Efciency of Workplace Surveys Conducted by Finnish Occupational Health Services

by Minna Savinainen, PhD, and Panu Oksa, PhD, MD

RESEARCH ABSTRACT
In Finland, workplace surveys are used to identify and assess health risks and problems caused by work and make suggestions for continuous improvement of the work environment. With the aid of the workplace survey, occupational health services can be tailored to a company. The aims of this study were to determine how occupational health professionals gather data via the workplace survey and the effect survey results have on companies. A total of 259 occupational health nurses and 108 occupational health physicians responded to the questionnaire: 84.2% were women and 15.8% were men. The mean age of the respondents was 48.8 years (range, 26 to 65 years). Usually occupational health nurses and foremen and sometimes occupational health physicians and occupational safety and health representatives initiate the workplace survey. More than 90% of the surveys were followed by action proposals, and about 50% of these were implemented. The proposals implemented most often concerned personal protective equipment and less often leadership. Survey respondents should have both the opportunity and the authority to affect resources, the work environment, work arrangements, and tools. Teamwork among occupational health and safety professionals, management, and employees is vital for cost-effectively solving todays complex problems at workplaces around the globe.

n Finland, occupational health services are structured as dictated by the Occupational Health Care Act of 1978 (and amended in 1991 and 2002). Employers are obligated by law to organize and pay for occupational health services for their employees, regardless of the size or industrial sector of the company. In Finland, 92% of employees have access to employer-organized occupational health services (Kauppinen et al., 2010). The
ABOUT THE AUTHORS
Dr. Savinainen is Specialized Research Scientist and Dr. Oksa is Specialized Research Scientist, Finnish Institute of Occupational Health, Research and Development in OHS, Tampere, Finland. The authors disclose that they have no signicant nancial interests in any product or class of products discussed directly or indirectly in this activity, including research support. Address correspondence to Minna Savinainen, PhD, Specialized Research Scientist, Finnish Institute of Occupational Health, Research and Development in OHS, P. O. Box 486, FI-33101 Tampere, Finland. E-mail: minna.savinainen@ttl.. Received: September 29, 2010; Accepted: April 4, 2011. doi:10.3928/08910162-20110624-06

ultimate goals of occupational health services are creating a healthy and safe work environment and a wellfunctioning work community, preventing work-related diseases, and maintaining and promoting employees work ability (Rantanen, 2004). A company and occupational health service collaborate to provide preventive services promoting work ability (e.g., health-related examinations, health education, guidance on occupational health and safety concerns, and health care interventions) and recognizing and assessing the harmful risks of workplace exposures (i.e., workplace surveys and risk assessments) that affect occupational health and safety. In addition to statute-mandated preventive occupational health care, employers may voluntary arrange health care for employees. Employers are reimbursed for part of the occupational health services costs by the Social Insurance Institution. In Finland, occupational health services can be organized in four different ways: municipal health care centers,

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Applying Research to Practice

Workplace visits increase cooperation between occupational health professionals and company representatives. Based on study results, the action proposals were more likely to be implemented if the cooperation between occupational health professionals and the company was effective. In practice this means that occupational health professionals should visit workplaces regularly. To make a workplace survey more effective, it is useful to focus on a few specic problems rather than trying to impact all identied workplace problems simultaneously. To measure the effectiveness of the workplace survey, it is obligatory to monitor implementation of the proposed actions.

private medical centers, company-organized occupational health services alone, or company-organized occupational health services in collaboration with other companies. Regardless of the organization, nurses and physicians providing occupational health services must be specialists in occupational health care. Typically, other experts working in occupational health services are occupational physiotherapists and occupational health psychologists. According to the Occupational Safety and Health Act (2002), employers are responsible for occupational safety and health at the workplace. Every company nominates an occupational safety and health manager and, depending on the number of employees, also appoints an occupational safety and health representative and forms an occupational safety and health committee. The occupational safety and health committee, together with the employer, employees, and occupational health professionals, plans, organizes, implements, improves, and monitors occupational safety and health interventions at the workplace (Ministry of Social Affairs and Health, 2004). The goal of the work of occupational health and safety professionals is to improve occupational safety and health for all employees (Ministry of Social Affairs and Health, 2004). Work ability can be dened as the combination of factors that enable workers to successfully manage their work demands (Tuomi, Huuhtanen, Nykyri, & Ilmarinen, 2001). Workplace surveys create a basis for occupational health services activities in companies. This workplace survey was used for the identication and assessment of health risks and problems caused by the work, the working environment, and the workplace community and making suggestions for continuous improvement of the working environment and the workplace community, for preventing and combating known health risks, and for maintaining and promoting working capacity and functional capacity (Government Decree, 2001,

