Book Notes 1 November This content is PDF only. Please click on the PDF icon to access. Abstract Through its thoughtful and vigorous discussion, this book comfortably meets the need for a practical guide in current occupational medical practice. Citations Citation. Published: Ann Intern Med. DOI: Related Articles. View More View Less. PubMed Articles. Health perspectives among Halabja's civilian survivors of sulfur mustard exposure with respiratory symptoms-A qualitative study. A parallel development which has affected the physical state of the workplace is that of health and safety legislation.
The Health and Safety at Work etc. Act required employers to provide a safe place of work. Since then there has been continual development in safety requirements, most recently stemming from European Community EC health and safety legislation. Employment law has set basic standards for employee welfare which are also being influenced by EC legislation. Not only are there mandatory reasons for being a responsible employer but good business reasons to ensure an effective and motivated workforce.
It is surprising that, in view of the general acceptance of the ideas of the human relations school of management, plans for employee health are The organisational health plan not a common part of any business plan. Developing the health plan Developing a plan for individual and organisational health provides an opportunity to assess the needs of the organisation in a structured way and put in place policies and procedures relevant to its activities and culture.
Cytostatics as hazardous chemicals in healthcare workers’ environment
An organisational commitment to health has to encompass not only the stated intention to enhance employee health and well-being, but also the provision of resources to carry this forward. Any health plan needs to include initiatives for both individual and organisational health. To ensure ownership at an early stage, a small working party should be set up to include a committed senior operations manager, union representative, personnel manager, occupational health and safety adviser and, if not one of the above, the individual who will carry out the assessment.
It cannot be emphasised too strongly how important it is to have senior management involvement at this stage. Assessment In order to develop a comprehensive plan for employee health, it is necessary first to look at the existing organisational structure and culture. The right person to do such an assessment is likely to be trained in the broad area of human resource management and may be a personnel manager, occupational medicine practitioner or occupational psychologist.
Where the expertise is not available in-house, it can be obtained from outside agencies. A sample checklist can be found at the end of this chapter see pages 50—1. The organisation structure and culture The deep-set beliefs about the way work should be organised, authority exercised, and people recognised, rewarded and controlled make up the culture of an organisation and determine what sort of people are employed and what their career aspirations are likely to be.
It is important to identify the culture of the organisation, which may be power-based, role-based, support-based or achievement-based. The structure of the organisation will depend on this culture and reflects how the organisation is managed and communication is achieved. It is important to identify not only the current state of the organisation but also any imminent or ongoing changes. In general, contracts of employment are becoming shorter and there are few employees who are in a job for life. This may produce particular stresses where terms of employment have changed significantly.
Total quality concepts emphasise the need for continuous improvement and life-long learning. Few companies now provide the sort of paternalism that was seen in companies such as Unilever in the s and the s when you could be born in a Port Sunlight hospital, go to a Port Sunlight school, work for the company for 40 years and be buried by them.
However, there is still a world of difference between the in-and-out quick profit world of the money-broking companies and the traditional philanthropy of organisations such as the John Lewis Partnership. Chapter 1 gives a detailed account of organisational structures and cultures. The nature of the work In deciding on an appropriate health plan probably the two most important aspects of an organisation are its culture and the nature of the work.
There are likely to be significant differences in the requirements, say, of a construction company and a bank. The role of the personnel department This is likely to reflect the prevailing mores and may be restricted to ensuring that the organisation conforms to employment law and has a The organisational health plan satisfactory industrial relations structure. In other organisations there may be a strong pastoral role, where personnel officers are trained as counsellors and are seen as employee representatives.
There may be a degree of confusion about the role of personnel. In most cases the emphasis is on a specialist management role see Chapter 1. Personnel selection procedures These are often a matter of custom and practice, and their efficacy may not have been assessed. But an assessment of their efficacy should be part of the development of the health plan. It will include such issues as the appropriateness of the use of practical and psychological tests.
Should they be used? Are they valid? What part should they play in selection? Are assessment centres used? Sickness absence procedures Sickness absence entitlement for different grades and the effective management of sickness absence are both issues crucial to employee wellbeing. This will also include procedures for early retirement on the grounds of ill health. Health-related personnel policies The assessment should include an examination of existing health-related policies, such as control of alcohol misuse and smoking control. Staff representation New employment law has lessened the powerful unionisation of many industries and staff representatives may have little negotiating power within the organisation.
