A hierarchical organization and traditional learning methods emphasize sharply delineated roles. A learning organization and networking, on the other hand, tend to break these rigid roles that often restrict development. In a learning organization, the distribution of work is flexible and bounda- ries can be crossed easily.
Some boundaries that can hinder co-operation in occupational health serv- ices are: 1) boundaries between different professional groups in an occupa- tional health unit, 2) boundaries between an occupational health unit and other expert functions, 3) boundaries between occupational health services and client groups, and 4) boundaries between occupational health services and other health care and occupational safety and employment authorities. Flexible models of activity are established in the joint meetings of the dif- ferent parties, and the distribution of tasks is agreed upon. However, meet- ings and discussions are not always enough to create new ways of proceed- ing. It is also important to do things together, to participate in the same events, to switch over to work in the other person’s area, etc. An expert will face uncertainty, as well as differences in opinions, attitudes, etc. Tackling such situations often requires a new way of proceeding. Examples of these situations are: the occupational health personnel having to work occasion- ally in different departments of an enterprise, or transferring traditional health services from health care centers to the work units. Boundary cross-
In order for the integration of different kinds of expertise to actualize, and not remain an empty phrase, it is important that an occupational health unit recognizes ways in which the flexible distribution of work can be promoted. Work distribution models that are flexible and cross the traditional bound- aries between professions are, for example:
w Creating common models of activity, instead of emphasizing the way of thinking in one’s own professional group.In team meetings, experts often look at the matters at hand from the standpoint of their own work or the field of expertise they represent. Issues that would involve interfering in the other person’s work or field of expertise are purposefully avoided. This guarantees in return a kind of professional integrity. In teamwork situa- tions like this, the problem is often ascribed to the lack of a common lan- guage, which, however, always reflects the lack of shared thinking models needed for directing the activity, as well as a disintegration of opinions.
w Putting oneself in another person’s position broadens the perspective on the issues at hand. For instance, when occupational health personnel dis- cuss the situation of the clients or the client enterprises, it is often agreed in the group that someone should try to look at the issues from the client’s point of view during the whole discussion. This is often a much more effec- tive way of learning to understand different points of view than to ask the other party to join the discussion, and at the same time to hold on to your own point of view. In training events, putting yourself in another person’s position is called a sociodrama or simulation. Also in everyday situations at work, it is possible to put oneself in another person’s position for a while, and try to look at things from a different point of view.
w “Tacit knowledge” in work teams. Some people are quiet in teamwork situations, even if they have significant, experience-based knowledge on the issue in question. Ways of co-operation which can be traced back to the traditions of functioning in a hierarchical organization can be overcome in many ways. Turns can be taken in arranging meetings and in preparing the issues, and people can take different roles in teamwork situations. Also cards or stick-on notes, etc., can be posted on the wall to help people bring forward their opinions. These methods are described in books on teamwork and creativity, and suitable alternatives can be found for various purposes.
the other hand, the real values, contradictions and differing points of view connected with concrete events and situations are not discussed nor ana- lysed. The desire to preserve the consensus culture is greater than the desire to evaluate and integrate different viewpoints and alternative ways of action.
w Concrete trials and utilization of differences. Team work should not be mere discussion of principles or agreeing on the distribution of routine tasks. New practices in the flexible distribution of work in a team can be achieved only by working together. Instead of, and in addition to, docu- menting general principles, concrete decisions must be made. We are often told that we should tolerate differences better. However, the question is not only of toleration, but of being able to make use of differences in concrete situations. This means that different viewpoints are not immediately la- belled as right or wrong, but are discussed and evaluated without bias or prejudice.
w A learning organization regularly revises its own procedures, i.e. the ‘script’ of its co-operation practices. Although it might seem that the team is working smoothly together, it should from time to time ponder which issues are dealt with together and how they are handled. In this way every- one gets an opportunity to participate in putting the script together. Issues that should be dealt with together are, for example:
w Plans for the development and training of a work unit, new ways of action, and the building of co-operative networks
w A unit’s co-operative networks and their functioning
w Problems and the anticipation of problematic situations, handling difficult questions
w Routines, co-ordination of tasks, and flow of information.
Although different issues require different ways of dealing with them, the following is a general check-list:
w Does everyone have an opportunity to prepare for the topics to be dis- cussed by producing, collecting and receiving relevant information on them?
w Does everyone have the opportunity to participate in the mutual discus- sion of common issues? For example, meeting times agreed on well be- forehand, and adhered to?
w Is the manner of discussing issues such that the bringing up of different viewpoints is encouraged, and they can be evaluated as issues, regardless of whose opinion it was?
The plan of action for occupational health services should include an ac- count of what has been planned to do together and how different things are to be done together.
Bibliography in English
Argyris C: On organizational learning. TJ Press Ltd, Padstow, Cornwall 1992.
7
Ethics in Occupational Health Care
Mari Antti-Poika
Introduction
The same ethical principles are followed in occupational health care as in general health care. Due to the role of occupational health services, partic- ular pressure regarding ethical conduct is directed toward occupational health personnel. It is important that the occupational health personnel recognize and take into consideration the ethical problems that are connected with their work.
As a part of everyday life, ethics affects the values, attitudes, and the man- ner in which one interacts with clients and co-workers. Ethics cannot be treated as a separate entity. Ethically acceptable activity is also effective and of high quality. Absolutely correct, exact ethical instructions cannot be given in this manual, which offers only guidelines. Ethical choices always involve decisions that depend on the situation in question, on one’s own conviction, on autonomic choices, and on self-control.
The ethical principles of occupational health care are:
w following good occupational practice
w maintaining and promoting the employee’s health and work ability, and prevention of work-related health hazards in particular
w anticipating possible risks related to the procedures of occupational health services, so that they will not harm the employee’s health or have nega tive effects on his/her position in the work community (Hippocratic Oath, see also Chapter 14 Health examinations, section Ethical aspects)
w respecting human rights and dignity of the human being
w independence and impartiality
w ensuring secrecy of data
Good Professional Practice
The methods and procedures chosen should be advantageous enough in relation to the possible disadvantages. In occupational health care, the dis- advantages are rarely life-threatening, but they can have other negative ef- fects, such as losing one’s job, losing one’s profession, lowered income, unnecessary fears, or a false sense of security. Weighing the pros and cons is part of the professional skills.
The continuous maintenance of professional skills is necessary for main- taining quality in occupational health services. Although the judicial re- sponsibility for the training of occupational health personnel lies with their employer, it is the responsibility of the occupational health personnel to plan their own training and actively take initiatives to maintain their pro- fessional skills on a high level.
The professional credibility of the occupational health personnel is main- tained when they keep within the limits of their own expertise. The occupa- tional health personnel also have to inform openly about the problems that cannot be solved by means of health care.