Methods Used for Quality Assessment in Occupational Health Services

- a review

Jacek Michalak,

Department of Health Care Organization

NIOM, Lodz, POLAND

Methods Used for Quality Assessment in OHS- a Review ICOH SC Conference, Lodz September 22-23, 2001

• Lay physician approach

• Trends in medicine:

• Individualization

• Aggregation (DRG - cook-book medicine

Methods Used for Quality Assessment in OHS- a Review ICOH SC Conference, Lodz September 22-23, 2001

• Quality is like beauty – easy to assess, difficult to measure

• If you can measure it - you can manage it• Qualitative methods• Quantitative methods• Semi-quantitative methods• Assessment(s)

Methods Used for Quality Assessment in OHS- a Review ICOH SC Conference, Lodz September 22-23, 2001

Objective:

• to delineate the methods and techniques which are used for quality assessment in OHS

• to find the most useful methods for Polish Occupational Health Service

Methods Used for Quality Assessment in OHS- a Review ICOH SC Conference, Lodz September 22-23, 2001

Methods (1)

• survey of the current literature (Evidence Based Occupational Medicine)

• Review of international reports on OHS

Methods Used for Quality Assessment in OHS- a Review ICOH SC Conference, Lodz September 22-23, 2001

• legislation• inspection(s)• financial

incentives• supervision

• accreditation• certification• training• research priorities• management

Methods (2) International reports on OHS

Methods Used for Quality Assessment in OHS- a Review ICOH SC Conference, Lodz September 22-23, 2001

• NIOM reports

• Milbank Quarterly 1999

• Priorities and Strategies in Occupational Safety and Health Policy in the Member States of the European Union

• GP HESME

Methods Used for Quality Assessment in OHS- a Review ICOH SC Conference, Lodz September 22-23, 2001

Terminology• Occupational Health• Occupational Medicine• Occupational Safety and Health• Occupational Health and Safety• Professional (occupational) diseases• Health Environment and Safety

Methods Used for Quality Assessment in OHS- a Review ICOH SC Conference, Lodz September 22-23, 2001

Evidence-based Occupational Medicine

• Cochrane Databases – 0 reports

• MEDLINE – 0 to 5 reports (EBM reviews)– Evidence-based occupational health – 0 reports

– Evidence-based occupational medicine – 0 reports

– Evidence based OHS- 0 reports

– Quality Assurance methods – 1 report

Methods Used for Quality Assessment in OHS- a Review ICOH SC Conference, Lodz September 22-23, 2001

Supervisory system in Polish Occupational Health Service:

national consultant (specialist) appointed by the government

regional consultants (specialists) appointed by local authorities - Voivodes

Methods Used for Quality Assessment in OHS- a Review ICOH SC Conference, Lodz September 22-23, 2001

The standards for prophylactic examinations in Poland:

minimum extend of medical examinationminimum set of laboratory testsminimum set of specialist consultationsThis can be broadened by a doctorminimum frequency of prophylactic examinationsThis can be shortened by a doctor

Methods Used for Quality Assessment in OHS- a Review ICOH SC Conference, Lodz September 22-23, 2001

System of physicians’ specialist education in Poland:

6 years of medical studies1 year of postgraduate stages

Now you can start to cure, but not to be an occupational physician!

Methods Used for Quality Assessment in OHS- a Review ICOH SC Conference, Lodz September 22-23, 2001

Former system of specialists’ training:2 years of training– I0 specialtyNext 3 years - II0 specialtyPresent system:4 years of specialty training

Individual supervision of a specialist – tutor or MASTER

Methods Used for Quality Assessment in OHS- a Review ICOH SC Conference, Lodz September 22-23, 2001

Who is actually interested in better quality of OHS?• Central authorities?• Local authorities?• Employers and their organizations?• Employees and their representatives?• Research institutions – NIOM?• Labor Inspection?• Sanitary Inspection? • ???

Methods Used for Quality Assessment in OHS- a Review ICOH SC Conference, Lodz September 22-23, 2001

Criteria and indicators

• Input

• Process

• Output

• Outcome

• Performance

Methods Used for Quality Assessment in OHS- a Review ICOH SC Conference, Lodz September 22-23, 2001

Hierarchy of needs in enterprises

• Economic evaluation

• Positive image of the enterprise

• Health of employees

• Employees opinion

Methods Used for Quality Assessment in OHS- a Review ICOH SC Conference, Lodz September 22-23, 2001

Preliminary results of GP HESME in Lodz• Different needs of similar enterprises• Economic appraisal first• Evaluation of OHS • GP HESME as a marketing technique• GP HESME is realized as a set of different

programs in public transport company

Methods Used for Quality Assessment in OHS- a Review ICOH SC Conference, Lodz September 22-23, 2001

Conclusions (1)

• Predominate methods based on supervision system - labor and sanitary inspections.

• Numerous voluntary methods (ISO standards, Good Practice, accreditation etc.) are believed to be more effective. Their effectiveness was not unequivocally proven.

• Evaluation of employers’ and employees’ satisfaction is rarely performed

Methods Used for Quality Assessment in OHS- a Review ICOH SC Conference, Lodz September 22-23, 2001

Conclusions (2)

• Differences between majority of OHS models in EU countries, and Polish OHS

• OP as decision maker in Poland.

• QA methods in Polish OHS are more similar to those used in clinical medicine.

• GP HESME offers a new insight into QA in OHS: occupational health as the managerial problem

Methods Used for Quality Assessment in OHS- a Review ICOH SC Conference, Lodz September 22-23, 2001

Thank you for your attention