healthcare rm's Paul Nattrass and Jayne Rowe examine the benefits of the Biopsychosocial Model as an alternative to a traditional 'treatment first' approach for employee health and wellbeing.
In the 2021 budget, published on 3 March 20211, public spending on health is projected to be £230 billion, almost 22% of the total anticipated £1,053 billion public sector spending for 2021/22. The thorny problem remains, however, that total tax receipts for 2021/22 are forecast to be £820 billion, a shortfall of £233 billion. It was only a little over 10 years ago, in October 2010, that the then Chancellor, George Osborne, confidently asserted to the electorate that the deficit would be eliminated by 2015. Best laid plans…
Of course, the Covid-19 pandemic has had a profound impact on public spending, but the truth is that way before the pandemic emerged, public spending on healthcare was increasing at an unsustainable rate year-on-year. There are many drivers of this trend and unless we are prepared to commit an ever-increasing proportion of the public purse to funding healthcare, we must radically change our thinking and approach, to find an alternative to a mainly reactive ‘medical model'.
Approximately 31.5 million people are employed in the UK2; a significant proportion of the population whose health and wellbeing is influenced by their working lives and the organisational culture they experience each day. It may appear to be a significant leap from public spending on healthcare to organisational culture, but this represents a little under half the total UK population whose personal wellbeing, behavioural choices, and ultimate health outcomes, can be influenced, both positively and negatively, by their employers and their working lives.
Why does culture matter?
Organisational change and perceptions of workplace ‘climate' are significant contributing factors to employee health and wellbeing, which manifest frequently in sickness absence and staff retention. The CIPD Health & Wellbeing Report (2020)3 supports that "a culture of wellbeing, driven by great people management, is good for employees and good for business. It makes the workplace a more productive, attractive and socially responsible place to work".
Importantly, awareness of the importance of health at work has increased in recent years, as have the ‘tools for intervention', but how effective are these tools if the main contributing factors to employee wellbeing are poor management practices, communications or policies that don't facilitate a healthy, harmonious working environment? Through focus on organisational climate perception and good people practices, organisations can help create conducive working environments and cultures, and mitigate the risk of causing, or exacerbating employee ill-health, both mental and physical.
Inevitably, some employees will experience mental/physical health problems, but there can be an instinctive tendency to assume that people immediately need ‘treatment'. While this is sometimes necessary not everyone requires therapy, mental or physical, unless this is considered clinically appropriate following a comprehensive assessment.
How can we establish whether someone needs ‘treatment'?
Firstly, by looking through a different lens, avoiding applying a ‘medical' label in every instance and assuming everyone requires treatment. The ‘Biopsychosocial Model' is an alternative approach that considers an individual's underlying risk factors as well as occupational ‘climate'. It helps identify an individual's personal healthcare needs, which can then be aligned with an appropriate care pathway using the matched care model, aligning actions and interventions with the nature and severity of symptoms, thereby maximising the potential for a successful outcome, often without the need for medical intervention.
This approach has benefits for the individual, the employer, and wider society, by mitigating unnecessary medical treatments, making significant improvement in health risk identification, and ultimately reducing the cost of ill-health for all parties.
How does the Biopsychosocial Model work?
Simply by understanding the biological, psychological, and social dynamics that are influencing a person's health status and importantly, the individual's perceptions of a health condition or set of symptoms:
- Biological - Understanding of the ‘physical' and clinical aspects e.g., symptoms, diagnosis, prognosis, pain/discomfort
- Psychological - Individual attitudes, beliefs, thought constructs, perceptions, and prevailing emotions
- Social - Work, family, friends, support network, family ill-health, financial circumstances, hobbies, lifestyle
The Biopsychosocial Model
Only when the holistic dynamics underpinning an individual's health status are understood can an appropriate cause of action be advised, which may not necessarily require medical treatment. The matched care model emphasises the ‘medicine' is aligned to the nature and severity of the conditions / symptoms and matching the support accordingly to the individual.
Often advice and guidance on self-management of a condition or symptoms are beneficial, before instinctively referring people for medical or psychological clinical interventions. Of course, the biopsychosocial and matched care models do not preclude referrals for medical treatment where this is appropriate; they simply avoid assuming that this is the default pathway at the outset.
When it comes to understanding the full picture of an individual's health status, stressors contributing to the development of problems requiring ‘medicine' in the workplace are often linked to the environment and culture. Feeling valued, clarity of role, accord with organisational values and purpose, good communication, reward systems and effective people management policies are all extremely important factors underpinning employees' health and performance at work.
Although there is evidence that more employers are taking mental health seriously and implementing measures to increase awareness and support, if this is against a backdrop of a poor organisational culture and management style, then the root cause of the problem is not being addressed and employees are less likely to be very receptive to wellbeing initiatives.
By investing in a proactive approach to managing occupational stressors through promoting good working practices, building a positive ‘coaching culture', and creating an environment that emphasises the value of staff, employers can be more effective in tackling a cause of some health problems. Perhaps then, fewer of the 30+ million employees in the UK would end up having medical treatment.
Paul Nattrass is commercial director at healthcare rm, and Jayne Rowe is careline team manager/SME CBT lead at healthcare rm