Introduction

The organization

James Maclaren Industries Inc., the industrial setting used for this case study, is a pulp and paper company located in the western part of the Province of Quebec, Canada. A subsidiary of Noranda Forest, Inc., it has three major divisions: a hardwood pulp mill, a groundwood newsprint mill and hydroelectric energy facilities. The pulp and paper industry is the predominant local industry and the company under study is over 100 years old. The work population, approximately 1,000 employees, is locally based and, frequently, several generations of the same family have worked for this employer. The working language is French but most employees are functionally bilingual, speaking French and English. There is a long history (over 40 years) of company-based occupational health services. While the services were initially of an older “traditional” nature, there has been an increasing trend towards the preventive approach during recent years. This is consistent with a “continual improvement” philosophy being adopted throughout the Maclaren organization.

Provision of occupational health services

The occupational health physician has corporate and site responsibilities and reports directly to the directors of health, safety and continuous improvement. The last position reports directly to the company president. Full-time occupational health nurses are employed at the two major sites (the pulp mill has 390 employees and the newsprint mill has 520 employees) and report directly to the physician on all health-related issues. The nurse working at the newsprint division is also responsible for the energy/forest division (60 employees) and the head office (50 employees). A full-time corporate hygienist and safety personnel at all three facilities round out the health, and health-related, professional team.

The Preventive Approach

Prevention of disease and injury is driven by the occupational health and industrial hygiene and safety team with input from all interested parties. Methods used frequently do not differentiate between work-related and non-work-related prevention. Prevention is considered to reflect an attitude or quality of an employee—an attitude that does not cease or start at the plant fence line. A further attribute of this philosophy is the belief that prevention is amenable to continual improvement, a belief furthered by the company’s approach to auditing its various programs.

Continual improvement of prevention programs

Health, industrial hygiene, environment, emergency preparedness, and safety audit programs are an integral part of the continuous improvement approach. The audit findings, although addressing legal and policy compliance concerns, also stress “best management practice” in those areas which are felt to be amenable to improvement. In this way, prevention programs are being repeatedly assessed and ideas presented which are used to further the preventive aims of occupational health and related programs.

Health assessments

Pre-placement health assessments are carried out for all new employees. These are designed to reflect the exposure hazards (chemical, physical, or biological) present in the workplace. Recommendations indicating fitness to work and specific job restrictions are made based on the pre-placement health assessment findings. These recommendations are designed to decrease the risk of employee injury and illness. Health teaching is part of the health assessment and is intended to better acquaint the employees with the potential human impact of workplace hazards. Measures to decrease risk, particularly those related to personal health, are also stressed.

Ongoing health assessment programs are based on hazard exposure and workplace risks. The hearing conservation program is a prime example of a program designed to prevent a health impact. Emphasis is on noise reduction at the source and employees participate in the evaluation of noise reduction priorities. An audiometric assessment is done every five years. This assessment provides an excellent opportunity to counsel employees on the signs and symptoms of noise-induced hearing loss and preventive measures while assisting in the evaluation of the efficacy of the control program. Employees are advised to follow the same advice off the job—that is, to use hearing protection and to diminish their exposure.

Risk-specific health assessments are also carried out for workers involved in special job assignments such as fire fighting, rescue work, water treatment plant operations, tasks requiring excessive heat exposure, crane operation and driving. Similarly, employees who use respirators are required to undergo an assessment to determine their medical fitness to use the respirator. Exposure risks incurred by contractors’ employees are also assessed.

Health hazard communication

There is a statutory requirement to communicate health hazard and health risk information to all employees. This is an extensive task and includes teaching employees about the health effects of designated substances to which they may be exposed. Examples of such substances include a variety of respiratory hazards which may be either byproducts of other materials’ reactions or may represent a direct exposure hazard: one might name in this connection such materials as sulphur dioxide; hydrogen sulphide; chlorine; chlorine dioxide; carbon monoxide; nitrogen oxides and welding fumes. Material Safety Data Sheets (MSDSs) are the prime source of information on this subject. Unfortunately, the suppliers’ MSDSs often lack the necessary quality of health and toxicity information and may not be available in both official languages. This deficiency is being addressed at one of the company’s sites (and will be extended to the other sites) through the development of one-page health information sheets based on an extensive and well-respected database (using a commercially available MSDS generation software system). This project was undertaken with company support by members of the joint labor-management health and safety committee, a process which not only solved a communication problem, but encouraged participation by all workplace parties.

Cholesterol screening programs

The company has made a voluntary cholesterol screening program available to employees at all sites. It offers advice on the health ramifications of high cholesterol levels, medical follow-up when indicated (done by family physicians), and nutrition. Where onsite cafeteria services exist, nutritious food alternatives are offered to the employees. The health staff also makes pamphlets on nutrition available for employees and their families to assist them to understand and diminish personal health risk factors.

