The review below is a summary of the Annual Report 1999.
Review of the Director General
Jorma Rantanen, Director General
Evaluation as a tool for development
In 1994 the Science and Technology Policy Council of Finland recommended that all government research institutes undergo systematic evaluation. The quality, relevance and productivity of the different research sectors were specified as the objectives for evaluation. As a result, the recommendation created an evaluation activity that has spread throughout the sectors, and it currently supplements the practices of management by results within research institutes. All sections of the Ministry of Social Affairs and Health have already been evaluated or are currently under evaluation. The goal of this evaluation is to confirm that the resources and efforts given to certain research activities create relevant and high-quality results.
The scientific community has systematically evaluated research as long as scientific publishing has existed. For 200–300 years this evaluation has been accomplished by the aid of peer-review. Articles submitted for publication and their scientific results are reviewed by experienced researchers in the same field. Only seldom is such a reviewed article accepted without any requests for corrections or changes. The rates of rejection are also high, for some of the most acclaimed journals being 85–90% of all submitted articles.
The scientific evaluation of publications makes use of the internal criteria of science. These criteria include the originality of results and the scientific and technological quality of the study being reported, that is, the scientific value of the hypotheses and the reliability of the methods. In addition the discussion based on the results and the conclusions drawn are evaluated, as is the linguistic and structural quality of the article. Despite the occasional criticism that is directed toward peer-review as a method, it has proved, however, to be the only useful and universally accepted system for ensuring the quality of research.
In addition to the evaluation of an individual study, it is also possible to consider scientific publishing on a more general level. In many fields of science it is common to examine the number of scientific articles and references made to them. These data are used as criteria determining the 'scientific value' of different journals, the impact factor, and the reference or citation index of separate articles. The value of these indicators varies from sector to sector. For example, they are used well in biomedicine and the natural sciences, but in social sciences (which often focus on national systems and problems) they do not work. There is an ongoing debate on the value of the impact factor as an indicator of quality. In some cases it is even used as grounds for making decisions on funding of research projects. It can be useful in a limited system, for example, within a certain area of research and for studies published in English. Many hold serious reservations, however, about the mechanical use of this meter for deciding on funding and prioritization. Impact factors are typically low for journals in the field of occupational health (approximately 1–2), but high (10–30) for larger, more general scientific publications.
From the viewpoint of the reader, ensuring the quality of published scientific articles is important, and it will become even more so as the bulk of scientific information keeps growing. A great portion of published scientific material is also of minor significance. An investigation on the effectiveness of studies showed that, depending on the research topic, 37–98% of all published articles are not referenced during the 4 years following their publication. In other words, no one in the scientific community used the articles to support their own observations or as an impetus for their research. The aforementioned figures concern only material published in international journals. Nevertheless, at least the same number of national publications as international ones are published, often in the native language of the country in question. There is little information on the degree of interest or effect of these publications. The actual impact is often created outside the scientific community, among those who apply knowledge and “consume” scientific information. Investigations made within the Finnish Institute of Occupational Health on the circulation and readers of publications seem to indicate that impact of publications written in Finnish and targeted to those who apply knowledge can be high on a national level. Some of the national publications have created enough interest that sister institutions in other countries have had them translated, for example, into German, English or Japanese.
New expectations have been placed on the evaluation of research in recent years. Public authorities that decide on funding in Finland and other countries, such as the United States and Sweden, have started to require that research needs to provide documeneted evidence on the quality, quantity and economic impact of studies. In many OECD countries public research institutions have begun to be systematically evaluated. In addition to the existing internal scientific criteria, this new activity has created new criteria for evaluating research, for example, external effectiveness, efficiency, cost-benefit relationship and external (practical) relevance.
In addition, the strategy, system for planning, operative capacity, customer orientation, personnel and other resources, competence, leadership and administration have recently been included in the criteria of evaluation. For example, the Finnish Institute of Occupational Health (FIOH) and the National Research and Development Centre for Welfare and Health (STAKES) of Finland have not only been evaluated against internal scientific criteria, but also by different external criteria. This kind of broad evaluation can be seen as a way to apply quality management in research and development. If one wishes to ensure that research projects generate high-quality results, one must ensure that the conditions in which the information is produced is optimal. In 1994 the FIOH produced probably one of the first quality assurance systems of research in the world. It is based on the ISO-9004-2 system, and its influence on, for example, the quality of research project planning has been positive.
