Following a brief review of the development of educational contributions to worker health and safety and of the first attempts to establish the foundations of management education, this article will address curriculum development. The two career paths along which future senior managers develop will be considered as an issue relevant to the educational needs of managers. The curriculum content for managerial issues will be set forth first, to be followed by that pertinent to an understanding of injury causation.

Education for occupational safety and health has been directed, in the main, to people such as safety managers and occupational physicians, and more recently, to occupational health nurses, ergonomists and hygienists—people who have been appointed to specialist staff positions in organizations.

The advisory roles of these specialists have incorporated tasks such as the administration of pre-employment medical examinations, health surveillance, monitoring employee exposures to a range of hazards and environmental examination. Their activities moreover include contributing to job and task design in order to adjust engineering or administrative controls by way of minimizing if not eliminating (for example) the harmful effects of postural demands or of exposure to toxic hazards.

This specialist-oriented educational approach has tended to ignore the central fact that the provision of safe and healthy workplaces requires an extraordinarily broad scope of operational knowledge necessary to make them a reality. It must be borne in mind that managers carry the responsibility for planning, organizing and controlling work activities in public and private enterprises across all industry sectors.

Background

During the decade of the 1970s many initiatives were taken to offer study programmes at the tertiary level to provide a professional education with practical training for the range of specialist engineers, scientists and health care workers entering the field of occupational safety and health.

In the 1980s it was recognized that the people most directly concerned with occupational safety and health, the managers, the workers themselves and their associations, were the most significant entities in the move to reduce workplace injury and ill health. Legislation in many jurisdictions was introduced to provide education for workers serving on safety committees or as elected safety and health representatives. These changes highlighted for the first time the very limited education and training facilities then available to managers.

An early initiative to address management education

Several steps were taken to overcome this problem. The most widely known is Project Minerva, an initiative of the US National Institute for Occupational Safety and Health (NIOSH), which represented an early effort to inculcate that body of specific managerial skills which is necessary to ensure workplace safety and which “generally exceeds that which is offered through courses in the traditional business curriculum” (NIOSH 1985). Teaching materials intended to address the more urgent safety and health concerns were provided for business schools. The resource guide comprised instructional modules, case studies and a book of readings. Module topics are listed in figure 1.

Figure 1. Modular curriculum content, Project Minerva resource guide.

The Canadian Society of Safety Engineers has recommended this structure to business schools seeking to incorporate occupational safety and health materials into their curricula.

Fundamentals of Managing: General Rather Than Specific Needs

Any job responsibility entails the acquisition of relevant knowledge and appropriate skills in order to discharge it. Responsibility for managing occupational safety and health within any organization will be placed increasingly upon line managers at each level in the job hierarchy. Associated with that responsibility ought to be commensurate accountability and the authority to command the necessary resources. The knowledge and skills needed to discharge this responsibility form the curriculum for occupational safety and health management education.

At first sight, it would seem necessary that a curriculum of this sort be developed with the aim of meeting all the special demands of the whole range of management functions as they relate to such a diversity of positions as office administrator, nurse manager, operations director, supplies and purchasing superintendent, fleet coordinator and even ship’s captain. The curricula need also, perhaps, address the whole range of industries and the occupations found within them. However, experience strongly suggests that this is not so. The necessary skills and knowledge are, in fact, common to all management functions and are more fundamental than those of the specialists. They are operative at the level of basic management expertise. However, not all managers arrive at their position of responsibility by taking similar paths.

Managerial Career Paths

The usual path to a managerial career is through either supervisory or specialist functions. In the former case, career development is dependent on work experience and job knowledge and in the latter it ordinarily presupposes off-the-job college education and postgraduate study, for example as an engineer or nurse manager. Both streams need to develop occupational safety and health (OSH) skills. For the latter this may be done in graduate school.

It is usual today for successful managers to acquire the degree of Master of Business Administration (MBA). For this reason the Minerva Project directed its attention to the 600 or more graduate management schools in the United States. By incorporating into MBA curricula such aspects of occupational safety and health as were determined to be critical for successful management of the field, it was believed that this material would be integrated into the formal studies of middle management.

Given the extremely high rate of technological invention and scientific discovery, undergraduate courses, particularly in engineering and scientific disciplines, have only limited opportunities to integrate broadly-based safety theory and practice into design, process and operation studies.

Since managerial roles begin fairly soon after graduation for those with specialist education, there is a need to provide the knowledge and skills that will support the safety and health responsibility of both specialist and generalist managers.

It is important that an awareness of the content of any curriculum devoted to occupational safety and health objectives among management be promoted among other personnel having related responsibilities. Thus, the training of such key employees as safety and health representatives should be designed to keep them current with such curricular developments.

Curriculum for Managing Occupational Safety and Health

There are two broad classes of knowledge into which the discipline of occupational safety and health falls. One is that relating to the functions and principles of management and the other deals with the nature and proactive control of hazards. The model of curriculum development set forth below will follow this division. Both the supervisory path to management and the specialist path will require their own particular coverage of each of these classes.

The question of what level of complexity and technological detail needs to be provided to students may be determined by the purpose of the course, its length and the intention of the providers regarding subsequent education and skills development. These issues will be addressed in a later section.

Specifically, curricula should address machinery and plant safety, noise, radiation, dust, toxic materials, fire, emergency procedures, medical and first aid arrangements, workplace and employee monitoring, ergonomics, environmental hygiene, workplace design and maintenance and, most importantly, the development of standard operating procedures and training. This last is an essential component of managerial understanding. Not only must tasks and processes be the subject of operator training but the requirement for continuous improvement of people and processes makes training and retraining the most critical step in improving the quality of both. Adult learning theory and practice needs to be applied in the development of the curricular materials that guide this continuing training process.

The functions and principles of management

The fundamental purposes of management embrace the planning, organizing and control of workplace activities. They also embrace the incorporation of practices which maximize opportunities for workforce participation in goal setting, team operation and quality improvement. Furthermore, successful management requires the integration of occupational safety and health into all the organization’s activities.

It is rare for undergraduate programmes, outside those of colleges of business, to cover any of this knowledge. However, it is a most essential component for the specialist practitioners to have incorporated into their undergraduate study.

Organizational framework

The mission statement, strategic plan and structure set up to guide and facilitate the attainment of the organization’s objectives must be understood by the managers to be the basis for their individual activities. Each division of the organization whether it is a hospital, trucking business or coal mine, will in turn have its own goals and structure. Each will reflect the need to achieve organizational goals, and, taken together, will drive the organization towards them.

Policies and procedures

The primary embodiment of an organization’s goals are comprised by policy documents, the guides for individual employees on specific topics. (In some jurisdictions, the publication of an organization’s overall policy is required by law.) These documents ought to include reference to the range of occupational safety and health programmes designed with regard to the activities and processes which occupy the working time of employees. A sample of some general policy statements might include documents on emergency evacuation, fire fighting, purchasing procedures, injury reporting and accident and incident investigation. On the other hand, specific hazards will require their own process-specific policy materials concerning, for example, hazardous substances management, ergonomic interventions or entry into confined spaces.

After establishing policy, an activity preferably carried out with worker representative participation and union involvement, detailed procedures would then be put in place to give effect to them. Again, participative practices will contribute to the wholehearted acceptance of them by the workforce as a valuable contribution to their safety and health.

A safety and health management system is schematically illustrated in figure 2.

Figure 2. A health and safety management system.

Organizational structures defining key roles

The next stage in the management process is to define an organizational structure which characterizes the roles of key people—for example, the chief executive—and professional advisors such as safety advisors, occupational hygienists, the occupational health nurse, the physician and the ergonomist. In order to facilitate their roles, the relationships of these people and elected safety and health representatives (required in some jurisdictions) and worker members of safety committees to the organizational structure need to be explicit.

The planning and organizing functions of management will integrate structures, policies and procedures into the operational activities of the enterprise.

Control

Control activities—establishing processes and goals, determining standards of acceptable achievement and measuring performance against those standards—are the operational steps which bring to realization the intentions of the strategic plan. They also need to be established through co-determination. The tools for control are workplace audits, which may be continuous, frequent, random or formal.

An understanding of these activities is an important component of a management education syllabus, and skills should be developed in carrying them out. Such skills are as essential to the success of an integrated safety and health plan as they are to the discharge of any other management function, whether purchasing or fleet operation.

Organizational development and curriculum

Since the introduction of new organizational structures, new equipment and new materials is occurring at a rapid pace, special attention must be given to the processes of change. The employees who will be affected by these changes can have a deciding influence on their effectiveness and on the efficiency of the work group. An understanding of the psychosocial factors influencing the activities of the organization must be acquired and skills must be developed in using this knowledge to reach organizational objectives. Of particular importance is the delegation of the authority and the accountability of the manager to work groups formed into autonomous or semi-autonomous work teams. The management education curriculum must place at the disposal of its students the tools necessary to carry out their obligation to ensure not only process improvement and quality but the development of the multiple skills and quality awareness of personnel with which the issue of safety is so closely involved.

There are two further components of the management curriculum requiring examination. One of these is the activity of incident investigation and the other, on which the whole of this activity rests, is an understanding of the accident phenomenon.

