HEALTH MANAGEMENT SYSTEM

HEALTH MANAGEMENT SYSTEM Health management - Guidelines for ship-owners Søfartens Arbejdsmiljøråd Seahealth Denmark

Contents Foreword 3 1 General 4 2 Health policy 7 3 Company responsibilities and authority 8 4 Designated Person (DP) 9 5 The master s responsibilities and authority 9 6 Resources and personnel 10 7 Drawing up plans and procedures 11 8 Emergency planning 12 9 Reporting and investigations 13 10 Maintenance of the vessel and equipment 13 11 Documentation 13 12 Verification, review and assessment 14 Seahealth Denmark 2008, Copenhagen. All rights reserved. Developed in cooperation with Force Technology. This is a preliminary edition. Any comment or proposal is welcome, please contact us. Søfartens Arbejdsmiljøråd Amaliegade 33 B, 2. sal 1256 København K Tlf. 33 11 18 33 Email info@seahealth.dk Web www.seahealth.dk ISBN: 978-87-88496-27-7 2

Foreword Where should we intervene? What action should we take? And how? Health management is about systemising the health promotion process. Public and private sector workplaces are increasingly focusing on employee health and well-being. Many companies in the Danish commercial sector have nowadays introduced various forms of rules, schemes or offerings to promote health but efforts are often fragmented. Workplace health promotion requires a clear commitment from senior management and a system that can support a targeted, ongoing health promotion process. These guidelines have been drawn up so as to guide ship-owners in how they can set up a health management system. This document has been structured in line with the ISM Code so as to avoid the introduction of new management systems in parallel and to create the possibility of integrating health promotion in the company's Safety Management System (SMS). SMS is a well known management system in the shipping sector and is thus an ideal system for a dedicated health promotion service. A good health management system builds on the motivation and backup from management, involvement of employees in the process and an ongoing focus on the process of health promotion so as to generate motivation and promote a culture of health in the workplace. This document is not an official standard but constitutes guidelines drawn up on the basis of knowledge and working practice in the area of health promotion. Health management - Why? There are human, safety and financial incentives for looking into the area of health, both as regards individual employees and the workplace. Risk factors such as physical inactivity, unhealthy diet, smoking and a mentally demanding working environment are associated with poor health, shorter lives and more sick leave. Health promotion in the workplace can among other things contribute to: Increasing health and well-being and mean greater job satisfaction for individuals and greater input from them. Creating a healthy, safe working environment Reducing sick leave Attracting and retaining new employees Enhancing the company's image 3

1 GENERAL 1.1 Concepts and definitions This standard contains the following concepts and definitions: 1 DASE Designated Person Health profile Health promotion Health management -system Lifestyle Organisation Prevention Risk factors SMS Diet, Alcohol, Smoking and Exercise. A person ashore appointed by the ship-owner with responsibilities and authority as outlined in Section 4. A description of the health status of a person, group or a company at any given time. Health-related activity that seeks to promote the health of individuals by creating the framework and possibility of mobilizing the resources of individuals and their ability to act. That part of the company's SMS used to develop and implement health policy and to manage health conditions. Behaviour that in time affects the health of the individual. The owner of the ship or any other organization or person such as the manager, or the bareboat charterer, who has assumed the responsibility for operation of the ship from the ship-owner. Health-related activities intended to prevent illness, psychosocial problems or accidents arising and developing. Factors that increase the probability of illness, psychosocial problems or accidents. Safety Management System 1 The definitions of the concepts are also based on the Danish Board of Health's publication: "Terminology - prevention, health promotion and public health" and the ISM Code. 4

