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The organization of the occupational health service at Götaverken
ENVIRONMENTAL
RESEARCH
11,
166-169
The Organization
(1976)
of the Occupational at Gtitaverken AKE
Health
Service
SANDON
Gotaverken is a shipbuilding group in Sweden including two new shipyards, one repair yard, and facilities for manufacturing engines, steam boilers and facades of houses. The headquarters of the group is in Goteborg. Like most other heavy industries in the world, Gotaverken has increasing problems in the environmental field. To be able to master these problems, Gotaverken has developed an occupational health service, which now includes medical and dental services and a technical safety and environmental division. Since most problems in the environmental field have both a medical and a technical aspect, the Gotaverken management has coordinated the different units. The occupational health service (80 people covering 8000 employees) functions as a group division separated from the production units and directly subordinated under a staff committee consisting of representatives from the company and three unions in the plant. The unions represent the salaried employees, the foremen, and the bluecollar workers. Head of both the medical and the technical activities is the chief physician. He is present at the meetings of the board of directors and reports directly to the vice president. In this way, the occupational health service division participates in the planning of the different units of the company and, at an early stage, submits proposal hearings on the working environment. The medical division includes three health service stations, two in the Goteborg yards and one in another Swedish city, Landskrona. Doctors, nurses, audiologists, and physiotherapists work at the health service station. The activities include preventive work as well as medical treatment. In the medical treatment, we first of all take care of occupational complaints, accidents at work, and occupational diseases. There is a certain capacity also for other types of medical treatment. But the purpose of the occupational health service is not to replace but to complement the medical treatment of the national health service mainly in the field of occupational health. Physicians and nurses therefore get trained after they are employed to provide competence in the field of occupational medicine and hygiene. The health service stations are equipped to manage most accidents and diseases not requiring hospitalization. The emergency service is good, and a team of physicians can arrive at short notice at the scene of an accident, bringing advanced medical-technical equipment with them. Most accidents at work are fortunately of a minor type and do not demand advanced efforts. In the preventive field the tracing of occupational diseases is an important job. Examinations are made in cooperation with the technicians in the occupational 166 Copynght All rights
c 1976 by Academic Press, Inc. of reproduction in any form reserved.
HEALTH
SERVICE
..\T
GijTiZVERKEN
167
safety services. In these examinations we look into the exposure of the worker to different substances and possible symptoms of a disease in connection with this exposure. A health control program is being developed. This program consists of a general diagram combined with examinations aimed at special occupational risks. One field which at present is given priority to is the influence of welding fumes on the health of the welder. Another example is the health risks of exposure to cadmium and other metals. Another group representing medical, technical, and chemical experts is surveying the use of different chemical products in the industry. This group writes instructions for the use of the products. No new chemical products may be introduced in the production until this group has agreed to it. Experts from the occupational health service division participate in the layout of new workshops and working procedures. Ergonomical as well as hygienical evaluations influence the final layout. No project is completed before the em,ironmentcrl aspects of the uvrkplow lrat~ been considered. A new industrial safety and health law requires approval
from a safety and environment committee representing employers and employees before a new workplace can be built. A very important aspect of preventive health and safety is education and information in questions of workplace environment. Experts from the occupational health service division educate foremen in this field. In 1974. the activity also included the elected safety representatives, the safety stewards. These safety representatives are elected by the workers themselves and have a special responsibility to supervise safety at work. This activity is organized separately from the occupational health service division, but there is a close cooperation between the two functions. The employees do not pay for treatment of occupational complaints. For other treatments the patient pays SW. Crs. 12 (approx. $2.60) in accordance with the Swedish general health insurance system. If at least 50% of the resources of the occupational health service is spent on medical treatment, the company obtains half of the total costs from the national health insurance. Other costs are paid by the company. In the preventive field, the doctors participate in the discussions of how future ship sections will be built to be optimal from the workplace environment point of view. The dental unit includes dentists and dental nurses, and there are plans to add a dental hygienist to the staff. Two of the health service stations have dental surgery. Here most of the employees are eligible for dental treatment. Up to now it has been cheaper to go to the company dentists. However, a national dental insurance was introduced in Sweden as of January 1,1974. Still we think that the company dental service is justified as it is very timesaving both for the company and the employees. The technical occupational safety unit is managed by a chief engineer with responsibility for the preventive ergonomical work as well as for the safety service. At each yard there are safety engineers, ergonomical engineers, safety foremen. and safety men. Further, there is a development group consisting of three graduate engineers directly under the head of the technical occupational safety unit. The
168
.iKE
SANDkN