The accident phenomenon

The work of Derek Viner (1991) in clearly expounding the significance of energy sources as the potential hazards in all workplaces has defined half of the accident equation. In conjunction with Viner’s work, the contribution of Dr. Eric Wigglesworth (1972) in identifying human error, the crucial element in managing workplace safety activities, completes its definition. An emphasis on the process of each damaging occurrence has been shown by Benner (1985) when considering accident investigation methods to be the most productive approach to managing worker safety and health.

Wigglesworth’s visualization of the sequence of events which results in injury, damage and loss appears in figure 3. It highlights the role of nonculpable human error, as well as the essential element of loss of energy containment and the potential for the injury outcome where this occurs.

Figure 3. The error/injury process.

The implications of the model for management become clear when planning for work processes takes account of the behavioural inputs which affect those processes. This is so in particular when the role of design is given its rightful place as the initiating mechanism for both equipment and process development. When planning takes account both of the design of plant and equipment and of the human factors influencing work activity, coordination and control mechanisms can then be implemented to assure containment of the identified hazards.

A model may be used to illustrate the significance of the interaction between the worker, the equipment, tools and machines employed to further the task objectives and the environment within which the activity takes place. The model highlights the need to address factors within all three elements which may contribute to damaging events. Within the workstation environment, which encompasses the thermal, aural and lighting components, among others, the worker interacts with the tools and equipment necessary to get the work done (see figure 4).

Figure 4. Representation of workstation elements relevant to injury causation and control.

Accident investigation and analysis

Accident investigation serves a number of important functions. First, it can be a proactive process, being used in situations where an incident occurs which results in no damage or injury but where there is a potential for harm. Studying the sequence of events can uncover features of the work process which could lead to more serious consequences. Second, one may gain an understanding of the process by which the events unfolded and thus can identify the absence of, or weakness in, process or task design, training, supervision or controls over energy sources. Third, many jurisdictions legally require investigations of certain types of incidents, for example, scaffolding and trench collapses, electrocutions and failures of hoisting equipment. The work of Benner (1985) illustrates well the importance of having a clear understanding of the accident phenomenon and an effective protocol for investigating injury and damage events.

The nature and control of hazards

All injury results from some form of energy exchange. The uncontrolled release of physical, chemical, biological, thermal, or other forms of energy is a source of potential harm to a variety of workers. Containment by suitable engineering and administrative mechanisms is one essential aspect of suitable control. Identifying and evaluating these energy sources is a prerequisite for control.

A management education curriculum would thus contain topics covering a range of activities which includes establishing objectives, planning the work, developing policy and procedures, undertaking organizational change and installing controls over work processes (and specifically the energy sources utilized in carrying out that work), all aimed at injury prevention. While curricula designed for the technical areas of operations need address only fundamental principles, organizations that make use of very hazardous materials or processes must have in their employ a senior member of management with sufficient training in the specific modes of handling, storage and transport of such technology to ensure the safety and health of workers and members of the community.

Larger enterprises and small business

Managers who work in larger organizations employing, say, a hundred or more people usually have one or only a few functional responsibilities and report to a senior manager or a board of directors. They have occupational safety and health responsibility for their own subordinates and act within established policy guidelines. Their educational needs may be addressed by the formal programmes offered in business schools at the undergraduate or graduate level.

On the other hand, the sole managers or partners in small enterprises are less likely to have had graduate education, and, if they have, it is more likely to be of a technological than managerial sort, and it is more difficult to address their needs for the management of occupational health and safety.

Small business needs

Providing training programmes for these managers, who often work very long hours, has represented a difficulty of long standing. Although a number of large legislative jurisdictions have produced guidance booklets setting out minimum performance stands, the more promising approaches are being made available through industry associations, such as the Ontario Industrial Accident Prevention Associations funded by levies placed by the Workers’ Compensation Board upon all businesses in the given industrial sector.

Syllabus Content

A body of knowledge and skills which addresses the needs of managers at the first-line supervisory level, middle management and senior executives is outlined in figure 5 by topic. Individual short-form syllabuses follow in figure 6. These have been collated from the syllabuses of a number of university graduate study programmes.

Figure 5. Syllabus for an OSH study programme.

Figure 6. Short form syllabuses for an OSH study programme.

The needs of first-line supervisors will be met through the acquisition of knowledge and skills covered by those topics that relate to operational demands. The training of senior executives will concentrate on such topics as strategic planning, risk management and compliance matters as well as initiating policy proposals. The allocation of hours for each course of study should reflect student needs.

Summary

Management education for occupational safety and health demands an eclectic approach to the broadest range of issues. It shares with quality the imperative of being integrated into every management and worker activity, into every employee’s job description and should be a part of the performance appraisal of all.

Back

As a rule disabled people have far fewer opportunities for occupational integration open to them than does the general population, a situation confirmed by all available data. However, in many countries political initiatives have been developed to improve this situation. Thus we find, for example, legal regulations requiring business enterprises to employ a specific percentage of disabled people, as well as—often in addition to this—financial incentives for employers to hire disabled people. Moreover, recent years have also seen the creation of services in many countries providing support and assistance to disabled people making their way into working life. The following contribution aims to describe these services and their specific tasks in the context of vocational rehabilitation and the integration of disabled people into employment.

We are concerned with services which become active, providing advice and support, during the rehabilitation phase—the preparatory phase prior to the disabled person’s entry into working life. Whereas support services used to limit themselves almost exclusively to this area, modern services have, in view of the continued existence on a global scale of employment problems of the disabled, turned their attention increasingly towards the stages dealing with placement and integration in an enterprise.

The increase in importance achieved by these services for the promotion of occupational integration has come about not least by growing community-based rehabilitation activities and, from a practical viewpoint, ever more numerous and successful approaches to the social integration of the disabled into the community. The continuing tendency towards the opening and overcoming of care institutions as mere places of confinement for disabled individuals has made the occupational and employment requirements for this group of people really visible for the first time. We are thus confronted with a growing variety of these support services because the growing demand for the integration of all disabled people into the community brings with it an increase in the associated tasks.

Rehabilitation and Integration

Only when disabled people are integrated into the community is the real aim and purpose of rehabilitation actually achieved. The objective of vocational rehabilitation programmes thus ultimately remains the finding of a job and hence participation in the local labour market.

As a rule, measures for medical and vocational rehabilitation lay the foundations for the (re)integration of disabled persons into working life. They aim to put the disabled individual in a position to be able to develop his or her own abilities in such a way that a life with no, or with a minimum of limitations in society at large becomes possible. The services which are active in this phase and which accompany the disabled person during this process are termed rehabilitation support services. Whereas one used to be able to assume that a completed course of medical rehabilitation and a well-founded vocational rehabilitation were, if not guarantees, then at least key factors for occupational integration, these elementary conditions are no longer adequate in view of the changing situation on the labour market and the complex requirements of the workplace. Of course solid vocational qualifications still form the basis of occupational integration, yet under today’s conditions many disabled people require additional assistance in looking for work and in integration into the workplace. The services active during this phase can be summarized under the name employment support services.

Whereas medical and vocational rehabilitation measures take as their primary point of departure the disabled persons themselves, and attempt to develop their functional capacities and vocational skills, the main emphasis of the employment support services lies on the side of the working environment and hence on the adaptation of the environment to the requirements of the disabled individual.

General Perspectives for Vocational Integration

In spite of the importance of the support services it should never be forgotten that rehabilitation should never, in any phase, be a merely passive form of treatment, but a process actively directed by the disabled person. Diagnosis, counselling, therapy and other forms of support can at best be an aid in the pursuit of self-defined objectives. Ideally the task of these services is still to outline the various options for action available, options which disabled people should ultimately decide for themselves, as far as possible.

Another no less significant parameter for occupational integration is to be seen in the holistic character which should be a hallmark of this process. That means that rehabilitation should be comprehensive and not just deal with the overcoming of impairment. It should involve the whole person and provide him or her with support in finding a new identity or in coping with the social consequences of disability. The rehabilitation of disabled people is in many cases far more than a process of physical stabilization and the extension of skills; if the course of rehabilitation is to run successfully and satisfactorily it must also be a process of psychosocial stabilization, identity formation and integration into everyday social relationships.

An important area of work for support services, and one which is unfortunately all too often ignored, is the field of the prevention of serious disabilities. For working life in particular it is crucial that rehabilitation and employment services are open not just to people who are already disabled but also to those who are threatened by disability. The earlier the reaction to a commencing disability, the sooner that steps towards occupational reorientation can be taken, and the earlier that serious disabilities can be avoided.

These general perspectives for vocational rehabilitation also provide an outline of the essential tasks and parameters for the work of the support services. Furthermore, it should also be clear that the complex tasks described here can best be fulfilled by the interdisciplinary collaboration of experts from various professions. Modern rehabilitation can thus be seen as cooperation between the disabled person and a team of professional trainers as well as qualified medical, technical, psychological and educational personnel.

Medical Rehabilitation

Medical rehabilitation measures usually take place in hospitals or in special rehabilitation clinics. The task of the support services in this phase consists of initiating first steps towards coping psychologically with a disability which has been suffered. However, occupational (re)orientation should also take place as soon as possible, practically at the patient’s bedside, since the construction of a new vocational perspective often helps to lay decisive motivational foundations which can also facilitate the medical rehabilitation process. Other measures such as motor and sensory training programmes, physiotherapy, movement and occupational or speech therapy can also contribute during this phase towards accelerating the natural regenerative process and reducing or avoiding the creation of dependencies.

