How To Prevent Workplace Safety Hazards

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2 Occupational Health of Health Care Workers Proceedings of the Special Session in the Annual Meeting of the Baltic Sea Network on Occupational Health and Safety 30 September 1 October 2010 Tarto, Estonia

3 The authors are alone responsible for the views expressed in the signed articles of this publication. The Finnish Institute of Occupational Health is not liable for any use that may be made of the information contained in this publication. The Finnish Institute of Occupational Health (FIOH) holds the copyright for the collective work of which the individual proceedings articles for a part. Editor Suvi Lehtinen Linguistic editing Terttu Kaustia Cover design Tuula Solasaari-Pekki Helsinki 2011 ISBN

4 Table of contents Preface i Health care workers in Europe and WHO Programmes 1 Rokho Kim, WHO Regional Office for Europe Occupational safety and health (OSH) and health care workers 5 Wiking Husberg, ILO, Moscow Office Activities for health care workers Findings of the European Survey 8 of Enterprises on New and Emerging Risks Timothy Tregenza, EU-OSHA, Bilbao Finnish activities and practices related to occupational health of 11 health care workers Marjukka Laine, Finnish Institute of Occupational Health, Finland Health care workers in Norway: A perspective from the Labour Inspection 17 Axel Wannag, Labour Inspection, Norway Occupational health of health care workers. A system approach as an 21 example of practice at the national level - experience of Poland Piotr Sakowski, Nofer Institute of Occupational Medicine, Poland Relationships between work stress, burnout and health of 25 health care workers Eda Merisalu, Mare Vähi, Karmen Männik, Kaja Põlluste, University of Tartu, Estonia New and emerging occupational risks in the public health care system of 41 the Russian Federation S.V. Grebenkov, T.G. Shimanskaya, E.V. Milutka, SPMAPS, Russian Federation Development of the occupational health and safety situation among 46 Latvian health care workers I Vanadzins, L Matisane, M Eglite, Z Martinsone, D Sprudza, M Bake Institute of Occupational Safety and Environmental Health, Riga Stradins University, Latvia

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6 Preface The Baltic Sea Network on Occupational Health and Safety (BSN), established in 1995, is a network of occupational health and safety institutions in the Baltic Sea countries. Over the years several topical issues concerning occupational health and safety have been on the agenda of the Annual Meetings of the network. In 2010, the topic was the occupational health of health care workers. This topic was chosen as a concrete response to the implementation of the WHO Global Plan of Action on Workers' Health (WHA60.26). The Baltic Sea Network Annual Meeting offers an excellent forum for experts in the sub-region to share information and experiences. The presentations made by the countries and the three International Organizations, involved in the BSN work: the WHO Regional Office for Europe, the ILO Moscow Office, and the European Agency on Safety and Health at Work, have been compiled into this publication. These presentations focussed on topics of specific interest and urgency to the specific countries; they did not have to follow a common outline. Thus, this publication offers a window to various aspects of the health and work ability of health care workers in the countries. The Baltic Sea Network on Occupational Health and Safety also collaborates closely with the Northern Dimension Partnership on Public Health and Social Well-being (NDPHS), which is a network of the Ministries of Health in the northern region. This link is fruitful in that it provides a direct channel to policy-makers and helps in furthering health and safety issues in our countries. The aim of these Proceedings is to enable all those interested in the development of working conditions and well-being of health care workers to share information and experiences. This report is also one way to gather information on health care workers' health and safety in the European sub-region for the implementation of the WHO Global Plan of Action on Workers' Health. Professor Harri Vainio, MD, PhD Director General Finnish Institute of Occupational Health i