p. 5). A workplace survey is a process that includes justication, planning, implementation, analysis and assessment, reporting, and linkage to monitor mechanisms (e.g., absenteeism reports, risk assessments, employee health examinations) (Kurppa & Riala, 2001). The survey can be basic, directed, or specic. A basic workplace survey provides an overview of risk and load factors in the entire company. After that, directed surveys are used to solve specic problems such as physical load of workers upper arms or their occupational chemical exposure. Finally, a specic survey is used when, for example, occupational health professionals must clarify whether a pregnant woman is subject to harmful exposures in her work. In Finland, systematic methods such as the Risk Assessment of the Ministry of Social Affairs and Health (Sosiaali ja terveysministeri, 2003) are recommended. International scientic articles concerning the process of workplace surveys and the implementation of the resulting proposed actions (efciency) are lacking. The aims of this study were to determine how occupational health professionals conduct workplace surveys and assess their effectiveness. PartIcIPaNts aND MethoDs The questionnaire was sent to every sixth occupational health nurse and physician across the country (n = 937; 539 nurses and 398 physicians). Contact information was obtained from member association registers. A total of 259 occupational health nurses (response rate = 50.7%) and 108 occupational health physicians (response rate = 29.2%) answered the questionnaire. The total number of respondents was 367: 84.2% were women and 15.8% were men. The mean age of the respondents was 48.8 years (range, 26 to 65 years). The questions were related to the most recent workplace survey completed that occupational health professionals had conducted. The efciency of the workplace survey was assessed through questions on how well the proposed actions were implemented. The participants were rst asked if they had proposed any actions. If they answered yes, the questions continued: What issue were the proposed actions directed toward? and, nally, How well were the proposed actions implemented? (a) not at all, (b) poorly, (c) moderately, (d) fairly well, (e) very well, (f) unnished, or (g) I do not know. The answers were organized into ve categories by combining the not at all and poorly categories and the quite well and very well categories. The researchers used the chi-square test for differences between categorical variables (occupation, occupational health unit, size of company, and how long the company had had an occupational health services agreement). Logistic regression models were used for each dependent variable (proposed action implemented well vs. other categories in different issues) to test which factors were related to the efciency of the workplace survey. The factors taken into account in data analysis were specialized training, work experience, participants occupation/title,

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Table 1

Respondents Demographics by Occupation

Work Experience Mean Age in Years (SD)
48.2 (8.9) 50.3 (7.7)

Occupation
Occupational health nurse (n = 259) Occupational health physician (n = 108)

Women (%)
254 (98.1) 55 (50.9)

Men (%)
5 (1.9) 53 (49.1)

< 5 Years
14.3% 13.0%

> 5 Years
85.7% 87.0%

Table 2

Respondents Occupational Health Units

Occupational Health Unit
Municipal health care centers/public utility Private medical centers Occupational health unit of a company Occupational health unit of several companies Data missing Total
Note. Because some physicians worked in two different units, the total is more than 100%. Figure 1. Respondents to the workplace survey (n = 367).

