Education in occupational health psychology: Where have we been, where are we now and where are we going?

At the first full conference of the European Academy of Occupational Health Psychology (Lund, 1999), the decision was ratified to organise activities around three fora. These together represented the pillars on which the European Academy had been founded that same year: education, research and professional practice. Each forum was convened by a chair person and a small group of full members; it was agreed that a forum meeting would take place at each full conference and working groups would be established to move developments forward between conferences. The forum system has proven an effective means by which to channel the energies of individual members, and the institutions that they represent, towards advancements in all three areas of activity in occupational health psychology (OHP) in Europe. During the meeting of the education forum at the third full European Academy conference (Barcelona, 2001), the proposal was made for the establishment of a working party that would be tasked with the production of a strategy document on The Promotion of Education in Occupational Health Psychology in Europe. The proposal was ratified at the subsequent annual business meeting held during the same conference. The draft outline of the strategy document was published for consultation in the European Academy’s e-newsletter (Vol. 3.1, 2002) and the final document presented to the meeting of the education forum at the fourth full conference (Vienna, 2002). The strategy document constituted a seminal piece of literature in so far as it provided a foundation and structure capable of guiding pan-European developments in education in OHP – developments that would ensure the sustained growth of the discipline and assure it of a long-standing embedded place in both the scholarly and professional domains. To these ends, the strategy document presented six objectives as important for the sustained expansion and the promotion of education in the discipline in Europe. Namely, the development of: [1] A core syllabus for education in occupational health psychology [2] A mechanism for identifying, recognising and listing undergraduate and postgraduate modules and courses (programmes) in occupational health psychology [3] Structures to support the extension of the current provision of education in occupational health psychology [4] Ways of enhancing convergence of the current provision of education in occupational health psychology [5] Ways of encouraging regional cooperation between education providers across the regions of Europe [6] Ways of ensuring consistency with North American developments in education and promoting world wide co-operation in education Five years has elapsed since the presentation of these laudable objectives to the meeting of the education forum in Vienna in December 2002. In that time OHP has undergone considerable growth, particularly in Europe and North America. Expansion has been reflected in the evolution of existing, and emergence of new, representative bodies for the discipline on both sides of the Atlantic Ocean. As such, it might be considered timely to pause to reflect on what has been achieved in respect of each of the objectives set out in the strategy document. The current chapter examines progress on the six objectives and considers what remains to be done. This exercise is entered into not merely in order to congratulate achievements in some areas and lament slow progress in others. Rather, on the one hand it serves to highlight areas where real progress has been made with a view to the presentation of these areas as ripe for further capitalisation. On the other hand it serves to direct the attention of stakeholders (all those with a vested interest in OHP) to those key parts of the jigsaw puzzle that is the development of a self-sustaining pan-European education framework which remain to be satisfactorily addressed.

Relationships between tissue levels of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), mRNAs and toxicity in the developing male Wistar(Han) rat

We compared the effects of a single acute dose, or chronic fetal exposure, to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) on the male reproductive system of the Wistar(Han) rat. Tissue samples were taken from dams on GD16 and GD21, and from offspring on PND70 and 120. Steady state concentration of TCDD was demonstrated in the chronic study: body burdens were comparable in both studies. Fetal TCDD concentrations were comparable after acute and chronic exposure, and demonstrate more potent toxicity after chronic versus acute dosing. In maternal liver, cytochrome P450 (CYP)1A1 and CYP1A2 RNA were induced. In fetus, there was induction of both CYP1A1 and CYP1A2 RNA at medium and high doses, but inadequate evidence for induction at low dose in either study. The low level induction of CYP1A1 RNA at low dose in fetus argues against AhR activation in fetus as a mechanism of toxicity of TCDD in causing delay in balanopreputial separation, and the greater induction of CYP1A1 RNA in PND70 offspring liver suggests that lactational transfer of TCDD is crucial to this toxicity. These data characterise the maternal and fetal disposition of TCDD, induction of CYP1A1 RNA as a measure of AhR activation, and suggest that lactational transfer of TCDD determines the difference in delay in balanopreputial separation between the two studies.

