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