Evaluation and comparison of selected methodologies to investigate occupational accidents.

BACKGROUND: The choice of the "right" methodology to carry out the occupational accident investigation process is not an easy task. Each methodology has different conceptual and practical characteristics. The choice will depend to a large extent on the conceptual accident model being used. OBJECTIVE: The aim of this study has been to evaluate and compare a set of nine methodologies recognised as the most widely used in the field of occupational accident investigation. METHODS: For this purpose, six evaluation criteria are used which have already been applied and validated by the scientific community with a clear emphasis on the holistic nature of these methodologies. RESULTS: The results show a detailed analysis of the conceptual, methodological and practical characteristics of the nine selected occupational accident investigation methodologies. The conceptual framework of each of the methodologies, their holistic characteristics in terms of whether they cover the complete information cycle and its possible interrelation, reliability and validity of the methodologies, the experience required for their application, the flexibility in terms of being able to be used in different work environments and finally the ability of the methodology to motivate organisational improvement are presented. CONCLUSIONS: From this study, it is clear that the analysis of occupational accident investigation it is becoming increasingly necessary to employ scientific methodologies with a clear proactive approach in order to meet the challenges of changing socio-technical systems.

An Institutional System Proposal for Advanced Occupational Safety and Labor Standards in the Turkish Construction Industry.

The Turkish construction industry is problematic with its inferior occupational safety practices and labor standards. This paper explores the current institutional system's problems and designs a national institutional system to improve labor conditions in the Turkish construction industry. The study applies cause-and-effect analysis, stakeholder analysis, and information flow analysis based on the thematic literature and regulation reviews and the data collected from expert interviews. Findings revealed that the industry represents a drastically problematic context with high rates of occupational accidents, job insecurity, and excessive working time, and the inspection and enforcement system is still immature, calling for additional institutional arrangements to establish a collaborative and sustainable environment. There is a need for a holistic, multi-dimensional, and systematic perspective to develop coordination and inspection mechanisms in the sector. The paper proposes an institution and scorecard design by applying a quality function deployment framework matching needs and systemic functions that can overcome the existing deficiency in labor conditions. The paper contributes to filling the gap in the literature on the multi-dimensional, systematic institutional perspective to develop coordination and inspection mechanisms in the construction industry and proposes an institutional system example that could be adapted to other national contexts.

Research Paradigm of Network Approaches in Construction Safety and Occupational Health.

Construction safety accidents seriously threaten the lives and health of employees; however, the complexity of construction safety problems continues to increase. Network approaches have been widely applied to address accident mechanics. This study aims to review related studies on construction safety and occupational health (CSOH) and summarize the research paradigm of recent decades. We solicited 119 peer-reviewed journal articles and performed a bibliometric analysis as the foundation of the future directions, application bottlenecks, and research paradigm. (1) Based on the keyword cluster, future directions are divided into four layers: key directions, core themes, key problems, and important methods. (2) The network approaches are not independently applied in the CSOH research. It needs to rely on different theories or be combined with other methods and models. However, in terms of approach applications, there are still some common limitations that restrict its application and development. (3) The research paradigm of network analysis process can be divided into four stages: description, explanation, prediction, and control. When the same network method encounters different research objects, it focuses on different analysis processes and plays different roles.

Identifying and Evaluating the Essential Factors Affecting the Incidence of Site Accidents Caused by Human Errors in Industrial Parks Construction Projects.

In terms of safety management, the implementation of industrial parks construction projects (IPCPs) is incredibly challenging due to the special working conditions and the specific type of use of the buildings. On the other hand, the possibility of causing accidents in these areas based on human errors is high and important for project execution due to the risks of human errors and financial losses. Therefore, this study tries to fill this existing research gap by identifying and evaluating the effective key factors leading to the occurrence of construction accidents caused by human errors in the development of IPCPs. After a holistic review of the reported literature, four rounds of fuzzy Delphi survey were launched to capture the individual opinions and feedback from various project experts. Accordingly, 41 key factors affecting human errors in the implementation of industrial parks construction projects in Iran were identified and classified into nine main groups of wrong actions, observations/interpretations, planning/processes, equipment, organization, individual activities, environmental conditions, rescue, and technology. Then, the step-wise weight assessment ratio analysis (SWARA) method was adopted to rate and rank the identified factors of human errors in the implementation of IPCPs in Iran. The research findings indicated that among the elicited factors, time factor (0.1226), delayed interpretation (0.1080), and incorrect diagnosis/prediction (0.0990) are the three most crucial factors leading to human errors in the implementation of IPCPs in Iran. The results of this research study have provided various major project stakeholders with an effective decision-aid tool to make better-informed decisions in managing and reducing the occurrence of construction site accidents particularly caused by human errors associated with IPCPs.

