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Proposed Model of Care and Workforce Plan The Future Requirements For Occupational Health Physicians in the Health Service, Ireland. Submission to National Doctors Training and Planning from Workforce Health and Wellbeing Unit
Document developed by Dr Lynda Sisson Consultant and Accredited Specialist in Occupational Medicine National Clinical Lead in Workplace Health and Wellbeing MB BCh BAO MPH ACOEM FFOMI MCRN 012552
Sibéal Carolan Workforce Development Lead MSc , R.N.T,.R.G.N.,R.C.N. NMBI Registration Number 4838
May 22nd 2017
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Table of Contents
Introduction ..................................................................................................................................... 4
Setting The Context .......................................................................................................................... 5
Mapping of Occupational Health Services 2016 ............................................................................. 5
Service Delivery Units ................................................................................................................. 6
Table 1 Acute Services Profile .................................................................................................... 6
Table 2 .Community Services Profile .......................................................................................... 6
Table 3.Additional Staff ............................................................................................................. 6
Current Occupational Health Metrics ............................................................................................ 7
Integrated teams within Occupational Health Services ................................................................ 16
Information Communications Technology within Occupational Health Services .......................... 16
Drivers of Change ........................................................................................................................... 16
Table 4 . Public Health Service Employment ............................................................................. 18
Mission and Values of the HSE .................................................................................................... 19
Proposed Model of Care for Occupational Health Services in the Health Service in Ireland ............... 20
Background ................................................................................................................................ 20
The Experience of Occupational Health in the NHS, UK ................................................................ 20
WHWU Proposed Model of Care for Occupational Health Services in Irish Health Services ............ 21
Context ...................................................................................................................................... 21
1. Minimum Service Levels for Occupational Health Services .................................................... 22
2. Occupational health data collection and information sharing in the Irish Health Service ........ 23
3. Engagement of and with Occupational Health Services in the Irish Health Service ................. 24
WHWU’s Workforce Planning Methodology to support this Model of Care ...................................... 24
Context and National Approach .................................................................................................. 24
Supply and Demand Analysis ...................................................................................................... 26
Overview of the Occupational Health Physician Establishment in the Irish Health Service ......... 26
Table 5 .Overview of current specialist posts in the Irish Health Service ...................................... 26
Current Medical Career Pathways for Occupational Health Physicians .......................................... 27
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Faculty of Occupational Medicine, Royal College of Physicians in Ireland ..................................... 27
Current Levels/Grades ................................................................................................................ 27
Occupational Health Physicians and Irish Health Service Trends ................................................... 27
Specialist Registrar Training Positions.......................................................................................... 28
Alternative Pathway ....................................................................................................................... 29
Developing the Workforce Plan for the Heath Service ..................................................................... 29
Projected Need for Occupational Health Physicians 2017-2026 ................................................... 30
Table 6 Estimated Projections for Occupational Health Physician Posts for 2017-2027 .............. 30
Current Succession Planning ....................................................................................................... 31
Table 7. Profile of progression of Current Specialist Registrar Training ...................................... 32
Proposed Succession Planning ........................................................................................................ 33
Actions ........................................................................................................................................... 34
References ..................................................................................................................................... 35
Appendices .................................................................................................................................... 36
Appendix 1 Framework for Health and Wellbeing ........................................................................ 36
Appendix 2. Standards for Occupational Health Services .............................................................. 37
Appendix 3. Metrics to Monitor Quality of Occupational Healthcare ............................................ 39
Appendix 4 Measurement of demand ......................................................................................... 40
Appendix 5 Departmental Structure ........................................................................................... 41
Appendix 6 Capability Assessment .............................................................................................. 42
Appendix 7 Staffing Establishments ........................................................................................... 45
Appendix 8 Work & Well-being Survey (UWES) © ........................................................................ 47
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Introduction
The Workplace Health and Wellbeing Unit was set up in March 2016 under Priority 2 Staff Engagement within the Health Services People Strategy 2015-2018. [www.hse.ie]. With reference to the HSE People Strategy 2015-2018 “We have clearly defined workforce planning as a key component of our people strategy and we recognise that “across the health system a talented, committed workforce through their collective knowledge, skills and hard work provide excellent health services to those who need care and to the wider community”. [www.hse.ie]
The areas of governance and responsibility for the Workplace Health and Wellbeing Unit are:
Occupational Health Services
Health and Safety Function
Employee Assistance Programmes
Staff Health and Wellbeing
At a time when health resourcing costs are contracting, it is vital that services examine the potential to
maximise the efficiency of their services and resources. The objective of workforce planning is to
develop knowledge and intelligence data on the workforce, to inform decisions at local level and to
drive improvements in Occupational Health service outcomes. Buchan (2001) defined workforce
planning “the method of achieving the “best” mix of staff and skills, required to deliver a defined level
of care in a defined area of “organisational activity”.
Occupational Health Services are reasonably well established in the Irish health care setting, however
the future of the services have never been defined using a planned approach at national level As such
this is the first initiative to identify and calculate the requirements for the future that ensure a
sustainable future for the specialty and the service.
This document presents information on current Occupational Health Physician Staffing Establishments
in the Irish Health Service, and it proposes a model of care for future delivery of Occupational Health
Services provision in the Health Service in Ireland, and finally it articulates WHWU’S approach to
maximize Occupational Health Physician roles in the context of workforce planning within the service.
Recommendation 1. A National Workforce Plan for Occupational Health Physicians should be developed in 2017. The Faculty of Occupational Medicine is the Professional Body responsible for the co-ordination of a National Workforce Plan. The WHWU will support this project and provide necessary expertise.
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Setting The Context
The setting up of the Unit in March 2016 was in response to a number of reports and recommendations
over the years. The Report of the National Task Force on Medical Staffing, 2003 (The Hanly Report)
clearly recommended improvements in the organisation, structure and staffing of hospital systems to
deliver care at its best. The McDonald and Melly review of Occupational Health Services in the Health
Service Executive Dublin NE, 2008 and the publication of a Proposal for a Unified Health and Safety
Function 2015- Consultation Paper following a Review of Health and Safety Performance within the
HSE. Finally the publication of the Healthy Ireland Strategy (2014-2017) and the HSE people strategy
(2015-2018), led directly to the set up of the WHWU as part of the HR portfolio.
