2021 Volume 3 Issue 1 Article ID: 2020-0026-OA
Objectives: In Japan, as a result of legislation, the role of occupational physicians and the function of occupational health have been strengthened. Employers are now required to provide information to occupational physicians. This study explored what information occupational physicians considered should be available to them. Methods: We conducted a focus group discussion with eight professional occupational physicians and developed a draft list of the information that occupational physicians should obtain from employers. To assess the validity of the list, we conducted a questionnaire survey of 777 occupational physicians in the training and certification system of the Japan Society of Occupational Health. Results: We obtained valid responses from 155 occupational physicians. In total, over 80% agreed or somewhat agreed that all 24 categories were required, indicating that a consensus had been reached. In two of the eight categories for which fewer than 80% responded “agree”, more senior or specialized physicians were significantly more likely to respond “agree” than others. Conclusion: The results of the survey suggest specific experiences and systematic education influence decisions about whether certain types of information are considered necessary. Finally, based on the opinions in the open-ended section of the questionnaire, we recommend a list with 26 categories of information collecting from an employer. We believe the key to sharing information is to have a common understanding with employers and develop a good relationship so that additional information will be disclosed voluntarily. Occupational physicians need to be mindful of this need to develop relationships with employers.
In Japan, employers with 50 or more employees are required to appoint an occupational physician (OP) to manage the health of their employees by the Industrial Safety and Health Act. Various matters relating to employee safety and health are included in the duties of an OP, and a wide range of responsibilities are specified in the Ordinance of Industrial Safety and Health. For OPs to fulfill their expected role in responding to the changing needs of occupational health in recent years, they need an accurate understanding of the workplace. In Japan, the Industrial Safety and Health Act was amended as a part of the Act on the Improvement of Relevant Acts to Promote Reform of Working Methods, to strengthen the role of occupational physicians and the function of occupational health1). As part of this enhancement, the Act stipulated that employers should pass information to OPs.
Following amendments to the Occupational Safety and Health Act, the Ordinance of Industrial Safety and Health describe the information that employers should provide to OPs for their better understanding of the workplace. This includes “Section 1. Actions taken or planned after interviews with OPs for 1) those with health check findings, 2) those who work long hours, and 3) those with high stress levels in stress checks are conducted”, “Section 2. The names of employees whose overtime or holiday hours exceed 80 hours per month and the number of overtime hours worked by them”, and “Section 3. Information about an employee’s work that the OP believes is necessary for proper health care”. The Notice by the Director of the Labor Standards Bureau (No.0329-02, March 29, 2019)2) states that “Section 3” may cover “1) the work environment of the employee, 2) the hours worked, 3) the state of the work, 4) the status of the workload, 5) the number of times and hours of late-night work, etc.”. It also makes clear that it is desirable for the employer and the OP to discuss in advance what information the OP considers necessary for each workplace. There is no specific indication as to what information should be obtained and used for which purposes.
Under Japan’s Industrial Safety and Health Act, a licensed physician who is assigned as OP at the workplace need to have a certain level of knowledge about occupational health to manage the health of the employees. One of the ways to become certified as an OP is to undergo 50 hours of training under the governmental guidelines provided by the designated institutions by government. More than 100,000 physicians3) in Japan have already completed the training. However, many of them are not necessarily full-time occupational health professionals, but they are often engaged in other clinical practice and only work as commissioned OPs for short periods of time (e.g., half of a day per week).
The Japan Society for Occupational Health (JSOH) operates a training and certification system to develop professional OPs. In the system, they start training as a “Certified Associate Occupational Health Physician (CAOP)” after passing the basic examination, and then certified as a “Certified Occupational Health Physician (COP)” after completing the training for 3 or more years and passing the certification examination. Those completing certification are regarded as professional occupational physicians in Japan. There is also a higher level of seniority, “Certified Senior Occupational Physician (CSOP)”, which provides guidance to CAOPs. CSOP certification can only be achieved when physicians have acquired a certain level of experience as a COP. Most physicians who want to gain experience in occupational medicine as their primary profession are part of this system and take part in training to improve their skills and expertise. OPs in this system tend to build a personal network by participating in academic conferences, and therefore exchange information with other OPs. As a result, they are often able to work more effectively and meaningfully as OPs. Younger, part-time, and less experienced OPs might benefit from understanding what information is required from employers, and for what purposes, by more experienced OPs, or those who spend more time working as OPs.