The decision concerning the vocational perspectives of a disabled person should under no circumstances be taken from a purely medical point of view by a doctor, as is unfortunately still often the case in practice. The basis of any decision on the vocational future of a disabled person should be formed not just by deficits which can be medically diagnosed but rather by existing abilities and skills. The rehabilitation support services should therefore undertake together with the disabled person an extensive review of the client’s vocational background and an inventory of potential abilities and existing interests. Building on this an individual rehabilitation plan should then be drawn up which takes into account the potentialities, interests and requirements of the disabled person as well as the potential resources in his or her social environment.

A further area of work for the rehabilitation support services in this phase lies in the counselling of the disabled person with regard to any technical assistance, equipment, wheelchairs, artificial limbs, and so on which may be required. Use of this kind of technical assistance may at first be accompanied by rejection and refusal. Should a disabled person fail to receive the proper support and instruction during this initial phase, he or she may run the risk of the initial rejection escalating into a phobia which may later make it difficult to obtain the full benefit of the apparatus in question. In view of the wide variety of technical assistance nowadays available, the choice of such equipment must be made with the greatest care, tailored as far as possible to the individual needs of the disabled person. Ideally the selection of technical equipment required should also take into account both the disabled person’s vocational perspective and—as far as possible—the demands of the future workplace, given that the latter will also determine the purpose which the technical assistance must fulfil.

Vocational Rehabilitation

In the ILO “Convention (159) concerning vocational rehabilitation and employment (disabled persons)” adopted in 1983, the purpose of vocational rehabilitation is considered “as being to enable a disabled person to secure, retain and advance in suitable employment and thereby to further such person’s integration or reintegration into society”.

The past 30 years have seen rapid developments in vocational rehabilitation services for disabled persons. They include vocational assessment, which aims to get a clear picture of the person’s potential abilities; orientation courses to help the person to restore lost confidence in his or her abilities; vocational guidance, to develop a (new) vocational perspective and to choose a certain occupation; vocational training and retraining opportunities in the chosen field of activity; and placement services, designed to assist the disabled person in finding employment adapted to his or her disability.

A disabled person’s (re)entry into employment usually takes place via individual or combined vocational rehabilitation programmes, which can be carried out in different locations. It is the task of the rehabilitation support services to discuss with the disabled person whether the vocational qualification measure should be carried out in a mainstream institution for vocational training, in a specialized institution for vocational rehabilitation, by making use of community-based facilities or even directly in a normal workplace. The latter option is especially suitable when the previous job is still available and the workplace management have demonstrated their readiness in principle to rehire their former employee. However, in other cases cooperation with a regular workplace may already be a recommended option during the course of the vocational training, given that experience has shown that such cooperation also improves the chances of the participant subsequently being taken on by the firm. Thus in the case of vocational training in a vocational rehabilitation centre, it goes without saying that the support services should undertake the task of assisting disabled people in the search for possibilities of on-the-job practical training.

Of course these options for carrying out vocational rehabilitation measures cannot be seen separately from certain parameters and conditions which vary from country to country. Furthermore, the actual decision on the location of the vocational rehabilitation activity also depends on the kind of work envisaged and the type of disability, as well as on the disabled person’s social environment and the natural support potential available within it.

Wherever vocational rehabilitation takes place, it remains the task of the rehabilitation support services to accompany this process, to discuss together with the disabled person the experiences gained and to further extend the individual rehabilitation plan, adapting it to new developments as necessary.

Employment Support Services

Whereas medical and vocational rehabilitation in many countries can count on the support of a more or less extensive system of institutional settings, a comparable infrastructure for the promotion of the integration of disabled people into employment does not as yet exist even in some highly industrialized countries. And although various countries do have a number of quite successful models, some of which have been in existence for a number of years, employment services in most countries, with the exception of certain approaches in Australia, the United States, New Zealand and Germany, still do not form an integral part of national policy for disabled persons.

While the placement of disabled people into employment is an obligatory part of general labour administration in many countries, in view of the growing number of unemployed these institutions are less and less in a position to fulfil their obligations to place disabled people in work. This is exacerbated in many cases by a lack of appropriately qualified staff capable of doing justice to the abilities and wishes of the disabled person as well as to the requirements of the world of work. The creation of employment support services is also a reaction to the increasing lack of success of the traditional “train and place” approach implicit in institutionalized vocational rehabilitation. In spite of elaborate and often successful medical and vocational rehabilitation measures, integration into employment without additional assistance is becoming increasingly difficult.

It is at this point that the requirement for specific employment support services expresses itself. Wherever such services have been installed, they have been met by enormous demand from disabled persons and their families. This kind of service is particularly necessary and successful at the institutional interfaces between schools, rehabilitation institutions, sheltered workshops and other facilities for disabled persons on the one hand and the workplace on the other. However, the existence of employment support services also reflects the experience that many disabled people also require support and accompaniment not just in the phase of placement in employment, but also during the adjustment phase in the workplace. A number of larger firms have their own, internal employee assistance service, responsible for the integration of newly employed disabled people and for maintaining the jobs of disabled workers already employed.

Tasks of Employment Support Services

The primary intervention focus of the employment support services is on the critical threshold of entry into working life. Generally speaking, their task consists of creating links between the disabled person and the firm in question, that is, with the direct superior and future colleagues in the workplace.

Employment support services must on the one hand provide support for the disabled person in finding work. This takes place by means of self-confidence and (video supported) job interview training and assistance in the writing of letters of application, but also and primarily in placement in on-the-job practical training. All experiences have shown that such practical on-the-job training forms the most important bridge into the firm. Where necessary the services accompany the disabled person to job interviews, providing assistance with official paperwork and in the initial adjustment phase in the workplace. Lack of capacity means that most employment support services are unable to provide support beyond the confines of the workplace. However, in theory such support is also undesirable. To the extent that further assistance in the private sphere, whether psychological, medical or life-skills related in nature, is also required, it is usually provided by referral to the appropriately qualified facilities and institutions.

On the other hand, with regard to firms, the most important tasks of the support services consist initially of motivating an employer to take on a disabled person. Although many firms do have broad reservations about employing disabled people, it is still possible to find firms prepared to enter into continual cooperation with vocational rehabilitation facilities and employment support services. Once such a general readiness for cooperation has been identified or established, it is then a case of locating suitable jobs within the firm. Before any placement in the firm, there should of course be a comparison of the requirements of the job with the abilities of the disabled person. However, the time and energy occasionally spent in model projects which use supposedly “objective” procedures to compare differentiated ability and requirement profiles in order to work out the “optimal” job for a specific disabled person, usually bears no relation to the chances of success and the practical efforts involved in actually finding the job. It is more important to turn disabled persons into the agents of their own vocational development, since in terms of psychological significance we cannot place too high a value on the involvement of the persons concerned in the shaping of their own vocational future.

Placement approaches already elaborated attempt to build on detailed analyses of organizational structure and working procedure by making suggestions to the firm regarding the reorganization of certain working areas and hence to create work opportunities for disabled people. Such suggestions can include a reduction in certain working requirements, the creation of part-time work and flexible work times as well as the reduction of noise and stress in the workplace.

Employment support services also offer to assist firms in applying for public subsidies, such as wage subsidies, or in overcoming bureaucratic hurdles when applying for state grants for technical compensation for disability-related limitations. However, support for the disabled person in the workplace must not necessarily be only of a technical nature: people with visual impairment may under certain circumstances require not only a Braille keyboard for their computer and an appropriate printer, but also someone to read aloud for them; and persons with hearing impairment could be assisted through a sign-language interpreter. Sometimes support in acquiring the qualifications required for the job or in social integration into the firm will be necessary. These and other similar tasks are often undertaken by an employment support services worker designated as a “job coach”. The individualized support provided by the job coach decreases over time.

People with mental or psychiatric disabilities usually require a step-by-step integration with a gradual increase in work requirements, working hours and social contact, which has to be organized by the support services in cooperation with the firm and the disabled person.

For every form of support the maxim applies that it must be tailored to the individual requirements of the disabled person as well as harmonized with the firm’s own resources.

The Example of Supported Employment

Supported employment for persons with disabilities is a concept in which wage subsidies for the firms involved and individualized support services for disabled persons are connected with each other in order to achieve full integration into working life. This concept is particularly widespread in Australia and New Zealand, in various European countries and in the United States. It has so far primarily been used for the workplace integration of mentally and psychiatrically disabled people.

Employment support services undertake the placement of disabled people in a firm, organize the financial, technical and organizational support required by the firm and provide a job coach who accompanies the job-related and social integration of the disabled person into the firm.

The employer is thus relieved of all normally anticipated problems related to the hiring of disabled persons. As far as possible and necessary, the employment support services also undertake the required adaptations in the workplace and the disabled person’s immediate working environment. Occasionally it will be necessary for the applicant to receive additional training outside the firm, although instruction usually takes the form of on-the-job training by the job coach. It is also the job coach’s task to orient the colleagues and superiors in the technical and social support of the disabled person, since the aim in principle is to gradually reduce the professional assistance of the employment support service. It is, however, absolutely necessary that in the case of acute problems the employment support service should be present to provide continual assistance to the extent required. This means that support both for the disabled person and for the employer, the superior and colleagues, must be individualized and correspond to specific needs.

