Integrated Health Care Sector Strategy Ensuring Occupational Health and Safety for Workers in Health Care Facilities in Ontario

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Integrated Health Care Sector Strategy Ensuring
Occupational Health and Safety for Workers in
Health Care Facilities in Ontario

• Presentation to the Pan American Health
  Organization (PAHO) April 2007 Washington, DC
• Helle Tosine,
• Assistant Deputy Minister,
• Ontario Ministry of Labour

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Purpose of the Presentation

• To share learnings from the Ontario SARS
  experience
• To share best practices from Ontarios integrated
  occupational health and safety health care sector
  strategy

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BackgroundOntarios Occupational Health and
Safety (OHS) System

• The Health and Safety partners in Ontario form
  the OHS system include
• Ontario Ministry of Labours mandate of setting,
  communicating and enforcing the Occupational
  Health and Safety Act and related Regulations.
• The WSIB's prevention goals include developing
  information, programs to help employers build
  healthy and safe workplaces
• 12 not-for-profit Health and Safety Associations
  provide employers with specific health and safety
  information and assistance.
• Prior to 2003, the Ministry of Labours
  enforcement strategy was based on a risk
  assessment of 29 industrial sectors (health care
  was included in this group)
• 29 sub sectors are ranked based on the past 5
  years of field data
• In the year leading up to SARS, proactive field
  visits were made, orders had been issued to acute
  care facilities, long term care

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BackgroundOntarios Occupational Health and
Safety Act

• The foundation of the Ontario Occupational Health
  and Safety Act --The Internal Responsibility
  System (IRS)
• Ontario's law that governs health and safety in
  the workplace sets out legal duties and
  responsibilities for employers, supervisors and
  workers to follow.
• These legal duties and responsibilities overlap
  and complement each other. Together, they create
  the internal responsibility system (IRS)
• the IRS means everyone in the workplace has a
  role to play and a duty to actively ensure
  workers are safe, e.g.
• Every worker who sees a health and safety problem
  such as a hazard in the workplace has a duty to
  report the situation to management.
• Once a hazard has been identified, the employer
  and supervisor have a duty to look at the problem
  and eliminate any hazard that could injure
  workers.

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Background Prior to SARS outbreak

• The Ministry had an agreement (1984) with
  Ministry of Health that notification be given to
  the Ministry of Labour from Public Health re
  infectious disease outbreak
• The Ministry was notified of the SARS outbreak,
  shortly after, a provincial emergency was
  declared, with the Ministry of Health and Long
  Term Care as lead
• The Ministry of Labour became part of the
  provincial operations centre for the emergency,
  our physician was included in the Science Group
  contributing advice for infection control for
  workers
• Directives were produced in connection with the
  CDC and WHO information, provided to workers and
  public through web
• established a Ministry of Labour command
  centre staffed with health and safety
  specialists, hygienists, legal, communications,
  reporting to ADM
• established a committee with the health care
  labour organizations and employers associations
  to communicate, invited Ministry of Health to
  attend

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Background Following SARS outbreak

• The independent Commission to Investigate the
  Introduction and Spread of SARS was established
  in June of 2003 by the Ontario Minister of Health
  and Long Term Care (MOHLTC)
• The Commission investigated how the SARS virus
  came to the province, how the virus spread and
  how it was dealt with.
• Commission looked at all aspects of the outbreak
  to provide a public report on what happened, what
  lessons have been learned and what improvements
  should be made.
• Reports
• 1st Interim Report released Apr 15/04 - 21
  principles for reform
• 2nd Interim Report released Apr 5/05 - 113
  recommendations
• 3rd and Final Report released Jan 9/07 - 84
  recommendations

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Overview of the Recommendations

• 1st Interim Report April 2004 SARS and Public
  Health in Ontario
• Presented to the Minister of Health and Long-Term
  Care in April 2005
• 21 problem areas identified as principles of
  public health reform which focused on public
  health capacity (leadership, epidemiological
  capacity, infectious diseases capacity,
  communication)
• Ministry of Health and Long Term Care lead
  implementation of recommendations (Operation
  Health Protection, June 2004 public document)
• 2nd Interim Report April 2005 SARS and Public
  Health Legislation
• 113 Recommendations focused on amendments to the
  Health Protection and Promotion Act (HPPA) and to
  Bill 138, the Emergency Management Statute Law
  Amendment Act, 2004
• Implemented as part of legislative amendments or
  referred to other departments in Ontario
  government (e.g. Emergency Management lead)

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Overview of the Recommendations (contd)

• Final Report January 2007 Spring of Fear
• particular focus on health worker safety and the
  need for effective communication during crisis
• identifies areas from previous reports, and makes
  84 recommendations, which can be grouped, e.g.
• Public Health System improvements including, e.g.
  
• Ontario Ministry of Labour should assume a more
  proactive role in the health care sector
  (enforcement, consultation, communication)
• health care workers should have better access to
  knowledge of safety re infection control
  procedures, safety expertise, resources and
  awareness
• Emergency Planning improvements, including, e.g
• Ministry of Labour should have a more integral
  role in emergency management during infectious
  disease outbreaks
• Government Directives and Communications,e.g
• There should be increased collaboration between
  MOL and MOHLTC (e.g. developing directives,
  crisis teams during pandemics)

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The Goal

• An integrated Ontario Occupational Health and
  Safety Strategy for health care workers
• Through formal partnerships, provide an
  Occupational Health and Safety system-wide and
  Ontario government-wide approach to ensuring
  health and safety of health care workers in the
  province
• the Ministry of Labour in partnership with
  Ministry of Health and Long Term Care to address
  Commission recommendations
• Ministry of Labour, Workplace Safety and
  Insurance Board, Ontario Safety Association for
  Community and Health, and other health and safety
  associations to implement