%
24.8 42.5 22.1 10.4 2.2 102.0

type of workplace survey, target of the workplace survey (e.g., was it the entire workplace or a single department), to whom the workplace survey was reported, who was in charge of implementation, and which researchers used the chi-square test. The results of the models are presented as odds ratios (OR) with 95% condence intervals (95% CI). The statistical analyses were performed using SPSS software, version 15.0. All tests were considered statistically signicant if p was less than .05. ResuLts The occupational health professionals were highly experienced. More than 85% of them had more than 5 years of work experience (Table 1). No statistically signicant difference in the length of work experience was found between occupational health nurses and physicians. The respondents worked mostly at private medical centers (42.5%). Some of the physicians worked in two different units, which explains why the percentage exceeds 100% in Table 2.
Workplace Surveys

More than 60% of the most recent workplace surveys were basic (63.5%), fewer than one third were directed (30.2%), and the remainder were specic (6.3%). In general, occupational health nurses conducted basic workplace surveys more often than occupational health physicians, whereas occupational health physicians conducted more directed and specic surveys than occupational health nurses. The differences were not statistically signicant.

The most recent workplace surveys were usually directed toward the entire workplace (39.3%), department(s) of the company (35.0%), or several employees (26.8%) (basic surveys). A small proportion of workplace surveys focused on one employees work (4.1%) or multiple locations in the workplace (4.9%). Four to six workers participated in the workplace survey on average (58.7%)typically, the occupational health nurse (97.8%), foreman (70.6%), occupational health physician (69.8%), and occupational safety and health representative (58.0%). In addition to occupational health professionals and occupational safety and health personnel, individuals from management and administration, janitorial services, industrial safety districts, and various special areas (i.e., agriculture) sometimes took part in the workplace survey (Fig. 1). The objectives of the workplace survey were to assess physical workload (83.4%) and physical risks (73.6%). Other objectives (n = 38) were assessing ergonomics, updating the companys current situation (changes that have been made), renewing the occupational health services action plan, assessing risk, meeting the occupational safety and health committee, conducting rst aid training, and assessing indoor climate problems. In general, occupational health professionals used a systematic method when conducting workplace surveys (73.5%); they also commonly used many methods at the same time. The most prevailing method was recording on a form developed by their own occupational health unit

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fessionals used the Risk Assessment of the Ministry of Social Affairs and Health (Ministry of Social Affairs and Health, 2004). The occupational health professionals usually reported the workplace survey results to those who participated. The foreman (85.3%), occupational safety and health managers (65.9%), and occupational safety and health representatives (62.4%) most commonly received the reports. In addition, some occupational health professionals (n = 31) mentioned that they reported the results of the workplace survey to Human Resources and janitorial services.
Action Proposals

Figure 2. Focus of proposed actions (n = 344). OHS = occupational health services.

(38.1%). In addition to interviews, observations, and the units own form, about 12% of occupational health pro-

More than 90% (93.5%) of the workplace surveys were followed by action proposals. The proposed actions focused mainly on work performance (79.7%) and work environment (75.3%) (Fig. 2). Proposals concerning work performance included how to carry or lift objects or when to do work in a different sequence. Action proposals for the work environment included improved lighting or local exhaust ventilation. The category something else

Table 3

Implementation of Actions Proposed by Occupational Health Professionals

Focus of Proposed Action
Promotion of work ability (e.g., interventions/referral to rehabilitation) (n = 45) Occupational health services activities (e.g., more regular health examinations) (n = 91) Personal protective equipment or protection (e.g., earplugs) (n = 138) Tools, devices, machines (e.g., compensate for replacing an old broken tool with a new one) (n = 136) Work performance (e.g., how to avoid carrying by changing working technique) (n = 240) Training and guidance (e.g., employees need lifting training or guidance how to protect themselves from new exposure) (n = 114) Work environment (e.g., how to decrease noise by enclosing the machine) (n = 228) Leadership (e.g., what has to be taken into account when planning work shift) (n = 111)

