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Title: A Proactive Approach for Managing Healthcare Health and Safety


1
  • A Proactive Approach for Managing Healthcare
    Health and Safety
  • Raising the Bar on Leadership Effectiveness
    and Achieving Patient Care Excellence
  • A presentation by Christopher J. Lipowski, CRSP

2
  • The following are essential strategies
    healthcare senior leadership can utilize that
    will visibly demonstrate commitment to
    organizational safety initiatives, foster a
    strong safety culture, and set the foundation for
    healthcare management excellence.
  • ??????

3
  • The Healthcare Crisis at a Glance
  • 88 of health care workers report insomnia,
    headaches, depression, weight changes, and panic
    attacks related to work stress.
  • 35 of Ontario nurses report at least one
    musculoskeletal condition.
  • 28 of Ontario nurses report that they were
    physically assaulted at work over the past 12
    months by a patient.
  • 46 of Canadian physicians report that they are
    in advanced stages of burnout.
  • Average number of days of work lost due to
    illness or disability is at least 1.5 times
    greater for workers in health care than the
    average for all workers.
  • If the average absenteeism rate for health care
    could be reduced to that of all Canadian workers,
    it could mean the equivalent of more than 13,700
    extra full-time employees on the job, including
    5,500 Registered Nurses.
  • HealthForceOntario

4
A Recipe for Healthcare Failure Financial
Consequences of a damaged workforce
  • The significant rate of healthcare worker
    musculoskeletal disorder (MSD) injuries, most of
    which are related to patient handling activities,
    is demonstrating a disturbing trend - that a
    majority of the incidents occur in younger staff,
    with lumbar involvement being the primary injury.
  • If a 37-year-old nurse suffers a back injury
    today due to a patient-handling incident and it
    results in lost work-time of four weeks for
    recuperation, we can reasonably assume that this
    individual is now at higher personal risk for a
    recurrence of an MSD or back injury. If we add to
    this equation the aging factor, we could expect
    an elevated injury risk and severity probability.
    A workplace back injury for such a staff member
    in their fifties will likely result in even more
    time loss and associated direct and indirect
    costs.
  • Senior administration has to seriously consider
    the future financial implications of this trend.
    An aging workforce with a progressively growing
    history of MSD and back injuries can logically be
    regarded as a path towards a healthcare staffing
    crisis and a substantial financial burden on an
    already highly restrictive healthcare budget.

5
Why a Healthy Healthcare Work Environment is
Important
  • To reduce occupational injuries and diseases
  • To reduce the rate of staff absenteeism
  • To improve patient safety and the quality of care
  • To support healthcare system sustainability by
    reducing costs, losses and waste

6
  • The Value of Organizational Culture
  • An organizations culture consists of its values,
    beliefs, mission, goals, rituals and customs. All
    of this translates to a system of expected
    behavior.
  • Organizational attitudes for safety are
    determined by senior management.
  • ? Safety is culture-driven, and management
    establishes the culture.

7
  • ? Meaningful improvement in the quality of
    patient care, organizational performance, overall
    wellness, and sound financial management cannot
    be achieved without a strong corporate safety
    culture.

8
  • THE HEALTHCARE SAFETY BALANCE
  • Healthcare safety culture recognizes and
    emphasizes the importance of occupational
    healthcare provider safety and patient safety
    equally.

9
  • A Safety Focus Realignment
  • Therefore, a strong corporate healthcare safety
    culture requires a holistic approach by
    management that recognizes the close association
    between the quality of staff safety initiatives
    and resulting patient care outcomes.
  • This will require the leadership team to fully
    comprehend the intricate dynamics of this
    association and realign a unilateral focus on
    patient safety to simultaneously include
    occupational safety initiatives.

10
  • ? To achieve patient care excellence, improving
    the quality of occupational health and safety
    must be a senior management priority.

11
  • This will? reduce patient injury and infection
    rates and hasten patient well-being and recovery,
    thereby shortening hospital stays and lowering
    overall hospital and societal health care costs.
  • ? increase staff satisfaction and reduce
    injuries, illnesses, and stress levels, leading
    to a more satisfied, healthy and productive
    hospital workforce with lower rates of staff
    turnover, compensation claims and absenteeism.

