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Ann.
occup.
Wy9,
VoL
30, No. 1, pp. 1-18, 1986. MOBIL TOX COI fiPV
OO03-»878/86S3.OO
+
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Printed in Great Britaia IMCnmi.-r v|WLUfar Pergamon Press Ltd.
IIMf-f 1DU
A TI^.™^.....
"--national Hygiene Society.
MAY
1
THE
DEVELOPMENT
OF
OCCUPATIONAL
HYGIENE AND
THE
TRAINING
OF
HEALTH AND SAFETY
PROFESSIONALS*
A. R.
HALE
Safety Science Group, Delft University
of
Technology,
The
Netherlands
M. PlNEY
Health
and
Safety Unit, Department
of
Chemical Engineering, University
of
Aston, Birmingham,
U.K.
and
R. J.
ALESBURY
Occupational Hygiene Engineering Associated
Ltd, U.K.
Abstract—The paper seeks
to
contribute
to the
debate
on the
development
and
consolidation
of
the
professional field of occupational hygiene within
the
broader context of health and safety.
It
examines
developments over the last
10
years
since
the
1975
paper of
ATHERLEY
and
HALE(Ann.
occup.
Hyg.
18,
321-334).
It
discusses the overlap in training between four groups active
in
the area of hygiene
and the
ecological rivalry that this creates.
It
proposes
a
coordinated system
of
training
and
qualification
to
help
to
resolve this conflict
and
the confusion
it
creates in the minds of industry. The
scheme,
based
on
existing practices
of
BERBOH, would capitalize
on the
existing overlap
of
training provision
at
'rule
following' level
to
establish
a
comprehensive repertoire
of
proficiency certificates which would
be
accessible
to the
full range
of
people working
in the
field
and
would allow flexible combinations
to
meet industry's real needs
for
problem-based mixes of skills across
the
whole spectrum
of
health
and
safety.
INTRODUCTION
TEN
YEARS
ago
ATHERLEY
and
HALE (1975) discussed
a
number
of
obstacles
to
professionalization
in
'occupational safety
and
hygiene'
and
concluded that
the
then
recently
introduced Health
and
Safety
at
Work
Act
1974 provided
an
opportunity
to
overcome
them.
Ten
years later,
in the
wake
of the HSC
Discussion Document
on
Professional
Training
and
Qualification
in
Occupational Health
and
Safety (HSC,
1983b),
the
report
of
the House
of
Lords' Select Committee
on
Occupational Health
and
Hygiene Services (HOUSE
OF
LORDS, 1983),
the
proposed Control
of
Substances
Hazardous
to
Health (COSHH) Regulations (HSE, 1984)
and the
latest thinking
by
HSC
on
their future role (HSC, 1985), this paper considers developments since that
time
and
puts forward proposals
for
changes
in the
area
of
training
and
registration
aimed
at
tackling
the
remaining obstacles
to a
fully developed professional structure.
CRITERIA
FOR A
VIABLE PROFESSION
ATHERLEY
and
HALE (1975) used MILLERSON'S (1964) eight obstacles
to
*
Based
on a
paper presented
at the
BOHS Annual Conference
1984.
1
2 A. R. HALE, M. PINEY AND R. J. ALESBURY
professionalization to analyse the road to successful professionalization for occupa-
tional hygiene. In the light of subsequent research (CHILD, 1981; FIELDING and
PORTWOOD, 1980; CHILD and FULK, 1982; JOHNSON, 1977; FRIEDSON, 1977) it is
possible to summarize the characteristics which lead to a strong profession as follows:
(1) A developed, complex industrial/employment structure based upon division of
labour and producing specialized problems to be solved.
(2) Recognition by influential groups in society that the problems are important
and that incompetent solutions to them are dangerous or undesirable.
(3) A well developed knowledge base and practical techniques for the analysis and
solution of those problems.
(4) A sufficient number of practitioners with a guaranteed and suitable level of
training and competence and an accepted monopoly of the knowledge base and
the employment.
Problem complexity and importance
We take the first two points together, because they are inter-related. The belief was
expressed in much of the evidence to the Robens Committee (DoE, 1972) that health
and safety problems fell within the normal competence of managers and workers,
merely requiring more care and thought to be applied when and where needed. The
concept of self-regulation embodied in the Robens Report was implemented largely
through provisions for safety policy and safety representatives. Subsequent analyses of
the contribution of safety representatives (e.g. BEAUMONT et al., 1982; GLENDON and
BOOTH,
1982)
make it clear that they do not and, indeed, were not intended to fulfil the
technical and organizational problem-solving role essential to the analysis and control
of health and safety problems in the workplace. Analysis of the effectiveness of safety
policies (e.g. WARREN and ORCHARD, 1982; BOOTH, 1983a) has shown that they too
frequently do not exist or are totally inadequate in depth and detail.
It is clear from their publications on occupational health and safety services (TUC,
1980;
HSE, 1982; HSC, 1983a,b) that two of the bodies identified by ATHERLEY and
HALE
(1975)
as lukewarm or mildly opposed to specialists in the area have now changed
their attitude and have recognized the complexity of the subject and the need for
experts in it. In particular, the importance of and difficulties associated with the control
of chemicals have come even more to the forefront (HSC, 1984, 1985), giving a
boost to the 'expert' hygienist.