It is likely that the development of a health plan will be welcomed by staff representatives and they should form part of any working party to develop the plan. This is not a question of numbers or of accommodation but of what is actually being done, and how relevant it is to the real, rather than the perceived, needs of the staff.
The draft health plan The assessment period may take some time. This is worthwhile, however, as initial ideas can be tested out at later meetings and in group discussions.
Occupational Health Services and Practice
Procedures already in place which address the health needs of staff will have been identified, as will areas where there is a need for further development. For most jobs the profile of the perfect employee has not been defined. If psychological tests are to be used a profile must be established, so that the test can effectively measure elements of this profile. Psychological testing is used to assess motivation, attitudes, intelligence and abilities, and personality.
There is little information on the effectiveness of such tests which are widely used, particularly in management appointments. When considering the selection procedures, the working party should identify the areas where psychological testing may be appropriate and assess the validity of any proposed tests. Following cases such as that of Beverly Allitt there have been demands for psychological screening.
These demands usually fall short of identifying the personality factor which might be a valid measurement. Practical tests may be considered where an aptitude for certain functions, such as fine manual handling or colour discrimination, is important. Care should be exercised when interpreting the test results. For example, train drivers or electricians should not necessarily be excluded from such work because of imperfect colour vision, demonstrated by the Ishihara colour charts, if they are able to complete a practical test satisfactorily.
Where there are definite physical fitness requirements for posts, a proper assessment of the requirements should be made and tests put in place which assess these. The current interviewing procedures should also be examined to ensure that the length of interview is correct and the appropriate people are conducting it, and that those involved are trained for this role. There should be well-designed training programmes for staff at all levels. These will cover various areas. Employee training needs should be assessed and organised on appointment and on a regular basis.
The plan should include training programmes for posts and individuals. Life skills training The workforce is a captive audience for health promotion activity. To be effective the message will need to be repeated in different ways. Life skills training should be available to all members of staff. Such training allows individuals to understand what are healthy choices for physical and mental health, it enables them to express their views assertively, manage their time effectively and understand the dynamics of relationships.
This sort of training is probably most effective in a workshop. Individual training linked to fitness assessment can be useful, particularly in the area of lifestyle, but it is generally an expensive use of specialist resources. Unlike job skills training, participation is voluntary and a variety of initiatives will be needed to maximise the effect of these activities.
A detailed health promotion programme should be part of the plan. Further information is to be found in Chapter 8. Management training The ability to manage does not come naturally, although some would have us believe that managers are born and not made. There are still many managers who have received no training in the management of people. The specialist nature of work today means that most managers have risen up a professional or technical line, their managerial role requirement gradually overtaking their professional or technical role in importance.
Well-balanced communication with their own staff may be difficult, leading to either over-indulgence or apparent indifference. Good staff The organisational health plan appraisal systems are relatively rare and yet regular constructive appraisal is a significant part of job satisfaction. Tom Peters has said that the average American manager may take six months to recover from an appraisal. However, feedback on performance is now regarded as an essential part of good management. There should be no exception to the principle of training in the fundamental elements of good management for anyone in a management position.
The plan should contain a comprehensive management training programme. Training to manage stress The plethora of courses and books on stress emphasise the perception of the general workforce that work can produce a set of symptoms which are well defined elsewhere in this book to which is attached the diagnosis of stress.
This emphasises the individual nature of stress. Certain factors in the workplace are known to cause stress. Workshops for defined work groups should facilitate the recognition of stress-inducing factors specific to their own work setting and should enable participants to address these issues constructively. Apart from identifying stress symptoms in themselves, it is also important for managers to be able to recognise problems in their staff and have the skills to deal with the issues involved.
The thrust of such workshops is usually towards the individual. This enables members of the workforce to identify the signs and symptoms of stress in themselves, identify the causes of stress in the workplace and learn stress reduction techniques such as meditation and relaxation. A series of workshops, however, may well highlight organisational problems which need to be addressed. As with life skills training, attendance at such workshops is voluntary, but a significant percentage of personnel can be reached if workshops are available over a period as colleagues will encourage each other to attend.
