Differences in the performance of health officers at the workplace according to their qualifications

Differences in the performance of health officers at the workplace according to their qualifications Background: Health officers are an integral part of the occupational health service, and there have been studies to identify and improve the role of health officers in the workplace in order to improve the level of health care in the workplace. Thisstudy aimedtodetermine thecontributionofhealthofficerstothe role of ahealth officer as prescribed by law and the percentage of health management work performed during work according to their qualifications. Methods: Questionnaires were distributed to a total of 4584 workplaces where health officers were hired, and a total of 806 copies (17.58%) were returned. Of these, 336 questionnaires were finally analyzed, after excluding questionnaires missing the main variables. Using the data, the difference of role contributions and the percentage of health care work performed during the whole day according to the qualification of the health officer was analyzed. Results: Nurses were highly rated in the field of medical care, and industrial hygienists and air environmental engineers were highly rated in terms of chemicals and risk factor management. The percentage of health care work performed during the whole day differed according to the size of the workplace and industrial classification, but it was generally the lowest among air environmental engineers. Conclusions: Health officers play a very different role in the workplace depending on their qualification, and they need support for areas of other qualification. In order to effectively manage the health of the staff at a workplace, it is necessary to consider the development of a support system for small- and medium-sized enterprises and adjust the conditions of employment of the health officer according to the law. Keywords: Health officer, Nurse, Industrial hygienist, Air environmental engineer Background In Korea, the number of industrial accidents has Studies have shown that the economic costs of occupa- decreased with time. As of 2005, the industrial accident tional injuries and illnesses range from 1.8 to 6% de- rate was 0.77%, and the death rate due to industrial acci- pending on the country. [1] In the EU, the economic dents per 10,000 employees was 2.06; these rates were costs incurred by occupational injuries and illnesses are 0.5% and 1.01, respectively, in 2015. [3, 4] Moreover, in estimated to be 15 times the cost of preventing them. [2] Korea, the incidence of fatal occupational injuries was Thus, prevention of occupational injuries and illnesses 5.3 per 100,000 workers in 2015. However, in terms of through occupational safety measures and health Organisation for Economic Co-operation and Develop- services is important. ment member countries, the incidence was 1.6 per 100,000 workers in Germany and 3.3 per 100,000 workers in the USA. Efforts to improve the level of health manage- ment at the workplace are therefore needed. [5]. * Correspondence: juwon@yuhs.ac The Institute for Occupational Health, Yonsei University College of Medicine, Health officers are an integral part of the occupational Seoul, Republic of Korea health service [6], and previous studies have aimed to Department of Preventive Medicine, Yonsei University College of Medicine, identify and improve the role of health officers in the Seoul, Republic of Korea Full list of author information is available at the end of the article © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Kim et al. Annals of Occupational and Environmental Medicine (2018) 30:35 Page 2 of 8 workplace in order to improve the level of health care in Qualifications the workplace. In Korea, a health officer is defined as a At the time of the survey, the qualification of a health person who assists a business owner or the person in officer in Korea includes physicians, nurses, industrial charge of management with respect to technical matters hygienists, air environmental engineers, industrial health concerning the health of the staff as well as advises and instructors, and those who majored in occupational instructs the supervisor on such matters. Health officers health or industrial hygiene at a college. In this study, are professionals such as doctors, nurses, industrial 94.7% of the workplaces surveyed were found to employ hygienists, and air environmental engineers [7, 8]. nurses, industrial hygienists or air environmental engi- In Korea, the number of health officers employed in neers as health officer. Other qualifications such as an institution varies depending on the type of industry physician were excluded because the number of them and the number of workers in the workplace. For was insufficient to analyze. In addition, questionnaires example, a business with a size of 500 to 2000 workers filled out by health officers with multiple qualifications requires two or more people to be employed as health were excluded. officers, and a business with a size of more than 2000 people may require the employment of two or more Questionnaire health officers including at least one physician or nurse The administered questionnaire was based on the Indus- by profession. [8] As such, only a limited number of in- trial Safety and Health Act. A total of 17 question items dustries require that at least one physician or nurse be were selected based on the roles of health officers defined appointed among the two or more health officers. Thus, by the Industrial Safety and Health Law (Table 1). The there has been a question of whether it is possible to questions aimed at determining the role contribution of comprehensively perform the various roles of health offi- the health officer was as follows: “As a health officer, how cers, such as workers’ safety guidance, hazard risk factor much do you contribute to the following items? Please in- management, and medical practices. dicate your contribution to the role on a scale of 0 to 10.” To address this problem, previous studies have aimed In this question, 0 means “No role contribution”,and 10 to determine the role of health officers with different means “Maximum role contribution.” In this study, the qualifications. Hong et al. used a questionnaire based on high and low role contributions were divided by the me- the Industrial Safety and Health Law to determine the dian of each item in the questionnaire. The questionnaire competence of health officers according to their qualifi- also sought information on the percentage of health care cations; however, only doctors, nurses, and industrial work performed during the whole day. In addition, the hygienists were compared. [9] Lee et al. compared the following questions were asked to identify areas that need performances and behaviours of health officers accor- support in the field of occupational safety and health: ding to their qualifications, and reported a difference in “Which of the following areas do you need support for? - the performance of nurses, industrial hygienists, and air Safety and environmental management/Health manage- environmental engineers. [10] However, no further stu- ment/ Administrative support.” The size of the workplace dies have been conducted after a long period of time. and the type of business, as well as the sex, age, and total This study aimed to determine the contribution of industrial health career of the health officer were also health officers to health management work per the cri- identified. teria prescribed by the law in Korea and the percentage of health management work performed during an actual working day according to their qualifications. Statistical analysis All subjects were divided into groups according to their Methods qualifications. The average and standard deviations of Subjects role contributions established by health officers them- A questionnaire was mailed from August to September selves for each job item defined by law were obtained. 