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Recommended Practices for Safety and Health Programs

Case studies.

To help start or improve your organization's safety and health program, see the case studies listed below for lessons learned and best practices.

  • The Electric Power Industry relies on Safety and Health Programs to keep workers safe on the job ( PDF )
  • Hazards that OSHA's voluntary On-Site Consultation Program helped companies identify.
  • Methods companies implemented to correct the hazards.
  • Business practices that changed to prevent injuries and illnesses.
  • Challenges, successes, and overall impact on businesses.
  • More than 60 success stories from 2008 through 2016 are presented from a wide range of industries throughout the country.
  • You can read stories highlighting successes and best practices from companies participating in VPP – 21 recent stories arranged by industry - as well as 26 archived stories from 1994 to 2010 .
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health and safety case study questions

Injuries and Illness

Case studies in safety: a great training tool.

Updated: Nov 6, 2011

Case studies are a great safety training tool. It’s like CSI. Employees can really get involved examining the evidence and seeing why an accident occurred.

Safety case studies are fun, challenging, interactive, and a highly effective training method.

Armed with the knowledge they gain from examining the facts of real workplace accidents, workers can learn how to avoid similar incidents and injuries.

Here’s an example of such a case from BLR’s OSHA Accident Case Studies . This case is about a confined space incident.

The Incident

Two employees arrived at concrete pit at demolition site where they’d been working to salvage the bottom part of a cardboard baler imbedded in the pit. When the employees uncovered the pit, they both felt a burning sensation in their eyes.

Employee #1 climbed down into the pit to determine what might be causing their eyes to burn. He immediately climbed back out of the pit because it was hot. He decided to put a water hose into the pit to help cool it down.

The employees climbed down into the pit with the water hose. Both employees experienced chest tightness, difficulty breathing, and burning eyes. They decided to exit the pit because of the intolerable conditions.

Employee #2 climbed out first. As Employee #1 was climbing the ladder to get out, he was overcome by the fumes and fell back into the pit. He landed on his back, unconscious.

Employee #2 climbed down into the pit in an attempt to rescue employee #1, but was unable to lift him. Employee #2 exited the pit in order to get help. Unfortunately, by the time help arrived, Employee #1 had died of asphyxiation.

The accident investigation determined that employee #1 had attempted to extinguish a small cutting torch fire the day before by covering it with sand and dirt. Apparently the fire was not extinguished and smoldered overnight, which resulted in a build up of carbon monoxide inside the pit.

Try OSHA Accident Case Studies and give a boost to your safety training program with real-life case studies of actual industrial accidents from OSHA files. We have a great one on lifting. Get the details.

Discussion Questions

Once the case has been presented, some discussion questions can help kick off the analysis of the incident. For example:

  • What are the potential hazards of confined spaces?
  • What was the specific hazard in this case that cause a fatality?
  • Were these workers properly trained and equipped to enter a confined space?
  • What type of air monitoring should be done before entering a confined space?
  • Was this a permit-required confined space? If so, were the workers familiar with the safety requirements of the permit?
  • Was confined space rescue equipment readily accessible?
  • Training? There is no indication on the accident report that the employees were trained as authorized entrants of confined spaces. If they did receive any confined space entry training, they clearly didn’t apply what they learned. Authorized entrants are trained on the hazards of confined spaces, atmosphere testing procedures, symptoms of lack of oxygen or exposure to toxic chemicals, personal protective equipment (PPE), communication equipment, rescue retrieval equipment, etc.
  • Hazard warning? These employees entered the space despite experiencing "red flags," such burning eyes and unusual heat. An important part of training for confined space workers includes learning about hazards such as the symptoms of a lack of oxygen or exposure to toxic chemicals. Workers should never enter a space, and should immediately leave a space, in which they experience signs of hazardous conditions.

Even your most skeptical workers will see what can go wrong and become safety-minded employees with OSHA Accident Case Studies . They’ll learn valuable safety training lessons from real mistakes—but in classroom training meetings instead of on your shop floor. Get more info.

  • Permit-required? Most confined spaces require a permit before workers can enter the space. Permit-required confined spaces have the potential for hazards such as hazardous atmospheres, engulfment, entrapment, falls, heat, combustibility, etc. By reviewing a permit, entrants know they have obtained all the necessary equipment and the atmosphere has been monitored so they know the space is safe to enter.
  • Testing? This worker died of asphyxiation, or lack of oxygen. If the atmosphere in the pit had been tested prior to entry, this accident would not have occurred. Common monitoring practices require a check of the oxygen concentration, a check for flammable gases or vapors (especially important if welding is going to be done in the space), and finally, a check for any other toxic chemicals known to potentially be in the space. Monitoring is conducted before entering the space and periodically while workers are in the space.
  • Rescue procedures and equipment? The worker who collapsed back into the pit while climbing out could not be rescued because he was not wearing required rescue equipment. He should have been wearing a full-body harness attached to a retrieval line that was connected to a winch-type system that could have been used to pull the unconscious worker out of the pit. Of course, the other employee would have had to have been trained in confined space rescue procedures.

Tomorrow, we’ll introduce you to another case from OSHA Accident Case Studies, this one about a materials handling accident that resulted in a serious back injury.

More Articles on Injuries and Illness

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Case studies.

The Center’s research identifies and explores best practices, which in turn are the foundation for policies, programs, and practices that are implemented by organizations seeking to improve worker health, safety, and well-being. Our case studies provide concise summaries of organizational change implemented using a Total Worker Health ® integrated approach, and are based on the Center’s previous and current research projects.

The Workplace Organizational Health Study The Workplace Organizational Health Study sought to improve the health, safety, and well-being of front-line food service workers by identifying working conditions that could be modified to reduce pain and injuries and improve worker well-being. This case study, developed by the Center, summarizes the implementation of the 2+2 Feedback and Coaching tool, previously used with managers and modified for use with employees. Download the case study

Dartmouth-Hitchcock Medical Center To address rising employee health care expenses, Dartmouth-Hitchcock Medical Center (DHMC) launched an initiative to achieve its vision of the healthiest possible workforce, the foundation of which is an organizational culture that advances employee health, safety, and well-being. This case study, developed by the Center in collaboration with HealthPartners, summarizes the DHMC successful Total Worker Health approach and the resulting beneficial outcomes. Download the case study

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CASE STUDY #1 (OCCUPATIONAL SAFETY AND HEALTH

Profile image of Muhammad Afiq Areef

 Provide a handover when further medical help arrives EXAMPLE OF LOW RISKS HAZARDS AT OFFICE Electricity travels through electrical conductors which may be in the form of wires or parts of the human body. Most metals and moist skin offer very little resistance to the flow of electrical current and can easily conduct electricity. Other substances such as dry wood, porcelain, orpottery offer a high resistance and can be used to prevent the flow of electrical current. If a part of the body comes in contact with the electrical circuit, a shock will occur. The electrical current will enter the body at one point and leave at another. The passage of electricity through the body can cause great pain, burns, destruction of tissue, nerves,and muscles and even death. Factors influencing the effects of electrical shock include the type of current, voltage, resistance, amperage, pathway through body, and the duration of contact. The longer the current flows through the body, the more serious...