Key Work Areas are as follows:
Comprehensive Integrated and Streamlined Supports for Employees in the Irish Health Service
Providing a safe environment in which to work for all staff through standards and compliance with Health and Safety Legislation
Development of Standards and a Quality Improvement Tool for Occupational Health Services
Development of Standards and a Quality Improvement Tool for Employee Assistance Programmes and allied services
Promoting Positive Health and Wellbeing for all staff under a defined framework
Mapping of Occupational Health Services 2016 In April 2016 the Occupational health Services across Ireland were mapped. The following data was
generated.
Occupational Health Physicians: Please refer to Table 5 to page 27. Registered Nurses in Occupational Health Services 81 * excluding agency . 50 in Statutory and 31 in Voluntary Administration staff 47* excluding agency. 35 in Statutory 12 in voluntary Other grades Manual Handing Advisor 3 Senior Physiotherapist 1 Multi task attendant 1 Psychologist 1 Data Manager 1
Agency /outsourced provision of Occupational Health Services since the Melly Report (2008) has risen
year on year and currently stands at 25%. Occupational Health Services are largely based in acute sites
but serve a population across community and acute sites. Please refer to Table 1, 2 and 3 on page 6 .
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Occupational Health Services are provided to the following Service Delivery areas
Table 1 Acute Services Profile
Service Delivery Unit Staff Population
RCSI Hospital Group 9358
Ireland East Hospital Group 11270
Dublin Midlands Group 12206
Saolta Hospital Group 9548
South /South West Hospital Group 10786
University of Limerick Hospitals Group 4078
Childrens Hospital Group 3229
Table 2 .Community Services Profile
Service Delivery Unit Staff Population
Community Health Organisation 1 Donegal /Sligo/Cavan /Monaghan
5374
Community Health Organisation 2 Galway /Roscommon/Mayo
5481
Community Health Organisation 3 Clare /Limerick /North Tipperary
4539
Community Health Organisation 4 Kerry /North Cork /West Cork
7566
Community Health Organisation 5 South Tipperary /Carlow /Kilkenny /Waterford/Wexford
5008
Community Health Organisation 6 Wicklow /Dun Laoghaire /Dublin South East
4897
Community Health Organisation 7 Kildare /West Wicklow /Dublin West /Dublin South City /Dublin South West
6382
Community Health Organisation 8 Laois /Offaly/Longford/Westmeath /Louth /Meath
6736
Table 3.Additional Staff
National Ambulance Service Health Business Services Primary Care Reimbursement Service Corporate Services
5000
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Current Occupational Health Metrics
The following section presents an overview of the type of activity undertaken in an Occupational
Health Service. The data identifies the key specialised and important services that are provided by an
occupational health service. This data is recorded on a quarterly basis. Current ICT systems present
challenges in terms of recording, tracking and interpretation. A new ICT system is due to be in place for
year end, this will assist data collection and interpretation .
1. Pre Placement Health Assessment Numbers
Paper Screens
OHN medical
OHP medical
2. Surveillance Defined as a programme of systematic health checks to identify early signs and symptoms of work
related ill health and to allow action to be taken to prevent its progression.
Surveillance Type Numbers
Audiology
DSE /VDU eye tests
Night worker questionnaires sent
Pulmonary Function Tests
Category 1, Non Protection
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3.Immunisation Status
TB Status Numbers
Positive IGRA
Positive TST’s
Referrals to Respiratory Services
Requiring LTBI Treatment
Active TB diagnosis
Vaccinations Numbers
Hepatitis B Primary Course1st vaccine
Hepatitis B Primary course2nd vaccine
Hepatitis B Primary course3rd vaccine
Hepatitis B accelerated course1st vaccine
Hepatitis B accelerated course2nd vaccine
Hepatitis B accelerated course3rd vaccine
Hep B Booster
Hep A & B Combined 1st vaccine
Hep A& B Combined 2nd vaccine
Hepatitis A& B Combined3rd vaccine
Hep B secondary 1st vaccine
Hep B secondary 2nd vaccine
Hep B secondary 3rd vaccine
Hep A 1st vaccine
Hep A 2nd vaccine
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BCG
MMR1st vaccine
MMR 2nd vaccine
Varicella1st vaccine
Varicella 2nd vaccine
Pertussis
Influenza
Revaxis
Diftivax
Other:
Blood Tests Numbers Hep B Titre
Hep B Core
Hep B Surface Antigen
Hep B Repeat Serology
Hep B Viral load
Hepatitis A serology
Measles
Mumps
Rubella
Varicella
Hep C antibody
Hep C PCR
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HIV
Serum to Hold
FBC
U&E
Glucose
LFT
Lipid Profile
Carbohydrate-deficient transferrin (CDT’s)
Other:
4. Occupational Blood Exposures (OBE) Numbers Significant Injuries
Percutaneous
Human Bite ( which breaks the skin)
Exposure of Broken skin to blood/ body fluids
Exposure of mucous membranes to blood and body fluids (including the eye)
Non-Significant injuries
Superficial graze not breaking the skin
Exposure of intact undamaged skin to blood and body fluid.