2015 to entire workplaces in Korea where health officers The differences were analysed via one-way analyses of were hired. Health officers were requested to answer the variance and corrected for multiple comparisons using questionnaire, and in case of multiple health officers, the Bonferroni correction. The percentage of health care only one person answered the questionnaire. Question- work performed during the whole day was analysed in a naires were distributed to a total of 4584 workplaces similar manner, and was stratified into manufacturing nationwide, and a total of 806 copies (17.58%) were industry, non-manufacturing industry, workplace with returned. After excluding questionnaires missing the less than 300 employees, and workplace with more than main variables (sex, age, size of workplace, type of busi- 300 employees. In addition, the differences in the ness, total industrial health career, role contribution), percentage of areas that need support according to 336 questionnaires were finally included in the analysis. qualifications were illustrated. Kim et al. Annals of Occupational and Environmental Medicine (2018) 30:35 Page 3 of 8 Table 1 Question items based on the roles of health officers defined by the Industrial Safety and Health Law Abbreviation Question Occupational health and safety committee Establishment and management of occupational health and safety committee Safety and health actions on machinery Matters concerning safety and health actions when harmful or dangerous machinery and equipment and equipment and other facilities are introduced Advice and guidance on protectors Assistance to, and advice and guidance on selection of appropriate products in purchasing protectors Management of chemical substances Management of chemical substances and products containing a chemical substance Detecting harmful or dangerous factors Detect harmful or dangerous factors caused by those resulting from specific work behaviors or duties, and determine the degree of danger Preventing any danger or health Actions for preventing any danger to or health impairment of employees impairment Appropriate measures for the workers’ Taking appropriate measures for the workers’ health following the results, including work arrangements, health work conversions, and reduction of working hours Investigating and preventing worker’s Investigation into the cause of workers’ medical problems and medical treatment to prevent recurrence medical problem Health education Assistance to, and advice and guidance on the formulation of plans on health education and the conduct thereof at the place of business concerned Treatment of minor injuries Treatment of frequently occurring minor injuries, such as external wounds Emergency treatment Emergency treatment Preventing injuries or diseases from Treatment to prevent injuries or diseases from worsening worsening Management of workers after a Recuperation guidance and management for those who are found to have health trouble after a medical checkup medical checkup Management of ventilators and local Assistance to and advice on the inspection of facilities, such as general ventilators and local air air exhausters exhausters, etc., and the technical improvement of working method Routine inspections of workplace Routine inspections of the place of business concerned, guidance and recommendation of safety measures Investigating and preventing industrial Investigation into and analysis of the cause of industrial accidents and provision of technical assistance accidents to and advice and guidance on prevention of the reoccurrence Analysis of industrial accidents Assistance to, and advice and guidance on the maintenance, management and analysis of statistics on industrial accidents The question was “As a health officer, how much do you contribute to the following items? Please indicate your contribution to the role on a scale of 0 to 10” Logistic regression analysis was used to confirm the accounted for the majority of those included. Nurses association between the qualification of the health officer and industrial hygienists most frequently worked for less and the role contribution of the health officer. For in- than 5 years, but air environmental engineers reported dustrial hygienists and air environmental engineers, we more than 10 years of work. By industry, other indus- calculated odds to account for the assumption that role tries were the most common; however, this is typically contributions would be higher for each of the items observed in medical institutions where a nurse is work- when compared with nurses. The odds ratio and 95% ing while being employed as a health officer. Other than confidence interval were calculated by adjusting for con- that, manufacturing was the most common (Table 2). founding variables such as sex, age group, size of work- place, total career of industrial health, and industrial Role contribution classification. Statistical analysis was performed using Industrial hygienists and air environmental engineers the SAS 9.4 (SAS Institute Inc., Cary, NC, USA.) showed higher role contribution scores than nurses in the following 8 items: “Establishment and management of Result occupational health and safety committee”; “Matters con- General characteristics cerning safety and health actions when harmful or danger- Of the 336 subjects, nurses accounted for 67.0%. Among ous machinery and equipment and other facilities are nurses, the percentage of women was very high (98.7%), introduced”; “Assistance with and advice and guidance on and for other professionals, the percentage of men was selection of appropriate products when purchasing higher. The proportion of health officers aged 40 to protectors”; “Management of chemical substances and 49 years was higher among nurses than among other products containing a chemical substance”; “Assistance professionals. Workplaces with less than 300 employees with and advice on the inspection of facilities such as Kim et al. Annals of Occupational and Environmental Medicine (2018) 30:35 Page 4 of 8 Table 2 General characteristics of subjects stratified by qualifications of health officers Characteristics Nurse Industrial hygienist Air environmental n (%) n (%) engineer n (%) Total 225 (66.96) 34 (10.12) 77 (22.29) Sex Men 3 (1.33) 23 (67.65) 72 (93.51) Women 224 (98.67) 11 (32.35) 5 (6.49) Age group (years) 20 to 29 20 (8.69) 9 (26.47) 6 (7.79) 30 to 39 54 (24.00) 11 (32.35) 32 (41.56) 40 to 49 91 (40.44) 9 (26.47) 27 (35.06) 50 and over 60 (26.67) 5 (14.71) 12 (15.58) Size of workplace < 300 workers 167 (74.22) 13 (38.24) 67 (87.01) 300 to 499 workers 19 (8.44) 4 (11.76) 7 (9.09) 500 to 999 workers 20 (8.89) 8 (23.53) 1 (1.30) above 1000 workers 19 (8.44) 9 (26.47) 2 (2.60) Total career of industrial health less than 5 years 127 (56.44) 16 (47.06) 29 (37.66) 5 to 9 years 43 (19.11) 8 (23.53) 17 (22.08) 10 years and over 55 (24.44) 10 (29.41) 30 (40.26) Industrial classification Manufacturing 41 (18.22) 25 (73.53) 66 (85.71) Construction 5 (2.22) 1 (2.94) 0 (0.00) Trasportation/Warehousing/Networking 0 (0.00) 1 (2.94) 1 (1.30) Energy/Water supply 2 (0.89) 0 (0.00) 2 (2.60) Financing/Insurance 1 (0.44) 0 (0.00) 2 (2.60) Mining 1 (0.44) 0 (0.00) 0 (0.00) Agriculture/Forestry/Fishery 1 (0.44) 0 (0.00) 0 (0.00) Others 174 (77.33) 7 (20.59) 6 (7.79) general ventilators and local air exhausters and technical Air environmental engineers showed higher role con- improvement in the working method”; “Routine inspec- tribution scores than nurses for “Detection of harmful tions of the place of business concerned, guidance and or dangerous factors resulting from specific work recommendation of safety measures”; “Investigation into behaviours or duties and determination of the degree of and analysis of the cause of industrial accidents and danger.” Nurses showed higher role contribution scores provision of technical assistance to and advice and guid- than air environmental engineers for “Investigation into ance on prevention of recurrence”; “Assistance with and the cause of workers’ medical problems and medical advice and guidance on the maintenance, management, treatment to prevent recurrence” (Table 3). and analysis of statistics on industrial accidents” (Table 3). The odds of higher role contributions