A snapshot of the occupational health and safety system landscape
The province of Ontario boasts an impressive occupational health and safety system (OHS system) that is studied by other jurisdictions in the world. However, in the area of occupational disease (OD), progress has been slow, and there is still work to be done.
For the purposes of this review, the OHS system was considered to include:
- Ministry of Labour, Immigration, Training and Skills Development (MLITSD)
- Workplace Safety and Insurance Board (WSIB)
- workplaces (employers and workers), labour unions, employer and worker advocacy groups
- government-funded system partners, including the four sector-based Health and Safety Associations (HSAs), the Occupational Health Clinics for Ontario Workers (OHCOW), the Workers Health and Safety Centre (WHSC)
- MLITSD funded research centres
The OHS system is composed of many system partners striving to improve OD prevention and protect the health of workers. However, the system today is complex, and while efforts to establish a shared OD agenda have been tried, efforts to implement it have been fragmented, and results are uneven.
A snapshot of the healthcare system landscape
The Ontario healthcare landscape is in a state of stress and transition. It is a complex maze of healthcare providers and healthcare organizations serving the health needs of people living in the province.
The system is composed of many partners including:
- Ministry of Health
- Public Health Ontario
- healthcare institutions
- healthcare providers:
- primary care physicians and nurse practitioners (solo, team-based)
- medical specialists, such as occupational medicine, respirology, dermatology, oncology, neurology
- other health disciplines, such as nurses, rehabilitation (for example physiotherapy, occupational therapy)
- educational institutions
- research institutions
The Ministry of Health provides the majority of direction and oversight of the healthcare system.
Public Health Ontario is focused on population level health.
Following is a brief overview of the system and healthcare providers (HCPs) to provide the needed context for this review.
While there are many different regulated health professionals that may be involved in the provision of healthcare to workers with OD, this snapshot is focused primarily on physicians.
- There are approximately 31,000 practicing physicians in Ontario. One way to classify physicians is whether they are general practitioners and family physicians providing primary care or whether they are specialists. All physicians are licensed by the College of Physicians and Surgeons of Ontario, which is the regulatory body responsible for physicians.
- There are approximately 15,000 primary care physicians in Ontario. Primary care physicians practice in a number of different settings and organizational structures. These range from solo practice to large group and team practices. They are unequally distributed across the province, with many areas being designated as under serviced.
- Medical specialists are those who have Royal College of Physicians and Surgeons of Canada certification in recognized specialties and sub-specialties. Specialists practice in a number of different settings, from solo practice to group-based practice in the community or in a hospital.
Because of the many challenges in the healthcare system, the province has introduced Ontario Health Teams (OHT). OHT will manage and connect all levels of care within a geographic area. The OHT are fairly new and still in the process of getting up and running. Common clinical pathways are being developed to provide integrated care for chronic conditions such as congestive heart failure, diabetes, chronic obstructive lung disease and stroke.
Currently, there is much strain on the system. There are human health resource challenges for all health professionals. It is noted that 1 in 5 Ontarians do not have a primary care provider. A study estimated that by 2022, 3 million Ontarians would be without a primary care provider. Even those providers who are in the system are generally burnt out after 3 years of practice during the COVID‑19 pandemic.
The introduction of electronic systems, with their various benefits, has also added to the load of healthcare providers. There is much current activity focused on fixing the system. The fixes will not be quick, and the system as we know it may be substantially changed. It is in this environment that the OHS system steps.
The review builds on prior research and reports and the input of many committed individuals in both the health and safety system and the occupational disease clinical community.
The conclusions will not be a surprise.
There is strong interest in moving ahead and some momentum ready to be built upon. Leadership is needed. Decisions need to be made. And resources (human and financial) need to be committed.
Four summary conclusions that guide the recommendations that follow include:
- The crucial link between exposures at work and symptoms of disease is often missed by employers, healthcare providers and workers themselves. This matters to prevention efforts and accurate diagnosis and health management.
- The Ontario health and safety system and the healthcare system are not well connected. Workers must navigate between the work and healthcare landscapes on their own. Yet work can impact health, and health can impact work. Understanding this dynamic and intervening early is crucial at both the individual and system levels.
- Prevention, recognition and the diagnosis and management of occupational diseases are not straightforward. We need to pull back to the basics and move forward together. Just adding more of the same and expecting a better result is not recommended.
- Key design features identified over the course of the review include:
- leverage and build on current expertise and capacity.
- clarify roles and accountabilities.
- inform and empower workers at each step in their prevention and healthcare journey
- build trust in data sources, means of collection, and use
- centralize development of core activities and customize as required
- set performance standards and monitor results from the start
The recommendations are outlined in detail within each review topic chapter. Implementation advice is also provided.
- Awareness, recognition and reporting: Launch an OD public awareness campaign focused on the link between work and health. Follow up with an annual targeted multi-pronged prevention campaign.
- Workplace training: Centralize education resource development starting with designated substances and provide distributed delivery opportunities for customization and, in the case of smaller businesses, extra support. Improve WHMIS training to include OD content and consider accreditation.
- Workplace medical screening: Conduct an assessment of current workplace medical screening practices for designated substances and develop a best practice approach that considers three purposes:
- early symptom recognition and connection to care
- informing prevention
- standardized data collection for the provincial surveillance system
- Disease surveillance: A disease surveillance system for Ontario is needed. The first step is to decide on the purpose of the surveillance system considering prevention, emerging risks, and research on the impact of interventions. A small expert group is then required to design the system, including needed data inputs, where to house and manage, and how to analyse the data and communicate results publicly.
- Cluster management: A clear protocol for identifying clusters (acute/chronic and long-latency) and their management is required. Consider a one-time process for the backlog of clusters.
- Healthcare: Organization and health human resources: The recommendation is three-pronged, including:
- strengthen the occupational medicine specialist capacity in an academic hub of clinical practice, education and research
- establish a provincial network of medical specialists with occupational disease expertise
- work with an academic family team to identify practical methods and tools for facilitating making the link between work exposures and health
- Healthcare journey: Develop clinical care pathways for common occupational diseases, including screening, referral, diagnosis, management, and return to work. Start with respiratory diseases, silicosis and asthma. Establish a formal OD connection with cancer pathways of care.
- Healthcare: Physician education: Expand the WSIB-funded Champions Program delivered through six medical schools in Ontario to include postgraduate training for family medicine. Strengthen specialists’ training starting with respirologists.
- Healthcare: Occupation in the electronic medical record: Work with an academic family health team to understand practices related to occupational history taking and determine the barriers and facilitators to improving collection of occupational information.