It should be clear that attendance at a workshop does not identify the individual as being at risk. A detailed stress management programme is described in Chapter 4.
Training to manage change No one likes change. The poem below written by Machiavelli in the sixteenth century expresses this very well. No task is so difficult To set about, No leadership so delicate, No venture so hazardous, As the attempt to introduce A new order of things. Those who change Find as their adversaries All those who succeeded well Under the old order, And no more than lukewarm Supporters among those who Might function under the new.
If major change is envisaged in the workplace, the plan should include a strategy to minimise adverse effects on staff. Too often major change finds managers beleaguered, with no skills or time resources to negotiate the change successfully. Developing a healthy organisational structure and culture It is not appropriate in this chapter to describe in any detail theories of good management and variations in organisational structure.
Employee-directed initiatives should not be used to plaster over these cracks. Chapter 1 describes these issues in some depth. Developing health-related policies Sickness absence Inevitably, in any organisation some people will become ill. Concern is likely to arise if there is long-term absence or frequent short-term absences.
The latter are likely to be related to factors other than illness and require good management. The organisation should have a written sickness absence policy which includes guidance for managers on how to manage both types of absence. This will indicate points at which action should be taken and what this action should be, when medical advice should be sought and what weight should be given to that advice. Where there is little flexibility for either of these initiatives, sickness absence is inevitably prolonged.
Chapter 6 discusses sickness absence issues. Smoking A smoking policy is essential in all organisations. There is a detailed discussion of this in Chapter 7. Substance misuse There have been many attempts to quantify the extent of substance misuse including alcohol in the workplace. Many organisations have developed sympathetic policies for the management of individuals with this problem.
Unfortunately, most cases remain concealed and form a small but inefficient element in many workforces. An increasingly serious approach is being taken by employers in organisations where there may be a safety or security risk. On recruitment the urine or blood of candidates is screened for drugs or alcohol. In some organisations this is followed by unscheduled testing during employment. It remains doubtful whether such screening is adequate or effective.
The substance misuse policy should address this issue with regard to its relevance to the particular organisation. See Chapter 4 for detailed discussion and a model policy. Equal opportunities This issue is considered in Chapters 9 and 10 where model policies are provided. Developing staff support systems Counselling Counselling at an early stage can and does reduce poor performance and sickness absence Reddy The level of counselling provision will depend very much on the organisation.
The original assessment should give some indication of the level of need. In many instances there may be sufficient expertise within the human resource management and the occupational health teams. The organisational health plan Where the need is great, consideration should be given to the appointment of counsellors or to setting up an external counselling provision, using one of the many organisations providing such services. A full employee assistance programme provides counselling for staff on many issues unrelated to work including social and legal problems.
Payment is usually on a per capita basis. The cost may not be justified for average need when there is a reasonable level of expertise in-house. The issue of counselling is described in greater detail in Chapter 4. These groups may provide useful indicators of organisational problems.
To be effective such groups should be well constructed and their purpose must be clear. If not properly established they serve little useful purpose. Summary The health plan should include guidelines on staff support and counselling. Health promotion The Health of the Nation Department of Health proposed the setting up of a task force to examine and develop activity on health promotion in the workplace.
None of these targets can be achieved solely by action in the workplace but all are important to the working population. The health plan should include consideration of appropriate health screening programmes for this particular workforce and what form health education should take. For further discussion see Chapter 8. Summary Recommendations for health promotion activities and health screening should be clear. Implementation and audit The working party will now be in a position to submit the draft health 45 46 Occupational health plan for general discussion.
At this stage the cost implications should also be developed. Because the requirements and commitment of individual organisations will be varied, it is impossible to give overall guidance on the resources that will be needed. The outline of a model health policy is shown on pages 47—9. Some elements will already be in place, others will be possible within a short timescale, yet others may require anything up to five years to develop. Targets should be set for implementation and also for assessment of the results of revised or new activities in areas such as personnel selection and health promotion.
