Quality Key – A self-evaluation tool for quality assessment of Occupational Health Services

Good quality of occupational health services (OHS) is required by law

The Act on Occupational Health Services (1383/2001) stipulates that every provider of occupational health services shall have a system for evaluating the effectiveness and quality of its activities. Although formal external audits are not required, many occupational health service providers have organized their services according to, e.g. ISO 9001 and OHSAS 18 001 standards or Quality Award (EFQM) criteria. The driving force behind the quality work is the need to serve customers better and to improve services A standard quality of services is important especially for large occupational health service providers operating over the whole country, and their customers. Although some tools have been available for the quality assessment of services, thus far there has not been a common quality-standard-based self-assessment tool for occupational health services in Finland.

The structure of Quality Key (QK) tool

The structure of QK tool is adapted from international quality management standards. It follows the ISO 9001 quality management standard (Figure 1).

The QK tool is composed of four content areas: 1) management and planning, 2) resource management, 3) processes in the main areas of action, and 4) assessment and improvement. These four content areas are further divided into 20 items. The idea is to assess how the content area is planned (plan), whether the plans have been carried out (do), and whether the actions have been assessed (check), and improvements started (act - improve). Quality management is based on the assumption that well planned and managed actions and processes will lead to good results in the same manner as a well trained athlete has better chances of winning in a competition.

Management and planning

The first part of the QK tool is composed of six items: 1) business idea, values and ethics, 2) contract management, 3) planning of activities, 4) responsibilities and possibilities to influence, 5) meeting practices and internal dissemination of information, 6) marketing and communication with clients.

Resource management

The second part consists of four items: 1) staff competence, 2) training and well-being, 3) premises and equipment, and 4) data management.

Action areas

The third content area is divided into six items: 1) workplace health assessment, 2) workplace health promotion, 3) health promotion of individual employees, 4) occupational-health-oriented care, 5) rehabilitation, and 6) information, counselling and advising.

Assessment and improvement

The fourth part comprises four items: 1) quality management, 2) customer feedback, 3) feedback on quality, and 4) effectiveness.

Each item consists of a short statement against which occupational health service practices are assessed with a four-level scale: 1) no activity, 2) activity under preparation, 3) ongoing activity 4) established and documented activity. The statements are formulated so that there are no definitive answers to them. Thus, an assessor needs to consider several matters simultaneously, and relate them to the best achievable quality level of practice in the occupational health service unit. The level should be agreed upon together, and should correspond to generally accepted good occupational health practices. Here is an example of a statement concerning the first item in content area three: Workplace health assessment: "Workplace risk assessments are systematically planned and implemented together with the employer and employees. Hazards and workload are identified, and their health risks are assessed and documented. Corrective actions are planned and implemented in co-operation with the workplace, and their impact on the work environment and the workers' health and safety are followed up and assessed."

Interpretation guide

We have developed an interpretation guide to help in the use of the QK tool. The guide consists of each item and the same short statement as in the QK tool. First, there are some questions to guide the assessment, followed by a short description of good occupational health practice, relevant legislation, and some examples of documents that can be used to show that the practice has been implemented.

Experiences in the use of the QK tool

The QK tool has been developed in several stages since 2003 by the experts of FIOH, by occupational health practitioners, and quality experts. We have piloted it in about 50 occupational health service units. It has proven to be an easy, quick and practical tool for the self-assessment of occupational health practices. Only a brief introduction is needed before starting to use the QK tool. Assessment of each item can be made first individually or in teams. The person responsible for the assessment process makes a summary of the assessments, which are then discussed together. Corrective action and development projects are agreed upon and prioritized. The QK tool is recommend to be used at least once a year.

Systematic and documented quality work is required for evaluating the effectiveness of occupational health practices. The QK tool is a good starting point for quality management and the continuous improvement of the practices.