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These are challenging times for health care executives. The health care field is experiencing unprecedented changes that threaten the survival of many health care organizations. To successfully navigate these challenges, health care executives need committed and productive physicians working in collaboration with organization leaders. Unfortunately, national studies suggest that at least 50% of US physicians are experiencing professional burnout, indicating that most executives face this challenge with a disillusioned physician workforce. Burnout is a syndrome characterized by exhaustion, cynicism, and reduced effectiveness. Physician burnout has been shown to influence quality of care, patient safety, physician turnover, and patient satisfaction. Although burnout is a system issue, most institutions operate under the erroneous framework that burnout and professional satisfaction are solely the responsibility of the individual physician. Engagement is the positive antithesis of burnout and is characterized by vigor, dedication, and absorption in work. There is a strong business case for organizations to invest in efforts to reduce physician burnout and promote engagement. Herein, we summarize 9 organizational strategies to promote physician engagement and describe how we have operationalized some of these approaches at Mayo Clinic. Our experience demonstrates that deliberate, sustained, and comprehensive efforts by the organization to reduce burnout and promote engagement can make a difference. Many effective interventions are relatively inexpensive, and small investments can have a large impact. Leadership and sustained attention from the highest level of the organization are the keys to making progress.

Background This study introduces a protocol for developing anational profile for occupational safety and health services (NPOSH), tailored for Iran (IRANOSH). Itfocuses on basic information, structure, programs, and human resources, highlighting challenges and practicesin the context of OSH services. Methods Forty-six NPOSH indicators were identified through content analysis of literature and categorized into ten domains and six types. The NPOSH framework was customized for Iran (IRANOSH) following an initial focus group discussion. Quantitative data were collected by 2,317 occupational health inspectors from820,846 workplaces across Iran, including3,734,249 workers. The quantitative and qualitative indicators were further discussed in a second focus group. Results Quantitative findings show the target population for occupational safety and health (OSH) services was estimated to be 34% of the country’s population. Small workplaces comprised 98% of all workplaces including 40% of workers. Access to OSH structures indicates one OSH center per 154 workers and 33 workplaces, one OSH engineeringcompany per 12,447 workers and 2,736 workplaces, and one OSH medical examination center per 3,404 workers and 748 workplaces. Access to OSH human resources involves one OSH inspector for every 354 workplaces and 1,612 workers and one occupational medicine specialist for every 3,270 workplaces and 14,877 workers.Qualitative findings show that thekey OSH programs in Iran include targeted inspections, occupational medical examinations, and monitoring of occupational exposures focusing on difficult and hazardous occupations in medium to large workplaces. Small workplaces present the most significant challenge and priority. A pronounced shortage of human resources hampers service provision, making developing OSH services for these settings a top priority. Conclusions Implementing an OSH self-assessment system through trade unions is proposed to bridge OSH service gaps. Additionally, expanding the PHC system to incorporate OSH structures within public organizations is essential for improving service delivery. Customizing the NPOSH framework for other countries with various health system contexts is recommended. Updating this study and comparing current findings with other data sources will help validate the current findings.

In the Czech Republic, employers and employees are bound by legal regulations that ensure occupational health and safety. These regulations are based on international conventions of the International Labour Organization and directives of the European Parliament and Council and have long been incorporated into Czech legislation. During the COVID-19 epidemic, emergency and crisis measures led to a limitation of occupational health examinations (OHEs) in the Czech Republic, which represented a significant disruption of the occupational health and safety system. The aim of the study was to assess the impact of these measures in order to find the right model for providing occupational health services in similar situations in the future. The method used was a survey, with participants including representatives of employers, state organizations, and employees (trade unions). Participants from all three groups showed differing views on limiting OHEs during emergencies. While representatives of public administration and employers were generally open to postponing or adjusting pre-employment or periodic OHEs for non-hazardous work, the majority consistently opposed any limitation of OHEs for hazardous work. Statistical differences were observed particularly in attitudes toward future regulation of OHEs during epidemics. The dominant conclusion of the survey is a strong recommendation against limiting initial occupational health examinations for jobs with occupational risks and in high-risk work categories.