Recession and government cuts leading to reduced HSE starring have forced a
reappraisal of HSC policy (HALE, 1983a). This has led to the clearest statemement yet
from HSC that securely established specialist health and safety expertise in-house
should be one of seven criteria for judging that an organization is controlling its own
health and safety problems adequately (HSC, 1985). Recession has also sharpened the
arguments over cost-effectiveness of safety measures (CHURNSIDE, 1983; BOOTH 1983b)
and increased the realization that expert judgement is needed to eliminate unnecessary
expenditure on ineffective measures.
Industry, despite recession, has shown itself prepared to employ larger numbers of
qualified experts either on a full- or part-time basis, as increased membership of the
various professional bodies demonstrates. This has been evident mainly in large
industry and in the more complex technologies (HOUSE
OF
LORDS, 1983), but there are
Development of occupational hygiene 3
signs that recognition of the need is spreading to the lower technologies, albeit in a
dangerous industry (HSC, 1983a). The Confederation of British Industries in its
evidence to the House of Lords' Committee gave general support to the provision of
Occupational Health Services. However, it was opposed to any legislation and was
broadly satisfied with current provisions. It is interesting that occupational hygienists
received no mention in either the oral or written evidence given by the CBI.
In summary, the recognition of health and safety as an important problem area
requiring experts to control it has advanced greatly since ATHERLEY and HALE'S paper.
However, the position in Britain remains behind that of some European countries, e.g.
the Federal Republic of Germany, Belgium, the Netherlands, where this recognition
has been codified into the legislative requirement for Health and/or Safety Services in
specified organizations (HALE, 1985a). Also, the public at large may not yet have
accepted this need (PRESCOTT-CLARKE, 1982). It
is
significant that the public concept of
occupational health and safety shown by that study is still pervaded by the
individualistic view in which human error and carelessness, not working conditions,
are seen as the main causes of accidents. This is closer to the medical 'disease' model
than the hygienists' more system-based model.
Knowledge base and practical techniques
The integration of the various inspectorates into the HSE and the attempt to
produce integrated legislation across the whole spectrum of employment, while slow
(RIMINGTON,
1983),
has brought in its wake more serious consideration of the
field
as an
integrated whole, rather than a series of disparate subjects and careers.
The development of professional and university-level training in health and safety
(DORVAL, 1979; ULIANA et al., 1981; HEWITT, 1983; HALE, 1985a) has done much to
clarify the structure of knowledge in the field. Both the British Examining and
Registration Board in Occupational Hygiene (BERBOH) and the Institution of
Occupational Safety and Health (IOSH) have issued syllabuses, the latter in objective
form, which form the basis of courses at polytechnics and technical colleges. In recent
years the Royal College df Nursing has revised its syllabus in the light of the findings of
a research study (SILVERSTONE and WILLIAMS, 1982) and IOSH is in the process of doing
so.
The Faculty of Occupational Medicine also has put in place an experience and
training scheme for Associate Membership.
In the first three requirements for a strong profession set out above the changes
since 1975 have therefore been largely positive. It remains necessary to organize the
knowledge base into a structure recognizable to those with the problems, namely
industry.
Professional monopoly
The requirement here is that there should not be overlapping and competing
groups possessing different training and qualifications and all claiming the area. It is in
this respect that health and safety still conspicuously fails the test. The HSC Discussion
Document on professional qualifications and training (HSC, 1983b, p. 14) states:
Several studies have found evidence of confusion among employers about the recruitment and use of
health and safety specialists, their roles in relation to one another as well as to other functions, and their
training needs. This may not have been helped by the fact that both in the universities and elsewhere activity
has been fragmented for such a relatively small field, with the inevitable differences of emphasis and priority
between the various professional and training bodies concerned.
4 A. R.
HALE,
M.
PINEY
AND R. J.
ALESBURY
The report on the Joint ILO/WHO Committee on Occupational Health
(ILO/WHO, 1981) set out the committee's views on the training objectives and, by
extension, the tasks of occupational physicians, safety and health engineers and
occupational hygienists. All are allotted tasks and training needs in the broad areas of
ergonomics, assessment of health hazards, epidemiology and statistics, legal aspects of
the subject, education of management and workers and development of preventive
measures. While the level of knowledge implied does differ in some of those areas, in
many, particularly in the task descriptions of the hygienist and the safety and health
engineer, the overlap is very considerable
(see
Table
1).
The report goes on to advocate
the development of modular training courses to avoid duplication of effort and to
promote flexibility.
The ILO/WHO document implies that the overall academic level of training of the
three groups should be the same, i.e. of professional or university level. As Table 1
TABLE
1.
COMPARISON
OF
TRAINING
NEEDS
(ILO/WHO,
1981)
Physician Hygienist Safety engineer
Introduction to H & S + + +
Occupational psychology + P P
Occupational toxicology + P +
Occupational diseases + + P
Chronic morbidity +
Hygiene and social medicine +
Health care +
Medical care of special
categories of worker +
Principles of administration +
Occupational health services P
Research methods +
Epidemiology + P P
Descriptive statistics + +
Analytical statistics P +
H & S legislation + + +
Occupational psychology + + P
Ergonomics P + P
Procedural and personal
prevention methods P + +
Health education +
Training +
Occupational safety P + +
Hazard recognition + +
Fire protection +
Accident prevention +
System safety +
Environmental health P + P
Evaluating physical hazards P +
Evaluating air contaminants P +
Prevention of physical, chemical
and biological hazards P + +
Radiation protection +
+ = in-depth knowledge.