We therefore conducted a survey of OPs in the JSOH’s training and certification system to find out what information is collected, to ensure that OPs will receive appropriate information from employers and can use it to support employees to manage their health.
We asked eight individuals in the COP or CSOP categories to join a focus group discussion about the information they collected as OPs. This discussion was used to develop a draft list of the information that OPs should obtain from employers. We then used a questionnaire survey to test the list among CAOPs, COPs, and CSOPs. We conducted a consensus survey of the contents of the draft information list and analyzed the differences in the responses by experience and affiliation of respondents.
The process of creating the draft list of informationOne of the researchers (RM, who is a COP) moderated a focus group discussion with eight OPs (one COP and seven CSOPs). The topics of the discussion were “What kind of information do you obtain to ensure that employees receive appropriate healthcare in your work as an occupational physician?” and “For what purpose do you obtain the information?”. Following the discussion, three researchers (two COPs and one CSOP) developed a draft list of information that occupational physicians should obtain from employers, based on the input from the discussion. Those involved in the discussion were asked to confirm the content of the draft list. Based on their input, we modified the draft (for example, added categories, changed the wording, and merged or separated categories) and created a final draft list of information containing 24 major categories to be used in the consensus study. The 24 major categories in the draft information list are listed in the results, along with the results of the consensus survey.
Questionnaire surveyFollowing the prescribed application process, we obtained the roster of OPs in the training and certification system from JSOH. In total, 777 people registered on the roster as of August 2019, including 243 CAOPs, 193 COPs, and 341 CSOPs, were invited to participate in the study.
We conducted the survey using the online survey tool Survey Monkey®. The questionnaire consisted of questions about individual characteristics, such as years of experience, gender, relevant qualifications, and current main type of employment. It also included a consensus survey on the 24 major categories in the draft information list. For each of 24 major categories, we prepared a list of specific examples of information (medium and small categories), based on views from the researchers and those involved in the initial discussions, to provide a better understanding of meaning. We enclosed the list including the medium and small categories with a letter asking people to participate in the survey and to answer the questions using the list as a reference. For each of the 24 major categories, we asked them “Do you think occupational physicians should obtain this information to enable them to deliver employees’ healthcare?” with four choices, “agree”, “somewhat agree”, “somewhat disagree”, and “disagree”. We felt that OPs’ answers might change if they answered the questions assuming a particular workplace, so we included a statement at the beginning of the response entry screen that said, “In this survey, please answer the questions based on your thoughts as an OP, not assuming activities in a particular industry or workplace”. To obtain suggestions for modifying or improving the list, we asked them to add more information in an open-ended column if they felt that more information should be obtained than the 24 categories provided.
Evaluating the results of the consensus survey and analyzing response trends by respondent attributesIn this survey, consensus was judged to have been reached in a category when at least 80% of respondents answered “agree” or “somewhat agree”. It was difficult to examine differences in the responses by respondent characteristics when the response rate for “agree” was 80% or more, so we only examined differences for categories where fewer than 80% agreed. In the categories where the response rate for “agree” was less than 80%, four characteristics were analyzed as explanatory variables: gender (male and female), years of experience as an OP, applicable qualifications (CAOP, COP, or CSOP), and current primary employment status (exclusively working as an occupational physician, others). The number of years of experience is a continuous variable, so we divided OPs into two groups. On the basis that above half of respondents have experience 9 years and more in the CSOP group, we divided them into less than 8 years’ and more than 9 years’ experience. There is a multicollinearity between years of experience as an OP and applicable qualifications. However, length of experience as an occupational physician and qualification status did not necessarily coincide, as there were respondents who had been practicing as an occupational physician for as long as 30 years but were still COPs. For this reason, we decided to treat these two factors separately.
The chi-square test was used to analyze the relationship between the percentage of respondents who answered “agree” and each characteristic, for categories with fewer than 80% of the respondents answering “agree”. We then used multiple logistic regression analysis to examine the categories that were significantly different in the chi-square test. A two-sided P value <0.05 was considered statistically significant in all analyses. All analyses were performed using Statistical Analysis System (SAS) Software Version 9.4 (SAS Institute, Cary, NC, USA).