Exposure to sterile or uncontaminated sharps
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Occupational Health Key Metric
Metric Source Notes Number and %
Completeness of hepatitis B immunisation
OH Records Number and % of sharps injuries managed in which injured member of staff was fully immunised against hepatitis B
5. Referrals Numbers
New Self referrals
New Management referrals*varying in
complexity
6.Critical Illness Policy Assessments Type Numbers
Clinic Visit
Paper assessments
Meet Criteria
Failed to Meet Criteria
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Occupational Health Key Metric 2, 3, 4:
Metric Source Notes Range
Time from receipt of management referral to first appointment
OH Records Frequency distribution
Time from first appointment following receipt of management referral to delivery of a report to the manager
OH Records Frequency distribution
Prevalence of referral of musculoskeletal disorder for treatment
OH Records Number and % of patients seen after an absence Health & Wellbeing Improvement Framework of > 4 weeks because of a musculoskeletal disorder, who are under care of or have been referred to a treatment service by 6 weeks from the start of their absence
Number and %
7.Referrals to Other Departments
Department Number
Physiotherapy
Dermatology
Orthopaedics
Psychiatry
Occupational Therapy
Functional Assessment
Other
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8.Disease Outbreaks by Incident
Type No. of No. of
Incidents Staff Exposed
Norovirus
H1N1
Seasonal Influenza
Vomiting & Diarrhoea – unconfirmed
TB
Scabies
Bacterial Meningitis
Strep A
Varicella
Measles
Mumps
MRSA
SSSS( Staphylococcal Scalded Skin Syndrome)
Parvovirus B19
E Coli 0157
Other
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9.Telephone Consultations – (Not part of Management Referral and Self-Referral, lasting>15 minutes)
Number of
calls
10 .Education & Training
Training No. of Sessions No. Of Attendees
Sharps Training
Induction
Other
11. Presentations No. of Sessions No. Of Attendees
12.Feedback Questionnaire Name of Survey Response Rate
Client Feedback
Manager Feedback
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13. Number of Meetings/ Committees Attended
Name of Committee Number
Health & Safety
Radiation Protection
Infection Control
Quality & Risk
Other
14. Audits
Title of Audits Total Numbers Completed
This section has listed the type of activity provided by an Occupational Health Service. It demonstrates
the various types of activity ranging from direct healthcare worker consultations, indirect activity and
associated work. It must be acknowledged that Occupational Health Service provision involves clinical
expertise and significant partnering with other services.
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Integrated teams within Occupational Health Services
Although the focus of this document is on Occupational Heath Physicians within the Irish Health
Service , it must be noted that the WHWU is also conducting a number of workforce planning projects
in relation to the role of the Advanced Nurse Practitioner, Clinical Nurse Manager, Clinical Nurse
Specialist, administrative roles and case manager roles in occupational health services. The WHWU
recognises the importance of inter professionalism in the context of workforce planning. The Unit is
working on a number of transformational leadership projects for example the development of National
Standards for Occupational Health Services, Standards for Employee Assistance Programmes and the
development of a Healthy Doctor’s Strategy. Each project involves teams from across the disciplines
with clearly defined outcomes and a structured governance framework.
Information Communications Technology within Occupational Health Services
The WHWU recognises that the use of a national IT system is essential for information sharing and data
collection in order to meet standards and Key performance Indicators. The WHWU is commissioning a
new ICT for 2017/2018 as a priority. This will be central for data collection and management
/interpretation of data.
Historically a number of ICT systems are in place across Occupational Health Services in Ireland. There
are two comprehensive OHS systems available nationally both of which have been invited to tender for
service for a national system. It is recognised that the introduction of a national contract will result in
economies of scale and the costs of introducing the new system will reduce in existing spend in the
national service. This is a key transformational project for the Unit and is expected to be completed by
year end.
Drivers of Change
The WHWU approach to work and activity will focus on transparency, flexibility and project-based
work. It will involve transformational collective leadership.
Occupational Health Services and Standards
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Occupational Health Services are reasonably well established in the Irish health care setting.
Following an international trend many OHS services were seeking an accredited service that would
encourage standardisation of services .One of the first priorities of the newly formed Workplace Health
and Wellbeing Unit was to commence a review of existing International OHS Standards. An approach
was made to Health Information and Quality Authority. Following discussions, it was agreed that the
service would develop unique standards in line with the Quality Assurance Framework (QAF) Safety and
Quality Improvement Directorate.
A workshop was held with HIQA to discuss the format and process to develop standards under this
Framework. A Standards Project Group first met in October 2016 and on 6 occasions since. The group
included representatives from Health and Safety, Staff Health and Wellbeing and Occupational Health
Services Nationwide. In accordance with the Framework, an Expert Advisory group was convened and
presented with an early draft in November 2016 and launched in May 2017.
Information Technology:
The potential to utilise IT as a means of delivering efficiency, reporting and as a stated requirement
from staff involved in WHW activity was set out in detail in the Workplace Health and Wellbeing 2017
business plan.
Significant support from the Office of the Chief Information Officer will result in key deliverable of a
standards based IT system in 2017. The delivery of a cloud based E-Health system to support the work
of occupational health, employee assistance and related activity is on target for delivery in 2018.
Changing Workforce Nationally and Internationally
The World Health Organisation Report 2016, ‘Working for Health and Growth’ has recommended
investment in the health workforce to stimulate and guide the creation of at least 40 million new jobs in
the health and social sectors, and to reduce the projected shortfall of 18 million health workers.
In 1976 the Faculty of Occupational Medicine was established at the RCPI and a 4 Year Specialist
Training Scheme in Occupational Medicine commenced in 2000.
Occupational Medicine is a clinical medical speciality that deals with the interface between health and
work. Occupational Medicine involves preventative programmes such as vaccinations, surveillance,
rehabilitation, advisory roles and optimising the health of employees.
Although the role of the Occupational Health Physician has remained essentially unchanged for a last
number of decades, the context has changed considerably.
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The Role of the Registered Nurse working in the Occupational Health Service will also be developed
with defined capabilities, competencies and up skilling in the WHWU Workforce Plan.
The total number of Whole-time Equivalent staff employed in the public health services during the past
decade has increased by 7% since 2014.
The total number of consultant and non consultant hospital doctors has increased by almost 23% since
2007 with the largest increase of 26% in consultant posts. Non Consultant Hospital Doctors have
increased by approximately 21 % during the same period. [Department of Health Trends - 2016]
There is a current total population of healthcare workers of 140,000. This include health service
workers from both the HSE and the Voluntary Sector. As our working population ages teh demand for
OHS will invariably increase
It is imperative to view the levels of Public Service Employment as this has a direct effect on
Occupational health Physician demand and deliverables .
