Iran Occupational Health

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Background and aims: Observance of Health, Safety and Environment (HSE) guidelines is becoming more pervasive in all organizations, and governments and regulators are becoming more strict on it. The onset and prevalence of Coronavirus disease (COVID-19) is an example of a lack of attention or disregard for such standards and guidelines. Adherence to such standards is much more important in all organizations, especially in health-oriented organizations such as hospitals, and they increases safety and improves the efficiency of hospitals and the community (environment). Because health and safety factors are closely related to ergonomic factors (E), attention to this factor has led to the evolution of HSE and the emergence of HSEE. Much research has been done on HSE management, related evaluations, and other related issues, but due to the novelty of HSEE, such models have rarely been researched in HSEE. Also, in previous models, the weight of all factors was considered the same, and the evaluations were practically turned into checklists. While in any organization or in any situation, the importance of observing some factors may be more or less than others, and at the same time the ergonomic factor should be considered in this model. The purpose of this study is to provide a quantitative model for measuring the performance of organizational units based on the observance of the usual HSE criteria and consider the ergonomic factor (HSEE). Numerous studies have shown that ergonomics play a major role in increasing human performance in all areas. Developing such a model can lead to more accurate information to managers and their better decision-making in order to reduce harm in the organization and in the organization environment. It will also provide more accurate feedback to the organization's units for self-assessment and calculation of any points for them, and ultimately ranking the units.
 Methods: Since the result of this research is a model that can be used in practice by organizations (especially hospitals), this research is an applied research. It is also a descriptive study because it explores the current situation and tries to describe and clarify it and present the result in the form of a quantitative model. Finally, because the data in this study is collected through a questionnaire, it is a survey study. In the first phase, studies related to the HSE and HSEE models were reviewed. In each model, the main variables (health, safety, environment and ergonomics) were collected along with the following variables for each. Then, by combining them into one large model, all variables entered the model and overlaps were eliminated. Because this model is made for a hospital, the variables were redefined based on the characteristics of the hospital and the model was modified. Finally, a model including the main variables of safety, health, environment and ergonomics and 12 sub-variables were designed and based on it, a research questionnaire was developed. To calculate the reliability of this questionnaire, Cronbach's alpha method with 11 samples were used. This sample was selected by emphasizing on people's familiarity with HSE and HSEE models. The alpha value was calculated to be greater than 0.8 and the reliability of the questionnaire was confirmed. In order to discover the relationship between the 4 main factors and 12 sub-factors, the DEMATEL method with 8 samples was used. DEMATEL's method is a well-known method used to models whose variables are not independent of each other. Using the initial classification of factors as well as HSE(E), the decision tree was designed based on ANP method and also the weight of the indicators was obtained. The ANP method is a method based on pairwise comparisons and a subset of multi-criteria decision-making (MCDM) techniques used to discover the weight of criteria simultaneously with ranking alternatives. Because each of the ANP and DEMATEL questionnaires requires a lot of patience and concentration, the YungLan method was used to combine DEMATEL and ANP. In this method, the data collection is required only once by the questionnaire and this data is reused in both models. At this stage, the weight of 12 factors was calculated and the research model was completely architectural. The designed model was implemented in ArabNia Hospital in Qom. The goal is to determine how well each of the eight units in the hospital complies with HSEE. Qom ArabNia Hospital is the first hospital in Iran in which patients with COVID-19 were quarantined in February 2020. Because there was no information on how well each of the HSEE components were observed in the hospital, a simple questionnaire using the Likert's spectrum was designed to collect this information. This questionnaire was published in a total of 8 units and 11 questionnaires were completed. This data was entered into the model as input, and after analysis, hospital units were ranked based on compliance with safety, health, environmental and ergonomic criteria.
Results: The most important achievement of this research is a quantitative model including 4 areas of safety, health, environment and ergonomics with 12 sub-variables. The results showed a correlation between the main domains as well as the research variables. Identifying these connections revealed that the decision hierarchy is network type and the model governing the problem is ANP type. However, in some research the AHP model was used for this purpose. The premise of this model is that the variables are sufficiently independent of each other, which was rejected in this study. The results of using this model in ArabNia Hospital in Qom also showed that ergonomic factor has the greatest impact on other macro factors, and employee factor has the greatest impact on other 11 sub-variables of research. This model was used to evaluate all 8 units of the hospital. The goal is to determine how well each of these units complies with HSEE. If there is data related to the observance of each sub-variable by each unit in the hospital documents, the relevant data can be entered into the model and after analysis, the amount of HSEE observance by each unit can be determined. Because many cases are not recorded in organizations, access to the necessary data is not possible through the hospital's databases. Since the organization's staff are the only ones who have a lot of data and metadata in their mental history (albeit to some extent, vague and erroneous), a questionnaire was used to solve this problem. For ease of response, the Likert range was used in qualitative measurements. This questionnaire was distributed in 8 units and 11 questionnaires were completed and received. The required data were analyzed by the research model and 8 hospital units were ranked based on HSEE compliance. The results showed that, firstly, the weight of each of the 12 factors of the HSEE model is not the same, and secondly, there is a relationship between them, and finally, the ranking of the units is not the same.
Conclusion: The findings of using the research model in ArabNia Hospital in Qom proved the power of model differentiation. Using the results obtained in this study, the extent to which each of the components of the HSEE model is affected and different from each other. The use of the model in ArabNia Hospital in Qom showed that the medical, financial and administrative equipment units are ranked first to third in the field of HSEE, respectively. With the development of the HSEE measurement model, including the determination of indicators, sub-indicators, their relationship and the weight of each of them, it was found that the weight of the employee invoice is higher than other sub-factors. This study provides a framework for measuring hospital performance in terms of HSEE compliance. This model can be used in other hospitals as well. The point to keep in mind is that it is necessary to recalculate the weight of the variables and sub-variables, which is very simple. This model can also be used in other organizations. Provided that all sub-variables are redefined in accordance with the same organization and replaced in the model. It should be noted here that the main foundation and architecture of the model is fixed, but due to the difference in the nature of organizations, such a change in the details of the model is necessary. Also, the relationship between the factors and their weight must be recalculated. The results of this study are consistent with many studies conducted in the field of HSE. Including the fact that the human factor is very important in establishing HSE in organizations and complying with the relevant rules and regulations. The difference between the model presented in this study and other research is that the relationship between the factors in this model is considered. Although this is not explicitly stated, the use of AHP in some studies is due to the fact that independent HSE variables have been considered and the relationship between them have not been considered. Some recent research has shown that the combination of  DEMATEL and ANP has been used in the HSE model, which indicates an increase in accuracy in such research. However, ergonomic factors are absent in these studies. In the present study, an attempt has been made to pay attention to all these aspects.

Keywords: Safety, Health, Environment, Ergonomics, DEMETAL, ANP, HSE, HSEE

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