Assessment of fitness

first_imgRelated posts:No related photos. Comments are closed. Previous Article Next Article Assessment of fitnessOn 1 Apr 2002 in Personnel Today Any judgement of a person’s ability to do a job must be rigorous butfair.  The proposed framework offers aconsistent and transparent method for assessment, by Siva Murugiah, GretaThornbory and Anne Harriss Assessment of fitness for employment is not a new concept. In fact it has along history originating from the times when young men were required toundertake tests of endurance for their tribal initiation as warriors. More recently it has taken the form of pre-employment health assessment,health surveillance, and screening during work. However, assessment of fitnessto or for work according to Battigelli1 has two aspects: “On one side itpresents the functional and anatomical endowment of the subject examined and onthe other, the task to which the individual is operationally fitted”. The recent implementation of the Disability Discrimination Act (1995)appears to have accelerated the debate on assessment of fitness to workfollowing a period of illness and the diagnosis of a health deficit. In O’ Neil v Symm & Co2, one of the first cases brought under the DDA,the industrial tribunal ruled in favour of the employer. The tribunalestablished that the employer has to ensure that an effective assessment offitness to work is undertaken, before deciding on the employment status of thenow “disabled” employee. According to Battigelli1, clinical assessment of fitness to work”regretfully Éremains all too often inadequately documented, resulting infailure by the examiner… to match the worker’s endowment to the task orwork”. It is clear that occupational health nurses need to recognise the legalrequirements of employment for the benefit of both employers and employees.What would be desirable is a framework that would help integrate the manyvariables that need to be considered when assessing fitness to work of anemployee diagnosed with a health deficit, or for assessing disabled people foremployment. This article proposes such a framework, taking into account the intricaterelationship between employers and employees. It is not the intention to evaluate the current battery of assessment toolsin use, but rather to consider the factors that should be considered whenassessing the fitness of employees returning to work following the diagnosis ofa health deficit. The framework could also be used to help with documenting theassessment process. The fitness to work framework The proposed framework fits in with the two aspects suggested by Battigelli1and includes the work environment and legal aspects to ensure that theassessment is comprehensive, equitable and transparent. Assessment of fitnessto work must take into consideration personal aspects, work characteristics,work environment and legal aspects. Personal aspects From a clinical perspective, the whole process of determining fitness is aseries of measurements and, as such, is an exercise in relativity. The extentof fitness or impairment must be gauged in terms of the demand of the task tobe performed. Assessment of fitness to work in a manual labourer, for example,will require that the worker’s ability to undertake heavy muscular tasks bemeasured. However, this will obviously not be a consideration when assessingthe fitness to work of an office worker. Assessment must be made for each individual as generalisation of assessmentfor fitness to work, based on medical criteria alone, may not stand up incourt. An individual with Multiple Sclerosis may be able to continue with the samejob for many years after diagnosis before any disability or impairment affectswork performance. Equally, another person with the same diagnosis may requiredeployment much earlier because of the rate or progress of the disease. When assessing each person, past occupational experience, skill levels,technique and ability have to be taken into account in light of themedicalhistory. Clinical assessment may explore basic stamina and physiological endowment3and examples of methods used are maximal work capacity, oxygen consumption andaerobic capacity, plus a range of motion and related features or strengthtesting. Besides these, it may be necessary to undertake a battery of tests and toexplore lifestyle that may inadvertently impact on work performance. Disabilityapplies equally to physical and mental impairment4. The person’s psychologicalstate should also be assessed. An illness or injury resulting in disability maywell leave psychological scars. Thus, assessment of fitness to work has toconsider the psychological, physical, sociological and intellectual aspects ofhealth. Characteristics of the work Care must be taken that assessment for fitness to work does not become amere inventory of anatomical and functional attributes without attempts tocompare the individual to his or her work. The fitness to work model advocates that the OH nurse needs to have athorough knowledge of the job specification in terms of essential and desirablequalities