when compared Nurses showed higher role contribution scores than with nurses were calculated. In the case of industrial other professionals in the following 4 items: “Treat- hygienists, the odds for higher role contribution were ment of frequently occurring minor injuries, such as significantly higher for the following 3 items: “Matters external wounds”; “Emergency treatment”; “Treatment concerning safety and health actions when harmful or to prevent injuries or diseases from worsening”; “Re- dangerous machinery and equipment and other facilities cuperation guidance and management for those who are introduced”; “Management of chemical substances are found to have health trouble after a medical and products containing a chemical substance”; “Detec- check-up” (Table 3). tion of harmful or dangerous factors resulting from Kim et al. Annals of Occupational and Environmental Medicine (2018) 30:35 Page 5 of 8 Table 3 The differences of role contiribution and percentage of health care work during the whole day of health officers by qualifications The role contiribution of health managers Nurse Industrial hygienist Air environmental engineer Comparison* Mean SD Mean SD Mean SD Occupational health and safety committee 4.95 2.79 6.24 2.51 5.86 2.56 B > A, C > A** Safety and health actions on machinery and equipment 5.04 2.99 6.65 2.27 6.10 2.50 B > A, C > A Advice and guidance on protectors 5.99 2.92 7.32 2.18 7.22 2.16 B > A, C > A Management of chemical substances 6.31 2.86 7.53 1.93 7.60 1.85 B > A, C > A Detecting harmful or dangerous factors 5.64 2.76 6.35 2.39 6.65 2.14 C > A Preventing any danger or health impairment 6.45 2.68 7.24 2.16 6.92 2.02 Appropriate measures for the workers’ health 6.49 2.86 6.09 2.84 6.21 2.48 Investigating and preventing worker’s medical problem 6.55 2.82 5.68 2.59 5.56 2.77 A > C Health education 7.22 2.47 7.29 2.17 7.18 2.12 Treatment of minor injuries 7.46 3.00 4.35 2.96 4.10 3.05 A > B, A > C Emergency treatment 7.68 2.77 5.43 3.18 4.57 2.97 A > B, A > C Preventing injuries or diseases from worsening 7.55 2.79 5.27 3.14 4.45 3.07 A > B, A > C Management of workers after a medical checkup 7.78 2.50 6.21 2.21 5.48 2.80 A > B, A > C Management of ventilators and local air exhausters 4.78 2.89 6.29 2.42 6.24 2.46 B > A, C > A Routine inspections of workplace 5.90 2.56 6.97 2.11 7.04 2.11 B > A, C > A Investigating and preventing industiral accidents 5.16 2.79 6.59 2.32 6.76 2.31 B > A, C > A Anaylsis of industrial accidents 5.05 2.90 6.53 2.45 6.35 2.34 B > A, C > A Percentage of health care work during the whole day Nurse Industrial hygienist Air environmental engineer Comparison* Mean SD Mean SD Mean SD Manufacturing industry 74.39 27.75 53.04 30.20 23.89 21.82 A > B, B > C Non-manufacturing industry 32.02 31.10 75.00 28.78 21.18 14.03 B > A, B > C The workplaces with 300 employees or less 26.70 26.68 37.92 28.40 21.22 18.84 The workplaces with more than 300 employees 77.41 26.11 70.05 26.33 38.00 27.41 A > C, B > C *The differences were analyzed by one-way ANOVA and corrected by multiple comparisons using bonferroni correction. P-value< 0.05 **“B > A, C > A” means a statistically significant higher score or percentage of industrial hygienist(B) than Nurse(A) and a statistically significant higher scoreor percentage of air environmental engineer(C) than Nurse(A). However, there is a no significant difference between Industrial hygienist(B) and Air environmental engineer(C) SD, Standard deviation specific work behaviours or duties and determination of workers’ medical problems and medical treatment to the degree of danger.” However, the odds for higher role prevent recurrence”; “Treatment of frequently occurring contribution were significantly lower in the following 4 minor injuries, such as external wounds”; “Emergency items: “Treatment of frequently occurring minor injur- treatment”; “Treatment to prevent injuries or diseases ies, such as external wounds”; “Emergency treatment”; from worsening”; “Recuperation guidance and manage- “Treatment to prevent injuries or diseases from worsen- ment for those who are found to have health trouble ing”; “Recuperation guidance and management for those after a medical check-up” (Table 4). who are found to have health trouble after a medical check-up” (Table 4). Percentage of health care work during the whole day In the case of air environmental engineers, the odds The percentage of health management work performed for higher role contribution were significantly higher for during the whole day in manufacturing industries was the following 2 items: “Management of chemical sub- highest in the order of nurses, industrial hygienists, and stances and products containing a chemical substance”; air environmental engineers. In non-manufacturing in- “Detection of harmful or dangerous factors resulting dustries, the proportion of health management work from specific work behaviours or duties and determin- performed during the whole day was higher for indus- ation of the degree of danger.” However, the odds for trial hygienists than for nurses and air environmental higher role contribution were significantly lower for the engineers. There was no significant difference in qualifi- following 5 items: “Investigation into the cause of cations among health officers in workplaces with 300 Kim et al. Annals of Occupational and Environmental Medicine (2018) 30:35 Page 6 of 8 Table 4 Association between the qualification of the health manager and the role contribution of the health officer a a The role contribution of health manager Industrial hygienist Air environmental engineer b b b b OR 95% CI OR 95% CI Occupational health and safety committee 1.79 0.71–4.52 2.16 0.78–5.97 Safety and health actions on machinery and equipment 3.57 1.41–9.05 2.46 0.89–6.80 Advice and guidance on protectors 2.46 0.98–6.22 2.14 0.78–5.90 Management of chemical substances 2.94 1.16–7.46 4.72 1.69–13.17 Detecting harmful or dangerous factors 2.54 1.01–6.40 2.78 1.01–7.67 Preventing any danger or health impairment 1.98 0.79–5.00 2.00 0.73–5.52 Appropriate measures for the workers’ health 0.57 0.23–1.44 0.60 0.22–1.66 Investigating and preventing worker’s medical problem 0.42 0.17–1.07 0.35 0.13–0.97 Health education 0.49 0.19–1.24 0.57 0.20–1.56 Treatment of minor injuries 0.05 0.02–0.14 0.03 0.01–0.09 Emergency treatment 0.10 0.04–0.27 0.04 0.01–0.11 Preventing injuries or diseases from worsening 0.13 0.05–0.33 0.06 0.02–0.17 Management of workers after a medical checkup 0.08 0.03–0.21 0.05 0.02–0.15 Management of ventilators and local air exhausters 2.04 0.81–5.13 2.48 0.90–6.83 Routine inspections of workplace 1.72 0.68–4.32 2.35 0.85–6.46 Investigating and preventing industiral accidents 2.15 0.85–5.41 3.52 1.27–9.72 Anaylsis of industrial accidents 1.30 0.52–3.26 1.22 0.45–3.34 Odds that role contributions would be higher for each of the items compared with nurse Odds ratio and 95% CI calculated using a logistic regression model adjusted for sex, age group, size of workplace, total career of industrial health, industrial classification OR, Odds ratio; CI, Confidence interval employees or less when stratified by workplace size. of nurses, the contribution to items related to medical Nurses and industrial hygienists in workplaces with treatment was significantly higher than that observed more than 300 employees performed a higher per- with other professionals. On the other hand, industrial centage of health care work than air environmental hygienists and air environmental engineers contributed engineers (Table 3). more to the management and action of harmful factors. In a study by Lee et al., nurses demonstrated a high Areas that need support in the field of occupational implementation rate of health management and health safety and health planning, and industrial hygienists demonstrated a high Among the nurses, 44.1% responded that they needed implementation rate of work environment management, support for ‘Safety and environmental management’ indicating a difference in contributions to the role of a when they were working as health officers. There was no health officer between professionals, similar to that ob- significant difference in the percentage of nurses who served in our study. [10] Of course, these results can be answered that they needed support for ‘health manage- interpreted as each job category having its own ment (27.7%)’ or ‘administrative support (28.2%).’ 