Summary conclusions

Staying safe and healthy at work is important. However, not everyone realizes that exposure to things like chemicals, noise, and dust can affect our health. Cancers, respiratory illness, skin rashes, and hearing loss can be life changing diagnoses.

Two systems have critical roles to play. The occupational health and safety system focuses on workplace prevention while the healthcare system provides clinical services for the diagnosis and management of occupational disease. There are challenges related to occupational disease in both systems. We must improve both workplace prevention and clinical care.

Principles to guide the path forward include:

  • strengthening bridges between the occupational health and safety and healthcare systems
  • empowering workers at each step in the prevention and healthcare journey
  • addressing prevention needs of smaller workplaces and industries most at risk 
  • building trust in data collection and use 

To achieve this, we need a shared, focused and coordinated approach that will require:

  • strong leadership
  • clear health and safety system roles and accountabilities
  • investments in improved prevention and clinical resources
  • better data tracking

The building blocks are outlined below. See the recommendations summary following for specifics.

Recommendations summary by review topic

  1. Awareness, recognition and reporting – increase awareness of occupational exposures that cause disease by getting everyone moving forward together.
    1. Launch a public occupational disease (OD) awareness campaign.
    2. Develop a suite of OD recognition tools.
    3. Implement simple self-screening tools for workers starting with lung and skin disease.
    4. Develop a shared data strategy between the MLITSD and WSIB.
    5. Develop technologically enabled tools to assist workers with prevention.
  2. Workplace training – increase training through coordinated development of adult learning platforms and content. 
    1. Establish Ontario as a jurisdictional leader in OHS continual learning and training.
    2. Develop e-learning modules for key OD-causing exposures starting with designated substances.  
    3. Trial innovative ways to reach marginalized workers and workplaces.
    4. Change the audit focus from compliance (training delivered) to demonstrated knowledge/learning.
    5. Once modules (suite of products) for designated substances are completed, identify other key hazards and develop similar tools.
    6. Redesign WHMIS and leverage it as an entry for OD awareness and prevention activity.
  3. Workplace medical screening – identify early disease using trusted processes and better data collection and use.
    1. Assess the current state of workplace medical screening in Ontario by investigating what is actually being done for medical surveillance of designated substances (as identified in the regulations).
    2. Improve the review of requirements for medical codes for designated substances.
    3. Develop a multi-pronged programmatic approach to medical screening for designated substances.
    4. Expand the screening activities for other emerging exposures of concern as identified through the provincial disease surveillance system.
    5. Implement simple self-screening tools for workers starting with lung and skin disease.
  4. Disease surveillance – agree on purpose of disease surveillance system and then build a robust data system.
    1. MLITSD lead an OHS stakeholder meeting/process to agree on the purpose of an Ontario disease surveillance system and from where it will operate.
    2. MLITSD commission an expert task force of OHS system data users and experts in disease surveillance methodology to develop the business plan for establishing a disease surveillance system for Ontario.
  5. Cluster management – agree on types of clusters and purpose of investigation and then establish protocols to support effective response.
    1. MLITSD and WSIB agree on cluster definitions, statements of purpose, and criteria for the identification of clusters.
    2. For acute and long-latency clusters:
      • Assign an expert clinical task force to develop response protocols.
      • Establish a clinical response team to investigate and provide specialized diagnostic services.
      • Develop a protocol and response capability to provide assistance to the workplace, particularly small and medium-sized workplaces, for the evaluation and recommendations for controlling exposure and improving prevention.
    3. For long-latency, historic clusters:
      • MLITSD assign an expert task force to establish a protocol for accepting referrals, steps and methods of investigation, and steps in management.
    4. Develop an implementation plan and process for phasing in the new cluster protocols.
    5. Ensure cluster data is well linked with provincial surveillance system to inform prevention efforts.
  6. Healthcare: Organization and health human resources – increase clinical capacity from primary care through specialty care.
    1. Recognize and resource the Occupational Medicine Clinic as the provincial academic OD hub.
    2. Establish a regional network of specialist physicians and nurse practitioners for patient referrals from medical screening programs, to provide clinical care for workers with OD across the Province and to participate in acute and long-latency cluster clinical response teams where the key issue is diagnosis.
    3. Create a primary care “incubator” with a large academic Family Health Team (FHT) to identify helpful and feasible ways to improve primary care involvement in the occupational health response in Ontario.
    4. Continue to develop the occupational medicine academic hub and regional specialist networks, adding additional specialties as needed.
    5. With a better understanding of the landscape of primary care, consider a pilot of a OHS navigator embedded in a FHT to support occupational healthcare.
    6. Consider the roles of other health professions specifically related to occupational health to continue to build capacity.
  7. Healthcare journey – establish and activate clinical care pathways using an equity lens.
    1. Develop clinical pathways for common ODs.
    2. Pilot the use of enhanced clinical diagnostic tools, including some already developed and evaluated in Ontario, for use in primary and specialist care.
    3. Implement clinical pathways and evaluate using the Knowledge Translation framework.
    4. Determine the next pathways to develop based on clinical and health human resource needs in the province.
  8. Healthcare: Physician education – continue to enhance physician education to strengthen MD awareness and competency.
    1. Expand Workplace Champions Program to primary care training and look for ways to evaluate activity using information from literature review of medical education.
    2. Review relevant specialty training for occupational disease content, and grow is possible, starting with respirology.
    3. Advance continuing education offerings.
    4. Based on learning from work above, expand to other specialties/specialists.
  9. Healthcare: Occupation in the electronic medical record – improve occupational data capture in health records to support diagnoses and connection to work exposures.
    1. Complete baseline study of occupational information in the EMR already underway.
    2. For primary care, understand how the information is used in practice, who is best suited to collect information, and what information is needed as a baseline for clinical care.
    3. For respiratory network, pilot use of the asthma history tool to understand barriers and facilitators.
    4. For lung cancer, determine where occupational information could be collected in the lung cancer pathway using the Cancer Services (Ontario Health) team.
    5. Based on results of short-term activities, move forward with FHT incubator to implement and evaluate occupational information collection for EMR.
    6. For the cancer system, consider help with exposure information from the OHS system partners.