PubMed · 6904004
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S Quinn. 1980-10-23. Planning--zero growth.. https://pubmed.ncbi.nlm.nih.gov/6904004/
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The OPSS is an 8 stage program which was developed as a practical tool for occupational health services planning. This paper examines the theoretical aspects of the first two stages. The OPSS is a planning tool with a theoretical grounding in OHP (The practical theory of Occupational Health Planning). The target population setting has two functions. The first is to establish the physician's first-hypothesis to design a program. The other is deciding the group which has an occupational health problem in a company. The Needs Assessment helps to clarify the physician's hypothesis, which may be weak due to the limited knowledge of various demands of the employees and senior management. On the other hand, the risks and needs vary according to what kind of expert looks at a situation. To date, occupational physicians have been limited to their medical background in determining only risks and needs. However, understanding the various stakeholders in a particular environment means that any project will be more relevant to all concerned. Another limitation of the occupational physicians hypothesis can be the lack of objective data to support it. This makes it difficult to persuade senior management to sign on to a program. The Needs Assessment procedure with OHQ steps is useful in a number of ways. The Observation step allows for finding risks and needs from various situations in the company from the occupational physician's viewpoint (prehypothesis setting). Hearing is for understanding the subject's demands and finding common themes in the company (final hypothesis setting). Finally, the questionnaire step is for providing objectivity of these common themes and quantitative data for the next Priority Setting procedure. The BITOP (Budget, Information, Time, Order, key Person) has been proposed as a way to diagnose the structural and functional aspects of an organization's procedures. Budget tracks the financial flow through the organization, while Information identifies key information sources. Time helps to understand the reaction speeds of a company against environmental changes in the business community. Order looks at the flow of information from senior management through strategic gatekeepers. Understanding this flow helps the occupational physician to identify specific issues at various levels of the organization. Finally, key Person looks at the flow of information up through the organization, and identifies which key executives the occupational physician needs cooperation from in order for the project to be approved and successful. The above two procedures are essential tasks for insuring that an occupational physician can effectively implement a project that identifies what is necessary for the company and what the company wants to do, and works effectively within the organizational structure.
This report focuses on the final six procedures of the 8-stage OPSS. The first two procedures were covered in an earlier report. This paper examines the theoretical underpinnings of these six procedures. In the Priority Setting procedure, three factors are compared (TCP; Time/timing, cost, and population) for the OPSS in the general community, and also those in industry. These sometimes differ, especially with respect to responsibility and implementation. TCP allows the appropriate factors to be considered for a more objective prioritization of the various factors. As discussed earlier, the first TCP is used for prioritizing occupational health problems through the Needs assessment procedure. The second TCP prioritizes the countermeasures of those problems selected in the first TCP. In the Program Design procedure, we discuss the MIO (Merit, Impact, Outcome). Merit is defined as the effectiveness of a program as viewed by the company, taking into account the managerial and social merits. Impact refers to the behavioral effectiveness and behavioral change from the viewpoint of the program designer. Outcome refers to the effectiveness of the program from the traditional medical and epidemiological view-point. The study goes on to discuss the relationship amongst participation level, program development, and the subject's compliance, as a means to ensure that subjects participate indirectly through both steps of OHQ. In the Presentation procedure, we summarize the flow of effective presentations in the company setting. This covers initial understanding of the target audience wants, together with what the planner wants to focus on. In this way common issues and themes can be developed. Further assistance is given with strategy formation, presentation aids, time category presentations, evaluation and feedback. In the Process and Final Evaluation procedures, we discuss the objectives, and their significance to the overall process. In the Post Project Appraisal Making procedures, the previous three procedures are strongly affected by each proceeding procedure. In OPSS, we did not include the program development step in the Program Design procedure because the development skills can be referred from behavioral sciences methodologies. In the final part of this paper, we discuss the merits of the underlying theories of behavioral sciences, which have potential to apply to the occupational health settings.
BACKGROUND: Double loop learning, an attempt to question underlying organizational policies and goals, offers the possibility of making quality improvement (QI) efforts more productive. Joint Commission standards in the Improving Organizational Performance (PI) chapter of the Comprehensive Accreditation Manual for Hospitals regarding the measurement of important processes or outcomes related to patient care and organization functions seem to incorporate the principle of double loop learning. IMPROVING PI PROCESSES: QI can be applied to five sets of PI processes: planning, designing, measuring, assessing, and improving. A composite case study is presented, in which a consultant used the PI framework to review a 300-bed state mental hospital's QI function. EXAMPLE--ASSESSING: When data are assessed, is the organization using tools such as run charts and process control charts correctly to understand sources of variation? Because QI and other hospital staff were unfamiliar with run and control charts, the consultant gave a brief introduction to variation and process control and helped them evaluate their data. The hospital's quality council voted to send two of its members, the directors of management information systems and QI, to a course on statistical process control and agreed to put in their QI plan and annual appraisal a reassessment of their needs for more staff to be familiar with statistical process control. SUMMARY AND CONCLUSIONS: Taking an honest look at the value of QI within one's organization can lead to actual performance improvement instead of "paper" improvement. Indicators should be developed to assess and improve QI processes.