It should also be clear who is responsible for implementation and the monitoring of progress. The organisational health plan A model health policy Introduction The [name of organisation] recognises the need to protect and promote the health of employees. The provision of a pleasant and safe workplace, where employees will feel enhanced, can contribute significantly to the overall health of employees. The International Labour Organization has defined health as a state of physical, mental and social well-being.
This organisation has a holistic approach to the health of the workforce and has developed health and safety and personnel policies in line with that philosophy. Consideration will be given to the form of interviews and who should participate. All interviewers will receive training in interviewing techniques and equal opportunities.
Training Training plans will be developed for each job category and each post holder to improve their ability to carry out the job. Everyone placed in a supervisory or managerial position will receive training in general management skills on appointment, if not previously trained. Staff will also receive training in coping with change. General life skills training will be available for all staff. Appraisal Fair appraisal systems will be in place for all employees to provide a mechanism for structured assessment of performance, feedback on that performance, identification of strengths and weaknesses, and a plan for training and development.
Organisational style and structure Every effort will be made to enhance communication upwards, downwards and sideways, to provide opportunities for personal growth and initiative, and to provide appropriate reward and recognition. Special health-related policies The organisation has developed personnel policies to enhance employee health. A series of workshops is available to staff on life skills, stress management and surviving change.
The organisational health plan Campaigns on, for example, smoking and alcohol abuse are run from time to time. The organisation is also a member of the Look After Your Heart campaign. Audit There is a regular audit of these activities. Managers are responsible for ensuring that staff have access to appropriate areas of this policy. They are also required to put in place measurements of staff health, such as sickness absence, staff turnover and performance.
Staff representation Formal Informal 7. Galbraith, The Affluent Society, Chapter As work has become less physical, the psychological health of employees has assumed increasing importance. It has been estimated that 80 million working days are lost each year because of stress-related and mental illness. The case of Walker v. Northumberland County Council in which Walker, a social worker, succeeded in proving that his employers had not shown sufficient care in preventing his work-related mental illness, suggests that employers may now be at significant risk of litigation.
This chapter explores the concept of mental health and the development of mental illness. An attempt is made to overcome misconceptions about the meaning of stress. The causes of stress at work are described, including job overload, role ambiguity, communication problems and change. Guidance is given on the development of a mental health policy. This includes methods of recognising and measuring stressful work situations, techniques for managing stress and change, and relevant personnel policies. The chapter concludes with a model policy for mental health and the suggested contents of a stress management workshop.
Introduction Each year 6 million people in the UK suffer from some sort of psychiatric disorder such as depression or anxiety. Mental health is largely a problem of the working age population and therefore impacts significantly on any business organisation. It has been estimated that 8 million working days are lost each year through drink-related disease and as many as 80 million 55 56 Occupational health days through all forms of stress-related and mental illness. In the same survey 95 per cent of employers considered that the mental health of their employees should be a concern. This concern was not matched by significant action, only 13 per cent of these same companies having developed a policy or programme for promoting mental health in the workforce.
One might pause for a moment to consider the syndrome of stress in the workplace which has been an increasing cause of concern over the last two decades. Or is it that life in the latter part of the twentieth century has become generally more pressurised, faster, and hence more demanding?
One obvious change in the world of work is from physical to mental activities. The risks to health from exposure to chemical and physical hazards have been significantly reduced through technological advances and effective health and safety legislation. Now a great deal of time in the average workplace is spent relating to electronic information processors. This results in difficulties not experienced when communication is between human beings. The keyboard operator seems unable to control the pace of work—a new variation of machine-paced performance.
Controlled by computer technology, the operator is left without the natural recuperative breaks which occurred in the pre-computer age. The body is overused and exhausted, resulting in problems such as repetitive strain injury and stress. The role of the manager is now much more complex. Organisational structures are less hierarchical, decisions more participative, objectives more competitive.
There is never any time to stand and stare. Add to this the continuing change process and lack of job security, which can be found in almost every industry, and the potential for stress is enormous. Any plan for mental health in the workplace must address these various causes of stress, suitable health education interventions, facilities for early diagnosis and support, and development of policies enabling rehabilitation and resettlement of those who become mentally ill. These form part of a spectrum of disease. Mental health and illness at work Mental health has been described as a state of psychological wellbeing which allows the individual to enjoy life and be able to cope with the inevitable problems of living without prolonged or significant change of mood.