Ethical considerationsThose who were involved in the discussion or sent the questionnaire were given written information about the research objectives, methods, and ethical considerations. The discussion participants were asked to sign a consent form for research collaboration in writing, and those who participated in the questionnaire survey were asked to click the “I agree” button on the online survey screen to confirm their willingness to participate in the research. This study was approved by the Ethics Review Committee of the University of Occupational and Environmental Health, Japan.
Among 777 OPs, we received responses from 157 (response rate, 20.2%). Two of the 157 respondents were excluded because their input was interrupted during questions about their characteristics, leaving 155 valid respondents. The characteristics of these respondents are shown in Table 1.
| Characteristic | Distribution N (%) |
|---|---|
| Experience as a doctor, years | |
| ≤10 | 28 (18.1) |
| 11–20 | 60 (38.7) |
| ≥21 | 67 (43.2) |
| Experience as an occupational physician (years) | |
| ≤8 | 43 (27.7) |
| ≥9 | 112 (72.3) |
| Qualifications certified by the Japan Society for Occupational Health | |
| CAOP, Associate Occupational Health Physician Certified by JSOH | 24 (15.5) |
| COP, Occupational Health Physician Certified by JSOH | 44 (28.4) |
| CSOP, Senior Occupational Health Physician Certified by JSOH | 87 (56.1) |
| Gender | |
| Male | 102 (65.8) |
| Female | 53 (34.2) |
| Experience as an occupational physician in a manufacturing company | |
| Yes | 147 (94.8) |
| No | 8 (5.2) |
| Experience working exclusively as an occupational physician | |
| Yes | 132 (85.2) |
| No | 23 (14.8) |
| Current main employment type | |
| Exclusively as an occupational physician | 93 (60.0) |
| A commissioned occupational physician | 50 (32.3) |
| Non-occupational physician | 12 (7.7) |
Abbreviations: JSOH, The Japan Society for Occupational Health.
Over 80% of respondents either agreed or somewhat agreed on all 24 categories, indicating that a consensus had been reached. In 18 categories, the percentage responding “agree” was over 70%, and in 10 of these categories, the percentage was over 90% (shown in Table 2).
| Category | N (%) | |||
|---|---|---|---|---|
| Agree | Somewhat agree | Somewhat disagree | Disagree | |
| Category 1: Overview and background of the company | 135 (87.1) | 20 (12.9) | 0 (0.0) | 0 (0.0) |
| Category 2: Organizational chart of the site | 140 (90.3) | 13 (8.4) | 2 (1.3) | 0 (0.0) |
| Category 3: Composition of health and safety staff (e.g., affiliation, qualifications, employment status) | 143 (92.3) | 12 (7.7) | 0 (0.0) | 0 (0.0) |
| Category 4: Composition of employees (e.g., gender, age, employment status) | 129 (83.2) | 24 (15.5) | 2 (1.3) | 0 (0.0) |
| Category 5: Situation of workers for which consideration should be given in employment | 143 (92.3) | 12 (7.7) | 0 (0.0) | 0 (0.0) |
| Category 6: The system and management of working patterns and hours, including the leave system (Contents of employment regulations and collective bargaining agreements) | 141 (91.0) | 14 (9.0) | 0 (0.0) | 0 (0.0) |
| Category 7: Health insurance associations (e.g., type, financial status, activities) | 58 (37.4) | 68 (43.9) | 26 (16.8) | 3 (1.9) |
| Category 8: Annual schedule | 119 (76.8) | 35 (22.6) | 1 (0.6) | 0 (0.0) |
| Category 9: Information on safety and health hazards (Hazardous factors) | 140 (90.3) | 15 (9.7) | 0 (0.0) | 0 (0.0) |
| Category 10: Content of the crisis management structure and system | 106 (68.4) | 44 (28.4) | 5 (3.2) | 0 (0.0) |
| Category 11: Disasters and media coverage that could have a significant impact on the business or the load on workers at the site | 95 (61.3) | 52 (33.5) | 8 (5.2) | 0 (0.0) |
| Category 12: Situation report of disasters or media coverage as described in Category 11, in case of actual occurrence | 106 (68.4) | 44 (28.4) | 5 (3.2) | 0 (0.0) |
| Category 13: Health and safety issues and risks at the site | 138 (89.0) | 15 (9.7) | 2 (1.3) | 0 (0.0) |
| Category 14: Changes in the company’s financial condition | 81 (52.3) | 65 (41.9) | 7 (4.5) | 2 (1.3) |
