Aligning Patient & Workforce Safety:An OSHA Presentation

PfP Campaign EventMarch 18, 2013 3:00 – 4:00 PM ET

Affinity Group Breakout Sessions 4:00 – 5:00 PM ET

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Introduction

Paul O'Neill,72nd Secretary of the

U.S. Treasury

Aligning Patient and Workforce Safety

David Michaels, PhD, MPHAssistant Secretary of Labor

for Occupational Safety and Health

Healthcare Is Not a Safe Industry for Its Workforce

• Patient lifting/ repositioning

• Needlesticks

• Violence

• Exposure to chemicals

• Unique challenges

We All Pay the Price

Worker’s compensation costs

Treating patient injuries, too

Overtime, temporary staffing

Turnover, recruiting, retraining

Productivity and morale

Connecting Patient and Workforce Safety

Synergies

Challenges

Similar approaches can help– Management systems

– Culture of safety

Worker safety improves patient safety

OSHA-CMS Partnership Interagency agreement

Develop products in three areas:– Injury and illness “factbook”

– Injury and illness prevention programs (I2P2)

– Safe patient handling

Format under development

Goals: build momentum and drive results

Injury and Illness Prevention Programs

Dorothy Dougherty,OSHA Directorate of Standards

and Guidance

*I2P2 is OSHA’s term for Safety and Health Management Systems

Injury and Illness Prevention Programs*

Management system approach applied to occupational safety and health (Plan-Do-Check-Act)

Proactive: employers and workers findand fix hazards before someone gets hurt or ill

Taps into workers’ unique knowledge of the workplace, hazards that may be present, and how to prevent or control them

Helps employers meet their fundamental duties under the OSH Act and comply with OSHA standards

Injury and Illness Prevention Programs

Already in wide use in U.S. industry and abroad

Required or encouraged by 34 U.S. states

Consensus standards– OHSAS 18001 (1999, revised 2007)

– ANSI/AIHA Z10 (2005, revised 2012)

Promoted by OSHA since 1982 (VPP)

Flexible framework adaptable to any industry, any size workplace

Six Core Elements of I2P2

1. Management leadership– Set policy, establish goals, provide resources

– Lead by example, be visible on safety issues

2. Employee participation– Build trust, engage workers, spread responsibility

– “Few resist their own ideas”

Polling Question – Safety Culture

SELECT ALL THAT APPLY:

Our hospital has a full-time occupational safety and health specialist on staff.

Our staff are authorized to stop any work procedure if they have a safety concern.

Top management participates in safety inspections.

Departmental managers' performance reviews include an occupational safety and health element.

Our hospital has established specific occupational safety and health goals and monitors and reports on our progress toward those goals.

Six Core Elements of I2P2Continued

3. Hazard identification– Baseline inventory of hazards

– Mechanisms to ensure ongoing assessment

4. Hazard prevention and control– Identify, evaluate, and assess feasible options to

eliminate, reduce, or control hazards

– Monitor and evaluate effectiveness of controls

Six Core Elements of I2P2Continued

5. Education and training– Understand the basics of the I2P2 and how to participate

– Identifying, reporting, and controlling hazards

– Unique safety competencies

6. Program evaluation and improvement– Is the program meeting its goals?

– Are established procedures being followed?

– Make any necessary adjustments using a corrective action process

Worksite-based program to recognize outstanding occupational safety and health management efforts– Performance-based criteria

– Site application process

– Onsite review by OSHA

Over 2,300 sites nationally, including 14 hospitals

DART case rate52%

OSHA’s Voluntary Protection Programs

A Request for the HENs:

1. Please read the OSHA White Paper on Injury and Illness Prevention Programs: http://www.osha.gov/dsg/InjuryIllnessPreventionProgramsWhitePaper.html

2. Please visit the OSHA web page for healthcare workers: http://www.osha.gov/SLTC/healthcarefacilities/index.html

3. Please share these materials with the hospitals in your network.

What Are We Hearing?

Mitzi Ressmann, Texas Hospital Association

Rosalie Weakland, Ohio Hospital Association

Monica Barrington, Premier

Lynda Martin, Hospital & Healthcare

System of Pennsylvania

Wendy Goshert, Ascension

Tania Daniels, Minnesota Hospital

Association

Pursuing a Culture of SafetyOSHA/CMS Pacing Event

Bob WilliamsonDirector, Associate Safety

Ascension HealthMarch 18, 2013

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“Every 54 minutes an Ascension

Health Associate sustains a work related injury or

illness.”