Table 4 . Public Health Service Employment
Grade Category 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 % Change
2007-2016 2015-2016
Medical/Dental 8005 8109 8083 8096 8331 8320 8353 8817 9336 9587 19.8 2.7
Nursing 39006 38108 37466 36503 35902 34637 34178 34509 35353 35534 -8.9 0.5
Health and Social Care Professionals#
15705 15980 15973 16355 16217 15717 15844 13640 14578 15109 -3.8 3.6
Management/Administration
18044 17967 17611 17301 15983 15726 15503 15112 16164 16554 -8.3 2.4
General Support Staff
12900 12631 11906 11421 10450 9978 9700 9419 9494 9444 -26.8 -0.5
Other Patient and Client Care
17846 18230 18714 18295 17508 17129 16883 17829 18960 19658 10.2 3.7
Total
111506
111025 109753 107972 104392 101506 100460 99327 103884 105886 -5.0 1.9
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Other drivers of change include the proposed new model of care that is outlined in the next section.
Mission and Values of the HSE
The HSE Mission clearly states that people in Ireland are supported by health and social care services to
achieve their full potential. It identified access, safe, compassionate and quality care as priorities. The
HSE Corporate Plan 2015-2017 set our values of Care, Compassion, Trust and Learning.
With the proposed changes in the Irish Health Services and the development of commissioning
services/service provision in the CHO /Hospital Group Model, the most effective model of care is a
central governance unit i.e. WHWU with areas covered geographically by defined Area /collaborative
service delivery units, this is referred to as a “hub and spoke” model . The structure of each hub
will include occupational health physician services , occupational health nursing services ,employee
assistance programmes , rehabilitation services, health promotion , health & safety, and the provision
of governance and support.
The targets for the area /collaborative service delivery units, “hub and spoke” model will be exactly as
described by the Healthy Staff, Better Care for Patients. www.dh.gov.uk 2011.
In order to met these service needs there must be integration with local health and Safety, CISM
services, rehabilitation services, health and wellbeing and counselling services.
1. Prevention – of ill health caused or exacerbated by work
2. Timely intervention- easy and early treatment for the main cause of sickness absence.
3. Rehabilitation – to help staff stay at work or return to work after illness
4. Health Assessments for work- to help manage attendance, retirement and related matters
5. Promotion of health and well being – using work as a means to improve health and well being and
using the workplace to promote health
6. Teaching and training – encouraging staff and managers to support staff health and well-being
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Proposed Model of Care for Occupational Health Services in the Health
Service in Ireland
Background
This proposal forms part of a broader plan for integrated employee supports delivery. The current
model of care for Occupational Health Services in the health services have been in place for the past 25
years. To date, there has been limited planning which has resulted in a fragmented service nationwide,
with gaps in service and a lack of standardisation of services.
The formation of the WHWU is the first opportunity to centralise and standardise a governance system
for forward planning and clarification of the best model of care for OHS in the health services for the
future.
The Experience of Occupational Health in the NHS, UK
In the UK in 2016 an All Party Parliamentary Group on Occupational Safety and Health (2016) stated
that urgent action was necessary in order to manage the challenges with workforce planning.
This report clearly stated the role of OHS in terms of value within the multidisciplinary team. It
recommended urgent action to manage the demographics of OHPs to address the supply issue if the
level of capacity of the occupational medicine workforce is to meet the demand and the age
demographic of Occupational Health Physicians.
The report recommended the following
The NHS ensures that occupational medicine physician posts are part of safe, effective, quality
assured multidisciplinary teams.
Government and insurers explore how to incentivise employers to provide workers with
access to multidisciplinary occupational health services
Incentives for OHP ‘s considering retirement
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Third Level Colleges and Training Bodies to include occupational medicine within the
curriculum
The NHS Health and Wellbeing Improvement Framework (D.O.H 2011) articulated key responsibilities
and the WHWU proposes to replicate this framework. Appendix 1
The Boorman Report (May 2015) on Health and Wellbeing in the NHS provides a vision of care focussed
on health and wellbeing.
The three main areas in the Boorman Report are:
Organisational Behaviours and performance
This is to be achieved by the development of prevention centred approaches to health and
wellbeing. In addition developing and equipping leaders and managers.
Achieving an exemplar service
This is to be achieved by enhancing staff engagement, team engagement and conducting risk
assessments and interventions.
Embedding Health and well being in the NHS systems and infrastructure
This is to be achieved through National and Regional levels. Health and Wellbeing must not
be viewed as a separate addition to a system or function.
WHWU Proposed Model of Care for Occupational Health Services in Irish Health
Services
Context The proposed Model of Care for OHS in the Irish Health Service is informed by and supported by
evidence from the research and optimum workforce planning methodologies. The vast majority of best
practice and evidence comes from the NHS, UK.
Healthy Staff, Better Care for Patients (2011) proposed a realignment of Occupational Health Services
for the NHS. From an Irish Health Service perspective, this model can be replicated.
To provide services to prevent staff becoming ill or injured at work - this will be lead through
the Health and Safety Function and Occupational Health Division of WHWU
To actively promote health and well-being in the workplace through Occupational Health
Divisions and Human Resources portfolios.
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To maximise access to and retention of work through timely rehabilitation services through
Occupational Health Services and Human resources portfolios and internal and external
rehabilitation services.
Three specific areas will be addressed within the proposed model of care for OHS for the Irish
Health Service
1. Minimum Service Levels for Occupational Health Services
One of the first priorities of the Workplace Health and Wellbeing Unit was to commence a review of
existing International OHS Standards. In accordance with the Quality Assurance Framework (QAF)
Safety and Quality Improvement Directorate, A Standards Project Group and an Expert Advisory group
was formed. The group included representatives from Health and Safety, Staff Health and Wellbeing
and Occupational Health Services Nationwide. The draft standards were sent out for broad
consultation, including to service users, in April 2017. Standards for Occupational Health Services for
The Irish Health Service were launched in May 2017.
