Body@Work, Research Center for Physical Activity, Work and Health, TNO-VU University Medical Center, Amsterdam, the Netherlands.
Implement Sci. 2013 Jun 3;8:57. doi: 10.1186/1748-5908-8-57.
Continued improvements in occupational health can only be ensured if decisions regarding the implementation and continuation of occupational health and safety interventions (OHS interventions) are based on the best available evidence. To ensure that this is the case, scientific evidence should meet the needs of decision-makers. As a first step in bridging the gap between the economic evaluation literature and daily practice in occupational health, this study aimed to provide insight into the occupational health decision-making process and information needs of decision-makers.
An exploratory qualitative study was conducted with a purposeful sample of occupational health decision-makers in the Ontario healthcare sector. Eighteen in-depth interviews were conducted to explore the process by which occupational health decisions are made and the importance given to the financial implications of OHS interventions. Twenty-five structured telephone interviews were conducted to explore the sources of information used during the decision-making process, and decision-makers' knowledge on economic evaluation methods. In-depth interview data were analyzed according to the constant comparative method. For the structured telephone interviews, summary statistics were prepared.
The occupational health decision-making process generally consists of three stages: initiation stage, establishing the need for an intervention; pre-implementation stage, developing an intervention and its business case in order to receive senior management approval; and implementation and evaluation stage, implementing and evaluating an intervention. During this process, information on the financial implications of OHS interventions was found to be of great importance, especially the employer's costs and benefits. However, scientific evidence was rarely consulted, sound ex-post program evaluations were hardly ever performed, and there seemed to be a need to advance the economic evaluation skill set of decision-makers.
Financial information is particularly important at the front end of implementation decisions, and can be a key deciding factor of whether to go forward with a new OHS intervention. In addition, it appears that current practice in occupational health in the healthcare sector is not solidly grounded in evidence-based decision-making and strategies should be developed to improve this.
只有基于最佳可用证据，才能确保职业健康方面的决策得以持续改进，从而实施和持续推行职业健康和安全干预措施（职业健康干预措施）。为了确保这一点，科学证据应该满足决策者的需求。作为弥合职业健康经济学评价文献与职业健康日常实践之间差距的第一步，本研究旨在深入了解职业健康决策过程以及决策者的信息需求。
本研究采用目的抽样法，选择安大略省医疗保健部门的职业健康决策者作为研究对象，开展了一项探索性定性研究。共进行了 18 次深入访谈，以探讨职业健康决策的过程以及决策者对职业健康干预措施的经济影响的重视程度。此外，还进行了 25 次结构化电话访谈，以探讨决策者在决策过程中使用的信息来源，以及决策者对经济评价方法的了解程度。采用恒比法对深入访谈数据进行分析。对于结构化电话访谈，编制了汇总统计数据。
职业健康决策过程通常包括三个阶段：启动阶段，确定干预措施的需求；实施前阶段，制定干预措施及其商业案例，以获得高级管理层的批准；以及实施和评估阶段，实施和评估干预措施。在此过程中，发现职业健康干预措施的经济影响信息非常重要，尤其是雇主的成本和收益。但是，很少参考科学证据，几乎没有进行合理的事后方案评估，似乎需要提高决策者的经济评价技能。
财务信息在实施决策的前期尤为重要，是决定是否推行新的职业健康干预措施的关键因素之一。此外，医疗保健部门的职业健康实践似乎并非基于循证决策，应该制定相关策略加以改进。