| Category 15: Inspections by labor standards inspectors and guidance in doing so | 123 (79.4) | 26 (16.8) | 6 (3.9) | 0 (0.0) |
| Category 16: Minutes of safety and health committee meetings | 126 (81.3) | 23 (14.8) | 6 (3.9) | 0 (0.0) |
| Category 17: Records of workplace patrols conducted by the hygiene officer | 99 (63.9) | 47 (30.3) | 9 (5.8) | 0 (0.0) |
| Category 18: Number and status of workers who are working long hours | 147 (94.8) | 7 (4.5) | 1 (0.6) | 0 (0.0) |
| Category 19: Results of general medical examination | 149 (96.1) | 5 (3.2) | 1 (0.6) | 0 (0.0) |
| Category 20: Results of special medical examinations (medical examinations for employees engaged in hazardous work) | 149 (96.1) | 5 (3.2) | 1 (0.6) | 0 (0.0) |
| Category 21: Results of “Job stress questionnaire” | 130 (83.9) | 20 (12.9) | 3 (1.9) | 2 (1.3) |
| Category 22: Results of work environment measurements (including office environment) | 146 (94.2) | 8 (5.2) | 1 (0.6) | 0 (0.0) |
| Category 23: Number of accidents and disasters and an overview of their occurrence | 138 (89.0) | 16 (10.3) | 1 (0.6) | 0 (0.0) |
| Category 24: Number of serious accidents and serious disasters, and an overview of their occurrence | 140 (90.3) | 14 (9.0) | 1 (0.6) | 0 (0.0) |
We examined differences in the eight categories (Categories 7, 8, 10, 11, 12, 14, 15, and 17) for which fewer than 80% of respondents provided the answer “agree”. The comparisons were made using four characteristics: gender, years of experience as an OP, applicable qualifications, and current primary employment status.
A chi-square test was conducted for the relationship between each characteristic and the percentage of “agree” responses. For “Category 14: Changes in the company’s financial condition”, two groups (those who currently worked exclusively as OPs, and CSOPs) were significantly more likely to select “agree”. For “Category 15: Inspections by labor standards inspectors and guidance in doing so”, both the group with 9 or more years of OP experience, and CSOPs, were significantly more likely to select “agree”. No other significant differences were found. The results are shown in Table 3.
| The eight categories in which fewer than 80% of respondents answered “agree” | Comparison of the percentage of respondents who “agree” with the category | |||||||
|---|---|---|---|---|---|---|---|---|
| Gender (Male [n=102] vs. Female [n=53]) | Experience as an occupational physician (years) (9 ≤ [n=112] vs. [n=43] ≤ 8) | Differences in qualifications (CSOP [n=87] vs. CAOP+COP [n=68]) | Current main employment type (Exclusively occupational physician [n=93] vs. Others [n=50]) | |||||
| χ-squared | p-value | χ-squared | p-value | χ-squared | p-value | χ-squared | p-value | |
| Category 7: Health insurance associations (e.g., type, financial status, activities) | 0.085 | 0.771 | 1.313 | 0.252 | 0.669 | 0.413 | 0.037 | 0.847 |
| Category 8: Annual schedule | 0.015 | 0.901 | 0.000 | 0.996 | 0.214 | 0.644 | 2.670 | 0.102 |
| Category 10: Content of a crisis management structure and system | 1.397 | 0.237 | 1.922 | 0.166 | 1.482 | 0.223 | 0.732 | 0.392 |
| Category 11: Disasters and media coverage that could have a significant impact on the business or the load on workers at the site | 0.028 | 0.866 | 0.056 | 0.812 | 1.219 | 0.270 | 0.023 | 0.880 |
| Category 12: Situation report of disasters or media coverage as described in Category 11, in case of actual occurrence | 0.008 | 0.929 | 0.052 | 0.819 | 0.272 | 0.602 | 0.732 | 0.392 |
| Category 14: Changes in the company’s financial condition | 0.331 | 0.565 | 2.579 | 0.108 | 5.963* | 0.015* | 3.836 | 0.050 |
| Category 15: Inspections by labor standards inspectors and guidance in doing so | 0.244 | 0.621 | 5.155* | 0.023* | 5.683* | 0.017* | 0.244 | 0.621 |
| Category 17: Records of workplace patrols conducted by the hygiene manager | 1.010 | 0.315 | 0.329 | 0.566 | 2.369 | 0.124 | 1.075 | 0.300 |
CAOP, Associate Occupational Health Physician Certified by Japan Society for Occupational Health; COP, Occupational Health Physician Certified by Japan Society for Occupational Health; *p<0.05
CSOP, Senior Occupational Health Physician Certified by Japan Society for Occupational Health.