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8 Health care workers in Europe and WHO Programmes Dr. Rokho Kim, World Health Organization Regional Office for Europe European Centre for Environment and Health, Bonn, Germany Introduction There are 59 million health care workers around the world, ranging from direct care providers to medical waste handlers. Health care workers comprise about 10% of the workforce in the European Union. Health care is a high-risk sector because of the high incidence of work-related injuries and diseases. Almost all the countries in the European Union are facing a serious lack of active health care workers. As a consequence, the proportion of younger people in the working-aged population will decrease, and the proportion of older people in the working-aged population will increase. Health care workers tend to retire earlier than workers in other sectors of the economy because of work-related stress and other occupational health risks. Occupational health and safety of health care workers in Europe The major workplace hazards in the health care sector are biological (influenza, TB, HIV, hepatitis), chemical (drugs, disinfectants, pesticides), ergonomic (lifting, transfers), stress/violence (staffing shortage, shift rotation), and physical hazards (radiation, heat, accidents) are. According to the NEXT study, a substantial proportion of nurses report having had the following occupational or work-related diseases or injuries (1): Injury due to an accident 13% (9.7% physician's diagnosis); Musculoskeletal disorders in the back, limbs or other body part 52.8% (28.7% physician's diagnosis); Cardiovascular disease 11.6% (9.1% physician's diagnosis); Respiratory disease 13.8% (9.2% physician's diagnosis); Mental disorder 18.9% (5.4% physician's diagnosis); Neurological or sensory disease 19.4% (10.5% physician's diagnosis); Digestive tract disease / condition 22.3% (11.3% physician's diagnosis); Skin disorders 27.7% (15.6% physician's diagnosis). If we recall the pyramid of the severity and frequency of occupational diseases (Fig. 1), it is obvious that there are many more unreported or unnoticed cases of dangerous exposure and sub-clinical health outcomes than reported by the NEXT Study.

9 Source: FIOH 30 years of Epidemology Sven Hernberg Symposium, ILO/SafeWork Figure 1. Pyramid of the severity and frequency of occupational diseases. WHO assessment and recommendations for preventing needle stick injuries In 2003, WHO published a report on the disease burden due to sharps injuries among health care workers (2). Three million exposures occur per year globally. As a consequence, 40% of hepatitis B, 40% of hepatitis C, and 4.4% of HIV in health care workers are due to needle stick injuries. One thousand health care workers die every year from occupational HIV, which can and should be prevented. Unfortunately, over 80% of health care workers remain unimmunized in many parts of the world, despite the 95% efficacy of HBV immunization. WHO recommends preventive measures to be introduced to the health care sector according to the order of effectiveness in Box 1. Box 1. Occupational health hierarchy of controls ranking from the most to the least effective means for preventing needle stick injuries (3) Immunizing health care workers Elimination or substitution of sharp instruments (eliminate unnecessary injections, use jet injectors, needleless IV systems, blunt suture needles) Engineering controls (safer needle devices, sharps containers) Administrative means (policies and training programmes) Work practice controls (universal precautions, no recapping, provision & placement & removal of sharps containers) Personal protective equipment (gloves, masks, gowns, etc.) 2

10 WHO Global Plan of Action on Workers Health, 2007 Following the WHO Global Strategy on Occupational Health for All (1996), the Global Plan of Action on Workers' Health was endorsed by the WHA in The WHO Member States agreed to strengthen the capacity of the ministries of health to provide leadership in activities related to workers health, to formulate and implement policies and action plans, and to stimulate intersectoral collaboration. Specific programmes should be established for promoting the occupational health of health care workers. WHO activities were specified to include global campaigns for immunization of health care workers against hepatitis B, as well as other actions addressing the priority of work-related health outcomes. Partnerships for the implementation of the WHO Global Plan of Action include ILO, ICOH, and the Global and European Network of WHO Collaborating Centres in Occupational Health. Box 2 lists the tools and resources for occupational health and safety of health care workers. Box 2. WHO tools and resources for health care workers' safety. Global Burden of Disease from sharps injuries to health care workers, Joint WHO/ILO Guidelines on health services and HIV/AIDS, June Protecting Health Care Workers Preventing Needlestick Injuries Tool Kit, 2005 (Spanish version 2006; French and Arabic coming soon) National occupational health programmes for health care workers article in Global Occupational Health Network Newsletter (GOHNET), November Joint WHO/ILO Guidelines for HIV Post-exposure Prophylaxis (PEP), 2007 Field guide for Hepatitis B immunization of health care workers and PEP, 2008 WHO/ILO Global Framework for National Occupational Health Programmes for Health Workers, 2010 WHO guidance documents on prevention and control of occupational hazards WHO has published several guidance documents useful for the prevention and control of occupational hazards affecting health care workers in collaboration with WHO collaborating centres and partners. The Protecting Workers Health Series is based on general occupational health approaches; it provides conceptual and practical guidance on various topics, including psychosocial risk factors, musculoskeletal hazards, and their prevention. For the prevention of violence at work, Joint ILO/WHO/ICN/PSI guidelines for Workplace Violence in the Health Sector are available. (4) For the prevention of biological hazards, in addition to the abovementioned Global Burden of Disease from sharps injuries to health care workers, 2003, there is tuberculosis infection control, expanding HIV care and treatment (5), 3