Background The United Nations General Assembly (UNGA), the International Labour Organization (ILO), the World Health Organization (WHO), the International Commission on Occupational Health (ICOH), and the European Union (EU) have encouraged countries to organize occupational health services (OHS) for all working people irrespective of the sector of economy, size of enterprise or mode of employment of the worker. The objective of this study was to survey the status of OHS in a sample of countries from all continents. Methods A questionnaire focusing on the main aspects of OHS was developed on the basis of ILO Convention No. 161 and several other questionnaire surveys used in various target groups of OHS. The questionnaire was sent to 58 key informants: ICOH National Secretaries. Results A total of 49 National Secretaries responded (response rate 84.5%), from countries that employ 70% of the total world labour force. The majority of the respondent countries, 67%, had drawn up an OHS policy and implement it with the help of national occupational safety and health (OSH) authorities, institutes of occupational health or respective bodies, universities, and professional associations. Multidisciplinary expert OHS resources were available in the majority (82%) of countries, but varied widely in quantitative terms. The average OHS coverage of workers was 24.8%, with wide variation between countries. In over two thirds (69%) of the countries, the content of services was mixed, consisting of preventive and curative services, and in 29% preventive only. OHS financing was organized according to a mixed model among 63% and by employers only among 33% of the respondents. Conclusions The majority of countries have drawn up policies, strategies and programmes for OHS. The infrastructures and institutional and human resources for the implementation of strategies, however, remain insufficient in the majority of countries (implementation gap). Qualitatively, the content and multidisciplinary nature of OHS corresponds to international guidance, but the coverage, comprehensiveness and content of services remain largely incomplete due to a lack of infrastructure and shortage of multiprofessional human resources (capacity gap). The estimated coverage of services in the study group was low; only a quarter of the total employed population (coverage gap).

The review aimed to synthesise recent evidence on health service use and health outcomes among international migrant workers, compared with non-migrant workers. A search was carried out in MEDLINE, PubMed, Embase, and CINAHL for studies published between Jan 1, 2010, and Feb 29, 2020. Included outcomes were: occupational health service use, fatal occupational injury, HIV, and depression. Two authors independently screened records, extracted data, assessed risk of bias and judged quality of evidence. We meta-analysed estimates and conducted subgroup analyses by sex, geographical origin, geographical destination, and regularity of migration. Twenty-one studies were included comprising >17 million participants in 16 countries. Most studies investigated regular migrant workers in high-income destination countries. Compared with non-migrant workers, migrant workers were less likely to use health services (relative risk 0·55, 95% confidence interval 0·41 to 0·73, 4 studies, 3,804,131 participants, I2 100%, low quality of evidence). They more commonly had occupational injuries (1·27, 95% confidence interval 1·11 to 1·45, 7 studies, 17,100,626 participants, I2 96%, low quality of evidence). Relative risks differed by geographical origin and/or destination. There is uncertainty (very low quality of evidence) about occupational health service use (0 studies), fatal occupational injuries (5 studies, N = 14,210,820), HIV (3 studies, N = 13,775), and depression (2 studies, N = 7,512). Migrant workers may be less likely than non-migrant workers to use health services and more likely to have occupational injuries. More research is required on migrant workers from and in low- and middle-income countries, across migration stages, migrating irregularly, and in the informal economy.

Various basic occupational health services (BOHS) are provided, particularly in-plant BOHS; however, it might be necessary to start expanding BOHS. The current study focuses on BOHS model development using participatory action research (PAR) at a large-sized enterprise in northeastern Thailand. The PAR began with a situation analysis using ILO Convention C161, problem and cause analysis, the development of an action plan, observation and action, evaluation, and replanning. The research tools included interviews, focus group discussions (FGDs), and participant observations. The participants included managers, human resource staff, safety officers, and workers. Both inductive and deductive thematic analyses were undertaken. The results showed that (1) education and learning experience led to the workers detecting work-related diseases early by themselves and the implementation of medical surveillance programs; (2) the workers’ occupational health needs led to return-to-work assessments and first aid room system development; (3) the employer’s experience led to appropriate fit-for-work examinations and emergency preparedness; and (4) the feedback from BOHS providers led to a hospital-to-in-plant return-to-work conversion. The study concluded that the enterprise could develop fit-for-work and return-to-work assessments as per the ILO Convention C161 under the policy; however, medical surveillance and the first aid room system need to be developed through counseling at the hospital’s occupational medicine clinic.

