Micro and small enterprises (MSEs) are commonly defined in Europe as “enterprises with fewer than 50 employees"; MSEs are further divided into micro enterprises (with fewer than 10) and small enterprises (10–49).
The enterprises referred to in this paper are indeed micro-enterprises, but also small enterprises with fewer than 20 employees since those companies operate very similarly to micro-enterprises.
For several years now, micro-enterprises have been the focus of socio-economic reflection. In this context, occupational health in micro-enterprises has become important for public policy and social partners, both at European level and at French level, underlining the need to develop risk prevention in small enterprises.
In 2009 the French national research and safety institute for the prevention of occupational accidents and diseases (INRS) created a micro-enterprises unit in charge of reviewing the occupational risk prevention approaches in those companies, proposing and testing a methodology to secure those companies’ involvement, and assessing the effectiveness and appropriateness of the methodology. This work is based on an analysis of the different models for intervention in small enterprises (Favaro, 2004).
Since 2012, the national occupational risk insurance fund has been heavily involved in this approach, developing a pilot programme aimed at micro-enterprises for implementing actions at national level with regional occupational health and pension funds. The purpose of this article is to paint a picture of prevention in micro-enterprises, describe the approach adopted, present the process and tools designed and used within this framework and draw lessons from the different partnerships.
Overview and context of prevention in micro-enterprises
In France, the general social security scheme insures 2.1 million establishments, 85% of which have fewer than 10 employees.
The European research programme SESAME identified “a set of socio-economic and regulatory factors that act in concert to raise the risks to health and safety experienced by workers in a substantial proportion of smaller firms to levels greater than those experienced in larger enterprises in comparable sectors. In brief, numerous studies identify reasons for poor uptake of arrangements for managing OSH in these enterprises. They include:
- the weak economic position of many MSEs and the low investment they are able to make in OSH infrastructure;
- the limited knowledge, awareness and competence of their owner-managers in relation to both OSH and its regulatory requirements;
- limited capacity to manage their affairs systematically; and
- their attitudes and priorities, given the limited resources at their disposal and their concerns for the economic survival of their business, in which OSH has a low profile."
(EU-OSHA SESAME project 2016).
An analysis by company size shows that micro-enterprises (< 10 employees) employ 24% of all workers covered by the general social security scheme, i.e. 4.5 million salaried workers. These businesses account for 19% of occupational accidents (frequency index of30). Because certain activities are done mostly in small companies, there is a concentration of occupational accidents in those companies as well. The car repair industry is a prime example: 91% of employees work in business with fewer than 20 employees; they account for 87% of occupational accidents (Figure 1).
This graph also shows that the frequency index is not a relevant indicator for determining actions in this case. It shows that establishments with 50 to 99 employees have the most accidents, because the number of accidents/number of employees ratio is high, but there are very few employees in such establishments. Improving safety in garages requires action to be targeted at small establishments, since they have the most workers and the most accidents.
Business operation in small companies is heavily centred around the business owner, with a very informal organisation and versatile employees. They have no particular expertise in occupational risk prevention. Because they are often single entities, it is even more complicated to reach them on a large scale. As a result, these companies remain isolated as regards occupational health, and even more so when they do not draw on external expertise.
Lack of concern for occupational health
Because small enterprises are fragile and have very short-term concerns, they are not predisposed to reflecting about and constructing long-term action plans. From a statistical point of view, there are few accidents, but they also have no incentive to invest in prevention because the cost they incur for occupational accidents and diseases is only partly linked to the company’s accident rate(ViaVoice-INRS, 2015; P. Laine and M. Malenfer, 2015).
Occupational risk prevention in small enterprises is therefore very complex – a combination of the owner’s identity, the business and the development model of the enterprise as well as the relationship with occupational health stakeholders. The business owner is a key player when it comes to risk prevention. Proposing prevention actions to this target requires all the different categories of business owners to be taken into account. To better understand the different behaviours adopted by company owners, several classifications of attitude towards prevention have been defined. The classification proposed by P. Hasle (2011) includes the relationship with workers. It sets out four behaviour categories:
- Avoidance: the business owner attempts to ignore occupational health
- The necessary evil: the business owner accepts rules to the minimum extent possible but considers that it is a waste of time and money.