Implemented Implemented Completely Moderately

48.9% 17.8%

Implemented Poorly/Not at All

6.7%

Unnished
20.0%

Do Not Know
6.7%

48.4%

8.8%

4.4%

31.9%

6.6%

46.4%

13.8%

2.2%

24.6%

13.0%

29.4%

23.5%

5.1%

33.8%

8.1%

27.9%

23.8%

3.3%

35.4%

9.6%

24.6%

21.9%

4.4%

36.0%

13.2%

22.4%

22.8%

7.9%

36.8%

10.1%

17.1%

18.9%

11.7%

40.5%

11.7%

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(n = 26) included action proposals that focused on vaccinations, work-time arrangements, work organization, safety, indoor climate, violence prevention, drug abuse, chemical and operational safety bulletins, ergonomics, rst aid, and pension application. The implementation rate differed substantially among different action proposals. More than half of the proposals related to work ability (i.e., lifestyle interventions or organized events concerning a special issue in the company), referral to rehabilitation, or personal protective equipment were implemented to at least some extent. On the other hand, leadership proposals (e.g., to monitor the use of personal protective equipment among employees) were less likely to be implemented or were more often left uncompleted (Table 3). Factors related to the implementation of proposals depended on the issue addressed. Signicant factors were workplace survey type, who received the survey report, who participated in the survey, the type of occupational health unit, and how long the company had offered occupational health services. All of these factors were related to the efciency of the workplace survey (Table 4). Proposals to improve work performance (i.e., the order in which various work tasks are completed and changes in work techniques) were more successfully implemented if the workplace survey was specic (OR = 4.24), the results were reported to an occupational safety and health manager (OR = 2.75), or an occupational physiotherapist participated (OR = 2.17). Changes in work environment (i.e., more lighting with spotlight or less noise by enclosing the machine) were implemented if the workplace survey was specic (OR = 3.58), the proposer was an occupational health nurse (OR = 2.49), or the occupational safety and health manager participated in the workplace survey (OR = 2.03). If the companys own occupational health unit proposed an action plan about personal protective equipment, the proposals were implemented more often (OR = 6.97) compared to similar proposals by other units. The factors that led to the effective implementation of proposals about work tools, machines, and devices (e.g., changing old work tools to new ergonomic work tools) were a specic workplace survey (OR = 34.61), participation of a foreman (OR = 14.58), less than 5 years of cooperation between occupational health services and the company (OR = 4.69), reporting the results of the workplace survey to the occupational safety and health manager (OR = 3.53), and a workplace survey focused on many employees work (OR = 3.22). Changes in occupational health services activities (e.g., increasing regular health examinations for exposed workers or monitoring sickness absences) were more obvious if the occupational safety and health representative participated in a workplace survey (OR = 8.89) or if the occupational health nurse made the proposals (OR = 5.62) (Table 4). The implementation of proposals about training, guidance, and counseling (e.g., workers need training on lifting, guidance in the use of a new work tool, or counseling about ways to prevent chemical exposures) was more than three times (OR = 3.38) more likely when

employees participated in the workplace survey (p = .024). In addition, changes in management behavior (e.g., broaching concerns about employees absences) were more than 17 times (OR = 17.58) more likely if a workplace survey was reported to the manager of the company (p = .007). The occupational health professionals mainly considered foremen to be responsible for implementing proposals (87.2%) and ensuring that the proposed actions were implemented (78.2%). Occupational health professionals also suggested employers, entrepreneurs, company executives, personnel administration, technical departments, janitorial services, and occupational health services be responsible for implementation. DIscussIoN The workplace survey is a challenging process for both occupational health services and companies. This study demonstrated that four to six representatives from occupational health services, occupational safety and health personnel, production employees, and foremen often took part in the workplace survey, providing support for realistic proposals and effective implementation. Instruments that are typically used in workplace surveys include interview forms and questionnaires, observation checklists, videotaping, and instruments for quick hygienic measurements (e.g., noise meter, thermometer) (Kurppa & Riala, 2001). These results are consistent with previous ones. More than two thirds of the occupational health units used several systematic methods simultaneously when implementing the workplace survey. Information about essential stages, equipment, and hazards is mainly gathered through interviews with individual employees and employee groups. The largest private occupational health units have their own nationwide systematic procedure for conducting workplace surveys (e.g., structured forms and basic methods). Based on these results, more than 90% of the workplace surveys were followed by action proposals. However, only about 50% of these action proposals were implemented. One explanation for this low number might be that if the proposals are too general, the company does not know exactly what to do. It might also be that the state of implementation is not known when it takes a long time to implement proposals (i.e., proposals concerning leadership), or that no one is responsible for monitoring progress. Sometimes the implementation may be too expensive (e.g., changes in work environment or machines) and the nancial situation of the company prevents its realization. Action proposals made on the basis of a specic workplace survey were the most effectively implemented. One explanation for this might be that a specic workplace survey has a tight focus and the resulting proposals are precise and concrete. In this study, occupational health units whose relationship with the company had lasted less than 5 years made more proposals focusing on work tools, and these proposals were implemented better than those in occu-

