How multidisciplinary index has moved rail health and wellbeing from the sidings

Occupational health practitioners are increasingly embracing multidisciplinary working.  Nic Paton speaks to the team behind the Rail Safety and Standards Board’s Health and Wellbeing Index, which is changing the OH conversation on our railways, and won ‘Best multidisciplinary initiative’ at the 2021 Occupational Health & Wellbeing Awards.     

In November last year, the Rail Safety and Standards Board (RSSB) published a study which suggested that more than two in five (43%) of employees in the rail sector met the clinical criteria for a mental health condition, and that the mental health of many within the sector had deteriorated over the course of the pandemic.

This, if nothing else, illustrates that, while health and safety always has to remain a priority for rail operators and employers, it mustn’t be at the expense health and wellbeing.

This imperative to better understand and manage the often-complex health and wellbeing needs of rail workers was a key driver behind RSSB developing a new cross-industry Health and Wellbeing Index (HWI), a move that won it ‘Best multidisciplinary initiative’ in the 2021 Occupational Health & Wellbeing Awards.

The index, which RSSB’s principal strategy implementation manager for health and wellbeing Dr Michelle O’Sullivan also wrote about in December, was developed in response to the recognition that there has been a lack of good-quality data on health and wellbeing available within the industry or being collected.

This, in turn, has limited the industry’s ability to benchmark or understand what good looks like in rail and has too often meant safety – where the data and benchmarking will often be much clearer – ends up being prioritised over health when it comes to focus, engagement and investment.

The HWI involves weighting different health conditions according to the severity of their effect and has been designed to help rail companies monitor the health of their employees in much the same way as the industry’s long-standing Fatalities and Weighted Injuries Index (FWI), meaning it is already familiar.

It also means that, for the first time, organisations with the sector have access to a shared health data system, can build health data dashboards, and can benchmark against others. It can be used to produce tangible, single measures of the health and wellbeing of a workforce, from which business cases can be made for investment and or decisions informed around health management. The index encompasses musculoskeletal disorders, mental health conditions, hand-arm vibration cases and respiratory issues.

Collaborative effort

Its multidisciplinary element was the fact it was created by both a multidisciplinary team at RSSB and through a multidisciplinary industry effort, as Dr Ann Mills, head of health and safety at RSSB, tells OHW+.

“At RSSB, it was a combination of health economists, health professionals (including occupational health), clinical psychologists, safety and risk professionals, data experts and modellers, among others. Each person brought a different perspective and a piece of the puzzle together,” she says.

“But it was not just RSSB’s team. It was about bringing on board those people who have got to utilise it; it comes back to making sure that whatever you’re developing can actually be used by industry and colleagues. It is no good doing something that is incredibly scientific and robust if the outputs don’t resonate or can’t be used by the businesses,” she adds.

Once constructed, for example, the HWI was tested by a number of different rail companies, with pilot participants including Network Rail, VolkerRail, OH teams at two train operators and a large construction company. In addition, the Department for Transport, Health and Safety Executive, the Office of Rail and Road and Leeds University’s Institute for Transport Studies were all actively involved.

It was this close collaborative teamwork that caught our judges’ eyes. The HWI was described as “much needed”, with one judge adding: “The creation of the index illustrates how, by working together, the rail industry has brought a new focus to health and wellbeing, one that, I am sure, will bring considerable long-term dividends.”

What’s more, the input, expertise and leadership of occupational health practitioners was critical, Dr Mills explains.

“Occupational health were ultimately the experts who allowed us to say, for example, one day of sickness relates to however many MSDs. It is that expertise and also specifically understanding it in the context of the rail industry. That was really critical to the development of the tool,” she says.

“We couldn’t have done it without occupational health professionals,” agrees John Halsall, managing director of Southern Rail and chair of the Rail Wellbeing Alliance, which works to inspire healthy lives across the railways.

Health and wellbeing conversations

Since winning in the Occupational Health & Wellbeing Awards, the HWI has expanded in scope and remit, explains Dr Mills. “Originally it was piloted with nine companies but now, demonstrating what it looks like on the dashboard and how the information is being used, there are another three that are already using it and more in the pipeline. So there is real momentum in terms of organisations utilising the index,” she says.

“Six-monthly benchmarking meetings are now also being held where relevant companies are brought together. It could be the train operating companies or it might be one for various sectors, so they have commonality in the challenges they are facing. It might be that their record in a particular area is not so good, but another organisation’s is. So, using the index allows them to think about what they need to be doing, how can they learn?” Dr Mills continues.

“It is certainly being used and is really now a cornerstone of the industry in terms of how we can encourage our colleagues to see health and wellbeing as being at the same level as how we manage safety.

“It is really a groundswell of trying to get people to think about health and wellbeing in the same way as we think about safety; bringing health and wellbeing up to the safety, which is an area where we are quite mature in terms of its management. It is really exciting,” Dr Mills adds.

The HWI’s success in raising the profile of health and wellbeing is important, given how often safety, fatalities and injuries – for very good reason of course – can dominate the health conversation within this sector, points out Halsall.

