Who should run worksite health programmes in hospitals?

The authors discuss the pros and cons of having each of the following occupational groups heading a worksite health promotion in a hospital: health educators/promoters, nurses, managers, external consultants. The authors draw on recently completed research in New Zealand organisations to suggest that: 1) Health educators have the necessary diagnosing and programme planning skills, but may not have a good grasp of workplace issues and hazards; 2) Nurses have an extensive medical background, but may lack the skills of consultation and/or the ability to see worker-clients in the context of the total environment; they may be biased towards changing the individual worker rather than an unhealthy environment; 3) Managers may understand the client population at the workplace, and have the power to make comprehensive, system-wide changes, but may not have an extensive medical or health background, requiring ongoing liaison with resources that do; 4) External consultants are probably able to bring in fresh ideas borrowed from similar organisations and may have excellent initiative and coordination for recreational events. They may be expensive, and may not be familiar or powerful enough with an organisation to be able to make organisation-wide changes for health. Multiple factors must be considered when a health programme leader is chosen. The situation in each organisation will require a unique blending of the roles and skills for the smoothest implementation of the programme. An example is offered of how these could come together in a hypothetical hospital situation.