12
  • Genuine Commitment by Senior Management
  • Leadership of successful healthcare organizations
    demonstrate a genuine commitment to and support
    for staff health and safety initiatives because
    they genuinely believe that their most valuable
    asset is its human resources capital.

13
Establish Integrity Standards The Power Trust
  • A successful safety culture is highly dependent
    on a leadership that sets standards for strong
    organizational ethics. Strong ethical standards
    are the building blocks of a solid safety culture
    and the power of trust.
  • Personal or professional integrity standard
    compromises, not only fosters a poor safety
    culture, but may even jeopardize health and
    safety of staff or clients in the organization.
    For example, the potential tragic effects of
    concealing presence of asbestos hazards
    dramatically illustrates the consequences of not
    maintaining appropriate ethical standards.

14
  • Health and Safety Policy with a Vision
  • Develop and communicate a robust occupational
    health and safety (OHS) policy that states senior
    managements commitment to industry best
    practices for achieving safe working conditions
    for all members of the organization.

15
  • The OHS Policy should
  • be guided by internal responsibility system (IRS)
    principles.
  • indicate recognition that occupational safety
    best practices will be accomplished through its
    health and safety management system (HSMS)
    initiatives.
  • promote openly the important relationship between
    occupational and patient safety.
  • indicate that occupational health and safety is a
    value and is required to meet the organizations
    mission for achieving patient care excellence.
  • clearly define management OHS responsibilities
    and accountabilities and the method that will be
    used to determine compliance.

16
  • Show OHS Commitment with Transparency
  • Craft a written statement signed by all members
    of the senior management team outlining its
    commitment to and involvement in corporate OHS
    initiatives and advertise it throughout the
    organization (e.g., via intranet mass emailing).
  • - Make this statement available to the public
    through access on the hospital external website.

17
  • The Health and Safety Management System
  • Initiate development of an organizational health
    and safety management system (HSMS).
  • Use formal system development guidelines such as
    those provided in the CSA Z 1000-06 standard that
    is based on the Plan-Do-Check-Act management
    structure, and provides a model for identifying
    occupational health and safety hazards,
    evaluating associated risks, and managing
    preventative and protective measures.
  • The primary goal behind the HSMS is to move
    beyond basic legislative compliance and strive
    towards attaining safety excellence and due
    diligence by integrating OHS best practices into
    all management functions of core hospital
    business activities.
  • A major underlying feature of the HSMS is
    continuous improvement.

18
  • Establish a permanent HSMS sub-committee of the
    JHSC headed by a senior management team member
    with the mandate to guide the evolution of the
    System and assure its continuous improvement.
  • Engage staff and encourage their contributions to
    the System by inviting them to join as members of
    the HSMS sub-committee.
  • Perform objective annual audit of the HSMS to
    identify needed improvements and subsequently
    initiate required changes in a timely manner.

19
  • Health and Safety Communication
  • Regularly communicate and raise awareness of the
    HSMS and OHS initiatives to all staff using
    effective modern information dissemination
    technologies, e.g., intranet video presentations.

20
  • Management Safety Inspections
  • Develop a mandatory regular management workplace
    safety inspection practice policy.
  • Require managers to submit to the leadership team
    a written report on the inspection results,
    including date of risk remediation measures
    implemented for identified uncontrolled hazards.

21
  • Mind-set Change and Root Cause Analysis
  • Educate management to shift focus from reactive
    accident victim blame to proactive response
    strategies that effectively control workplace
    hazards including high-risk processes and
    practices.
  • Develop policy for root cause analysis as a
    standard operating practice for investigating
    occupational accidents, illnesses, diseases and
    incidents in order to examine factors beyond the
    direct causes such as management system failures.

22
  • Create Organization-Wide Hazard Identification
    Risk Assessment / Matrix Process
  • Develop policy and required procedures for
    performing hazard identification and risk
    assessments.
  • Educate all managerial staff on these procedures.

23
  • Integrate Hazard Identification and Risk
    Assessment into all Organizational Activities
  • Important Concepts for Management to Know
  • a hazard is something with the potential to
    cause harm and includes any condition, practice,
    act, behaviour or thing that can cause injury,
    illness, or death.
  • risk is the likelihood that illness, injury or
    death might result due to the hazard.
  • each hazard has a probability or likelihood of
    exposure, frequency of exposure by staff and
    severity of injury in the event of exposure or an
    accident.
  • a risk matrix with hazard probability and
    exposure frequency criteria is used to determine
    risk severity level.