required for that job. The extent of fitness or impairment must be weighed in terms of the demandof the job to be performed, the specific type, intensity (concentration,strength, vigour), duration (length of time) and schedule (shift patterns,etc.) plus an understanding of materials and work processes to ensure effectiveassessment. Liaison with human resources and management is essential in establishing thefitness standards required for specific jobs or areas of work. For certainoccupations such as drivers5,6, offshore workers7 and teachers8, standardrequirements for fitness to work are published in key documents and these needto be consulted. Equally, some professional associations provide guidelines for standardrequirements on fitness to work, such as those produced by the Association ofNational Health Occupational Physicians for healthcare professionals, the Associationof Local Authority Medical Advisors for fireman and police, and the JointAviation Authority for pilots. It is also essential that the process of decision-making is adequatelydocumented1,9, or it may result in failure to display a reasoned match of anempolyee’s attributes to specific work requirements. The fitness to work modelprovides occupational health nurses with a framework to match a person’sattributes with specific work requirements, as well as a framework for thedocumentation of the decision-making process. It therefore aids transparencyand equitability. For some jobs, there may be a need to test hand-eye co-ordination and thework-pause sequence may need to be examined in relation to individual abilitiesor impairments. The person’s functional capabilities must always be matched tothe operational requirements of the job they are doing. It may be necessary totake into account the timing of meal breaks, for example, for people who havehealth conditions such as diabetes. The effects, including known side effects, of medication taken by theemployee should also be considered as these may impact on the health and safetyof both the individual and others including co-workers, contractors, visitors,customers or clients. The work environment Able-bodied individuals may previously have worked effectively andefficiently but after illness or impairment they may become a hazard tothemselves as well as others. Occupational health nurses need to reassessenvironmental risks with particular reference to the disabled person’sabilities. The temperature of the environment in which the person had previouslyworked, for example, may be inappropriate after serious illness. Thermalcomfort is generally a skin temperature of between 32.0C and 35.5C and a coretemperature of between 36.6C and 37.1C. However, these temperatures apply toable-bodied individuals and may not be suitable for those with compromisedhealth status. At temperatures substantially higher than these, optimal levels bothphysical and mental performance, may deteriorate due to a complicated interplayof physiological processes. At temperatures substantially lower, there is areduction in neuromuscular function, due to reduced nerve conduction velocity11,and a reduction in manual dexterity12. Lighting conditions, noise levels, exposure to chemicals, etc. must also betaken into consideration. The assessment has to consider the individual’sabilities and/or deficits in light of the work environment. Welfare facilities such as toilets and showers or washing facilities in thework place should be assessed to ensure that the individual is able tomanoeuvre and use them. In certain circumstances facilities must be suitablefor wheelchair access. Equally, access to and from the work site or buildingmust be assessed and consideration given to evacuation in an emergency such asfire, as generally lifts cannot be used and wheelchair users and others withrestricted mobility may not be able to use stairs. Legal aspects The whole issue of defensible medical rationale is based in the firstinstance, on the common law duties of the employer to take reasonable care oftheir employees. The duties can be summarised as follows: – The employer must take reasonable and positive steps to ensure the safetyof his employees in the light of the knowledge that he has, or ought to have – The employer is entitled to follow current recognised practice unless, inthe light of common sense or new knowledge, this is clearly unsound – Where there is developing knowledge, the employer must keep reasonablyabreast with it and not be too slow in applying it – If the employer has greater than average knowledge of the risk, he musttake greater than average precautions – The employer must weigh up the risk (in terms of the likelihood of injuryand the possible consequences) against the effectiveness of the precautions tobe taken to meet the risk and cost and inconvenience. Still within the common law position, the employer owes a higher duty ofcare to the vulnerable employee with a known pre-existing medical condition.This is defined as the “egg shell skull” principle as illustrated inthe case Paris v Stepney Borough Council13. Besides the common law