11 and prevention and control of epidemics and pandemics of acute respiratory diseases: WHO interim guidelines (6). Conclusion Health and safety at work is a basic human right that employers and governments should ensure for the workers. A substantial proportion of health care workers suffer from occupational or work-related diseases, or injuries due to biological, chemical, ergonomic, psychosocial and physical hazards at the workplace. Adopting the WHO Global Plan of Action on Workers Health, the governments agreed to establish specific programmes to support the occupational health of health-care workers, and WHO is carrying out global campaigns for the immunization of health care workers against hepatitis B. Guidance documents published by WHO and its partner organizations are useful in the prevention and control of occupational hazards in the health care sector. Without healthy and motivated workers in the health sector, the public health goals of the countries cannot be met. Considering the critical shortages of health personnel caused by the high turnover and early retirement in many European countries, the protection and promotion of occupational health and safety of health care workers should be a high priority in Europe. References 1. Nurses' Exit Study - Quality of life and management sustaining Working Ability in the Nursing Profession, = accessed 10 October Prüss-Üstün A, Rapiti E, Hutin Y. Environmental Burden of Disease Series, No. 3 Sharps injuries: Global burden of disease from sharps injuries to health-care workers accessed 10 October Joint ILO/WHO guidelines on health services and HIV/AIDS accessed 10 October Framework guidelines for addressing workplace violence in the health sector guidelinesen.pdf accessed 10 October WHO. Guidelines for the prevention of tuberculosis in health care facilities in resource-limited. Geneva settings accessed 10 October WHO. Infection prevention and control of epidemic- and pandemic-prone acute respiratory diseases in health care. Geneva accessed 10 October

12 Occupational safety and health (OSH) and health care workers Wiking Husberg, International Labour Ofiice, Moscow, Russian Federation Convention 149, 1977 The ILO has expressed concern regarding the working conditions of health care workers by adopting the Convention No. 149, the Nursing Personnel Convention, in Interestingly, already in 1977, the preamble notes that the present situation of nursing personnel in many countries, in which there is a shortage of qualified persons and existing staff are not always utilised to best effect, is an obstacle to the development of effective health services. This note applies to the present day situation to a great extent, even though 40 countries have ratified the Convention. The Convention requirements have been framed in cooperation with the World Health Organization (WHO). Continuing cooperation was foreseen at the time of adoption to promote and secure the application of the standard of the Convention. This cooperation has materialized on several occasions. Article 2 of the Convention highlights both the professionalism of the health care staff and, even more strongly, their working conditions, career prospects and remuneration. Article 2, clause 2: In particular, it shall take the necessary measures to provide nursing personnel with-- (a) education and training appropriate to the exercise of their functions; and (b) employment and working conditions, including career prospects and remuneration, which are likely to attract persons to the profession and retain them in it. Taking into account the continuous need for health care workers in health care facilities, special attention is paid to the conditions of employment in Article 6: Nursing personnel shall enjoy conditions at least equivalent to those of other workers in the country concerned in the following fields: (a) hours of work, including regulation and compensation of overtime, inconvenient hours and shift work; (b) weekly rest; (c) paid annual holidays; (d) educational leave; (e) maternity leave; (f) sick leave; 5

13 (g) social security. Both the preamble and Article 7 focus attention on the special need to protect the health and safety of health care workers, due to the work environment and related hazards. In addition to the direct medical hazards, health care workers are exposed to chemical, ergonomic, biological, psychosocial and physical (radiation) hazards. ILO Guidelines on OSH Management Systems (ILO-OSH 2001) International experience has shown that a coherent and systematic approach, involving worker participation, is the most cost-effective in providing safe working conditions. The modern enterprise-based occupational safety and health management systems (OSH MS) are based on open sharing of information related to working conditions and risk assessment aimed at prevention, and they operate in an atmosphere of frank social dialogue. The basis of the OSH MS is thorough risk assessment (identification of hazards, assessment of the levels of risk, priority setting and applying technical means to improve working conditions). The risk assessment should be directly aimed at improving the work environment, based on the priority of prevention, starting from the elimination of hazards, and using personal protective equipment only as the last resort (ILO OSH 2001): Prevention and control measures Hazards and risks to workers' safety and health should be identified and assessed on an ongoing basis. Preventive and protective measures should be implemented in the following order of priority: (a) eliminate the hazard/risk; (b) control the hazard/risk at source, through the use of engineering controls or organizational measures; (c) minimize the hazard/risk by the design of safe work systems, which include administrative control measures; and (d) where residual hazards/risks cannot be controlled by collective measures, the employer should provide for appropriate personal protective equipment, including clothing, at no cost, and should implement measures to ensure its use and maintenance. Information on occupational safety and health The OSH MS and risk assessment is normally managed by the safety committee at the workplace, consisting of the workers and employer's representatives. It is crucial that all participants receive relevant information about existing hazards and their potential impact on the human being. The ILO has published a variety of Codes of Practice, which describe sectorial and thematic hazards and their prevention. Such Codes and other guidelines, aimed at health care workers, are, e.g. Ambient factors in the workplace HIV/AIDS and the world of work Management of alcohol- and drug-related issues in the workplace Workplace violence in the service sector 6

