The Importance of Blue & Black Flags in Occupational Health

How an employee responds to treatment can depend on much more than just their physical condition and natural healing times.

There are many factors that play a part in this process, including physical recovery, level of support available outside work (I.e. from the NHS), the availability of occupational health intervention at work and mindset and psychology.

As specialists in occupational and workplace health, screening for ‘Flags’ is a fundamental part of our workplace physiotherapy assessments and below I have listed some information that will help to explain what ‘Blue’ and ‘Black’ flags are:

‘Blue Flags’ relate to a worker’s perception of the relationship between work and health. 

Examples of blue flags may include: 

  • High job demands or time pressures,  
  • Little involvement in decision making, 
  • A lack of variation in work tasks, 
  • Reduced social contact, 
  • Poor or unhelpful management style, 
  • Low job satisfaction, 
  • The belief that work is harmful or caused the employee’s physical problem. 

As part of our in-depth assessments, we are looking for cues from employees suggestive of blue flags, for example: 

  • “The rates/targets/expectations at work are too high” 
  • “My manager is not supportive” 
  • “My work is boring or repetitive” 
  • “Work doesn’t care about me” 
  • “I don’t like my team / I have no friends at work” 
  • “My manager only cares about targets and not their employees” 
  • “The job has caused my pain or makes it worse” 

To identify blue flags, sometimes it is helpful to think about the opposite of these factors, which might sound something like: 

  • “I love my job, it’s really interesting” 
  • “I Have a good set of workmates and I want to get fit and back to work as soon as possible as I know they are having to work extra hard to cover me when I am not there” 
  • “I have a great supportive manager who listens to my ideas and concerns” 

‘Black Flags’ relate to organisational factors that create a system or contextual obstacles (including policies and procedures) 

Examples of black flags may include: 

  • The Company sick policy, sick pay entitlement and disciplinary procedures, 
  • The availability of ‘Phased Return to Work’ plans, 
  • The need to be fully fit before returning to work, 
  • A lack of rotation or variety, 
  • A lack of training / Injury prevention / Health promotion / Occupational Health support, 
  • Job security or restructuring 
  • A lack of Health & Safety or risk management, 
  • Shift patterns, hours, and flexibility. 

Cues we would listen out for when assessing employees to identify black flags may be: 

  • “If I come back too quickly and go off again, it will count as another episode of sickness” 
  • “I don’t feel fit enough to return to work, but I can’t afford to be off as there is no company sick pay” 
  • “I’m in no rush to get back as we get 13 weeks full sick pay” 
  • “I don’t get time to warm up and stretch my back before early morning shifts” 
  • “I’ve asked many times for training to allow me to have more rotation” 
  • “I don’t get my fair share of rotation if I’m on easier duties” 
  • “My manager says I must be 100% fit before I return to work” 

There is no great need for non-clinicians to know if the factors above are blue or black flags, these are just ways we can identify and group such factors.

Our expert Occupational Health physios are trained to identify such factors and address them in a positive manner within our sessions with employees. 

Wherever possible, we encourage companies we work with to: 

  1. Acknowledge these factors exist.
  1. Look to identify them in individual case meetings (commonly known as welfare, depot, ‘keeping in touch’ or return to work meetings).
  1. Train managers conducting these meetings to ask probing questions to help identify such factors to allow them to be effectively addressed. 
  1. Review the company’s culture, policies and procedures to establish if they can be enhanced to minimise the prevalence of these factors.

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