The Following Themes form the basis for the Occupational Health Standards which will be supported
using the HSE Quality Assessment + Improvement Framework
Theme 1: Worker Centred Care
Theme 2: Safe Effective Care
Theme 3: Workforce Planning and Resources
Theme 4: Leadership, Management and Governance
Theme 5: Use of Information
As described, Occupational Health Services will provide six core services informed by the above themes:
1. Prevention – of ill health caused or exacerbated by work
2. Timely intervention- easy and early treatment for the main cause of sickness absence.
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3. Rehabilitation – to help staff stay at work or return to work after illness
4. Health Assessments for work- to help manage attendance, retirement and related matters
5. Promotion of health and well being – using work as a means to improve health and well being
and using the workplace to promote health
6. Teaching and training – encouraging staff and managers to support staff health and well-being
It is essential that Occupational Health Services for healthcare staff meet a minimum specification
based on the six core services as listed above and includes the following:
All OHS must work towards an accreditation /standards process (Appendix 2) which will include
Key Performance Indicators.
Service Provision must be clearly defined and include financial reporting
Organisations must state clearly the following points, accessibility, equity, independence,
inclusiveness, innovation and partnering with communities.
Workforce planning must be optimal
2. Occupational health data collection and information sharing in the Irish
Health Service
The ICT system will be configured in such a way that data management across occupational health
services will be managed in a co-ordinated way. Compliance with Occupational Health Service
Standards and the integration of Quality Assessment + Improvement will support the above.
The following data metrics will apply
Activities of the Occupational Health Service
The quality of the Occupational Health Service, based on the National Standards /Quality
Assessment + Improvement
Metrics to monitor Staff Health and Wellbeing e.g. using quantitative data such as sickness
absence levels, number of ill health retirements etc. And/or numbers and % responses in the
HSE Staff survey e.g. job satisfaction, enjoyment of work, violence at work etc.
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3. Engagement of and with Occupational Health Services in the Irish Health
Service
Occupational Health Services have taken a transformational leadership approach to engage with all
stakeholders to align their services to the delivery of high quality care. Engagement is based within a
framework of positive organisational behaviour and includes staff engagement, well being and team
engagement.
This will be led by the WHWU through implementation of the HSE People Strategy and involvement in
Staff Engagement Surveys. See Appendix 8
This will include the collection of metrics as outlined in point 2
Recommendation 2 Future HSE Staff engagement surveys will include more specific metrics to monitor Staff Health and Wellbeing with input from WHWU
WHWU’s Workforce Planning Methodology to support this Model of Care
Context and National Approach
Currently a cross- sectoral Steering Group in the Department of Health (2017) is developing a
framework for workforce planning for health services in Ireland that will support recruitment and
retention of healthcare workers across the health system. The WHWU is continuing to progress
workforce planning at an operational and a strategic level using these principles. The workforce
planning approach in WHWU for Occupational Health Services in the Irish Health Service involves the
following:
Main stakeholders are committed to and involved in the planning process with clear lines of
responsibility and accountability being defined.
Building from a structured information base on current staffing, and relevant activity for
departments.
Development of an overview analysis to identify need for and scope for change.
An agreed unit workforce plan, which will include a cycle of review and update.
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The unit is using a practice development approach; this involves collaboration and engagement, a
“bottom up and top down approach” which is recognised as optimal.
This will include the following data collection
• Measurement and interpretation of demand for Occupational Health Physician Services in
the Health Service
• Assessment and review of organisational characteristics of services care to understand their
influence on staffing
• Examination of the current capacity of the Occupational Health Service to meet service
demand
• Profile the capability of the Occupational Health Physician, Registrars, Registered Nursing
Services and Administrative staff for appropriate staffing utilisation. In particular we want to
outline the capabilities of physicians who have achieved or are working towards achieving
MFOM /LFOM on the specialist register.
• The development of key performance indicators/key metrics for OHS across the professions
and services. (Appendix 3)
• Measurement of staff engagement levels to enhance positive organisational behaviours
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Supply and Demand Analysis
Overview of the Occupational Health Physician Establishment in the Irish Health Service
Quantitative data was collected in April 2017 to establish the number of funded Occupational Health
Physician posts and contracted sessions for Occupational Health Physicians.
Current situation
Table 5 .Overview of current specialist posts in the Irish Health Service Area Funded
Establishment OHP .FTE
Privately Contracted Sessions (Per month)
Permanent Vacancies
Specialist Registrars
Sligo General Hospital Temp contract 1 Galway University Hospital
1 16
Limerick University Hospital
1 14.5
Cork University Hospital .75 14 Kilkenny Hospital 1 4 Tullamore Hospital 12 Dr Steeven’s Hospital 11 1 Connolly Hospital 1 1 Beaumont hospital .8 1 Tallaght Hospital 1 St James’s Hospital 1 1 Mater Misericordiae Hospital
.8
St Vincent’s University Hospital
12
Children’s University Hospital
.5
Ou Lady’s Hospital for Sick Children
8
Our Lady’s Hospice 4 North East 1 The National Maternity Hospital
8
The Rotunda Hospital .2 St Michael’s Hospital 4 St John’s Hospital Limerick
4
Portiuncula Hospital 20
Important notes: One session = 3 hours.
All leave- maternity, study leave, sick leave and absences are built in to the existing staffing
Establishments
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Current Medical Career Pathways for Occupational Health Physicians
Faculty of Occupational Medicine, Royal College of Physicians in Ireland
The Faculty of Occupational Medicine in the RCPI is the accredited training body for training in the
speciality of occupational medicine and currently has 7 specialist training posts. Specialist Trainees must
complete Basic Specialist Training before acceptance on this programme.