1.2 Purpose and scope These guidelines are intended to provide guidance for ship-owners wishing to take a systematic, structured approach to health promotion in the shipping sector. The overall purpose of the guidelines is to contribute to the prevention of health problems and risks and to promote health in the workplace. The management system must ensure: That the work done on health promotion is integrated into the company's routine operations Compliance with legislation and regulatory requirements Compliance with the other requirements or guidelines to which the organization may have signed up Current national regulatory and legislative requirements in the field of health include for example: Act amending the Safety at Sea Act and the Seamen's Act (Act No. 547 of 08.06.2006) Smoke-free Environment Act (Act No. 512 of 06.06.2007) Statutory Instrument on Medical Examinations for Mariners and Fishermen (SI No. 438 of 06.06.2005) Statutory Instrument on Duty Hours for Mariners, etc. (SI No. 515 of 21.06.2002) Act on the Use of Health Data etc., in the Labour Market (Act No. 286 of 24.04.1996) i. Personal Data Processing Act. Other external requirements might for example be customer requirements or best practice. The following guidelines are listed by way of example: TMSA (Tanker Management Self Assessment) OCIMF (Oil Companies International Marine Forum) The document may be used by all types of organisation. It provides guidance to ship-owners wishing to develop, implement and maintain a health management system that includes the following: Initial identification process Health policy Objectives, targets and action plans for the health promotion process. Well-defined roles and areas of responsibility Documentation and reporting procedures Crisis management systems Assessment, control and management review procedures 5

Management review Initial identification process Health policy Plans & procedures Implementation Assessment 1.3 Initial mapping process Status and starting point where are we now? The company could consider an initial mapping process to provide an overview of existing activities and/or significant health problems/risks in the organisation. The initial mapping process could consider: Mapping existing policies, activities, systems and reporting. The aim is to gain an overview of the company's current health activities, including: What are our policies (in the areas of lifestyle/dase, occupational health and CSR)? What action have we taken in the area of health (targeted at whom and why)? What do we register (sick leave, job satisfaction etc.)? And what do we report? To whom? Mapping significant health problems/risks in the organisation The aim is to home in on important health problems/risks in the organisation that the management system should address. Mapping should be based on what is currently known at the individual level (such as repeated problems in getting medical certificates renewed), at the organisational level (such as registrations of sick leave or time off-duty, results of well-being surveys, etc.) or the sector level (such as statistics or research-based knowledge of the sector's most significant health problems). Health problems identified in the mapping process should not define the actual health policy since this might make it too narrow. But for some organisations, an initial mapping can help in addressing health in general and also identify significant health problems/risks in the organisation. There should be a written report on the initial mapping process. 6

Specifying the concept of health It is essential early on in the process to consider the concept of "health". How do we understand and delimit the concept? And as a result, what should we be focusing on in our healthcare policy? Should we focus on the part of health promotion that relates to risk factors associated with the lifestyles of individuals (DASE) and/or focus more broadly on a range of occupational health areas such as sleep/off-duty time, well-being, stress and the mental impact of work? We could also opt for an integrated approach, for example by identifying healthcare factors associated with various work operations. What characterizes for example the working conditions for deck watch officers and how in focusing on the individual and the working environment, can we promote health for and within this group of employees? In identifying the concept of health, it is important to be aware of what is not being included. Focusing on one area may be at the expense of other significant health problems, which could have a real impact on outcomes and impacts. It might for example turn out to be difficult to get employees to change their lifestyles if the working environment and conditions are generally poor. 2 Health policy What do we want to achieve? What are our overall objectives? The health policy specifies how the company wishes to work towards the objectives outlined in Sec. 1.2. The policy lays down the overall objectives, framework and guidelines for the health promotion process in the organization. The policy should: Be approved and drawn up by senior management Be appropriate with respect to the most important health problems in the organization Express the overall objectives of health promotion in the workplace Include an obligation to work to improve health standards Be documented, implemented and updated Be drawn up with the involvement of employee representatives Be communicated to all employees Be reviewed at suitable intervals 7

Health policy The health policy may act as an umbrella for a whole range of sub-policies and activities which together help support the overall objectives. As illustrated in the figure below, the scope of the health policy can embrace a range of areas associated with lifestyle, working environment and social responsibility. Health policy Lifestyle Diet, smoking, alcohol, exercise, etc. Working environment Terms and conditions of work, wellbeing, stress, sleep, etc. Social responsibility Sick leave, retention, special considerations, etc. Health policies may have various levels of ambition, ranging from ensuring compliance with the law (for example with respect to smoking and alcohol ) to a more ambitious objective of "promoting the development of a healthy workplace which provides job satisfaction and the opportunity for a healthy lifestyle" to individual employees. 3 Company responsibilities and authority - Who does what? Structure and responsibilities The company should define and document roles, responsibilities and relationships between the personnel who manage, perform or verify the work being done on health promotion. The company should designate a management representative to be responsible for ensuring that the health management system is implemented and maintained. The designated management representative should report to senior management. The company is responsible for ensuring that sufficient resources and support are given to the designated management representative to enable him/her to do the job. Such resources would include Human Resources and specific competencies, infrastructure and financial resources. Law and regulatory requirements The company should establish and maintain procedures for identifying and assessing legal and regulatory requirements to which the organisation is subject and other external requirements to which the organisation has signed up. 8