Expert perspective on health and safety determinants in wineries.

BACKGROUND: The scientific literature contextualizes health and safety (H&S) in two major models, the first is based on a holistic perspective with H&S processes in all company departments, and the second approaches health and safety management from a more operational perspective. In this study, we examine the issue of health and safety in wineries. In 2017, a census showed that wineries account for 14% of the food and beverage industry in Spain. They provide direct employment for 24,051 people and involve complex winemaking processes that can cause accidents or occupational diseases. Wineries are part of the industrial sector, which, with 5,264 lost-time accidents per 100,000 workers in 2017, ranks second in the number of occupational accidents in Spain. This shows the need to determine the changes needed to improve health and safety in wineries. METHODS: In this study, we identify H&S determinants in wineries using Delphi methodology with a panel of 11 experts. CONCLUSION: The experts gave high scores to the "activities" dimension, and others such as "control of personal and collective protective equipment" and "training", together with "accident investigation", "coordinated health and safety measures" and "signage" are associated with operational health and safety determinants, namely, capitalizing on knowledge gained in situ and promoting organizational learning.

Identification of factors that influence occupational accidents in the petroleum industry: A qualitative approach.

BACKGROUND: Exploring experiences of individuals for barriers they confront relating to safety could help to design safety interventions with an emphasis on the most safety influencing factors. OBJECTIVE: This study strived to present an empirical exploration of individuals' experiences across the petroleum industry at different levels of the organizational structure for factors that influence occupational accidents. METHOD: Based on accidents history, face-to-face semi-structured interviews were conducted with individuals who engaged in fatal activities, as well as authorities responsible for managing safety. The qualitative content analysis of 46 interview transcripts was conducted using MAXQDA software. RESULTS: A three-layer model comprising organizational, supervisory and operator level influencing factors with 16 categories were found influence factors of occupational safety. The results highlighted the role of organizational factors, including inappropriate contract management, inadequate procedures, and issues relating to competency management and the organizational climate. Moreover, defects relating to the monitoring and supervision system were identified as important causes of accidents. CONCLUSIONS: The findings demonstrated that the qualitative approach could reveal additional latent aspects of safety influencing factors, which require consideration for the appropriate management of occupational safety. This study can guide the planning of preventive strategies for occupational accidents in the petroleum industry.

The Mindfulness-Based Phase-Oriented Trauma Therapy (MB-POTT): Hypnosis-informed mindfulness approach to trauma.

Hypnosis has long been successfully used in the treatment of trauma and related disorders. In this paper, I describe a hypnosis-informed approach to PTSD using mindfulness. The Mindfulness-Based Phase-Oriented Traumatic Therapy (MB-POTT) follows the phase-oriented tradition that was originally proposed by Pierre Janet, later expanded by Daniel Brown and Erika Fromm using clinical hypnosis. MB-POTT comprises four distinct, yet recursive, stages: (1) therapeutic alliance building and symptom stabilization, (2) formation of a narrative about the trauma, (3) re-creation of meaning of life after trauma, and (4) future symptom management. In explaining these categories, I delineate the nature of mindfulness, both similarities and dissimilarities to hypnosis, with an emphasis on techniques that resemble hypnotic approaches (e.g., ego state therapy, ego-strengthening). Finally, I provide a case study in which MB-POTT was implemented with a client who suffered from PTSD after a near-fatal industrial accident.

Rapid detection of plutonium contamination with and without uranium contamination in wounds by x-ray fluorescence.

In the event of an accident at a nuclear fuel handling facility, the wounds of affected workers may be contaminated with plutonium. The current approach for identifying plutonium contamination is by detecting α-particles in the blood stream. However, the applicability of this approach is impeded due to the α-particles being easily shielded by the bodily fluid components. In this study, we investigate a contamination testing method for such cases that involves the collection of blood with a small piece of filter paper, sealing the sample with thin films, and performing x-ray fluorescence analysis. Our previous study on collecting uranium-contaminated blood with filter paper and performing x-ray fluorescence analysis revealed that the effects arising from blood components could be completely removed by peak fitting, and thus water instead of blood was used as a solvent here. Samples containing various amounts of plutonium as well as samples with 150 Bq of plutonium and uranium were prepared with a mass ratio of 0 to 500 times greater than that of plutonium. x-ray fluorescence measurements showed a high linearity and reproducibility of the Pu Lα peak intensity and plutonium radioactivity, and it was clarified that the signal intensity of the Pu Lα peak did not depend on the amount of coexisting uranium. This method will allow for the simple and rapid assessment of plutonium contamination in wounds.

