Quality is a way of conforming constantly to the standards that have been agreed with the client. This means that occupational health services must be client-focused at all times (see Chapter 4 for more on quality and audit).
Quality is paramount, whether the client is an employee visiting the occupational health nurse or doctor for a health or medical assessment, or the employer who is paying for the service. Each will have different expectations. The employer will be looking for a service that responds to their needs, perhaps in getting people seen and reports issued quickly, whereas the employee will measure the quality of the service provision by the way he or she is received by the nurse or doctor and the time and empathy given.
To start the process of quality, the occupational health service should do the following:
1. Decide what services it has to offer and target the market.
2. Find out from customers what it is they want from an occupational health service.
3. Employ the right people to provide the service.
4. Provide the services to the agreed standard – ‘get it right first time’.
Quality control procedures are implemented through auditing. Audit- ing is a method of looking critically at what is being done and objectively comparing the findings with an agreed standard. By so doing, standards can be improved and changed in order to improve the quality of service provision.
The occupational health service must set the standards that it wishes to achieve, thereby providing a base from which quality can be assessed.
This will be founded on the needs of the client, taking account of health and safety requirements, legislation and professional practice standards.
The business planning process will identify the overall occupational health policy and objectives, and will be linked to the critical success factors in defining the purpose. It is important to select services for audit that are common, high-risk or costly in terms of human and monetary factors. Examples of services to be audited might include return-to- work health assessments, ill-health retirement procedures, reasons for ill-health retirement and health surveillance.
The audit process will require that objectives be set. These should identify what is important about the quality of the service and what will be achieved by the audit. For example, for return-to-work health assessments the service standard to be achieved could be:
1. That the manager has access to occupational health advice as neces- sary on weekdays from 9 a.m. to 5 p.m.
2. That individuals are seen within two days of referral to the occupa- tional health service.
3. That a report is sent to the referring manager by the occupational health service within 24 hours.
Clearly, this example is aimed at standards of response times that would have been agreed in the contract. It is important to realise that the other aspects of audit will be aimed at quality in relation to clinical audit, which is a professional activity to ensure that standards are met in line with latest research and current best practice. In this chapter, audit is discussed in relation to the management sphere and does not include clinical audit.
Some occupational health services have achieved BS5750/ISO 9000 quality standards. This is a set of requirements for quality management systems. It is based on a process approach requiring documentation and control of what is done, of how it is to be done and of records (sup- porting information). The areas to be considered are: document control;
purchasing; maintenance of equipment; process control; corrective ac- tion; handling, storage and packaging; records; and training. Each is discussed in more detail below.
Document Control
This requires a procedure to be introduced that will ensure that the staff is working from the latest documents. For example, a new work instruc- tion on carrying out audiometry tests will need to be controlled so that it is known that all staff members are working to the same instruction;
likewise, all staff members will need to be made aware of a new piece of health and safety legislation and understand the implications of it for the occupational health service and the business.
Purchasing
This means getting the supplies that will comply with requirements delivered when they are wanted, and will be particularly significant for occupational health services purchasing expensive equipment such as audiometers, lung function testing equipment, etc.
Maintenance of Equipment
If equipment has been purchased or is on loan it is necessary to have a system for regular maintenance and calibration as appropriate. This must be documented to ensure that the equipment is working to the agreed specification. This will be vital to the service as most screen- ing work is carried out to an agreed standard. Audiometry results, for example, could have grave consequences if not accurate.
Process Control
This is to make sure that work is carried out in the correct way. For example, if different people carry out health/medical assessments it is important to know that the assessments are being carried out to the same standard by all those concerned, so a written work procedure will be necessary.
Corrective Action
When something does go wrong, procedures are needed to ensure it is not repeated and that the reason for the problem is identified and put right. Action should then be taken to identify the cause, and correc- tive action implemented to ensure it does not happen again. This then needs to be monitored. Corrective action can be applied to all types of problems, including complaints that are usually dealt with as isolated incidents; it would be better to learn from such experiences in order to take preventive action and avoid mistakes happening in the future.
Handling, Storage and Packaging
This requires controls on all items and materials used in the occupa- tional health service. The most important of these will be health/medical records and consumables such as vaccinations, which have special stor- age needs. Records must be kept securely and for a given length of time.
The Control of Substances Hazardous to Health (COSHH) Regulations 2004, for example, require health/medical records to be kept for 40 years.
Vaccinations have special temperature storage requirements and a shelf life. These and other similar situations must be properly controlled, with the supporting documentation demonstrating and proving the control methods.
Records
Records must be kept of all quality control systems; these records must demonstrate that the systems are working effectively. They must be comprehensive, with enough detail to trigger any need for corrective action. However, it is important not to let quality be consumed by paper;
this is not a paper exercise, and should be used to ensure that it is known what is happening. A good quality system will support the management process, be a monitoring tool and highlight problem areas that can be addressed before things get out of hand.
Training
Training for quality will be an integral part of staff training and de- velopment. All occupational health service staff members will need to
be trained regarding the quality system that is being implemented. As well as being committed to making it work, they will need to understand what is expected of them and how the system operates.