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The Goal Implementation

• Occupational Health and Safety partnership
  (OSCHO) includes 12 safety associations, e.g. for
  industry (IAPA), construction (CSAO),
  transportation (THSAO)
• Specific to health and safety of all health care
  workers in the province, the Ontario Safety
  Association for Community and Healthcare (OSACH)
  mandate is to educate and support health care and
  community services clients to proactively adopt
  occupational health and safety best practices and
  prevention strategies that will prevent or reduce
  workplace accidents, injuries and occupational
  diseases.
• OSHCO partnership develops and implements
  strategies and initiatives, e.g.
• Emergency and pandemic management to co-ordinate
  activities between all partners during a
  pandemic, nuclear emergency or other emergencies
  affecting Ontario workers

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Implementation of Recommendations, e.g

• Improving the Workplace Safety Culture, e.g.
• An effective IRS requires internal communications
  with staff and the Joint Health and Safety
  Committees
• Specialized health care inspectors have been
  hired all OHS Inspectors have been provided with
  specialised training in IRS and during field
  visits to workplaces, routinely audit the
  functioning of IRS
• All acute care facilities have been inspected,
  large portion of long term care facilities

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Implementation of Recommendations, e.g

• 2. Improving communications between all
  partners, e.g.
• Ministry of Labour Provincial physician working
  formally as part of infectious disease and
  pandemic system with the Ministry of Health and
  Long term Care across regional structures
• MOL Health Care inspectors have liaison with the
  established regional health care networks.
• Ministry of Labour and Ministry of Health and
  Long Term Care are formalizing effective
  coordination, mandatory sharing of information,
  expertise and knowledge re infectious disease
  and reporting of occupational illness

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Implementation of Recommendations, e.g

• Improving Communications between all partners
  (contd)
• Communication and tools for health care workers
  are aligned between OSACH, the MOHLTC and the
  Ministry of Labour, e.g
• Ontario Health Plan for an Influenza Pandemic
  (MOHLTC)
• Avian Flu influenza (MOHLTC, and MoL documents)
• Examples of products for prevention of infectious
  disease include
• Self Assessment Audit tool Avian Flu, Fast
  Facts, information for health care professionals
• Video for c.difficile personal protection against
  infection
• Pandemic Planning Toolbox Infection
  Control Resources
• Emergency Management Resources

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Implementation of Recommendations, e.g

• Improving Communications to workers (contd)
• Examples of products for the industrial and
  service sectors
• provide links, resources and information for
  business to develop and source up-to-date,
  current information on Pandemic planning and on
  the current knowledge and thinking around
  prevention and workplace health safety.

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Accomplishments (2003 07)

• Co-ordination of Approaches and Co-operation re
  Infectious Diseases
• Ontario Provincial Infectious Disease Advisory
  Committee (PIDAC) was established by MOHLTC June
  2004
• MoL Provincial Physician is a member
• Integration also with Ministry of Labour through
  e.g., scientific response team
• Ministry of Labour is connected to MOHLTC 14
  Regional Infection Control Networks (RICNs)
• Ministry health care inspectors working closely
  with RICNS
• Ontario Health Plan for an Influenza Pandemic was
  developed with organized labour, Ministry of
  Labour, and health care sector
• Emphasis on hierarchy of controls for
  occupational health and safety during a pandemic

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Accomplishments (2003 07)

• Co-ordination of Approaches and Co-operation re
  Infectious Diseases (contd)
• Directives to be used in a health crisis being
  drafted in consultation with health care
  stakeholders and the Ministry of Labour
• Ministry of Labour, the Ministry of Health and
  Long-Term Care, the Workplace Safety and
  Insurance Board, the Ontario Safety Association
  for Community and Health Care and other partners
  are continuing to address health and safety
  issues in the health care sector.

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Accomplishments (2003 07) contd

• A stronger focus on health and safety of health
  care workers
• a new, permanent tripartite health and safety
  advisory committee under Occupational Health and
  Safety Act established to advise Minister of
  Labour, in 2006
• 200 new health and safety inspectors hired,
  increasing the overall complement to 430
  inspectors across the province 233 inspectors
  and hygienists were trained on infection control
  measures and procedures to protect workers
• Ministry of Labour has developed and implemented
  a proactive strategy of is inspecting all acute
  care facilities and selected long-term care
  facilities in Ontario, focus on infectious
  disease, violence and MSD

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Next Steps include, e.g

• To continue to strengthen communication and
  formalize relationships between all partners
• To work with partners towards a higher level of
  performance from health care facilities through
  accreditation systems, e.g.
• Canadian Council on Health Service Accreditation
  (covers e.g. acute care, community care, long
  term care, home care, first nations care)
• Ontario Laboratory Accreditation Program (lab
  services in area of specimen collection)
• To work with partners to support infection
  prevention and control as part of curriculum for
  health care professionals
• To continue to partner within and outside Ontario
  with professionals and experts infectious disease

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International Conference April 18-20, 2007

• International Association of Labour Inspections
  Conference,Toronto, Ontario, never before held in
  North America
• Themes include innovative approaches, how
  regional co-operation, CSR have helped reduce
  injuries, measuring impacts of enforcement and
  intervention
• Special session on worker health and safety and
  pandemics, e.g.
• Dr. Tennassee, PAHO (keynote speaker)
• Presentations include how emergency preparedness
  has worked for pandemics, examples of regional
  co-operation, strengthening accountability

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IALI 2007 Conference April 18-20, 2007
Focus on innovative approaches to pandemics and
EM. Hope you can join us in Toronto!
http//www.iapa.ca/iali/