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Electricity workers are facing significant electrical hazards, preventive actions are important to decrease these hazards. This study Aimed to evaluate the effect of preventive program on electricity workers' awareness regarding occupational health hazards. Design: A quasi experimental design was used. Setting: This study was carried out at two districts of Qalubiya electricity sector. Sample: All electricity workers from the above mentioned settings were included. There were 78workers. Tools: I-structured interviewing questionnaire to determine electricity workers' socio-demographic characteristics, exposure to electricity hazards, knowledge regarding electricity hazards and its prevention and practices of workers regarding precaution to avoid electricity hazards. Results: The current study results revealed that, 35.9% of participants aged from 30 to 39 years old, 57.7% of them were experienced from 1 to 10 years, 43.6% of workers were exposed to injury during their current work, none of workers had good total knowledge scores regarding electricity hazards, and only 2.6% of workers had high satisfactory total practices score preprogram. While, after the program implementation, 89.7% of them had good total knowledge score, and high satisfactory total practices score increased to 88.5%. Conclusion: This study concluded that there were a significant improvement in electricity workers' knowledge and practices regarding prevention of electricity health hazards. Recommendation: ongoing periodic health education programs carried out by the occupational health nurse to raise the awareness of electricity workers about electrical health hazards and periodic training on hazards prevention and electrical safety as well as first aids should be sustained for electricity workers.

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Statistics have shown that the number of fatality and permanent disablement cases due to accident at construction sites in Malaysia is one of the highest in comparison to other sectors. Therefore, there is an urgent need to mitigate this problem. In general, there are three basic steps that should be taken to ensure the safe and conducive working conditions: identifying the hazard, assessing the risk and controlling the risk. The implementation of effective hazards control methods may require different approaches due to changing working environment at the construction sites. This project is intended to identify and highlight the common hazards at construction sites today. The data collection was carried out through site investigation using a checklist forms and interview in construction. The study determines fourteen (14) types of work at building construction sites and their common hazards. The works include wood carpenter, bar bender, excavation work, boring rig, hacking and drill, crane work, roof work, bricks installation, scaffolding, electric welding, general activity, mechanical lifting, concreting and electrical equipment usage. The study was conducted at a building construction site and the results showed that the most common hazards for the project around the study area are associated with protective clothing, manual handling and roof work.

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health and safety case study questions

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Safety+Health

OSHA's most interesting cases

What happened – and lessons learned.

OSHA-cases.jpg

Every OSHA investigation offers an opportunity for using what comes to light to help prevent similar incidents.

At the 2022 NSC Safety Congress & Expo in September, OSHA staffers highlighted three investigations – and the lessons learned – during the agency’s “Most Interesting Cases” Technical Session.

OSHA speakers

  • Brian Elmore , an OSHA inspector based in Omaha, NE
  • Marie Lord , assistant area director of the OSHA office in Marlton, NJ
  • Peter Vo , safety engineer in OSHA’s Houston South area office

Here are the cases they presented.

  • Shelving collapse in a cold storage warehouse
  • Lockout/tagout-related amputation
  • Crane collapse  

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Supporting Occupational Health and Safety Risk Assessment Skills: A Case Study of Five Companies

Financial burden due to poor occupational safety practices remains high although occupational health and safety (OHS) have improved in recent years. Conducting risk assessment is one way to improve OHS. Workplaces may not have sufficient expertise in risk assessment. The aim of this study was to identify the needed OHS risk assessment skills, current support in the workplaces and the ways to improve risk assessment skills. This study was conducted with the Delphi survey for OHS experts ( n = 13) and with interviews ( n = 41) in the case companies. OHS experts agreed that the most significant skills were for employees to identify hazards and minimize risks in one’s work; for supervisors to influence others with a good example; and for OHS experts to understand and manage the wholeness of safety practices and understand and manage the meaning, concepts, and criteria of risk assessment. The current main support methods were learning at work, training and written instructions. However, many of the interviewees felt that they had not received risk assessment training and that the support depended on their activity. Finally, the OHS experts determined that the most feasible ways to improve risk assessment skills were training, coaching and giving clear instructions. Likewise, the interviewees suggested various training methods. Based on these results, concrete development plans to improve risk assessment skills can be made.

1. Introduction

Even though occupational health and safety (OHS) have been developed and improved in recent years, almost two million employees die each year because of exposure to work-related risks [ 1 ]. The economic burden of poor OHS practices is estimated to be 3.9% of the global gross domestic product (GDP) (i.e., EUR 2680 billion) each year [ 2 ]. According to previous studies, health promotion programs and various interventions related to occupational safety and health seem to reduce absenteeism and healthcare costs, and they have the potential to achieve business benefits [ 3 , 4 ]. At workplaces based on Finnish Occupational Health and Safety Act [ 5 ] and European OSH legislation [ 6 ], employers are responsible for ensuring the safety and health of their employees, for preventing occupational accidents and diseases and for eliminating hazards stemming from the work environment and the work itself. One key responsibility of employers is to carry out hazard identification and risk assessment [ 5 , 7 ].

The OHS risk management process involves different concepts (e.g., hazard, hazardous events, consequences and risk) which can be defined in different ways, thus affecting the results of the risk assessment [ 8 , 9 ]. How risk assessors understand these concepts, the differences between them, and the process of risk assessment has a remarkable effect on the results and the success of the risk assessment [ 10 , 11 , 12 ]. Overall, the specific knowledge, experience, abilities, skills, attributes, values, attitudes, understanding and behaviors of the risk assessor may affect the OHS risk assessment results [ 13 , 14 , 15 ]. In addition to the risk assessor, initial assumptions, oversimplification, inaccuracy of consequence models, ill-defined data, as well as poor hazard identification, teamwork, chosen method and documentation may all affect the quality of a risk analysis [ 16 , 17 , 18 ]. Previous studies have found that risks remain unidentified or uncontrolled due to limitations in OHS risk assessment skills, processes and tools [ 11 , 12 , 19 , 20 ]. Risk assessments may also be omitted altogether or delayed [ 21 ]. In addition, the research suggests that insufficient guidance on how to use risk matrices may lead to variation in the quality of risk assessment [ 22 ].

Even though previous studies have recognized the effect of the risk assessor’s and the risk assessment team’s skills to conduct a risk assessment, not many studies have primarily focused on these assessment skills or on developing them. However, for example, Hrica and Eiter [ 23 ] identified critical competencies (i.e., general hazard knowledge, site-specific hazard knowledge and situational awareness) regarding hazard recognition, which is a part of OHS risk assessment skills. Previous research has revealed that when workers are trained by effective training methods, they are able to recognize more hazards and experience higher risk levels in similar cases than workers who have not received training [ 24 ]. Hazard identification can, for example, be developed through visual hazard identification exercises [ 25 ]. Brandt et al. [ 26 ] found that, in a participatory workshop, participants can discuss problems with their colleagues and might learn from others. Namian et al. [ 27 ] argued that both the type of education (low engagement or high engagement) and the training transfer effect (e.g., upper management engagement and supervisor support) are important. Achieving a better training transfer does not necessarily mean creating new processes, but more benefits accrue by integrating learning into the company’s existing process and reward systems [ 28 ].

OHS training often uses lectures and courses as teaching and training methods. In addition, novel approaches are being used, such as e-learning, online and distance learning, as well as computer-assisted teaching and virtual reality simulation [ 29 ]. Approaches requiring participation and commitment are generally considered to be more effective [ 30 , 31 ], and using examples pictures, and other illustrative methods has often been found to be more effective than using traditional lectures or reading material [ 32 , 33 ]

The need to develop risk assessment skills, and to do it based on one’s own initiative, is a widespread phenomenon in Finnish workplaces [ 21 , 34 , 35 , 36 ]. Previous research states that companies typically do not evaluate the risk assessment skills of risk assessors or the success of risk assessment [ 37 ]. Using the Occupational Health and Safety Act as framework, the aim of this study was to recognize what are the risk assessment skills of persons who carry out risk assessment related to OHS; how the skills are currently supported in the workplaces; and how the risk assessment skills can be improved. The results of the study can be used to make the OHS risk assessment more resource-efficient and better meet the needs of the workplace. Thus, risk assessment can reap the necessary benefits and serve as a tool for safety management and safety improvement. The practical contribution of the study consists of suggestions about what the risk assessment skills of employees, supervisors and OHS experts should include, and how to support risk assessment skills.