Cost-benefit analyses of this approach carried out in the United States have shown that although the initial integration phase is very intensive in terms of support provided and hence costs, the longer employment lasts, the more this investment is also justified from a financial point of view, not just for the disabled person, but also for the employer and the public budget.

Placement of disabled people by supported employment approaches is most common in relatively undemanding jobs, which tend to run the risk of being eliminated. The future of the supported employment approach will be decided not just by developments in the labour market but also by the further development of the concept.

Challenges for the Future of Employment Support Services

The following sections contain descriptions of a number of critical points whose significance for the further development of the concepts and for the practical work of employment support services should not be underestimated.

Networking with Vocational Rehabilitation Facilities and Firms

If employment support services are not to miss the mark in terms of what is actually required, a central task everywhere will be to create organic links with the existing vocational rehabilitation facilities. Integration services with no links to rehabilitation facilities run the risk—as experience has shown—of functioning primarily as instruments of selection and less as services for the vocational integration of disabled persons.

However, support services require not only networking and cooperation with vocational rehabilitation facilities, but also and more importantly, a clear positioning with regard to cooperation with firms. Under no circumstances should employment support services function merely as counselling services for disabled persons and their families; they must also be active in work-finding and placement services. Proximity to the labour market is the key to access to firms and ultimately to the possibilities of finding employment for disabled individuals. If these services’ access threshold to the firm is to be maximized, they must be situated as close as possible to actual economic activity.

Connections Between Qualification, Placement and Employment

An important part of all vocational integration efforts, and hence a central challenge for employment support services, is the coordination of vocational preparation and qualification with the requirements of the workplace—an aspect often still neglected. As justified as a criticism of the traditional “train and place” model may be, in practice just to first place and then provide training in the required skills is not enough either. Working under today’s conditions means not only having the so-called secondary working virtues at one’s disposal—punctuality, concentration and speed—but also a number of technical qualifications which are always required and which must already be present before employment can be started. Anything else would be asking too much, both of the persons to be placed and of the firms prepared to take them on.

Mobilizing Natural Support

The chances of the successful vocational integration of disabled people into the labour market increase with the possibility of organizing help and support, either in parallel to the work process or directly in the workplace. Especially in the initial adjustment phase it is important both to assist the disabled person in coping with the demands of work and also to provide support for those who make up the working environment. This form of accompanying assistance is usually provided by the employment support services. The integration of a disabled person will be all the more successful in the long term, the more this kind of professional help can be replaced by a mobilization of natural support in the firm, whether by colleagues or superiors. In a project recently carried out in Germany for the mobilization of natural support by so-called foster workers in the workplace, 42 disabled people were successfully integrated in the course of 24 months; over 100 firms were asked to participate. The project showed that few employees had the required level of knowledge and experience in dealing with disabled people. It thus appeared to be of strategic importance for the employment services to develop a conceptual framework in order to organize the replacement of professional support and the mobilization of natural support in the workplace. In the UK for example, employees prepared to act as foster workers for a certain time receive recognition in the form of a small financial reward.

Success Orientation and User Control

Finally, employment support services should also offer their own employees incentives to go into firms and bring about the placement of disabled people, for it is on these placement efforts within the firms that the central focus of the services must lie. Yet the placement of disabled people can be secured in the long term only when the funding of the employment support services and their employees is to a certain extent related to their success. How can service employees be motivated in a continual way to leave their institution, only to undergo the frustration of rejection in the firms? The placement of disabled people in employment is a difficult business. Where is the impetus to come from to battle doggedly and constantly against prejudice? All organizations develop their own interests, which are not necessarily in accord with those of their clients; all publicly funded institutions run the risk of becoming divorced from the needs of their clients. For this reason a corrective is required which creates general incentives—not just for employment support services but also for other social facilities—in the direction of the desired result.

A further necessary modification of the work of publicly funded social facilities consists of the users and their organizations having a say in matters relating to them. This culture of participation should also find an echo in the concepts behind the support services. In this context the services, like all other publicly funded institutions, should be subjected to regular control and evaluation by their clients—their users and their families—and last but not least by the firms cooperating with the services.

Concluding Remarks

Which and how many disabled persons can ultimately be integrated into the labour market by the activities of vocational rehabilitation and employment support services cannot be answered in the abstract. Experience shows that neither the degree of disability nor the situation on the labour market can be regarded as absolute limitations. The factors determining development in practice include not just the support services’ way of working and the situation on the job market, but also the dynamics arising within institutions and facilities for disabled persons, when this kind of employment option becomes a concrete possibility. In any case, experiences from various countries have shown that collaboration between employment support services and sheltered facilities tends to have considerable effect on the internal practices within these facilities.

People need perspectives, and motivation and development arise to the extent that perspectives exist or are created by new options. Important as the absolute number of placements realized by the employment support services is, of equal importance is the opening up of options for the personal development of disabled people made possible by the very existence of such services.

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Categories of Occupational Safety and Health Professionals Requiring Training and Education

The delivery of occupational safety and health services requires a highly-trained and multidisciplinary team. In a few less-developed countries, such a team may not exist, but in the vast majority of countries in the world, experts in different aspects of OSH are usually at least available though not necessarily in sufficient numbers.

The question of who belong to the categories of OSH professionals is fraught with controversy. Usually there is no dispute that occupational physicians, occupational nurses, occupational hygienists and safety professionals (sometimes referred to as safety practitioners) are OSH professionals. However, there are also members of many other disciplines who can make a plausible claim to belonging to the OSH professions. They include those ergonomists, toxicologists, psychologists and others who specialize in the occupational aspects of their subjects. For the purpose of this article, nevertheless, the training of these latter types of personnel will not be discussed, as the main focus of their training is often not on OSH.

Historical Perspective

In most countries, specific OSH training is of fairly recent origin. Until the Second World War, most OSH professionals received little or no formal training in their chosen calling. Few schools of public health or universities provided formal OSH courses, though some such institutions offered OSH as a subject in the context of a wider degree course, usually in public health. Segments of OSH were taught at the postgraduate level for physicians training in disciplines such as dermatology or respiratory medicine. Some engineering aspects of safety, such as machine guarding, were taught in technological and engineering schools. In most countries, even training in individual components of occupational hygiene courses were hard to find before the Second World War. The development of occupational nursing training is even more recent.

In the developed countries, OSH training received a boost during the Second World War, just as OSH services did. The mass mobilization of whole nations for the war effort led to greater emphasis on protecting the health of workers (and therefore their fighting capability or productivity with respect to the manufacturing of more munitions, warplanes, tanks and warships). At the same time, however, wartime conditions and the drafting of both university teachers and students into the armed forces made it extremely difficult to set up formal courses of OSH training. After the Second World War, however, many such courses were established, some with the help of the generous study grants for demobilized servicemen awarded by grateful governments.

After the Second World War, most colonies of European empires achieved independence and embarked upon the path of industrialization to a greater or lesser extent as a means to national development. Before long, such developing countries found themselves confronting the ills of the industrial revolution of nineteenth-century Europe, but within a much telescoped time span and on an unprecedented scale. Occupational accidents and diseases and environmental pollution became rampant. This led to the development of OSH training, although even today there are large variations in the availability of such training in these countries.

Review of Current International Initiatives

International Labour Organization (ILO)

There have been several initiatives of the ILO in recent years which relate to OSH training. Many of them relate to practical training for interventive measures at the worksite. Some other initiatives are carried out in collaboration with national governments (Rantanen and Lehtinen 1991).

Other ILO activities since the 1970s have been carried on largely in developing countries throughout the world. Several such activities relate to the upgrading of training of factory inspectors in countries such as Indonesia, Kenya, the Philippines, Tanzania, Thailand, and Zimbabwe.

The ILO, together with other United Nations agencies such as the United Nations Development Programme, has also assisted in the establishment or upgrading of national institutes of OSH, the training functions of which are usually among their top priorities.

The ILO has also produced several practical monographs which are very useful as training materials for OSH courses (Kogi, Phoon and Thurman 1989).

World Health Organization (WHO)

The WHO has held in recent years a number of important international and regional conferences and workshops on OSH training. In 1981, a conference entitled “Training of Occupational Health Personnel” was held under the auspices of the Regional Office for Europe of the WHO. In the same year, the WHO convoked with the ILO a Joint ILO/WHO Committee on Occupational Health which focused on “educational and training in occupational health, safety and ergonomics” (WHO 1981). That meeting assessed the needs for education and training at different levels, developed policies in education and training and advised on methodology and programmes for education and training (WHO 1988).

In 1988 a WHO Study Group published a report entitled Training and Education in Occupational Health to address particularly the new policies on primary health care strategies adopted by the WHO member states, new needs resulting from technological developments and new approaches to health promotion at work (WHO 1988).

International Commission on Occupational Health (ICOH)

In 1985, the ICOH established a Scientific Committee on Education and Training in Occupational Health. This Committee has organized four international conferences as well as mini-symposia on the subject in the International Congresses on Occupational Health (ICOH 1987). Among the conclusions of the second conference, the need to develop training strategies and training methodologies received prominent mention in the list of priority issues (ICOH 1989).

A main feature of the third conference was the methodology of OSH training, including such functions as learning by participation, problem-based learning and evaluation of courses, teaching and students (ICOH 1991).

Regional initiatives

In different parts of the world, regional bodies have organized training activities in OSH. For example, the Asian Association of Occupational Health, established in 1954, has a Technical Committee in Occupational Health Education which conducts surveys on training of medical students and related subjects.