Acute Respiratory Obstruction due to Accidental Inhalation of Perlite: A Novel Mechanism for Upper Airway Occlusion with Cast Formation.

A 56-year-old man died following a fall resulting in complete submersion into a deep pit containing insulation material, expanded perlite. The most striking finding at autopsy was of impacted, moist pale yellow perlite that extended from the epiglottis into the main bronchi resulting in complete obstruction of the larger and smaller airways with cast formation. Perlite inhalation differs from inhalation of inert materials such as sand and wheat due to its hygroscopic properties and ability to expand forming an occlusive cast. Subsequent analyses of perlite from the worksite and within the airways indicated that hydration of perlite and adsorption of organic molecules into the perlite glass flakes had formed an interlocking, three-dimensional structure that was likely responsible for triggering a coagulation-flocculation process causing strong cohesion between the aggregates of glass flakes. This unique mechanism was likely responsible for the formation of the plug of perlite that obstructed the upper airway.

Lifejackets and Lobstermen: Giving Safety Equipment a Competitive Advantage.

Background: Falls overboard are the most frequent cause of death in the Northeast lobster fishing industry. National Institute for Occupational Safety and Health (NIOSH) surveillance indicates every victim of a fall overboard who has been found was not wearing a lifejacket. Preliminary research conducted in Maine and Massachusetts indicates lifejacket use is relatively uncommon among lobstermen due to barriers such as comfort, practicality, and social norms.Methods: This study highlights an initiative to: (1) trial various lifejacket designs with lobstermen; (2) identify the most popular designs; and (3) identify other features that could encourage use of lifejackets. In 2017, nine designs were trialed with lobstermen in Maine and Massachusetts during the winter and summer fishing seasons. Participants were recruited dockside, and lifejackets were randomly assigned. Participants completed surveys at 1 week and 4 weeks to assess positive and negative design features and to understand the importance of survival technology that can be used in conjunction with lifejackets.Results: 181 lobstermen in Maine and Massachusetts agreed to participate. Recruitment rates were 90.5%, while the survey completion rate was 88.4%. Survey results identified no clear preference for a specific lifejacket design; however, the ability to choose from many options appeared to be an important factor.Conclusion: Previous studies have indicated that lifejacket preferences are fisheries specific. In the Northeast lobster fishery, however, individual preferences varied. Our research demonstrates that a range of devices covering different buoyancies, wear type, and retrieval systems should be made more available to lobstermen.

Injuries and Exposure to Time Lobstering in Northeast US Inshore Lobster Fleet.

Objectives: The study objective was to estimate a denominator of exposure to inshore lobstering in Full-Time Equivalents (FTEs), to count incident injury data from a sample cohort of this population, to use this count to calculate rates for incident injuries, and to use official counts of fatalities to estimate a fatality rate.Methods: Captains were randomly selected from those licensed to fish in Maine and Massachusetts. Data on work exposure and injuries that occurred on the boat were collected using a survey that was administered once per season via phone or face-to-face interview with the captain. Data included self-reports of the number of weeks worked during the season, average crew size, number of trips per week, and average trip length in hours. In addition, this survey captured relevant information (body segment affected, type of injury, and whether treatment was received) on all acute injuries occurring during the season. Only data on acute injuries were collected, and defined as having newly occurred within the last 3 months. Counts of fatalities were obtained from an official surveillance database at the National Institute for Occupational Health and Safety.Results: The total occupational exposure reported for the cohort was over 2 million man-hours over 4 years, resulting in an average annual FTE of 5,847. The fatality rate averaged over 4 years was 21/100,000 FTE. The incidence rates for all injuries (51.0/100 FTE) and injuries receiving treatment (17.5/100 FTE) were much higher than those reported in other studies of fishing that used US Coast Guard data. Lobstermen presented with all categories of injuries, sprains being the most frequent (7.8/100 FTE) and amputations the least (0.2/100 FTE). Wrist/hand injuries on the right side occurred most frequently of all body locations (3.6/100 FTE).Conclusion: Non-fatal injuries occur at high rates in lobstering. The impact of interventions aimed at exposure to risk for sprains and cuts has potential to affect the most lobstermen. Fatality rate appears to have been unchanging since the year 2000.