The subsequent Materials and Methods subsection contains background information on the companies that cooperated and the research methods we used. The results obtained are presented grouped by theme. First, the OHS risk assessment skills of employees are discussed, in which the research method was the Delphi survey. Then, the results of the interviews on the current support for risk assessment skills are provided. Finally, the development of risk assessment skills was examined through both the Delphi survey and interviews. The discussion section considers the results obtained by different methods and compares them with previous research. In addition, further research and research limitations are presented at the end of the section. Finally, the main results and the obtained contribution are highlighted in these conclusions.

2. Materials and Methods

The aim of this study was descriptive in nature, and the phenomena of interest are contextual so that the researchers have limited influence on them [ 38 ]. In this mixed methods study [ 39 ], there were two different phases. In phase 1 (December 2020–January 2021), a Delphi survey [ 40 , 41 ] was conducted to explore what kind of risk assessment skills people in different positions need to have and how their risk assessment skills can be supported. In order to gain a deeper understanding of the current OHS risk assessment skills, in phase 2 (January–March 2021), a qualitative interview study was conducted using a semi-structured interview form [ 42 ]. The interviews were conducted in five Finnish companies from different industries: manufacturing, transportation and storage, electrical power generation, and another technical testing and analysis field. This qualitative and descriptive study has followed research ethical principles in accordance with the Finnish National Board on Research Integrity [ 43 ] and the General Data Protection Regulation [ 44 ]. Companies involved in this study committed to participate in interviews and surveys. Participants agreed to participate in the study after being informed of voluntary participation, anonymity and confidentiality.

2.1. Delphi Survey

The iterative Delphi survey is a method in which respondents evaluate their anonymous responses until a consensus is reached on the responses [ 40 , 41 ]. The Delphi survey consisted of three rounds in which the aim was to gather the views of OHS specialists and managers on what should be included in the risk assessment skills of the employee, the supervisor and the expert (e.g., the OHS representative or OHS manager). The request to participate included information about the study; instructions on how to participate in the survey; and the link to the survey. It was emailed to 17 individuals; 13 agreed, yielding a response rate of 76.5%. Three rounds of the Delphi survey were conducted. The response percentages for each round were 47.1% ( n = 8) in the first; 70.6% ( n = 12) in the second; and 76.5% ( n = 13) in the third round. It was possible for the respondents to take part in the survey later, even if they had not been involved in the first round. In addition, it was assumed that OHS specialists and managers are, by definition, aware of the risk assessment principles. Their experience in occupational safety was on average 13 years (SD = 16). The respondents worked for industrial companies, research institutions and authorities (see summary in Table 1 ). The survey was created through Lime Survey.

Background information of the Delphi survey ( n = 17).

Questions asked in the first round of the Delphi survey were “What is included in the risk assessment skills of (a) the employee, (b) the supervisor, and (c) the OHS expert?” and “How can risk assessment skills be supported?” Respondents ( n = 8) answered open-ended questions and the length of the answers was not limited. Background information collected from the respondents included their name, the name of the company, the position in the organization (supervisor, specialist), work experience in the current position and work experience in similar positions. The name of the respondent was asked so that reminder emails could be targeted to people who had not yet responded.

Researchers performed a qualitative analysis and the participants received feedback. The thematic categorization of the qualitative material of the first round was conducted by applying the open coding analysis approach [ 45 ]; the process identified four factors in the OHS risk assessment skills of employee, six factors in the OHS risk assessment skills of the supervisor and six factors in the OHS risk assessment skills of experts. In addition, responses to the question about how to support OHS risk assessment skills received 12 suggestions. In the second round of the survey, respondents ( n = 12) commented on the categorized lists and explained their answers to open-ended questions.

After the second round, a quantitative analysis was performed using Microsoft (MS) Excel, and the participants again received feedback. In the third round of the survey, the respondents ( n = 13) chose the four most important factors for employee’s OHS risk assessment skills, the five most important factors for supervisor’s and expert’s OHS risk assessment skills, and the eight ways to support OHS risk assessment skills. In addition, respondents chose the eight most feasible ways to support OHS risk assessment skills. If desired, respondents were allowed to choose fewer options for their response. The third-round answers were again analyzed using MS Excel and IBM SPSS. Before each round ended, participants were sent reminders to answer.

2.2. Semi-Structured Interviews

The companies were chosen based on their needs and interests to develop their risk assessment processes. There are some similarities and differences between the companies. Four of the companies are large, while one is medium sized, employing approximately 200 people. In addition, almost all companies employ subcontractors. One company operates only in Finland, while others have international operations, or they are part of larger international corporations. The companies involved in this study are stable, traditional Finnish companies, where attention is paid to employee persistence. The duration of employment of the persons interviewed at the company was on average 14 years (SD = 10). This study focused on the Finnish sites of these companies.

The interviews were conducted with members of the risk assessment team or with managers. The position of the interviewees varied widely depending on the company. In one company, the interviewees were chosen as a cross-section of the process from design to implementation, while in another, mainly managers and immediate supervisors were interviewed. Altogether, the interviewees’ positions were manager ( n = 10), immediate supervisor ( n = 15), employee ( n = 20), and OHS manager or representative ( n = 8). When describing the status of the interviewees, it must be considered that, for example, the OHS manager can also be the supervisor and that the OHS representative of employees is usually an employee themselves or an expert on certain tasks. They are classified here as OHS managers and representatives. Table 2 summarizes the distribution of the companies, the interviewees and the interviews. All the interviews were held via MS Teams. Interview types were divided into individual interviews ( n = 32) and group interviews ( n = 9), and the average duration of interview was 59 min, lasting between 38 and 96 min. The transcriptions resulted in 324 pages.

Background information about the interviews ( n = 41) and interviewees ( n = 53).

The semi-structured interview form included questions such as the following: “How is the conducting of a risk assessment instructed?”; “Have you/others involved in the risk assessment received orientation about the risk assessment? What kind?”; “How are individual employees instructed to assess the risks of their own duties?”; “How are risk assessment skills currently supported?”; and “In what ways could the risk assessment skills be improved?” A few questions had to be slightly modified for companies to suit their operations. The question “How are individual employees instructed to assess the risks of their own duties?” received an answer in 25 interviews. It was not answered if the interviewee was an expert with no subordinates, if there was time pressure due to the group interview, or the discussion was about guidance in general. One interviewee did not answer the questions “How are risk assessment skills currently supported?” and “In what way the risk assessment skills could be improved?” All the interviews were recorded except for one, when the interviewee did not want to be recorded. However, the notes from that interview were added to transcriptions. A total of three companies had both individual and group interviews; one company had only group interviews, and one had individual interviews. The duration of the interviews varied depending on whether it was a group or an individual interview.