Types of Professional Programmes

Degree-granting and similar programmes

Probably the prototype of degree-granting and similar programmes is the sort which was developed in schools of public health or equivalent establishments. Higher education for public health is a relatively recent development. In the United States, the first school dedicated to this purpose was established in 1916 as the Institute of Hygiene at Johns Hopkins University. At that time, the overriding public health concerns centred around the communicable diseases. As time went on, education about the prevention and control of man-made hazards and about occupational health drew increasing emphasis in the training programmes of schools of public health (Sheps 1976).

Schools of public health offer OSH courses for a postgraduate diploma or for the degree of Master of Public Health, allowing students to concentrate in occupational health. Usually entry requirements include the possession of a tertiary educational qualification. Some schools insist upon relevant prior experience in OSH as well. The duration of training on a full-time basis is usually one year for the diploma and two years for the Master’s course.

Some of the schools train the different OSH personnel together in core courses, with training in the specific OSH disciplines (e.g., occupational medicine, hygiene or nursing) being offered to students specializing in these areas. This common training is probably a great advantage, as trainees of the different OSH disciplines could develop a greater understanding of each other’s functions and a better experience of team work.

Especially in recent years, schools of medicine, nursing and engineering have offered courses similar to those in schools of public health.

A few universities are offering OSH courses at the basic or undergraduate level. Unlike the traditional OSH tertiary courses, admission to which is usually dependent upon the acquisition of a previous degree, these newer courses admit students who have just graduated from high school. Much controversy still surrounds the merits of this development. Proponents of such courses argue that they produce more OSH professionals in less time and at lower cost. Their opponents argue that OSH practitioners are more effective if they build their OSH training on a basic discipline into which they integrate their special OSH practice, such as occupational medicine or nursing. Knowledge of basic sciences may be acquired at the specialization level if they have not been taught as part of undergraduate training.

Training courses in OSH for physicians vary in their clinical component. The conference, mentioned above, on the training of occupational health personnel organized by the WHO/Regional Office for Europe emphasized that “occupational medicine is fundamentally a clinical skill and its practitioners must be fully competent in clinical medicine”. It must also be stressed that the diagnosis of chemical intoxication among workers is largely clinical, as is the differentiation between “occupational disease” and other diseases and their management (Phoon 1986). It has become, therefore, a worldwide trend to insist upon postings to different clinics as part of the training of the occupational physician. In the United States and Canada, for example, trainees undergo a four-year residency programme which includes a substantial clinical component in such subjects as dermatology and respiratory medicine in addition to the curriculum required for the degree of Master of Public Health or its equivalent.

Formal training for occupational nurses probably varies even more in different parts of the world than that for occupational physicians. These differences hinge on the variations of responsibilities and functions of occupational nurses. Some countries define occupational health nursing as “the application of nursing principles in conserving the health of workers in all occupations. It involves prevention, recognition, and treatment of illness and injury and requires special skills and knowledge in the fields of health education and counselling, environmental health, rehabilitation and human relations” (Kono and Nishida 1991).On the other hand, other countries understand occupational nursing as the role of the nurse in an interdisciplinary occupational health team, who is expected to participate in all the fields of general health management, delivery of health services, environmental control, healthy and safe working procedures and OSH education. A survey in Japan showed, however, that not all the graduates from an occupational nursing staff took part in all these activities. This was probably due to a lack of understanding of the nurse’s role in OSH and to inadequate training in some of the fields (Kono and Nishida 1991).

The discipline of occupational hygiene has been defined by the American Industrial Hygiene Association as the science and art devoted to the recognition, evaluation and control of those environmental factors and stresses, arising in or from the workplace, which may cause sickness, impaired health and well-being, or significant discomfort and inefficiency among workers or among the citizens of the community. Speciality training has also emerged within the general field of occupational hygiene, including that in chemistry, engineering, noise, radiation, air pollution and toxicology.

Curricula for Occupational Safety and Health Personnel

The detailed contents of the curricula for the training of occupational physicians, nurses, hygienists and safety personnel, as recommended by the 1981 Joint ILO/WHO Committee an Occupational Health mentioned above will be represented in the pages to follow. As regards the main subject areas to be taught, the Committee recommends:

• organization of occupational safety and health services, their activities, legislation and regulations
• occupational medicine
• occupational hygiene
• occupational safety
• work physiology and ergonomics, dealing particularly with the adaptation of work to man, but also with the readjustment of the handicapped to work
• occupational psychology, sociology and health education.

According to the profile of the personnel, the educational programmes will go more or less deeply into different subjects to meet the demands of the respective professions, as discussed below for several categories.

It is difficult to comment in detail what should go into the curricula of OSH courses. It is generally agreed that such courses should have a greater input of behavioural sciences than is now the case, but such input should be relevant to the sociocultural milieu of a particular country or region for which a course is designed. Moreover, OSH should not be taught in isolation from the general health services and the community health situation in a given country or region. The fundamentals of management science should be included in OSH curricula to improve the understanding of organizational structures and practices in enterprises as well as to enhance administrative skills of OSH professionals. The art of communication and the ability to conduct an investigation of OSH problems scientifically and to formulate solutions were also recommended for inclusion in all OSH curricula (Phoon 1985b).

Physicians and nurses

All medical students should be taught some occupational health. In some countries, there are separate courses; in others, occupational health is dealt with in such courses as physiology, pharmacology and toxicology, public health, social medicine and internal medicine. Nevertheless, medical students do not, as a rule, acquire sufficient knowledge and skill to allow them to practice occupational health independently, and some postgraduate training in occupational health and safety is necessary. For further specialization in occupational health (e.g., occupational diseases, or even more narrow fields, like occupational neurology or dermatology), postgraduate training programmes should be available. For nurses active in occupational health services, both long-term and short-term courses need to be organized, depending on their range of activities.

Figure 1 lists subjects to be included in specialized postgraduate training for physicians and nurses.

Figure 1. Postgraduate training syllabus for physicians and nurses.

Safety and health engineers and safety officers

The practice of occupational safety is concerned with such failures of materials, machines, processes and structures as may give rise to dangerous situations, including the release of harmful agents. The aim of education in this field is to enable students to foresee danger, both at the planning stage of projects and in existing situations, to quantify the danger and to design measures to combat it. Training in occupational safety involves the student in a substantial study of selected topics from engineering and materials science, particularly those related to mechanical, civil, chemical, electrical and structural engineering.

Separate curricular units would be concerned, for example, with the structure and strength of materials, in mechanical engineering; with forces in structures, in civil engineering; with handling and transportation of chemicals, in chemical engineering; with design standards, protective equipment and the theory of preventive maintenance, in electrical engineering; and with the behaviour of strata, in mining engineering.

Safety engineers, in addition to acquiring a basic knowledge, should also undergo a course of specialization. The 1981 Joint ILO/WHO Committee recommendations for a specialized safety engineering course of study are listed in figure 2.

Figure 2. A syllabus for specialization in safety engineering.

Courses can be either full-time, part-time or “sandwich courses”—in the lattermost case, periods of studying are interspersed with periods of practice. The selection of which courses to take is very much a matter of individual circumstances or preference. This is especially true since many safety practitioners have extensive knowledge gained through on-the-job experience in particular industries. However, within a large community or a country, there should preferably be a large range of choices to cater for all these different needs.

The recent enormous advances in communications technology should enable the greater usage of distance-learning courses which can be delivered both to remote areas of a country or even across national frontiers. Unfortunately, such technology is still quite expensive, and countries or areas which need such distance-learning capabilities most may be the very ones least able to afford them.

Primary health care practitioners

There is a severe shortage of OSH professionals in developing countries. In addition, among primary health care practitioners and health professionals as a whole, there is a tendency to direct their main activities to curative services. This should be counterbalanced with the help of appropriate training to emphasize the great value of instituting preventive measures at the workplace in collaboration with other responsible parties such as workers and managers. This would help, to a certain extent, to alleviate the problems caused by the present shortage of OSH personnel in developing countries (Pupo-Nogueira and Radford 1989).

A number of developing countries have recently embarked on short courses of OSH training for primary health care and public health personnel. There is a wide spectrum of organizations which have undertaken such training. They include national productivity boards (Phoon 1985a), farmers’ associations, national safety councils, national institutes of health, and professional bodies such as medical and nurses’ associations (Cordes and Rea 1989).

A scarcity of OSH professionals affects not only developing countries, but many developed ones as well. In the United States, one response to this problem took the form of a joint report by a preventive medicine and internal medicine study group that recommended that training programmes in internal medicine emphasize controls of hazards in the workplace and in the environment, since most patients seen by internists are members of the workforce. Furthermore, the American Academy of Family Physicians and the American Medical Association have published several monographs on occupational health for the family physician. A study by the American Institute of Medicine reaffirmed the role of the primary care physician in occupational health, outlined the basic skills required and emphasized the need to enhance occupational health activity in basic training and continuing education (Ellington and Lowis 1991). In both developed and developing countries, however, there is still an inadequate number of OSH training programmes for primary health care personnel and an insufficient number of trained personnel.

