To the knowledge of the authors, this is the first study to analyze and compare the activities of OPs in Japan and the Netherlands, the two countries where all workers are provided OH care irrespective of enterprise size. The study is also among a few that successfully collect the opinions of active OPs who serve primarily in small- and medium-scale enterprises for the improvements of OHS. As discussed previously, the levels of OHS in SSEs are lower than that in large-scale enterprises (Bradshaw et al. 2001
; Park et al. 2002
; Furuki et al. 2006
; Kubo et al. 2006
); it is no need to add that participation of competent OPs and other OH experts is essential to provide high-quality OHS for the development of sound occupational health there (Nicholson 2004
Probably in reflection of different legal systems in the two countries, OPs in the Netherlands serve longer time (146 h per month) than OPs in Japan (22 h per month; Table ), and allocation of service time are also different, i.e., OPs in Japan focus their activities on mental health care, attendance at health and safety committees, worksite rounds, and prevention of health hazards due to overwork, where as OPs in the Netherlands gave much more time for guidance of sick leave workers as well as rehabilitation during the absent period (Table ). Nevertheless, majorities (74–87%) in both groups of OPs are unanimous in stressing the importance of education and training of employers for good OHS in SSEs. The emphasis was comparable to or even higher than that on education and training of employees, the traditional target of occupational health education in enterprises.
This suggestion should be quite correct. In a review on preventive occupational health and safety in small enterprises, Hasle and Limborg (2006
) summarized that the owner (note that the employer in small business is often the owner-manager) is the dominant actor in relation to any changes made in SSEs and the personal values and priorities of the owner are determinants of the culture, social relations, and the attitude of the enterprises. Thus, the owner is indeed the key person also in occupational health in SSEs. They are also crucial for the development of trust and for the dialog with OPs. Previous reports by Lamm (1997
), Nicholson (2004
) and Linnan and Birken (2006
) are on the same line. In fact, it is an advantage of OPs in SSEs that OPs may have better opportunity to educate the employer not only through the activities of the OHS committee but also by direct conversation with the employer.
In communicating with an employer or an owner-manager, the documents to be submitted to him/her should be short (Brosseau et al. 2007
), easy to interpret (Walker and Tait 2004
), industry subgroup specific (Mayhew 2000
), and carry with practical applications (Mayhew 1997
) and good practice examples (Russell et al. 1998
). Brosseau and Li (2005
) stressed the importance to demonstrate the positive effects of OHS on employee health and to present improved quality outcome. Different time expenditure patterns between Japanese and Dutch OPs may be influenced by legal requirement, at least in part. Dutch OPs devote long hours for sick leave guidance and rehabilitation (Tables , ) as previously discussed. This may be due to the regulatory requirement that OPs are requested to take care of employees’ sickness absence in the Netherlands (Ministry of Social Affairs and Employment, the Netherlands 2006
). The fact that Japanese OPs use times for attendance at the safety and health meetings, worksite rounds and prevention of health hazard due to overwork (Tables , ), which are also related to the regulatory stipulation that these are among the duties of OPs in Japan (Ministry of Health, Labour and Welfare 1972a
Increasing hours for plan and advice for OSH policy and attendance at the meeting of HS committee are common wish in both countries. These might be activities to improve OH climate in enterprises. Parker et al. (2007
) have reported HS committee is the important predictor of workplace safety. Management commitment to safety would result in positive outcome such as job satisfaction and job-related performance of employees beyond improved safety performance (Michael et al. 2005
There are several limitations in this study. Participating OPs in the Netherlands was randomly selected, whereas OPs in Japan were limited to those in member organizations of National Federation of Industrial Health Organizations, Japan, and might not be representative of external OPs in Japan. It is possible that the OPs with a more positive attitude toward OH activities especially for SSEs were more likely to respond to the questionnaires. Moreover, Japanese OPs in this study are better qualified and presumably more active in OH than average Japanese external OPs who mostly belong to a clinic or a hospital. There situations might have affected the results of the present study.
Another and possibly more serious problem may be the low response rates, i.e., effective reply rates were 17% in Japan and 21% in the Netherlands as previously described in the Methods section. It appears likely that the response rates used to be lower for the medical profession (as in the present study) than for other target populations e.g., patients. Thus, Oudhoff et al. (2007
) obtained responses from general practitioners (GPs) and occupational physicians (OPs) at substantially lower rates (32.5 and 46.7%, respectively) than that from patients (65.6%) when they sent the same questionnaires on prioritization in surgical waiting lists.
In a questionnaires survey on mutual trust between GPs and OPs in the Netherlands, Nauta and Grumbkow (2001
) had an over-all response rate of 23.8%. Further breakdown showed that the rate was 19.6% for GPs and 36.7% for OPs. In a survey on required competence of OPs in United Kingdom, Reetoo et al. (2005
) intended a questionnaires survey by post but had to switch to telephone interviewing due to a very low response rate.
In Japan, Hirobe et al. (2005
) had response from OPs at a rate of 20.4% when they made a survey on myocardial infarction morbidity of workers. When a questionnaires survey on OPs’ activities in SSEs was conducted, Terada et al. (2005
) succeeded to obtain a higher response from OPs at 37.5% that was achieved when the survey was conducted in cooperation with medical associations in the regions. Muto et al. (1997
) reported a similarly high response rate of 37.9% in a questionnaire survey on the methods to persuade high management to support OHS, but the respondents included non-MDs (such as occupational nurses and safety and health supervisors) and OPs accounted for 37%. Taking these experiences by other study groups into consideration, the response rates in the present study may not be too low.
The structure of the questionnaires used in the present study might have contributed to reduce response rates. The questionnaires set was rather bulky with 20 questions [including some complicated ones (e.g., Q. 11, Q. 12 and Q. 13); see the appendix], and several questions (e.g., Q. 14 and Q. 15) requested answers in free writing. In fact, some OPs in both countries complained in the margin of the questionnaires sheet that “the questionnaire is too complicated and time consuming to complete”. The authors could not prepare a reward for the reply as well. These situations might have affected the response rate. There remain several points to be studied. The points include the satisfaction of employers and employees with current OHSs, effectiveness of OHSs to solve or prevent problems, and possible effects of socio-economic factors. They are the subjects of future studies.
In conclusion, the present survey suggests that service patterns are different between OPs in Japan and OPs in the Netherlands, i.e., more time for health and safety committees, worksite rounds, and overwork prevention in cases of Japanese OPs, whereas it is sick leave issues for OPs in the Netherlands. Both groups of OPs consider that the education of employers (possibly owner-managers in cases of SSEa) is important in addition to traditional education of workforces. These conclusions should, however, be taken as preliminary, due to various limitations especially low response rates. Further studies are apparently necessary before reaching solid conclusions.