Transcriptions were analyzed using Atlas.ti version 9 software by applying the open-coding analysis approach [ 46 ] (i.e., written data were conceptualized into separate categories and given a name that represents or stands for it) [ 47 ] in order to identify the current risk assessment support and how to develop it. During the analysis, the codes that needed further processing were discussed together. Researchers coded one interview at a time, resulting in 482 codes. The researchers then checked the codes for consistency, removed unnecessary codes, and compiled similar codes, resulting in 409 codes. During the third round, the researchers categorized the codes into 104 themes. A thematic categorization of the data was conducted by using Whimsical SaaS because of its visuality for categorizing the themes that emerged. Questions with clear answers did not require thematic processing. Hence, two groups of codes were obtained, some of which were processed numerically and some through thematic design. Because there is more than one code categorized within a single theme, participants might have mentioned a particular theme more than once per interviewee. In other words, the number of respondents or interviews does not necessarily correlate with the number of themes. In addition, MS Excel was used as a support tool in the analysis. The questions and their occurrences in the interviews are presented in Appendix A , Table A1 .

The used risk assessment methods in the companies were checklists, the potential problems analysis (PPA) method and the task risk assessment completed either in the OHS system or with MS Excel and MS Word forms. The composition of the risk assessment team varied considerably depending on the company but usually comprised of the immediate supervisor and the employee(s), the OHS representative, and in some cases, safety/quality manager as well as the work experts.

3.1. Required OHS Risk Assessment Skills of Employee, Supervisor, OHS Expert

In the Delphi survey, the most significant OHS risk assessment skills of employees and supervisors were unanimously found. Identifying hazards and minimizing personal risks were the most significant skills for employees. Influencing others by their own example and attitude was seen as the most considerable skill for supervisors. The skill requirements of the experts were not as unanimously chosen as for the employees and supervisors. The two things considered to be the most significant OHS risk assessment skills were both understanding and managing the wholeness of safety practices and understanding and managing the meaning, concepts and criteria of risk assessment as well as the related workplace safety legislation.

3.1.1. Employees’ Risk Assessment Skills

All respondents considered identifying risk factors in their own work and minimizing risks to be the most important factors in an employee’s OHS risk assessment skills. In addition, the theme “Identify situations where work should be suspended” was highlighted in the second round and was considered the second most important factor by over 80% of the respondents in the third round. “Identifying situations in which a risk will be taken” and “Knowledge of one’s own responsibilities and rights (in occupational protection)” were chosen as the third and fourth most important factors by 46% of the respondents, respectively. Employees are expected to have experience of the work and knowledge of the work-related hazards, which is why understanding the meaning, principles, and concepts of risk assessment was considered to be the least important factor in an employee’s OHS risk assessment skills. Two respondents chose only three options instead of four. Figure 1 shows the results given by occupational health specialists and managers on the requirements for employee risk assessment skills.

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Opinions of occupational health specialists and managers on the most important risk assessment skills needed by the employee.

3.1.2. Supervisors’ Risk Assessment Skills

The most important factor in the supervisor’s OHS risk assessment skills was unanimously “influencing others through one’s own example and attitude (developing safety thinking and safety culture).” This option was added based on comments from the second round. The second most important factor, “Responsibility for risk assessment (able to guide and participate as well as identify and minimize risks in the work environment),” was chosen by 92% of the respondents. The third and fourth options also received more than 60% of choices. “Team motivation (for risk assessment and daily safe operations)” was added based on the second-round answers and was chosen by 69% of the respondents. “Identifying situations where risks need to be assessed” received the fourth highest score, as was chosen by 62% of the respondents. The fifth, “General duty to exercise care of safety at work,” received only 38% of the choices. The options which were only chosen once were “Competence in the use of risk management tools,” “Knowledge of the task to be assessed and ability to identify hazards,” and “Competence to assess the magnitude and probability of the identified risk.” Four respondents decided to choose only four factors instead of five. Figure 2 shows the results given by occupational health specialists and managers on the requirements for supervisor risk assessment skills.

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Opinions of occupational health specialists and managers on the most important risk assessment skills needed by the supervisor.

3.1.3. Experts’ Risk Assessment Skills

The most important factors related to an expert’s risk assessment skills caused more variation than those of employees and supervisors. The two most important were “Understanding and managing the wholeness of safety practices” and “Understanding and mastering the meaning, concepts, rationale, and knowledge of risk assessment (occupational safety legislation),” which received 85% of the choices. “Guiding in the risk assessment and in the use of risk assessment tools” also received more than 60% of the choices. “Knowledge of good practices in risk management” and “Understanding human factors” were chosen as the fourth and fifth factors by 46% of the respondents. Indicating the variation of the answers, even the least voted factors received more than 20% of the points. For the experts, these factors were “Be able to identify risks, assess the magnitude and probability of the identified risk, and target measures and evaluate their effectiveness” and “Knowledge of the use of risk management tools.” Two respondents felt that four of the five factors were sufficient. Figure 3 shows the results given by occupational health specialists and managers on the requirements for expert risk assessment skills.

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Opinions of the occupational health specialists and managers on the most important risk assessment skills needed by the expert.

3.2. OHS Risk Assessment Skills Support at The Case Companies

Based on the interviews, learning at work and training were considered to be the most often used forms of orientation, mentioned in 56% and 59% of the interviews, respectively. Almost as many felt that they had not received risk assessment orientation. Written instructions were raised in all companies as a considerable way to guide the conduct of an OHS risk assessment. Perceiving the dangers in one’s own job was seen as a part of everyday activities. Some companies also use a so-called last-minute risk assessment, being mentioned in 29% of interviews. Lastly, in 63% of interviews, the interviewees felt that the support they received mainly depended on the employee’s own activity and that they needed to be able to either ask for it or apply it. The number of responses per interviews or mention per theme varied in each question. All results are presented in Appendix A , Table A1 .

3.2.1. Orientation Regarding Risk Assessment Process

There are different ways to support OHS risk assessment skills in the workplace. One way to support employees involved in OHS risk assessment is to have an orientation about how to carry it out. In OHS risk assessment orientation, the three most often mentioned themes in interview responses were almost equally divided between “Learning at work” in 56% of the interviews, “Training” in 59% of the interviews and “Employees feel that there was no orientation” in 56% of the interviews. It was felt that orientation can be obtained almost as much through on-the-job learning as through training:

“Online training materials where all supervisors need to undergo these trainings. They are compulsory trainings.” “I actually started using that program—and practiced myself.”

It was generally pointed out in the responses that the skills were gained through work even prior to present-day orientations. Those who had worked less time felt that they had received more orientation. However, in an equal amount of the interviews, the respondents did not feel that they had received any orientation at all with regard to performing the risk assessment.:

“I have not received any orientation with risk assessment in particular.”

Responses to interviews in the “Other” category (20%) refer to a review of instructions prior to conducting a risk assessment, ongoing safety discussions and developing risk assessment models. Responses regarding orientation received similar answers in each company.

3.2.2. Instructions to Perform a Risk Assessment and for Individual Employee to Assess the Risks of Their Own Duties

By instructing employees, support can be provided both to conducting the risk assessment and guiding the individual employee to identify the hazards associated with their own work. When asked how to conduct a risk assessment, in 56% of interviews, the risk assessment guidelines as well as the written instructions used in the company and their location were mentioned. Some companies also received instructions from their customers:

“When you start doing a risk assessment, it goes how it is in this risk assessment form. It helps us, but it is not slavishly observed. ”

However, in 41% of the interviews, the respondents were uncertain regarding the instructions, the number of instructions was considered low, or the interviewee was unsure about the location of the guidelines or instructions. There was only one company where no one was unsure of guidance:

“If I have to name a guide, I find it terribly difficult to say. But yes, I go to a safety management system where I don’t remember exactly what it says.“

Training was mentioned in 34% of interviews. The interviewees felt that they had received guidance in various trainings, such as e-learning programs, educational days and video trainings. In addition, in 17% of interviews, guidance provided by a particular person, such as an OHS manager, or a leader of the risk assessment before each audit, was mentioned. In one interview, unwritten instructions were highlighted. At the corporate level, there were two themes—training and guidance provided by a particular person—that were not recognized in two companies.

