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Safe Workplace

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Safe Workplace Adelaide Maria Ansah Ofei (MPhil, MBA, BA, SRM, SRN) * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Outline of Presentation Introduction ... – PowerPoint PPT presentation

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Title: Safe Workplace


1
Safe Workplace
  • Adelaide Maria Ansah Ofei
  • (MPhil, MBA, BA, SRM, SRN)

2
Outline of Presentation
  • Introduction
  • Definition of terms
  • What nurses do
  • Why health care errors occur
  • Active and Latent failures
  • Reaction to errors
  • Threats to patient safety
  • Ensuring workplace safety
  • Conclusion

3
Introduction
  • An organizations workers and their work
    environment have a reciprocal relationship, each
    influencing the other in an ongoing, dynamic
    interplay that affects the level of safety within
    the organization (Cooper, 2000).
  • To construct a nursing work environment that
    maximizes patient safety,
  • the characteristics of the nursing workforce,
  • the settings in which they provide care, and
  • the nature of their work,
  • as well as the implications of these elements for
    patient safety, need to be considered.

4
Definition of Terms
  • According to the Oxford Advanced Learners
    dictionary
  • Safe is defined as
  • protected from danger and harm secure
  • Not or unlikely to be damaged, hurt or loss, etc.
  • Not likely to cause or lead to damage.
  • Work is defined as
  • use of bodily or mental power in order to do or
    make something
  • Place is defined as
  • particular area or position in space occupied by
    something
  • From the above safe workplace is the
    environment of professionals or workforce that
    protects clients or consumers from injury or
    danger in the course of providing quality service.

5
What Nurses Do
  • The work of nursing staff includes both visible
    and invisible activities.
  • The visible activities are those physical actions
    observable by patients and others and often
    portrayed in the media, such as assisting a
    patient to walk, administering medications and
    treatments, and educating patients about their
    disease and therapies.
  • The invisible or cognitive work incorporates
    knowledge learned from formal education and
    subsequently acquired expertise.

6
What Nurses Do
  • The specific activities performed by a particular
    nurse depend on
  • Patient(s) needs,
  • the nurses education and expertise,
  • the setting of care in which the nurse practices,
  • how nursing care services are organized and
    delivered within that setting of care, and
  • the nurses licensure status and scope of
    permitted practice as delineated in state
    licensure laws.
  • Nursing Assistants versus Registered Nurse

7
Why Health Care Errors Occur
  • According to Reason (2000) there are two very
    different views
  • Individuals are primarily responsible for any
    error or unsafe action.
  • Unsafe acts arise principally from an
    individuals faulty mental processes or
    weaknesses of character, such as forgetfulness,
    inattention, poor motivation, carelessness,
    negligence, and recklessness.
  • Bad outcomes are viewed largely as the result of
    bad behaviour by people, behaviour that should be
    corrected through workplace policies and
    procedures, safety campaigns, disciplinary
    measures, the threat of litigation, retraining,
    and naming, blaming, and shaming.
  • When workplace errors occur, the person most
    directly involved in the work at the time the
    error is thought to have taken place might well
    be blamed.

8
Why Health Care Errors Occur
  • Errors typically result from problems within the
    system in which people work and typically
    originate in multiple areas within and external
    to an organization.
  • Error results when these multiple problems
    converge and impair an organizations
    performance.
  • When an error occurs, the question should not be
    Who is at fault? but rather Why did our
    defenses fail?.
  • Human beings contribute to the commission of
    errors in two ways through the commission of
    active failures and the creation of latent
    conditions.

9
Active Failures
  • Active failures occur at the level of the
    front-line worker (e.g. nurses, physicians, and
    pharmacists).
  • Such failures are sometimes called the sharp
    end of an error.
  • Types of errors committed by front-line workers
    include lapses in memory, misreading or
    misinterpretation of written data, incorrect
    performance of a routine activity as a result of
    a distraction or interruption, or simply human
    variations in fine motor skills.
  • The consequences of these actions are experienced
    almost immediately.

10
Latent Conditions.
  • Latent conditions are factors in the production
    process or system that are not under the direct
    control of front-line workers.
  • They include poor design of work or equipment,
    inadequate training, gaps in supervision,
    insufficient supply of equipment to perform work,
    undetected manufacturing defects or faulty
    maintenance, inadequate personnel deployment, and
    poorly structured operations.
  • They arise from strategic and other top-level
    decisions made by entities at the blunt end of
    an organization or production system, such as
    government regulators, manufacturers, system
    designers, and high-level managers and decision
    makers.

