Quality audit industrial health


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from Health Action- October 2012

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Quality audit industrial health

  1. 1. .. :i ,!ii ?!r:; r:. :"... ;:iiil;ii;iilii:jiifi :i;i:, f;ii:ffjf.i$$$i and Ouality Audit inOccupational Health is fitnessforpurposethenwhat is purpose? Jf QualitV Inadequate evidence-based standards practice in of IPurpose and excellenceare not necessarilyself- occupationalhealth are fundamentalweaknesses. In evident. many contexts, there is a wide diversity of practice In an occupationalhealth service context, is the betweenoccupationalhealth services,and between purpose for: differentcategories occupational of healthpractitioners r Improving the healthof the worker(s). ostensibly working to achievethe sameend. Debateis o Reducingrisks to health,detectingdisease or neededabout how Occupational Health is practised, assessing risks to health, what the aims and purposes are (and hence the o Increasing availability,fitnessandproductivity the measures appropriate ensurequality). Often there to of the workforce (and henceprofits)? is inadequate scientificevidenceto justify a particular p r a c t i c e . I f t h a t p r a c t i c eo r p o l i c y i s a c c e p t e d Perhaps Quality in Occupational Health is ,,in the eyes uncritically as a quality assurance standardor as an of the beholder"l audit criterion, health outcomesin the long-term might If so, who is the beholder? suffer rather than benefit. Perhaps,there is a case for o The employer o The emplovee(s) Cochrane type collaboration occupational in health,or o The occupational healthserrice supplier a firrmof evidence-based occupational medicine help to o The external quality sysremsauditor le.(rlve thi. iundantental ditficultr. o The occupational healthauditor/peer rerieuer or In the .ib.en.. perhaps of n_crd rl.rndrrd.. rThe legislator one nte hu c itrWorkers Perception COnlp;rco Goodhealth o h . e r r e di _r- struCture. lnd .Fo Stableand satisfactory employment practiee.ucain:t "*"tMancrgersperception "*!lo Rapid response r Authoritativereporl -suidelines as follorr s:o Advice thatwill pennit a managerial decisionOccupat i orta I heet t h p rctfe.s ctIs 1t rc ept i on I Assuring and measuring quality in si cut eo Impartial advice . Accuraterisk assessment occupational healtho Valid adviceon risk reduction Our response the difficultiesoutlinedaboveshould to avoid the two opposingpitfalls of nihilism or ofStandards quality of measunnganything that can be measuredsimply If the perceptions quality are so diffbrent. is it of because can. itpossibleto define a single GoldStandard"l Severalapproaches assure to quality and to conduct Is therelikely to be a simple unitary LeagueTable audit in occupationalhealth have been considered.Ifmeasure quality? of all of thesewere pursuedto the extent to which they Given the complexity of the issues- the answersto are individually advocated, considerable a amount ofthesequestions almostcertainlyNO. are resourcewould need to be invested.and if this had aH e a l t hA c t i o n. O c t o b e r 0 1 2 2 l2
  2. 2. limited return, serious inefficiency could arise. Debateis neededabout howMoreover, if an inappropriate choice of qualityassurance standards of audit topics or methodsis or Occupational Healthis practised, what themade,false (positive or negative)conclusions may be aims and purposesare (and hencethedrawn about an occupational health service, and measures appropriateto ensurequality).ineffective, or even counter-productive, changesimplemented. Often thereis inadequate scientific Education and professional competence of evidenceto justify a particularpractice.occupational healthprofessionals well asof managers asmust not be overlookedin the questfor quality assurance questionnairesare being administered to the workersstandardsand audit criteria. In a controlled study at significant risk.investigating changes brought aboutby cycles of peer Examplereview audit,the effect of audition.the process care of Consider issueof industrialaudiometry. part of the aswas limitedto one aspect process.of resulting slieht in a hearingr-onservation monitoringprogramme. andi m p r o v e m e n tu h e n c o m p a r e d o t h e m u c h l a r g e r . t C l e a r i r i t i : i m p o r r a n rr o h e l p a s s u r eq u a l i t y b ydifferences the process care associated in of rrith pnor establishing management systems callingemployees fortraining and standards competence.Thus issuesof of to undertaketheir audiomeffy,for regularly calibratingcontlnuingprofessionaUmedical education, so-called of the audiometer,for recording and storing the audiograms,"Clinical Governance" of professional and (re)validation for recalling the employeesafter an interval, and so on.are closely linked to the pursuit of quality and its audit. Good professional occupational health practice Issuesof quality and audit must address occupational requires much more than thal the workplace needstohealth throughout the whole working organizationand be assessed suitable and sufficient noise surveys, bynot merely within its occupationalhealth service. For appropriateadvice must be given regarding reductionexample, an audit of the managementof sickness of noise at source,personalprotection etc. Moreover,absenceby an occupationalhealth service in isolation the appropriate employees who need "Healthwill have a limited value, if it doesnot also address the Surveillance" must be clearly identified. If impeccableextent to which the organizationas a whole recognizes, audiometryand systemsmanagement applied to a isaccepts and implements appropriate referrals as well poorly selectedsubsetof employees(while others atas the ensuing action to prevent ill-health and to equal or greater risk are overlooked) or if inadequaterehabilitate. steps are taken to reduce exposureat source and/or It is essentialto develop quality assurance standards implement personal protection, then sadly goodand audit criteria for thosepolicies, structures, processes occupationalhealth standards have not been achieved.and outcomes which have a critical bearing on It is essentialto searchfor the fundamentaloweakoccupational healthcare. Al1 too often quality standards links" in the pursuit of audit and quality in occupationalare devised and audits undertakenin circumstances health both within the discipline as a whole and withinmerely where it is easy to set arbitrary standards to or each and every workplace, where it must be practised.conduct simple audits. These may prove to be very Scientificresearch, appropriate professional competencepoor surrogatesfor the true quality of care. For and debate between the practitioners concerned withexample,in one study,essentiallyno co-relationwas help achievethis. The pressure quality improvement forshown between responsetimes following referral to and the advent of third party audits may help in someoccupationalhealth service and the peer reviewed circumstances.However, if thesepressures result inquality ofthe response.It is relativelyeasyto establish arbitrary quality standardsor in auditing what can bequality assurance standards, and to audit the use of, for audited rather than what should, they may lead toexample, occupationalhygiene equipment to measure unwarrantedself-satisfaction hiding fundamentalfl awsgases, vaporsor respirabledust as well as lung function in occupationalhealth care.lequipment.However,it may be muchmore fundamental (Clinical Instructor (Psychiatric Nursing), College of Nursing,and important to questionwhether the correct hazardis Jawarharlal Institute of Post Graduate Medical Education andbeing sampled,how and why the sampling strategyfor Research(JIPMER), Puducherry. The author acknowledgesthe workplace has been determined,and whether and various sources which are available on request)to what extent appropriately sensitive and specificHealthAclion o October2012