A total of 39 responses were received from the 25 interviews regarding the instructions of an individual employee concerning the assessment of the risks of their own work tasks. Nearly half of the respondents felt that assessing the risks of one’s own job was a daily activity:

“A proactive approach to occupational safety [is needed], with the aim of making safety observations or reporting near misses, perhaps to achieve day-to-day foresight. ”

The second most common way to instruct assessing the risks of one’s own work is a last-minute risk or hazard assessment, which was mentioned in 29% of interviews. One of the companies used a paper memory card to perform a last-minute hazard assessment. In addition, one’s own activity was felt to be important in obtaining information in three responses. The oral work permit policy used in one company was also mentioned twice here as a guideline for assessing the risks of one’s own work. Two of the respondents felt that they were not introduced to how to assess the dangers of their own work.

3.2.3. Current Risk Assessment Skills Support

In 63% of interviews, the respondents thought that when they are active themselves, they also receive support. In other words, it was felt that support was available as long as it was requested. In addition, it was felt that individual initiative was needed to go through the guidelines:

“But it [support] may not be actively offered directly. In that sense, … one has to be active if one wants to further develop it.”

The next most usual way to support OHS risk assessment skills was various training sessions and guidelines, which were mentioned in 41% of interviews. In 29% of interviews, the respondents said that OHS risk assessment skills were not supported. In 22% of interviews, guided discussions, such as safety talks and meetings led by the supervisor, were seen as one way to support risk assessment skills.

3.3. Development of OHS Risk Assessment Skills

Based on the Delphi survey, no overwhelming feasible proposal was found for the development of OHS risk assessment skills. The two most frequently chosen development methods were the organization of training and coaching related to OHS risk assessment methods and clear instructions for the implementation of OHS risk assessments. Various training methods emerged in the interviews as the most significant way to develop OHS risk assessment skills.

3.3.1. Feasible Ways to Support Risk Assessment Skills

In the Delphi survey, the experts were asked to choose the eight most feasible ways to support OHS risk assessment skills. The question divided opinions and only seven of the respondents chose all eight options. The other six respondents either did not feel that they found any other feasible options on the list or were satisfied with fewer choices. The number of selected choices ranged from four to eight. The options receiving the most choices (77%) were “Organizing trainings and coaching on risk assessment methods” and “Clearly guiding the implementation of the risk assessment.” The other most viable forms of support that received more than 50% of the votes were “Defining consistent processes and models for risk management” (69%), “Providing easy-to-use tools” (69%), “Providing expert support to supervisors and employees” (62%), “Conducting a risk assessment participatory with employees, specialists, and supervisors from different departments” (62%) and “Incorporating the results of risk assessments into everyday decision-making” (54%). The choice for the most feasible way to support OHS risk assessment skills was not as unanimous as in the previous questions, which was partly due to the different risk assessment practices of companies. None of the respondents saw “Using support provided by an insurance company” as a the most feasible way to support OHS risk assessment skills. The form of support “By clearly defining the risk matrix (explaining verbally what probability and severity of consequences mean for different factors, such as physical and chemical factors)” was only chosen once. Figure 4 shows the results from the occupational health experts and supervisors on feasible ways to support risk assessment skills.

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Opinions of occupational health specialists and managers for the most feasible ways to support risk assessment skills.

3.3.2. Ideas for Developing OHS Risk Assessment Skills

Ideas for developing risk assessment skills varied more than the themes in the previous subsections. In 63% of interviews, participants mentioned training activities as the largest factor to improve risk assessment skills. The various training methods related to OHS risk assessment skills included, for example, training given by an outsider, video training, or training provided by a specific person working in the organization. In addition, the regular reviewing of the risk assessments, orientation of new employees and mentoring were mentioned:

“It could be, for example, an online course that allows you to concretely identify certain dangers from pictures and in some way figure out the risks associated with them.”

The next most common point was to increase the understanding of risk assessment (mentioned in 32% of the interview responses) and obtain different perspectives (mentioned in 24% of the interview responses):

“It would be good to hear how to carry out a risk assessment elsewhere—whether it’s similar, whether similar forms, for example, or are those matrices different, whether something else would work for us. Or the whole world of risk assessment could be opened up to us from a little different scope.”

In connection with the development of communication, in 17% of the interviews’ responses, participants mentioned that repeating information improves the person’s recollection. In 12% of the interviews categorized as “Other”, the respondents could not give any development proposal. The activities and discussions of the team as well as clear guidance and resources were mentioned in 10% of the interviews.

4. Discussion

In this study, the OHS risk assessment skills were examined. The Delphi survey provided information gathered from OHS experts on what they considered to be the important OHS risk assessment skills of people working in different roles. The role of safety experts in research extensively covers the need for safety management and related training, but there are few actual competence criteria related to purely risk assessment [ 48 , 49 , 50 ]. The present study shows that the experts agreed that the most important issue for an employee’s OHS risk assessment skills is identifying the hazards of their own work and minimizing the associated risks. According to the literature, various methods have been developed to identify hazards, such as using visual hazard identification and transmission boards [ 12 , 19 , 25 ].

The second most important requirement for employee’s OHS risk assessment skills was being able to identify situations in which work needs to be suspended. According to the Finnish Occupational Safety and Health Act [ 5 ], an employee has the right to refrain from doing work that poses a danger to their own health or the health of others. The employee is also obliged to notify the employer that they have eliminated or rectified the defect or deficiency. Wang et al. [ 51 ] have investigated the safety risks posed by high frequency and low severity that could be avoided if corrective action is taken in a timely manner. In two of the companies included in this study, the nature of the work was such that unsafe work was prevented by redesigning the work plan.

Regarding the skills of supervisors in the OHS risk assessment, “influencing by one’s own example and attitude” was considered to be the most significant by experts. This was somewhat highlighted in the interviews when participants discussed different safety sessions and discussions and reviewed risk assessments with the employees involved. In addition, improving the understanding of risk assessment was mentioned as a development measure, which also affects the supervisor’s motivation. This is in line with the study by Huang et al. [ 52 ], which emphasized that when a supervisor leads by example, they encourage subordinates to maintain a safer workplace. It should be noticed that employee’s and supervisor’s skills include more specific factors than OHS experts. For the OHS expert, the most important risk assessment skills were related to understanding and managing the wholeness, concepts and principles of the risk assessment. As the quality of risk assessment is dependent on many steps [ 16 ], it is important that certain persons have a holistic view of the risk assessment.

In the interviews, the most important guidelines for assessing the hazards of one’s own work were considered to be daily activities, which is in line with previous studies, as safety management should be a daily activity in which supervisors and managers lead by example and encourage their subordinates to work safely [ 52 ]. However, Jeschke [ 53 ] has revealed a major conflict between managers’ daily work and safety, which they viewed as an extra task. In this study, it was found that, in the workplaces, employees are encouraged to make safety reports and do various safety rounds, sessions, or walks. In addition, incidents are regularly reviewed under the supervision of a supervisor. The last-minute hazard assessment emerged as another form of guidance in the interviews. Both the memory card method and the silent self-assessment of work hazards were used.