Blood pressure screening programs

Both in conjunction with annual community programs (“Heart Month”) on heart health, and on a regular basis, the company encourages employees to have their blood pressure checked and, when necessary, monitored. Counseling is provided to employees to assist them, and indirectly their families, to understand the health concerns surrounding hypertension and to seek help through their community medical resources if further follow-up or treatment is needed.

Employee and family assistance programs

Problems that have an impact on employee performance are frequently the result of difficulties outside the workplace. In many cases, these reflect difficulties related to the employee’s social sphere, either home or community. Internal and external referral systems exist. The company has had a confidential employee (and, more recently, family) assistance program in place for over five years. The program assists about 5% of the employee population annually. It is well publicized and early use of the program is encouraged. Feedback received from the employees indicates that the program has been a significant factor in minimizing or preventing deterioration of work performance. The primary reasons for using the assistance program reflect family and social issues (90%); alcohol and drug problems account for only a small percentage of the total cases assisted (10%).

As part of the employee assistance program, the facility has instituted a serious-incident debriefing process. Serious incidents, such as fatalities or major accidents, can have an extremely unsettling effect on employees. There is also the potential for significant long-term consequences, not only to the efficient functioning of the company but, more particularly, to the individuals involved in the incident.

Wellness programs

A recent development has been the decision to take the first steps towards the development of a “wellness” program that targets disease prevention in an integrated approach. This program has several components: cardiorespiratory fitness; physical conditioning; nutrition; smoking cessation; stress management; back care; cancer prevention and substance abuse. Several of these topics have been mentioned previously in this case study. Others (not discussed in this article) will, however, be implemented in a stepwise fashion.

Special communication programs

1. HIV/AIDS. The advent of HIV/AIDS in the general population signalled a need to communicate information to the workplace community for two reasons: to allay fear of contagion should a case become known from among the employee population and to ensure that employees are cognizant of preventive measures and the “real” facts about communicability. A communication programme was organized to meet these two objectives and made available to the employees on a voluntary basis. Pamphlets and literature could also be obtained from the health centers.
2. Communication of research study results. The following are examples of two recent communications about health research studies in areas that were considered to be of special concern to employees.
3. Electromagnetic field studies. The results of the electromagnetic field study undertaken by Electricitй (E.D.F.), Hydro Quebec, and Ontario Hydro (Thйriault 1994), were communicated to all exposed and potentially exposed employees. The objectives behind the communication were to prevent unwarranted fear and to ensure that employees had firsthand knowledge of issues affecting their workplace and, potentially, their health.
4. Health outcome studies. Several studies in the pulp and paper industry relate to health outcomes from working in this industry. The outcomes being investigated include cancer incidence and cancer mortality. Communications to employees are planned to ensure their awareness of the existence of the studies, and, when available, to share the results. The objectives are to alleviate fear and ensure that employees have the opportunity to know the results of studies pertinent to their occupations.
5. Community interest topics. As part of its preventive approach, the company has reached out to community physicians and invited them to tour the workplace and meet with the occupational health and hygiene staff. Presentations related to issues relevant to health and the pulp and paper industry have been made at the same time. This has assisted the local physicians to understand the working conditions, including potential hazardous exposures, as well as the job requirements of the employees. As a result, the company and the physicians have worked in concert to diminish the potential ill effects of injury and illness. Community meetings have also been held to provide the communities with information on environmental issues related to the company’s operations and to give the local citizens an opportunity to ask questions on matters of concern (including health issues). Prevention is thus carried to the community level.
6. Future trends in prevention. Behaviour modification techniques are being considered to further improve the overall level of worker health and to diminish injuries and illness. Not only will these modifications have a positive effect on the health of the worker in the workplace, they will also carry over to the home environment.

Employee involvement in safety and health decision making already exists through the Joint Health and Safety Committees. Opportunities to extend the partnership to employees in other areas are being actively pursued.

Conclusions

The essential elements of the program at Maclaren are:

• a firm management commitment to health promotion and health protection

• integration of occupational health programs with those aimed at non-occupational health problems

• involvement of all workplace parties in program planning, implementation and evaluation

• coordination with community-based health care facilities and providers and agencies

• an incremental approach to program expansion

• audits of program effectiveness to identify problems that need addressing and areas where programs may be strengthened, combined with action plans to ensure appropriate follow-up activities
• effective integration of all environmental, health, hygiene and safety activities.

This case study has focused on existing programs designed to improve employee health and prevent unnecessary and unwanted health effects. The opportunities to further enhance this approach are boundless and particularly amenable to the company’s continual improvement philosophy.

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