Occupational Safety and Health professionals’ work ability concept perception,and comprehension of regulations

1 Introduction

Workers in the cleaning sector are reported to have high incidences of dermatitis and rhinitis conditions which lead to these workers falling out of the workforce [1–3]. In one review of epidemiological studies, it was reported that among 35 studies, respiratory diseases (n = 17) and dermatologic diseases (n = 9) were the most common, and these were associated with exposure to cleaning agents, wet work, and rubber latex [4]. Cleaning companies in Norway are required to have an affiliation with the occupational health services (OHS). The OHS are independent, non-governmental establishments tasked with conducting workplace preventive interventions [5]. In Norway, the OHS can be either “internal” where the OSH personnel are a part and parcel of individual companies they serve, or “external” where services come from contracted OHS companies [6]. The external OHS can be put into freestanding i.e. one single unit, or as a chain of units. The work of OHSs serves to protect the health and well-being of workers, to promote work ability, and to prevent ill health and accidents [7]. Their duties include supporting employers in workplace risk assessment, workers’ safety training, and health controls. However, OHS are not duty-holders; they only serve as an advisory body to employers, workers and their representatives. This study focuses on work ability.

Over the years, significant efforts have been made to bring into use work ability as an occupational health research concept [8]. For OHS, promoting work ability starts with a familiarity with, and proper comprehension of what the concept work ability entails. Ilmarinen [9] defined the concept of work ability as the capacity of a worker to manage his/her job in terms of health and mental resources. Although this definition is short and not very elaborate, it is conceptualised in this study as the benchmark definition due to its simplicity, brevity and clarity of purpose. In an earlier study, Ilmarinen et al. [10] reported that work-related physical and psychosocial factors and an individual’s personal characteristics have a clear effect on work ability. Further, Moschhäuser and Sochert [11] pointed out that work ability is a result of the interaction of general company and objective working conditions (e.g. physical strain); social environment (e.g. work colleagues); individual competencies; and individual’s physical and mental health statuses. Such assessments render a proper comprehension of the work ability construct vital.

In Norwegian, the construct work ability is a compound word. This may explain difficulties in understanding the construct. Norwegian generally tends to make such constructions with compound words have predefined meanings, their meanings change when the intermingling words part. This phenomenon is obvious in work environment regulations in Norway; one of the shortest comprises 22 B5-pages. In this short regulation, there are many compound-constructs [12] such as one meaning either “safety precaution” or “security precaution” in compound form, but “safety consideration” when in non-compound form. Another such example is the ordinary construct, “commonplace” implying “ordinary/not unusual” in contrast to “common place” which denotes a physical sense. The Organisation of Economic Co-operation and Development (OECD) attests to low compliance with regulations on average, a plausible explanation has been the degree of comprehension of the regulations [13]. Understanding regulations is important; but, as the size and complexity of the regulations increases, it is irrational to assume that duty-holders understand regulations in their entirety [13].

It is quite normal that circumstances of implementation of regulatory requirements may differ from one workplace to another, and hence different strategies may apply. However, correct interventional measures depend greatly on the similar understanding of the concepts by employers and by the safety advisors. Where the understanding is not entirely correct or is inadequate, the shortcoming may affect both the extent and how the measures are put in place. This is important to factor in because it is the case in many cleaning companies that workers, including most of the supervisors and other practitioners, are immigrants with low educational backgrounds and little competence of their host nation’s language [14]. With the reported rising of the prevalence of work-related ailments among cleaning workers [1–3], promotion of work ability in the cleaning sector is thus increasingly essential.

Since 2010, all OHS in Norway have had to meet certain requirements laid down by the Labour Inspection Authority before being granted approval for operating. The objective of the approval process is to ensure similar standards among the services. Factors such as experience, training, competence and point of reference influence the occupational safety and health (OSH) professionals’ understanding and interpretation of the concepts in the regulations. Hulshof et al. reported a varying picture of the evidence of the effectiveness of OHS, and that there is need for justification of the effectiveness of the services [15]. Correct understanding of the requirements of the OSH regulations is a prerequisite for effective implementation. Generally, health promotion at workplaces is a common endeavour, but how effective this is, is mostly unclear [16].

