Those responsible for the management of health, environment and safety matters should consider the following guidance when determining what function the occupational health nurse specialist will fulfill within the company. There may well be variation in the function of an occupational health nurse between different organizations depending on the needs and priorities of the working population and the health care system in which they are operating. Some useful questions to consider are:
- Has a comprehensive health needs assessment been performed recently to identify the needs of the organization and to help with setting priorities for action?
- Has the workplace health management policy been reviewed and agreed in light of the needs assessment, taking into account both legislative demands and voluntary agreements?
- Have the goals of the occupational health service been defined clearly and communicated throughout the organization?
- Does the occupational health service have adequate resources to achieve these goals, including staff, expertise, facilities and management support?
- Is it clear how the performance of the occupational health service or of individual professionals within that service, is to be evaluated and are there clear, objective criteria agreed?
The answers to each of these questions will help to shape the discussion about the role and function of the occupational health nursing specialist within a specific organization.
Workplace health management is most effective when there is:
- Commitment from senior management
- Active participation of employees and trade unions
- Integration of company policies and clear targets for HES (health, environment and safety management)
- Effective management processes and procedures
- Adequate resources
- A high level of management competence, and
- Rigorous monitoring of company performance using the principles of continuous quality improvement.
Policy making should be based on legislation and on a voluntary agreement between social partners at work, covering the total concept of health, safety and wellbeing at work.
Evaluation of Performance
Evaluation can take place on three levels:
- Company performance in the area of workplace health management
- Contribution of the occupational health and safety service
- Contribution of the individual occupational health nurse
All review procedures should be based on the principles of continuous quality improvement or audit. The criteria and indicators against which performance is to be measured should be defined clearly as a part of the initial planning and contracting process so that everyone is clear about what performance indicators are being used. Some caution is required if health measures are to be used as performance indicators for the occupational health service as much of the work of an occupational health service is orientated primarily towards the prevention of disease or injury or the reduction of risk. The success or failure of preventative strategies can be difficult to measure using health data on its own as it is sometimes uncertain to what extent a single intervention or programme of interventions can claim responsibility for preventing the effect. Furthermore, many health effects only become apparent a long time after initial exposure and sometimes only become apparent in particularly vulnerable individuals. Where prevention is dependent upon the employee, the line manager or the organization following the advice of the occupational health professional, where this is not followed the adverse event may not necessarily indicate a failure on the part of the occupational health service, but rather a failure of the individual, manager or organization to respond appropriately to the advice they were given.
Evaluation can be based on the structure, input, process, output and outcome indicators, and both direct and indirect effects, positive or negative, can be taken into account when judging the relative success or failure of the service. It is often useful to consider two inter-related aspects of occupational health practice in the evaluation process, the professional standards that underpin professional practice and the delivery or services within the organization. Professional practice can be evaluated by, for example, evidence of participating in continuing professional development and adapting practices to take account of new knowledge, self-assessment of compliance with current best practice guidelines, regular internal and external peer review, or systematic audit of compliance with standards. The criteria used to evaluate professional practice should also take account of ethical standards, codes of practice and guidance from the professional bodies. Evaluating service delivery can be done by, for example, comparing the delivery of services against predetermined service level agreements or contracts, including meeting agreed quality standards for services, through customer or client satisfaction surveys, or by assessing the adequacy of access to and level of uptake of services.