Development of an Auditing Tool for Clinical Occupational Health Services: A Modified Delphi Technique
Article Sidebar
Main Article Content
Abstract
Objective This study aim to develop a comprehensive auditing tool for clinical occupational health services (OHS) in corporate settings.
Methods The design used a modified Delphi technique. The study was comprised of four steps: questionnaire construction and panelist selection, two rounds of questionnaires, and consensus determination. The participating experts included 31 occupational health professionalsfrom 7 countries, representing management, occupational medicine, and auditing roles. Two rounds of questionnaires were administered to achieve 80.0% agreement on essential activities across the 7 key domains.
Results The Delphi process yielded an audit tool encompassing 62 activities across seven domains: policy management (4 activities, 100.0% consensus), fitness for work assessment (7 activities, 85.7% consensus), medical surveillance programs (13 activities, 100% consensus), return to work assessment (7 activities, 71.4% consensus), occupational disease management (10 activities, 80.0% consensus), medical emergency preparedness (15 activities, 86.9% consensus), and health promotion (6 activities, 66.7% consensus). Experts’ backgrounds influenced their focus, with hospital- based physicians emphasizing clinical protocols, company-based practitioners stressing implementation, management prioritizing governance, and auditors ensuring comprehensive assessments.
Conclusions This auditing tool required consideration of 7 domains, where experts rated the policy management and medical surveillance processes as the most important, whereas the domain of health promotion had the lowest importance score. This tool can help guide organizations in strengthening the foundational domains of OHS.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
International Labour Organization. A call for safer and healthier working environments. ILO (Internet). 2023 (cited 2025 Jan 12). Available from: https://researchrepository. ilo.org/esploro/outputs/report/995343988202676
British Standards Institution. BS 8800: guide to occupational health and safety management systems. London: The Institution; 1996.
British Standards Institution. OHSAS 18001:2007 Occupational health and safety management systems - requirements. London: The Institution; 2007.
International Organization for Standardization. ISO 45001:2018 - Occupational health and safety management systems - requirements with guidance for use. Geneva: The Organization; 2018.
Caponecchia C, Wyatt A. Defining a “safe system of work.” Saf Health Work. 2021;12(4):421–3.
World Health Organization, International Labour Organization. WHO/ILO joint estimates of the work-related burden of disease and injury, 2000-2016: global monitoring report. (Internet). Geneva: World Health Organization; 2021 Sep (cited 2023 Apr 20). Available from: https://www.who.int/publications-detail-redirect/9789240034945
Rantanen J. Occupational health services: an overview. Copenhagen: World Health Organization Regional Office for Europe; 1990.
Occupational Safety and Health Act of 1970, Pub. L. No. 91-596, 84 Stat. 1590 (Dec. 29, 1970) (Internet). Washington, DC: United States Department of Labor; 1970 (cited 2023 Apr 18). Available from: https://www.osha.gov/laws-regs/oshact/completeoshact
Health and Safety at Work Act 1974, c. 37 (UK). London: Her Majesty’s Stationery Office; 1974.
Ministry of Manpower. Workplace Safety and Health Act 2006. Singapore; 2006.
Department of Occupational Safety and Health Malaysia. Occupational Safety and Health Act of 1994. Malaysia: DOSH; 1994.
Royal Thai Government Gazette. Ministerial Regulation on the Prescribing of Standards for Services of Occupational Health Units B.E. 2567 (A.D. 2024). Sect. Pt 73 k Nov 25, 2024 p. 38-46.
Tang KHD. A comparative overview of the primary Southeast Asian safety and health laws. IJWHM 2020; 13:601-32.
Standards for safe effective quality occupational health service (SEQOHS) (Internet). London: Faculty of Occupational Medicine; 2023 (cited 2024 Apr 23). Available from: https://www.seqohs.org/CMS/Page.aspx?PageId=77
American College of Occupational and Environmental Medicine. Guide to the health, safety and environmental management (HSEM) system. Elk Grove Village (IL): The College; 2005.
Pokkapat Prasatkettkarn. Enterprises’ expectation on competencies of occupational physicians and occupational health administration in Thailand. Dis Control J. 2022;48:626-36.
Cashman C. A survey of current audit practice in occupational health. Occup Med. 2019;69:287–9.
Lalloo D, Demou E, Macdonald EB. Impact of peer review audit on occupational health report quality. Occup Med. 2015;65:440–3.
Rahman MS. The advantages and disadvantages of using qualitative and quantitative approaches and methods in language “testing and assessment” research: a literature review. J Educ Learn. 2016;6:102-12.