Non-Fatal Injuries and Injury Treatment in the West Coast Dungeness Crab Fishery.

Objectives: Non-fatal injuries in the high risk US Dungeness crab fishery have been under-documented, despite their potential for lost work time and income, long-term disability, and early unwanted retirement. The Fishermen Led Injury Prevention Program (FLIPP) characterized injuries in this fishery, in order to identify work hazards and inform injury control measures.Methods: The FLIPP injury survey was completed by 426 fishermen in 23 Washington, Oregon, and California fishing ports prior to the 2015-2016 Dungeness crab season; 413 (97%) provided injury information for this analysis. Participants indicated whether they had been injured in the previous 12 months, described the injury, any treatments received, and whether the injury limited their ability to work.Results: Participants were mostly male (98%), more than half (56.6%) worked as deckhands, and reported considerable fishing experience (median = 14 years, interquartile range 5-27). Eighty-nine fishermen (21.5%) reported an injury incident in the past year, of which 49 (55.1%) were limiting. The 89 incidents yielded 102 injuries, of which nearly two-thirds were sprains/strains (23, 22.5%), surface wounds/bruises (17, 15.0%), cuts (18, 17.6%), or punctures (11, 10.8%). More severe injuries, including eight fractures, were rare. The majority of injuries received either no treatment (27, 26.5%) or first aid (35, 34.3%); clinical care was less common (22, 21.6%), and emergency care rare (3, 2.9%).Conclusion: One in five Dungeness crab fishermen reported an injury incident in the previous year. Most injuries were not severe and did not result in clinical care, but approximately half were work-limiting. Control measures must account for the remote and resource-limited workplace in commercial fishing.

Understanding the Factors and the Corresponding Interactions That Influence Construction Worker Safety Performance from a Competency-Model-Based Perspective: Evidence from Scaffolders in China.

Purpose: Construction workers' reactions to safety-related issues during operation vary from person to person due to their different occupational levels, which can be attributed to various influencing factors and their correspondingly complicated interactions. This research aims to propose an integrated framework to combine the concepts of these factors and provide a holistic interpretation of the interrelationship among them. Methods: Based on items that were mainly extracted from competency theory, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted to identify the critical factors from the data collected from 243 scaffolders on Wuhan Metro construction sites. The interactions among the identified factors were then analyzed, and the safety competency model was thus established with the use of structural equation modeling (SEM). Results: A total of 17 items were identified as critical to workers' safety competency, and these were further tested and attributed to four factors: (1) individual character and inclination; (2) self-adjustment and adaptability; (3) working attitudes; (4) safety-related operation qualification. Subsequent analysis showed that all the factors significantly contributed to one's safety competency, and individual character and inclination contributed most to the formation of one's ability, while the intermediating effects of self-adjustment and adaptability should not be neglected both in theoretical and practical terms. The resultant safety competency model consisting of these four factors was revealed to share a hierarchical structure with the classical competency model. Significance: This study provided an integrated theoretical framework and a set of modeling approaches to combine the related concepts and facilitate a greater understanding of construction safety in terms of workers' characteristics and behaviors. Practical implications: This study presented a tentative approach for assessing construction workers' safety competency, as well as emphasized to the managers and professionals the necessity of developing training systems to ensure workers are integrated into a crew in an appropriate and smooth manner. Limitations and Future Work: The volume and the scope of samples impeded the study from achieving a more generalized result and a more cost-efficient data collection approach is in need of development for a comprehensive and in-depth investigation.

[Multi-disciplinary cooperative treatment and management experience of 35 patients with extremely severe burns involved in August 2nd Kunshan factory aluminum dust explosion accident].

On August 2nd, 2014, 35 patients with extremely severe burns involved in August 2nd Kunshan factory aluminum dust explosion accident, including 18 males and 17 females, aged from 21 to 50 years, were admitted to our unit. According to the patient's condition, the rescue members divided the participants into groups according to their characteristics, and used the multi-disciplinary cooperative treatment and management mode of integrating critical care medicine, anesthesia, traditional Chinese medicine, rehabilitation, and nursing led by burn medicine. Totally 27 patients were successfully treated, with a success rate of 77.14%.

