What determines the size of occupational health services in UK universities?

Background There is wide, largely unexplained, variation in occupational health (OH) provision between UK employers.

Aim To explain the variation in OH provision across the UK university sector.

Methods Analyses of data from a survey of university OH services and from the Higher Education Statistics Agency. The outcome variable was clinical (doctor + nurse) staffing of the university's OH service. The explanatory variables examined were university size, income, research activity score and presence or absence of academic disciplines categorized by an expert panel as requiring a high level of OH provision.

Results All 117 UK universities were included and 93 (79%) responded; with exclusions and incomplete data, between 80 and 89 were included in analyses. There was wide variation in clinical OH staffing (range 0–8.4 full-time equivalents). Number of university staff explained 34% of the variation in OH staffing. After adjusting for other factors, neither the research activity nor the presence of high-needs disciplines appeared to be factors currently used by employers to determine their investment in OH.

Conclusions Government or other guidelines for university employers should take organizational size into account. Employers may need guidance on how to provide OH services proportionate to specific occupational hazards or other OH needs.

Occupational health provision in UK universities

Background Very few studies have been done of occupational health provision across an entire employment sector and universities are particularly understudied. The British government published updated guidance on university occupational health in 2006.

Aim To describe the occupational health services to all the universities in the UK.

Methods All 117 universities in the UK were included. Detailed surveys were carried out in 2002, 2003 and 2004 requesting self-completed information from each university occupational health service. This paper presents information on general characteristics of the service, staffing, services provided and outcome reporting.

Results There was variation in the type of occupational health provision; half the universities had an in-house occupational health service, 32% used a contractor, 9% relied on the campus primary care or student health service and 9% had ad hoc or no arrangements. In all, 93 of the 117 (79%) universities responded to the detailed questionnaire, the response rate being higher from in-house services and from larger universities. There was a wide variation in staffing levels but the average service was small, staffed by one full-time nurse with one half-day of doctor time per week and a part-time clerical or administrative member of staff. A range of services was provided but, again, there was wide variation between universities.

Conclusions It is unclear if the occupational health provision to universities is proportional to their needs. The wide variation suggests that some universities may have less adequate services than others.

Quality of occupational health provision: two rating scales and their determinants

Background To develop quality scales for occupational health services (OHSs) and describe and explain variation in quality across the UK university sector.

Methods Analysis of data from a national survey, to which 93 of 117 (79%) UK universities responded, and from the Higher Education Statistics Agency. Two quality scales were generated, one from the 1985 International Labour Organization recommendations on OHSs and one from clinicians’ perceptions (good, adequate, poor) about their OHS. The determinants examined were number of university staff, type of OHS (in-house, contracted, none/other), number of full-time equivalent occupational health doctors and nurses and OHS leadership (doctor, nurse, other).

Results There was wide variation in quality and a correlation (r = 0.65) between scales. In-house service, increasing service size and leadership by a doctor or nurse were determinants of higher quality; size of the university was not statistically significant after taking account of these factors.

Conclusions Some university OHSs may not be structured or operated to promote the highest quality of service. Inspection of individual quality scale items may be informative. These scales may be applicable in other employment sectors.

Occupational health services in higher education : third annual report

Occupational health services can make a valuable contribution to the performance of HEIs, yet a pilot study in 1999 suggested that occupational health provision in the HE sector lags behind other sectors, with some noticeable gaps. This project will:

* survey all UK HEIs to establish a baseline and identify examples of good practice in occupational health provision
* disseminate benchmarking information and case studies
* establish a collaborative network to encourage the development, sharing and implementation of recognised good practice and ensure the sustainability of improvements resulting from the project
* evaluate the outcomes of the above work.

Occupational health services in higher education : second annual report : summary

The second of three surveys of occupational health provision in UK higher education institutions was carried out in March 2003.

Information was collected on occupational health provision arrangements for all 193 members of UUK, other HEIs funded by HEFCE, constituent parts of the University of London and the University of Wales, and degree awarding bodies in the UK. There was a wide variety of arrangements. Thirty-eight percent had in-house services, 33% contracted with external providers for occupational health services, 13% made use of a local general practice or student health service, 6% had other or ad hoc arrangements and 9% had no occupational health service.

Occupational health and safety management systems : system types and effectiveness