The more scientific evaluation focuses on non-scientific aspects, the more difficult it will be to find appropriate criteria and references for comparison. Especially in a small country in which almost every institute and field of expertise of research is unique, it is difficult to find other institutions for comparison. Thus the evaluation process should be repeated regularly to enable the use of institutes as their own controls. International comparisons of research results are possible, but many other activities primarily have only national relevance and are impossible to compare internationally.
It would be beneficial to standardize evaluation methods so that the results of different research institutions can be compared within a country. An even more ambitious goal would be to create an internationally standardized methodology for evaluation.
Many important questions will affect the future development of evaluation, ethical questions and decisions concerning the use of the evaluation results, the independence of the evaluation because it affects the legal rights of the institution under evaluation. Independence of the evaluation is aspired by selecting an evaluation group of several experts from different countries; by having this group to present the evaluation criteria and the variables that will be evaluated beforehand; by documenting the evaluation process as well as possible; by listening to the comments of the institution under evaluation, its customers and interest groups, and by ensuring that the information used in the evaluation process is both transparent and reliable. The participation of the institution under evaluation is best realized by having it produce a self-evaluation report for the external evaluation group. During this process the institution being evaluated analyzes its own activities and achievements. Often it turns out that the institution under evaluation considers this phase of the evaluation to be the most important in the entire evaluation process.
It is evident that the evaluation of research activities and institutions has come to stay. The process can still be developed considerably to serve the purposes of the financiers and administration, the individual needs of institutions and research. It is also possible to develop the practices of information management to enable the real-time gathering of information on actions and results in the course of normal activities and without a special effort. Self-evaluation can also be made part of the planning, steering and follow-up system of an institution so that accurate results are available for internal or external evaluation at any time.
In addition to the yearly evaluation of results inherent in management by results practice, comprehensive periodic evaluation is an important tool for the management and long-term development. As the normal follow-up of results looks mainly at short-term objectives and the accomplishment of routine goals, a holistic periodic evaluation enables one to examine trends in development and to accomplish goals over a longer time-span. Rarely can the final effects of a project or program be seen in an evaluation period of 1 year, but they can well be detected, for example, in an evaluation done every 5 years.
Further methodological development of evaluation is necessary to measure, for example, innovativeness, effectiveness and the effects of learning. It is also more and more important to evaluate the transfer of research into practice.
The FIOH has adopted self-evaluation and external evaluations that are realized in different ways and during different time-spans as tools for its own development. Information management systems support the planning and follow-up of activities. When the use of internal scientific criteria and external criteria is combined, a system is created that supports an ongoing evaluation process along the lines of the knowledge management principle. Through this activity, it is possible to answer many of the essential questions raised by the Institute itself, its personnel and its leadership, as well as the questions of external interest groups, owner (state) and the public. Thus evaluation activities have become a tool for continuing improvement and development.
The year 1999 at the FIOH
Sphere of action
The final year of the Millennium was historical for Finland. For the first time – and probably not again for quite a while – Finland held the Presidency of the European Council. Finland was well prepared and succeeded in its task with grace. At the same time Finland gathered much experience on the functioning of the European Union, and connections were established with other member states on many different levels. The FIOH participated in these functions actively within its role of expertise.
The year 1999 was again a period of rapid growth in the Finnish economy. Gross production grew by 6.6%, and industrial production by 16%. The gross national income grew by 3.5%, and employment increased in all main sectors of economy except in transport. The growth was significant in hotel and restaurant services, industry, construction and other services. According to Statistics Finland the unemployment rate was reduced to 10.2%; and the number of unemployed persons was cut by 24,000 persons. At the same time the increase in the number of employed doubled this figure, reaching 50,000 persons. According to preliminary information the number of occupational accidents was reduced by approximately 2,200 (1.6%) when compared with the figures for the preceding year. A total of 171 deaths occurred as a result of occupational disease or accidents, the number being 8 less than in 1998. Of these, 33 resulted from accidents at the workplace, 107 were related to occupational diseases (mainly asbestosrelated cancers), 10 occurred in work-related transportation, and 21 happened during commuting to work.
The total number of occupational diseases was reduced by 4% from the year before. The reduction concerned, for example, noise injuries, severe cases of asbestosis and allergic respiratory diseases. Of the workplaces covered by the Register of Employees Occupationally Exposed to Carcinogens (the ASA Register), 31% thought that their registration had led to reductions in hazardous exposure and the risk of cancer.
