Impact Stories for Musculoskeletal (MSK) Health

Case studies from the Musculoskeletal Toolkit developed in partnership with PHE and ARM categorised by Promising and Good Practice. 


Good Practice 

John Lewis Partnership
Nick Davison, Head of Health Services

Health services were first established in the Partnership in 1929, in recognition that John Lewis Partners needed to be fit to provide the quality of service customers expected. Whilst they have changed many times  the original premise remains valid today. Whilst John Lewis haven’t historically talked in the language of “Wellbeing” many of their initiatives and opportunities have a developed a culture which aligns strongly with a health and wellbeing agenda and explicitly supports the first of the Partnership’s seven principles which underpin how the business is run: Principle One – “the John Lewis Partnership’s ultimate purpose is the happiness of all its members, through their worthwhile and satisfying employment in a successful business”.
John Lewis is a large business with 94,000 Partners working across 400 sites, with the majority working in shops or the supply chain, often in physically demanding roles, but also including a diverse range of other functional roles including manufacturing, hospitality, farming and back-office IT, Marketing, Buying, Personnel and Financial roles. Their Health Services approach combines an internal team of occupational health nurses and allied health professionals, working alongside an independent network of podiatrists and a single national physiotherapy provider, Physio Med, and a psychological service provider, Rehab Works. Their health service is structured to channel all incoming referrals through a central Health Hub, accessed via a portal, enabling greater accessibility, transparency and routing through online referral. 90% of all referrals arrive electronically and allow centralized triage and organisation of work flow across the whole service. The Hub is supported by regional Clinical Case Managers who support the business management and Partners locally in returning Partners to work.
MSK health is particularly important due to the size of John Lewis' Partner population and they have taken specific measures to tailor an insight based approach focused on injury type and severity, improving the speed of response, focusing on outcome measures and returning Partners to better health and greater productivity faster. With nearly half of Partners still at work requiring treatment (rather than off sick), and with lower backrelated injuries making up 40% of injuries they have been able to introduce targeted remote exercise pathways, supported by physiotherapists, which have delivered outcomes as good as traditional face to face treatment but over significantly shorter time scales and at much lower costs. This has allowed affected Partners to remain at work and get better faster, producing significant productivity gains for the business whilst more severe injures continue to receive hands on treatment. With so many of their partners being shopbased, podiatry is also an important area for us. This year they scanned 2,000 pairs of feet to help people understand their feet and their gait – identifying early issues before they have become problematic and giving advice on footwear. This proactive approach to education will develop over time as greater emphasis switches to a wider proactive wellbeing agenda, focused on the long-term health of our Partners and the Partnership which will drive the long-term success of the Partnership.
Mars Chocolate UK
Helen Wray, Health & Wellbeing Business Partner; Louisa Mead, Health, Safety & Environment Advisor