14 Protection of workers confidential data Guidelines on health surveillance Mental and physical stress caused by overload, shift work, night shifts, sleeping disorders. The ILO has also developed a training package SOLVE aimed at enterprises in general to deal with the following issues; Stress, tobacco, alcohol & drugs, HIV/AIDS, violence ( ILO and WHO cooperation The ILO and WHO are cooperating on a vast variety of issues linked to the safety and health of health care workers. A summary is shown below: Blood-borne pathogens and HIV/AIDS: joint ILO/WHO guidelines on health services and HIV/AIDS; guidelines for post-exposure prophylaxis for occupational and non-occupational exposures Tuberculosis (TB): WHO/ILO guidelines for workplace TB control activities and TB control in the community Workplace Violence: Joint (ILO, WHO, PSI, ICN) Programme on Workplace Violence in the Health Sector: Framework guidelines Ionizing Radiation (under the leadership of International Atomic Energy Agency): Revision of Basic Safety Standards; Action plan for protection of workers Global Health Workforce Alliance: Jointly with IOM - migration of health workforce Joint ILO/WHO Tripartite Working Party of Experts on Occupational Health and HIV/AIDS for Health Services Workers: Geneva, July ILO Moscow has initiated cooperation between the OSH and HIV/AIDS teams, by including HIV/AIDS as one of the hazards to be considered in the development of OSH MS at enterprises. HIV contamination can be an especially high risk for health care workers and emergency workers (police, militia, fire-fighters, etc.). The modernization of occupational health services in the Russian Federation and the CIS countries is in progress, based on ILO Convention No. 161 on Occupational Health Services and utilizing the WHO/ILO joint Guidelines on Basic Occupational Health Services (BOHS). Appropriate working conditions for health care workers need to be a part of this process. References International Labour Organization. Convention No. 149, Nursing Personnel Convention, ILO-OSH Guidelines on occupational safety and health management systems,

15 Activities for health care workers Findings of the European Survey of Enterprises on New and Emerging Risks Timothy Tregenza, European Agency for Safety and Health at Work Overview Eurostat reports that 3.2% of workers in the EU had an accident at work during a one-year period, corresponding to almost 7 million workers, and 8.6% of workers in the EU-27 experienced a work-related health problem in the past 12 months, corresponding to 20 million persons. Bone, joint or muscle problems and stress, anxiety or depression were the most prevalent work-related health problems. Of all workers in the EU-27, 1.9% were off work for at least one month in the past 12 months due to their most serious work-related health problem, and the percentage of workers off work due to work-related health problems increased with age. Furthermore, 40% of workers in the EU-27 (80 million people) are exposed to factors that can adversely affect physical health and 27% of workers (56 million people) are exposed to factors that can adversely affect mental well-being. (1) A picture of occupational safety and health in health care sector In 2009, the EU-27 employed over 21.5 million people in the health and social work activities sector. (2) According to the 4 th European working conditions survey, over 10% of workers in the health care sector are over 55 years of age, and less than 10% are under 24 years. Women predominate in the sector, with 79% of workers being female the highest ratio of any sector: there is also a higher than average proportion of women s part-time jobs (above 20%). The sector demonstrates a relatively high proportion of evening and night work and shift work. Shift work appears to correlate with a greater feeling of risk at work, and a higher number of negative health outcomes. Health care workers experience the highest incidence of violence, threats of violence, and bullying/harassment of any sector. Professionals (those with more senior positions) report a high level of violence from noncolleagues, but a comparatively low level of violence from colleagues. On the other hand, associate professionals (more junior positions) are just as likely to experience violence from the people at their workplace, as from people outside the workplace. Those affected by violence or harassment at work tend to report higher levels of work-related ill-health. There is also significant exposure to biological and chemical risk factors in the sector. (3) 8