55.2% strengths. However, it is more likely that the role of the of industrial hygienist responded that they needed health officer will not be balanced in the case of small support for ‘Health management’, followed by ‘Safety and business settings with one health officer. In addition, in environmental management (27.6%)’ and ‘Administrative large-scale workplaces hiring only a physician or nurse support (17.2%). In the case of the air environmental en- as a health officer may also be inadequate. gineer, 65.1% of respondents answered that they need Traditionally, occupational health and safety includes support for ‘ Health management’, followed by ‘Safety occupational safety, industrial hygiene, occupational and environmental management (23.8%)’ and ‘Adminis- medicine, and occupational health nursing. Occupational trative support (11.1%)’ (Fig. 1). physicians play a major role in the prevention, discovery, and treatment of occupational injuries and illness, and Discussion they may be hired or consulted at a medical institution In this study, there was a difference in contribution to or company. [11] In terms of clinical practice, they the role of a health officer between nurses, industrial mainly play a role in treating workers, but when hygienists, and air environmental engineers. In the case employed in a company, they often engage in Kim et al. Annals of Occupational and Environmental Medicine (2018) 30:35 Page 7 of 8 Fig. 1 Response to question: “Which of the following areas do you need support for?” administrative work as well as in medical practice. [12] Because of the high percentage of nurses among domes- Occupational health nursing is also expanding its role tic health officers, nurses accounted for a large propor- compared to that in the past, and these nurses act as ex- tion of the respondents. Therefore, the imbalance perts, managers, or researchers of occupational health as between qualifications compared was severe, and the well as medical personnel. [13] Industrial hygienists play number of doctors was too small to conduct a compara- a role in controlling potential health hazards using envir- tive analysis. onmental monitoring and several other methods. [14]In Korea, however, air environmental engineers can also be Conclusion appointed as health officers. In this study, although there This study found that each qualification plays a very dif- were differences in contribution according to workplace ferent role in the workplace; moreover, health officers size and type of business, the percentage of health care need support for areas of other qualifications. It is diffi- work performed over one entire working day was the cult to effectively manage the occupational health of the lowest among air environmental engineers. In a study by workplace in Korea when only one health officer is Lee et al., 95.9% of air environmental engineers per- employed at small and medium-sized workplaces. There- formed other tasks besides health care work. [10] Al- fore, in the case of small and medium-sized enterprises, though there is no clear difference in terms of quality of it is necessary to consider the establishment of a support health care work performed, there are the possibility of system at the local or national level for the areas where the health care at a workplace being poor if the time one health officer is insufficient. In addition, in the case invested is small. As part of the deregulation of compan- of a workplace where two or more health officers are ies in Korea, an air environmental engineer hired under employed, coordination is needed to ensure that each the Clean Air Conservation Act could also serve as a specialty is equally deployed. health officer, and therefore, their work may be dis- persed. In our study, it was not statistically significant; Funding however, we identify that the contribution to the role of The survey used in this study was supported by Ministry of Employment and a health officer was lowest among air environmental en- Labor. gineers. In addition, not only are there differences in role contribution according to the qualifications of health of- Authors’ contributions YKK designed the study and drafted the manuscript. JHY and WHL ficers, but they responded that they need support for suggested the study design and revised the manuscript. JHK and SSL areas of other qualifications. Countermeasures such as analyzed the data and revised the manuscript. JUW suggested the study reducing the additional posting of air environment en- design, interpreted the data, and revised the manuscript. All authors read and approved the final manuscript. gineer or strengthening education are warranted. This study does include some limitations. This study Ethics approval and consent to participate conducted a wide range of surveys, but the response rate This study was approved by the Institutional Review Board of Severance was low because it was conducted via mail; moreover, Hospital (IRB no. Y-2017-0110). All subjects provided written informed the responses had a large amount of missing data. There consent for their participation. was also the disadvantage that the objectivity of the evaluation was inferior because the contributions to the Competing interests role were assessed by the participants and not externally. The authors declare that they have no competing interests. Kim et al. Annals of Occupational and Environmental Medicine (2018) 30:35 Page 8 of 8 Publisher’sNote Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Author details The Institute for Occupational Health, Yonsei University College of Medicine, Seoul, Republic of Korea. Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea. Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea. Department of Occupational and Environmental Medicine, St. Mary’s Hospital, College of Medicine, the Catholic University of Korea, Seoul, Republic of Korea. Received: 9 March 2018 Accepted: 16 May 2018 References 1. Takala J, Hämäläinen P, Saarela KL, Yun LY, Manickam K, Jin TW, Heng P, Tjong C, Kheng LG, Lim S. Global estimates of the burden of injury and illness at work in 2012. J Occup Environ Hyg. 2014;11(5):326–37. 2. Ahonen G. OSH and corporate competitiveness in a global context. In PEROSH Seminar at European Parliament. 2010; 3. Ministry of Employment and Labor. Statistics of industrial accidents. In: 2006; 4. Ministry of Employment and Labor. Statistics of industrial accidents. In: 2016; 5. ILOSTAT database. International Labour Organization. http://www.ilo.org/ ilostat/faces/ilostat-home/home?_adf.ctrl-state=tmypciqwp_134&_afrLoop= 674516030148438#! . Accessed 17 Jan 2018. 6. Institute of Medicine. Safe work in the 21st century: education and training needs for the next Decade's occupational safety and health personnel. Washington, DC: The National Academies Press; 2000. p. 33–5. 7. Occupational safety and health act. Act no. 13906. Available from: http://www. law.go.kr/LSW/eng/engLsSc.do?menuId=2&query= OCCUPATIONAL%20SAFETY%20AND%20HEALTH%20ACT. Accessed 17 Jan 2018. 8. Enforcement decree of the occupational safety and health act. Act no. 27767. Available from: http://www.law.go.kr/LSW/eng/engLsSc.do?menuId= 1&query=ENFORCEMENT+DECREE+OF+THE+OCCUPATIONAL+SAFETY+AND +HEALTH+ACT&x=0&y=0. Accessed 17 Jan 2018. 9. Hong YC, Ha EH, Jun KJ, rho YM, park HS, jo HS, lee HJ, Yang MR. job performance of occupational health personnel. Annals of Occupational and Environmental Medicine. 1997;9(3):496–507. 10. Lee J-H, Kim K-S, Ahn Y-s. A study on the practical behavior of health care managers at the worksite. Annals of Occupational and Environmental Medicine. 1995;7(1):88–100. 11. LaDou J, Harrison R. Current occupational & environmental medicine: McGraw-Hill New York; 2007. P. 112–120. 12. Harber P, Rose S, Bontemps J, Saechao K, Liu Y, Elashoff D, Wu S. Occupational medicine practice: activities and skills of a national sample. J Occup Environ Med. 2010;52(12):1147–53. 13. World Health Organization. The role of the occupational health nurse in workplace health management. 2001. 14. Plog BA, Niland J, Quinlan P. Fundamentals of industrial hygiene: National Safety Council Press; 2002. P. 3–31. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Annals of Occupational and Environmental Medicine Springer Journals