Multidisciplinary training

Training in the multidisciplinary nature of OSH can be enhanced by making sure that everyone who trains is fully familiar with the roles, activities and areas of concern of the other OSH personnel. In an OSH course in Scotland, for example, members of the different OSH professions participate in the teaching programme. The students are also provided with self-instruction packages designed to give them detailed knowledge of and insight into the different OSH professional areas. Extensive use is also made of experiential learning techniques such as role-playing simulations and participative case studies. For example, students are asked to complete personal checklists on how each particular area of occupational health activity is likely to affect them in their own work situations, and on how they can cooperate effectively with other occupational health professionals.

In the running of a multidisciplinary OSH course, a key element is the mix of learners of different professional backgrounds in the same class. The course material, such as group exercises and essays, must be carefully selected without any bias to a particular discipline. Lecturers must also receive training in the setting of multidisciplinary questions and problems (D’Auria, Hawkins and Kenny 1991).

Continuing Education

In professional education as a whole, there is an increasing awareness of the need for continuing education. In the field of OSH, new knowledge concerning old hazards and new problems arising from changes in technology are developing so rapidly that no OSH practitioner could hope to keep up to date without making a systematic and constant effort to do so.

Continuing education in OSH can be formal or informal, voluntary or obligatory in order to maintain certification. It is essential for every OSH practitioner to keep up with reading the key professional journals, at least in his or her own disciplines. When a new hazard is encountered, it would be very useful to mount a literature search on that subject through a library. If such a library is unavailable, the CIS service of the ILO could be asked to undertake that service instead. Moreover, having continual and direct access to at least a few up-to-date texts on OSH is essential to any kind of OSH practice.

More formal kinds of continuing education could take the form of conferences, workshops, lectures, journal clubs or seminars. Usually tertiary institutions of learning or professional organizations can provide the means of delivery of such programmes. Whenever possible, there should be annual events in which a broader range of views or expertise could be canvassed than is usually available within the framework of a small community or town. Regional or international conferences or seminars can provide extremely useful opportunities for participants, not only to take advantage of the formal programme but also to exchange information with other practitioners or researchers outside the formal sessions.

Nowadays, more and more OSH professional organizations require members to attend a minimum number of continuing education activities as a condition for extension of certification or membership. Usually only the fact of attendance at approved functions is required. Attendance by itself is, of course, no guarantee that the participant has benefited from being present. Alternatives such as subjecting OSH professionals to regular examinations are also fraught with problems. Within a single OSH discipline, there is such a wide diversity of practice even within the same country that it is extremely difficult to devise an examination equitable to all the OSH practitioners concerned.

Self-learning

In every OSH training course there should be emphasis on the need for self-learning and its continuing practice. To this end, training in information retrieval and critical analysis of published literature is imperative. Training on the use of computers to facilitate obtaining of information from the many excellent OSH resources around the world would be also beneficial. Several courses have been developed in recent years to promote self-learning and information management through microcomputers (Koh, Aw and Lun 1992).

Curriculum Development

There is an increasing demand on the part of trainees and the community to ensure that curricula are constantly evaluated and improved. Many modern curricula are competency-based. A series of professional competencies required is first compiled. Since competence may be defined by different groups in different ways, extensive consultations on this matter should be held with faculty members and OSH practitioners (Pochyly 1973). In addition, there is a need for consultations with “consumers” (e.g., students, workers and employers), an inbuilt evaluation programme and well-defined but flexible educational objectives (Phoon 1988). Sometimes the establishment of advisory committees on curriculum or teaching programmes, which normally include faculty and student representatives, but sometimes also involve members of the general community, can provide a useful forum for such consultations.

Infrastructure Development

Infrastructure is often ignored in discussions on OSH training and education. Yet supporting facilities and human resources such as computers, libraries, efficient administrative staff and procedures and safe and convenient access are among the host of infrastructure considerations which could be crucial to the success of training courses. Proper monitoring of students’ progress, counselling and assistance of students with problems, health care of students and their families (where indicated), minding of students’ children, canteen and recreational facilities and provision of lockers or cupboards for the storage of personal possessions of trainees are all important details which should receive careful attention.

Faculty Recruitment and Development

The quality and popularity of a training programme are often vital factors in determining the quality of staff applying for a vacant position. Obviously, other factors such as satisfactory service conditions and opportunities for career and intellectual development are also important.

Careful consideration should be given to job specifications and job requirements. Faculty should have the necessary OSH qualifications, though flexibility should be exercised to allow the recruitment of staff from non-OSH disciplines who may be able to make special contributions to teaching or especially promising applicants who may have the capability but not all the qualifications or experience normally required for the job. Whenever possible, faculty should have practical OSH experience.

After recruitment, it is the responsibility of the leadership and senior members of the school or department to make sure that new staff are given as much encouragement and opportunity to develop as possible. New staff should be inducted into the culture of the organization but also encouraged to express themselves and to participate in decision-making processes related to teaching and research programmes. Feedback should be given to them concerning their teaching performance in a sensitive and constructive manner. Whenever necessary, offers of help to remedy identified limitations should be given. Many departments have found the regular holding of teaching or evaluation workshops for staff to be extremely useful. Cross-postings to industries and sabbatical leave are other important measures for staff development. Some extent of consultancy work, which could be either clinical, worksite or laboratory (depending on the discipline and areas of activity of the faculty member) helps to make academic teaching more practical.

Teaching Venues

Classrooms should be designed and furnished according to appropriate ergonomic principles and equipped with audio-visual aid equipment and video projection facilities. The lighting and acoustics should be satisfactory. Access to an exit should be located in such a way as to minimize the disturbance of an ongoing class.

Proper principles of OSH should be applied to the design and construction of laboratories. Such safety equipment as showers, eye washing facilities, first aid supplies and resuscitation equipment and fume cupboards should be installed or made available where indicated, and laboratories should be bright, airy and odourless.

Venues for field visits should be chosen to provide a wide range of OSH experiences for the trainees. If possible, worksites with different levels of OSH standards should be chosen. However, on no account should the safety or health of trainees be compromised.

Locations for clinical work would very much depend on the nature and level of the training course. In some circumstances, bedside teaching may be indicated to demonstrate the appropriate clinical approach to skills in history taking. In some other circumstances, presentation of cases with or without patients could serve the same purpose.

Examinations and Assessment

The recent trend has been to seek alternatives to administering an all-important and single final examination at the end of a course. Some courses have abolished formal examinations altogether and replaced them with assignments or periodic assessments. Some other courses have a combination of such assignments and assessments, open book examinations and closed book examinations as well. It is nowadays increasingly understood that examinations or assessments are as much measures of the quality of courses and teachers as of the trainees.

A feedback of trainees’ opinions concerning the entire course or components thereof through questionnaires or discussions is invaluable in the evaluation or revision of a course. As far as possible, all courses should be constantly evaluated, at least on an annual basis, and revised if necessary.

Insofar as modes of examination are concerned, essay questions can test organization, integrating ability and writing skills. The precision and validity of essay examinations, however, have been found to be weak. Multiple-choice questions (MCQs) are less subjective, but good ones are difficult to formulate and do not allow a display of practical knowledge. Modified essay questions (MEQs) differ from essays or MCQs in that the candidate is presented with a progressive amount of information about a problem. It avoids cueing by requesting short-answer responses rather than presenting candidates with alternatives from which to choose the appropriate answer. Oral examinations can measure problem-solving skills, professional judgement, communication skills and ability to retain composure under stress. The main difficulty with the oral examination is the potential for so-called “lack of objectivity”. The oral examination can be made more reliable by imposing some structure on it (Verma, Sass-Kortsak and Gaylor 1991). Perhaps the best alternative is to use a battery of these different types of examination rather than to rely on one or two of them only.

Certification and Accreditation

The word certification usually refers to the conferment upon a professional of authorization to practise. Such certification could be conferred by a national board or a college or an institution of practitioners of an OSH discipline. Usually, the OSH professional is given certification only after fulfilling a stipulated period of training in connection with an approved course or positions and also upon passing an examination. In general, such “global certification” is valid for life, unless there is proven professional negligence or misconduct. However, there are other forms of accreditation which require periodic renewal. They include such accreditation as that required in some countries to either conduct special statutory medical examinations or to report on radiographs of asbestos-exposed persons.

Accreditation, on the other hand, refers to the recognition of OSH courses by a national board or professional organization or a scholarship-granting body. Such accreditation should be subject to periodic reappraisal to ensure that courses keep to an appropriate level of currency and effectiveness.

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* Portions of this article have been adapted from Shrey and Lacerte (1995) and Shrey (1995).

Employers are faced with increasing societal and legislative pressure to integrate and accommodate people with disabilities. Increasing workers’ compensation and health care costs are threatening the survival of business and draining resources otherwise allocated to future economic development. Trends suggest that employers can be successful in the effective management of injury and disability problems. Impressive disability management programme models are prominent among employers that assume control and responsibility for injury prevention, early intervention, injured worker reintegration and worksite accommodation. Current disability management practice in industry reflects a paradigm shift from services provided in the community to interventions occurring at the worksite.

This article offers an operational definition of disability management. A model is presented to illustrate the structural components of an optimal worksite-based disability management programme. Effective disability management strategies and interventions are outlined, including key organizational concepts that strengthen service delivery and successful outcome. This article also includes a focus on joint labour-management collaboration and the use of interdisciplinary services, which are considered by many to be essential to the implementation of optimal disability management programmes in industry. Promoting respect and dignity between workers with disabilities and the professionals who serve them is emphasized.

