Reflections on managing conflict, and resolution in occupational health practice

 Occupational Health Swaziland, Matsapha Industrial Complex, Manzini, Swaziland

Correspondence: Dr Chris van Selm, PO Box 692, Ezulwini, Swaziland. e-mail:


Chris van Selm is a SASOM member.




Dysfunction at workplaces often relates to occupationally-associated risks that encompass clinical and legal criteria, and impact on health and safety. This also relates to inappropriate and prolonged exposures to various hazards, interspersed with behavioural dysfunction.



Concerns often find their way into external statutory bodies, such as the Department of Labour, and the media, with a number of medical, legal and environmental experts, as well as the general public, becoming increasingly involved. This can lead to increased anxiety, stress and potential for conflict, manifesting itself in confrontation with employers, unions, and the media. In turn, perceptions often divert from the fact that most ethical and high profile companies do respond positively to potential conflicts. This is particularly noticeable now that health and safety is such a major part of global business practices.



Clinical manifestations of immuno-compromised conditions (such as tuberculosis, HIV and poor nutrition) might not be comprehensively managed, disclosed, or fully evaluated, with disparity between clinical presentation and assessment criteria for subjecting such persons to hazardous exposures. Communication is therefore paramount and, associated with poor command of local languages, also an impediment to those who are investigating the scenario.

Confusion may also be associated with potential and/or diagnosed occupational illnesses resulting from exposures. Difficulties arise, both in terms of the level of toxicity and the degree to which such persons may be compromised, currently or in the future.  

Although a number of potential and/or real hazards are well documented and the risk management protocols are effectively implemented, they require continuous review and upgrading.


Professional support

Assessment of risk requires high levels of professional input and clear guidelines. This might add confusion and cloud judgement if different persons and entities are involved, such as unions, health and safety personnel, the Department of Labour, lawyers, etc.



A number of initiatives have been considered to find ways of dealing with the emotional and personal issues of many individuals, to address the complex and long-term hazardous exposures associated with high-risk operational requirements, in terms of safety and health. In the interim, individualised and collective assessments are taking place to address such concerns, and to facilitate some, if not all, of the support systems that are available to assist employees.



Ultimately, the costs (both medical and legal) add up. The old adage of ‘prevention is better than cure’ is no more relevant than in health and safety!



Social awareness

Because of the nature and sensitivity surrounding emotive stressors and concerns, not only among workers, attempts should be made to find ways to address these. The fundamental principle is that there is always an element of emotive stress experienced by all, and often forgotten – in particular, by health and safety personnel on site! When an emotive ‘barrier’ arises, progress is hampered, frustrating efforts to do something about the situation. In the eyes of the affected persons, appropriate levels of professionalism are ‘expected’ from the health and safety personnel, to provide some measure of comfort.


Moral concerns

People who work together get to know each other, and build relationships that require acknowledgement. When a crisis involves the working environment, there is an unspoken moral obligation that peers, friends and management should provide assistance and support. This is often experienced by people who work together for many years. The moral expectation is often (if not always) that, on retirement, there should be acknowledgement and respect from others. In the same context, but more dramatically, an emergency in the place of employ creates a far more serious realisation of the support expected and, in the extreme situation where death is the ultimate price, that support should be extended way beyond expectation.

Moral concerns are not measured in monetary terms but in relation to caring. This needs to be enhanced and consolidated when dealing with those who have their own emotive dysfunctions to address. Complicating features of moral concern are, amongst others, the duration of active support; the methodologies required, that might include training; and the extent to which the company takes responsibilities in pursuing this directive.


Community relationships

In the South African context, building relationships with local communities by industry has been an objective of Government since 1994.This is exemplified by large industrial complexes, and should be seen to have real benefits in facilitating both structural and social communications, but with resources for people to work in and around the industrial setting. To become part of this positive relationship, it is essential to embrace recognition of such support. There also needs to be a commitment to improving local and rural developments through accountability. This includes a commitment to health and education, as well as norms to strengthen moral standing and cultural values. At the same time, there must be continued and progressive environmental commitments to accommodate communal concerns about pollution and poor health from harmful exposures.


Financial and other support structures

Money is the most effective way in which people transact for the purpose of living, and it is the exchange medium upon which we all depend to survive. This becomes the core concern of all persons who are potentially and/or actually aggrieved by hazardous exposures. The immediate worries to persons who are affected are how they are going to cope if they cannot work, fear of losing their jobs, and their health – to the extent that they might become permanently impaired. These issues are strongly debated by both management and unions, as well as other qualified professionals, all of whom bring technical expertise to the table.