With all of these things in mind, the aim of this present study is to make an evaluation of the perception of the construct of work ability among OSH professionals from approved OHS that serve cleaning companies, thereafter make a postulation of understanding regulations by those involved. The study thus gives an insight on subsequent dissimilarities in understanding concepts of different regulations, and postulates the reasons for eventual failures in fulfilment of the objectives of regulations and policies.

2 Method

An online questionnaire conducted a survey to assess OSH professionals’ perception of the concept work ability in OHS, and their involvement in implementation of work environment regulatory requirements in cleaning companies. Use of online questionnaires allows for a setting that prevents repeated responses from the same participant. The questionnaire included the following questions:

What do you understand by the concept work ability?

These questions were selected on a consultative basis with the OHS personnel on their involvement and work with cleaning companies. The first four were the most relevant for this study.

Definitions and elaborations on OSH professionals’ perception of work ability were collected and analysed for their commonalities and differences in content and frame of references. The definitions were put into two groups; the first included those that were considered as simple and not very elucidative. The inclusion criterion for this group was that a definition should contain no more than three parameters e.g. ability, health, knowledge, or any other three, but without additional descriptions/elaborations. An example of a simple definition is Ability to perform work (see Table 2). Such explanations give little elucidation on what the concept entails. In the second group, more parameters are included in the definitions, other dimensions added and have broader context than those in the first group. An example of a detailed definition is The prerequisites one has to meet the requirements and expectations put in place in occupational life, seen from one’s health, education, competence, work experience and life situation. (Table 3). The criteria classifying the groups were determined in collaboration with a labour inspection authority inspector and an occupational hygienist, both of whom have the work environment in cleaning companies as their main area of work.

Responses in these principle groups were put into subsets according to nearness or similarity of meaning. A short discussion based on the different definitions of the work ability construct is included to describe the commonality of the items of the subsets.

Responses were received from OSH professionals including occupational physicians (n = 9), nurses (13), occupational hygienists (5), safety engineers (2) and other OHS employees (15), as is shown in Table 1. Only external OHS are included here; therefore, none of the OHS was a part of the cleaning companies they serve. Among the OHS included in the study (n = 40; 20%), 29 (72.5%) were freestanding OHS units. The remaining 11 (27.5%) were part of a group/chain of units.

Analyses of perceptions and the meaning of the work ability construct as elaborated by those given in Table 1 showed varied understandings of the concept. The answers given ranged from simple explanations as The capacity to work to detailed ones as A person’s ability to get a job, or keep one despite changes in health, what the person has of resources and limitations seen in relation to what is required (in day-to-day life and occupational life), and which possibilities are available. The simple (S) and the detailed (D) explanations of the work ability construct are given in Tables 2 and 3 respectively. Table 1 also gives an indication on which side of the definition spectrum the different OSH professionals lean towards. Occupational physicians, nurses and OHS administration personnel show more inclination towards applying the simple explanations with S/D ratios of 1.25, 1.60 and 1.50 respectively. Occupational hygienists and other such therapist, on the other hand, had a little more of the detailed explanations with an S/D ratio of 0.67.

From the definitions in both Tables 2 and 3, various aspects are introduced as guiding principles. These principles include the more standard physical and mental capacity, health, disorders and reduced work capacity. Less conventional factors applied include the willingness of workers to take-up work, expectations by employers and the professional fraternity, willingness of employers to pay for the work the employees perform and the level of sickness absenteeism. Included among the detailed explanations were additional factors such as one’s life situation as a determinant of work ability.

In some cases, differences emerge when a specific term is elaborated. Capacity, for example is explained as “capacity to do physical work” in one case, and as “capacity to do all kinds of work” is used in another. In yet another case, capacity is “measured against what is fundamental for the position or expectation to perform work.” Such differences further increase the breadth of understanding.

On the training of workers, 43.5% indicated that they are involved in the training of workers, while 34.8% only gave advice and supplied training materials to the employers, but do not conduct training. The remaining 21.7% are not involved in workers’ training at all. Variations in the understanding of the concept in question would therefore affect the training the workers may receive.