ObjectivesIn Finland, the reimbursement system for occupational health services (OHSs) was reformed on 1 January 2020 to shift the focus from curative care to preventive OHS and promote employees’ work ability. We investigated the OHS trends and how the reimbursement affected them.DesignA register-based study that used moving averages to visualise OHS trends in 2018–2022. To detect the impact of the reform, we used two types of interrupted time series (ITS) analyses: a linear regression model (ITS linear model) and an analysis of variance (ANOVA) lagged dependent variable model (ITS ANOVA).SettingRetrospective register data (2018–2022) of a major OHS provider in Finland.Outcome measuresTime spent on OHS activities and the number of OHS activities per 1000 individuals per month. Level and slope changes in these measures in the ITS linear model, as well as the changes in these measures in the ITS ANOVA.ResultsAfter the reimbursement reform, the trend of preventive OHS shifted from a decline to a rise. Among nurses, the ITS linear model also showed changes of 0.6 hours (95% CI: 0.2 to 0.9) and 0.9 activities (95% CI: 0.2 to 1.7) per 1000 individuals per month. Throughout the study period, the trend of work ability health examinations for both physicians and nurses rose, with a monthly slope change of 0.03 hours (95% CI: 0.01 to 0.04) per 1000 individuals among nurses in the ITS linear model. We observed a descending trend in curative care with a monthly decrease of 14.3 hours (95% CI: −25.5 to −3.1) and 32.4 activities (95% CI: −64.1 to −0.1) per 1000 individuals by all professionals in the ITS ANOVA.ConclusionsAfter the 2020 reimbursement reform, the focus of OHS shifted from curative care to preventive OHS. It is likely that the reform affected these changes, although other factors may also have influenced them.

To determine the impact of the Covid-19 pandemic on the number of occupational health consultations and to highlight influencing factors. Retrospective observational study of consultations from an inter-company occupational health service. Data were retrieved during three consecutive years: 2019 (baseline), and 2020-2021. For comparisons purposes, we used the number of occupational health consultations per day and per full-time equivalent occupational healthcare worker (n consultations/d/FTE). Multivariate analysis was performed using logistic regression, for each lockdown vs the same period one year before. A total of 103,351 consultations were included. The number of consultations decreased by 14.3% in 2020 compared to 2019 but increased by 33.7% in 2021 compared to 2020. There were 4.9 consultations/d/FTE, 4.69 to 5.12 in 2019; 4.07, 3.81 to 4.34 in 2020; and 5.35, 5.16 to 5.55 in 2021. The first lockdown had a massive impact on the number of consultations, whereas the activity returned to normal from August 2020 with an increase in 2021. Age was associated with a decrease in the propension of consulting for the three lockdown periods (p < 0.001). The proportion of consultations for return-to-work was multiplied by 2.44 (2.02 to 2.95, p < 0.001) during the first lockdown, associated with a reduced risk of being declared unfit to work (OR = 0.48, 95 CI 0.27 to 0.84, p = 0.010). The Covid-19 pandemic had a huge impact on the medical activity of occupational health departments, with a massive decrease in 2020 followed by an increase in 2021 compared to 2019.

Objectives: Interprofessional collaboration (IPC) among professionals in occupational health (OH) services is crucial when rendering a service to clients and customers. The aim of this study was to describe and compare perceptions relating to IPC among professionals working as OH providers in Sweden.Methods: This cross-sectional study with a descriptive and comparative design included 456 respondents representing different OH professions in Sweden. Data were collected using the Swedish short version of the Assessment of Interprofessional Team Collaboration Scale adapted for OH ([AITCS]-SII[OH]), with its 3 subscales Partnership, Cooperation, and Coordination, and were analyzed and presented descriptively. Items and sum scores were dichotomized into inadequate and adequate and compared between sexes, workplaces, types of employment, and professions.Results: According to the responses, items related to openness, honesty, and trust were perceived as adequate among the respondents. The findings show that perceptions about IPC differed among the professions. The perception of IPC also differed between different types of organizations.Conclusions: The results show diverse perceptions between professionals and organizations. The perception of IPC may be influenced by the professional’s education in occupational safety and health. Study findings may be used to support further development of IPC in the OH service for the benefit of the clients. To develop IPC in the best interests of both professionals and customers/clients, further studies need to be performed to gain a deeper understanding of IPC in the OH context.