Work conversations in healthcare: How, where, when and by whom? A review to understand conversations about work in healthcare and identify opportunities to make work conversations a part of everyday health interactions

Serena Bartys, Amanda Edmondson, Anthony Burton, Christine Parker, Rachel Martin

Research output: Book/ReportCommissioned report


As part of a 10-year strategy to improve employment outcomes for working-age people with health conditions and/or disabilities, the Joint Work and Health Unit (WHU) has funded Public Health England (PHE) to implement a ‘work as a health outcome’ programme. The programme seeks primarily to promote healthcare professionals’ (HCPs) understanding of the health benefits of good work and encourage HCPs to have supportive conversations about work and health. The programme has been informed by the evidence base for Making Every Contact Count (MECC) (1). To further understand whether and/or to what extent the MECC framework is transferable to this context, a comprehensive literature review with stakeholder engagement was conducted.
Following a search of peer-reviewed and grey literature sources, 79 articles and documents were included in a realist best evidence synthesis. In addition, 59 online stakeholder surveys were completed, and 16 telephone interviews were conducted. Data were synthesised and presented as key findings, aligned to specified research questions. An in-depth examination of interactions with a wide range of HCPs for a variety of health conditions was produced, providing a more detailed understanding of conversations about work in healthcare: how, when, where and by whom.
Despite the launch of numerous, potentially relevant initiatives over the last decade, few have been directed specifically at stimulating conversations about work during routine clinical encounters. Promotion and implementation of these initiatives has been limited and, as a result, healthcare awareness, engagement, and adoption has remained low. The evidence reveals many barriers.
Most of these barriers are underpinned by the lack of a consistent, agreed description or measure of ‘supportive’ conversations, and because the purpose of such conversations has not been clearly articulated or formally embedded within clinical practice. There was no evidence from research or evaluation to establish the outcome or efficacy of any particular components, content, or strategies of conversations about work in healthcare, nor how these may be measured. It was found that most HCPs accept that work is generally good for health and wellbeing, but these fundamental limitations mean that most do not engage their patients in conversations about work.
However, there are reasons for optimism: the evidence points to some short- and long-term policy solutions that will better equip HCPs to have supportive conversations about work, and to further advance the ‘work as a health outcome’ agenda within routine healthcare. These are conceptualised as ‘cultural awareness’, ‘conversation starters’ and ‘practice integration’.
Original languageEnglish
Place of PublicationLondon
PublisherPublic Health England
Number of pages90
Publication statusPublished - 4 Oct 2019


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