In general, physical and mental ability, capacity to work, health, skills and competence were the more frequently used terms in the explanations. Seldom used terms included expectations, disorders, sick leave, willingness to work, and employers’ willingness to pay for.

4 Discussion

The elaborations of the concept given were viewed as the understanding of the individual OSH professionals who answered the survey questions and not as the official definition of the OHS. As is apparent from the results, there is clearly a wide spectrum of the understanding of the concept among the OSH professionals. In assessing the definitions, where several definitions had similar meaning and were similarly worded, only one such definition was included in Tables 2 and 3.

The basis for the use of the benchmarked definition, in addition to that mentioned earlier, lies in Ilmarinen’s involvement in the establishment, validation and application of the work ability index, a tool used for measuring work ability [17]. Unquestionably, the bases for work ability are health and mental resources as indicated in the definition by Ilmarinen [9]. The essence of the concept of work ability as determined by Ilmarinen [9] and Moschhäuser and Sochert [11] is perspicuously broader than a simple “capacity” or “ability to perform work”. It is therefore problematic to view work ability in a simplistic manner as a number of the respondents in this study did. Many of the simple definitions given in Table 2 clearly fall short of the contemplated application of the work ability construct. The differences emanate undoubtedly from the experiences of the OSH professionals, the type of training one has had, and from the needs of the clients. As for the detailed views (see Table 3), additional aspects, such as one’s life situation and willingness of the employer to pay for the work done, are superfluous and can derail the significance and usefulness of the concept application. The disparities indicate the non-uniformity of purpose on application of the concept, which is pertinent to the working of the OHS.

A number of respondents had physical and mental health and capacity as the main defining aspects of work ability, hence coming closer to the definition by Ilmarinen [9], and the framework provided by Moschhäuser and Sochert [11]. Other aspects brought forward included competences/skills of the worker, a willingness by the worker to perform the work assigned, disorder and reduced capacity of the workers. In some of the responses, the definitions were angled from the employers’ perspective. At least one respondent included an employers’ willingness to pay a salary for the assignment the worker does as premise of work ability. All of these further highlight on the variations of the understanding of the construct and give a picture of how diversely, and in some cases divergently, the OSH professionals would work with the workers.

There are instances where work ability is associated with work performance during sickness or injuries. Lower performance level is expected and is a normal consequence during sickness/injuries or disorders. Where sickness/injury and disorders are defining factors of work ability, it can be deduced that one makes a comparison between the healthy and the sick/injured.

A majority in the study (78.3%) indicated that they are involved in some way in the training of workers. When Willingness, skills, knowledge to perform an assignment is the preferred work ability definition, two possible strategies become evident. Where one considers competence and skills as comprising the most essential premise for work ability promotion, focusing on vocational or in-service workers’ training with direct interactive teaching, demonstration, modelling and simulation to increase the knowledge and skills of the workers would be considered the correct and most befitting intervention [18]. In the case where workers’ willingness to work is the driving force, then motivation, probably through coaching, setting goals for performance coincident with learning objectives, giving feedback on progress, and behavioural change, may be the more appropriate approach [19]. Disorders, sickness and reduced capacity as the main criteria would necessitate rehabilitation and follow-up of the workers. When other external factors such as one’s life situation are used, much broader social interventions may be necessary as a way of promoting work ability. Floderus et al. [20] identifies the defining aspects of “life situation” as social activities, personal relationships, lifestyle, psychological well-being, self-perception, markers of alienation and guilty conscience. Identifying life situation as a determinant of work ability gives dimensions surpassing the boundaries of OSH professionals’ competences. The more encompassing the premise is the more challenges promotion of work ability will entail. Accommodating such a wide range of needs will put pressure on the OHS making “treating the company”, as formulated by Schmidt et al. [21], the most pragmatic approach, thereby reducing the significance of the needs of the individual employee. However, this would be greatly disadvantageous for the workers and their safety paradigm development as employees may have different needs.

Similarly, as is discussed above, a complete and uniform comprehension of several constructs in the different work environment regulations can raise great implementation challenges when the provisions of the regulations are presented, and are understood in a non-elaborative, simplistic manner. As is seen in work ability elaboration by Moschhäuser and Sochert [11], other influencing factors not necessarily directly read from the constructs of the regulation concepts can be the key to understanding the regulations and the objectives therein.