Mars have a strong global culture with people at its heart, that helps to create an environment that supports wellbeing. They are committed to giving Associates (employees) the opportunity to maintain their health and fitness at work and beyond. Their UK Occupational Health service works closely with Health & Safety supporting wellbeing and health across their Slough site which goes beyond a traditional office environment; they have a large factory as well as a research and development facility, engineering workshops and product dispatch. Health and safety is a priority for all Associates and manual handling training is compulsory for those with more physically active roles.
Musculoskeletal (MSK) health is one of the most significant factors that contributes to absence among manufacturing Associates, and remains a cause for concern in other areas of our business. Mars' in-house ‘Winning with Wellness’ campaign supports their focus on MSK issues – it is designed to educate Associates to take the best care of themselves and to create the right environment to promote wellbeing. They recognise that it is important to keep people moving and to support more sedentary office-based Associates to be more active. Mars encourage people to put this into practice, through simple activities such as walking meetings and calls, which help people take more steps in their normal course of business. In addition, they conduct regular health hazard audits and identify at-risk groups who are then seen every two years for MSK assessments and other health checks. They have created a bespoke manual handling training programme for trainers based on behavioural principles which has significantly reduced this hazard in their manufacturing site. Associates have access to a recently-opened on-site gym, as well as personal trainer support, weekly exercise classes and sports clubs and they have quarterly plans for health and wellbeing programmes throughout the year. Line managers know where to get help for their Associates and they understand the need for early referral – MSK issues are dealt with rapidly and collaboratively. It is important that Associates are part of the process for identifying any adaptations needed to accommodate an issue and, for the majority, a collaborative solution is achieved. Absence is never a desirable outcome, so Mars' approach is to keep people doing something where they can. Their aim is to give an Associate with MSK issues the necessary adjustments to keep them in their current roles.
Mars find they can achieve a lot with small modifications that allow Associates with MSK issues to continue working. They have on-site physiotherapy available to all Associates on a self-referral basis; for remote working or field-based people such as our Sales force they also provide rapid access to external physiotherapy. They have high mileage notifications for Associates who do a lot of air travel and they take simple steps to help, such as ensuring they have appropriate wheelie bags and light weight laptops to make their travel easier and more manageable.
They promote wellbeing initiatives through internal communications channels, making use of email, posters and noticeboards in high footfall areas, for example. Many managers include wellbeing and resilience objectives in Associates’ Personal Development Plans and it is established practice to begin all one-on-one interviews with the question ‘how are you?’. This helps Associates feel comfortable talking about their general health and raising any specific concerns. It is a good way to understand the impact of wellness on individual performance. For Mars, keeping people motivated, productive, happy and healthy isn’t just important – it’s essential.
Marcus Hunt, Health & Wellbeing Manager, Europe; Sarah Forsythe, UK Occupational Physician
Unilever has 23 sites in the UK and employs 7,500 staff engaged in the Supply Chain, Research and Development and office environments. This includes the Global head office. They take a holistic approach to employee health using a UK led, global health and wellbeing strategy. This is based on four critical pillars: emotional, mental and physical health, and purposefulness. Employee Wellbeing is also embedded into the Unilever Sustainable Living Plan, in which they strive to enrich the lives of up to 2 billion people across the globe – which includes our valued employees.
Within their Physical Health pillar their Occupational Health team has performed a deeper dive into protecting the musculoskeletal (MSK) health of staff. Their two target employee groups (and largest) are the UKI Supply Chain business and our office-based sedentary colleagues. In addition, across their business MSK issues account for up to 40% of wellbeing costs within Occupational Health and Medical insurance. This is consistent across the industry and across Supply Chain and office based roles, but to Unilever this is a substantial employee group to whom they want to offer an increasing level of support. For this, they have built an educational and engaging programme upon which to showcase MSK support, awareness and to encourage employee empowerment of prevention and condition management. Decreased activity, especially with a sedentary lifestyle can have a negative health impact, often described as the new smoking. Being active for 20 minutes per day has a notable impact upon depression (30%), some cancers (up to 40%) and reduces the incidence of MSK injury. For line managers, staff wellbeing, diversity and inclusivity are given equal importance. For all line managers a one-page guide for how to manage musculoskeletal health is available and for all employees there is a similar guide on how to access Unilever's holistic health services.
All colleagues also have access to a Wellbeing journey planner – a credit card size guide describing our Wellbeing resources, the reason to access them and how to make access. The emphasis mostly being upon our Mental Health and Physical Health resources. Their MSK management support is our ‘Day 1 Referral’ into occupational physiotherapy, which promotes immediate referral for a colleague who is reporting difficulty with a musculoskeletal concern. This process is supported by the close working relationship between Occupational Health, HR and the local site line managers. Unilever work closely with the business to manage MSK health problems and get staff back to work appropriately, they promote early access to physiotherapy and early return to work rehabilitation programmes with a growing number of our site having on site gym/rehab facilities.
Unilever's ‘Active U’ campaign started in May 2016, with its aim being to reduce sedentary behaviour for those desk based employees and to increase an employees’ understanding of the importance of physical capability in non-office environments. We wanted to empower employees to understand and improve their physical capabilities and to assist employees learning more about building components of movement into their everyday lives (and how it benefits upon physical and mental health).
Staff participation has been excellent: Unilever conducted ‘Active U’ roadshows at 15 sites and have seen more than 2,000 colleagues visit these during their working day. The roadshow presents Active U in four components – Active Workplace, Active Transport, Active Health and Active Happiness. The theme is to enable discussions of how impactful ‘being active’ can be and how just 20 minutes per day can have a positive impact, within these four areas. These roadshows were held collaboratively with our partners from Connect Physiotherapy (our national occupational physio provider), UK Active and our local site Wellbeing champion teams, to open discussions on physical capacity, movement measurement and the perceived barriers of being active. They also provided mini-physiotherapy functional assessments during the events to help our employees understand their physical capabilities and areas of improvement, that we could support – for enhanced work and home functional movement.
As a national programme, Unilever have yet to analyse the national results, but can report many colleagues are increasing activity in their day, with the support of workplace teams – with our Gentle Gym classes, workplace walking maps, increasing the onsite gym provision, providing active meeting rooms, senior leaders role-modelling ‘active behaviour’ and work location specific yoga stretch routine which is
periodically displayed across all site plasma screens. All material is also held within their Wellbeing hub, which all our employees have access to on our company intranet.
For Unilever data is crucial – it has made a big difference in allowing us to justify initiatives using sound evidence. Data has proved crucial in getting the right stakeholder support and convincing sites to adopt health initiatives. To support early physiotherapy referral and empower line managers to be increasingly proactive to consider the wellbeing of their employees. Results have been outstanding with a 6-figure saving in absenteeism identified in one factory, because of a pro-active and holistic approach to managing musculoskeletal absence. Data has also supported the design of initiatives where they use a ‘keep it simple’ approach – they try to understand what staff “need to know” and how they like this information to be communicated to them.
Their approach is to present a case for good health and fitness that helps staff to understand that they need to be fit for their jobs, fit for their kids and fit for their eventual retirement. Individual health management and Wellbeing education is their opportunity to be ready for the future.
L’Oréal Professionnel
Tanguy Le Baud, Director of Global Business Development