11
Latent Conditions.
  • Latent conditions pose the greatest risk to
    safety in complex or high-technology systems
    because of their capacity to result in multiple
    types of active failures.
  • Their impact spreads throughout an organization,
    creating error-producing factors within
    individual workplaces.
  • Efforts to discover and fix latent system
    conditions are more likely to result in safer
    systems than attempts to minimize active errors
    at the point at which they occur.
  • Protecting patients from errors and adverse
    events therefore requires an examination of
    health care delivery systems to identify defects
    and create stronger system-level defences.

12
Reaction to Errors
  • Response to error, tend to focus on retraining,
    discipline (reprimanding, firing, or suing), or
    other responses aimed at specific individuals.
  • Punitive response may be appropriate in cases of
    wilful wrongdoing, but evidence has shown it is
    not an effective way to prevent subsequent
    errors.
  • Focusing only on the sharp end allows latent
    conditions to remain undetected in the system,
    and their accumulation makes the system more
    prone to additional accidents and errors in the
    future.
  • Efforts to discover and fix latent system
    conditions are more likely to result in safer
    systems than attempts to only minimize active
    errors at the point at which they occur.
  • Nurses are the largest component of the health
    care workforce, and are also strongly involved in
    the commission, detection, and prevention of
    errors and adverse events, our work environment
    are critical elements of stronger patient safety
    defenses.

13
Threats to patient safety
  • Patient safety is threatened by
  • Inadequate staffing levels,
  • Long work hours,
  • Poor education and training,
  • Unsafe work practices,
  • Rapid increases in new knowledge and technology
  • Increased interruptions and demands on nurses
    time
  • Documentation and paper work
  • Diversity of tasks and tools
  • Vulnerability of the consumers of production
  • Underutilization of information technology, and
  • A variety of other work conditions.

14
Basic Components of Organizations and
Corresponding Patient Safety Defenses
15
Ensuring a safe workplace
  1. adopting transformational leadership and
    evidence-based management practices,
  2. maximizing the capability of the workforce,
  3. designing work and workspace to defend against
    errors, and
  4. creating and sustaining cultures of safety.

16
Transformational Leadership and Evidence-Based
Management
  • Creating work environments for nurses that are
    most conducive to patient safety will require
    fundamental changes throughout many health care
    organizations
  • Work design and
  • Personnel deployment, and
  • Culture of the organization must understand and
    act on the science of safety.

17
Five Essential Management Practices
  • Balancing the tension between efficiency and
    reliability
  • Creating and sustaining trust
  • Actively managing the process of change
  • Involving workers in work design and work flow
    decision making
  • Creating a learning organization

18
Learning organization
  • A learning organization is an organization
    skilled at creating, acquiring, and transferring
    knowledge, and at modifying its behavior to
    reflect new knowledge and insight (Garvin,
    1993).
  • Learning organizations do not passively wait for
    knowledge to present itself, but actively manage
    the learning process by taking advantage of all
    sources of knowledge, using systematic
    experimentation to generate new knowledge
    internally, and transferring knowledge quickly
    and efficiently throughout the organization.
  • These processes are used to create better work
    tools, processes, systems, and structures in
    order to improve the organizations production
    processes.

19
2. Maximizing the Capability of the Workforce
  • Promote safe staffing levels
  • Support knowledge and skill acquisition and
    clinical decision making
  • Benchmark Training Practices
  • Use preceptors for novice nurses.
  • Provide ongoing educational support and resources
    to nursing staff.
  • Provide training in new technology.
  • Provide decision support at the point of care.
  • Foster interdisciplinary collaboration
  • Provide formal education and training in
    interdisciplinary collaboration for all health
    care providers.

20
Characteristics of Collaboration
  • Shared understanding of goals and roles
  • Shared decision making
  • Conflict management
  • Building and Nurturing Collaboration
  • Leadership modelling of collaborative behaviours
  • Commitment of resources to build nurse expertise
  • Design of work and workspace to facilitate
    collaboration
  • Interdisciplinary practice mechanisms
  • Training
  • Human resource policies

21
Work and Workspace Design to Prevent and Mitigate
Errors
  • The largest, best-trained, and most dedicated
    workforce will still make errors its fallibility
    is an immutable part of human nature.
  • This innate fallibility can be compounded when
    the practices, procedures, tools, techniques, and
    devices used by workers are unreliable, complex,
    and themselves unsafehaving been designed,
    selected, and maintained by other fallible
    humans.
  • Poor designs set up the workforce to fail,
    regardless of how hard they try. Safer health
    care requires redesigned health care processes.