P
= knowledge of principles.
Development of occupational hygiene 5
indicates there is a distinction drawn in a number of subjects between an appreciation
level of knowledge and deep competence, and this does provide differing emphasis
between the
jobs,
but the overlap in subject areas is still very marked.
The overlap in tasks allocated to the different expert groups is repeated in the
documents issued by HSE
(1982)
and by TUC (1980) setting out their view of the tasks
and training of the various groups considered. In both documents the hygienist is
considered last and the unique tasks allocated to him read more as a collection of
leftovers that the other groups cannot claim than as a coherent and independent
job.
The impression created is of four groups (physicians, hygienists, nurses and safety
practitioners) being compressed into only three jobs.
Table 2 summarizes the syllabus material contained in the examination require-
ments of the professional bodies governing each of the groups as it relates to
TABLE 2. SYLLABUSES IN OCCUPATIONAL HYGIENE OF VARIOUS PROFESSIONAL BODIES
(A) BERBOH Preliminary Certificates (60 h/modute)
(1) Principles of occupational hygiene (6) Noise and vibration
(2) Industrial ventilation (7) Thermal environment
(3) Air pollution (8) Radiation
(4) Toxic metals (9) Fires and explosions
(5) Microbiological dangers (10) Pneumoconioses and byssinosis
(B) NEBOSH Modules in Occupational Health and Hygiene
Ordinary (Approx. 50 h) Higher (Approx. 100 h)
Nature and history of occupational
health and hygiene Principles of ventilation
Classification of health risks Thermal environment
Occupational hygiene role and practice Environmental lighting
Anatomy, physiology and toxicology Noise and vibration
Radiant energy Dust sampling
Basic noise and vibration Gas detection
Occupational diseases Laboratory analysis
Environmental measurement and control Radiological protection
Personal protective equipment Ergonomics
(C)
AFOM:
BLAT(British Life Assurance Trust) Distance Learning Modules
(Approx. 300 h study required for taught part of AFOM)
Occupational health services Thermal environment
History of occupational health Light and vision
Practical applications of law Noise and vibration
Epidemiology and statistics Compressed air and diving
Ergonomics Toxicology
Shift working and circadian rhythm Occupational lung disorders
Aging and employment Occupational skin disorders
Radiation Occupational cancers
Microbiological hazards Occupational hygiene
(8 other titles which fall more clearly outside the boundaries of occupational hygiene)
(D) OHNC Prevention Module (Approx. 60 h)
Role,
structure and history of occupational health and occupational hygiene services
The occupational health team
Principles of hazard control and workplace environmental surveys
Workplace monitoring, environmental standards, personal protective equipment
Accident causation, ergonomics, machinery safety, human error, supervision
Health assessment, special health risks, occupational toxicology
Notifiable diseases, epidemiology, data collection, record keeping
Health education
6 A. R.
HALE,
M.
PINEY AND
R. J.
ALESBURY
occupational health and hygiene. The hours indicated are derived from typical courses
leading to the qualifications mentioned. They are only approximate guides, but they
give some idea of the variation in depth of coverage between the groups. The overlap
between groups is, however, clearly considerable. All of those groups are therefore,
in
their own eyes
at
least, equipped
to
practise
to a
greater
or
lesser extent within the
sphere that occupational hygiene would identify as central to its expertise.
It is clear that, while the health and safety groups as
a
whole have fought for and
gained greater recognition, there are still widespread misconceptions of the role and
abilities of occupational hygienists. Symptomatic of this is the finding of CHOVIL and
ALEXANDER (1984) that, while managements generally appreciated the need for regular
occupational assessment, they did not in the main look to occupational hygienists
to
perform those assessments.
THE ECOLOGY OF PROFESSIONS
In order
to
help
in
the discussion
of
the rivalries
in
the field, we would like
to
propose an ecological analogy to try to capture the complexity of the problem which
faces the various competing professional and pseudo-professional groups.
Professions can usefully be compared to biological species struggling to survive in
an environment filled with competing species
of
varying size and specialization. The
driving forces and constraints for biological species competing for ecological niches are
the battles for food and reproductive success;
in
professions they are the battles
for
membership and control of the knowledge base as they compete for jobs (occupational
niches) in the health and safety environment. The environment is
a
changing one,
so
there are evolutionary pressures which affect long-term survival. When
a
new niche is
created by
a
change in the environment (e.g.
a
change in technology or social concern)
established species may try to claim the niche as their own or adapt into it. If more than
one do so, they will battle for its ownership. Engineering and medicine in particular
have done so in relation to the niche called occupational health and safety. However,
professions which
fit
an occupational niche perfectly at one stage may, if they do not
grow and adapt with
it,
find themselves displaced and superseded by more flexible,
vigorous species prepared
to
fit
themselves
to
those changing conditions.