“It is progressing but we’re also not in a rush with it at all,” he explains, highlighting that the FWI developed over decades. “The reason we’re excited about it is that it is the beginning of a journey and something tangible that we can promote. What’s more, it doesn’t need to be limited to our industry; it is something that we really want to promote more widely.”

Halsall emphasises how the prevalence and frequency of, say, mental ill health and musculoskeletal injuries can have a massive impact on a sector such as rail, yet too often won’t end up getting the same attention or investment as managing risk, safety, injuries or accidents.

“You’re 15 times more likely to have a day off work as a result of mental health issues than you are for every form of workforce incident or injury put together. You are six-and-a-half times more likely to have a day off work as a result of musculoskeletal injuries than every possible workforce injury put together. The list goes on,” says Halsall.

“So, one can argue that we should be spending 15 to 20 times more of our leadership energy on health and wellbeing than we do on workforce safety. You can look at it through the lens of caring about people or you can look at it through the lens of helping to everyone to get home safe, or you can look at it through the lens of the economics. Whichever lens you look at it, we should be doing an awful lot more.

“Meanwhile, if you look at the statistics associated with suicide, typically one in about 7,500 men take their own lives a year; it is a man’s problem more than a woman’s problem. Network Rail employs about 35,000 men (out of a total of around 42,000 people). So in any given year we can expect four or five people to take their own lives. And we work in five-year control periods, so we could say something like 25 to 35 people will kill themselves in our control period,” Halsall adds.

By being able to provide reliable, consistent metrics, the HWI is now managing to shift that dial, Halsall argues. “Every period now in Network Rail executive meeting, we review the HWI and there is a commentary.

“It is very easy to get fixated with absolute numbers, and HWI isn’t as mature as FWI. But to some extent that doesn’t matter; the most important thing is trends. So, are we getting better, are we getting worse? If we’re getting worse, why are we getting worse, what are we doing about it, what are the interventions? If we’re getting better, do we understand whether it is luck or judgement?

“All of those conversations are now taking place within the executive of Network Rail as a direct result of HWI. This is transformational, not so much because of the accuracy or otherwise of the indicator but simply because it is there, it is present, and people start to talk about it. It just creates this virtuous circle that doesn’t exist unless you put it on the table,” Halsall adds.

Understanding effective interventions

What, then, do Dr Mills and Halsall suggest makes for an effective occupational or workplace health initiative; what makes an intervention resonate?

“If we can shift the language from ‘occupational health’ to real stories and a real narrative, which you and I can engage with and go ‘wow, I totally get that’, that is what we’re about,” advises Halsall.

“It is not complicated and it’s not about being ‘generous’ and or ‘kind’ to your workforce; it is a business decision in terms of engagement and efficiency, but the trouble is that we have lost the connectivity. HWI just allows you suddenly to have a little bit of a ‘eureka moment’, when you realise this is a huge opportunity that we’ve been missing,” he adds.

“I think one of the things that makes interventions work engaging actively with the people who are there, who it is aimed at; involving them in the intervention itself,” agrees Mills. “It is about having them involved in developing it; they have got to want to own it. I think their involvement is one of the critical things.

“It is about recognising you need constantly to re-engage with the people the intervention is aimed at, both in its development but also in terms of getting them to pick it up. We mustn’t forget, too, that it is critical to engage the leadership and any cultural change. They need to own it and be accountable for it at board level.

“I think there is also something around programme management. It is not just leadership, but we need to make sure that health and wellbeing or occupational health is embedded in companies’ competency and performance management frameworks. How do we get our managers and supervisors to consider the health and wellbeing of their teams, and how do we support them? Our top leaders through to our managers and supervisors through to frontline staff – they all have a part to play in making interventions work,” Dr Mills adds.

Finally, as all our 2021 winners have highlighted, the kudos and peer and industry validation that comes with winning an award is important to team morale, motivation and recognition. But whether you win or not, even simply the reflective process involved in entering an award can be valuable in terms of kickstarting conversations around what you’ve achieved, what you’ve done well and where you could perhaps improve.

“It is always good to be recognised and valued by colleagues, and not just colleagues within the rail industry, about your achievements,” agrees Dr Mills. “I think the railways should be really proud of the work we are talking about but also how it is trying to tackle occupational health inequalities. It basically builds awareness and confidence that we are making a valuable difference to people who work in the sector. Also, it prompts interest; people talk about it.

“The RSSB team, certainly, is actively promoting it. Winning an award initially gets people interested and then as they see the power of the tool, it is like a magnet, it brings more people to the party. For me, that is the benefit of winning an award such as this,” she adds.

“It is lovely for the individuals involved of course, because you are celebrating success,” says Halsall. “There is undoubtedly something about, where you are trying to convince somebody that you’re best, that you do put some more thought into it. There is the wider independent validation and, through that, you’re promoting your expertise.

“The more awards there are, the more people recognise that and potentially learn from it. So it is really important, and I am really grateful for the award,” he adds.