useful to provide information about a condition (with consent and based on the referral) but it must be matched to the person to make it relevant and useful.
The advice in the report must be relevant to the organisation to make it practical and useful and needs to answer the employer’s questions fully. Any interventions that could support an earlier recovery and return to work or assist with remaining in work, for example, physiotherapy or psychological support must be advised even if it is only to direct the individual to the GP (should the organisation not support this). Advice needs to be qualified with a statement that it is a management decision whether the advice can be actioned to ensure the expectations of the employee aren’t raised. Should they be disappointed, then there is the potential that we in OH have caused a relationship rift which would be contrary to our goal of breaking barriers to work.
In conclusion. A well-presented, professional report which is relevant to the referral; evidence-based and justified; bespoke to the individual and provides clear pragmatic advice which is useful for the manager will demonstrate the added value of OH.
Janet O’Neill RGN, Dip OH, MSc
Janet is iOH Director of Professional Development and Clinical Director of PAM Group Ltd.