Processos psicossociais da aquisição de uma deficiência / Psychosocial processes of acquiring a disability / Procesos psicosociales de la adquisición de una discapacidad

A aquisição de uma deficiência pode ter extenso impacto na vida de uma pessoa, pois ocorre, muitas vezes, sob condições traumáticas e obriga tanto a ressignificações subjetivas quanto a adaptações práticas no cotidiano. O principal objetivo do trabalho aqui descrito consistiu em compreender aspectos psicossociais do processo de aquisição de uma deficiência, considerando diversos fatores que podem interferir nestas experiências. Para a realização da pesquisa, foram entrevistadas, de forma semiestruturada, 13 pessoas que adquiriram uma deficiência física, auditiva ou visual na idade adulta, sendo os relatos analisados pelo método de análise de conteúdo. Ao se discutir as falas dos pesquisados, são traçadas algumas semelhanças e distinções entre as experiências dos participantes, buscando também tecer considerações com base na literatura acadêmico-científica sobre o tema. Observou-se que os processos psicossociais de aquisição da deficiência foram permeados tanto por sentimentos negativos, relacionados à angústia e à depressão, bem como por reações mais harmônicas e de valorização da vida, em que se relativiza a perda do membro ou da capacidade sensorial. Representando um momento marcante na vida de quem a adquire, a deficiência pode levar à aprendizagem e ao amadurecimento, à medida que o tempo após a aquisição aumenta. Entende-se que os estudos acerca da deficiência, em especial a adquirida, devem ser ampliados e aprofundados, tendo em vista que o campo de estudos sobre esta temática ainda precisa de mais contribuições a respeito.(AU)

Becoming disabled may cause a considerable impact in someone's life, because, in most of the cases, it happens under traumatic conditions and it results in subjective resignification and practical adaptations. The main objective of this study is to understand the psychosocial aspects involved in becoming disabled, considering several factors which may interfere these experiences. For this research, 13 people who got a physical disability, a hearing or visual impairment in adulthood were interviewed in a semi-structured way and the results were evaluated using the content analysis method of Bardin (2011). When the speeches of the interviewed people are evaluated, some comparisons and distinctions among experiences of the participants are made for establishing relations with academic-scientific literature on this theme. It was noticed that the psychosocial processes involved in becoming disabled were permeated by negative feelings related to anguish and depression, as well as more harmonic reactions and valorization of life, in which the loss of a member or of a sensorial capability is relativized. As a defining moment in the lives of those who acquired it, the disability may result in learning and maturating over the years after the event. It is recommended that the studies concerning disability, especially the acquired ones, get broadened and deepened because there is a need for more contributions about this subject.(AU)

La adquisición de una discapacidad puede tener un amplio impacto en la vida de una persona, pues ocurre, muchas veces, bajo condiciones traumáticas y requiere tanto la reinterpretación subjetiva como las adaptaciones prácticas en la vida cotidiana. El principal objetivo del trabajo que se describe aquí fue entender los aspectos psicosociales del proceso de adquisición de una discapacidad, teniendo en cuenta diversos factores que pueden interferir en estas experiencias. Para la investigación, fueron entrevistadas de manera semiestructurada, 13 personas que adquirieron una discapacidad física, auditiva o visual en la edad adulta, siendo los relatos analizados por el método de análisis de contenido. En la discusión de los relatos de los entrevistados, son trazadas algunas similitudes y diferencias entre las experiencias de los participantes, buscando también tejer consideraciones con base en la literatura académica y científica sobre el tema. Se observó que los procesos psicosociales de adquisición de la discapacidad fueron permeados tanto por sentimientos negativos relacionados con la angustia y la depresión, así como por las reacciones más armónicas y de valorización de la vida, en que se relativiza la pérdida de un miembro o la capacidad sensorial. Representando un momento decisivo en la vida de quién la adquiere, la discapacidad puede llevar al aprendizaje y al crecimiento, a medida que el tiempo después de la adquisición aumenta. Se entiende que los estudios acerca de la discapacidad, en especial la adquirida, deben ser ampliados y profundizados, teniendo en cuenta que el campo de los estudios sobre este tema aún necesita más contribuciones al respecto.(AU)

Chronic Pain Rehabilitation for Upper Extremity Pain Following Stimulator Removal.