One of the most contentious issues is how to find regulated and appropriate measures of generating financial support, i.e. compensation. While a number of statutory guidelines have been written into the Compensation for Occupational Injuries and Diseases (COID) Act1 which focus specifically on compensable claims emanating from occupationally-induced injuries as a result of accidents at work, occupational diseases have not been addressed to the same degree.

The problems that now confront employers and the COID Commissioner alike, are: 1) the compensation payable to persons whose health has been adversely affected is focused on what constitutes a valid claim, and 2) if accepted, what amount would be paid to address not only temporary or partial impairments and consequent levels of disability, but long term and permanent disability, to support the living standards to which he/she has become accustomed by way of related income?

More serious, is a perception that there is discrepancy amongst medical and other professionals regarding clinical interpretation of such occupational exposure, and the findings that may, or may not, define a level or degree of harm introduced. For example, headaches are common in occupationally-related illness, but how is a headache ‘measured’ to support a claim?  It is the legal interpretation upon which claims are based, not the medical interpretation! By applying comprehensive investigations that invariably do not result in objective findings to confirm such headaches, does this mean that there is no headache? Is the person then considered to be declaring false information or, worse, lying?



In an effort to increase our awareness and understanding of the Occupational Health and Safety (OHS) Act² some areas could include the principle of the ‘Reasonable Man’ test.

It is important to note that the employer is responsible for ensuring compliance with the legislation (the OHS Act, the COID Act, etc.) in order to ensure the health and safety of not only employees and neighbourhood communities, but also contractors. In the event of any incident or health-related issue, actions will be judged against the so-called ‘Reasonable Man’ test (in a court of law). According to the courts, the reasonable man would have acted differently if the wrongful causing of damage was reasonably foreseeable and preventable.

The reasonable man is the average person of normal intelligence. He is “not . . . a timorous faint heart always in trepidation lest he or others suffer some injury; on the contrary, he ventures out in the world, engages in affairs and takes reasonable chances”.3

In any activity requiring expertise, the employer could be tested to the standard of a reasonable expert (e.g. engineer, doctor), according to the common-law rule of Impartia culpea adnumeratur (lack of skill is considered negligent). This would be defined under the auspices of the occupational health professional. 

Proof of Due Diligence can be viewed in Table 1. If the response to any issue raised in the table is negative, then it can be rightfully concluded that it is not ‘reasonably practicable’.


Additional considerations

If the conclusion is that it is not ‘reasonably practicable’ to take action against an unacceptable risk/hazard, an alternate plan must be devised. There is still a responsibility to deal with the risk, i.e. once the risk is noted, something must be done about it.


An alternative plan could be to:

• inform the employees/company why it was necessary for an alternative plan (in terms of the above)

• make the employees/company conversant with the hazard (i.e. warn against the hazard)

• decide on specific instructions, training, supervision, personal protective equipment, etc.

• test the plan so that it ensures the health and safety of the employees



It is vital to create channels of communication where potential and/or real conflict may arise at the workplace. Such precipitants are particularly noticeable when risks are perceived to be high, and related and relevant to the level of conflict. Complex procedural interactions become relevant when various professional bodies and related groups are motivated to actionable tension, and the challenge and clarity of focus is critical to isolate chains of custody of management as well as continuity of progress. This implies co-ordination and interactive support and consolidation by all when addressing and managing the situation, as well as clarity of focus by the occupational health medical practitioner (OHMP).

Other aspects of coping with conflict are to always consider accommodating issues such as communal concerns, financial implications, and moral applications. Awareness of the ‘reasonable man’ takes on legal and clinical interpretations, together with ‘due diligence’ to enable cohesive, and clarity of focus when reacting to, or coping with, risk and potential conflict situations.

Finally, The OHMP takes on the important role of the caring, integrative liaison professional to facilitate (by leadership) the responsibilities towards case closure, where appropriate.



1. Republic of South Africa. Compensation for Occupational Injuries and Diseases Act, No. 130 of 1993. Government Gazette no. 15158. Pretoria: Government Printer.

2. Republic of South Africa. Occupational Health and Safety Act No 85 of 1993. Pretoria: Government Printer.

3. SA Law of Derelict – Herschel v Mrupe 1954 (3) SA 464 (A) at 477A-C.


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