A successful occupational health service is one that is appropriate to the needs of the organization it serves, efficiently managed, and beneficial in relation to cost. The offerings of the health services marketplace are virtually without limit and, lacking a well considered plan, an employer can easily fall into the trap of paying for a system that fails to meet the need. A successful service is rarely found "off the shelf". Obtaining the right system to meet the needs of the employer requires careful analysis and good planning. The variety of "packaged" occupational health programs for sale in the marketplace does not obviate the need for planning and evaluation because many of these package deals may be of little or no value to the employer. They may be poorly conceived, badly implemented, inflexible, or unsuitable to the employer's particular situation. Lacking a plan and carefully considered expectations, an employer can easily fall into the trap of paying for a system or program that fails to meet the real need.

The more important components of occupational health services are discussed in some detail in the succeeding chapters of this book. This chapter is written from a slightly different perspective, that of an employer selecting an occupational health service to meet a particular need. It describes a process of planning which should enable the employer to identify and to select service components appropriate to the need and to dispense with those that are not needed.

The first step in the process is to determine priority needs in occupational health. The objectives described in chapter 1 should be reviewed and, with these in mind, the following pieces of information about the company and its workforce should then be gathered:

1. Those workplace health hazards presented to employees in the company's daily operations (See Chapter 25):
   • 1.1 hazardous materials used
   • 1.2 hazardous substances or energies produced
   • 1.3 hazardous work processes or procedures

2. The main characteristics of the employee population which affect the type and degree of response to the hazards (See Chapter 17 and 19):
   • 2.1 age span and average age
   • 2.2 sex ratio
   • 2.3 average length of employment with the company
   • 2.4 average educational and skill level

3. The injury and illness experience and the sickness absence record of the workforce, with a careful and honest analysis of the effect of the following factors (See Chapter 22):
   • 3.1 nature of the work carried out by employees
   • 3.2 conditions under which the work is carried out
   • 3.3 quality of employee supervision
   • 3.4 state of worker-management relations
   • 3.5 the employer's existing health and safety policies and procedures
   • 3.6 health problems prevalent in the community at large

Obviously, some of these factors are complex and it may be difficult to assess their particular significance to the planning process. Where this is a serious problem, the manager with responsibility should give consideration to acquiring input from qualified occupational health consultants experienced in assessing individual company needs. Advice can be obtained from firms which provide occupational health services, universities with occupational health programs, independent specialist consultants or from government agencies.

Analysis by occupational health service firms may be affected to some degree by an interest in marketing their own services, but they also may be able to provide some needed elements, sometimes in a packaged form which may be less expensive than trying to develop them anew. Quality assurance is sometimes lacking, however, and the employer would be wise to pay careful attention to this.

Independent consultants hired as individuals usually provide unbiased advice based on careful and thorough analysis. However, it then becomes the company's responsibility to obtain services or to implement programs. Governmental advice is free, but is often quite limited in scope and does not normally include direct provision of occupational health services to private employers.

Having obtained and analyzed this information, the manager can then rationally select the specific programs or delivery components it requires. The following elements should be given first consideration as they are general needs prevalent throughout industry and are also building blocks for later development:

1. The occupational health and safety policy of the company (See Chapter 5)
2. Acute care for illnesses and injuries (See Chapter 17)
3. Environmental monitoring (See Chapter 25)
4. Preplacement, periodic health, and other fitness-to-work evaluations (See Chapter 18 and 19)
5. Industrial hygiene and other prevention-oriented services

Note that the employer's policy has been given first place on the list. This is for a good reason: the company's policy is the keystone which supports the entire array of delivery programs and establishes the importance which the company gives to the maintenance of employee health and safety.

The company occupational health and safety policy should originate with, or at least be clearly endorsed by, top management. It must be more than a mere statement of good intent. Specific policy statements on environmental hazard control, employee health monitoring, confidentiality of personal health information, rehabilitation post-injury or illness, informing workers of hazards and of their monitoring results should all be included. This policy statement should be accessible to all company employees. The critical role of the policy statement is described in more detail in Chapter 5.

There are a number of other service components, the importance of which will vary with the individual workforce and the hazards faced:

1. Employee assistance (See Chapter 23)
2. Health promotion and education (See Chapter 24)
3. Special preventive programs (such as immunizations, assessment for fitness to wear respirators, physical fitness)
4. Rehabilitation for employees returning to work after injury or illness (See Chapter 21)
5. Disaster response (see chapter 26)

Successful and worthwhile occupational health services are designed to meet real needs. The specific needs, in turn, are determined by an objective analysis of the company's health hazards, the characteristics of the workforce and the workforce's illness and injury experience. A company must support its health service with a well-defined policy which addressed the interests of the employees and which is accessible to them.