Cost-benefit analysis in occupational health: a comparison of intervention scenarios for occupational asthma and rhinitis among bakery workers.

OBJECTIVES: Use of cost-benefit analysis in occupational health increases insight into the intervention strategy that maximises the cost-benefit ratio. This study presents a methodological framework identifying the most important elements of a cost-benefit analysis for occupational health settings. One of the main aims of the methodology is to evaluate cost-benefit ratios for different stakeholders (employers, employees and society). The developed methodology was applied to two intervention strategies focused on reducing respiratory diseases. METHODS: A cost-benefit framework was developed and used to set up a calculation spreadsheet containing the inputs and algorithms required to calculate the costs and benefits for all cost elements. Inputs from a large variety of sources were used to calculate total costs, total benefits, net costs and the benefit-to-costs ratio for both intervention scenarios. RESULTS: Implementation of a covenant intervention program resulted in a net benefit of €16 848 546 over 20 years for a population of 10 000 workers. Implementation was cost-effective for all stakeholders. For a health surveillance scenario, total benefits resulting from a decreased disease burden were estimated to be €44 659 352. The costs of the interventions could not be calculated. CONCLUSION: This study provides important insights for developing effective intervention strategies in the field of occupational medicine. Use of a model based approach enables investigation of those parameters most likely to impact on the effectiveness and costs of interventions for work related diseases. Our case study highlights the importance of considering different perspectives (of employers, society and employees) in assessing and sharing the costs and benefits of interventions.

Quality of working life and organizational performance--two sides of the same coin?

OBJECTIVE: This discussion paper presents the debate on the theoretical and practical claim that a simultaneous improvement in the quality of working life and organizational performance can be achieved by workplace development. METHODS: We discuss theories that support this claim or could provide additional support, and mention six "programs" on workplace development or social innovation in European countries. We present the results of evaluation studies in Finland, Germany, Ireland, and the Netherlands. RESULTS: A correlation of 0.50 was found between the quality of working life and organizational performance. All evaluations showed that the simultaneous improvement in the quality of working life and performance was achieved in a number of, but not all, projects. The percentage of successful projects is not always clear and depends on which aspects of quality of working life and performance were taken into account. Our estimation would be 25-50%. Which factors are important for success? With the exception of the commitment of top management and employee participation, other determinants were difficult to distinguish due to differences in research designs and programs. CONCLUSIONS: Important issues for discussion remain with respect to theory, research and practical approaches. Research should be more concerned with patterns of independent variables and how organizations deal with dilemmas. The most important pitfall appears to be taking a top-down as opposed to participatory approach involving employees and their supervisors in projects. National programs seem to be more effective than the initiatives of separate stakeholders groups.

Positive outcomes of participatory ergonomics in terms of greater comfort and higher productivity.

UNLABELLED: Ergonomics sometimes has a negative connotation, as it is seen to be connected to illness or guidelines that limit innovations. This paper is focused on the positive aspects of ergonomics in improvement of the working environment. It consists of a part that studies the literature on success factors in the process towards higher productivity and greater comfort, the formulation of a model and a hypothesis, which is illustrated by four cases. The model distinguishes the success factors in 'goal', 'involvement' and 'process'. GOALS: evidence is found in the literature that a positive approach has benefits in terms of shareholder value and productivity, and for comfort. Involvement: the literature shows that participation of end-users and management contributes to success. PROCESS: in the process it is essential to have a good inventory of the problems, a structured approach, a steering group responsible for the guidance, and end-users involvement in testing of ideas and prototypes. It is hypothesized that the chance of success increases by empowerment (making the end-user responsible for deciding on the next step in the process) and positive experiences of end-users with the potential improvement (end-users feel or see the benefits). The four cases illustrate that the hypothesis can be used in evaluating cases.

Participation for understanding: an interactive method.

INTRODUCTION: There are many available models that help evaluate the effectiveness of safety and health measures, but many are complex and require input from many departments within an organization. There is a need to develop a more user-friendly model. METHOD: A participative model was developed that involves face-to-face interviewers with workers, maintenance department, purchasing department and health and safety experts. They were asked about costs, efforts, benefits, and effects of gauging the effects of prevention efforts. RESULTS: Cost effectiveness analyses are essential in all cases and can include whatever the end-user requires, whether it is a small or lasting improvement. Having management participate helps validate the data. CONCLUSIONS: Organizations who collaborate with someone with at least some skill in cost-benefit evaluations will find that they will be able to establish policies and procedures from the data. The end result is a calculation that is understood by all involved.

A system to test the ground surface conditions of construction sites--for safe and efficient work without physical strain.

Ground surface conditions on construction sites have an important influence on the health and safety of workers and their productivity. The development of an expert-based "working conditions evaluation" system is described, intended to assist site managers in recognising unsatisfactory ground conditions and remedying these. The system was evaluated in the period 2002-2003. The evaluation shows that companies recognize poor soil/ground conditions as problematic, but are not aware of the specific physical workload hazards. The developed methods allow assessment of the ground surface quality and selection of appropriate measures for improvement. However, barriers exist at present to wide implementation of the system across the industry. Most significant of these is that responsibility for a site's condition is not clearly located within contracting arrangements, nor is it a topic of serious negotiation.

Reasons for applying innovations for scaffolding work.

In this paper reasons for applying and for not applying technical and organisational innovations in scaffolding work are studied. In a participatory ergonomic approach these innovations were developed to reduce problems concerning physical load of scaffolders. In this study reasons for the adoption of the innovations in the scaffolding sector are evaluated in 2 studies, in 48 companies. More than half of the scaffolding sector in the Netherlands adopted the innovations. Reasons for applying innovations concerned improvement of work and health and satisfaction with usage. The reason for not applying the innovations concerned specific situations, such as offshore work, in which innovations were not applicable.

Physical effects of new devices for bricklayers.

Bricklaying is a physically demanding job. Bricklayers frequently flex their trunk to pick up bricks and mortar and position these in a wall. The experienced workload is highest working with bricks at 0 to 50 cm from the floor. In this study the effects of 2 devices that have proven to be feasible in practice are evaluated. The 50 cm raise due to the 2 devices is experienced as comfortable, the estimated lumbar compression force was reduced, and observations indicate likewise. It is discussed that the field experiments have many drawbacks. Nevertheless, based on this study in combination with other literature the improvements could be recommended.