development group is working with projects in the environmental field, for instance elimination of welding fumes, surveying and eliminating dangerous metals in the company, problems in connection with X rays. ionizing radiation, and use of the laser in the technical field. Directly under the head of the technical occupational safety unit, there are also other specialist groups. for instance. the firefighters division. Earlier, the technical occupational safety unit was mainly concerned with safety matters. However, parallel with a continued concern for these matters a preventive ergonomical service has been developed. Here as well as in the chemical-technical field there is a close cooperation with the medical experts. Experts from the technical occupational safety unit participate in the planning meetings of the different technical units and there they keep watch over safety and environmental aspects. This cooperation is highly appreciated by both parties. and the responsible production technicians get a valuable support. A special activity within the technical occupational safety service which is worth mentioning is the organization of the safety on tankers coming to the yard for repair. Each such tanker is given a special safety foremen. He is present when the gas certificate is prepared and is responsible for control of gas and other safety questions on board as long as the tanker is in the yard. When necessary, this man can ask for further help from the technical occupational safety service. At alI times he has an overaIl and clear picture of the safety problems of the different sections of the ship and he can point out the safety instructions of immediate interest. Parallel with the occupational health service division a comprehensive medicaltechnical research effort within the environmental field is carried out. Supervising this research is a medical council, The chairman is the vice president of the company. In addition to the chief physician there are four scientists from the University of Gd’teborg and Sahlgrenska Sjukhuset (hospital) as members of the medical council. In every research project technical experts from Chalmers University of Technology in Gd’teborg have been called in. The four research projects at present given priority to are without relative ranking: 1. the influence of welding fumes on the function of the lung and from the point of view of toxicity. 2. the damaging effect of the welding radiation on human eyes and problems concerning lightning and glaring in working life. Parallel with this project. a sociological study of the situation of the welders has been done. It shows that the welders’ main concern is the working environment and especially the welding fumes and the noise. 3. The effect of noise on hearing, transient noise in particular. In this field, the importance of hearing deterioration in social and occupational relations is also studied. 4. Neurophysiological studies of muscles and the fatigue of neurological functions in connection with different working periods. Gd’taverken hopes to be able to clear and eliminate some of the most serious environmental problems. The means to obtain this is a well developed medical-
HEALTH
SERVICE
AT
GiiTAVERKEN
169
technical occupational health service with an independent status but working in close cooperation with the persons responsible for production and construction and a concentration on research within several of the most important environmental fields. This way opportunities are created for a future shipbuilding industry which is not only safer and sounder. but also a more comfortable place of work.
RESEARCH
11,
166-169
The Organization
(1976)
of the Occupational at Gtitaverken AKE
Health
Service
SANDON
Gotaverken is a shipbuilding group in Sweden including two new shipyards, one repair yard, and facilities for manufacturing engines, steam boilers and facades of houses. The headquarters of the group is in Goteborg. Like most other heavy industries in the world, Gotaverken has increasing problems in the environmental field. To be able to master these problems, Gotaverken has developed an occupational health service, which now includes medical and dental services and a technical safety and environmental division. Since most problems in the environmental field have both a medical and a technical aspect, the Gotaverken management has coordinated the different units. The occupational health service (80 people covering 8000 employees) functions as a group division separated from the production units and directly subordinated under a staff committee consisting of representatives from the company and three unions in the plant. The unions represent the salaried employees, the foremen, and the bluecollar workers. Head of both the medical and the technical activities is the chief physician. He is present at the meetings of the board of directors and reports directly to the vice president. In this way, the occupational health service division participates in the planning of the different units of the company and, at an early stage, submits proposal hearings on the working environment. The medical division includes three health service stations, two in the Goteborg yards and one in another Swedish city, Landskrona. Doctors, nurses, audiologists, and physiotherapists work at the health service station. The activities include preventive work as well as medical treatment. In the medical treatment, we first of all take care of occupational complaints, accidents at work, and occupational diseases. There is a certain capacity also for other types of medical treatment. But the purpose of the occupational health service is not to replace but to complement the medical treatment of the national health service mainly in the field of occupational health. Physicians and nurses therefore get trained after they are employed to provide competence in the field of occupational medicine and hygiene. The health service stations are equipped to manage most accidents and diseases not requiring hospitalization. The emergency service is good, and a team of physicians can arrive at short notice at the scene of an accident, bringing advanced medical-technical equipment with them. Most accidents at work are fortunately of a minor type and do not demand advanced efforts. In the preventive field the tracing of occupational diseases is an important job. Examinations are made in cooperation with the technicians in the occupational 166 Copynght All rights
c 1976 by Academic Press, Inc. of reproduction in any form reserved.