An imperative of ecology is an appropriate degree of adaptation
of
fit
a
defined
niche. For professions we would define
it
in terms of meeting the needs of employing
organizations in the most cost-effective way. Industry defines its needs in health and
safety within the constraints and pressures of statutory requirements and public and
state attitudes. This introduces an essential difference between the ecology of biological
species and that of professions, namely that the niche that the latter are competing for
has
a
subjective as well as an objective element. Industry may not accurately perceive
the extent of its problems and their priorities. In particular, it may have its own way of
dividing up the field of health and safety into several, perhaps ill-considered, niches.
These may
be
based upon more traditional views
of
the field and may
be
strongly
influenced
by the
views held
by the
exisiting professional groups. Powerful
and
dominant professional species will always try to impose their own subjective view of the
niche (adapting the niche
to
themselves and not themselves
to
the niche). Thus, the
medical profession will always emphasize individual factors, medical examination and
diagnosis, engineers will emphasize technical failures and automating the man out of
Development
of occupational hygiene
7
the system (HALE, 1985b),
while
personnel managers emphasize selection, training and
discipline.
For
traditional professions this
is
where their interest lies.
To
adapt
themselves well to the real niche would be difficult for
a
large, established and well-
defined
body.
It would involve radical changes to training programmes and might even
threaten its adaptation
to
the more important niches
at
the centre of its ecological
range. While it would be possible for a small group from any of these bodies to evolve
into the niche, this might only be at the cost of their ability to interbreed with
(i.e.
to
retain recognition by and pursue careers in) the central stock. This would be the case,
for
example,
if occupational physicians seriously set out
to
learn environmental control
technology, an endeavour which would involve them
in
learning basic engineering
principles.
In this battle for control of the perception of the occupational niche the 'wares'
which each can offer
in
reality are obviously important. We argue later that
the
hygienist
has
potentially more
to
offer towards solution
of
the real problems
of
industry. However, the numbers of people dedicated to that conception of the
field
is
also important,
as is
the proportion
of
people practising
in
the area who are
not
members
of
the relevant professional body
and so
are
not
under
its
control (the
monopoly held by the professional group).
NUMBER OF PRACTITIONERS
The total numbers of practitioners
in
the U.K. estimated,
by
each of the professional
bodies,
to be
working
in the
various parts
of
the field,
as
reported
in the
HSC
Discussion Document (1983b)
or in
the House
of
Lords Select Committee report
(1983),
are shown in Table
3,
together with the actual membership of the professional
TABLE
3.
PRACTITIONERS
IN
OCCUPATIONAL HEALTH AND SAFETY (ESTIMATES)
Occupational
hygienists
Occupational
physicians
Safety
practitioners
Occupational
health nurses
1028
3000
10,000
9500
(P.
Certs)
(Practitioners)
(Practitioners)
(Practitioners)
742*
1131
3809f
3248
(BOHS)
135
(FOM)
(IOSH)
(OHNC)
(IOH)
Data
from House
of
Lords Report
(1984),
HSC Discussion Document (1983) and from professional
bodies.
* U.K. members only.
f
Includes affiliates who have not passed qualifying examinations.
bodies. It is interesting that the only body which did not give an estimate of the total
number of practitioners was the hygienists. The number of Preliminary Certificates
does not give a good guide, since an unknown proportion of people will have acquired
more than one and many people practising hygiene
in
some form will have none.
Hygienists
are
clearly severely outnumbered
by
other health and safety
groups.
Bearing
in mind the syllabuses reviewed in the earlier section of this paper, it
is
likely that there
are more people outside
the
BOHS
and
particularly outside
the
Institute
of
Occupational Hygienists (IOH) who are practising hygiene in some form or other than
there are within those bodies.
Comparison of numbers of hygienists per head of the working population
in
the
United States
and in the
United Kingdom reinforces
the
point.
For a
working
8 A. R. HALE, M. PINEY AND R. J. ALESBURY
population of 65 million there are 7000 hygienists in the United States, a ratio of
1:10 000. The U.K. figures are 750 hygienists to 22 million workforce, or 1:30 000. The
U.S.
figures combine the membership of the two main bodies [the American Industrial
Hygiene Association (AIHA) and the American Conference of Governmental
Industrial Hygienists (ACGIH)], eliminating so far as was possible the overlap from
dual membership (LIPPMANN,
1983;
CORN, 1983). We have used BOHS figures for the
U.K. numbers, recognizing that this overestimates the number of hygienists as
recognized by IOH because not all members have qualifications in hygiene, but the
figures also underestimate numbers in so far as not all who practise some aspect of
hygiene are members. Even allowing for the inaccuracies inherent in the calculation, a
factor of three represents a very significant difference between two countries whose
industrial base is broadly similar in type.
More importantly, the Occupational Safety and Health Administration (OSHA),
estimated the real needs of
U.S.
industry, for new hygienists by 1985, at 750 per annum
compared with an actual annual output of
218
(HARRIS,
1983).
In contrast, the House of
Lords Select Committee in its report, based upon the evidence of, among others, the
hygiene profession
itself,
considered: 'that the numbers and the level of training of
senior professional hygienists are adequate. . . There is, however, room for improving
the standards of training and qualification of those who engage in part-time hygiene
work for their employers.'
