Certification and quality assurance in Dutch occupational health services.

Since 1994, each Dutch enterprise has to be affiliated to an independent occupational health service (OHS), recognized by the government. In addition, each enterprise has to be supported by this occupational health service in its activities for the improvement of working conditions, and in the guidance of employees absent from work. From 1994 to 1998, the government was carrying out the certification and recognition of occupational health services. Since 1998 the certification has been carried out by private certifying institutions, in general consultancy bureaus that also provide ISO certification. In the Netherlands, the supervision of the quality of occupational safety and health care is twofold. Firstly, the Labor Inspectorate is checking if the enterprises keep to the rules. For example, each enterprise should have a risk assessment report at its disposal. The latter should be approved by the OHS. If an enterprise does not meet these rules, a penalty may be imposed. In practice, this happens rather seldom. Secondly, each OHS unit should be recognized by the Ministry of Social Affairs and Employment. The recognition takes place if the private certifying institution has assessed that the OHS meet a large number of requirements laid down in the "Guideline for the Certification of Occupational Health Services". This Guideline consists of 50 conditions and about 200 verification points. The requirements deal with the internal organzation and the output. By order of the Dutch government the IVA, a Dutch institute for social research, has recently investigated if this certification leads to a sufficient guarantee for appropriate occupational safety and health care. By means of a large number of discussions and workshops, the IVA has investigated how OHS, employees, employers, insurance companies and others judge the quality management. In this study, the current method of certification turned out to produce insufficient incentives for quality improvement. None of the involved parties turned out to be satisfied with the current system. The fundamental problem of this certification system can be summarized as follows. The requirements prescribe a quality management system in conformity with ISO, but they also contain a lot of organization rules, much more than ISO. It is this degree of specification that, if practiced slavishly, leads to an output that is not able to satisfy the needs and demands of employers, employees and government. There are no rules with regard to this output, but only to the process, e.g. the way an advice has been brought about. In this paper, we show how the current certification system is working, how this system has been evaluated, and what criticisms have been uttered. We also indicate how we might achieve a real improvement of quality management in prescribing much less details about the OHS internal organization, and in demanding employers and employees to make clear agreements about the desired OHS output and to monitor carefully if the agreed output quality has been achieved.