HEALTH
SERVICE
..\T
GijTiZVERKEN
167
safety services. In these examinations we look into the exposure of the worker to different substances and possible symptoms of a disease in connection with this exposure. A health control program is being developed. This program consists of a general diagram combined with examinations aimed at special occupational risks. One field which at present is given priority to is the influence of welding fumes on the health of the welder. Another example is the health risks of exposure to cadmium and other metals. Another group representing medical, technical, and chemical experts is surveying the use of different chemical products in the industry. This group writes instructions for the use of the products. No new chemical products may be introduced in the production until this group has agreed to it. Experts from the occupational health service division participate in the layout of new workshops and working procedures. Ergonomical as well as hygienical evaluations influence the final layout. No project is completed before the em,ironmentcrl aspects of the uvrkplow lrat~ been considered. A new industrial safety and health law requires approval
from a safety and environment committee representing employers and employees before a new workplace can be built. A very important aspect of preventive health and safety is education and information in questions of workplace environment. Experts from the occupational health service division educate foremen in this field. In 1974. the activity also included the elected safety representatives, the safety stewards. These safety representatives are elected by the workers themselves and have a special responsibility to supervise safety at work. This activity is organized separately from the occupational health service division, but there is a close cooperation between the two functions. The employees do not pay for treatment of occupational complaints. For other treatments the patient pays SW. Crs. 12 (approx. $2.60) in accordance with the Swedish general health insurance system. If at least 50% of the resources of the occupational health service is spent on medical treatment, the company obtains half of the total costs from the national health insurance. Other costs are paid by the company. In the preventive field, the doctors participate in the discussions of how future ship sections will be built to be optimal from the workplace environment point of view. The dental unit includes dentists and dental nurses, and there are plans to add a dental hygienist to the staff. Two of the health service stations have dental surgery. Here most of the employees are eligible for dental treatment. Up to now it has been cheaper to go to the company dentists. However, a national dental insurance was introduced in Sweden as of January 1,1974. Still we think that the company dental service is justified as it is very timesaving both for the company and the employees. The technical occupational safety unit is managed by a chief engineer with responsibility for the preventive ergonomical work as well as for the safety service. At each yard there are safety engineers, ergonomical engineers, safety foremen. and safety men. Further, there is a development group consisting of three graduate engineers directly under the head of the technical occupational safety unit. The
168
.iKE
SANDkN
development group is working with projects in the environmental field, for instance elimination of welding fumes, surveying and eliminating dangerous metals in the company, problems in connection with X rays. ionizing radiation, and use of the laser in the technical field. Directly under the head of the technical occupational safety unit, there are also other specialist groups. for instance. the firefighters division. Earlier, the technical occupational safety unit was mainly concerned with safety matters. However, parallel with a continued concern for these matters a preventive ergonomical service has been developed. Here as well as in the chemical-technical field there is a close cooperation with the medical experts. Experts from the technical occupational safety unit participate in the planning meetings of the different technical units and there they keep watch over safety and environmental aspects. This cooperation is highly appreciated by both parties. and the responsible production technicians get a valuable support. A special activity within the technical occupational safety service which is worth mentioning is the organization of the safety on tankers coming to the yard for repair. Each such tanker is given a special safety foremen. He is present when the gas certificate is prepared and is responsible for control of gas and other safety questions on board as long as the tanker is in the yard. When necessary, this man can ask for further help from the technical occupational safety service. At alI times he has an overaIl and clear picture of the safety problems of the different sections of the ship and he can point out the safety instructions of immediate interest. Parallel with the occupational health service division a comprehensive medicaltechnical research effort within the environmental field is carried out. Supervising this research is a medical council, The chairman is the vice president of the company. In addition to the chief physician there are four scientists from the University of Gd’teborg and Sahlgrenska Sjukhuset (hospital) as members of the medical council. In every research project technical experts from Chalmers University of Technology in Gd’teborg have been called in. The four research projects at present given priority to are without relative ranking: 1. the influence of welding fumes on the function of the lung and from the point of view of toxicity. 2. the damaging effect of the welding radiation on human eyes and problems concerning lightning and glaring in working life. Parallel with this project. a sociological study of the situation of the welders has been done. It shows that the welders’ main concern is the working environment and especially the welding fumes and the noise. 3. The effect of noise on hearing, transient noise in particular. In this field, the importance of hearing deterioration in social and occupational relations is also studied. 4. Neurophysiological studies of muscles and the fatigue of neurological functions in connection with different working periods. Gd’taverken hopes to be able to clear and eliminate some of the most serious environmental problems. The means to obtain this is a well developed medical-
HEALTH
SERVICE
AT
GiiTAVERKEN
169
technical occupational health service with an independent status but working in close cooperation with the persons responsible for production and construction and a concentration on research within several of the most important environmental fields. This way opportunities are created for a future shipbuilding industry which is not only safer and sounder. but also a more comfortable place of work.