- Compliance with requirements: acceptance of a set of constraints to reach a level of security acceptable for employees, clients and the authorities.
- Business strategy: occupational health is included in the development strategy, with a proactive attitude to maintain a high level of safety.
Lastly, all occupational health data shows a very strong influence of the size of the company: the Sumer surveys (2016), the European survey on new and emerging occupational risks (EU-OSHA, 2016a) and the Dares survey (2016) all establish a relationship between occupational risk consideration and the size of the enterprise (Figure 2).
At European level, the situation is very similar, as confirmed by the recent publication of the first report of the SESAME project (EU-OSHA, 2016b).
Prevention programmes aimed at micro-enterprises
The particularities described above require a specific approach to occupational health in small enterprises, based on the perceived usefulness of the approach. For that purpose, it is best to base the approach on the company’s needs in order to remedy its lack of involvement in prevention.
Needs of small enterprises: job-based approach
Small enterprises may not express any particular expectations as concerns occupational health, but they do have needs in this field. Recruitment of expertise, employee retention and employee attendance give companies a competitive edge, through the quality of the product or service and compliance with deadlines. In such a context, employee absenteeism because of an accident or occupational disease is a difficult constraint to manage.
Some business owners also express the need for regulatory compliance, and risk assessment is the main element required by regulation in Europe. Since occupational health is not always a concern in small enterprises, it is highly unlikely that drawing their attention to a specific risk will encourage them to take action. It is preferable to address the topic of prevention using an approach based on the job, so as to target their business directly as well as their specific concerns. This allows risk situations in connection with the business to be addressed and suitable prevention measures to be recommended. It also enables detailed examination of needs according to the profession. Some professions are more in tune to regulatory compliance (catering) while others have greater needs for qualified and skilled workers (car repair). These needs can be used to put forward the most convincing arguments that might drive business owners to take action.
Objectives in prevention: establishing priorities
The need for a job-based approach and to provide the business owner with operational solutions also requires a precise analysis of the accidents in each profession. This falls within the scope of expertise of OSH practitioners. Safety inspectors from the regional occupational accident funds are aware of the reality of the job in the companies targeted. If necessary, they can visit companies to make first-hand observations. In addition to these qualitative elements, OSH practitioners have statistics from the national health insurance fund, which provide an overview of the accident rate in the sector. However, this data is often not precise enough for operational recommendations to be made. Once operators from the regional funds have read and analysed a large number of occupational accident statements, this statistical data becomes more reliable as it is associated with concrete work situations. Clearly, the need for prevention is not only related to occupational accidents and the objectives should also target prevention of musculoskeletal disorders, psychosocial risks and chemical risks, also with the use of a job-based approach.
The need for supporting the business: tools and intermediaries
For business owners, implementation of prevention is complex. In the ESENER-2 European survey, the “complexity of legal obligations" is the first difficulty reported in addressing health and safety (by 40 % of surveyed establishments). They have expressed the need for support, particularly for obtaining concrete recommendations and tools. The large number of enterprises makes it impossible for them all to be followed individually by an OSH expert. It is therefore necessary to draw on other players that have links to the businesses in areas other than occupational health. For actions not requiring any specific expertise, it is wise to promote an autonomous approach by the company.
According to the level of expertise required, company support falls into one of three categories:
- Independent action by the company, through messages and appropriate tools.
- Support for the company by an intermediary not active in prevention: professional organisations, chambers of commerce, sector-specific training funds run both by employer associations and trade unions (OPCA - organisme paritaire collecteur agréé), technical centres or innovation clusters, accounting firms, etc. These structures can promote occupational safety and health and also assist companies in two ways: transmit information recommended by OSH practitioners or support companies after they themselves have acquired an initial level of training from such practitioners.
- Assistance from experts – external occupational health services, social security funds, consultants – is necessary when an action requires a high level of expertise.
Tool- and partnership-based approaches tested in four professions
Over the 2014-2017 period, an innovative programme was ran by the occupational risk branch of social security to support four professions made up of small enterprises:
- traditional catering, 97,000 enterprises with fewer than 20 employees,
- car repair, 40,000 enterprises with fewer than 20 employees,
- masonry, 35,000 enterprises with fewer than 20 employees,
- road freight transport, 17,000 enterprises with fewer than 20 employees.