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Table 4

Private medical center Occupational health unit of company Work tools, machines, devices

2.02 6.97

0.50-8.23 .327 1.59-30.52 .010

Factors Signicantly Related to Implementation of Proposals

Focus of the Action Proposal and Related Factor
Work performance Workplace survey type Basic Directed Specic Reporting workplace surveys Reported to other than the occupational safety and health manager Reported to occupational safety and health manager Physiotherapist survey participant Did not participate Participated Work environment Workplace survey type Basic Directed Specic Proposer Occupational health physician Occupational health nurse Occupational safety and health manager survey participant Did not participate Participated Protective equipment Occupational health service unit Companies have shared occupational health unit Municipal health care center/public utility 1.00 1.00 2.03 1.04-3.95 .038 1.00 2.49 1.07-5.83 .035 1.00 1.92 3.58 0.95-3.86 .068 1.02-12.64 .047 1.00 2.17 1.09-4.31 .027 1.00 1.00 1.71 4.24 0.84-3.46 .137 1.15-15.56 .030

OR

95 CI

Workplace survey type Basic Directed Specic Foreman survey participant Did not participate Participated How long the occupational health service and the company had an agreement 1.00 14.58 2.51-84.52 .003 1.00 1.90 0.68-5.31 .220 34.61 3.61-332.33 .002

2.75

1.23-6.12 .013

> 5 years < 5 years Reporting the workplace survey Not reported to occupational safety and health manager Reported to occupational safety and health manager Focus of the workplace survey Did not focus on several employees work Focused on several employees work Activities of occupational health service Occupational safety and health representative participant of the workplace survey Did not participate Participated Proposer Occupational health physician Occupational health nurse

1.00 4.69 1.54-14.22 .006

1.00

3.53

1.13-11.01 .030

1.00 3.22 1.10-9.41 .033

1.00 8.89 1.00 5.62 1.38-22.80 .016 1.59-49.69 .013

2.78

0.65-11.97 .170

Note. OR = odds ratio; CI = condence interval. OR and 95% CI for proposed actions implemented well versus other categories in different issues.

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pational health units with longer periods of cooperation. One explanation might be that these issues had already been taken into account during a long cooperation period, so new tools, machines, or devices were not necessary. Otherwise, the length of cooperation between occupational health services and the company (i.e., how long the occupational health services and company have had an agreement) did not appear to be a signicant factor. Employers, workers, occupational safety and health committees, and other stakeholders must be fully informed of the survey ndings and recommendations. It is advisable to arrange an open information meeting at which ndings and recommendations can be discussed with the stakeholder group (Kurppa & Riala, 2001). Information gained from workplace surveys can also be used in occupational safety programs, and vice versa (Riala, 2004). In this study, occupational health professionals usually reported the results of the workplace survey to the foremen and company occupational safety and health personnel. Management seldom received reports directly from occupational health professionals because the company and occupational health services had agreed to whom the reports were to be sent, then the company recipient distributed them throughout the company. However, occupational health professionals do need to be involved when results are presented to company management. If cooperation between the company and occupational health professionals is effective, the implementation and monitoring of proposed actions is more efcient. It is important to know who is in charge of the process. It was noticed that if the workplace survey was reported to the manager of the company, the proposed actions were more likely implemented. The stakeholder groups, especially managers who had the power to allocate required resources for corrective actions, must be involved in the discussion of the conclusions and recommendations based on the workplace survey. In addition, decisions regarding actions, priorities, responsible individuals, time frames, and monitoring mechanisms for corrective measures and improvements must be made and documented. Monitoring must result in proposal completion (Kurppa & Riala, 2001). Teamwork among occupational health professionals and occupational safety and health personnel, management, and employees is vital for solving todays complex problems in cost-effective ways (Wachs, 2005). The occupational health professionals in this study were experienced. More than 85% of them had more than 5 years of work experience. The strength of this study was that the respondents worked in different types of occupational health units. The weakness was the rather low response rate of occupational health physiciansbelow 30%. Reasons for this might be that physicians did not receive the questionnaire at all because the member register was not updated, many physicians had changed workplaces but had not updated their contact information in the member register, or randomly selected representatives were occupational physicians but they did not practice clinically so could not answer practical questions.