The aim of this thesis is to develop a framework to evaluate the relative performance of different types of health and safety management system. This objective is an analytical one, but it stems from a policy issue of public importance. Over the past decade Australia, like other countries, has seen the emergence and growth of interest in developing health and safety management systems. But are they all the same, and if not, do they differ in their effectiveness? The thesis does not seek to give a definitive answer to these questions. Given the novelty of the phenomenon and the lack of research on this subject, the research is exploratory. An hypothesis about the effectiveness of different health and safety management systems is developed rather than tested. The thesis proceeds by first defining health and safety management systems as a combination of the planning and review, the management arrangements, the consultative arrangements and the specific program elements that work together in an integrated way to improve health and safety performance. A research procedure is described involving twenty exploratory case studies. The thesis then - develops - from the literature and the case study research - an analytical framework to evaluate the performance of different health and safety management systems. That framework has two parts. First is a typology of health and safety management systems. This is constructed from two distinctions - between 'safe place' and 'safe person' approaches to health and safety; and between 'innovative' and traditional' management methods and structures. These distinctions yield four types of system. The typology was applied to the case studies which yielded a reasonable fit in most instances. The second part of the framework is a 'process evaluation' technique akin to Quality standards. Derived from the Victorian SafetyMAP audit criteria, the "e;process evaluation tool "e; is preferred to traditional outcome measures such as incident or claim rates. Using this measure, the twenty case study enterprises were classified as above average, average or below average in performance. These results correlated poorly with traditional incident trend and benchmark measures. The two elements of the framework are then combined to explore the relationship between the different types of system and their performance. Evidence from the twenty case studies showed a tendency for innovative/safe place firms to perform better than traditional/safe person firms. This finding can form the basis for a hypothesis that may be subject to statistical testing on a generalisable sample. In addition five 'best practice' cases were selected and subjected to a cross case analysis to search for common characteristics that might explain their performance. This analysis suggests the importance of a number of factors: senior managers who drive health and safety change and mobilise all possible resources in the pursuit of change; health and safety representatives who work with managers in a 'joint regulatory relationship' across system activities; the involvement of employees more generally, but not as a substitute for action by managers and health and safety representatives; a comprehensive approach to elimination of all hazards; and the introduction of innovative programs to continually improve systems and facilitate employee involvement in health and safety.

Benchmarking occupational health and safety performance of Australian construction companies.

It is mandatory for Australian construction companies to provide a safe working environment for their workers and sub-contractors. Consequently, occupational health and safety (OHS) is a major issue for construction firms mainly due to the fear of prosecution. The recent introduction of Zero Tolerance by the Victorian government WorkCover Authority provided even higher OHS safety standards for the construction industry. This has placed a increased burden on construction companies especially small firms that are not in a position of financial strength.

The size of the companies has been found to be a major contributing factor to the OHS performance of construction contractors. This research is based on benchmarking study of 44 construction companies in Victoria, Australia. The results show that the major factors influencing safety performance were; company size, and management commitment to OHS.

Measuring the occupational health and safety performance of construction companies in Australia

Many facility managers are now required to deal directly with small firms engaged in the maintenance, alteration and cleaning of physical infrastructure. Increasingly the performance of small firms reflects on the manager of the facility, and so an understanding of their operation is required. It is mandatory for all firms to provide a safe working environment for their workers and subcontractors. Consequently, occupational health and safety (OHS) is a major issue for companies mainly due to the fear of prosecution. The introduction of Zero Tolerance by the Victorian government WorkCover Authority in 1999 provided even higher OHS safety standards for the construction industry. This has placed an increased burden on construction and maintenance companies especially small firms that are not in a position of financial strength. The size of the company has been found to be a major contributing factor to the OHS performance of construction contractors. This research is based on a benchmarking study of 44 construction companies in Victoria, Australia. The results show that the major factors influencing safety performance were; company size, and management and employee commitment to OHS.

Effect of company size on occupational health and safety

It is mandatory in all Australian jurisdictions for construction companies to provide a safe working environment for their workers and sub-contractors. Consequently, occupational health and safety (OHS) is a major issue for construction companies mainly due to the fear of prosecution. The introduction of zero tolerance by the Victorian government “WorkCover Authority” in 1999 provided increased legislative OHS standards for the construction industry. This has placed an increased burden on construction companies especially small firms that are not in a position of financial strength. This research is based on benchmarking study of OHS performance of 44 construction companies in
Victoria, Australia. The results show that the size of the company is a major contributing factor to their OHS performance. Small companies employing less than 25 employees have comparatively low levels of OHS performance compared to larger firms. Company size is a limiting factor that impacts on the ability of small firms to implement comprehensive OHS plans. This research calls into question that notion that increasing legislative requirements will improve OHS outcomes.

Occupational health and safety among commercial sex workers

The concept of occupational health and safety (OHS) for commercial sex workers has rarely been investigated, perhaps because of the often informal nature of the workplace, the associated stigma, and the frequently illegal nature of the activity. We reviewed the literature on health, occupational risks, and safety among commercial sex workers. Cultural and local variations and commonalities were identified. Dimensions of OHS that emerged included legal and policing risks, risks associated with particular business settings such as streets and brothels, violence from clients, mental health risks and protective factors, alcohol and drug use, repetitive strain injuries, sexually transmissible infections, risks associated with particular classes of clients, issues associated with male and transgender commercial sex workers, and issues of risk reduction that in many cases are associated with lack of agency or control, stigma, and legal barriers. We further discuss the impact and potential of OHS interventions for commercial sex workers. The OHS of commercial sex workers covers a range of domains, some potentially modifiable by OHS programs and workplace safety interventions targeted at this population. We argue that commercial sex work should be considered as an occupation overdue for interventions to reduce workplace risks and enhance worker safety.