Improving Education and Training of Dutch Major Hazard Control Inspectors: A 15 Years Longitudinal Case Study.

The education and training program for inspectors of Major Accident Hazard Establishments, specifically the EC Seveso III directive implicated Dutch chemical companies, changed considerably over a fifteen year period. This longitudinal, time-series cross sectional case study describes the development of the education and training program for Major Hazard Control inspectors, acting as regulators from the Labour inspectorate, belonging to the Dutch Ministry of Social Affairs and Employment. A blueprint had to be constructed in order to assess the development and quality of this program in four cross sections over time. The description highlights both the safety related content and the regulator skills parts of the program in its changing context. Professional standards, educational objectives, quality of education, evaluation method, education change process and the response to the dynamic operational environment were examined. The main findings are that the education and training program kept the same main structure over the time period while its contents were adapted to respond to external context changes. Internal evaluation of performance data and education style led to a shift in contents from theoretical knowledge towards safety management and inspection practice oriented experience related knowledge. An active teaching style, increased usage of professional standards and more systematic evaluation, starting from the blue print in this study, offer the best opportunities for further improvement. Current insights on regulatory performance lead to a recommended future perspective for the inspectors' role to be translated into education and training: balancing empathy, inquisitiveness and support with control and enforcement, or rather: exert tough love, staying between too soft and too hard.

An approach for optimal allocation of safety resources: using the knapsack problem to take aggregated cost-efficient preventive measures.

On the basis of the combination of the well-known knapsack problem and a widely used risk management technique in organizations (that is, the risk matrix), an approach was developed to carry out a cost-benefits analysis to efficiently take prevention investment decisions. Using the knapsack problem as a model and combining it with a well-known technique to solve this problem, bundles of prevention measures are prioritized based on their costs and benefits within a predefined prevention budget. Those bundles showing the highest efficiencies, and within a given budget, are identified from a wide variety of possible alternatives. Hence, the approach allows for an optimal allocation of safety resources, does not require any highly specialized information, and can therefore easily be applied by any organization using the risk matrix as a risk ranking tool.

Evaluation and economic impact analysis of different treatment options for ankle distortions in occupational accidents.

RATIONALE, AIMS AND OBJECTIVES: Appropriate use of diagnostic and treatment modalities are essential for rational use of resources. The aim of this study is to evaluate the use of diagnostic modalities and different treatment options and their economic impacts following an acute ankle distortion resulting from an occupational accident. We evaluated the type-of-treatment impact on the victims' course of recovery as well as its impact on the associated accident costs. Research was carried out in Belgium. METHODS: An ankle distortion victims' database consisting of 200 cases of (Belgian) occupational accidents during the period 2005-2007 was analysed. RESULTS: Patients who were prescribed immobilization or the use of adjuvant support or physical therapy (118 cases) were not employed during a period of 37 days on average, with a mean total cost of 3140.14 Euros caused by the ankle sprain. Patients without any adjuvant therapy (82 cases) were characterized by an unemployment rate of 15 days on average, and a total cost of 1077.86 Euros. Cast immobilization, although its application is not supported by evidence-based literature, was still applied in 36% of the population studied and resulted in the longest average absence of work of 42 days with an obvious significant increase in medical and total costs. CONCLUSIONS: Our results show a high rate of inappropriate use of cast immobilizations for ankle distortions. From an economic point of view and for the same clinical endpoint (being full resumption of the occupational activities), simple conventional treatment, consisting of rest, ice, compression and elevation at diagnosis with allowance of early weight bearing in the further clinical course, leads to the quickest full resumption of activities in combination with the lowest medical costs, if compared with any other kind of treatment.