Multiple logistic regression analysis of Categories 14 and 15 showed that for Category 14, a significantly higher percentage (odds ratio [OR] 3.25) of the CSOPs selected “agree” compared to the CAOPs. For Category 15, a significantly higher percentage of COPs (OR 3.25) and CSOPs (OR 4.89) selected “agree” than CAOPs (shown in Table 4). There were no other significant differences.
| Adjusted | |||
|---|---|---|---|
| OR | 95% CI | p-value | |
| Category 14: Changes in the company’s financial condition | |||
| CAOP | Reference | ||
| COP | 2.15 | 0.73 - 6.30 | 0.163 |
| CSOP | 3.25* | 1.02 - 10.36 | 0.047* |
| Category 15: Inspections by labor standards inspectors and guidance in doing so | |||
| CAOP | Reference | ||
| COP | 3.25* | 1.07 - 9.87 | 0.038* |
| CSOP | 4.89* | 1.36 - 17.53 | 0.015* |
CAOP, Associate Occupational Health Physician Certified by Japan Society for Occupational Health; CI, confidence intervals; COP, Occupational Health Physician Certified by Japan Society for Occupational Health; CSOP, Senior Occupational Health Physician Certified by Japan Society for Occupational Health; OR, odds ratios.
Adjusted for gender, years of experience as an occupational physician, and current primary employment status.
We asked for open-ended comments on whether there was any additional information that was required. We received 27 comments from 17 respondents. There were six comments suggesting two additional categories, with three respondents suggesting each. Another seven comments related to amendments or new sub-categories to the main categories, and four comments did not relate to information that should be included in this list. The remaining 10 suggestions were already included in the proposed list, although there were some differences in wording.
The first additional category was on “Managing health management information”, and comments included:
“I think you should add a provision for managing health management information.” (7 years’ experience as an OP, COP)
“Related to Category 6, I believe that we need more information about the handling rules for health information.” (13 years’ experience as an OP, CSOP)
The second additional category was “System for support of leave of absence, return to work/system for supporting an employee’s work-treatment balance”, where comments included:
“I think we need an overview of the Leave of Absence and Return to Work System.” (7 years’ experience as an OP, COP)
“Whether or not there is a manual for returning to work (e.g., an interview with an occupational physician is required before returning to work), and how many days an employee can take off sick and absent and so on.” (12 years’ experience as an OP, CSOP)
We reached a consensus on all 24 categories in the draft information list through a questionnaire survey of OPs in the training and certification system operated by JSOH. Following multiple suggestions received, it was considered that we should add two new categories, on “Managing health management information” and “System for support of leave of absence, return to work/system for supporting an employee’s work-treatment balance”. “Category 6. Systems and management of work arrangements and hours of service and leave” was originally designed to cover various schemes relating to employee work patterns, work hours, vacation, and leave of absence. However, “Managing health management information” is not a regulation or system for the treatment of employees, but a rule for employers about the handling of employees’ personal and health information. Based on the opinions expressed in the survey, it was considered that we should exclude this from Category 6 to avoid ambiguous language, and instead made it an independent category. We also considered that “System for support of leave of absence, return to work/system for supporting an employee’s work–treatment balance” needed to be an independent category because there are various regulations and systems that differ from company to company, and this is important information for OPs. Finally, we suggest a list with 26 categories of information collecting from an employer (see eTable 1).