In this study, the interviewees mainly named written instructions, on-the-job learning and training as methods of current orientation, training, and guidance. In addition to traditional training methods, interviewees mentioned, among other things, training via MS Teams, video training and e-learning. Based on previous studies, the use of different training methods in developing skills has been highlighted [ 23 , 24 ]. For example, COVID-19 has caused changes in the organization in terms of teaching and accelerated the possibilities of distance learning [ 54 ]. Although it is often assumed that skills are developed in training programs, especially via textbook- and computer-based methods, previous research has shown that this is not a certainty. Training with both safe and high-risk examples has shown the highest accuracy and may lead to fewer under- or overestimations of risk in the assessment [ 32 ]. However, this study revealed an experience of not receiving any risk assessment-related orientation. In addition, companies did have written instructions and guidelines but a large proportion of respondents were uncertain about the instructions, felt the amount of instructions was low, or were unsure where to find the instructions. Furthermore, it was felt that although support is available, one must be able to take the initiative and ask for support from the right party.

Further study is needed to explore the effective intervention for training OHS risk assessment skills. In the current study, the experts thought that training and coaching are among the most feasible methods of developing risk assessment skills. Burke et al. [ 30 ] suggested enhancing learning through activity, dialogue and reflections. Ho and Dzeng [ 29 ] revealed that an e-learning method can be effective if the learning environment motivates the learner. In this study, the interviewees also raised education as the most significant way to develop OHS risk assessment skills. Suggested training methods included training given by a person outside of the organization, self-learning on the computer and mentoring. The OHS experts said that another feasible method of developing employees’ risk assessment skills is having clear guidance. Supporting this, a study by Bruhn and Frick [ 55 ] showed how a project can fail with under- or oversteering as well as with overly general or overly detailed guidance. Furthermore, in this study, the interviewees suggested improving risk assessment understanding and reviewing different perspectives.

Huang et al. [ 52 ] emphasized the importance of supervisors having a comprehensive understanding of safety rules and raised the need for communicating well with their employees. The current study made similar findings [ 52 ]; there is a need to improve communication between management and employees. Furthermore, the results of risk perceptions among employees and assessors differ, but the situation can be improved by using information strategies that simplify learning and improve risk perception [ 56 ]. Further research should be focused on how to make existing instructions and guidance better known to workers. Important questions include, why does one person easily find the right instructions and another feels that the instructions are unclear? Likewise, the employees’ experience of their own activity in obtaining support also raises questions, so how much can the support depend on the person? The focus could be on the communication and communications methods by studying various case companies.

Limitations

The companies that participated in this study developed their own OHS management systems long before this study. Consequently, the results of the study may not be directly generalizable to companies with a lower level of safety. Furthermore, the reference framework for this study was European OSH legislation [ 6 ] and its national Finnish Occupational Health and Safety Act [ 5 ]. As this is an EU Framework Directive, it sets minimum standards risk assessment and hence, the results are generalizable to European countries at some level. As the Delphi survey and interview process are explained in detail with explanations about the demographics of the participants, similar research can be carried out by other researchers in other countries. Further studies are recommended in multiple companies under different conditions, for example micro and small companies, in order to further generalize the results.

The other limitations of this study are the response rate to the Delphi survey and the limited number of interviewees ( n = 53) in the qualitative studies as well as the interpretation of these studies. A Delphi survey was e-mailed to the OHS specialists and managers, whose response rates varied [ 57 , 58 ]. By sending a reminder email each round, the number of responses increased. Small variations in the questionnaire questions or in the words used may affect the results obtained; consequently, in the second round, organizational factors were asked in addition to individual ones [ 47 ]. The results of this study were supported by the fact that the number of respondents increased in each round: 8 respondents in the first round, 12 respondents in the next round and 13 respondents in the last round.

Some of the interviews were conducted under time pressure, and in some of the companies interviewed, participants were supervisors, managers, and occupational safety and health representatives with no employees. However, the ratio of employees’ positions was overall fairly uniform. Although the interviewees had different education levels, work experience and backgrounds, similar issues began to emerge from the responses, so it can be said that this study used enough interviews. The design of the interviews took into account the interaction between the researchers and the interviewees. The interview questions were shown as text and spoken aloud. The semi-structured interview ensured that all themes were discussed, but it also provided room for more in-depth and free discussion [ 59 ]. This was done to make the interviewees feel comfortable and ensure that the discussion stayed on topic [ 42 ]. Similarly, some pitfalls and problems were taken into account when conducting a qualitative interview [ 60 ]. Efforts were made to improve the reliability of the study in a number of ways. The interviews were conducted in collaboration with two researchers. After each interview, the notes were reviewed and a separate file was compiled from them. The material was mainly coded by the same two researchers, who discussed the meaning of citations and codes [ 61 ]. The coding was iteratively carried out, reviewing the citations of a particular code if necessary and ensuring that they corresponded to the code [ 62 ]. In addition, the theme design was done by two researchers.

5. Conclusions

The results of this study are in line with those of previous studies. The most important issues related to the risk assessment skills of the employees and supervisors were unanimously determined to be identifying hazards and minimizing the risks of one’s own work for employees and the supervisors influencing of their subordinates through their own example and attitude. Understanding and managing the wholeness of safety practices and understanding and managing the meaning, concepts, and criteria of risk assessment as well as the related workplace safety legislation were the most important risk assessment skills for the OHS experts.

The interviews were used to determine the most significant ways to support risk assessment skills. Currently, learning at work and training as well as written instructions are the most often used support methods. However, there were some uncertainties about the instructions and feelings of not receiving enough orientation, guidance and support. Interviewees felt that in order to receive the support, they have to be the active party.

For the development of risk assessment skills, the survey provided expert opinions on the most feasible ways to support risk assessment skills, such as training and coaching, clear instructions, as well as suggestions from interviews on how risk assessment skills can be supported, such as via various training methods. Training methods included video teaching and training provided by a person outside the organization. In addition, the need to increase understanding of risk assessment and utilizing different perspectives were highlighted.

The results of this study can be used to find the most import development needs in order to create concrete development plans to improve risk assessment skills. Based on a Delphi survey, companies receive information on what OHS experts consider important risk assessment skills for personnel in different positions. Furthermore, this study presents how risk assessment skills are currently supported and suggests ways to further support and develop the risk assessment skills. Knowledge of the current situation can enable a company to choose the best development actions and implementations. Hence, it is recommended that companies perform a similar survey and interviews to determine their personnel’s need and receive feedback on risk assessment skills and support.

The number and percentage of responses to the themes as well as the number and percentage of interviews in which the theme is mentioned.

Author Contributions

Conceptualization, M.R. and M.L. Data curation, M.R. and M.L. Formal analysis, M.R. and M.L. Funding acquisition, S.T. Investigation, M.R. and M.L. Methodology, M.R. and M.L. Project administration, S.T. Supervision, S.T. Visualization, M.R. Writing—original draft, M.R. Writing—review and editing, M.R., M.L. and S.T. All authors have read and agreed to the published version of the manuscript.

This research was funded by the Finnish Work Environment Fund, grant number 200089.

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Conflicts of Interest

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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99 million people included in largest global vaccine safety study

19 February 2024

Health and medicine , Faculty of Medical and Health Sciences

The Global Vaccine Data Network, hosted at the University of Auckland, utilises vast data sets to detect potential vaccine safety signals

Global Vaccine Data Network co-director Dr Helen Petousis-Harris: Latest study uses vast data sets to ensure vaccine safety.

The Global Vaccine Data Network (GVDN) assessed 13 neurological, blood, and heart related medical conditions to see if there was a greater risk of them occurring after receiving a Covid-19 vaccine in the latest of eight studies in the Global COVID Vaccine Safety (GCoVS) Project.