In addition, the FOM oversees the Licentiate Program and Examination and the Membership Programme of the Faculty of Occupation Medicine (LFOM and the MFOM). Specialist Registrars graduating from the training programme are entitled to Specialist Registration with the Medical Council of Ireland. Those who have acquired the MFOM by alternative means can attain specialist registration via an alternative pathway that is currently poorly defined. This pathway accounts for a small number in the national workforce entering the specialist registrar, less than 3 per year.
Current Levels/Grades
Currently there are two levels of Physician working in the Occupational Health Physician roles in the
services
1. General Physicians who have achieved or who are working towards achieving MFOM
(Occupational Health Physicians
2. Physicians on the Specialist Register for Occupational Medicine ( Specialist Occupational Health
Physicians)
There are various levels of proficiency and capabilities across the grades; as expected in any healthcare
setting. A framework for capability and competency development is outlined in appendix 5
Occupational Health Physicians and Irish Health Service Trends
At present there are 11.3 FTE Specialist OHP in the Health Services. 25% of OHS in the Irish Health
Services are privately contracted.
The gender balance at present is 50/50. One third of OHP are working less than full time.
Of the existing OHP, 8.3 FTE (75%) are within 10 years of retirement. This is a key finding from a
workforce planning perspective in terms of succession planning.
28
A recent recruitment campaign in April 2017 attracted a significant expression of interest and
competition both in Ireland and internationally.
A recent submission to the Department Of Health following an independent review (Hay report)
recommended that Specialists in Occupational Health in the HSE be granted Consultant Status and
offered equivalent contracts.
Specialist Registrar Training Positions.
The HSE currently funds seven (7) Specialist Registrar positions in the Faculty of Occupational Medicine
in a 4 year programme with 1-2 graduating per year.
Unlike other medical specialities, some graduates work in the health services and others are employed
in other Irish Public Services e.g.
The Civil Service
Department of Social Protection
Irish Rail
Department of Education
Dublin Fire Brigade
Dublin City Council
A number of graduates from the training programme are recruited to the private/independent sector.
EWTD compliance is 100%.
The gender balance in the Spr is 75:25 in favour of females.
The group are culturally diverse.
Migration is a not a major factor in comparison to other specialties.
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Alternative Pathway
A number of privately contracted Occupational Health Physicians are not specialists but have LFOM
qualification work within the Irish Health Service.
Approximately two of these doctors are working toward MFOM and specialist registration with the IMC
in any three year period.
This is an area that has been identified as an area of potential growth as a career pathway as an
alternative career.
Recommendation 3 The alternative pathway to specialisation should be more clearly defined by the Faculty of Occupational Medicine. WHWU will provide supports to doctors currently working in Occupational Health in the Irish Health Service to progress to specialisation if desired through mentoring, coaching and teaching within existing resources.
30
Developing the Workforce Plan for the Heath Service
Projected Need for Occupational Health Physicians 2017-2026
Currently there are 11 Occupational Health Physicians employed in the Irish Health Service with the
clinical equivalent of 6 OHPs contracted privately for Occupational Health Services. (Current provision
of contracted services is 131.5 sessions per month equating to 33 clinical sessions per week. This
constitutes a workload for approximately 6 full time OHPs including indirect work and travel time.)
It is estimated that taking potential retirements and attrition into consideration the following is the
requirement to provide OHP for the next five years (based on date of birth) (Table 2)
Table 6 Estimated Projections for Occupational Health Physician Posts for 2017-2027
Year Additional OHP Posts Required for the Irish Health Service
2017 6 Posts (unmet demand)
2018 1 Post
2019 0 Posts
2020 0 Posts
2021 4 Posts
2022 0
2023 0
2024 1
2025 1
2026 3
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Recommendation 4 6 OHPs need to be employed immediately to replace private and temporary contracts* In the next 10 years, with normal attrition, the Health Service will need a further 10 OHPs to maintain existing services
*A national panel is being formed from an existing campaign and will address this need
Current Succession Planning
At present there are 7 Specialist Registrars (SpR) in a four year training programme. Two (2) will
graduate in June 2017 and one (1) will take Leave of absence. The FOM support flexible working
arrangements.
3 new trainees are scheduled to commence the programme in July 2017
The Specialist Registrars are employed in the Health Services and many other public services ( the
Police, fire brigade, civil service) on graduation. At any given time 3 Specialist Registrars are working
directly in the health service
It is important to document that the current number of Specialist Registrars Training Positions will
not meet the demand for the profession in the health services alone in the next 5-10 years.
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Table 7. Profile of progression of Current Specialist Registrar Training
2016/2017 2017/2018 2018/2019 2019/2020 2020/2021
SpR 1
Yr 1 Yr 2 Yr 3 Yr 4 Graduate
July 2021
SpR 2
Yr 1 Yr 2 Yr 3 Yr 4 Graduate
July 2021
SpR 3
Yr 1 Yr 2 Yr 3 Yr 4 Graduate
July 2021
SpR 4
Yr 1 Yr 2 Yr 3 Yr 4 Graduate
July 2021
SpR 5 Yr 1 Yr 2 Yr 3 Yr 4
Graduate July 2020
SpR 6 Yr 2 Yr 2 (LOA) Yr 2 (LOA) Yr 3 Yr 4 Graduate
July 2021
Spr 7 Yr 2
Yr 3 Yr 4
Graduate July
2019
Spr 8 Yr 2
Yr 3 Yr 4
Graduate July
2019
Spr 9 Yr 3
Note .5
Yr 4
Note .5
Graduate July
2018
Spr 10 Yr 4 Graduate July
2017 2017
Spr 10 Yr 4 Graduate July
2017 2017
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Proposed Succession Planning The intake of Specialist Registrars needs to be increased significantly. An 8th position has recently been
secured and filled by the WHWU.
There is sufficient capacity, and available trainers in existing services to increase this number to 18 for
the Irish Health Service alone, given current trends and prediction of 8 retirements in the next ten
years.
To meet the service demand in the health service, an additional 2 SpRs for the next 4 years is required.