These four professions were chosen based on the following criteria: the number of employees, the number of accidents and the cost of these accidents for the social protection scheme.
Sector offers tailored to needs
For each of these professions, investigations, analysis of the accident rate and exploration of needs were done following the principles described above by working groups bringing together OSH practitioners from the regional social security funds and from INRS. At the same time, INRS worked to define the types of material best suited to micro-enterprises. This work resulted in the production of prevention material comprising the following:
- A web page on INRS’s website for each of these professions. It contains or links to all of the material aimed at micro-enterprises in the sector. Each page has a short explicit link that is easy to remember if it is read in a letter, an article or on a poster. All of the material disseminated within the framework of a profession experiment, as well as websites, newsletters and other communication tools from project partners link to this page.
- A set of core essential measures expected of the profession. For each profession, “basic" prevention measures were selected, with the aim of recommending to professionals some simple and economical actions corresponding to the main risks in their sector. These core measures are presented in very concise sheets that provide a solution to a risk situation frequently encountered in that specific business sector. These documents are available on the internet page devoted to the profession.
- An online risk assessment support tool. For four of the professions, INRS developed an OiRA (Online interactive Risk Assessment) tool adapted to the profession.This software, designed and proposed by EU-OSHA (European Agency for Safety and Health at Work), is used to develop sector-specific tools which are then offered free of charge to micro-enterprises. These tools guide users in the risk assessment process and suggest prevention measures adapted to the context of a micro-enterprise in that sector. The company can draw up and download its risk assessment document and action plan that it will have drafted with the help of the tool (more than 18,000 sessions have been launched in the French OiRA tools).
- A very short campaign leaflet supplements this offer. It aims to draw the attention of business owners with the use of key figures, highlights the main causes of occupational accidents and diseases and directs the company to the web page where it can find all of the resources required for it to take action. The format of this document allows massive distribution guaranteeing that each micro-enterprise in the profession targeted receives information about the subject. Within the framework of national programmes, 153,000 documents were disseminated to companies with 1 to 19 employees in the sectors targeted.
- Complementary tools. Apart from these basic elements, sector approaches can be used to convey other actions or tools of the occupational risk branch of social security and INRS. Reciprocally, these traditional tools can be used to enhance a programme, in particular
- The MAVImplant tool which is a workplace design support tool aimed at helping micro-enterprises to express their expectations regarding the building or redesigning of a workplace while incorporating health and safety requirements. MAVImplant tools are also tailored to different sectors
- The “Synergie" mechanisms which aim to combat the high accident rate affecting young people in their initial professional experiences. These mechanisms are also sector-oriented. Each has two parts. The first aims to improve induction with material that can be used to structure discussions with new recruits. The other is intended for technical and vocational teachers, to assist them with incorporating occupational safety and health into their programmes.
- In 2016, simplified financial aid was introduced to support sector programmes. It serves to encourage the company to implement, in particular the abovementioned essential core prevention measures.
This offer aims to empower some of the micro-enterprises of the target sectors by enabling them to take prevention action autonomously. Digital tools have a key role because of their advantages for this type of approach (Malenfer, 2014). Building this offer also enables its adoption by relay partners, which could also contribute to its dissemination.
Partnerships: intermediaries in each sector
For each of the professions, collaboration was set up with one or several partner-intermediaries. The goal of these partnerships was to find players among those in contact with micro-enterprises that could effectively spread a message of prevention by advising and supporting the company in a relationship based on trust. It was systematically ensured that potential partners were interested in taking up occupational safety and health. Only win-win partnerships guaranteeing longevity and commitment were maintained. The different sector programmes therefore all have a partnership component:
- For the catering sector, a partnership was established with the chambers of commerce and industry (CCI), targeting in particular their tourism advisors, who are the restaurant owners’ exclusive source of information about regulations, especially during the building or takeover of an establishment. Professional organisations are also associated with the programme. In 2015 and 2016, more than 180 CCI advisors were trained by the social security funds of their region. The goal of this training was to provide advisors with essential elements governing prevention (general principles, regulatory requirements, rules pertaining to insurance coverage, etc.), to give them insight into risks specific to the catering business (main risks, vulnerabilities, etc.), and to make them familiar with the tools available for informing and assisting professionals.
