Chapter 5: Providing Services to a Single Large Employer

Providing occupational health services to a single large employer requires a fundamental understanding of how such organizations work.

All large organizations, whether places of business, military establishments, universities, unions or governments, have a common basic structure (Figure 5.1). Each type of organizations has its own characteristics, but for simplicity the business organization alone will be described in some detail. One line of authority extends from the ultimate leader to the lowest level employee. Along this line all actions take place resulting in the goods or services produced by the business. The staff line, perpendicular to the line of authority, supports it by providing necessary services such as financial, legal, human resources and occupational health and safety.

All businesses operate in a context that influences how the organization will function (Figure 5.2). The business climate affects the company's financial status, productivity, employee morale and indeed its very existence. Unions may or may not cooperative with achieving the goals of the company. Employee expectations may be too high or too low. Laws and regulations always govern how a company will conduct its business. A company may have a particular image it wants to project. The individual characteristics of the business itself are important, such as its size, type, age, history, location, ownership and mission.

The most critical factor for occupational health is the company business philosophy. (Figure 5.3) Does the company management, from the most senior levels down to the most junior worker, show concern for its employees and the public health and safety, obey laws, recognize industry codes of practice, reflect and respect human values? If such a philosophy is lacking, then the provision of effective occupational health services is not possible. At times it may fall to the occupational health professional to help establish an enlightened business philosophy in a company. On the other hand, if such a philosophy is evident occupational health services will enjoy a nurturing environment and, if run well, will be a valuable asset to the business.

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Figure 5.1. Basic structure of all organizations.

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Figure 5.2. Context within which business operates.

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Figure 5.3. The forces acting on the occupational health and safety department reflect the forces within the context of the company as a whole, with the critical addition of the company's philosophy and policy.

The company occupational health and safety policy should in turn reflect the company's business philosophy, articulate its commitment to employee well being, recognize the relevant laws, define roles, and assign responsibility. The occupational health service plays many roles within the organization and serves many functions. These include daily routine (operational) functions, short- or medium-term (tactical) functions, and (strategic) long-term functions to achieve organizational goals. The context for each is different and must be clearly understood. Walsh1 has identified management and medical axes of concern for the occupational physician in a corporate setting (Table 5.1). These include concern for environmental health and product liability issues and personal health problems among employees as well as occupational health per se.

Other forces of context which may influence the actions of the occupational health and safety group are the legal and regulatory environment, social and economic forces, and the nature of the relationship between labour and management (Figure 5.3). The company may be in an environment where aggressive litigation is the rule of the day, or where regulations are stiff and enforced routinely. Social and economic forces which bear directly on the company can have a significant impact. If the company is doing well, the occupational health and safety function will likely not have to fight so hard for funding, but conversely in lean times the occupational health and safety function, regardless of the impact it can make on the bottom line, may find itself fighting for its very survival. Sometimes the company will be doing well, but is located in a difficult social environment. The occupational health and safety department may have to deal with a workforce with special linguistic, educational and economic problems. Labour and management relationships are critical. Occupational health and safety can be swept up into acromonious situations between labour and management especially if a union is present and feels that the health and welfare of its membership is not being managed properly by the company. However, the occupational health and safety group, if well run and understands its role, and if its role is understood by others, can have a very positive influence on labour/management relations. The underlying role of the occupational health and safety department, focusing on matters of health, is to help create a fair balance between employee rights and obligations and those of the company (Figure 5.4).

Table 5.1.  Matrix of Occupational Health Service Responsibilities 
            in Large Organizations

Medical Level: Individual            Group            Community
Management     (Worker)             (Workers)        (External)

Operational    Clinical care:       Health hazard    Environmental/product 
               case management      identification    hazard management
                                       and control

Tactical       Prevention-oriented  Comprehensive    Regulatory affairs
               health services,     occupational
               preplacement         health
               evaluation           services

Strategic      Health promotion     Health policy,   Risk/liability 
                                    cost,            control

Modified after Walsh. 

Occupational and Environmental Health and Safety Policy

A model occupational and environmental health policy that could apply to any company large enough to have a corporate office, diverse operations, and affiliated businesses might be written as follows:


To confirm the company's commitment to protect the health and safety of its employees and of persons living or working near company operations, and to assign responsibility for the actions and decisions required to maintain this commitment.

Policy Statements

  1. Protect the health and safety of employees by establishing programs and services designed to promote and maintain the health and safety of employees both while at work and while away from work.
  2. Protect the health and safety of persons living or working in areas near company operations by establishing procedures and programs that minimize the impact of these operations on the environment.
  3. Establish and maintain practices and services which meet or exceed legislated standards by implementing company occupational health and safety standards which reinforce or, where appropriate, exceed current legislated standards.
  4. Provide leadership, support, and review on occupational health and safety matters to help affiliated businesses meet their obligations.
  5. Require that all contractors comply with company occupational health and safety policy by inserting specific health and safety clauses within their contracts and by performing periodic inspections of the contractors' operations.