Extending this discussion of the understanding of the work ability concept to the understanding of OSH regulations, a myriad of implementation approaches based on what one understands of the concepts in the regulation becomes an unavoidable reality. This makes implementation of the provisions in which the concepts are embedded arduous for the employers, the OSH professionals and the regulators. The intention of the provisions of the regulations is to serve a specific purpose and achieve a certain desired outcome [22]. The provisions assume a kind of a vision that requires objective knowledge of some “failure” that can be countered with a pertinent instrument [22]. This vision, however, maybe altogether not attainable when the understanding of the advisors varies considerably, as is seen in the comprehensions of the simple and detailed definitions given above. On the one hand, large companies with sufficient resources can readily implement broader paradigms for promoting work ability as presented by the safety advisors, based on their understanding. With their limited resources, smaller companies, on the other hand, may prefer the simple approach on work ability promotion, based on simple definitions such as Ability to perform every type of work, and How much one manages to work; definitions that are individual-worker based. Further, employer-based definitions of work ability promotion such as Ability an employee has to meet employers’/occupational expectations and demands with abilities, skills, competence one has may not be completely agreeable to the small companies. Most of the simple definitions require little or no input from the employer and make the work ability promotion the responsibility of workers. As for the more detailed definitions, where issues such as competence/skills, workplace adjustments due to employees’ disorders and injuries come into perspective, employers’ self and financial involvements are required. One can easily conclude here on which path the company will take in putting in place work ability promotion measures. The same assessment applies when it comes to implementing the requirement of provisions of regulations. Moreover, there are no elaborate mechanisms other than short commentaries in the regulations and, to some little extent, guidance from enforcers to ensure uniform comprehension of the different constructs and concepts in the majority of regulations. In many cases, legal expertise may be necessary in order to fully understand the intended requirement in legal provisions.

The fact that this study, to all appearances, has investigated perceptions in one country, in a narrow European cultural context and focused only on one sector, may be considered a limitation in terms of a wider international applicability and relevance. However, the understanding of the concepts of OSH regulations has universal significance and goes beyond the confines of a specific geographic zone and culture. In countries where OSH and other legislations are in languages other than the native languages, or in countries with multiple national languages, complete understanding of constructs of regulations by workers and their supervisors, may not be an obvious certainty. Furthermore, there are reports showing that other non-European countries use Work Ability Index (WAI) to gather reference data for maintenance of work ability [23–27]. Moreover, the WAI is available in at least 28 languages including several non-European ones [28], indicating a wider international application of the work ability concept.

Another limitation could be the seemingly small number of respondents. Nevertheless, the number of respondents should be considered as ample bearing in mind that OHS have rather broad clients’ portfolios, and the focus of this study was narrowed to only those serving cleaning companies. Another thing to consider is that the questionnaire was sent to OHSs, and not directly to OSH professionals, thus reducing the participants’ pool. One OSH professional from each OHS was expected to respond, despite the presence of several professionals in the same service. And for the chain OHSs, the questionnaire was only sent to the central unit, locking out many other potential respondents in the other units. These are all systemic limitations relating to Norway as a country. The results are nonetheless a reasonably good indication of the general situation as the OHSs are expectedly similar in their practice in the light of the required approval. The larger part of the responses lacked essential aspects and/or deviated from the construed standard definition.

5 Conclusion

The work ability construct is defined and explained rather disparately by different OSH professionals. Some have a simple and straightforward approach, while others opt for more encompassing and elaborative definitions. Varied understandings lead to different paths, which in turn lead to dispersive occupational health assessment. Similarly, differences in the understanding of the concepts and construct in a given regulation are tantamount to differences in implementation of the requirements of the provisions of that regulation.

The different approaches the different OHS may commission to those they serve based on the understanding of OSH professional in question could lead to failure in the fulfilment of the objectives of the provisions of the regulation set in focus. It is therefore important to have an apparatus to help streamline and improve the understanding of the regulation by OSH professionals in order to ensure uniformity of purpose and hence fulfilment of the vision of the regulation.

Conflict of interest

The author has no conflict of interest to report.