At L’Oréal Professionnel our approach to wellbeing extends beyond our staff. We supply hairdressing products to over 7 million hairdressers worldwide. These are our partners and we recognise that musculoskeletal disorders (MSDs) are the cause of high levels of absenteeism and early retirement compared with other industries. Hairdressers are particularly exposed to MSDs. Standing for many hours in
salons, repeating gestures and adopting bad postures while shampooing, styling or blow drying can lead to severe back and neck pains and carpal tunnel syndrome affecting hands and wrists. In the US, absenteeism and financial compensation due to MSDs represent 20 billion dollars; in France, the financial impact is estimated at 1 billion euros. MSDs can also lead hairdressers to retire up to 10 years before their planned retirement date. We help our partners in the hairdressing industry to take better care of their own musculoskeletal health. We have developed a training programme built around the concept of a 15-minute warm up each day with a subsequent focus on adopting appropriate postures when attending to client’s hairdressing needs.
As of the end of 2016, 431,000 hairdressers worldwide have been trained in the 15 minute daily exercise regimen. To further our commitment, L’Oréal Professionnel has launched a new free mobile application, “15’ Coach”, to help hairdressers prevent MSDs. As well as the exercises we have a facility in the App which enables individual hairdressers to monitor their own personal pain levels on a regular basis. The pain
measurements are automatically fed back to our database and through analysis we can measure overall the impact of our programme. Take up of the App continues to grow and we are pleased to see the number of countries where the App is in daily use. We expect continued success and we expect the incidence of MSDs in hairdressers to be better managed on a self-help basis, reducing absence from work and with hairdressers enabled to work for longer periods. 

Recognising that MSDs are the single biggest reason for working days lost throughout the world we strongly recommend that other industries take a similar approach to ours. Work to identify what are the main occurrences of MSDs within your own sector; find expert opinion that will help with solutions and then develop a strategy to implement those solutions. Absence is no good for anyone and MSDs are the biggest cause of absence. Working to prevent MSKs will benefit your organization and the lives of your staff.