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Figure 5.4. The occupational health and safety department must strike the balance between the rights and obligations of the employee and the company.

Responsibility and Authority

Management of all company operations, subsidiary and affiliated companies are responsible for their operations' compliance with this policy, and are required to ensure:

  1. Compliance with all laws relating to employee health and safety, including Occupational health and safety, public health and safety, workers' compensation, and human rights acts;
  2. Compliance with company occupational and environmental health and safety standards;
  3. Compliance with programs designed to promote employee and public health and safety; and
  4. Immediately inform the next level of management of any health and safety matter requiring the attention of the corporate occupational health and safety department or an appropriate government agency.

Occupational Health and Safety is Responsible for:

  1. Providing leadership, support, audit and services to operating components of the company and its subsidiary and affiliate companies in all areas relating to employee and public health and safety;
  2. Developing, in coordination with operating components, company occupational health and safety standards, practices, services and reporting methods necessary to comply with company and legislated standards;
  3. Monitoring and auditing operating components' compliance with legislated and company standards;
  4. Developing programs and services designed to promote employee and public health and safety.
  5. Preparing quarterly and annual reports for senior management on company performance relating to occupational health and safety including recommendations for corporate level action.

Reservation of Authority

All employees engaged in those specialties relating to the occupational health and safety department are professionally responsible to the vice president, occupational health and safety, who is provided with the authority to affect their appointment, promotion, compensation or termination.

All procedures, guidelines and communications relating to occupational health and safety shall be based on this policy.


No exceptions.


Large employers, by definition, have more than 1,000 employees and ought to have a full-time in-house occupational health service. The service should have a close working relationship with the safety and occupational hygiene functions. In a company this size the occupational health services will likely be part of the personnel department while safety and hygiene will report to an operating manager. Once a company has grown to around 3,000 employees, a single administrative grouping of health, safety and hygiene should be formed (Figure 5.5).

The occupational health and safety department needs a clearly defined mission statement which is fully supported by the company policy document. A typical mission statement might read as follows:

The mission of the occupational health and safety department is to provide leadership, support, audit and service to ensure:

  1. the health and safety of employees is maintained and protected while at work,
  2. the health of people living or working near the company's operation is not adversely affected, and
  3. the company meets or exceeds legislated requirements to protect it from changes and inappropriate liability.

The occupational health and safety unit clearly falls within the staff side of the organization (Figure 5.1), as it generally does not make goods or provide services outlined in the company's overall business mission.

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Figure 5.5. Once a company has grown to 3,000 employees, a single administrative grouping is needed to coordinate the three occupational health and safety functions.

In a large company the organizational positioning of occupational health and safety is quite critical. The model policy statement outlined in a general way the role and responsibilities of the occupational health and safety group but did not spell out specific reporting relationships. It did, however, define lines of authority that can account for the circumstance where a company has both corporate and operating occupational health and safety personnel.

The corporate occupational health and safety group should be headed up by a senior manager reporting as high in the organization as is practical (Figure 5.6). The leader should have a strong administrative and professional background. This position can be occupied by a physician who has such a background, but in no way does this imply that safety and hygiene are subordinate to health. They each have an equal role to play (Figure 5.7). The corporate group will often be quite small, providing leadership, support and audit to the occupational health and safety personnel distributed throughout operations. In effect a matrix of relationships is formed where there is a combination of straight line and dotted line representing professional links (Figure 5.8).

Even if the corporate vice president of occupational health and safety is a physician, a corporate medical director to provide professional leadership to the occupational health programs is needed. This position is particularly important in companies where occupational health nurses provide most of the occupational health services in operations. Part-time occupational health physicians usually are not able to provide the kind of support needed by the nurses, and often need strong professional support themselves. The corporate medical director, if he or she does not report to a vice president of occupational health and safety, should at least report to someone at the policy-making level. The corporate medical director should have sufficient power by virtue of the position to be able to influence or set policy, and to establish standards of practice. Some large companies have neither a senior manager nor a company medical director responsible for occupational health and safety. Some use outside medical consultants primarily or exclusively. Neither of these models work well and reflect a lack of commitment to occupational health and safety on the part of the senior management of the company.

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Figure 5.6. The corporate occupational health and safety department should report as high in the organization as possible.

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Figure 5.7. The occupational health and safety department may develop units for each of its major functions, each on an equal basis with the others.

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Figure 5.8. The matrix of professional relationships and reporting relationships in an occupational health and safety department.

A successful occupational health and safety service can be achieved only in an organizational environment that is based on a sound business philosophy that requires the company to care about people and to obey laws. Lacking this underlying value system, occupational health and safety policy and programs cannot achieve their potential.

Further Reading

Walsh DC: Is there a doctor in-house? Harvard Business Review 1984 (July-August); (4)84-94.