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Amanda, Thanks for your response, You say that, in your dissertation, you demonstrated that you can audit the difference between output and outcome in OH. I can see that this might be relatively straight forward for things like vaccination programmes - over time you would hope to see no new cases of for example Hep B and might reasonably assume that (if the risk of exposure has remained the same) that the vaccination programme has contributed to this, particulary if you had a control group. There might also be an impact from raised awareness, improved working practices, mechanical aids etc. So direct cause and effect relationships might be difficult to demonstrate in groups. But when it comes to other core OH activies such as, pre employment assessment, health promotion, counselling and even things like workplace assessment, exposure assessment, health surveillance - I would be interested to know: a what outcome measures you use for these activities b how you measure these outcomes (taking into account latency) c how you put a 'cost' to them Thorney issues...... but if you have published something on this I would be interested in the referrence. Stuart Dr. S.C. Whitaker Senior Research Fellow Head of Health Services Research Unit Institute of Occupational Health University of Birmingham Birmingham B15 2TT Tel (44) 0121 414 6010 Fax (44) 0121 414 6217 e-mail [log in to unmask] %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%