It may be that they also meant to state that the number of such part-time hygienists
should also be improved, but they did not. This is in strong contrast to the
recommendations to increase the training places for occupational physicians, general
practitioners and occupational health nurses. The medical model of the occupational
health and hygiene niche was clearly dominant.
The inescapable conclusion from these facts is that occupational hygienists as a
separate professional body with an important say in the field are in danger of being
swamped. Their numbers may be too small to provide an effective voice and they do not
speak for the majority of those who practise hygiene in one form or another. It is
perhaps symptomatic of this problem that the module on occupational health and
hygiene which the Business and Technician Education Council is currently using in its
scheme of Certificates is the IOSH syllabus module and not one from BERBOH.
It might be tempting to suggest that the resolution of the overlap and rivalry we
have described lies in an increase in restrictive practices, with hygienists imposing their
own view of the occupational niche upon industry and forcing other groups out of
'their' territory by erecting walls of registration and qualification around it, buttressed
by legislation. We believe that this approach is not possible, because the number of
hygienists is too small and their control over the occupational niche is too weak. Also,
the medical model of the niche is too appealing to industry, tending as it does to
emphasize individual factors and so to legitimize lack of expensive action to change
basic working conditions. In the remainder of the paper we propose a solution to the
problem of numbers and voice based upon recognition of what we believe to be the true
nature of the occupational niche of health and safety. We also put forward a scheme of
training and qualification which we believe would turn the overlaps which we have
indicated to positive advantage through a coherent, cooperative strategy, involving all
of the professional bodies which genuinely believe in a system-based solution to health
and safety problems. This would allow occupational hygiene to establish and
Development of occupational hygiene 9
consolidate its rightful leading role in its part of the field, overseeing the competence of
all those who practise hygiene.
THE FIELD OF EXPERTISE IN HEALTH AND SAFETY
We believe that the discipline of occupational health and safety is by its nature
'applied'. This means that it is defined by the problems which are perceived to exist in
employing organizations, not by boundaries drawn with reference to theories or types
of knowledge. In this it contrasts with subjects such as physics or chemistry and their
various sub-branches. Its boundaries reflect the amount of knowledge and the
techniques which are necessary to solve the problems which exist now or will exist in
the future; no more and no less. Thus the detailed knowledge of
a
basic science such as
aerosol physics is only relevant to hygiene experts in so far as it assists in predicting and
explaining the movement and control of paniculate air contaminants. Conversely,
experts in aerosol physics cannot claim to be hygiene experts unless they have also
acquired all the other knowledge necessary to apply that specialist expertise in the
solution of real-life hygiene problems. Equally, the technical skills of hazard
measurement and the design of control measures are only a part of the field, which is
incomplete without the management skills to get such control measures accepted and
implemented in the organization. Just as the GP who stops at prescribing tranquillizers
for stress-related sleeplessness cannot claim to be solving the real problem, so the
hygienist who stops at prescribing low volume-high velocity (LVHV) extraction is not
solving the real problem of health and safety in a small, marginally viable fettling shop
with an untrained workforce and no safety policy. Industry needs its problems solved,
not half solved, and those problems come in groups which are dependent upon the
processes being operated, not upon the lines drawn around scientific disciplines such as
human physiology, toxicology, engineering or industrial psychology. These sets of
problems define the environment to which professions in the field must adapt
themselves.
This view of occupational health and safety can be represented by a two-
dimensional matrix (Table 4,
HALE
1983b). The dimension across the top of the matrix
represents the various hazards or problem areas which need to be controlled. The
vertical dimension consists of the steps which are needed to recognize and solve the
problems represented by each of those hazards. The steps are the classic ones
appropriate to any problem-solving activity:
(1) the recognition that a problem exists;
(2) measurement of the size of the problem and what is causing it;
(3) establishment of appropriate standards which would constitute a solution to the
problem;
(4) assessment of the relative priority of solving any one problem among many;
(5) the development of technical and organizational solutions;
(6) the choice of the best solution;
(7) implementation and monitoring of the solution to reveal any residual problems;
(8) the provision of contigency plans to cope with those residual problems.
The common methodology and techniques which make up these steps are the
cement which binds together the range of hazards which constitute health and safety
TABLE
4.
MATRIX
OF
HEALTH
AND
SAFETY
Problem
Recognition and monitoring
Measurement and analysis
Standards
Priority assessment
Solution
Technical solutions
Organizational solutions
Choice of solution
Implementation
Contingencies
Fire and
explosion:
buildings,
specific
processes
TOYIP
chemicals:
metals, dust
and fumes,
liquids and
mists,
gases
and vapours
Micro-
biological
hazards
Examples of hazard
Noise and
Radiation vibration
areas
Fatigue,
stress and
overworking Ergonomics
Machinery
and plant
dangers: Air
hand tools, pollution,
robotics etc. etc.
•*«
m
S
I
1
Z
D
7*
1
Development of occupational hygiene 11
problems. The dimension of hazards is very long if we consider all undesirable effects of
work and its environment upon health, both acute and chronic, and the figure contains
only selected examples. If, as is advocated by the proponents of Loss Control and Risk
Management (e.g. PETERSEN, 1978), the list is extended to include all loss from non-
speculative risk, it could even encompass product damage and security. We would not
wish to extend the subject-matter of this paper to those extremes, but equally we wish to
indicate that the limits placed upon that dimension and the boundaries drawn within
those limits are to an extent arbitrary and their position differs between different
organisations and different countries
(HALE,
1985a).