Differences in the performance of health officers at the workplace according to their qualifications

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Abstract

Background: Health officers are an integral part of the occupational health service, and there have been studies to identify and improve the role of health officers in the workplace in order to improve the level of health care in the workplace. Thisstudy aimedtodetermine thecontributionofhealthofficerstothe role of ahealth officer as prescribed by law and the percentage of health management work performed during work according to their qualifications. Methods: Questionnaires were distributed to a total of 4584 workplaces where health officers were hired, and a total of 806 copies (17.58%) were returned. Of these, 336 questionnaires were finally analyzed, after excluding questionnaires missing the main variables. Using the data, the difference of role contributions and the percentage of health care work performed during the whole day according to the qualification of the health officer was analyzed. Results: Nurses were highly rated in the field of medical care, and industrial hygienists and air environmental engineers were highly rated in terms of chemicals and risk factor management. The percentage of health care work performed during the whole day differed according to the size of the workplace and industrial classification, but it was generally the lowest among air environmental engineers. Conclusions: Health officers play a very different role in the workplace depending on their qualification, and they need support for areas of other qualification. In order to effectively manage the health of the staff at a workplace, it is necessary to consider the development of a support system for small- and medium-sized enterprises and adjust the conditions of employment of the health officer according to the law. Keywords: Health officer, Nurse, Industrial hygienist, Air environmental engineer Background In Korea, the number of industrial accidents has Studies have shown that the economic costs of occupa- decreased with time. As of 2005, the industrial accident tional injuries and illnesses range from 1.8 to 6% de- rate was 0.77%, and the death rate due to industrial acci- pending on the country. [1] In the EU, the economic dents per 10,000 employees was 2.06; these rates were costs incurred by occupational injuries and illnesses are 0.5% and 1.01, respectively, in 2015. [3, 4] Moreover, in estimated to be 15 times the cost of preventing them. [2] Korea, the incidence of fatal occupational injuries was Thus, prevention of occupational injuries and illnesses 5.3 per 100,000 workers in 2015. However, in terms of through occupational safety measures and health Organisation for Economic Co-operation and Develop- services is important. ment member countries, the incidence was 1.6 per 100,000 workers in Germany and 3.3 per 100,000 workers in the USA. Efforts to improve the level of health manage- ment at the workplace are therefore needed. [5]. * Correspondence: juwon@yuhs.ac The Institute for Occupational Health, Yonsei University College of Medicine, Health officers are an integral part of the occupational Seoul, Republic of Korea health service [6], and previous studies have aimed to Department of Preventive Medicine, Yonsei University College of Medicine, identify and improve the role of health officers in the Seoul, Republic of Korea Full list of author information is available at the end of the article © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Kim et al. Annals of Occupational and Environmental Medicine (2018) 30:35 Page 2 of 8 workplace in order to improve the level of health care in Qualifications the workplace. In Korea, a health officer is defined as a At the time of the survey, the qualification of a health person who assists a business owner or the person in officer in Korea includes physicians, nurses, industrial charge of management with respect to technical matters hygienists, air environmental engineers, industrial health concerning the health of the staff as well as advises and instructors, and those who majored in occupational instructs the supervisor on such matters. Health officers health or industrial hygiene at a college. In this study, are professionals such as doctors, nurses, industrial 94.7% of the workplaces surveyed were found to employ hygienists, and air environmental engineers [7, 8]. nurses, industrial hygienists or air environmental engi- In Korea, the number of health officers employed in neers as health officer. Other qualifications such as an institution varies depending on the type of industry physician were excluded because the number of them and the number of workers in the workplace. For was insufficient to analyze. In addition, questionnaires example, a business with a size of 500 to 2000 workers filled out by health officers with multiple qualifications requires two or more people to be employed as health were excluded. officers, and a business with a size of more than 2000 people may require the employment of two or more Questionnaire health officers including at least one physician or nurse The administered questionnaire was based on the Indus- by profession. [8] As such, only a limited number of in- trial Safety and Health Act. A total of 17 question items dustries require that at least one physician or nurse be were selected based on the roles of health officers defined appointed among the two or more health officers. Thus, by the Industrial Safety and Health Law (Table 1). The there has been a question of whether it is possible to questions aimed at determining the role contribution of comprehensively perform the various roles of health offi- the health officer was as follows: “As a health officer, how cers, such as workers’ safety guidance, hazard risk factor much do you contribute to the following items? Please in- management, and medical practices. dicate your contribution to the role on a scale of 0 to 10.” To address this problem, previous studies have aimed In this question, 0 means “No role contribution”,and 10 to determine the role of health officers with different means “Maximum role contribution.” In this study, the qualifications. Hong et al. used a questionnaire based on high and low role contributions were divided by the me- the Industrial Safety and Health Law to determine the dian of each item in the questionnaire. The questionnaire competence of health officers according to their qualifi- also sought information on the percentage of health care cations; however, only doctors, nurses, and industrial work performed during the whole day. In addition, the hygienists were compared. [9] Lee et al. compared the following questions were asked to identify areas that need performances and behaviours of health officers accor- support in the field of occupational safety and health: ding to their qualifications, and reported a difference in “Which of the following areas do you need support for? - the performance of nurses, industrial hygienists, and air Safety and environmental management/Health manage- environmental engineers. [10] However, no further stu- ment/ Administrative support.” The size of the workplace dies have been conducted after a long period of time. and the type of business, as well as the sex, age, and total This study aimed to determine the contribution of industrial health career of the health officer were also health officers to health management work per the cri- identified. teria prescribed by the law in Korea and the percentage of health management work performed during an actual working day according to their qualifications. Statistical analysis All subjects were divided into groups according to their Methods qualifications. The average and standard deviations of Subjects role contributions established by health officers them- A questionnaire was mailed from August to September selves for each job item defined by law were obtained. 