16 The European Survey of Enterprises on New and Emerging Risks (ESENER) In 2009, The European Agency for Safety and Health at Work (EU-OSHA) conducted a survey among establishments with ten or more employees in the EU-27 plus Croatia, Turkey, Norway, and Switzerland. The survey covered private and public organizations from all sectors except fishing, agriculture and forestry. the survey interviewed Over 28,500 managers and over 7000 health care and safety representatives were interviewed. The survey investigated the success factors and obstacles to effective prevention, with a focus on psychosocial risks a major concern in the health care sector. The preliminary results of the survey were published in 2010, and a secondary analysis is due for publication in In all sectors, accidents, musculoskeletal disorders (MSD), work-related stress, and dangerous substances were all reported to be of major concern. In addition, noise and vibration, violence or threat of violence, and bullying or harassment also aroused concern. However, violence or the threat of violence were a cause of special concern in the health care sector. The survey found that the involvement of line management was above average in the management of health and safety issues in the health care sector in the EU-27 countries. Furthermore, some level of risk assessment was reported in almost 90% of the establishments surveyed, regardless of the sector. The health care sector was the most active in carrying out sickness absence monitoring; nearly 60% reported such monitoring. Because psychosocial risks are prevalent in the sector, it is not surprising that the health care sector used the services of psychologists to a greater extent than the other sectors. Occupational health physicians and safety experts were also widely used in the sector in over half of the establishments. Surprisingly, ergonomics experts were used less often, in only 30% of the establishments. It was reported that labour inspectorates paid fewer than average visits to premises in the health care sector; less than 50% reported a visit from the labour inspectorate in the past three years. By far the greatest barrier to addressing occupational safety and health (OSH) issues in the health care sector was reported to be a lack of resources, e.g. time, staff or money. The health care and social sector reported psychosocial risks to be the greatest problem. In all sectors, the following psychosocial risks were reported: time pressure (57%), dealing with difficult patients, etc. (50%), poor communication between the management and employees (27%), poor co-operation between colleagues (25%), and long or irregular working hours (22%). In the health care sector, namely having to deal with difficult patients, etc. aroused most concern. Also, the health and social work sector reported that the measures for controlling psychosocial risks were mostly in order. In all sectors, training (58%), changes in work organization (40%), and the redesign of the work area (37%) had been handled quite well. In the health care sector, where preventive measures were in order, most respondents reported that the measures were very or quite effective. In contrast to dealing with OSH issues in general, the sensitivity required for dealing with 9

17 psychosocial risks was seen as much of a barrier to action as was the lack of resources. Looking at the involvement of the workers' representatives, the survey showed that employees in the health care and social work had reported the greatest number of requests to deal with violence at work, and with work-related stress. There is a high level of direct employee participation in the management of psychosocial risks in the health care and social sector. ESENER shows that both formal and informal participation of employees in the management of OSH, and in particular of psychosocial risks, pays off in terms of improved effectiveness and the use of a broader range of preventive measures. However, employee representatives reported the need for additional training, particularly in dealing with work-related stress, but also in ergonomics, and in the prevention of bullying and violence. (4) EU-OSHA an available resource The European Agency for Safety and Health at Work was established in 1996 to improve the lives of people at work by stimulating the flow of technical, scientific and economic information among all those involved in occupational safety and health issues. EU-OSHA, through its website OSHA.EUROPA.EU provides access to a wide range of materials in many languages on all aspects of prevention in the health care sector. The available material ranges from survey data, as discussed here, through practical risk assessment guidance and case studies, to training materials. All materials are available for download free of charge. References 1. Eurostat. 8.6% of workers in the EU experienced work-related health problems. Results from the Labour Force Survey 2007 ad hoc module on accidents at work and work-related health problems. Statistics in focus 63/2009. ISSN European Foundation for the Improvement of Living and Working Conditions. Employment and industrial relations in the health care sector. Accessed 13 May 2001 at 3. Parent-Thirion A, Fernández Maciás E, Hurley J, Vermeylen G. European Foundation for the Improvement of Living and Working Conditions. Fourth European Working Conditions Survey ISBN x Rial González E, Cockburn W, Irastorza X. European Agency for Safety and Health at Work. European Survey of Enterprises on New and Emerging Risks. Managing Health and Safety at Work. ISBN