Rapidly changing work life and the increase in production in many business sectors, together with growing competition, internationalization, and new technologies and production methods put the entire labor force, and especially the work ability of aging workers, to the test. In April 1999 the program of the new Government included several objectives for the promotion of work life, working conditions, occupational health, work ability and coping with work. The Ministry of Social Affairs and Health summarized these goals into seven lines of action:
1. to introduce activating social policy and ensure the economy of social progress
2. to promote work ability and encourage longer working careers
3. to prevent social marginalization
4. to promote healthy living habits, functional capacity and the living environment
5. to ensure the availability of services and improve health care practices
6. to strengthen equality
7. to improve steering and control in the social sector.
Of these actions, especially the second through the fifth concern the FIOH. The Ministry of Social Affairs and Health also finalized its 5-year programme of work, and it included several research and development tasks for FIOH. The Institute was also involved in coordinating two programs of the Advisory Committee on Social and Health Sector (TUKE) of the Ministry of Social Affairs and Health, one being “The Work Environments, Work Ability and Well-Being of Personnel in Social and Health Services” and the other being “Maintenance of Work Ability and Functional Capacity.”
The Institute had, however, already earlier initiated action programs concerning the aging of health care personnel, the promotion of their work ability, the prevention of burnout among them, and the development of their working conditions. The Government program also contains goals for developing the information society. The existence of the Brain@Work Laboratory within the Institute and its research on optimizing the conditions of information-intensive work led to the Institute being assigned to coordinate one of the national programs on “Information-Intensive Work”. A special action program ‘Human Aspects of Work in the Information Society’ was launched as a specific response of the FIOH to the broad national program. It will be put into operation at the beginning of 2000.
According to Statistics Finland the funding of research activities amounted to FIM 22 billion, 3.12% of the GNP. With that percentage, Finland is among the top four investors in research, together with Sweden, Japan and Korea. Of the totalfunding for research, 67% was spent by private enterprises, 19% in universities and 13% in public sector. The amount of public funding devoted to occupational safety and health research was, however, reduced, as in the public sector in general. Funding for research in universities has grown in recent years, but growth has been especially strong among private enterprises (approximately 15% in 1999). Although EU funding for research on occupational safety and health issues increased, it did not compensate the deficit created by the decrease in research funding granted by the state. On the whole, the trend indicates that, in the future, research will increasingly depend on external funding collected from the market.
In light of current trends, it must be asked whether it would be justified to give equal funding to the promotion of work life and the health, safety and work ability of the work force (which is under tremendous stress) as to the development of technical production facilities. If this sector is left behind, it may create disturbances in human production factors that could result in shortcomings in the use of technology.
Promotion of occupational health and work ability
Within the FIOH the promotion of occupational health is the most important area of activity when rated by the input of resources. Approximately 50% of the Institute’s resources were devoted to this effort.
The primary areas of emphasis included the development of occupational health services, the promotion of work ability, and also research, training, evaluation, and the provision of services to diagnose occupational diseases and evaluate work ability. Similarly occupational health research was the largest research area, covering approximately 49% of the entire funding for research.
At the request of the Ministry of Social and Health Affairs and in connection with the 1997 collective agreement, the Finnish Institute of Occupational Health studied the activities to promote work ability (MWA) in Finnish work life. The Work Ability Barometer showed that over 80% of the country’s wage-earners worked in enterprises that had some form of activity of MWA, and 85% of the employers that had organized such activities, as well as their employees, found the activities beneficial for both health and work ability and company economics.
Research concerning the functioning and contents of occupational health services was continued as a part of efforts to develop occupational health services; the results of the 1997 occupational health service survey were published in the Occupational Health Services in Finland report. According to this report, the coverage of occupational health services had changed very little in comparison with the situation in 1995. The most essential development had occurred in matters of content, that is, in the development of occupational health service practices and the promotion of work ability. The occupational health, working conditions and living habits of municipal workers, work ability and aging, the working conditions and work load of physicians, occupational health services in small enterprises, and the work ability, working conditions and professional expertise of the physically disabled workers were also studied.
The research on work-related diseases and occupational diseases concerned the occupational etiology of musculoskeletal disorders of the upper extremities, especially carpal tunnel syndrome, risk factors associated with the deterioration of intervertebral discs of the lumbar spine and the significance of physical work load in the use of nursing services. Physical load in general and especially the load on the lumbar spine seem to double the need for hospital care of workers. Allergic respiratory and skin diseases were studied intensively, and, for example, a poor prognosis was found for work ability of workers who have contracted occupational asthma from isocyanate exposure. An increase in the risk for pneumonia or paranasal sinus infection was detected in groups of workers (for example, health care workers, farmers and cleaning personnel) with a high risk of exposure to organic dusts and biological agents. The risk of occupational dermatoses among dental personnel was extremely high. During 1999 the Institute found five new agents (chemicals) causing occupational allergies.