24
Setting Priorities - Effective Risk Management
  • Prioritizing risks using a risk matrix is an
    efficient method for determining which hazards
    have the most serious consequences and therefore
    where to begin allocating resources for effective
    risk control measures - this is an example of
    healthcare financial resource management
    excellence.

25
  • The Risk Control Process
  • Educate management to implement measures that
    reduce the risks associated with a hazard.
    Hazards are controlled at the source along the
    path and at the worker. The process must follow
    the occupational hygiene control hierarchy in
    decreasing order of effectiveness
  • engineering controls - elimination of hazard.
    - substituting hazard for one with an acceptable
    risk level.- isolation of the hazard.
  • administrative controls
  • personal protective equipment

26
  • Organizational OHS Education
  • Senior management must recognize that a high
    quality training and education program is a vital
    component of a successful health and safety
    management system.
  • Achieving OHS safety education program excellence
    has significant positive financial implications
    for the organization.
  • Considering the importance of successfully
    achieving effective knowledge transfer and the
    complexities of safety educational requirements
    for healthcare staff, hiring or contracting a
    qualified professional OHS educator is a wise
    financial investment.

27
  • Organizational Health and Safety Knowledge
    Management
  • a collaborative effort
  • Shift concept from simple safety training to
    safety knowledge management.
  • Strive to use web-based technologies for safety
    training.
  • For adult learning and knowledge acquisition to
    occur successfully develop an interactive health
    and safety workshop education program. The
    program should involve a collaborative effort
    between occupational health and safety
    practitioners, clinical educators, infection
    control instructors, and patient safety experts.

28
  • Make Interdepartmental Collaboration a Reality
  • Promote genuine collaboration of functional
    activities between the OHS, Patient Safety, Risk
    Management, and Infection Control Departments
    because all these departments should be
    collectively pointing their noses in the same
    direction - working towards aggressively reducing
    staff and patient safety risks and associated
    organizational financial losses.

29
New Technologies for Improving Management OHS
Accountability
  • Improve efficiency of management accountability
    for OHS by integrating these responsibilities
    into routine hospital business activities through
    implementation of a web-based OHS management
    program, such as the, OSH Works, available from
    CCINFO, that is installed on all management staff
    computers.

30
How it Works
  • This software program will assist managers and
    senior administration to
  • - follow the Plan, Do, Check and Act components
    of the HSMS
  • - receive specific OHS timeline reminders e.g.
    workplace safety inspections- maintain records
    on leading indicator performance measures such as
    workplace safety inspections, risk assessments,
    and hazard control measures implemented
  • - maintain accident investigation records and
    implemented prevention measures
  • - instant access to tools such as hazard
    identification check-lists, risk assessment
    procedures, accident investigation using root
    cause analysis ergonomic set-up of computer
    workstation, etc..
  • - obtain up-to-date information on OHS
    legislative requirements.

31
Setting Organizational Health and Safety
Responsibility Standards
  • Promote overall organizational OHS
    responsibilities by
  • a) requiring compliance to OHS principles and
    practices as a signed condition of employment by
    all new hires
  • b) embedding basic written OHS requirements
    into staff job descriptions
  • c) establishing in-house OHS standards based on
    proactive safety leading indicators as an
    evaluation method in employee annual performance
    reviews.

32
Healthcare Staff Psychosocial Stress a growing
trend with many roots and significant costs
  • Working in a highly stressful healthcare
    environment increases the risk of psychological
    distress and physical symptoms as well as
    work-related accidents and injuries.
  • Uncontrolled chronic high levels of workplace
    stress contribute to organizational inefficiency
    and increased healthcare administrative costs,
    diminished productivity, increased workplace
    accident / incident risk, elevated rates of staff
    musculoskeletal problems, increased absenteeism,
    decreased job satisfaction and high staff
    turnover, and compromised quality of patient
    care.

gtgtgt
What to do
33
  • Occupational Stress Management Program
  • Provide occupational stress management service
    that has
  • - stress awareness education
  • - stress coping methods training
  • - stress counseling