Consideration should be given to these requirements when setting up, implementing and maintaining a health management system. Employees should receive relevant information about the law and regulatory requirements. Stakeholders and communication The company should decide whether it wishes for external communication about health promotion and if so how. Shorebased organigram President Management representative DP 4 Designated Person (DP) In order to ensure that the process of health promotion is implemented aboard and to ensure clear lines of communication between the company's office and its vessels, the company should appoint a designated person (DP) based ashore with direct access to the appointed management representative responsible for the health management system. The DP should set up and maintain procedures to ensure that relevant information about health promotion is passed to and received from employees and other relevant players in the health management system. The designated person is responsible for: Ensuring the best possible communication between company office and vessels Supervising the work being done on health promotion aboard vessels Ensuring access to the resources and support required from company office so that health promotion can be implemented aboard vessels Carrying out any internal audits 5 The master s responsibilities and authority The company should define and document the responsibility of the master with respect to: Implementing the company's shipboard health policy, targets and action plans 9

Responsibilities and tasking associated with information and motivation of employees in the health policy process and objectives Reviewing the health management system Reporting to the company on status, progress and divergence 6 Resources and personnel The company should ensure that the master: Is up to date with the company's health maintenance system Is qualified to undertake tasking associated with the health management system Receives the resources and support required to undertake his/her duties The company should: Ensure that all vessels are manned with crew that have been declared fit for sea duty in line with national and international health requirements Ensure that all employees are aware and conscious of the health policy and its objectives and that relevant information is available in the working language aboard Set up and maintain procedures to ensure that crew involved in the health management system have sufficient understanding of legislation, policies, objectives and ethical guidelines and their roles and responsibilities respectively Ensure that employees carrying out duties as a result of the health management system have the necessary competencies to do so Ensure that external consultants undertaking health promotion duties in the organisation have the appropriate education, training or experience to do so The company should maintain a register of all personnel involved in the health promotion process. (When setting up a register, be aware of the rules in the Act on processing personal data and use of health data in the labour market, cf Sec. 1.2). Ethical guidelines How should health promotion be introduced in the workplace? And what ethical problems may need to be addressed in the process? Every workplace has its culture and approach to health promotion. As part of the process, it is important to be aware of the values that should /must direct the work involved in health promotion, including for example confidentiality, limits and respect, etc. The Labour Market Ethical Council has released a folder Ethics and Health in the Workplace (2005) that focuses on various ethical considerations associated with health promotion. 10

7 Drawing up plans and procedures Turning policy into practice Significant health problems/risks The company should establish and maintain procedures for routinely identifying and assessing health problems/risks aboard associated with one or more of the following: The health profile of the organisation Working conditions (design, equipment, machinery, air, lighting, noise, hygiene, etc.) Health problems associated with specific duties and/or sailing routes (such as very sedentary/ tough/stressful duties, jetlag, infectious disease, etc.) Occupational health in general (such as the mental working environment, time off-duty and sleep) Other relevant areas Methods for identifying and assessing health problems/risks must be documented. Methods for identifying health problems/risks Consider using one or more of the following methods/sources, for example, in identifying health problems/risks. Obligatory medicals (Blue Book) Off-duty time registration Sick leave statistics Workplace risk assessments (WRA) Well-being surveys Questionnaire-based health profiles Physiological checks (blood pressure, cholesterol, blood sugar, weight, BMI and body fat percentage, etc.) Dialogue-based sources of information Observations Statistics or research-based knowledge of the most important health problems in the sector Objectives and action plans The company should work with the designated person and employee representatives to draw up and maintain documented objectives for the health promotion process. Objectives should comply with the health policy and must insofar as possible be SMART (Specific, Measurable, Accepted, Realistic Timescale). When setting objectives, take into consideration: Legal and regulatory requirements and other external requirements to which the organisation has signed up 11