2015 to entire workplaces in Korea where health officers The differences were analysed via one-way analyses of were hired. Health officers were requested to answer the variance and corrected for multiple comparisons using questionnaire, and in case of multiple health officers, the Bonferroni correction. The percentage of health care only one person answered the questionnaire. Question- work performed during the whole day was analysed in a naires were distributed to a total of 4584 workplaces similar manner, and was stratified into manufacturing nationwide, and a total of 806 copies (17.58%) were industry, non-manufacturing industry, workplace with returned. After excluding questionnaires missing the less than 300 employees, and workplace with more than main variables (sex, age, size of workplace, type of busi- 300 employees. In addition, the differences in the ness, total industrial health career, role contribution), percentage of areas that need support according to 336 questionnaires were finally included in the analysis. qualifications were illustrated. Kim et al. Annals of Occupational and Environmental Medicine (2018) 30:35 Page 3 of 8 Table 1 Question items based on the roles of health officers defined by the Industrial Safety and Health Law Abbreviation Question Occupational health and safety committee Establishment and management of occupational health and safety committee Safety and health actions on machinery Matters concerning safety and health actions when harmful or dangerous machinery and equipment and equipment and other facilities are introduced Advice and guidance on protectors Assistance to, and advice and guidance on selection of appropriate products in purchasing protectors Management of chemical substances Management of chemical substances and products containing a chemical substance Detecting harmful or dangerous factors Detect harmful or dangerous factors caused by those resulting from specific work behaviors or duties, and determine the degree of danger Preventing any danger or health Actions for preventing any danger to or health impairment of employees impairment Appropriate measures for the workers’ Taking appropriate measures for the workers’ health following the results, including work arrangements, health work conversions, and reduction of working hours Investigating and preventing worker’s Investigation into the cause of workers’ medical problems and medical treatment to prevent recurrence medical problem Health education Assistance to, and advice and guidance on the formulation of plans on health education and the conduct thereof at the place of business concerned Treatment of minor injuries Treatment of frequently occurring minor injuries, such as external wounds Emergency treatment Emergency treatment Preventing injuries or diseases from Treatment to prevent injuries or diseases from worsening worsening Management of workers after a Recuperation guidance and management for those who are found to have health trouble after a medical checkup medical checkup Management of ventilators and local Assistance to and advice on the inspection of facilities, such as general ventilators and local air air exhausters exhausters, etc., and the technical improvement of working method Routine inspections of workplace Routine inspections of the place of business concerned, guidance and recommendation of safety measures Investigating and preventing industrial Investigation into and analysis of the cause of industrial accidents and provision of technical assistance accidents to and advice and guidance on prevention of the reoccurrence Analysis of industrial accidents Assistance to, and advice and guidance on the maintenance, management and analysis of statistics on industrial accidents The question was “As a health officer, how much do you contribute to the following items? Please indicate your contribution to the role on a scale of 0 to 10” Logistic regression analysis was used to confirm the accounted for the majority of those included. Nurses association between the qualification of the health officer and industrial hygienists most frequently worked for less and the role contribution of the health officer. For in- than 5 years, but air environmental engineers reported dustrial hygienists and air environmental engineers, we more than 10 years of work. By industry, other indus- calculated odds to account for the assumption that role tries were the most common; however, this is typically contributions would be higher for each of the items observed in medical institutions where a nurse is work- when compared with nurses. The odds ratio and 95% ing while being employed as a health officer. Other than confidence interval were calculated by adjusting for con- that, manufacturing was the most common (Table 2). founding variables such as sex, age group, size of work- place, total career of industrial health, and industrial Role contribution classification. Statistical analysis was performed using Industrial hygienists and air environmental engineers the SAS 9.4 (SAS Institute Inc., Cary, NC, USA.) showed higher role contribution scores than nurses in the following 8 items: “Establishment and management of Result occupational health and safety committee”; “Matters con- General characteristics cerning safety and health actions when harmful or danger- Of the 336 subjects, nurses accounted for 67.0%. Among ous machinery and equipment and other facilities are nurses, the percentage of women was very high (98.7%), introduced”; “Assistance with and advice and guidance on and for other professionals, the percentage of men was selection of appropriate products when purchasing higher. The proportion of health officers aged 40 to protectors”; “Management of chemical substances and 49 years was higher among nurses than among other products containing a chemical substance”; “Assistance professionals. Workplaces with less than 300 employees with and advice on the inspection of facilities such as Kim et al. Annals of Occupational and Environmental Medicine (2018) 30:35 Page 4 of 8 Table 2 General characteristics of subjects stratified by qualifications of health officers Characteristics Nurse Industrial hygienist Air environmental n (%) n (%) engineer n (%) Total 225 (66.96) 34 (10.12) 77 (22.29) Sex Men 3 (1.33) 23 (67.65) 72 (93.51) Women 224 (98.67) 11 (32.35) 5 (6.49) Age group (years) 20 to 29 20 (8.69) 9 (26.47) 6 (7.79) 30 to 39 54 (24.00) 11 (32.35) 32 (41.56) 40 to 49 91 (40.44) 9 (26.47) 27 (35.06) 50 and over 60 (26.67) 5 (14.71) 12 (15.58) Size of workplace < 300 workers 167 (74.22) 13 (38.24) 67 (87.01) 300 to 499 workers 19 (8.44) 4 (11.76) 7 (9.09) 500 to 999 workers 20 (8.89) 8 (23.53) 1 (1.30) above 1000 workers 19 (8.44) 9 (26.47) 2 (2.60) Total career of industrial health less than 5 years 127 (56.44) 16 (47.06) 29 (37.66) 5 to 9 years 43 (19.11) 8 (23.53) 17 (22.08) 10 years and over 55 (24.44) 10 (29.41) 30 (40.26) Industrial classification Manufacturing 41 (18.22) 25 (73.53) 66 (85.71) Construction 5 (2.22) 1 (2.94) 0 (0.00) Trasportation/Warehousing/Networking 0 (0.00) 1 (2.94) 1 (1.30) Energy/Water supply 2 (0.89) 0 (0.00) 2 (2.60) Financing/Insurance 1 (0.44) 0 (0.00) 2 (2.60) Mining 1 (0.44) 0 (0.00) 0 (0.00) Agriculture/Forestry/Fishery 1 (0.44) 0 (0.00) 0 (0.00) Others 174 (77.33) 7 (20.59) 6 (7.79) general ventilators and local air exhausters and technical Air environmental engineers showed higher role con- improvement in the working method”; “Routine inspec- tribution scores than nurses for “Detection of harmful tions of the place of business concerned, guidance and or dangerous factors resulting from specific work recommendation of safety measures”; “Investigation into behaviours or duties and determination of the degree of and analysis of the cause of industrial accidents and danger.” Nurses showed higher role contribution scores provision of technical assistance