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A Single Approach to Safety

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Interventions for a Comprehensive Solution for Associate Safety

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VPP Pilot Sites

• University Medical Center Brackenridge Austin, TX

• Baptist Hospital Nashville, TN

• St. Vincent’s Medical Center Bridgeport, CT

© Seton Healthcare Family

University Medical Center BrackenridgeCommon Safety Behaviors for Patient & Worker SafetyMarch 18, 2013Kristina Walker, Sally Pawsat

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© Seton Healthcare Family

Patient & Worker Safety Injury Trends

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© Seton Healthcare Family

Key Approach for Integrating Patient & Worker Safety

• High Reliability Organization (HRO)• HRO principles and safety behaviors changed culture

• Flattens hierarchy permitting anyone to speak up for safety

• Promotes transparency by providing forum for reporting of near misses/good catches

• Safety and Health Management System• Followed VPP Challenge program to develop• Comprehensive SHMS provides foundation and

infrastructure • Establishes structure, programs and policies• Sets clear and consistent expectations• Provides accountability for safety

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© Seton Healthcare Family

Principles of High ReliabilityFive Principles of High Reliability Organizations (HROs) Three Principles of AnticipationPreoccupation with FailureRegarding small, inconsequential errors as a symptom that something’s wrongSensitivity to OperationsPaying attention to what’s happening on the front-lineReluctance to SimplifyEncouraging diversity in experience, perspective, and opinion

Two Principles of ContainmentCommitment to ResilienceDeveloping capabilities to detect, contain, and bounce-back from events that do occurDeference to ExpertisePushing decision making down and around to the person with the most relevant knowledge and expertise

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© Seton Healthcare Family

Elements of a Successful High Reliability Organization

• HRO raised worker safety to same level of importance as patient safety• “Quality care starts with my safety”

• Strong leadership engagement & visibility• Rounding, coffee, thank you notes, daily brief

• Worker Involvement• Safety Coach program• Safety concerns & suggestions reporting

• may be anonymous • Safety related goal in worker performance evaluations• Safety behaviors

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© Seton Healthcare Family

UMCB Injury Prevention ModelCulture

PerceptionsBeliefs

Systems Physical Conditions

BehaviorInvolvement

IncidentError

Error/Injury Prevention Model

· Perception Surveys· Intentional Rounding· Feedback/Comment

Cards

· SERTs (Serious Event Review)

· RCATs (Root Cause Analysis

· 72 hour event follow up

· EOC Rounds· Quarterly Area

Inspections· Preventive

Maintenance· Medical Equipment

Management· Life Safety

· Good Catches· Behavior

Observations· Peer Coaching/Peer

Checking· Hand off· Rounding· Safety Coaches· Fall Champions· Safe Patient Handling

(SPHR)· Daily Brief· Training/

Competencies· Education Fairs

Metrics-· Observations· Survey Results

Metrics-· Mock Surveys/

Tracers· Self Assessments

Metrics-· Round/Inspection

completion· Corrective Action

Completion

Metrics-· Observations· Participation

Mea

sure

men

tsA

ctiv

ities

Focu

s A

reas

DRAFT

Metrics-· Serious Event Rate· TCIR· DART· Falls· Readmission Rate· Core Measures

· High Reliability· Commitment to

Resilience· Deference to

Experience· Preoccupation

with failure· Sensitivity to

Operations· Reluctance to

Simplify· Accreditations

· Joint Commission· Magnet· Chest Pain· Stroke/Spine· VPP/SHMS

Saint Thomas HealthPatient Mobilization Program

David Wheeler, System Safety Officer, Emergency Preparedness Coordinator, St. Thomas Health

Amy Williamson, VPP Project Coordinator, St. Thomas Health

Facility Injuries Days Lost Days Restrict

ed

Total Replaceme

nt Labor Cost*

Total Cost of Claim

2008 39 127 1,563 $419,796 $247,0212009 30 150 1,432 $392,969 $197,4742010 18 175 678 $211,885 $697,3362011 10 47 237 $70,546 $242,6332012 21 152 139 $72,284 $145,460TOTALS 118 651 4,049 $1,167,480 $1,529,92

3$2,697,403

*Average Labor cost based on Average RN & PCT wages, working 12-hour shifts (does not include overtime)

BH Patient Handling Injuries 2008-2012

BH Patient Admission Weights

2010 2011500+ lb 35 40300-499 lb 2,248 2,677200-299 lb 19,939 23,778Total Admissions 67,481 78,913

NIOSH (National Institute of Occupational Safety and Health) Safe lifting limit for healthcare workers is 35 pounds.

