3. Referral to the co-ordination of working ability issues in occupational health care

The specialties of occupational health care are the estimation of working ability, supporting the ability to work, and returning to work and referring patients to rehabilitation. As with any other specialist field in medicine, it is possible to refer a patient to occupational health care. These referrals should be done when a patient is diagnosed with anything that can affect their working ability or when a patient needs support returning to work after being on sick leave.
Image: digital referral

Collaboration through a referral system

Most occupational health care providers have established an electronic referral-feedback connection with their local hospital that allows them to share their patient files with each other. Typically, this connection has been used in a way where the OHC makes a referral to the hospital and in return the hospital returns treatment feedback to the OHC. In the TYÖOTE project, this connection was used to help establish the possibility of also sending referrals from the hospital to the OHC. As of January 2023, the opportunity to refer patients to occupational health care has been established in most wellbeing services counties.

When the information of a patient's inability to work is received by occupational health care as a referral specifically, it allows the OHC to react quickly. The OHC has set practices for reading referrals daily and the patient's case can be immediately directed to appropriate specialists who are familiar with the conditions of the workplace. This allows the patient's ability to work to be assessed and supported with maximum efficiency without any unnecessary delays.

Referral to occupational health care

Basic and specialised health care can issue referrals to occupational health care. The below image details the progress of the referral process. Open a larger version of the image.

Referral to occupational health care

See "Referral to occupational health care" -video (duration 8:41)

Co-ordinating working ability issues in occupational health care according to the TYÖOTE operating model

The referring doctor produces a plan of how to treat the illness and estimates how the illness affects the patient's working ability and assigns sick leave from the procedure according to the guidelines of the TYÖOTE operating model. After primary health care takes action on the case, the patient's information is sent to occupational health care in order to estimate their working ability and their need for support.

The assigned person in occupational health care in charge of the "referral mailbox" checks it daily and forwards the referrals to an assigned case manager.

The estimation of the patient's working ability and need for support is done by a multiprofessional occupational health care team that is familiar with the work environment, and the length of the sick leave is decided by an occupational health physician. Primary health care can also refer a patient to OHC in cases where they believe that the patient's work affects their symptoms or illness. The referral transfers the treatment responsibility of estimating the patient's working ability or need for support to occupational health care and legally binds the OHC to take action. Co-ordinating the patient's return to work and the required supporting actions are the OHC's responsibility, regardless of the extent of the occupational health care contract.

The co-ordination of working ability and its supporting actions

Case management in occupational health care stands for taking responsibility for evaluating the patient's working ability, their need for support and referring them to rehabilitation.

A case manager in OHC is an employee who is responsible for evaluating the patient's working ability and co-ordinating the supporting actions the patient needs in regards of their ability to work. The case manager contacts the patient and, if deemed necessary, refers them to specified professionals to evaluate their working ability. Visits to these professionals should be co-ordinated with the patient's needs in mind, and they should be booked before their specialist health care assigned sick leave ends.

In addition to estimating the patient's working ability, the case manager also co-ordinates the required supporting actions regarding the patient's ability to work (e.g., occupational health care negotiation) and their follow-ups (makes appointments with OHC professionals and experts if required). When planning the multiprofessional working ability estimation and the need for supporting actions necessary for returning to work, the patient's illness or injury that affects their health and the requirements regarding their work are taken into consideration. The multiprofessional knowledge of the OHC is utilized when estimating the patient's working ability and planning the required supporting actions for the patient to be able to return to work.

Helpful questions when designing case management - what should be taken into consideration in occupational health care?