to and advice and guid- than air environmental engineers for “Investigation into ance on prevention of recurrence”; “Assistance with and the cause of workers’ medical problems and medical advice and guidance on the maintenance, management, treatment to prevent recurrence” (Table 3). and analysis of statistics on industrial accidents” (Table 3). The odds of higher role contributions when compared Nurses showed higher role contribution scores than with nurses were calculated. In the case of industrial other professionals in the following 4 items: “Treat- hygienists, the odds for higher role contribution were ment of frequently occurring minor injuries, such as significantly higher for the following 3 items: “Matters external wounds”; “Emergency treatment”; “Treatment concerning safety and health actions when harmful or to prevent injuries or diseases from worsening”; “Re- dangerous machinery and equipment and other facilities cuperation guidance and management for those who are introduced”; “Management of chemical substances are found to have health trouble after a medical and products containing a chemical substance”; “Detec- check-up” (Table 3). tion of harmful or dangerous factors resulting from Kim et al. Annals of Occupational and Environmental Medicine (2018) 30:35 Page 5 of 8 Table 3 The differences of role contiribution and percentage of health care work during the whole day of health officers by qualifications The role contiribution of health managers Nurse Industrial hygienist Air environmental engineer Comparison* Mean SD Mean SD Mean SD Occupational health and safety committee 4.95 2.79 6.24 2.51 5.86 2.56 B > A, C > A** Safety and health actions on machinery and equipment 5.04 2.99 6.65 2.27 6.10 2.50 B > A, C > A Advice and guidance on protectors 5.99 2.92 7.32 2.18 7.22 2.16 B > A, C > A Management of chemical substances 6.31 2.86 7.53 1.93 7.60 1.85 B > A, C > A Detecting harmful or dangerous factors 5.64 2.76 6.35 2.39 6.65 2.14 C > A Preventing any danger or health impairment 6.45 2.68 7.24 2.16 6.92 2.02 Appropriate measures for the workers’ health 6.49 2.86 6.09 2.84 6.21 2.48 Investigating and preventing worker’s medical problem 6.55 2.82 5.68 2.59 5.56 2.77 A > C Health education 7.22 2.47 7.29 2.17 7.18 2.12 Treatment of minor injuries 7.46 3.00 4.35 2.96 4.10 3.05 A > B, A > C Emergency treatment 7.68 2.77 5.43 3.18 4.57 2.97 A > B, A > C Preventing injuries or diseases from worsening 7.55 2.79 5.27 3.14 4.45 3.07 A > B, A > C Management of workers after a medical checkup 7.78 2.50 6.21 2.21 5.48 2.80 A > B, A > C Management of ventilators and local air exhausters 4.78 2.89 6.29 2.42 6.24 2.46 B > A, C > A Routine inspections of workplace 5.90 2.56 6.97 2.11 7.04 2.11 B > A, C > A Investigating and preventing industiral accidents 5.16 2.79 6.59 2.32 6.76 2.31 B > A, C > A Anaylsis of industrial accidents 5.05 2.90 6.53 2.45 6.35 2.34 B > A, C > A Percentage of health care work during the whole day Nurse Industrial hygienist Air environmental engineer Comparison* Mean SD Mean SD Mean SD Manufacturing industry 74.39 27.75 53.04 30.20 23.89 21.82 A > B, B > C Non-manufacturing industry 32.02 31.10 75.00 28.78 21.18 14.03 B > A, B > C The workplaces with 300 employees or less 26.70 26.68 37.92 28.40 21.22 18.84 The workplaces with more than 300 employees 77.41 26.11 70.05 26.33 38.00 27.41 A > C, B > C *The differences were analyzed by one-way ANOVA and corrected by multiple comparisons using bonferroni correction. P-value< 0.05 **“B > A, C > A” means a statistically significant higher score or percentage of industrial hygienist(B) than Nurse(A) and a statistically significant higher scoreor percentage of air environmental engineer(C) than Nurse(A). However, there is a no significant difference between Industrial hygienist(B) and Air environmental engineer(C) SD, Standard deviation specific work behaviours or duties and determination of workers’ medical problems and medical treatment to the degree of danger.” However, the odds for higher role prevent recurrence”; “Treatment of frequently occurring contribution were significantly lower in the following 4 minor injuries, such as external wounds”; “Emergency items: “Treatment of frequently occurring minor injur- treatment”; “Treatment to prevent injuries or diseases ies, such as external wounds”; “Emergency treatment”; from worsening”; “Recuperation guidance and manage- “Treatment to prevent injuries or diseases from worsen- ment for those who are found to have health trouble ing”; “Recuperation guidance and management for those after a medical check-up” (Table 4). who are found to have health trouble after a medical check-up” (Table 4). Percentage of health care work during the whole day In the case of air environmental engineers, the odds The percentage of health management work performed for higher role contribution were significantly higher for during the whole day in manufacturing industries was the following 2 items: “Management of chemical sub- highest in the order of nurses, industrial hygienists, and stances and products containing a chemical substance”; air environmental engineers. In non-manufacturing in- “Detection of harmful or dangerous factors resulting dustries, the proportion of health management work from specific work behaviours or duties and determin- performed during the whole day was higher for indus- ation of the degree of danger.” However, the odds for trial hygienists than for nurses and air environmental higher role contribution were significantly lower for the engineers. There was no significant difference in qualifi- following 5 items: “Investigation into the cause of cations among health officers in workplaces with 300 Kim et al. Annals of Occupational and Environmental Medicine (2018) 30:35 Page 6 of 8 Table 4 Association between the qualification of the health manager and the role contribution of the health officer a a The role contribution of health manager Industrial hygienist Air environmental engineer b b b b OR 95% CI OR 95% CI Occupational health and safety committee 1.79 0.71–4.52 2.16 0.78–5.97 Safety and health actions on machinery and equipment 3.57 1.41–9.05 2.46 0.89–6.80 Advice and guidance on protectors 2.46 0.98–6.22 2.14 0.78–5.90 Management of chemical substances 2.94 1.16–7.46 4.72 1.69–13.17 Detecting harmful or dangerous factors 2.54 1.01–6.40 2.78 1.01–7.67 Preventing any danger or health impairment 1.98 0.79–5.00 2.00 0.73–5.52 Appropriate measures for the workers’ health 0.57 0.23–1.44 0.60 0.22–1.66 Investigating and preventing worker’s medical problem 0.42 0.17–1.07 0.35 0.13–0.97 Health education 0.49 0.19–1.24 0.57 0.20–1.56 Treatment of minor injuries 0.05 0.02–0.14 0.03 0.01–0.09 Emergency treatment 0.10 0.04–0.27 0.04 0.01–0.11 Preventing injuries or diseases from worsening 0.13 0.05–0.33 0.06 0.02–0.17 Management of workers after a medical checkup 0.08 0.03–0.21 0.05 0.02–0.15 Management of ventilators and local air exhausters 2.04 0.81–5.13 2.48 0.90–6.83 Routine inspections of workplace 1.72 0.68–4.32 2.35 0.85–6.46 Investigating and preventing industiral accidents 2.15 0.85–5.41 3.52 1.27–9.72 Anaylsis of industrial accidents 1.30 0.52–3.26 1.22 0.45–3.34 Odds that role contributions would be higher for each of the items compared with nurse Odds ratio and 95% CI calculated using a logistic regression model adjusted for sex, age group, size of workplace, total career of industrial health, industrial classification OR, Odds ratio; CI, Confidence interval employees or less when stratified by workplace size. of nurses, the contribution to items related to medical Nurses and industrial hygienists in workplaces with treatment was significantly higher than that observed more than 300 employees performed a higher per- with other professionals. On the other hand, industrial centage of health care work than air environmental hygienists and air environmental engineers contributed engineers (Table 3). more to the management and action of harmful factors. In a study by Lee et al., nurses demonstrated a high Areas that need support in the field of occupational implementation rate of health management and health safety and health planning, and industrial hygienists demonstrated a high Among the nurses, 44.1% responded that they needed implementation rate of work environment management, support for ‘Safety and environmental management’ indicating a difference in contributions to the role of a when they were working as health officers. There was no health officer between professionals, similar to that ob- significant difference in the percentage of nurses who served in our study. [10] Of course, these results can be answered that they needed support for ‘health manage- interpreted as each job category having its own ment (27.7%)’ or ‘administrative support (28.2%).’ 