| Categories used in the survey | Categories revised after the survey |
|---|---|
| Category 1: Overview and background of the company | Category 1: Overview and background of the company |
| Category 2: Organizational chart of the site | Category 2: Organizational chart of the site |
| Category 3: Composition of health and safety staff (e.g., affiliation, qualifications, employment status) | Category 3: Composition of health and safety staff (e.g., affiliation, qualifications, employment status) |
| Category 4: Composition of employees (e.g., gender, age, employment status) | Category 4: Composition of employees (e.g., gender, age, employment status) |
| Category 5: Managing health management information | |
| Category 5: Situation of workers for which consideration should be given in employment | Category 6: Situation of workers for which consideration should be given in employment |
| Category 6: The system and management of working patterns and hours, including the leave system (Contents of employment regulations and collective bargaining agreements) | Category 7: The system and management of working patterns and hours (Contents of employment regulations and collective bargaining agreements) |
| Category 8: System for support of leave of absence, return to work/system for supporting an employee’s work-treatment balance | |
| Category 7: Health insurance associations (e.g., type, financial status, activities) | Category 9: Health insurance associations (e.g., type, financial status, activities) |
| Category 8: Annual schedule | Category 10: Annual schedule |
| Category 9: Information on safety and health hazards (Hazardous factors) | Category 11: Information on safety and health hazards (Hazardous factors) |
| Category 10: Content of the crisis management structure and system | Category 12: Content of the crisis management structure and system |
| Category 11: Disasters and media coverage that could have a significant impact on the business or the load on workers at the site | Category 13: Disasters and media coverage that could have a significant impact on the business or the load on workers at the site |
| Category 12: Situation Report of Disasters or Media Coverage as described in Category 11, in case of actual occurrence | Category 14: Situation report of disasters or media coverage as described in Category 12, in case of actual occurrence |
| Category 13: Health and safety issues and risks at the site | Category 15: Health and safety issues and risks at the site |
| Category 14: Changes in the company’s financial condition | Category 16: Changes in the company’s financial condition |
| Category 15: Inspections by labor standards inspectors and guidance in doing so | Category 17: Inspections by labor standards inspectors and guidance in doing so |
| Category 16: Minutes of safety and health committee meetings | Category 18: Minutes of safety and health committee meetings |
| Category 17: Records of workplace patrols conducted by the hygiene officer | Category 19: Records of workplace patrols conducted by the hygiene officer |
| Category 18: Number and status of workers who are working long hours | Category 20: Number and status of workers who are working long hours |
| Category 19: Results of general medical examination | Category 21: Results of general medical examination |
| Category 20: Results of special medical examinations (medical examinations for employees engaged in hazardous work) | Category 22: Results of special medical examinations (medical examinations for employees engaged in hazardous work) |
| Category 21: Results of “Job stress questionnaire” | Category 23: Results of “Job stress questionnaire” |
| Category 22: Results of work environment measurements (including office environment) | Category 24: Results of work environment measurements (including office environment) |
| Category 23: Number of accidents and disasters and an overview of their occurrence | Category 25: Number of accidents and disasters and an overview of their occurrence |
| Category 24: Number of serious accidents and serious disasters, and an overview of their occurrence | Category 26: Number of serious accidents and serious disasters, and an overview of their occurrence |
The eight categories that were agreed by fewer than 80% of respondents generally included content that was difficult to learn on a routine basis, and where views could change depending on experience. Categories 10, 11, 12, and 14 would all be experienced by OPs during non-routine events. These experiences may not necessarily be gained even with longer OP experience. The value of the experience may also depend on whether the response was appropriate (e.g., gathering information, giving advice, planning and implementing measures).
“Category 7: Health insurance unions” and “Category 17: Records of workplace patrols conducted by hygiene officer” may not be related to experience of non-routine events. We suggest that OPs’ views on health insurance unions may be influenced by factors, such as experience of joint health policies implemented by health insurance unions and companies and experience with health disparities among employees because of the existence of multiple health insurance unions. We included the hygiene officer’s patrols because under the Ordinance of Industrial Safety and Health, one of the conditions for an OP to reduce the frequency of workplace patrols from monthly to two-monthly is to check the results of the hygiene officer’s workplace patrols. However, in practice, it may be sufficient for OPs to be informed when the hygiene officer finds a problem, and they may not need to receive every report. In addition, some OPs may make regular patrols with the hygiene officer, and so will not need to be sent the reports. The proportion responding either “agree” or “somewhat agree” was 94.2%, so the reason for the variation in the responses may be the background. We therefore believe that the information in Category 17 is necessary.