Recently published in the journal Vaccine , this observed versus expected rates study included 99 million people (over 23 million person-years of follow-up) from 10 collaborator sites across eight countries. The study identified the pre-established safety signals for myocarditis (inflammation of the heart muscle) and pericarditis (inflammation of the thin sac covering the heart) after mRNA vaccines, and Guillain-Barré syndrome (muscle weakness and changed sensation (feeling)), and cerebral venous sinus thrombosis (type of blood clot in the brain) after viral vector vaccines.

Possible safety signals for transverse myelitis (inflammation of part of the spinal cord) after viral vector vaccines and acute disseminated encephalomyelitis (inflammation and swelling in the brain and spinal cord) after viral vector and mRNA vaccines were identified.

So far, these findings were further investigated by the GVDN site in Victoria, Australia. Their study and results are described in the accompanying paper. Results are available for public review on GVDN’s interactive data dashboards .

Observed versus expected analyses are used to detect potential vaccine safety signals. These studies look at all people who received a vaccine and examine if there is a greater risk for developing a medical condition in various time periods after getting a vaccine compared with a period before the vaccine became available.

Lead author Kristýna Faksová of the Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark, remarked that use of a common protocol and aggregation of the data through the GVDN makes studies like this possible. “The size of the population in this study increased the possibility of identifying rare potential vaccine safety signals,” she explains. “Single sites or regions are unlikely to have a large enough population to detect very rare signals.”

By making the data dashboards publicly available, we are able to support greater transparency, and stronger communications to the health sector and public.

Associate Professor Helen Petousis-Harris Co-Director, Global Vaccine Data Network hosted at University of Auckland

GVDN Co-Director Dr Steven Black said, “GVDN supports a coordinated global effort to assess vaccine safety and effectiveness so that vaccine questions can be addressed in a more rapid, efficient, and cost-effective manner. We have a number of studies underway to build upon our understanding of vaccines and how we understand vaccine safety using big data.”

GVDN Co-Director Dr. Helen Petousis-Harris said, “By making the data dashboards publicly available, we are able to support greater transparency, and stronger communications to the health sector and public.”

The GCoVS Project was made possible with support by the Centers for Disease Control and Prevention (CDC) of the U.S. Department of Health and Human Services (HHS) to allow the comparison of the safety of vaccines across diverse global populations.

About the Global Data Vaccine Network

Established in 2019 and with data sourced from millions of individuals across six continents, the GVDN collaborates with renowned research institutions, policy makers, and vaccine related organisations to establish a harmonised and evidence-based approach to vaccine safety and effectiveness.

The GVDN is supported by the Global Coordinating Centre based at Auckland UniServices Ltd, a not-for-profit, stand-alone company that provides support to researchers and is wholly owned by the University of Auckland. Aiming to gain a comprehensive understanding of vaccine safety and effectiveness profiles, the GVDN strives to create a safer immunisation landscape that empowers decision making for the global community. For further information, visit globalvaccinedatanetwork.org.

Disclaimer: This news release summarises the key findings of the GVDN observed versus expected study. To view the full publication in Vaccine, visit doi.org/10.1016/j.vaccine.2024.01.100.

This project is supported by the Centers for Disease Control and Prevention (CDC) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totalling US$10,108,491 with 100 percent funded by CDC/HHS. The contents are those of the author and do not necessarily represent the official views of, nor an endorsement by, CDC/HHS, or the U.S. Government. For more information, please visit cdc.gov

Media enquiries: gvdn@auckland.ac.nz and communications@uniservices.co.nz

Some virtual care companies putting patient data at risk, new study finds

Canadian researchers have patient privacy concerns as industry grows post-covid.

health and safety case study questions

Social Sharing

This story is part of CBC Health's Second Opinion, a weekly analysis of health and medical science news emailed to subscribers on Saturday mornings. If you haven't subscribed yet, you can do that by  clicking here .

If you visit a doctor virtually through a commercial app, the information you submit in the app could be used to promote a particular drug or service, says the leader of a new Canadian study involving industry insiders.

The industry insiders "were concerned that care might not be designed to be the best care for patients, but rather might be designed to increase uptake of the drug or vaccine to meet the pharmaceutical company objectives," said Dr. Sheryl Spithoff, a physician and scientist at Women's College Hospital in Toronto.

Virtual care took off as a convenient way to access health care during the COVID-19 pandemic, allowing patients to consult with a doctor by videoconference, phone call or text.

It's estimated that more than one in five adults in Canada —  or 6.5 million people — don't have a family physician or nurse practitioner they can see regularly, and virtual care is helping to fill the void.

But the study's researchers and others who work in the medical field have raised concerns that some virtual care companies aren't adequately protecting patients' private health information from being used by drug companies and shared with third parties that want to market products and services.

A female doctor with long, brown hair standing in a medical office.

Spithoff co-authored the study in this week's BMJ Open , based on interviews with 18 individuals employed or affiliated with the Canadian virtual care industry between October 2021 and January 2022. The researchers also analyzed 31 privacy documents from the websites of more than a dozen companies.

The for-profit virtual care industry valued patient data and "appears to view data as a revenue stream," the researchers found.

One employee with a virtual care platform told the researchers that the platform, "at the behest of the pharmaceutical company, would conduct 'A/B testing' by putting out a new version of software to a percentage of patients to see if the new version improved uptake of the drug."

health and safety case study questions

Many virtual care apps pushing products, selling personal data, research finds

Concerns about how data might be shared.

Matthew Herder, director of the Health Law Institute at Dalhousie University in Halifax, said he hopes the study draws the public's attention to what's behind some of these platforms.

"All of this is happening because of a business model that sees value in collecting that data and using it in a variety of ways that have little to do with patient care and more to do in building up the assets of that company," Herder said.

Bearded man standing in front of a chalkboard.

Other industry insiders were concerned about how data, such as browsing information, might be shared with third parties such as Google and Meta, the owner of Facebook, for marketing purposes, Spithoff said.

The study's authors said companies placed data in three categories:

  • Registration data, such as name, email address and date of birth.
  • User data, such as how, when and where you use the website, on what device and your internet protocol or IP address.
  • De-identified personal health information, such as removing the name and date of birth and modifying the postal code.

Some companies considered the first two categories as assets that could be monetized, employees told the researchers.

  • Many Canadians welcomed virtual health care. Where does it fit in the system now?
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Not all of the companies treated the third category the same way. Some used personal health information only for the primary purpose of a patient's virtual exchange with a physician, while others used it for commercial reasons, sharing analytics or de-identified information with third parties.

The study's authors said while each individual data point may not provide much information, advertisers and data analytic companies amalgamate data from browsing history and social media accounts to provide insights into an individual's mental health status, for example.

One study participant described how a partnership for targeted ads might work: "If an individual is coming through our service looking for mental health resources, how can we lean them into some of our partnerships with corporate counselling services?"

health and safety case study questions

Nurses’ union says virtual care is a move toward privatization of health care

Conflict-of-interest questions.

Lorian Hardcastle, an associate professor of law and medicine at the University of Calgary, studied  uptake of virtual care in 2020. She highlighted issues of continuity of care, privacy legislation and consent policies.

Since then, she said, uptake in virtual care accelerated during the COVID-19 pandemic.

"I think that the commercialization of the health-care system raises concerns around conflicts of interest between what is best for patients on the one hand and then on the other hand, what has the best return for shareholders," said Hardcastle, who was not involved in the BMJ Open study.

A woman with long brown hair wearing a blouse and jacket.

Hardcastle said it is helpful to have industry insiders acknowledge problems that health professionals and academics have expressed about commercialization.

The Office of the Privacy Commissioner of Canada, which funded the study, said in an email that privately funded health professionals are generally considered to be conducting commercial activities.