When put under pressure the body has few physiological responses. These are no different from those available to the cave man or our mammalian ancestors. The available responses prepare the individual to fight or flee. An anxiety-provoking situation stimulates the higher centres of the brain, from which a series of nerve and hormonal connections cause stimulation of the adrenal glands. These 57 58 Occupational health glands respond by excreting the catecholamines, adrenaline and noradrenaline, and cortisol into the bloodstream. None of these changes assists the individual to deal with work overload, a frustrating work situation or a difficult interview with the boss in fact, a throbbing heart and breathlessness are counterproductive , but that is all we have available.
A continual or recurrent state of stress can eventually lead to anxiety states and depression. Stress has also been shown to be associated with diseases such as cancer and coronary heart disease. Not all mental ill health arises from a gradual deterioration of mental well-being. Although there is disagreement about the influence of the environment on the development of some forms of mental illness, such as depression and schizophrenia, in many individuals these illnesses seem to arise without reference to the general psychosocial environment.
Cause of stress at work If we now look in more detail at the development of stress symptoms in the workplace there are three obvious components: the mental and physical state of the individual, pressures in the social and domestic environment and in the workplace, and the interplay of all these components. Individual factors There is a tremendous variation in the ability of individuals to cope with pressures. Others may produce transitory vulnerability, such as the occurrence of a number of traumatic life events at any one time, the development of feelings of inadequacy, physical illness and loss of social support.
Nature of the work Although all work may be potentially stressful, certain types of work are recognised as being more likely to induce stress. This is particularly true of service industries, such as the police force, the ambulance service and health care. In such work there is a continual demand for empathy; the worker may be placed in life-threatening situations and may be frequently exposed to the physical and emotional trauma experienced by others.
Other types of work which are inherently stressful are associated with frequent deadlines, short response times and no room for error. These conditions are found in the work of groups such as money brokers and television news teams. Culture and structure Not only is the nature of the job a significant factor but also the culture of the organisation. Many organisations where the work undertaken is not intrinsically stressful nevertheless provide employees with an 59 60 Occupational health uncomfortable environment where disease is common. Management style, communication structures, objective-setting and appraisal systems may be perceived as unfair or at best quixotic.
A significant factor may be a cultural refusal to recognise that stress can be a problem, so there is fear of discrimination if it is admitted. Where there is quantitive overload the problem will be compounded if the employee has little or no control over the load. Machine-paced work has long been recognised as a source of pressure. This applies not only to process workers but also to those working with display screen equipment who are dependent on the timescale which the electronics can achieve. In many organisations the workload of one department is wholly dependent on other departments with little opportunity to control the flow.
It is common for an employee to perceive that he is overloaded but be unable to find any solution, or at least any solution not perceived as making him vulnerable to management censure. Underload, although less common, may cause great anxiety where there are to be job losses or where the individual loses self-esteem because he is not making a worthwhile contribution.
Interpersonal relationships If there is no relationship of mutual trust and respect between the manager and the member of his team, the subordinate is likely to feel under pressure. The manager may feel equally under pressure when there is a mismatch between formal and actual power, or when a more democratic approach to decisions has been adopted.
Unsatisfactory peer group relationships may cause much distress. Scapegoating is not unusual in work groups. This may be difficult for the manager to control and is usually not amenable to outside intervention. Job ambiguity and role conflict A common problem for an employee is the lack of a clear job specification. The expectations of the employee may be entirely different from those of the manager or, indeed, the peer group.
Often individuals are responsible to more than one manager and may be servicing several work groups. Priorities may be difficult to determine and clarification, when sought, may not be forthcoming. Mental health and illness at work Lack of communication It seems almost impossible to achieve good communications in any but the smallest organisations. This may be a minor irritant where the unavailable information will in any case have little impact on the employee. However, in times of change when jobs may seem to be at risk, lack of information and consequent rumour only increase anxiety.