The questionnaire was condential, so no one else in the unit could answer it. Despite the low response rate among occupational health physicians, the results represent the prevailing practice in Finland well. Occupational health services are functional, wellcovered service systems in Finland. The efciency and benets of occupational health services depend to a great extent on relationships and communication among occupational health professionals and clients (Peltomki & Husman, 2002). IMPLIcatIoNs for PractIce The workplace survey is an effective tool for occupational health nurses to learn about workplaces and employees. The rates of implemented actions presented in this study were, on average, 50%. To increase the efciency of workplace surveys, occupational health nurses should use specic workplace surveys that concentrate on a few issues at the workplace, report their ndings to occupational safety and health managers who are in charge of occupational safety and health in the company, and systematically monitor the implementation of proposed actions to document what has been done and what requires clarication. Moreover, survey participants should have both the opportunity and the authority to affect resources, the work environment, work arrangements, and tools so that the proposed actions are put into practice. Cooperation among occupational health services staff, occupational safety and health personnel, management, and employees is vital for improving occupational safety and health at workplaces. CONCLUSION Occupational health services need to conduct workplace surveys together with companies representatives. Occupational health professionals must report the ndings to and discuss them with companies representatives. Cooperation ensures the efciency of workplace surveys and that the implemented action proposals are relevant and effective. In addition, action proposals must be monitored. Companies and occupational health services must work together to develop the method for doing so. RefereNces
Government decree on the principles of good occupational health care practice, the content of occupational health care and the qualications of professionals and experts (No. 1484). (2001). Helsinki, Finland: Ministry of Social Affairs and Health. Kauppinen, T., Hanhela, R., Kandolin, I., Karjalainen, A., Kasvio, A., Perki-Mkel, M., et al. (2010). Ty ja terveys Suomessa 2009 [Work and health in Finland 2009]. Helsinki, Finland: Finnish Institute of Occupational Health. Kurppa, K., & Riala, R. (2001). The workplace survey as part of workplace risk assessment. Asian-Pacic Newsletter on Occupational Health and Safety, 8, 4-7. Ministry of Social Affairs and Health. (2004). Occupational safety and health in Finland. Helsinki, Finland: Author. Occupational Health Care Act (No. 1383/2001). (2001). Retrieved from www.nlex./en/laki/kaannokset/2001/en20011383.pdf Occupational Safety and Health Act (No. 738/2002). (2002). Retrieved from www.nlex./en/laki/kaannokset/2002/en20020738.pdf Peltomki, P., & Husman, K. (2002). Networking between occupational

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health services, client enterprises and other experts: Difculties, supporting factors and benets. International Journal of Occupational Medicine and Environmental Health, 15, 139-145. Rantanen, J. (2004). Development of occupational health services. In H. Taskinen (Ed.), Good occupational health practice: A guide for planning and follow-up of occupational health services. Helsinki, Finland: Finnish Institute of Occupational Health. Riala, R. (2004). Workplace surveys. In H. Taskinen (Ed.), Good occupational health practice: A guide for planning and follow-up of occupational health services. Helsinki, Finland: Finnish Institute of Occupational Health.

Sosiaali ja terveysministeri, tysuojeluosasto; Tampere. (2003). Riskien arviointi typaikalla: Tykirja [Risk assessment at the workplace: A workbook]. Helsinki, Finland: Ministry of Social Affairs and Health, Department of Occupational Safety. Tuomi, K., Huuhtanen, P., Nykyri, E., & Ilmarinen, J. (2001). Promotion of work ability, the quality of work and retirement. Occupational Medicine, 51, 318-324. Wachs, J. (2005). Building the occupational health team: Keys to successful interdisciplinary collaboration. AAOHN Journal, 53, 166171.

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