The research and early detection of diseases related to asbestos was continued, and the screening for asbestos cancer proved to be justified and useful. Cytogenetic research on toxic exposures was also continued, and methods for predicting the risk of cancer were developed.
The interaction between alertness, lack of sleep, work performance and exhaustion among people in information technology, control room and traffic occupations was studied. A high (42%) occurrence of sleep debt was found among Finnish workforce.
Development of the work environment
Altogether 35% of the Institute’s resources were devoted to work environment activities. Because of the needs for risk evaluation within the European Union and the great significance of the forest industries to Finland, the Institute decided to direct some of its resources into research on the health effects of wood dust, the risk of allergies and cancer, and respiratory diseases and dust control. These issues were discussed in a national seminar on wood dust that was organized jointly by the Finnish Institute of Occupational Health and The Finnish Scientific Committee on Assessment of Health Risks of Chemicals. Studies in this field produced important new information on the chemistry of wood particles, factors that affect the creation of wood dust emissions in the processing of wood and the composition and quantities of chemical emissions when different types of wood are sawed.
The FIOH also studied exposure to tobacco smoke and the impact of 1995 legislation on control of passive smoking at the workplaces on the request of the Ministry of Social Affairs and Health. The amendment has significantly reduced exposure to tobacco smoke in large workplaces. The same cannot, however, be said for small workplaces.
New research projects were initiated to intensify the study of health risks created by wet buildings, mycotoxins, fungal spores released from buildings and building materials, and related chemical agents. In the field of ventilation research, an internationally unique study was completed in which the learning indoor-air analyzing model was developed using the Bayesian model.
Within the sphere of the Work in the Cold Program diverse exposure to cold and its risk, human physiological and psychological response to cold, the prevention of cold hazards and protection from cold were studied.
Several research projects were in progress on occupational safety. One was a broad analysis of the threat of violence at work, especially in the commercial sector and in prison welfare occupations, to mention a couple. A campaign to promote a “zero accident” attitude was very successful in large enterprises. A community project to prevent accidents in all sectors of life (work, leisure time, transportation, school, etc.) was continued successfully in a middle-sized city in Finland.
Development of work organizations
Altogether 15% of the Institute’s resources were devoted to developing work organizations. Two action programs were in progress, the Learning Organizations – Innovativeness and New Information and Human Resources for Work.
The prerequisites for effective organizations and the relation to work ability, health and well-being were investigated in several studies. A positive association was found between an effective work organization, well-being and the enterprise’s ability to manage change and develop. Stress and disturbances caused by organizational changes can be prevented by involving workers in the planning stage, active training and the sharing of information. Activities that promote work ability at the workplace proved to be valuable and effective, for example, from the viewpoint of the development of work ability and work organization.
In a project initiated as a part of the 1998–1999 collective agreement, equality at the workplace was studied. Equality was surveyed in certain enterprises, and the association between equality and the work atmosphere was investigated. Men were more satisfied with the equality situation at their workplaces than women, and women had more encounters with equality violations, belittlement or sexual harassment. Competition in the work life was hard, but the high level of equality was considered to help workers cope with their work.
An association between unemployment and health was observed. The risk of long-term unemployment precipitates mental health problems and stress symptoms. As the period of unemployment grows longer, stress symptoms increase even though the morbidity was not found to increase and living habits even improved.
A random training intervention called JOBS, which strived to reduce and prevent unemployment, was effective from the point of view of employability, placement within the labor market, health and well-being of young people.
Two independent studies found that the general development of work life (staff reduction, outsourcing, unemployment, high pressures at work) in the 1990s had adverse effects on health. This development was manifested, for example, by increase in sickness absences and perceived work load. Especially the mental stress factors of work life will need more and more attention as work organizations and communities are developed in the future.
Research activities
During 1999 the Institute devoted 40% of its resources to research and 230 research projects were in progress. Twenty-five projects were completed, and 32 new projects were initiated. Of the resources, 49% was used in studies of occupational health, 35% in studies of work environments and 15%for research on work organizations. The external funding of research increased, mainly because of the increase in EU funds. New important studies were initiated, for example, on wood dust, occupational respiratory diseases, and information-intensive work.