Patient Mobilization Training at STH

Changed teaching method from “how to use equipment” to “how to mobilize your patient”

Trained 98 Super Users and 826 End Users

Positive feedback from staff (97%)

Went from 11.5 days between SPH injuries to over 30 since “go-live” on December 3

Risk Tool/Equipment Tags

Risk Tool Label/tag all portable

equipment

Improve patient mobilization Reduced skin breakdown related

to shearing forces Decrease patient falls Shorten length of stay

Patient Benefits…

Creating a Common Platform for Patient & Associate

Health and Safety St. Vincent’s Medical Center, Bridgeport CT

Joe Laveneziana Exec. Director Safety, Security and Facilities

Joanne Velardi Exec. Director Occupational Health, Wellness and Rehabilitation

Senior Leadership Commitment “Walk the Talk” Safety Trumps All Flatten the Hierarchy Define the Culture

Build the Foundation

High Reliabilit

y

Just Culture

Reluctance to

SimplifySafety First

Reward and

Recognize

TRUST. VINCENT’S

Safety is the key to T.R.U.S.T.BEHAVIORSI commit to...

ERROR PREVENTION TOOLS:

T Think twice •Use S.T.A.R. (Stop, Think, Act, Review)

R Recognize and reward

•Publicly celebrate and recognize on-the-spot

U Utilize each other

•Include patients and families•Validate and Verify (trust your instincts)•Practice peer checking and peer coaching

S Speak up for safety

•Use SBAR (Situation, Background, Assessment, Recommendation) •Use CUSS (“I’m Concerned; I’m Uncomfortable; This is a Safety issue; We need to Stop”)

T Teamwork •Practice 200% accountability (know and follow policies and advocate for compliance)•Stop and Resolve when unsure or concerned•Use direct (person-to-person) communication

Foster Awareness and Empowerment Behavioral

Expectations Transparency SBAR Communication Safety Huddles Reporting Tools

Intentional Focus Risk Assessment Gap Analysis Cause Analysis Review Policies and

Procedures Protocols

Game Changers

Thank You!

Psychiatrist triage Detoxification

Protocols Behavioral Response

Team SOMA beds Sitter safe rooms Care Partners High Risk Flag Event De-briefings GPS Duress Alarms MOAB/ CPI Training .

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“I start with the premise that the function of leadership is to produce more leaders, not more followers.”

Ralph Nader

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Questions

Bob WilliamsonDirector, Associate Safety

Ascension Health(Office) 989.781.8842 (Cell) 989.714.1109

rwilliamson@ascensionhealth.org

Tom JacksonNational Content Developer

Summary

Opportunities for PfP Hospitals to Get Ahead of the Curve on Integration of

Workforce and Patient Safety:

• “1000 Hospital” Event prior to role out of OSHA Tools

• OSHA participation in Affinity Groups• Access to OSHA web site• VPP Hospital support for hospitals interested

in transitioning to alignment of workforce and patient safety

Upcoming Events(Tentative)

Key

Campaign Events

Topical Events

Hospital Events

DATE Time (EST) NCD Pacing Event/Affinity Group Meeting3/19/13 3:00-4:30 Medication Safety Affinity Group Meeting with Rural Affinity Group and Readmissions Affinity Group 3/25/13 3:00-4:00 Campaign Event – Formative Evaluation HEN Reports

4:00-5:00 Product Safety and Resource Management Affinity Group Meeting4:00-5:00 Patient and Family Engagement Affinity Group Meeting

4/1/133:00-4:30 Hospital Event: Preventing Medication Related Readmissions - No breakouts possible with 5,000

hospital event.

4/8/13 3:00-4:00 Campaign Event –   4:00-5:00 Rural Affinity Group Meeting  4:00-5:00 Procedural Harm Affinity Group Meeting

4/9/13 12:00-1:00 Harm Across Board Affinity Group Meeting4/15/13 3:00-4:00 Campaign Event -

  4:00-5:00 Maternal Health Affinity Group Meeting4/22/13 3:00-4:00 Campaign Event -

  4:00-5:00 Product Safety and Resource Management Affinity Group Meeting  4:00-5:00 Patient and Family Engagement Affinity Group Meeting

4/23/13 3:00-4:30 Medication Safety Affinity Group Meeting4/29/13 3:00-4:00 Campaign Event -

  4:00-5:00 Readmissions Affinity Group Meeting  4:00-5:00 Provider Affinity Group Meeting

• Please stay on the line and follow the prompts on your screen to be moved into your pre-selected affinity group:– Maternal Health– Readmissions

• If you experience difficulty with your connection, please close your internet browser, and try signing back in through the original link/phone line provided in your confirmation email.

Breakout Sessions

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