Within the matrix can be placed all the knowledge and techniques required by the
field of health and safety. We believe that the essence of the real need of industry is the
coordination of this knowledge to produce effective solutions. This coordination
requires knowledge from several disciplines to control even one hazard; behavioural
and organizational knowledge is as vital to a competent solution as biological and
engineering knowledge. Looking across hazards, many of the behavioural and
organizational and indeed the analytical techniques are common across widely
differing hazards. Over and above this the solutions to differing hazards often interact
in practice (machines which must be guarded aginst operator access and have their
noise output reduced, extraction systems for toxic chemicals or particulates which also
present explosion or fire risks, etc.). We believe that a training scheme needs to produce
such coordinated knowledge within the members of one profession if competent
professional solutions are to be applied in this field, since the use of a team to provide
the framework for such coordination is only a viable solution for larger organizations.
We recognize that this must be sold to industry as the true perception of the
occupational health and safety niche which it has, but we believe that such an emphasis
on coordination is in the common interest of a larger number of the practitioners
working in the field. They all need to counter the one-sided, mono-disciplinary
perceptions which emanate from the traditional engineering and medical professions.
TRAINING AND QUALIFICATION
The HSC Discussion Document (1983b) indicates the current fragmentation of
training and qualification in the United Kingdom to meet the training needs in the
area; both it and the report of the House of Lords Select Committee (1983) advocate the
development of more integrated training to overcome both the practical and academic
problems of qualification in the field. The scheme set out below aims to provide that
integration. It aims to meet the following objectives:
(1) To provide a unified structure of training for the whole field of health and safety,
into which the various specialisms which comprise it can be located.
(2) To provide a clearly defined career pattern both vertically, to cater for
progression from technician to professional and managerial responsibility, and
horizontally, to allow for movement between industries and problem areas.
(3) To incorporate both academic and practical training in their appropriate places
and under the control of the appropriate groups or bodies.
(4) To provide training populations large enough to make well-designed and
professionally tutored college or distance learning courses commercially viable.
(5) To provide a flexible, adaptable range of certificates of competence suited to the
12 A. R. HALE, M. PINEY AND R. J. ALESBURY
varying needs of employing organizations (and potential recruits) and easily
comprehensible to them.
Rule following and problem solving
The type and level of training required depends upon the level of the tasks and
responsibilities that individuals have to fulfil. In introducing the proposed structure we
wish to distinguish two basic levels, using distinctions derived from the educational
psychology and training literatures (e.g. BLOOM, 1956; MAGER, 1975). The two levels
correspond broadly with technician and professional competence, although the latter
terms are usually not so precisely constrained.
Rule following is the ability to carry out a set of actions, whether physical or mental,
in a prescribed way to arrive at a defined end point within specified criteria of accuracy,
speed or quality. The competence is procedural and closed-ended. The measurement of
the exposure to noise of a group of employees in a workshop following prescribed
sampling methods and measurement techniques would largely fit into this category.
Problem solving is the ability to apply knowledge in new ways to situations not
previously encountered by the individual in order to arrive at acceptable solutions or
decisions. The competence is much deeper and more open-ended, involving
generalization beyond the limits of personal experience. This would encompass the
provision of a report to management on the most effective way to lower the exposure of
the same group of employees to noise, using the range of control strategies available.
Few activities are wholly without some problem solving, but there are large
differences in the scope and degree of
it
between different tasks in occupational health
and safety; these need to be reflected in the type and style of training given. It is
particularly necessary to make the distinction between the two levels, because the
problem-solving level requires at least an order of magnitude greater learning time to
achieve mastery, a greatly different style of learning management and a different
method of assessment of competence. Within the problem-solving level there are also
different depths of competence, ranging from conceptual appreciation of how to
approach a problem to detailed competence based upon deep experience. The
conceptual level of appreciation comes from the learning of generalizable theoretical
knowledge and problem-solving techniques and does not necessarily result from nor
require detailed study of all of the specific problem areas.
Training structure
The essential features of the proposed structure are depicted in Table 5:
(1) A modular structure at the rule-following level, based upon the hazard
dimension from Table 5 and relating to the whole range of health and safety problems
occurring in industry. It would embrace techniques for diagnosis and measurement,the
development and implementation of technical and organizational solutions to the
problems, and appropriate monitoring and contingency planning. Each module would
be very similar in concept to (though perhaps not of the same length as) existing
BERBOH Preliminary Certificates. Each would, as appropriate, include practical
training. Those passing the two aspects would be awarded a certificate of competence in
that area, subject, if necessary, to some experience criterion. These certificates would be
the common base for any qualification in health and safety; the aim would be to
eliminate all duplication of certificates in order to simplify the qualification structure,
Development of occupational hygiene
TABLE 5. TRAINING STRUCTURE
13
Technician —•
entry
Graduate —»
entry
Rule-following modules >
based on individual
hazards (e.g. noise, fire
toxic metals, machinery
dangers, etc.) (c.f. Table 4)
Problem-solving courses >
(including illustrative
rule-following elements)
Common core plus
specializations (e.g.
occupational hygiene,
environmental pollution,
risk assessment, etc.)