Consultation is also important. Communication should be possible upwards, downwards and sideways. There is little point in consultation, however, if there is no discernible impact on management decisions. It is difficult to say what is a correct balance, although the eight-hour working day does seem to have many credentials. Few organisations approach this problem realistically. The involvement of partners is usually perfunctory. Change Cultural anthropologists have found that all human societies evolve in a cultural pattern—a tightly woven system of habits, status, beliefs, traditions and practices.
The cultural pattern is a vital stabiliser. Change is often introduced without any consideration of the threat that it may pose to the cultural pattern—which habits; whose status; what beliefs? In such cases resistance is the result. Change is of such significance that it almost deserves a separate chapter. It is difficult to think of an industry which is not undergoing massive change. Much of this is government-led in fields such as health care, education and transport.
The aspirations of many organisations to achieve world class and competitive needs are also prime motivators of change. Perhaps a more significant force for change is information technology. Those over 40 can soon feel illiterate. It is difficult to imagine a greater change than that which has occurred in the typing pool.
The clattering, noisy, bright environment is now quiet, enclosed, gently illuminated. Human communication is cut to a minimum; in fact, in many cases it hardly needs to occur in the day-to-day work routine. The 61 62 Occupational health routine and often inappropriate use of e-mail may reflect the isolation felt by some employees. In other areas well-developed technical skills are no longer required because sophisticated technology has taken over. Those who were able to accomplish complex tasks requiring manual dexterity and problemsolving strengths may derive little satisfaction from overseeing an electronic system programmed to perform the same task.
At the very least, the locus of control has shifted away from the individual. Holmes and Rahe have demonstrated clearly in a scale of some 40 items that too many changes happening together, giving a total score of or more, may be associated with the development of significant diseases such as cancer and coronary heart disease. An extract from the scale illustrates the relative importance of work-related change: Life event Death of spouse Fired at work Retirement Business readjustment Change to a different type of work Change in responsibilities at work Trouble with boss Value 47 45 39 36 29 24 To most people change is associated with insecurity either because of a reduction in the number of posts, or because the requirements of the job are subtly changed and the individual may feel deskilled or unskilled and vulnerable.
People prefer stability and resist change. National Health Systems. Market and Feasibility Study. National Statistics Bureau. Beijing, China: National Statistic Bureau. Niemi, J and V Notkola. Occupational health and safety in small enterprises: Attitudes, knowledge and behaviour of the entrepreneurs. An intervention programme to promote improvements of the work environment in small enterprises: Functional adequacy and effectiveness of the intervention model. Paoli, P. Pokrovsky, VI. The environment, occupational conditions and their effect on the health of the population of Russia.
Occupational Health: A Practical Guide for Managers
Guidelines on organization and operation of occupation health services. Occupational Health Services. European Series, No. Paper presented at the African sub-regional workshop on occupational health services, April, Mombasa. How to organize plant-level collaboration for workplace actions. Helsinki: Finnish Institute of Occupational Health.
Geneva: WHO. New epidemics in occupational health. People and Work. Research reports No. Reverente, BR. Occupational health services for small-scale industries. The year experience of an academically affiliated occupational and environmental medicine clinic. Western J Med Emergence of occupational medical services outside the workplace.
Am J Ind Med Prague: National Institute of Public Health. Global Strategy for Health for All by Year Health for All, No. Report of the Working Group. Publication No. Country reports. World Summit for Social Development. Declaration and Programme of Action. Copenhagen: World Summit for Social Development.
Zaldman, B. Industrial strength medicine. J Worker Comp Zhu, G. Rate this item 1 2 3 4 5 3 votes. Confusion often occurs because the term occupational health services may be used to denote: the provision of occupational health services i. Occupational health approaches embodies a number of principles and approaches to guide action, such as the general principle of primary health care advocated by the WHO and the improvement of the working conditions and environment advocated by the ILO. The concept of working culture is intended in this context to mean a reflection of the essential value systems adopted by the undertaking concerned.
Such a culture is reflected in practice in the managerial systems, personnel policy, principles for participation, training policies and quality management of the undertaking.
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Read times Last modified on Tuesday, 11 October Published in Preface Part I. The Body Part II. Tools and Approaches Part V. Chemicals Part X. Occupational Health Services Additional Resources. Click the Button below to view additional resources for this topic. Occupational Health Services References.
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