I have reflected on Christmas in previous years (December 2018 and December 2019) so I will move on from Christmas to the opportunities that the new year brings. In particular, how we can learn more about the services that we provide and how they are perceived by our customers – hereafter called disadvantaged individuals (DIs).

Purchasers of services are always looking for evidence that the services they buy are meeting the needs of their DIs. For vocational rehabilitation professionals (VRPs), this might be a simple classification e.g. returned to some form of paid employment/education or not, or retirement on medical grounds. Does this end-point arrive at the conclusion of the vocational rehabilitation contract – if time-limited or when the VRP concluded that further interventions would not be helpful? Was the return to work (RTW) full time or part-time with or without modifications, working from home or in the office or both? What was the total duration of sickness absence (SA)? Alternatively one might measure results for a predetermined time period e.g. one year [1]. Lastly, what does the DI feel about the RTW process and your part in it?

For some members of the VRA, all this data is routinely collected, but many VRPs are relatively new to the profession and may need to think this through. It is surprising how much information can be collected relatively simply and the first thing to think about is whether to collect this information by telephone or by post. My experience in setting up a new service was to get the team together and ask what information we wanted to collect. Unsurprisingly different professional groups wanted different data and we ended up with 5-6 page questionnaire which we completed by telephone interview – usually done whilst waiting for DIs to arrive – delayed by ambulances – or at the end of the day. It usually took about 10 minutes to complete and yet the data collected was unique and published in the international literature [2].

So what might your DIs tell you about your service? Apart from the obligatory questions about satisfaction with all aspects of the service (both clerical and clinical), some open-ended questions might be revealing:-

• Please could you tell us what you felt was the most helpful aspect of the service we gave you? Leave plenty of space as there may be more than one answer!
• Please could you tell us if there are any ways you feel we could have helped you more? Again plenty of space may be needed!
• Specifically, in terms of getting you back to work, what did you feel was most the most helpful intervention….? open-ended question
• Were any of the following interventions helpful (if appropriate) – e.g.
  • Initial discussions with you and your employer
  • Constructing a RTW plan
  • Negotiating flexible working
  • Working from home
  • Negotiating for time off to attend treatment or outpatient visits
  • Were there any interventions that turned out to be unhelpful or that your employer refused to implement
  • Other?

Alternatively, you may be more interested in other aspects of the rehabilitation process e.g. the effect of your intervention on the DIs mood, pain experience or mobility. In this situation, the critical thing is to have a good outcome measure that you can introduce early in the assessment process and this can then be utilised at set periods during the rehab programme and completed finally at the end of your interventions.

Of course, all this takes time and those who are paying for your service may not want to facilitate this if you choose to discuss this aspect of practice with them. However:-

• You can point out to them that this is part of ‘reflective practice’ that you are obliged to perform as part of your professional practice
• The results may have already influenced your practice for the better e.g. by finding out things that you had not thought of as being significant for your DIs. E.g. we found out that DIs fell out of their wheelchairs – which we never thought to ask about [2]
• The initial results can act as a standard for your future practice and further audit might show that you are improving – or that changes in practice forced on you by others had been counter-productive!
• Evidence of effectiveness of your interventions must be useful in getting new referrals
• Referral to the literature may show that your findings are of more general interest and thus worthy of publication. This is particularly important in the UK as purchasers are sceptical and UK data is scarce!
• You may also find out that things that are of fundamental importance to your DIs are outside your control e.g. the time from an injury to the time that referral took place. This might strengthen your battle to get earlier referrals?

May I wish all VRPs a very happy Christmas and a reflective New year?

I am happy to discuss any of the issues raised in these reflections with colleagues who can email me at andrew.frank1 at btinternet.com and head the email VRA – professional reflections.

Andrew Frank

Trustee and Past-Chair, VRA.

References

1. McLeod, C.B., et al., Identifying return-to-work trajectories using sequence analysis in a cohort of workers with work-related musculoskeletal disorders. Scandinavian journal of work, environment & health, 2018. 44(2): p. 147-155.
2. Frank, A., et al., Introduction of the new NHS Electric Powered Indoor/outdoor Chair (EPIOC) service: benefits, risks and implications for prescribers. Clin Rehabil, 2000. 14(December): p. 665-673.