- For the car repair sector, professional organisations which are already heavily involved in occupational risk prevention take part in the programme. The choice was made to test with these partners, in a few pilot regions, the introduction of prevention advisors in the field (12 advisors were trained). These jobs are co-funded by the professional organisation (which is the advisor’s employer) and the national insurance fund for salaried workers. These advisors were tasked with visiting a large number of garages in person to raise the owner’s awareness, set in motion or reactivate the risk assessment process and propose measures to improve workstations using the materials provided by INRS. After ten months over the course of 2016/2017, 1,000 garages were involved in the experiment.
- For the masonry sector, the professional organisation bringing together single-family home developers is the vehicle chosen for reaching outsourcers in these small enterprises. The joint drafting of a good practice document, defining a set of prevention measures, identifies essential provisions for guaranteeing health and safety at worksites. By including those provisions in the contracts, the contractor contributes to the fast dissemination of recommended solutions and reduces competition from the cheapest companies. To supplement the information proposed to masons, a partnership with material suppliers ensures that the message is conveyed to them, since supply stores are places visited regularly by masons.
- For road freight transport, the main partner was OPCA Transports et Services (OPCA T&S). This body, which collects funds for vocational training in this sector, has a team of field advisors all over the country who meet up with small road transport companies to give them support concerning human resources and social matters. The partnership agreement between this body and INRS includes:
- training of all OPCA T&S field advisors and consultants (over 100 advisors trained in 2015 and 2016),
- participation of OSH insurance experts in information meetings organised by OPCA,
- integration of a prevention module in the online training offer for company tutors.
In an interprofessional approach, accounting firms are also partners that assist the company, enjoying the trust of the business owner and good knowledge of the company. Their position allows them to remind supervisors of regulatory occupational health requirements. In the experiment conducted with this profession (40 advisors trained), accounting firms assist the business owner with risk assessment.
These relays contribute to spreading the message of prevention, encouraging the business owner to better take into account occupational risks and implement the solutions proposed.
The partnerships set up in this programme are aimed at exponentially spreading occupational risk prevention in micro-enterprises.
The different collaborations were assessed in 2017 by a specialist firm (Planète Publique, assessment of the micro-enterprises project, October 2017). Different stakeholders were interviewed: 700 business owners, different intermediaries and prevention specialists. The main partnership results confirm the relevance of the choices adopted for building the programmes.
These partnerships have many elements in common with models developed in other countries for the purpose of lending OSH support to micro-enterprises through intermediaries thay may or may not be OSH-focused (Olsen and Hasle, 2015, Sinclair et al 2013). The partner’s ability to include OSH in its service offering is decisive (Sinclair et al, 2013).
Criteria for an effective partnership
The choice of partner is essential for ensuring massive dissemination. Three criteria are to be taken into account in choosing the partner: businesses’ familiarity with the potential partner, the positioning of the partners and the extent of their reach.
Familiarity refers to this partner being known by companies, knowledge of the role it plays, closeness with companies and the ease with which they may approach it.
Positioning of the partner means the quality of the relationship with small enterprises, the partner’s ability to establish a relationship of “trust" with micro-enterprises. With that in mind, the value of partners is their contribution to credibility, interest in and clarity of the prevention messages. Three parameters characterise positioning:
- Job expertise, i.e. knowledge of the constraints of the job which can be used to propose a suitable message. Professional organisations and CCIs have a very advantageous position in the job.
- Regulatory expertise, i.e. knowledge of businesses’ legal requirements and the ability to help them comply with regulations, acting as their single contact. This is particularly the case with accounting firms.
- Prevention expertise, i.e. knowledge of the solutions and measures for protecting employees as best as possible. This dimension concerns mainly occupational health services.
Extent of reach refers to the partner’s ability to “reach" a large number of micro-enterprises and have frequent contact with them. Three parameters characterise magnitude:
- volume: i.e. the number of companies with which the partner is in contact;
- coverage: i.e. ability to reach a large portion or all of the territory;
- frequency: i.e. partners’ ability to have frequent contact with micro-enterprises.