Being more certain about random assignment in social policy evaluations

Social experiments have been widely utilised in evaluations of social programmes in the US to identify ‘what works’, whilst in the UK their use is more controversial. This paper explores the paradigmatic, technical and practical issues evaluators confront in using randomised experiments to evaluate social policies. Possible remedies to some of these problems are outlined. It is argued that although no evaluation methodology is problem-free, policy makers and researchers should be more confident about the merits of using random assignment, provided it is used in conjunction with other methodologies more suited to understanding why and how interventions work.

Adaptive regulation or governmentality: patient safety and the changing regulation of medicine

Studies from across the world have shown that clinical mistakes are a major threat to the safety of patient care (World Health Organisation 2004). For the National Health Service (NHS) of England and Wales it is estimated that one in ten hospital patients experience some form of error, and each year these cost the service over £2billion in remedial care (Department of Health 2000). Unsurprisingly, ‘patient safety’ is now a major international health policy priority, questioning the efficacy of existing regulatory practices and proposing a new ethos of learning. Within England and Wales, the National Patient Safety Agency (NPSA) has been created to lead policy development and champion service-wide learning, whilst throughout the NHS the National Reporting and Learning System (NRLS) has been introduced to enable this learning (NPSA 2003). This paper investigates the extent to which, in seeking to better manage the threats to patient safety, this policy agenda represents a transition in medical regulation.

Doctors' thinking about the system as a threat to patient safety

‘Systems thinking’ is an important feature of the emerging ‘patient safety’ agenda. As a key component of a ‘safety culture’, it encourages clinicians to look past individual error to recognise the latent factors that threaten safety. This paper investigates whether current medical thinking is commensurate with the idea of ‘systems thinking’ together with its implications for policy. The findings are based on qualitative semistructured interviews with specialist physicians working within one NHS District General Hospital in the English Midlands. It is shown that, rather then favouring a 'person-centred’ perspective, doctors readily identify ‘the system’ as a threat to patient safety. This is not necessarily a reflection of the prevailing safety discourse or knowledge of policy, but reflects a tacit understanding of how services are (dis)organised. This line of thinking serves to mitigate individual wrong-doing and protect professional credibility by encouraging doctors to accept and accommodate the shortcomings of the system, rather than participate in new forms of organisational learning.

Safety and complexity: the inter-departmental threats to patient safety in the operating department

Purpose: Current thinking about ‘patient safety’ emphasises the causal relationship between the work environment and the delivery of clinical care. This research draws on the theory of Normal Accidents to extend this analysis and better understand the ‘organisational factors’ that threaten safety. Methods: Ethnographic research methods were used, with observations of the operating department setting for 18 month and interviews with 80 members of hospital staff. The setting for the study was the Operating Department of a large teaching hospital in the North-West of England. Results: The work of the operating department is determined by inter-dependant, ‘tightly coupled’ organisational relationships between hospital departments based upon the timely exchange of information, services and resources required for the delivery of care. Failures within these processes, manifest as ‘breakdowns’ within inter-departmental relationships lead to situations of constraint, rapid change and uncertainty in the work of the operating department that require staff to break with established routines and work with increased time and emotional pressures. This means that staff focus on working quickly, as opposed to working safely. Conclusion: Analysis of safety needs to move beyond a focus on the immediate work environment and individual practice, to consider the more complex and deeply structured organisational systems of hospital activity. For departmental managers the scope for service planning to control for safety may be limited as the structured ‘real world’ situation of service delivery is shaped by inter-department and organisational factors that are perhaps beyond the scope of departmental management.