BACKGROUND Both spinal cord stimulators (SCS) and interdisciplinary chronic pain rehabilitation program (CPRP) are evidence-based treatments for chronic pain but differ on treatment foci. SCS focuses on decreasing the subjective pain experience as a means of improving function and quality of life. CPRP focuses on addressing the cognitive, emotional, and behavioral factors associated with chronic pain to improve function. Due to experimental constraints, these 2 treatment options are difficult to compare; however, this case report offers a unique opportunity to examine outcomes for both interventions in a sequential manner for changes in pain, function, and mood. CASE REPORT This single case study examined the separate and sequential outcomes of SCS and CPRP in a 26-year-old patient with a work-related injury resulting in chronic upper extremity pain. This patient was treated within an interdisciplinary CPRP following failure and removal of an SCS. Outcomes were measured by psychological assessments and return-to-work through a 6-month post-CPRP follow-up. CONCLUSIONS Pain intensity decreased following SCS placement and CPRP, while pain-related distress, pain interference, and overall affect improved only after CPRP, with sustained improvements at 6-month follow-up. Patient evidenced improvement following treatment with SCS and CPRP. SCS resulted in improvement in subjective pain and modest improved self-reported activity. CPRP demonstrated marked improvement in pain, self-reported function, and mood with patient eventually returning to work and maintaining most of these gains 6-months after completing CPRP treatment.

Health effects of hyperbaric exposure on chamber attendants: a literature review.

BACKGROUND: Inside attendants working in hyperbaric chambers are exposed to risks related to the hyperbaric environment, handling and care. The aim of this study is to review the literature focusing on the impact of this activity on health. MATERIALS AND METHODS: This is a literature review using the Medline database. RESULTS: Eight articles studied decompression illness (DCI). The incidence of DCI ranged from 0 to 37 per 100,000 sessions in hyperbaric chambers (SHC). The incidence of injuries ranged from 0 to 412 per 100,000 SHC. The most prevalent cause of accidental death was fire: 77 deaths (patients and attendants) between 1923 and 1996. Dysbaric osteonecrosis has been reported in one study only. CONCLUSIONS: Inside attendants face risks in the chamber, even if serious health effects seems rare compared to the total number of SHC.

Gendered Safety and Health Risks in the Construction Trades.

Objectives: Despite women's increased representation in the overall workforce, construction remains a male-dominated industry. Prior studies have noted that the hazardous workplace environment combined with a culture that can be discriminatory and openly hostile can threaten women workers' health and safety. However, little information exists about the current physical and psychosocial hazards at work affecting tradeswomen. Methods: We examined differences in workplace exposure between women and men, and the association of these exposures with self-reported stress and work injury, in order to highlight how gendered conditions of work negatively affect tradeswomen's health. A holistic view of health that included the influence of both home and work spheres as well as hazards related to women's social experience was considered. Almost 300 workers (198 tradeswomen and 93 tradesmen) throughout Washington State completed surveys. We used descriptive statistics to compare exposures between genders, and logistic regression to model the association between psychosocial exposures and injury and stress outcomes. Results: We found that women were significantly more likely than men to report high perceived stress (31 and 18%, respectively) and being injured at work in the past year (31 and 12%, respectively). Ten of the 12 work-related psychosocial exposures were found to be associated with either stress (job strain, gender and age discrimination, bullying, work/life balance, isolation, sexual harassment, safety climate, and social support) or injury (gender discrimination, bullying, overcompensation, and sexual harassment) for women. Conclusions: The industry continues to lag in supporting tradeswomen's health and safety needs. This study suggests that multiple exposures (including discrimination, overcompensation, and work/life balance) have an important impact on worker well-being. The findings underscore the complex interaction of gender, psychosocial exposures, and occupational risks, and indicate areas for intervention.

[The German Statutory Accident Insurance: A successful example of a value-based healthcare structure]. / Die Gesetzliche Unfallversicherung in Deutschland als erfolgreiches Beispiel einer Value-based- Healthcare-Struktur.

In the mid-1920s Porter and others developed a reform approach for existing health care systems, aiming at a patient-focused, value-based orientation. Improving patient outcomes by attaining, preserving and restoring good health is inherently less costly than dealing with poor health. The authors of the present article will outline that the German statutory accident insurance system, which was already introduced in1884 and is of an evolving nature, reflects key elements of Porter's efficient value-based health care system. The German accident insurance system with its statutory mandate limited to the prevention and rehabilitation of work-related damage to one's health can also serve as a model for other larger health care insurance systems. Prevention and rehabilitation is pursued using all appropriate means to achieve the set goals of protecting and restoring individual health. In line with these objectives, the statutory health insurance controls the process in terms of the required care quality. The components of a complex health care system, usually managed by a variety of different institutions, are consolidated. Thus it can be ensured that in both prevention and rehabilitation all services that are necessary to keep focussing the value "individual health" rather than indemnities are applied.