34
  • POSITIVE FLOW STRATEGIES
  • Promote Staff Wellness
  • Develop a staff wellness program and policy that
    promotes best practice behaviors for staff health
    and visibly demonstrates that management cares
    about its staff - its most valuable resource.
  • Shift Focus to Positive Psychology Trends
  • Positive Psychology has three central concerns
    positive emotions, positive individual traits,
    and positive institutions. Positive institutions
    entails fostering a workplace philosophy of
    justice, responsibility, civility, strong work
    ethic, leadership excellence, teamwork, purpose,
    and tolerance.
  • Recognize Staff OHS Achievements
  • Initiate a formal staff OHS success and
    achievements recognition program.
  • Measure Positive Safety Progress
  • Set expectations and use leading indicators (e.g.
    of risk assessments performed of management
    workplace inspections completed and improvements
    made HSMS audit non-conformance items corrected)
    as a proactive measure of health and safety
    performance.

35
  • Proactive Integrated Disability Management
  • The nature and complexity of disability
    management is changing and requires an integrated
    (work and non-work related) absence management
    strategy. This involves a global proactive
    approach that considers all disability management
    components are addressed in concert. These
    include
  • occupational accident and illness prevention
    activities
  • wellness and health promotion services
  • attendance support
  • casual absence monitoring
  • short- and long-term disability administration
  • occupational absence management
  • education and training
  • employee assistance programs
  • Everyone involved in the disability management
    process must work together in a cohesive manner,
    ensuring that there is a common understanding
    regarding the conditions and objectives.

36
  • Adequate Qualified Health Safety Department
    Staffing
  • Healthcare Leadership should allocate adequate
    human resources for OHS initiatives that includes
    staffing of the OHS department to have a
    sufficient number of qualified health and safety
    professionals that focus their efforts towards
    hazard risk control and accident prevention
    activities.

37
  • The Challenge
  • It is logical and prudent to consider that a
    typical healthcare organizations OHS department
    will not be able to successfully administer its
    mandate for effective control of hospital costs
    associated with occupational accident injuries
    and illnesses if it is predominantly staffed with
    healthcare professionals such as physiotherapists
    and occupational health nurses that only treat
    post-incident victims. Although incident victim
    care is essential, there must be adequate safety
    professional staff to focus on hazard risk
    control and accident prevention activities.
  • Senior management will require research based
    evidence that clearly demonstrates expected
    effects of OHS department staffing levels and
    classification types on worker injury rates and
    patient care outcomes.
  • This presentation hopes to encourage initiation
    of such research.

38
  • The Conclusion
  • The Quality Worklife-Quality Healthcare
    Collaborative defines a healthy healthcare
    workplace as
  • A work setting that takes a strategic and
    comprehensive approach to providing the physical,
    cultural, psychosocial and work/job design
    conditions that maximize health and well-being of
    healthcare providers, quality of patient outcomes
    and organizational performance.
  • A fundamental way to better healthcare is
    through healthier healthcare workplaces. It is
    unacceptable to work in, receive care in, govern,
    manage and fund unhealthy healthcare
    workplaces.
  • NOTE
  • Thank you for your interest in and support of
    Canadian healthcare workplace and patient safety
    initiatives. Please feel free to use all or any
    part of this presentation as long as
    acknowledging the author below is respected.
  • Christopher J. Lipowski, CRSPPinnacle
    Enterprises Canada
  • chris_at_mtpinnacle.com
  • http//www.mtpinnacle.com/

39
  • References
  • Healthcare Safety Info-eLink Pinnacle
    Enterprises Canada
  • Connecting Worker Safety to Patient Safety a new
    imperative for health-care leaders Joseline
    Sikorski
  • Workplace Health, Safety and Well-being of the
    Nurse GuidelineRegistered Nurses'Association of
    Ontario
  • Hospital Wellness Projects -Four Facilities,
    British Columbia Health Canada
  • http//www.healthforceontario.ca/HealthForceOntar
    io
  • CSA Z1000-06, Occupational Health and Safety
    ManagementCanadian Standards Association
  • Creating a Safe and High-Quality Health Care
    EnvironmentPatricia W. Stone, Ph.D., M.P.H., R.N
    et al
  • Patient Safety - Worker Safety Building a
    Culture of Safety to Improve Healthcare Worker
    and Patient Well-BeingAnnalee Yassi, MD, MSc,
    FRCPC
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