Recommendation 5 At a minimum an additional 2 Specialist Registrars be recruited to the training programme year on year for the next five years to bring the total number of training places to 18, by 2022.
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Actions
Recommendation 1 and Recommendation 5 A National Workforce Plan for Occupational Health Physicians should be developed in 2017. Recommendation 5 At a minimum an additional 2 Specialist Registrars be recruited to the training programme year on year for the next five years to bring the total number of training places to 18, by 2022. The Faculty of Occupational Medicine is the Professional Body responsible for the co-ordination of a National Workforce Plan. ACTION: The WHWU will write to the Faculty to recommend this.
Recommendation 2 The HSE Staff Engagement surveys in 2018 will include specific metrics to monitor Staff Health and Wellbeing. ACTION: WHWU will engage in the survey design for 2018
Recommendation 3 The alternative pathway to specialisation should be more clearly defined by the Faculty of Occupational Medicine and the WHWU will write to the FOM highlighting this issue. ACTION: WHWU will provide supports to doctors currently working in Occupational Health in the Irish Health Service to progress to specialisation if desired through mentoring, coaching and teaching within existing resources.
Recommendation 4 In the next 10 years, with normal attrition, the Health Service will need a further 10 OHPs to maintain existing services ACTION: 6 OHPs are currently being recruited by WHWU and a panel is being formed for temporary vacancies
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References
A Report by the All Party Parliamentary Group (2016) Occupational Medical Workforce Crisis. October
2016.
Government of Ireland ( 2003) Hanly Report of the National Task Force on Medical Staffing. Government of Ireland. Government of Ireland (2016 ) Department of Health, Health in Ireland, Key Trends Future Trends 2016 Government of Ireland. Health Service Executive (2015) Health Service People Strategy 2015-2018, Leaders in People Services.
Health Service Executive.
www.dh.gov.uk/publications Healthy Staff, Better Care for Patients. Realignment of Occupational
Health Services to the NHS in England .July 2011.
www.dh.gov.uk/publications NHS Health and Wellbeing Improvement Framework .July 2011
www .nhs employers.org/publications. National Health Service 2016. Your Occupational Health Service
National Health Service December 2016.
www .nhs employers.org/publications. Commissioning Occupational Health Services. December 2016.
www.robertsoncooper.com The Boorman Report on the Health –and Wellbeing of the NHS Staff:
Practical Advice for implementing its recommendations. May 2010.
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Appendices
Appendix 1 Framework for Health and Wellbeing
Person/Sector Role
Staff
Personal Responsibility Health checks Prevention
Manager Occupational Health Staff engagement
Organisation WHWU Quality indicators
Health System HSE Department of Health
Community Public Health Strategy Government Policy
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Appendix 2. Standards for Occupational Health Services
Following an international trend many Occupational Health Services are seeking an accredited service
to ensure consistency of services and to provide benchmarking criteria.
Currently a set of National Standards for Occupational Health Services are in development with a
multidisciplinary consultative group. HIQA Safer Better Care Framework was used as a
framework.[www.hiqa.ie].
Following consultation with the Health Information and Quality Authority, it was agreed that the service
would develop unique standards in line with the Quality Assurance Framework (QAF) Safety and Quality
Improvement Directorate.
In accordance with the Framework, a Standards Project Group included representatives from Health
and Safety, Staff Health and Wellbeing and Occupational Health Services Nationwide. Also an Expert
Advisory group was also convened.
The draft standards were submitted for broad consultation in April 2017 and the National Standards for
Occupational Health Services standards will be launched on May 19th 2017.
• The aim of these standards is to help drive improvements in the quality and safety of
occupational health services in Ireland.
• Their purpose is to help the public, people who use occupational healthcare and the people
who provide them understand what a high quality, safe occupational health service looks like.
• In particular, the standards will:
• make sure that service providers are accountable to the public, service users and those
who fund them
• help the people in charge of occupational health services identify what they are doing
well, and where they need to improve
• help make sure that the quality and safety of occupational health services is the same
no matter where people live in Ireland or what health service they use – no matter
where the service is, it should be safe
• describe what should be in place for day-to-day services to be safe and effective.
38
In addition Quality Assurance + Improvement (QA+I) documents were developed to support
implementation of the standards.
39
Appendix 3. Metrics to Monitor Quality of Occupational Healthcare
Metric
Note
Time from referral to first appointment
Time from first appointment to delivery of a report to manager
Completeness of Hepatitis B vaccination
Prevalence of return to work planning
Completeness of referral for long term sickness absence
Prevalence of referral of musculoskeletal disorder for treatment
Completeness of referral for long term sickness absence
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Appendix 4 Measurement of demand
Demand
Assessing the volume and profile of health care workers attending OHPs is the first step in identifying
basic service demand, to make informed decisions about the OHP workforce. This requires a
systematic approach to collection of data. There are a number of potential challenges to measuring
demand. These include: inconsistency in the data being collected and reported, capability issues and
the resources to collect and interpret the data. However this data is critical to informing and
strengthening the understanding of demand for services.
Identifying the patterns of presentations to OHPS helps identify potential predictable ‘pressure points’
in the service and inform changes to produce more effective and efficient staffing deployment. For
example the start of an academic year presents an increase in relation to pre employment/clinical
placement processes, seasonal workloads associated with flu vaccination clinics.
Template for collection of data to measure demand.
Total number of presentations to OHD in a one year period Current Year
Previous Year
How many patients presenting in the same year are assigned to:
Assessment and determination of Fitness for work in uncomplicated cases
Management referrals seen by OHP
Referrals seen by OHN
Referrals seen by OHP
Health Surveillance work
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Appendix 5 Departmental Structure
The impact of the organisational environment is an important feature of workforce planning (Simmons
2011). The physical design of the department has implications for care delivery, that include number of
discrete spaces, distances between rooms, treatment bays and diagnostic areas, number of single
rooms etc.A first logical step is to consider the current layout/design features of an OHS. This will
provide a baseline for current, future and external comparative analysis on an OHP Service. The
template below provides a starting point to map current infrastructure and layout from the
consideration of a staffing perspective
How many reception areas are available?