Definition of Disability Management

Disability management is operationally defined as an active process of minimizing the impact of an impairment (resulting from injury, illness or disease) on the individual’s capacity to participate competitively in the work environment (Shrey and Lacerte 1995). The basic principles of disability management are as follows:

• It is a proactive (not passive or reactive) process.

• It is a process that enables labour and management to assume joint responsibility as proactive decision-makers, planners and coordinators of workplace-based interventions and services.

• It promotes disability prevention strategies, rehabilitation treatment concepts, and safe work return programmes designed to control the personal and economic costs of workplace injury and disability.

Successfully managing the consequences of illness, injury and chronic disease in the workforce requires:

• an accurate understanding of the types of injury and illness that occur

• the employer’s timely response to the injury or illness

• clear administrative policies and procedures

• the effective utilization of health care and rehabilitation services.

Disability management practices are based on a comprehensive, cohesive and progressive employer-based approach to managing the complex needs of people with disabilities within a given work and socio-economic environment. Despite rapidly escalating costs of injury and disability, rehabilitation technologies and disability management resources are available to facilitate immediate and recurrent savings among business and industry. Disability management policies, procedures and strategies, when properly integrated within the employer’s organization, provide the infrastructure which enables employers to effectively manage disability and continue to compete in a global environment.

Controlling the cost of disability in business and industry and its ultimate impact on employee productivity is not a simple task. Complex and conflicting relationships exist between employer goals, resources and expectations; the needs and self-interests of workers, health care providers, labour unions and attorneys; and the services available in the community. The ability of the employer to participate actively and effectively in this relationship will contribute to the control of costs, as well as to the protection of the worker’s sustained and productive employment.

Disability Management Objectives

Employer policy and procedure, as well as disability management strategies and interventions, should be designed to accomplish realistic and attainable objectives. Disability management programmes at the worksite should enable the employer to:

• facilitate control of disability issues

• improve corporate competitiveness

• reduce work disruptions and unacceptable lost time

• decrease incidence of accidents and magnitude of disability

• reduce illness and disability duration (and costs)

• promote early involvement and preventive interventions

• maximize use of internal (employer) resources

• improve coordination and accountability, with respect to external service providers

• reduce human cost of disability

• enhance morale by valuing employee physical and cultural diversity

• protect the employability of the worker

• ensure compliance with reintegration and employer equity legislation (e.g., Americans with Disabilities Act of 1990)

• reduce adversarial nature of disability and litigation

• improve labour relations

• promote joint labour-management collaboration

• facilitate direct worker involvement in planning

Essential Disability Management Conceptsand Strategies

Both labour and management have vested interests in protecting the employability of workers while controlling industry’s injury and disability costs. Labour unions want to protect the employability of the workers they represent. Management wants to avoid costly worker turnover, while retaining productive, reliable and experienced employees. Research suggests that the following concepts and strategies are important when developing and implementing effective worksite-based disability management programmes:

Joint labour-management involvement

Disability management requires employer and union involvement, support and accountability. Both are key contributors in the disability management process, participating actively as decision-makers, planners and coordinators of interventions and services. It is important for both labour and management to assess their joint capacities for responding to injury and disability. This often requires an initial analysis of joint strengths and weaknesses, as well as an assessment of the resources available to properly manage accommodation and return-to-work activities among workers with disabilities. Many unionized employers have successfully developed and implemented on-site disability management programmes under the guidance and support of joint labour- management committees (Bruyere and Shrey 1991).

Corporate culture

Organizational structures, worker attitudes, management intentions and historical precedents contribute to the corporate culture. Prior to developing a disability management programme in industry, it is important to understand the corporate culture, including the motivations and self-interests of labour and management regarding injury prevention, worksite accommodation and injured worker rehabilitation.

Injury and disability patterns

Disability management programmes in industry must be customized to address the unique patterns of injury and disability in the employer’s workforce, including types of impairments, ages of workers, lost-time statistics, accident data and costs associated with disability claims.

Interdisciplinary disability management team

Disability management requires an interdisciplinary disability management team. Members of this team often include employer representatives (e.g., safety managers, occupational health nurses, risk managers, human resources personnel, operations managers), labour union representatives, the worker’s treating physician, a rehabilitation case manager, an onsite physical or occupational therapist and the worker with a disability.

Early intervention

Perhaps the most important principle of disability management is early intervention. Rehabilitation policy and practice among most disability benefit systems recognizes the value of early intervention, in light of compelling empirical evidence resulting from disability management research over the past decade. Employers have substantially reduced disability costs by promoting early intervention concepts, including the systematic monitoring of workers with work restrictions. Early intervention strategies and programmes for an early return to work result in decreased lost time, increased employer productivity and decreased workers’ compensation and disability costs. Whether the disability is work related or not, early intervention is considered to be the primary factor upon which the foundation of medical, psychosocial and vocational rehabilitation is established (Lucas 1987; Pati 1985; Scheer 1990; Wright 1980). However, the successful management of disability also requires early return to work opportunities, accommodations and supports (Shrey and Olshesky 1992; Habeck et al. 1991). Typical early-return-to-work programmes in industry include a combination of disability management interventions, facilitated by an employer-based multidisciplinary team and coordinated by a skilled case manager.

Proactive interventions at individual and work environment levels

Disability management interventions must be directed at both the individual and the work environment. The traditional approach to rehabilitation often ignores the fact that occupational disability may originate as much from environmental barriers as from the worker’s personal traits. Workers dissatisfied with their jobs, supervisor-worker conflicts and poorly designed workstations rank high among the many environmental barriers to disability management. In short, to maximize rehabilitation outcomes among injured workers, an equally balanced focus on the individual and the work environment is needed. Job accommodations, as required under the Americans with Disabilities Act and other employment equity legislation, often expand the range of transitional work options for an injured worker. Redesigned tools, ergonomically correct workstations, adaptive devices, and work-schedule modifications are all effective disability management methods that enable the worker to perform essential job tasks (Gross 1988). These same interventions can be utilized in a preventive manner to identify and redesign jobs which are likely to cause future injuries.

Benefit plan design

Employee benefit plans often reward workers for remaining disabled. One of the strongest negative forces impacting on unacceptable lost time and associated costs is economic disincentives. Benefit plans should not create an economic disincentive to work, but should reward workers who have disabilities for returning to work and remaining healthy and productive.

Return-to-work programmes

There are two basic ways to reduce disability costs in industry: (1)prevent accidents and injuries; and (2) reduce unnecessary lost time. Traditional light duty programmes in industry have been less than fully effective in returning injured workers to their jobs. Employers are increasingly using flexible and creative work return transition options and reasonable accommodations for workers with restrictions. The transitional work approach enables employees with disabilities to return to work before they fully recover from their injuries. Transitional work typically includes a combination of temporary assignment to modified work, physical conditioning, safe work practices education and work adjustment. Reduced lost time through transitional work translates into lower costs. The injured worker is enabled to perform temporary alternative productive work while gradually transitioning back to the original job.

Promotion of positive labour relations

Relationships between workers and work environments are dynamic and complex. Compatible relationships often lead to job satisfaction, enhanced productivity and positive labour relations, all of which are mutually rewarding for the worker and the employer. However, relationships characterized by unresolved conflicts can lead to mutually destructive consequences for workers and employers. Understanding the dynamics of person-environmental interactions in the workplace is an important first step in resolving injury and disability claims. The responsible employer is one that supports positive labour relations and promotes job satisfaction and worker involvement in decision making.

Psychological and social aspects of disability

Employers need to be sensitive to the psychological and social consequences of injury and disability and the overall impact of work disruption on the worker’s family. Psychosocial problems that are secondary to the initial physical injury typically emerge as lost work time increases. Relationships with family members often deteriorate rapidly, under the strain of excessive drinking and learned helplessness. Maladaptive behaviours resulting from work disruption are common. However, when other family members become adversely affected by the consequences of a worker’s injuries, pathological relationships within the family emerge. The disabled worker undergoes role changes. Family members experience “role change reactions”. The once independent, self-supporting worker now takes on a role of passive dependency. Resentment abounds when the family is disrupted by the presence of an ever-demanding, sometimes angry and often depressed individual. This is the typical outcome of unresolved labour relations problems, fuelled by stress and ignited by litigation activity and intense adversarial proceedings. Although the relationship among these forces is not always understood, the damage is usually profound.

Accident prevention and occupational ergonomics programmes

Many employers have experienced significant reductions in accidents by establishing formal safety and ergonomics committees. Such committees are typically responsible for safety surveillance and monitoring risk factors such as exposures to dangerous chemicals and fumes, and establishing controls to reduce the incidence and magnitude of accidents. More frequently, joint labour-management safety and ergonomics committees are addressing problems such as repetitive motion injuries and cumulative trauma disorders (e.g., carpal tunnel syndrome). Ergonomics is the application of technology to assist the human element in manual work. The overall objective of ergonomics is to fit the task to humans in order to enhance their effectiveness in the workplace. This means that ergonomics aims at:

• eliminating or minimizing injuries, strains and sprains

• minimizing fatigue and overexertion

• minimizing absenteeism and labour turnover

• improving quality and quantity of output

• minimizing lost time and costs associated with injuries and accidents

• maximizing safety, efficiency, comfort and productivity.

