2. Methods Used for Quality Assessment in Occupational Health Services - a review Jacek Michalak, Department of Health Care Organization NIOM, Lodz, POLAND

3. 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

4. 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)

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. Methods Used for Quality Assessment in OHS- a Review ICOH SC Conference, Lodz September 22-23, 2001 Supervisory system in Polish Occupational Health Service: ènational consultant (specialist) appointed by the government èregional consultants (specialists) appointed by local authorities - Voivodes

12. Methods Used for Quality Assessment in OHS- a Review ICOH SC Conference, Lodz September 22-23, 2001 The standards for prophylactic examinations in Poland: èminimum extend of medical examination èminimum set of laboratory tests èminimum set of specialist consultations This can be broadened by a doctor èminimum frequency of prophylactic examinations This can be shortened by a doctor

13. Methods Used for Quality Assessment in OHS- a Review ICOH SC Conference, Lodz September 22-23, 2001 System of physicians’ specialist education in Poland: è6 years of medical studies è1 year of postgraduate stages Now you can start to cure, but not to be an occupational physician!

14. Methods Used for Quality Assessment in OHS- a Review ICOH SC Conference, Lodz September 22-23, 2001 Former system of specialists’ training: è2 years of training– I 0 specialty èNext 3 years - II 0 specialty Present system: è4 years of specialty training Individual supervision of a specialist – tutor or MASTER

15. 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? ???

16. 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

17. 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

18. 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

19. 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

20. 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

21. Methods Used for Quality Assessment in OHS- a Review ICOH SC Conference, Lodz September 22-23, 2001 Thank you for your attention