How many clinic rooms are available?
What is the seating capacity in the waiting area?
How many workstations are available?
Are these workstations shared?
Are you able to maintain privacy and confidentiality
Location and proximity of satellite clinics
Is the department located separate from other services?
Provide further information
What are the design factors that need to be considered?
E.g. confidentiality, lighting, signage disability requirements, clinical requirements such as hand
wash sinks compliant with hand hygiene stipulations.
Is the OHD located near to high use services such as laboratory, pharmacy, storage areas? (Describe
the key factors and impact of these locations on how the OHD is staffed)
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Appendix 6 Capability Assessment
Capability in the context of workforce planning defines a range of knowledge, skills and experience;
either within existing or future workforce. It is essential to ensure that the right person, with the right
skills delivers care in the right place. It is designed to increase OHP engagement via targeted
development programmes which match current and future service needs.
Assessment of OHP capabilities across various grades/roles within the OHS, focusing on academic
preparation, mandatory training, OHS specific clinical skills, and composite care competence is key to
workforce planning. The Benner Model for competency development – from Novice to Expert is used as
a reference point.
Mandatory Education Profile
The facilitation of the Occupational Health Physician to attend mandatory education is critical to both
care delivery and the safety of the workforce alike. Facilitation of continuous mandatory education
supports the protection of workforce safety along with providing clear objectives to support them to
fulfill their role and responsibilities for patient safety (HIQA 2012) for specific elements of care; e.g.
data protection / hand hygiene.
Assessing this profile element on a regular basis, based on the relevant governing legislation/local
policy for training/re-training, facilitates the identification of necessary actions to support compliance.
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Capability
Insert the total number (Headcount not WTE) of each OHP grade at the top beside N=. Insert the total
number (Headcount) of OHP staff grade with the capability in each section. This will allow you to
calculate the overall total and percentage
Domain Capability OHP SPR Advanced
Beginner
Competent Proficient Expert
Academic Profile LFOM
MFOM
Specialist
Mandatory
Education
Profile
Minimal Lifting and
Handling certified
current
Fire Training certified
current
CPR certified current
Hand Hygiene Training
certified current
Specific OHS
Skillset
Prevention Timely inter Rehab Health assessment Promotion Teach and training Management Referral
Vaccinations
Surveillance
Complex cases
Competent in use of ICT
systems
Leadership Management of client flow Advanced clinical
44
decision making Advanced knowledge of policy, legal, ethical & clinical governance Advance role modelling
Human
Resources
Advanced roster building Advanced workforce management: staff deployment/allocation, supervision Advanced activity to support staff retention/engagement
Communications Advanced inter-professional communication Effective inter-
disciplinary team
working to support
prompt clinical
decisions to affect
quality, safety &
processes
Quality and Risk Effective monitoring and action plans to support high quality services/client care Effective reporting & management of risks/client safety concerns. Competent project &
change management
Financial
Planning
Effective deployment of business plans to support service developments. Effective staffing budgetary management
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Appendix 7 Staffing Establishments
Determination of Staffing Establishments
Staffing establishment is defined as the number in the team. In this case it is the number of people
working in the OHP team. The funded establishment is the approved number of staff, whereas the
actual establishment is the number actually in post. Key terms and data in developing a staffing
establishment include: planned and unplanned leave/time out; permanent and temporary vacancies;
supplementary staffing; and staff turnover. There are many reasons for collecting data on staffing
establishments – see below
1. To identify variance in the staffing establishment
Gathering data on the staffing establishment, actual and funded provides important data on the
potential difference between the actual and funded establishment. The first step is to seek
confirmation on the current staffing establishment, as recent national and/or local changes may have
affected historical establishments. This data is critical in order to develop action plans on resourcing the
establishment. Similarly it is important to understand the establishment fund for supervisory roles that
are supernumerary to the core staffing such as clinical leadership roles
2. To determine staffing time out
Time out is described as any time away from the clinical area, which may be planned or un-
planned. Planned leave/time out is leave including annual leave, maternity leave, study leave or
parental leave as examples.
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Staffing Establishments -Data collection process to record staffing establishments
OHP Registrar Subtotal Total
Funded
Establishment
Actual
Establishment
Permanent
Vacancies
Temporary
Vacancies
Sick Leave
Agency – if
relevant
Bank- if relevant
Overtime
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Appendix 8 Work & Well-being Survey (UWES) ©
Work engagement has been defined by Schaufeli et al (2002b:72) as ‘a positive, fulfilling work related state of mind that is characterized by vigor, dedication and absorption’. Work engagement has been listed as an important construct for performance and well- being. (Halbesleben 2010) . Engaged staff display a positive attitude towards work and high levels of energy They stay healthy in stressful environments and will actively assist their colleagues.
The questionnaire below is a validated tool for measuring engagement levels.
The following 9 statements are about how you feel at work. Please read each statement carefully and decide if you ever feel this way about your job. If you have never had this feeling, cross the “0” (zero) in the space after the statement. If you have had this feeling, indicate how often you feel it by crossing the number (from 1 to 6) that best describes how frequently you feel that way.
0. Almost never , -0 – A few times per year 1. Rarely - a few times per year 2. Once a month
3. Sometimes , A few times per month 3 Often, 4. Often - Once a week 5. very often a few times per week Always 6 Every day
1. ________ At my work, I feel bursting with energy 2. ________ At my job, I feel strong and vigorous 3. ________ I am enthusiastic about my job 4. ________ My job inspires me 5. ________ When I get up in the morning, I feel like going to work 6. ________ I feel happy when I am working intensely 7. ________ I am proud of the work that I do 8. ________ I am immersed in my work 9. ________ I get carried away when I’m working
© Schaufeli & Bakker (2003). The Utrecht Work Engagement Scale is free for use for non-commercial
scientific research. Commercial
and/or non-scientific use is prohibited, unless previous written permission is granted by the authors