These different criteria serve to select the partner. The relationship that should be established can be of different types:
- information relays to disseminate the offer to members or clients. This is the case with professional organisations involved in each of the professions,
- changing of practices to incorporate a message of prevention in their business cases or promotional material, for example, building material suppliers or heavy truck dealers,
- integration of occupational risk prevention expertise, introduced for OPCA T&S, CCI tourism advisors, accounting firms and prevention advisors in the car repair sector.
Partnerships require resources in order to build and sustain the relationship. A “win-win" approach guarantees the proper operation and durability of the partnership.
First, the partner’s general interest in participating in protecting health and safety in companies and support micro-enterprises must be ensured. The programme provides concrete solutions to companies and tools and content suited to the micro-enterprises with which they are in contact. In order for the approach to be effective, the partner must be convinced of the value of developing prevention.
Positioning is particularly important in building a “win-win" partnership. This is easier with partners that have complimentary positioning. Partners involved in programmes are positioned in the profession or with regard to regulations, and do not have any real connection with prevention expertise, as this falls within the scope of INRS and OSH insurance. The “win-win" mind-set is in fact harder to build with a partner that has expertise or an offer related to risk prevention, since there is less complementarity.
Partners selected are interested in the tools developed in the programmes and show interest in improving their prevention expertise. This is even more so when the programme enables them to develop a service offering, which is beneficial to them either for their development, for sales, or for increasing or maintaining their members. For example, introducing prevention advisors in garages can build loyalty of members of professional organisations and possibly attract new members. In the transport sector, the development of OPCA T&S’s analysis offering in prevention contributes to revitalising this service provided to companies, thereby strengthening and expanding its service offering. Accounting firms can include risk assessment support in their offering of services to companies. As the accounting profession undergoes changes, accounting firms are willing to expand their offering.
Summary and prospects
Tailoring prevention approaches to the specificities of small enterprises has become a necessity.
The experimental work conducted by the prevention network targeted at small enterprises led to the definition, for each profession, of a core set of prevention measures. Since they are based on the experience of OSH practitioners out in the field, these measures provide solutions to risk situations commonly encountered in the profession while taking into account the need for implementation to be simple. This “recommended" prevention satisfies the need to provide concrete solutions to business owners.
The second component of the approach is to include different “products" in a coherent offer, with both printed material and online documents and applications.
The third component of this work is the partnership approach, for reaching a greater number of enterprises. This is the greatest innovation in this experiment, since it brings into play actors that originally were not involved in occupational health, in particular as concerns OPCA Transports et Services and accounting firms. For other actors, it strengthens their commitment to this matter (professional organisations, CCIs and outsourcers).
Choosing a profession-based approach also raises the issue of its implementation method and the resources needed. A more recent experiment, targeted at the non-food retail sector, shows that tools that are now “standardised" can quite easily be applied to another target sector by drawing on recurring content. Moreover, this action, conducted at sector level, can cover many jobs that have rather similar prevention issues. The progressive coverage of the main sectors through a minimal offering of information and tools is therefore an option. The partnership dimension of actions however requires strong involvement which could lead to the promotion of partnerships with actors covering many jobs as is the case with chambers of commerce, industry and of crafts.
More generally, the number of small enterprises and their specific situation require coordination between institutional players in charge of occupational health and greater involvement of actors close to the enterprise, with the distribution of roles between the different participants being based on their respective expertise, within the framework of a “win-win" mind-set.
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 European Commission Recommendation (2003/361/EC)concerning the definition of micro, small and medium-sized enterprises.
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 Occupational Health Plans No. 2 and No.3 (Labour Ministry, 2013, 2017)
 ''Caisse Nationale de l’Assurance Maladie des Travailleurs Salariés (CNAMTS)'' - national health insurance fund for salaried workers
 ''Contexts and arrangements for occupational safety and health in micro and small'' enterprises in the EU'' – SESAME project, EU-OSHA 2016, p.10''
 Frequency index (FI) = (number of accidents resulting in more than one day of absence/number of employees) x 1,000.
 Occupational risk insurance uses the same contribution rate known as the “collective rate" for all businesses with fewer than 20 employees under the same risk number (business code).
 ESENER-2 Overview report: Managing Safety and Health at Work, EU-OSHA, p.63-68
 For more information on MAVImplant: https://www.inrs.fr/mavimplant
 Pour en savoir plus sur les dispositifs. Synergie
 Organisme Paritaire Collecteur Agréé