18 Finnish activities and practices related to occupational health of health care workers (HWC) Marjukka Laine, Finnish Institute of Occupational Health, Finland According to the results of a national survey, the majority of the staff in the Finnish health care and social services perceive their health as good (Laine et al. 2011) (Table 1). 73% of the respondents now (which is more than five years ago) estimated that with regard to their health they will be able to cope with their job up until retirement age (Figure 1). However, health and work ability are not the only parameters for well-being at work. Developing working conditions is essential also for ensuring that professionals remain in the field, and that the branch continues to attract qualified professionals. Table 1. Perceived health and work ability of personnel in health care and social services according to a survey in Perceived health: good % Mental well-being: good % Perceived work ability: mean value (0 10) Social service sector Services for the disabled Outpatient care Mental health sector Hospitals Children's day care Supported accommodation Home care Elderly care units Health centre wards All A National Development Programme for Social Welfare and Health Care (KASTE) The KASTE programme ( ) was endorsed by the Government and launched by the Ministry of Social Affairs and Health of Finland in January 2008 ( One of the topical areas of the programme is 'Social and health care staff', the goal of which is to ensure access to health care, its adequacy and commitment of the staff by strengthening their skills and knowledge, and improving management practices and developing well-being at work. The programme is carried out through various development projects of municipalities or several municipalities together. The projects are either regionally or nationally significant, and several extensive projects have been con- 11

19 ducted since A new Kaste Programme ( ) is currently being prepared. Figure 1. Coping with one's job until retirement age with regard to health. Recent and ongoing activities of the Finnish Institute of Occupational Health The activities of the Finnish Institute of Occupational Health (FIOH) comprise research, advisory services to all developers of work life, information and training ( The successful implementation of research results plays an increasingly important role in our work. Several projects of FIOH focus on 'Health Care and Social Services'. Current and recently completed projects and other activities in this area are presented below. The working conditions and well-being of social and health care staff have been studied through national questionnaires conducted in 1992, 1999, 2005, and Each study included a sample of 5,000 persons selected from the workforce register of Statistics Finland. This cross-sectional study gives an opportunity to describe the current situation regarding different aspects of the quality of work life, as well as to follow up and compare the development trends between the years. Contact person at FIOH: Marjukka Laine (marjukka.laine@ttl.fi) 12

20 The Risk Profile of the Health Care and Social Services Sector 2010 At the request of the Ministry of Social Affairs and Health, FIOH prepared a risk profile of the Health Care and Social Services sector. The profile covers statistics and other information on staff and well-being at work during the previous years: staff numbers, age and professional distribution, occupational diseases and suspected occupational diseases, work-related injuries and exposures, and sick leaves. The most significant risk factors are described; they concern physical and mental strain as well as the work environment. Contact person at FIOH: Annika Parantainen (annika.parantainen@ttl.fi) Two large Finnish cohort studies of public sector employees. The Ten Town study and the well-being study of hospital staff have been conducted since the year They monitor the health of nearly employees in the municipal sector. The objective of these studies is to identify psychosocial risk factors among different groups of employees, to trace their causes from the psychosocial work environment through psychological processes and behaviour to disease, and to estimate the extent to which organizational measures for improving the psychosocial work environment are effective in disease prevention and health promotion. The studies use repeated surveys to measure a wide variety of psychosocial factors, healthrelated behaviour and health. Employer registers provide information on absences due to sickness, as well as the characteristics of each employee's workplace. We also check national registers for information on medication, rehabilitation, disability pensions and mortality rates. The results help us to better understand the role of psychosocial factors in the emergence and development of illnesses, and to find even more effective ways of preventing them and promoting health. Contact person at FIOH: Tuula Oksanen (tuula.oksanen@ttl.fi) Projects on hospital risk management. Employers in Finland are obligated to carry out risk assessment in order to ensure the safety and health of workers in all aspects related to work. Risk assessment is the process of hazard identification, evaluation of work-related risks, and of actions that are taken to manage those risks. However, it seems that in many health care organizations the process has failed to evoke concrete actions or to improve risk management as a whole. The Finnish Institute of Occupational Health investigated the reasons for this. The promotion of occupational health is unfortunately still very much regarded as a technical function that is not connected to the activities of the line organization. We need a wider perspective on risk management as a whole and an understanding of its influence on the quality of the basic operations. A new project, started in August 2010, investigates the connections between patient safety and work safety in Finnish hospital districts. It also aims to create a model in which these two essential areas of safety can be simultaneously handled in everyday work. Contact person at FIOH: Annika Parantainen (annika.parantainen@ttl.fi) FIOH has for long carried out research and development to improve the physical working conditions and to decrease the risk of musculoskeletal diseases of health care personnel. The current focus is on developing safety management in this area. A project to develop a physical risk control model as part of 13