Groups of related •
P.
Certs, plus
experience
1
Bridging courses
1
Planned experience •
Technician
grades
Professional
grades
avoid confusion and encourage courses which would bring together people from
different backgrounds for common training. This level would be an extension of the
existing BERBOH Preliminary Certificates into the other areas of
the
field, and would
encompass the Ordinary level and much of
the
Higher level examination of National
Examining Board in Occupational Safety and Health (NEBOSH), the Occupational
Health Nursing Certificate
(OHNC)
and much of the taught part of the Associate of the
Faculty of Occupational Medicine (AFOM).
(2) Additional Certificates, similar to the current BERBOH Certificate of
Operational Competence, would be issued when an individual had passed a particular
group of related modules and attained adequate experience. These could, at the
discretion of the professional bodies in consultation with the relevant industries and
with the
HSE,
be
attuned to particular industries or
classes
of problem, e.g. chemical or
construction industries. These certificates would be grounded in the rule-following
level but would also recognize the introduction of concepts generalizable across the
group of modules.
(3)
A
second level of courses with common core modules and specializations would
be aimed specifically at problem solving. The common core modules would cover the
range of problem-solving techniques appropriate across all divisions of the field,
including standard setting, risk assessment and monitoring techniques, legislative and
management techniques. This level would be the equivalent of the existing graduate
and post-graduate level courses and the BERBOH Diploma of Professional
Competence. The specializations would contain training at the two levels of detail
(appreciation and comprehensive knowledge), such that practitioners wishing to
specialize in certain parts of the
field
could still acquire the necessary appreciation of
the breadth of subjects encompassed by the other areas of the
field.
Thus, occupational
hygienists would place a major emphasis on epidemiology and hygiene-survey
techniques but could take appreciation courses in techniques of fault-tree analysis and
other hazard-assessment techniques, while the emphasis would be reversed for safety
technologists. Both would require the same level of knowledge in management and
organizational studies.
The
structure would offer
the
possibility of two
levels
of entry, for
the
technician and
the graduate. The technician would start with the rule-following modules and, if
14 A. R. HALE, M. PINEY AND R. J. ALESBURY
appropriate, graduate to the problem-solving
ones.
The mix
of modules taken would be
determined by the needs of
the
employer and the career aspirations of the technician.
Graduate entry would be into courses having main concentration on the problem-
solving
modules,
but also containing a judicious selection of
the
rule-following modules
to leaven and give a practical basis to the course. This would provide the necessary
accelerated training for the future leaders of the professions without leaving them
vulnerable to the criticism that they were out of touch with the grass roots of the
subject.
The common base level and subsequent specialization would both require and
promote collaboration between the existing professional bodies. They would need to
adopt a common approach to the specification of objectives for the development of
teaching modules, although their autonomy could be retained through an agreed
allocation of responsibility for particular parts of the structure on behalf of all those
active in the field. Thus, hygienists could be responsible for all modules relating to the
environmental assessment and control of health hazards, safety practitioners could
look after those dealing with physical safeguards, occupational physicians those on
epidemiology, health care, etc., nurses those on health counselling
etc.
The inclusion of
so many groups could present a formidable problem of coordination to avoid conflicts
and special pleading, but we consider that the pay-off in a coherent, publicly
comprehensible structure would outweigh the short-term difficulties.
We see this structure providing the necessary strength of numbers and community
of purpose to unify the efforts of the various groups working in the field. It would also
provide the flexibility for individuals to progress both vertically and horizontally
through the matrix as occasion demanded, giving the sort of career structure that
would attract a high calibre of professional. It would give the field as a whole the
flexibility to adapt to changing technology and societal priorities by adding to or
subtracting from the list of modules offered. Educational establishments, in particular,
could develop innovative modules in new areas, which could be offered to the
consortium of professional bodies for approval or to the market-place for its
judgement.
Theoretical knowledge and operational competence
A further aspect which needs to be incorporated in any scheme is the relationship
between theoretical knowledge and the ability to put that knowledge into practice in
the real world, i.e. operational competence. At both rule-following and problem-
solving levels both must be present. Rules concerned with the use of measuring and
monitoring equipment
in
work environments cannot
be
learned solely
in
the classroom
(nor indeed solely in the practical laboratory). Techniques of survey planning,
industrial relations and the techniques of persuasive communication to convince
management of a course of action to be taken require both theoretical and operational
competence. Any system of certification of competence must grapple with the
assessment of competence in the practical application of the theoretical knowledge.
This can be tested to an extent by written or oral examination, either in response to
specific questions or in the form of a dissertation or project. These assessment
techniques are at present seriously lacking
in
the NEBOSH examination structure, but
present to some degree in BERBOH, OHNC and AFOM. However, even these
methods do not assess experience
well.
Performance 'on the
job'
is
more normally, and
Development
of
occupational hygiene
15
better, coped with
by the
completion
of a
period
of
'apprenticeship'
or
'internship'
under
the
tutelage
of a
competent professional. Professions such
as
medicine
or
engineering rely upon
a
report by
a
qualified supervisor
on
satisfactory completion of
the time served under that person's supervision. Where, as
in
the case of occupational
hygiene, the professionals are scattered thinly among employing organizations, there
is
a need
to
resort
to
more formal
means.