The number of research reports remained about the same as the year before, but the number of congress presentations decreased (360 in 1998 and 297 in 1999). There was no increase in research output, primarily because there was more involvement in cooperative meetings and communication, especially among the senior researchers. Both the EU and standardization organizations also demanded much attention from the senior researchers, without generating actual research outputs. A similar influence could also have been created by the growing popularity of network collaboration. Research activities have focused more and more on surveys and development projects that, despite their great value, do not add to research output. One indication of this trend is the fact that the number of popular articles exceeded the objective by 86%. In fact the Institute has initiated a separate project to analyze research priorities, to check research resources and to identify the factors behind productivity and quality of research.
The education of researchers has been actively supported, for example, in the form of “doctoral schools” for researchers. Six PhD dissertations were published in the Institute in 1999.
Service activities
The Institute uses 34% of its resources for services. The demand for services was surprisingly high in the fields of occupational hygiene, the development of work organizations and aptitude testing. Expert consultation services increased by 100% in comparison with what was planned and with the expected and former levels. There was a slight decline in services dealing with occupational diseases.
Service activities were developed to achieve better quality and a better internal division of labor within the organization. Customer orientation increased and the availability of services was improved, for example, by putting information on the Internet. The accreditation of test services was continued. Several new service products were introduced, for example, in the fields of work organization, occupational hygiene, occupational health care, and information.
Training activities
The amount of training activity, and the income from such activities, decreased slightly in comparison with the year before. Training tailored for specific clients became more important than open training organized according to the Institute’s training program. The growing need for training because of the generation shift of the OHS personnel slightly influenced the demand for the so-called long courses. The challenges related to the contents of the Institute’s training program were set by the nation-wide MWA activity, the National Program for Aging Workers and training in the development of work organizations.
Dissemination of information
Quantitatively, the dissemination of information resembled the year before, but the contents underwent change. Finland’s Presidency of the European Council placed special emphasis on occupational health and safety questions, particularly aging workers and employability. Another significant area of development was the increase in electronic communication via the Internet and electronic media. For example, the Finnish Broadcasting Company initiated a special programme on work life jointly with FIOH and it was found successful.
There was a record-setting increase in the number of publications produced in 1999. Broad scientific material was published to meet the needs of the European Union, for example, Aging workers in the European Union: Status and promotion of work ability, employability and employment was published both in Finnish and in English.
Several good practice guidelines were published in Finnish. They dealt with, for example, the prevention of occupational cancer, occupational allergies, prevention of burnout, the prevention of mold problems of indoor air by occupational health services, the maintenance of work ability among the aging workers, and health practices in the occupational health services of farmers. There were also four guidebooks on MWA practices. At the same time the information services of the Institute’s Information Service Centre were improved to provide better services for both internal and external clients.
Development of facilities
The building project of the Helsinki facilities, which will have a great impact on the functioning of the Finnish Institute of Occupational Health as a whole, made swift progress. The foundation stone of the new facilities, for which excavation began in the summer of 1998, was laid in January 1999. The event was honored by the presence of the Finnish Prime Minister, Paavo Lipponen, who was also the first to add mortar to the stone. On the whole, the project proceeded according to plan and stayed inside the estimated costs.
International cooperation
Because Finland held the Presidency of the European Council in 1999, international activities were unusually brisk. The FIOH was directly involved in the arrangements of five events during Finland’s presidency and indirectly in the same number during either Finland’s or Germany’s presidency, the latter covering the spring of 1999. The FIOH had the main responsibility for arranging two major expert meetings “Safety in Modern Society” and “Occupational Health of Europeans”. The third meeting “The Organic PsychoSyndrome” was organized jointly with the Dutch Ministry of Employment and was held in Delft, The netherlands. The Finnish Government sent the conclusions and recommendations gathered from these meetings to the European Commission.
The Finnish Institute of Occupational Health was also active in adjacent fields of expertise and was chosen from among four competing countries to realize the PHARE-Twinning project, whose goal is to build an institute of occupational health in Estonia and develop the country’s occupational health care in general.
Traditional cooperation with the World Health Organization, its Network of Collaborating Centres in Occupational Health and the “SafeWork” project of the International Labour Organisation were continued.
Several projects and network strategies were continued with EU institutes, the Bilbao Agency and the EU Dublin Foundation. Not only are the EU projects becoming more and more network activities, but the same development can also be seen in other international cooperative projects. This trend is creating many synergistic benefits, and the exchange of information and cooperation is becoming more intense. However, more time must also be reserved for communication and meetings and therefore due concern to the productivity of such collaboration should be given.