55.2% strengths. However, it is more likely that the role of the of industrial hygienist responded that they needed health officer will not be balanced in the case of small support for ‘Health management’, followed by ‘Safety and business settings with one health officer. In addition, in environmental management (27.6%)’ and ‘Administrative large-scale workplaces hiring only a physician or nurse support (17.2%). In the case of the air environmental en- as a health officer may also be inadequate. gineer, 65.1% of respondents answered that they need Traditionally, occupational health and safety includes support for ‘ Health management’, followed by ‘Safety occupational safety, industrial hygiene, occupational and environmental management (23.8%)’ and ‘Adminis- medicine, and occupational health nursing. Occupational trative support (11.1%)’ (Fig. 1). physicians play a major role in the prevention, discovery, and treatment of occupational injuries and illness, and Discussion they may be hired or consulted at a medical institution In this study, there was a difference in contribution to or company. [11] In terms of clinical practice, they the role of a health officer between nurses, industrial mainly play a role in treating workers, but when hygienists, and air environmental engineers. In the case employed in a company, they often engage in Kim et al. Annals of Occupational and Environmental Medicine (2018) 30:35 Page 7 of 8 Fig. 1 Response to question: “Which of the following areas do you need support for?” administrative work as well as in medical practice. [12] Because of the high percentage of nurses among domes- Occupational health nursing is also expanding its role tic health officers, nurses accounted for a large propor- compared to that in the past, and these nurses act as ex- tion of the respondents. Therefore, the imbalance perts, managers, or researchers of occupational health as between qualifications compared was severe, and the well as medical personnel. [13] Industrial hygienists play number of doctors was too small to conduct a compara- a role in controlling potential health hazards using envir- tive analysis. onmental monitoring and several other methods. [14]In Korea, however, air environmental engineers can also be Conclusion appointed as health officers. In this study, although there This study found that each qualification plays a very dif- were differences in contribution according to workplace ferent role in the workplace; moreover, health officers size and type of business, the percentage of health care need support for areas of other qualifications. It is diffi- work performed over one entire working day was the cult to effectively manage the occupational health of the lowest among air environmental engineers. In a study by workplace in Korea when only one health officer is Lee et al., 95.9% of air environmental engineers per- employed at small and medium-sized workplaces. There- formed other tasks besides health care work. [10] Al- fore, in the case of small and medium-sized enterprises, though there is no clear difference in terms of quality of it is necessary to consider the establishment of a support health care work performed, there are the possibility of system at the local or national level for the areas where the health care at a workplace being poor if the time one health officer is insufficient. In addition, in the case invested is small. As part of the deregulation of compan- of a workplace where two or more health officers are ies in Korea, an air environmental engineer hired under employed, coordination is needed to ensure that each the Clean Air Conservation Act could also serve as a specialty is equally deployed. health officer, and therefore, their work may be dis- persed. In our study, it was not statistically significant; Funding however, we identify that the contribution to the role of The survey used in this study was supported by Ministry of Employment and a health officer was lowest among air environmental en- Labor. gineers. In addition, not only are there differences in role contribution according to the qualifications of health of- Authors’ contributions YKK designed the study and drafted the manuscript. JHY and WHL ficers, but they responded that they need support for suggested the study design and revised the manuscript. JHK and SSL areas of other qualifications. Countermeasures such as analyzed the data and revised the manuscript. JUW suggested the study reducing the additional posting of air environment en- design, interpreted the data, and revised the manuscript. All authors read and approved the final manuscript. gineer or strengthening education are warranted. This study does include some limitations. This study Ethics approval and consent to participate conducted a wide range of surveys, but the response rate This study was approved by the Institutional Review Board of Severance was low because it was conducted via mail; moreover, Hospital (IRB no. Y-2017-0110). All subjects provided written informed the responses had a large amount of missing data. There consent for their participation. was also the disadvantage that the objectivity of the evaluation was inferior because the contributions to the Competing interests role were assessed by the participants and not externally. The authors declare that they have no competing interests. Kim et al. Annals of Occupational and Environmental Medicine (2018) 30:35 Page 8 of 8 Publisher’sNote Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Author details The Institute for Occupational Health, Yonsei University College of Medicine, Seoul, Republic of Korea. Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea. Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea. Department of Occupational and Environmental Medicine, St. Mary’s Hospital, College of Medicine, the Catholic University of Korea, Seoul, Republic of Korea. Received: 9 March 2018 Accepted: 16 May 2018 References 1. Takala J, Hämäläinen P, Saarela KL, Yun LY, Manickam K, Jin TW, Heng P, Tjong C, Kheng LG, Lim S. Global estimates of the burden of injury and illness at work in 2012. J Occup Environ Hyg. 2014;11(5):326–37. 2. Ahonen G. OSH and corporate competitiveness in a global context. In PEROSH Seminar at European Parliament. 2010; 3. Ministry of Employment and Labor. Statistics of industrial accidents. In: 2006; 4. Ministry of Employment and Labor. Statistics of industrial accidents. In: 2016; 5. ILOSTAT database. 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Annals of Occupational and Environmental Medicine. 1997;9(3):496–507. 10. Lee J-H, Kim K-S, Ahn Y-s. A study on the practical behavior of health care managers at the worksite. Annals of Occupational and Environmental Medicine. 1995;7(1):88–100. 11. LaDou J, Harrison R. Current occupational & environmental medicine: McGraw-Hill New York; 2007. P. 112–120. 12. Harber P, Rose S, Bontemps J, Saechao K, Liu Y, Elashoff D, Wu S. Occupational medicine practice: activities and skills of a national sample. J Occup Environ Med. 2010;52(12):1147–53. 13. World Health Organization. The role of the occupational health nurse in workplace health management. 2001. 14. Plog BA, Niland J, Quinlan P. Fundamentals of industrial hygiene: National Safety Council Press; 2002. P. 3–31.

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Annals of Occupational and Environmental MedicineSpringer Journals

Published: May 30, 2018

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