For Category 14, the CSOPs were significantly more likely than the CAOPs to agree. Similarly, for Category 15, COPs and CSOPs were significantly more likely than CAOPs to agree. We therefore suggest that OPs with more experience found information in these two categories useful and tried to obtain it if possible. Respondents included CAOPs who had been in clinical practice for a longer period of time (e.g., 25 years as a clinical physician and 4 years as an OP) and COPs who had been in occupational health for a longer period of time (up to 33 years) but who may have begun to develop their professional training relatively recently. There was, therefore, not necessarily an association between years of experience as an OP and qualification status. It is possible to take the CAOP certification exam within 2 years of obtaining a medical license, and the COP certification exam within 5 years. There was no significant difference in the responses by years of OP experience, but there was a significant difference by qualification status. This suggests that the factor that influenced views on information collection was not simply the length of experience, but the experience of having undergone systematic training as part of an OP program. A previous study4) that examined the 61 competencies required of professional OPs in this system found that the examiners of the COP’s certification examination believed that the most effective way to learn about issues, such as appropriate placement of older people and pregnant women and the emergency response plan, was “experience and in-depth study of specific cases and policies” rather than “accumulation of daily experience as an OPs” or “acquisition of knowledge through lectures or books”. In that study, the “practical group” mainly working in occupational health services had significantly higher scores on the items related to appropriate assignment as “necessary for OPs as a practical skill” than the “academic group” from educational and research institutions such as universities. Together with our results, these findings suggest that OPs’ views on information and competencies may be affected by specific experiences and need to be acquired through conscious and systematic education and experience.
Moriguchi et al.5) reported the results of a survey on the information necessary for working as an OP. They explored attitudes toward corporate information by commissioned OPs mainly working in clinical practice who were part of a prefecture Medical Association. The survey was conducted before the statute was amended. The list used in this survey included many items similar to our categories. However, there were only four items of information that were deemed “absolutely essential to know” by more than 50% of respondents. We found that more than 80% of respondents answered “agree” in 16 categories, and fewer than 50% in only one category (information on health insurance associations) of the 24 categories listed. However, the survey question style differed, suggesting that OPs in the training and certification system may be trying to obtain more information. Many books have emphasized the importance of OPs understanding the realities of their workplaces6), but few have described the specifics of this. This was a survey of professionals in the JSOH about information collection in line with the Industrial Safety and Health Regulations. We, therefore, believe that its results will provide meaningful insights for many OPs regardless of their working style or experience.
The study had several limitations. First, the valid response rate was not high, at 20%. We also asked participants, “In this survey, please answer the questions based on your thoughts as an OP, not assuming activities in a particular industry or workplace”. This meant that the survey only obtained respondents’ personal views and did not examine the impact of workplace conditions or the amount of time spent in any particular workplace.
We consider that this list is appropriate information that should be obtained from employers to enable OPs to support employee healthcare. However, this does not mean that information in all 24 categories should always be obtained. We also did not give a level of priority to any categories. However, it would be difficult to classify and standardize cases, so OPs should select and prioritize the information they need, deciding timing (regular or occasional) and method of provision (oral or documentary). This also needs to be discussed with employers. Information is one of the inputs into decision-making, and OPs should have access to all the necessary information in a given situation. However, simply receiving excessive information without a clear purpose increases the burden on both the recipient and the person providing the information (defined as the employer, but in practice often the hygiene officer or the human resources and administration department). In the column for opinions about the information obtained (not shown in the Results section), some respondents answered “If possible, I would like to obtain all the information first, and then make choices and priorities based on the situation in the company” while others answered “I’d like the employer to tell me if I ask, but I don’t expect them to create a report document” and “As long as have a good relationship with the company so that they can tell me when I want information, that’s good enough for me”. These respondents were concerned about the increased burden on companies and the possibility that they as OPs might not be able to process all the information. These opinions suggest that the key to sharing information for employees’ healthcare is to have a common understanding and a good relationship with employers so that they will voluntarily provide information when necessary. OPs therefore need to be mindful of this.
To make the list of categories more effective, we are planning to revise the document issued with the consensus survey, which includes both medium and small categories. We may also be able to make the list more meaningful by including good practices for each category, such as the significance and use of information.
This study was financially supported by research grant for promotion of occupational health from University of Occupational and Environmental Health, Japan. We thank Melissa Leffler, MBA, from Edanz Group (https://en-author-services.edanzgroup.com/ac) for editing a draft of this manuscript.
The protocol for this study was approved by the Ethics Review Committee of the University of Occupational and Environmental Health, Japan.
Written informed consent was obtained from the participants in the development survey.
The authors declare that there are no conflicts of interest for this article.
R.M., Y.K., S.T., H.H. and K.M. conceived the ideas; R.M. and H.F. collected the data; R.M., H.F. and K.F. analyzed the data; R.M., Y.K. and K.M. led the writing; all authors read and approved the final manuscript.
