University Medical Centre Ljubljana dr. Marija Molan University Medical Centre Ljubljana Slovenia

Key lecture 1: Psychological Stress and Risk Assessment dr. Marija Molan University Medical Centre Ljubljana EASOM - European Association of Schools of Occupational Medicine Bled 2015

EASOM - European Association of Scools of Occupational Medicine Issues Perception of stress Perception of strain Psychological stress at the workplace (something new or heritage from the past): EASOM - European Association of Scools of Occupational Medicine What is more important at the workplace? dr. Marija Molan, Bled 2015

Risk assessment Experiences in identification Evaluation Reduction of environmental risk Safety management Due to health and safety legislation Due to the obviousness of the environmental risk EASOM - European Association of Scools of Occupational Medicine dr. Marija Molan, Bled 2015

Psychosocial risk Reality of the working places in the 21st century Poor psychosocial environment (what does it mean?) Less obvious (hidden) Depends on individual perception Depends on expertise of evaluators (health physicians, psychologists, safety engineers) EASOM - European Association of Scools of Occupational Medicine dr. Marija Molan, Bled 2015

Evaluation of psychosocial risk Is it possible to evaluate psychosocial risk? Is this evaluation as precise as evaluation of environmental risk? Is reduction of psychosocial risk possible? How to do this? EASOM - European Association of Scools of Occupational Medicine dr. Marija Molan, Bled 2015

Main issues Different approach compared to environmental risk Decision limited on symptoms of poor psychosocial environment Decision on the top Step-by-step approach EASOM - European Association of Scools of Occupational Medicine dr. Marija Molan, Bled 2015

First step: Critical Incidents Technique (CIT) Original Flanagan’s CIT from 1954 Modification of the method Description of stressful situations by workers reporting stress and strain Write or report (better is to write) EASOM - European Association of Scools of Occupational Medicine dr. Marija Molan, Bled 2015

EASOM - European Association of Scools of Occupational Medicine Graph of the CIT EASOM - European Association of Scools of Occupational Medicine Legend: w1 ... What w2 ... When w3 ... Who w4 ... Where dr. Marija Molan, Bled 2015

Obligatory elements of report Description of the critical situation as precisely as possible (causes, environment, crew, time, outcomes) Individual feelings and perceptions Actions taken during an incident Changes (if any) in worker’s future behavior (consequences fear…) EASOM - European Association of Scools of Occupational Medicine dr. Marija Molan, Bled 2015

Second step: Root Cause Analysis (RCA) Original method developed for NASA Flow chart and timeline of the incident Identification of event’s critical points Identification of event’s causes Reduction of the problem EASOM - European Association of Scools of Occupational Medicine dr. Marija Molan, Bled 2015

EASOM - European Association of Scools of Occupational Medicine Graph of the RCA EASOM - European Association of Scools of Occupational Medicine Legend: O ... Organization T ... Technology E ... Environment M ... Man dr. Marija Molan, Bled 2015

Third step: definition of critical limits Proportion of workers reporting the same event Number of workers reporting the same incident defined in advance Depends on the seriousness of the problem More workers report the same incident – higher probability of indentified risks EASOM - European Association of Scools of Occupational Medicine dr. Marija Molan, Bled 2015

Fourth step: evaluation of identified risk Collection of well being data from the workplace Matching of well being data with indentified risks Identification of correlations between both kinds of data Identification of most exposed workplaces or positions Indentified root causes (step 2) connected to poor well being EASOM - European Association of Scools of Occupational Medicine dr. Marija Molan, Bled 2015

Fifth step: elimination of main root causes Identification of possible elimination intervention for each particular root cause of perceived strain or stress Elimination intervention defined as humanization measures Collection of the best humanization measures with participation of workers EASOM - European Association of Scools of Occupational Medicine dr. Marija Molan, Bled 2015

Sixth step: Availability Humanization (AH) Cost estimations according to AH model Decrease of well being evaluation (costs of sick leave, absence, decrease of functions) Costs of humanization measures evaluation (costs of recruitment, education, training) Comparison of all costs (estimated cost of humanization interventions and estimated costs of well being decrease) EASOM - European Association of Scools of Occupational Medicine dr. Marija Molan, Bled 2015

EASOM - European Association of Scools of Occupational Medicine Graph of the AH-model EASOM - European Association of Scools of Occupational Medicine dr. Marija Molan, Bled 2015

The most important outcomes Identification of problems root causes Identification of possible eliminations Psychosocial risk should be managed All interventions need some investments EASOM - European Association of Scools of Occupational Medicine dr. Marija Molan, Bled 2015

The overview: Integration of proposed methods Critical incident technique (CIT) Root cause analysis (RCA) Availability humanization model (AH model) EASOM - European Association of Scools of Occupational Medicine dr. Marija Molan, Bled 2015

University Medical Centre Ljubljana dr. Marija Molan University Medical Centre Ljubljana Slovenia