Ergonomic interventions can be considered preventive as well as rehabilitative. As a preventive approach, it is important to analyse ergonomically jobs that cause injuries and to develop effective ergonomic modifications that prevent future work disabilities. From a rehabilitation viewpoint, ergonomic principles can be applied to the jobsite accommodation process for workers with restrictions. This may involve exerting ergonomic administrative controls (e.g., rest periods, job task rotation, reduced work hours) or by ergonomically engineering the job tasks to eliminate re-injury risk factors (e.g., changing the table height, increasing illumination, repackaging to reduce lift loads).

Employer responsibility, accountability and empowerment

Employer empowerment is a basic principle of disability management. Except for the worker with a disability, the employer is the central figure in the disability management process. It is the employer who takes the first step in initiating early intervention strategies subsequent to an industrial accident and injury. The employer, being intimately familiar with work processes, is in the best position to implement effective safety and injury prevention programmes. Likewise, the employer is best positioned to create work return options for persons with lost-time injuries. Unfortunately, history has revealed that many employers have relinquished control and responsibility for disability management to parties external to the work environment. Decision making and problem solving, as relates to the resolution of work disability, have been assumed by insurance carriers, claims managers, workers’ compensation boards, physicians, therapists, case managers, rehabilitation professionals and even attorneys. It is only when employers become empowered in disability management that the lost-time trends and associated costs of workplace injury are reversed. However, employer empowerment over disability costs does not occur by chance. Not unlike persons with disabilities, employers often become empowered upon recognition of their internal resources and potentials. It is only with a new awareness, confidence and guidance that many employers are able to escape the relentless forces and consequences of workplace disability.

Case management and return-to-work coordination

Case management services are necessary to facilitate the development and implementation of disability management strategies and return-to-work plans for workers with disabilities. The case manager serves as a central disability management team member by functioning as a liaison between employers, labour representatives,  injured  workers,  community  health  care  providers and others. The case manager may facilitate the development, implementation and evaluation of an on-site transitional work or worker retention programme. It may be desirable for an employer to develop and implement such programmes, in order to: (1)prevent work disruptions among employees with medical impairments that effect work performance; and (2) promote a safe and timely return to work among impaired workers on medical leave, workers’ compensation or long-term disability. In the administration of an on-site transitional work programme, the case manager may take on direct rehabilitative responsibilities, such as: (1)objective worker evaluations; (2) classification of the physical job demands; (3) medical surveillance and follow-up; and (4) planning for placement in an acceptable permanent modified-duty option.

Disability management policy and procedure: creating expec-tations among supervisors, labour representatives and workers

It is important for employers to maintain a balance between worker and union expectations and the intentions of managers and supervisors. This requires joint labour-management involvement in the development of formal disability management policies and procedures. Mature disability management programmes have written policy and procedure manuals that include mission statements reflecting the interests and commitments of labour and management. Written procedures often delineate the roles and functions of internal disability management committee members, as well as the step-by-step activities from the point of injury to the safe and timely return to work. Disability management policies often define the relationships between the employer, health care providers and rehabilitation services in the community. A written policy and procedures manual serves as an effective communication vehicle among the various stakeholders, including physicians, insurance carriers, unions, managers, employees and service providers.

Enhancement of physician awareness of jobs and work environments

A universal problem in work injury management involves the lack of employer influence over the physician’s return-to-work determination. Treating physicians are often reluctant to release an injured employee to work with no restrictions prior to a full recovery. Physicians are often asked to make return-to-work judgements without adequate knowledge of the worker’s physical job demands. Disability management programmes have been successful in communicating with doctors regarding the employer’s willingness to accommodate workers with restrictions through transitional work programmes and the availability of temporary alternate duty assignments. It is essential for employers to develop functional job descriptions that quantify the exertional demands of job tasks. These tasks can then be reviewed by the treating physician to make a determination of the compatibility of the worker’s physical abilities and the functional demands of the job. Many employers have adopted the practice of inviting doctors to visit production sites and work areas to increase their familiarity with job demands and work environments.

Selection, utilization and evaluation of community services

Employers have realized substantial savings and improved work return outcomes by identifying, utilizing and evaluating effective medical and rehabilitation services in the community. Workers who become ill or injured are influenced by someone to make treatment provider choices. Poor advice often leads to extended or unnecessary treatment, higher medical costs and inferior results. In effective disability management systems, the employer takes an active role in identifying quality services that are responsive to the needs of workers with disabilities. When the employer “internalizes” these external resources, they become a vital partner in the overall disability management infrastructure. Workers with disabilities can then be guided to responsible service providers that share mutual return-to-work goals.

Utilization of independent medical evaluators

Occasionally an injured worker’s medical report fails to substantiate objectively the worker’s alleged impairments and medical restrictions. Employers often feel that they are held hostage to the treating physician’s opinions, particularly when the doctor’s rationale for determining the employee’s work restrictions are unsubstantiated by objective medical tests and measurable assessments. Employers need to exercise their right to independent medical and/or physical capacity evaluations when evaluating questionable disability claims. This approach requires that the employer take the initiative to explore objective and qualified medical and rehabilitation evaluators in the community.

Essential Components of an Optimal Disability Management System

An employer’s foundation for an optimal disability management system  has  three  major  components  (Shrey  1995,  1996). First, a worksite-based disability management programme requires a human  resource  component.  A  major  part  of  this  component  is the development of the employer’s internal disability management team. Joint worker-management teams are preferred, and they often include members representing the interests of labour unions, risk management, occupational health and safety, employer operations and financial management. Important criteria for the selection of disability management-team membership may include:

• resourcefulness—familiar with employer’s operations, labour relations, internal/external resources and corporate culture

• influence—able to initiate change within management decision-making process

• leadership—earns respect among workers, supervisors and senior management

• creativity—ability to design proactive interventions that work, despite obstacles

• commitment—professional views that are consistent with disability management mission and principles

• motivation—both self-motivated and able to motivate others towards programme goals and objectives

Gaps often exist with respect to the assignment and delegation of responsibilities for resolving disability problems. New tasks must be assigned to ensure that the steps from injury to work return are properly orchestrated. The human resource component includes knowledge and skill supports or training which enable managers and supervisors to perform their designated roles and functions. Accountability is essential, and it must be built into the organizational structure of the employer’s disability management programme.

The second component of an optimal disability management system is the operations component. This component includes activities, services and interventions which are implemented at the pre-injury, during injury and post-injury levels. Pre-injury operations components include effective safety programmes, ergonomic services, pre-placement screening mechanisms, loss prevention programmes and the development of joint labour-management committees. A strong pre-injury operations component is oriented towards injury prevention, and it may include health promotion and wellness services such as weight loss programmes, smoking cessation groups and aerobic conditioning classes.

The during-injury level of an optimal disability management system includes early intervention strategies, case management services, formalized transitional work programmes, worksite accommodations, employee assistance programmes and other health services. These activities are designed to resolve the disabilities that are not prevented at the pre-injury level.

The post-injury level of an optimal disability management system includes worker retention services. Worker retention services and interventions are designed to facilitate the worker’s adjustment to work performance within the context of the worker’s physical or mental restrictions and environmental demands. The post-injury  level  of  a  disability  management  system  should also include programme evaluation, financial management for cost-effectiveness, and programme enhancements.

The third component of an optimal disability management system is the communications component. This includes internal and external communications. Internally, the operational aspects of the employer’s disability management programme must be consistently and accurately communicated among employees, managers, supervisors and labour representatives. The policies, procedures and protocols for return-to-work activities should be communicated through labour and management orientations.

External communications enhance the employer’s relationship with treating physicians, claims managers, rehabilitation service providers and workers’ compensation administrators. The employer can influence an earlier return to work by providing treating physicians with functional job descriptions, job safety procedures and transitional work options for injured workers.

Conclusions

Workplace disability management and transitional work programmes represent a new paradigm in the rehabilitation of workers with illnesses and injuries. Trends reflect a shift in rehabilitative interventions from medical institutions to the worksite. Joint labour-management initiatives in disability management are commonplace, creating new challenges and opportunities for employers, unions and rehabilitation professionals in the community.

The interdisciplinary members of the worksite-based disability management team are learning to harness existing technologies and resources within the work environment. The demands on employers are essentially limited to their creativity, imagination and  flexibility to  adapt  disability  management  interventions  to the work environment. Job accommodations and temporary non-traditional job options expand the range of transitional work alternatives for workers with restrictions. Redesigned tools, ergonomically correct workstations, adaptive devices and work schedule modifications are all effective disability management methods that enable the worker to perform essential job tasks. These same interventions can be utilized in a preventive manner to identify and redesign jobs which are likely to cause future injuries.

Protecting the rights of injured workers is an important component of disability management. Every year thousands of workers become disabled through industrial accidents and occupational diseases. Without transitional work options and accommodations, workers with disabilities risk discrimination similar to that faced by other individuals with disabilities. Thus, disability management is an effective advocate tool, whether advocating for the employer or the person with a disability. Disability management interventions protect the employability of the worker as well as the economic interests of the employer.

The profound impact of rapidly escalating workers’ compensation costs will be experienced worldwide by business and industry throughout the next decade. Just as this crisis offers a challenge to industry, disability management interventions and transitional work programmes create an opportunity. With a decreasing labour pool, an ageing workforce and increased worldwide competition, employers in industrialized societies must seize the opportunities to control the personal and economic costs of injury and disability. An employer’s success will be determined by the extent to which he is able to shape positive attitudes among labour and management representatives, while creating an infrastructure supportive of disability management systems.

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