position there are statutory laws such as theEmployment Protection (Consolidated) Act 1978 and therein employer’s liability.The Health and Safety at Work Regulations (1992), and the DisabilityDiscrimination Act (1995), to name a few. Within the Employment Protection (Consolidated) Act employees have beengiven protection against unfair dismissal provided they satisfy certainqualifying conditions. It is beyond the remit of this article to explore eachof the conditions except to say that these also need to be considered in theassessment. In Shook v London Borough of Ealing (1986)14 it was ruled that “theemployer must take all reasonable steps to ensure that the alternatives areexplored and the disabled individual is not discriminated against”. Thisruling was reached even before the DDA came into force. The DDA makes it illegal for employers of 15 or more staff to discriminatewithout justification against those with a disability as defined by the Act.The whole concept of disability and to a greater extent, deciding on fitness towork has to be based on the definition of disability as stated in the Act. Section 1 of Part 1 of the Act defines a disabled person as someone with”a physical or mental impairment, which has a substantial and long-termadverse effect on the person’s ability to carry out normal day-to-dayactivities”. The Act says that Part 11 (employment) and Part 111 (goods,facilities, services and premises) also apply in relation to a person who hashad disability as defined in Section 1. Accordingly, it is advised that occupational health nurses are fullyconversant with the Disability Discrimination (Employment) Regulations 1996.Further information and a variety of useful publications can be obtained fromthe Disability Rights Commission16. This legal position has given a greater impetus to the need for assessmentof fitness to work. It also brings into focus the need for health alliancesbetween the occupational health service, general practitioners, hospitalconsultants and employers. Occupational health practitioners, including nurses, need to be aware thatindustrial tribunals have made it clear that conflicting medical opinions onfitness to work would be ruled in favour of occupational healthpractitioners17. This implies that employers are entitled to rely on the viewsof the OH practitioner. Therefore assessment of fitness to work must be adefensible position. The fit to work framework thus proposes that the four variables mentionedabove are considered in assessment of fitness to work. It is also envisagedthat OH nurses use their professional knowledge and skills to ensure that theassessment is rigorous but equitable. Using the fitness to work frameworkenables a consistent and transparent method of assessment, decision-making anddocumentation. References 1. Battigelli MC (1994) Determination of Fitness to Work. In Zenz C,Dickinson OB, & Horvath EP (eds) Occupational Medicine, 65-69, 3rd ed. St.Louis:CVMosby. 2. O’Neil v Symm & Co. [1998] Disability Discrimination. Health Law. May1998 p 7; Reading Industrial Tribunal. 3. Magaria R (1979) Biomechanics and Energy of Muscular Exercise. Oxford:Clarendon Press. 4. Department for Education and Employment (1996) Disability DiscriminationAct 1995: Code of Practice for the eliminationof discrimination in the field ofemployment against disabled persons or persons whohave had a disability.London: HMSO. 5. Medical Advisory Branch (1996) At a Glance Guide to Current MedicalStandards of Fitness to Drive. Swansea: DVLA. 6. Taylor JF (1995) Medical Aspects of Fitness to Drive, a Guide for MedicalPractitioners. 5th ed. London: Medical Commission on Accident Prevention. 7. UK Off shore Operators Association (1992) Medical Aspects of Fitness forOffshore Work. A Guide for Examining Physicians. London: UK Off shore OperatorsAssociation. 8. Department for Education (1993) The Physical and Mental Fitness to Teachof Teachers and of Entrants to Initial Teacher Training. (Circular No. 13/93).London: Department for Education. 9. UKCC (1998) Guidelines for Records and Record Keeping. London: UKCC 10. Precht et al (1973)Temperature and Life. Berlin: Springer-Verlag. 11. Vangaard L (1975) Physiological reactions to wet-cold. Aviation Spaceand Environmental Medicine, 46, 33. 12. Wyon, et al (1979) The effects of moderate heat stress on mentalperformance. Scandinavian Journal of Work Environment Health, 5, 352. 13. Paris v Stepney Borough Council [1951] All ER 42. 14. Shook v London Borough of Ealing [1986] IRLA 46; All ER. 15. Department for Education and Employment (1996) Disability DiscriminationAct 1995: Guidance on matters to be taken into account in determining questionsrelated to the definition of disability. London: HMSO. 16. Disability Rights Commission. 17. Ford Motor Company v Nawaz [1987] IRLR 163. Siva Murugiah is Senior Lecturer in Life Sciences, RCN DevelopmentCentre, South Bank University. Greta Thornbory is a Consultant in OccupationalHealth, and Anne Harriss is Programme Director,Occupational Health Nursing, RCNDevelopment Centre, South Bank University last_img read more