We suggest that the use of a formal logbook of
activities undertaken, coupled with formal assessment of a sample of reports submitted
to
the
appointed supervisor, would
be a
workable compromise.
Administration
In the administration of the structure proposed
one
of
the
most delicate and difficult
tasks would be the definition of
the
roles of the various parties concerned, notably
the
professional bodies
and the
educational establishments.
The
broad lines
of
demarca-
tion which
are
suggested
are
that
the
professional bodies should
be
responsible
for
establishing the task objectives which must
be
met by the graduates of
the
system
and
for grouping modules into Certificates of Operational Competence, which make sense
for the
'clients'
(industry),
as recognized qualifications. The educational establishments
are
the
experts
in how
training
and
education should
be
organized
to
achieve
educational objectives
and how
competence should
be
assessed against those
educational objectives.
The two
meet
and
must cooperate
in the
translation
of
task
objectives into educational objectives, and the translation of assessment on educational
objectives into assessment
of
professional competence.
In providing the motive power
to get
such collaboration under way
and to
ensure
that
the
whole structure
is
coordinated efficiently, there
is a
clear role
for the Co-
ordinating Committee
for
Professional Occupational Health
and
Safety Organiza-
tions.
It
would
be at
that level that
the
Health
and
Safety Executive could most
fruitfully play a mediative role in linking
the
structure to the requirements
in
legislation
for competent
persons to
carry out defined
tasks.
This
role is
particularly relevant
to
the
introduction
of
such regulations
as
those proposed governing
the
Control
of
Substances Hazardous
to
Health (COSHH).
CONCLUSIONS
In
the
late 1950s
and
mid-1960s
the
BOHS
and
various authors recognized
the
requirement
to
educate employers, trades unions
and the
public
to the
need
for
occupational hygiene
(BOHS,
1959,1965;
HICKISH,
1965;
MURRAY,
1965)
and
as
early
as 1961 there was discussion
of
the possible syllabus of
courses.
It
was perceived that
there
was
a need for national publicity and for the state to provide
a
subsidy
in
one form
or another
to
stimulate the demand
for
the subject. We have argued
in
this paper that
the
field
of occupational health and safety has progressed significantly along
the
road of
professionalization since then, notably
in the
recognition
by
influential bodies
of
the
need
for
expertise and
in
the coherence of the knowledge base which underpins it.
The
demand so earnestly sought
for
in the 1960s has been largely created, although largely
by forces outside
the
health
and
safety professions.
The main problem still remaining
is the
confused perceptions which influential
bodies, including industry, have of the sort of experts they
require.
This
is
produced by
the
fragmentation and overlaps between the main aspiring professional
species.
For the
16 A. R. HALE, M. PINEY AND R. J. ALESBURY
occupational hygiene species in particular the major obstacles are the relatively small
numbers identified
as
belonging to
the
profession and the large numbers who practise it
in some form or other without any reference to or membership of either
BOHS
or IOH.
If the coherent problem-solving
view
of the
field
is
to
prevail,
it must
be
sold to industry,
to counter the fragmented view which it is in the interest of the traditional medical,
scientific and engineering professions to promote. This necessitates an imaginative,
outward looking and collaborative viewpoint in order to overcome the shortage of
numbers currently in the professional bodies.
The COSHH Regulations provide a time of opportunity for the hygienist but also
one of potential danger. If competence under the regulations
is
specified not in terms of
the comprehensive problem-solving approach appropriate to the hygienist but in terms
of
the
discrete and separable skills and tasks of diagnosis, measurement and design of
control strategies, the 'older' professional species of engineering, chemistry and
medicine will be able to lay greater claim to the respective parts of those discrete skills
than the hygienist and would succeed, yet again, in imposing their fragmented
perception of the subject onto the field.
In this paper it was proposed that the solution to the obstacles both for the
field
as a
whole and for occupational hygiene
lies
in
a
common base of training and qualification
modelled on the existing BERBOH Preliminary Certificates, but extended to
encompass the whole
field
of health and safety and accepted by all professional bodies.
This would provide the
flexibility,
coherence and simplification which could well gain
the acceptance
by
employers'
organizations of the
final
stage in professionalization, the
linking of qualifications to reserved tasks or occupations.
Only with such collaboration can
we see
the species 'occupational hygienist' finding
and controlling its proper ecological niche which otherwise will be dominated
numerically by less specialized groups and by the older, traditionally more powerful,
professional species of medicine and engineering. The crucial difference between the
biological and the professional species is that the latter can be conscious of the
evolutionary process of which it is a part and which will determine its destiny. It can
consider the environment in which it operates and identify advantageous adaptations
and fertile niches through which it can expand or consolidate its position. We believe
that hygiene, with its integrated approach to control, is objectively the best qualified
occupant of an important and sizeable niche in the occupational health and safety
environment and we would hope that the outcome of such a collaboration with other
like-minded groups would be the enhancement of the standing and understanding of
the contribution of occupational hygiene. It
is
hoped that this paper
is
a contribution to
that process.
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