Michalak J. Quality assessment in occupational health services: a review. Int J Occup Med Environ Health. 2002;15:165-71.
Bilban M. Quality assurance in occupational medicine. Saf Eng. 2014;4:17-24.
Meesil N. Delphi technique: avoidance of misconception. Veridian E-Journal Silpakorn Univ Humanit Soc Sci Arts. 2016;9:1256–67.
Von Der Gracht HA. Consensus measurement in Delphi studies. Technol Forecast Soc Change. 2012;79: 1525–36.
Macmillian TT. The Delphi technique. Paper presented at the annual meeting of the California Junior Colleges Associations Committee on Research and Development; 1971 May 3-5; Monterey; 1971.
Ismail FKM, Zubairi AMB. Item objective congruence analysis for multidimensional items content validation of a reading test in Sri Lankan university. Engl Lang Teach. 2022;15:106-17.
Royal Thai Government Gazette. Occupational health and safety and environment Act B.E. 2554 (A.D. 2011). Sect. Pt 4 k Jan 17, 2011 p. 5-25.
Republic of the Philippines. Republic Act No. 11058: An Act strengthening compliance with occupational safety and health standards and providing penalties for violation thereof. Quezon City: Republic of the Philippines; 2018.
International Labour Organization. Convention No. 161 concerning occupational health services. Geneva: The Organization; 1985.
International Labour Organization. Recommendation No. 171 concerning occupational health services. Geneva: The Organization; 1985.
Guidotti TL. The occupational health care system. In: Guidotti TL. Occupational health services: a practical approach. 2nd ed. Oxon: Routledge/Taylor & Francis Group; 2013. p. 1-17
World Health Organization Regional Office for Europe. Good practice in occupational health services: a contribution to workplace health. Copenhagen: The Organization; 2002.
Ikeda Y, Kameda T, Shirakawa C, Nagata T, Zama S, Kayashima K, et al. The relation among expertise level of occupational health physician, implementation of occupational safety and health management system (OSHMS) and occupational safety and health activity level in Japan in the companies listed on Tokyo stock exchange first section. J UOEH. 2007;29:469-84.
Lau B, Miguel SS, Chow J. Policy and clinical practice: audit tools to measure adherence. Ren Soc Australas J. 2010;6:36-40.
Lee LP, Martin DW, Kancelbaum B, Israel M, Reid N, Pick TA, Schumann SC, Thies RE. Occupational medicine: a basic guide. A publication of the ACOEM private practice section [DRAFT]. Elk Grove Village: ACOEM; 2018.
Hartenbaum NP, Baker BA, Levin JL, Saito K, Sayeed Y, Green-McKenzie J. ACOEM OEM core competencies: 2021. J Occup Environ Med. 2021;63:e445–61.
Mandanach C. Patterns in medical surveillance of workers exposed to lung carcinogens. RJOM. 2023; 74:23-9.
Şen S, Barlas G, Yakıştıran S, Derin İG, Şerifi BA, Özlü A, et al. Prevention of occupational diseases in Turkey: deriving lessons from journey of surveillance. Saf Health Work. 2019;10:420-7.
Murthy LI. Implementing workplace safety and health surveillance. Ann N Y Acad Sci. 1997;837(1):100-104.
Tan KWA, Koh D. Long COVID—Challenges in diagnosis and managing return-to-work. J Occup Health. 2023;65(1):e12401. PubMed PMID: 37098838
Nastasia I, Coutu MF, Lederer V, Lecours A, Rives R. Insights into small and medium enterprises practices of early return to work with modified tasks following a work-related injury [Abstract]. Occup Med. 2024;74(Supplement_1):i339.
Henshaw JL, Gaffney SH, Madl AK, Paustenbach DJ. The employer’s responsibility to maintain a safe and healthful work environment: an historical review of societal expectations and industrial practices. Empl Responsib Rights J. 2007;19:173-92.
Griffin MJ. Negligent exposures to hand-transmitted vibration. Int Arch Occup Environ Health. 2008;81: 645-59.
Dagrenat C, Cassan P, Issard D, Loeb T, Baer M, Descatha A. 541 First aid in the workplace in the world: a systematic review. Occup Environ Med. 2018;75(Suppl_2):A114.
National Institute for Occupational Safety and Health (NIOSH). Fundamentals of Total Worker Health approaches: essential elements for advancing worker safety, health, and well-being. Cincinnati (OH): U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, NIOSH; 2016. DHHS (NIOSH) Publication No. 2017-112.
