Background
Workers’ health surveillance (WHS) includes the assessment of workers’ health and factors in the working environment that can have a negative influence on the health and wellbeing of workers [
1]. WHS is aimed at the prevention of work-related diseases, and the maintenance and promotion of workers’ health. It is an important activity in occupational health care, developed to protect workers in the new and rapidly changing environment [
1‐
3].
In the Netherlands, a guidance document was developed by the Netherlands Society of Occupational Medicine to support the occupational physician (OP) with the performance of WHS [
2] . According to this guidance document, three core objectives of WHS can be distinguished 1) the prevention of work-related diseases, 2) monitoring and promoting workers’ work-related health, and 3) maintaining and improving workers’ health and sustainable employability of workers [
2]. Employers are legally obliged to periodically offer workers a WHS aimed at at least the first core objective; the prevention of work-related diseases [
4]. Several studies have found that WHS, when carried out according to the guidance document, can prevent work-related diseases, improve work functioning, and can have financial benefits for employers [
5‐
7].
OPs are employed at an occupational health service (OHS) or are self-employed [
8]. To comply to the legal obligation to periodically offer WHS to workers, companies can hire an OHS or a specific expert, an OP [
9]. In a study by Moriguchi et al., it was concluded that, compared to their Japanese counterparts, Dutch OPs spend a large amount of time managing workers’ sickness absence and little time on preventing workers’ health problems [
10]. Assuming that WHS is such a preventive activity, this means that despite the legal obligation for employers [
4], WHS is not regularly performed.
In promoting and implementing WHS, the behaviour of the OP is crucial. Several factors influence this. A model that can be used to develop and implement integrated health policies is the behaviour change ball (BCB) [
11]. According to the BCB model, the behaviour of several actors at different organizational levels can influence the implementation and performance of a health policy [
11]. Applied to the performance of WHS, this means that besides the behaviour of the OP, other stakeholders can also have an influence on the performance of WHS. The BCB model distinguishes three levels within an organization at which stakeholders can act: 1) the strategic level, where actors are involved in decisions concerning what will be done and define the short-term goals for the organization; 2) the tactical level, where actors are involved in decisions concerning how it will be done; and 3) the operational level, where actors are involved in the actual implementation of the policy [
11,
12].
In order to improve the performance of WHS, actors at different organizational levels are important. The aim of the present study was to investigate the view and policy on the performance of WHS of an acting party at the strategic level, namely the management of the OHS. The research questions were:
1.
What is the view of the management of the OHS on WHS?
2.
What is the current policy on WHS within the OHS?
Discussion
In answer to the first research question (‘What is the view of the management of OHSs on WHS?’), we found that a substantial part of the board members have a negative view on WHS. Other board members have a more positive view, they are convinced of the added value of WHS. Regarding the second research question (‘What is the current policy on WHS within the OHS?’), we found that in general board members do not provide training or instructions or any other form of support in carrying out WHS. The majority of the board members mentioned they only perform WHS at request of the company.
The views and policies of the management of OHSs can have an influence on the capabilities, opportunities and motivation of OPs to perform WHS [
11,
12]. The majority of the board members did not have a policy to provide OPs with training or instructions related to performing WHS. Horppu et al. (2017) investigated the behaviour of OPs and found that a lack of knowledge and skills can be considered a barrier to performing a desired behaviour [
17]. Lugtenberg et al. (2016) also found a lack of knowledge to be a perceived barrier for Dutch OPs to adhere to a guideline [
18]. A study of Olsen et al. (2014) showed that physicians play an important role in the implementation of an occupational health and safety programme by influencing the employers [
19]. The lack of instructions for OPs can therefore be seen as a negative influence on the capabilities of the OP to perform WHS. No literature on the training needs of OPs in the Netherlands has been found. Persechino et al. (2015) found that Italian OPs regard practical aspects of health surveillance and risk assessment the most important in a training to update their knowledge and skills [
20]. Assuming that improving the knowledge and skills of OP on WHS by instructions or training will improve the performance of WHS by the OP, it is important that the managements of the OHSs support the OPs with training in and instructions about the practical aspects of WHS.
Part of the board members reported that WHS is time-consuming. Some board members even mentioned that it will not be possible to perform WHS, as OPs’ schedules are already filled with other activities. This indicates that the infrastructural environment of the OHS is currently often not adapted to the performance of WHS, which can be considered a negative influence on the opportunities for the performance of WHS by OPs. De Brouwer et al. (2017) found that OPs’ activities in the Netherlands mainly focuss on return to work, which leaves them little time to conduct preventive activities [
21]. A change in occupational health practice towards a more preventive working environment is needed to improve the performance of WHS.
The contradiction found between the views on WHS – which were partly positive – and the policies adopted, which in general were not actively promoting WHS, may arise because OHSs have to sell their services to employers, who have to pay for it [
3,
9]. It appeared from the interviews that opportunities at companies (i.e. employers) to implement WHS were not always present. Some board members mentioned, for instance, that they adopted a passive strategy of only performing WHS upon request, because clients do not see the added value of it and do not respond positively when WHS is recommended, even though there is evidence that WHS can prevent work-related diseases and improve work functioning, and has financial benefits for the employer [
5,
6]. This is remarkable as it is the employers’ legal obligation to periodically offer WHS to workers [
4]. One of the goals of occupational health care is prevention of work-related diseases [
8]. Therefore, OHSs should stimulate the employers to oblige their legal obligations. This sense of urgency seems to be, however, lacking in the approach of a considerable part of the interviewed managers of the OHS.
Strengths and limitations
The board members of the OHSs were randomly selected from a list with OHSs. This led to the sample containing a large variety of types of OHSs. Assuming that this variety is representative of the variety of OHSs in the Netherlands, the results are applicable for Dutch OHSs in general. This can be considered a strength.
At international level, the European Union Directive recommends to provide workers access to health surveillance, aimed at prevention of work-related and occupational diseases [
3]. However, given the specific context of occupational health care in the Netherlands, the current findings may not be generalizable to an international level. This can be considered a limitation of the present study.
Another possible limitation of the study is that it may have been influenced by socially desirable responses [
22]. As the invitation for the interview stated that WHS is an important preventive activity, the board members could have felt the pressure to mention that WHS is indeed an important activity. However, board members were open and honest about their policy on WHS, which in almost all cases was not conducive to the performance of WHS. This indicates that the statements about the importance of WHS in the invitation may not have had a strong influence on the answers of the board members.
Future research
The results of the present study indicate that the current strategy and policy of the managements of the majority of OHSs in the Netherlands are not conducive to the performance of WHS. Future studies should investigate which interventions are most appropriate and effective in order to improve the performance of WHS.
The results of the interviews do not give us information about OPs’ perspective on factors that influence the performance of WHS. In order to improve the performance of WHS, we have started a longitudinal study with OPs, to investigate the needs, barriers, limitations and prerequisites related to performing WHS. The results will be used to develop appropriate intervention strategies to improve the performance of WHS by OPs.
Conclusion
The present study investigated the view and policy of the managements of OHSs on the performance of WHS. The mission statements and attitudes towards WHS indicated both positive and negative views on WHS. In general, the policy of the managements of OHSs can be considered as not facilitating to the performance of WHS. Managements of OHSs were not providing OPs with any instructions related to WHS, and adopted policies were not stimulating companies to perform WHS. Even though the board members’ mission statements and views on WHS suggest that board members of OHSs are positive about WHS, in practice the policy is in general not conducive to the performance of WHS. A change in the policy of OHSs towards a more preventive approach is needed to improve the performance of WHS.
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