22
Design of Work Processes and Workspaces
  • Inherent Risks to Patient Safety in Nursing Work
    Processes
  • Medication Administration
  • Hand washing
  • Reduced Patient Safety Due to Inefficient Nurse
    Work Processes
  • Documentation and Paperwork
  • Nurses spend much time documenting patient care
    activities.
  • Multiple sources of demands for documentation and
    paperwork.
  • Effect of the Physical Design of Workspace on
    Efficiency and Safety
  • Design of Patient Care Units
  • Patient Transfers
  • Poor Communication Technology
  • Sensory Interference

23
Reducing Workload and Increasing Patient Safety
Through Work and Workspace Design
  • What aspects of the physical environment can be
    sources of error or promote safety?
  • What in the physical environment ensures safe
    behaviour or allows room for unsafe behaviour?
  • What in the organization prevents or allows
    exposure to hazard, and what promotes or hinders
    patient safety?
  • What allows for assuming safe or unsafe behaviour
    by the individual?
  • Work design needs to consider all these elements,
    because of their interrelatedness. Whenever one
    work element changes, there will be implications
    for the other elements
  • Nurses work processes and workspaces need to be
    designed to make them more efficient, less
    conducive to the commission of errors, and more
    amenable to detecting and remedying errors when
    they occur.

24
Creating and Sustaining a Culture of Safety
  • Employing a nursing workforce strong in numbers
    and capabilities and designing the work of
    nursing to prevent errors are critical patient
    safety defenses.
  • Regardless of how strong and how well designed
    such measures may be, however, they will not by
    themselves fully safeguard patients.
  • The largest and most capable workforce is still
    fallible, and the best-designed work processes
    are still designed by fallible individuals.
  • Each introduction of new health care technology
    brings a host of unanticipated opportunities for
    errors.
  • An organizational commitment to vigilance for
    potential errors and the detection, analysis, and
    redressing of errors when they occur is crucial.
  • A high priority on safety is employed all
    employees are fully engaged in the process of
    detecting high-risk situations before an error
    occurs.

25
Essential Elements of an Effective Safety Culture
  • Cultures of safety result from the effective
    interplay of three organizational elements
  • environmental structures and processes within the
    organization,
  • 2. the attitudes and perceptions of workers, and
  • 3. the safety-related behaviours of individuals
    (Cooper, 2000).

26
Essential Elements of an Effective Safety Culture
  • Commitment of leadership to safety
  • All employees empowered and engaged in ongoing
    vigilance
  • Organizational learning from errors and near
    misses
  • Confidential error reporting and fair and just
    responses to reported errors
  • Reporting near misses as well as errors
  • Data analysis and feedback
  • Overall features of an effective error-reporting
    system

27
Need for a Long-term Commitment to Create a
Culture of Safety
  • Requires changes in attitudes, beliefs, and
    behaviours.
  • It is not easily accomplished. Some have
    estimated that it can take 5 years to develop a
    culture of safety that permeates the entire
    organization (Manasse et al., 2002).
  • Their development occurs in three stages
  • Stage 1Safety management is based on rules and
    regulations.
  • Stage 2Good safety performance becomes an
    organizational goal.
  • Stage 3Safety performance is seen as dynamic and
    continuously improving.

28
Nursing Culture That Fosters Unrealistic
Expectations of Clinical Perfection
  • Nurses are trained to believe that clinical
    perfection is an attainable goal and that good
    nurses do not make errors.
  • Requiring high standards of performance for
    nurses is both appropriate and desirable, but
    becomes counterproductive when it creates an
    expectation of perfection.
  • Because they regard clinical perfection as a
    professional goal, nurses feel shame when they
    make an error, which in turn creates pressure to
    hide or cover up errors.
  • It is difficult to transform thinking associated
    with the blame and shame mentality.

29
Need to Measure Progress in Creating Cultures of
Safety
  • Objective measurement and feedback is needed to
    manage planned change successfully, and efforts
    to create cultures of safety are no exception.
  • To this end, initial baseline assessment of each
    organizations safety culture and ongoing
    measurement of its progress in achieving the
    desired cultural shift are required.
  • Benchmarking Organizational Safety Culture

30
Conclusion
  • Errors will still occur even when the most
    capable workforce provides care using the
    best-designed work processes, because neither the
    nurse nor the work process is perfect.
  • Defenses against human errors can be developed
    and put in place only if nursing staff are not
    afraid of reporting the errors and are involved
    in designing even stronger defenses.
  • Finally, instituting all of these defense
    strategies can be accomplished only by
    individuals who have a vision of and command
    resources for the organization as a wholethat
    is, an organizations leadership and management.
  • The actions of these leaders are the essential
    precursor to the creation of safer health care
    environments.
  • They must be motivated by a passion to maximize
    the safety of all patients served by their
    institution.

31
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