Beyond Blame: cultural barriers to medical reporting

The paper explores the attitudes of medical physicians towards adverse incident reporting in health care, with particular focus on the inhibiting factors or barriers to participation. It is recognised that there are major barriers to medical reporting, such as the ‘culture of blame’. There are, however, few detailed qualitative accounts of medical culture as it relates to incident reporting. Drawing on a 2-year qualitative case study in the UK, this paper presents data gathered from 28 semi-structured interviews with specialist physicians. The findings suggest that blame certainly inhibits medical reporting, but other cultural issues were also significant. It was commonly accepted by doctors that errors are an ‘inevitable’ and potentially unmanageable feature of medical work and incident reporting was therefore ‘pointless’. It was also found that reporting was discouraged by an anti-bureaucratic sentiment and rejection of excessive administrative duties. Doctors were also apprehensive about the increased potential for managers and non-physicians to engage in the regulation of medical quality through the use of incident data. The paper argues that the promotion of incident reporting must engage with more than the ubiquitous ‘culture of blame’ and instead address the ‘culture of medicine’, especially as it relates to the collegial and professional control of quality.

New ethnicities online: reflexive racialisation and the internet

In this article we analyse the emergence of Internet activity addressing the experiences of young people in two British communities: South Asian and Chinese.We focus on two web sites: www.barficulture.com and www.britishbornchinese.org.uk, drawing on interviews with site editors, content analysis of the discussion forums, and E-mail exchanges with site users. Our analysis of these two web sites shows how collective identities still matter, being redefined rather than erased by online interaction. We understand the site content through the notion of reflexive racialisation. We use this term to modify the stress given to individualisation in accounts of reflexive modernisation. In addition we question the allocation of racialised meaning from above implied by the concept of racialisation. Internet discussion forums can act as witnesses to social inequalities and through sharing experiences of racism and marginalisation, an oppositional social perspective may develop. The online exchanges have had offline consequences: social gatherings, charitable donations and campaigns against adverse media representations. These web sites have begun to change the terms of engagement between these ethnic groups and the wider society,and they have considerable potential to develop new forms of social action.

Inclusion, Participation and the Emergence of British Chinese Websites

Previous work has drawn attention to the relative absence of British Chinese voices in public culture. No one is more aware of this invisibility than British-born Chinese people themselves. Since 2000 the emergence of Internet discussion sites produced by British Chinese young people has provided an important forum for many of them to grapple with questions concerning their identities, experiences and status in Britain. In this paper we explore the ways in which Internet usage by British-born Chinese people has facilitated forms of self-expression, collective identity production and social and political action. This examination of British Chinese websites raises important questions about inclusion and exclusion, citizenship, participation and the development of a sense of belonging in Britain, issues which are usually overlooked in relation to a group which appears to be well integrated and successful in higher education.

Ethnicity, Social Capital and the Internet

This article explores web sites developed to express the interests and experiences of young Chinese people in Britain. Drawing on content analysis of site discussions and dialogues with site users, we argue these new communicative practices are best understood through a reworking of the social capital problematic. Firstly by recognising the irreducibility of Internet-mediated connections to the calculative instrumentalism underlying many applications of social capital theory. Secondly, by providing a more differentiated account of social capital. The interactions we explore comprise a specifically “second generation” form of social capital, cutting across the binary of bonding and bridging social capital. Thirdly judgement on the social capital consequences of Internet interactions must await a longer-term assessment of whether British Chinese institutions emerge to engage with the wider polity.

Social Policy and Time

Time is crucial to the implementation, operation and effectiveness of social policies, yet the subject has often treated the meaning of time as theoretically unproblematic. It focuses more upon what policies do and less upon the contexts within which the practices and assumptions of social actors are embedded. The article offers a more sophisticated theoretical account of time upon which is based an exploration of the main temporal features of welfare capitalism. It then goes on to examine three recent and prominent research projects in order to show how and why they fail to incorporate a convincing social theory of time.

European Cosmopolitanism and Civil Society

The discussion of European cosmopolitanism and civil society has failed to take questions of culture seriously enough. While remaining sympathetic to liberal forms of cosmopolitanism, this article considers the view that such proposals fail to make space for the 'Other'. In the context of histories of nationalist violence, masculinism and consumerism this article discusses the charge that ideas of European civilization need to be reconsidered. In the final part of the article, I discuss the view that cultural feminism and certain versions of multiculturalism have much to contribute towards the European project. However, at this point, I seek to distance myself from essentialist arguments in respect of identity. A generative European cosmopolitanism would do well to take questions of cultural domination seriously without reducing the complexity of modern identities.