Hospitals, long-term care facilities and home care services that are publicly funded are not considered to be engaged in commercial activities and are covered by provincial privacy legislation, the office said. Health information falls into many categories and may be subject to different privacy laws across various jurisdictions.

Hardcastle also suggested that self-regulatory bodies, such as provincial colleges of physicians and surgeons, may need to revisit policies around relationships between health providers and industry.

Virtual care industry responds

CBC News heard from some Canadian virtual care companies that said they take the privacy of individuals seriously.

"Patient data is only used with patients' explicit consent and only when it's required for health-care interactions between a patient and a doctor," a spokesperson for virtual care platform Maple said. "We do not exploit patient data for marketing or commercial gain."

  • Is virtual care a cure for Canada's battered health-care system?

In a statement, Rocket Doctor said it is important to note that the company "does not do any of the things listed by the researchers as common in the telehealth industry."

Telus said that all of the data collected from its virtual care service is treated as personal health information.

"Telus Health doesn't receive any funds from pharmaceutical companies for our virtual care service and we do not sell any patient data collected," said Pamela Snively, the company's chief data and trust officer.

Source of information hard to pin down

Hardcastle said it may be difficult for some people to distinguish between receiving reliable and accurate information from a health-care provider on an app and getting services marketed to them that the health provider may or may not find useful.

"Your family doctor isn't trying to collect superfluous information in order to market services to you," she said.

Some provinces and territories pay for the virtual services. In other cases, patients pay themselves or are covered by employer or private insurance.

  • Patients tapping into alternative care options, but N.S. emergency departments still face challenges

Nova Scotia's government, for example, has a contract with Maple to provide residents without a primary care provider with unlimited virtual visits. Those who do have a regular provider can have two visits per year paid for by the province.

Tara Sampalli, senior scientific director at Nova Scotia Health Innovation Hub, said the province's contract with Maple means residents' data can't be used in other ways, such as by third-party providers.

The province doesn't have that level of control over other providers of virtual care, said Sampalli, who holds a PhD in health informatics.

Calls for an opt-out choice

Herder, of Dalhousie University, said users should be able to easily opt out of having their data used for commercial purposes. He also said that if the data doesn't represent the full diversity of Canada, algorithms shaping clinical decision-making could be racially biased.

Spithoff said while patient awareness is important, patients aren't in a position to fix this problem.

  • 140,000 Nova Scotians are waiting for a family doctor. Can virtual care help?

"We need better legislation, regulation, and we need better funding for primary care," she said. "Or people can get virtual care integrated into their offline care."

Spithoff and her co-authors said self-regulation by the industry is unlikely to lead to change. 

The researchers acknowledged they were limited to publicly available documents and that they did not interview those affiliated with the third-party advertisers.

health and safety case study questions

Canadian Medical Association calls for health-care system overhaul

Corrections.

  • An earlier version of this story suggested that all health professionals conduct commercial activities under federal legislation. In fact, some publicly funded health services are not commercial and are covered by various other legislation. Feb 12, 2024 6:11 PM ET

ABOUT THE AUTHOR

health and safety case study questions

Amina Zafar covers medical sciences and health topics, including infectious diseases, for CBC News. She holds an undergraduate degree in environmental science and a master's in journalism.

With files from CBC's Christine Birak

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Abortions by Telemedicine and Mailed Pills Are Safe and Effective, Study Finds

Pam Belluck

By Pam Belluck

Pam Belluck has covered reproductive health for more than a decade.

Taking abortion pills prescribed through telemedicine and received by mail — a method used by growing numbers of abortion patients — is as safe and effective as when the pills are obtained by visiting a doctor, a large new study found. The method was about 98 percent effective and was safe for over 99 percent of patients, the study reported.

A stack of orange Mifeprex boxes sits next to a stack of plastic cups.

The research

The study, led by researchers at the University of California, San Francisco, looked at the experience of more than 6,000 patients in the months after the federal government began allowing abortion pills to be mailed , from April 2021 to January 2022.

The patients used one of three telemedicine abortion organizations — Hey Jane, Abortion on Demand or Choix — that served 20 states and Washington, D.C. The research, published on Thursday in Nature Medicine, ended five months before the Supreme Court overturned Roe v. Wade, igniting a wave of state abortion bans and restrictions. Since then, more telemedicine services have opened, and are used by many patients who consider the method more convenient, private and affordable than visiting clinics or doctors, especially if they have to travel to another state.

The services in the study prescribed pills to patients who were 10 weeks pregnant or less (one service had an eight-week limit) and screened patients for medical issues that would make them ineligible , like ectopic pregnancies or blood-clotting disorders.

In most cases, the services’ doctors, nurse practitioners, physician assistants and midwives were able to determine eligibility from patients’ written or verbal information about their pregnancy and health, without requiring them to have ultrasounds, which are logistically difficult for some patients to obtain. If medical eligibility was unclear, patients were asked to get ultrasounds — 486 did and were then prescribed pills, comprising about 8 percent of the 6,034 patients who received pills in the study.

The results

Researchers reviewed the medical records of the services and were able to determine abortion outcomes for three-fourths, or 4,454, of the patients. A vast majority — 4,351 patients, or 97.7 percent — completed abortions with the standard regimen: mifepristone, which stops a pregnancy’s development, followed a day or two later by misoprostol, which causes contractions to expel the tissue.

Of the remaining patients, 85 needed additional measures to complete the abortion, usually with additional medication or a suction procedure in a medical facility.

Eighty-one patients visited emergency departments, and 15 patients had serious complications. Ten patients were hospitalized. Six received blood transfusions, two were treated for infections and one had surgery for an ectopic pregnancy.

Six patients turned out to have ectopic pregnancies, which would have made them ineligible for the pills. Studies show that ectopic pregnancies cannot always be identified early, even by ultrasound.

Of the patients who visited emergency departments, 38 percent ended up needing no treatment. Patients sometimes visit emergency departments because “they don’t know whether what they’re experiencing is normal and they sometimes don’t have anyone to ask and they don’t want to tell a lot of people about their abortion,” said Dr. Ushma Upadhyay, a public health scientist at U.C.S.F. and one of the study’s authors.

No patients were found to be beyond 10 weeks into pregnancy.

The effectiveness and safety rates were similar to those in several large studies of in-person medication abortion and of telemedicine abortion where ultrasounds were required . They were also similar to the rates on the Food and Drug Administration’s label for mifepristone .

Researchers also found no difference in safety or efficacy for patients who received real-time video consultations compared to those who received prescriptions based on written information they provided via text messaging, which most patients did.

Two patients asked about “abortion pill reversal,” a nonscientific theory that abortions can be stopped after taking the first drug. Both were told that “evidence-based reversal treatment does not exist” and were referred to urgent in-person care, the study reported.

Larger implications

Medication abortion is being challenged in a lawsuit filed against the F.D.A. by abortion opponents seeking to curtail mifepristone. One of the plaintiffs’ claims is that abortion pills are dangerous. The F.D.A. has cited overwhelming scientific evidence that the pills are safe , and two studies that abortion opponents referenced to support their claims were recently retracted by a scientific journal publisher .

In August, an appeals court said mifepristone could remain legal, but ordered significant restrictions that would prevent mailing or prescribing it by telemedicine. The Supreme Court will hear arguments in the case next month. The new study results may be mentioned by those urging the court to keep telemedicine abortion available.

Pam Belluck is a health and science reporter, covering a range of subjects, including reproductive health, long Covid, brain science, neurological disorders, mental health and genetics. More about Pam Belluck

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