The most significant health problems/risks Financial, operational and commercial considerations The company should draw up and regularly update one or more action plans (health programs) aimed at achieving objectives and targets. Programs should cover areas of specific input, delegation of responsibility and authority, resources and timescales for achieving targets. Objectives and action plans - example based on lifestyle Obesity, physical inactivity and smoking have been identified as core health problems of the organization. In line with the overall health policy, the company's objective is to: Set up frameworks and offerings giving individual employees the option of improving their health Take special initiatives with respect to employees with a higher risk of health problems because of the duties and/or their health profiles - example based on the working environment In line with the overall health policy, the company's objective is to: Ensure that all duties should be checked from a health point of view and health promotion activities introduced where needed. Activities should be implemented with respect to actual work stations/ departments (equipment and machinery, etc.) and individual personnel (specific healthrelated measures/offerings). Ensure that objectives are anchored in action plans that lay down specific areas of action (what specific actions should be taken?), allocation of responsibility and timetables (who does what and when?), resources (what resources should be made available?) and meeting targets (how to measure progress and results?). 8 Emergency planning - How should emergencies be handled? The company should set up and maintain procedures for effectively handling all kinds of emergencies aboard, such as acute conditions or illness, personal injury, conflicts, etc., so as to avoid or limit possible harm and consequences. The company should review its emergency procedures (apparatus, systems and procedures) for dealing with crisis situations and there must be clear guidelines for assessing their effectiveness. Emergencies should be dealt with by the vessel's Safety Organisation. 12

9 Reporting and investigations - How to ensure on-going reporting? The company should set up and maintain procedures specifying responsibilities and the authority to: Handle and investigate divergences (for example, breaches of policy, guidelines and plans) Handle and investigate events or crisis situations (cases of acute conditions or illness, injury, conflicts, etc.) Implement corrective/preventative action The company should establish and maintain procedures for routinely checking and reporting on: - Health-related problems/ risks aboard - Progress in health prevention 10 Maintenance of the vessel and equipment - Are the framework and equipment in order? The company should ensure that vessels are equipped to support the health and well-being of crew. The company should set up and maintain procedures for ensuring healthy working conditions. This includes: Space management Equipment and machinery Temperature, lighting, noise and air Water and hygiene The company must ensure that: Equipment/machinery is checked at appropriate intervals Faults and deficiencies are rectified A register is kept of equipment maintenance and checks 11 Documentation - Why do we act as we do (the coherence of the system)? The organization should set up and maintain documentation and registration systems insofar as required to be able to prove its work on health promotion. Documentation could cover: Methods and overall results of the identification process Health policy, objectives, targets and action plans A description of the core elements in the health management system and how they interact A description of the scope of the management system (all or selected parts of the organization) Other documents, including registration documents, that the organization has decided are essential for ensuring effective planning, operations and management of processes. Records must be easy to read, identifiable and trackable. Retention of records should be decided on and registered and must comply with applicable legislation. 13

12 Verification, review and assessment - How does the system work? The company should set up and maintain procedures for assessing the health management system. The company should regularly (at least once a year) review the system to ensure its continuing suitability, sufficiency and effectiveness. Any need for changes to the system should be considered. The company may choose to introduce internal audits so as to assess whether the health management system has been correctly implemented and is effective with respect to compliance with health policy and objectives. The personnel undertaking internal audits should be independent of those being audited. i Act on the Use of Health Data etc., in the Labour Market (Act No. 286 of 24.04.1996). The Act sets strict limits for the use of health data by employers. The aim of the Act is to ensure that health data are not used for the purposes of discrimination. The Act differentiates between relevant /irrelevant health data and current /future health data. An employer may only ask for relevant, current information, that is ask whether an employee has or has had an illness or symptoms that would be of considerable importance for the employee's ability to work in a specific job. An employer has no right to ask for irrelevant or future health data, that is general information about an employee's health (that is not specifically relevant for a particular job ) or information about risk factors. The Act specifically states that an employer may not request, obtain, receive or use health data that could identify an employee's risk of developing or getting a disease. 14