christopher lipowski, crsp 2010 a proactive approach for managing healthcare health and safety...

Christopher Lipowski, CRSP2010

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


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.


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


A Recipe for Healthcare FailureA Recipe for Healthcare Failure Financial Consequences of a damaged workforceFinancial 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.


I. To reduce occupational injuries and diseases

II. To reduce the rate of staff absenteeism

III. To improve patient safety and the quality of care

IV. To support healthcare system sustainability by reducing costs, losses and

waste

Why a Healthy Healthcare Work Environment is Important


The Value of Organizational CultureThe Value of Organizational Culture

An organization’s culture consists of its values, beliefs, mission, goals, An organization’s culture consists of its values, beliefs, mission, goals, rituals and customs. All of this translates to a system of expected behavior.rituals and customs. All of this translates to a system of expected behavior.

Organizational attitudes for safety are determined by senior management.Organizational attitudes for safety are determined by senior management.

Safety is culture-driven, and management establishes the culture.Safety is culture-driven, and management establishes the culture.


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


THE HEALTHCARE SAFETY BALANCETHE HEALTHCARE SAFETY BALANCE Healthcare “safety culture” recognizes and Healthcare “safety culture” recognizes and

emphasizes the importance of occupational emphasizes the importance of occupational healthcare provider safety and patient safety healthcare provider safety and patient safety equally.equally.


A Safety Focus RealignmentA Safety Focus Realignment

Therefore, a strong corporate healthcare safety culture Therefore, a strong corporate healthcare safety culture requires a holistic approach by management that requires a holistic approach by management that recognizes the close association between the quality of recognizes the close association between the quality of staff safety initiatives and resulting patient care staff safety initiatives and resulting patient care outcomes.outcomes.

This will require the leadership team to fully This will require the leadership team to fully comprehend the intricate dynamics of this association comprehend the intricate dynamics of this association and realign a unilateral focus on patient safety to and realign a unilateral focus on patient safety to simultaneously include occupational safety initiatives.simultaneously include occupational safety initiatives.


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


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.


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.


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.


Health and Safety Policy with a VisionHealth and Safety Policy with a Vision

Develop and communicate a robust occupational health and Develop and communicate a robust occupational health and safety (OHS) policy that states senior management’s safety (OHS) policy that states senior management’s commitment to industry best practices for achieving safe commitment to industry best practices for achieving safe working conditions for all members of the organization. working conditions for all members of the organization.


The OHS Policy should:The OHS Policy should:• be guided by internal responsibility system (IRS) principles. be guided by internal responsibility system (IRS) principles. • indicate recognition that occupational safety best practices indicate recognition that occupational safety best practices

will be accomplished through its health and safety will be accomplished through its health and safety management system (HSMS) initiatives.management system (HSMS) initiatives.

• promote openly the important relationship between promote openly the important relationship between occupational and patient safety.occupational and patient safety.

• indicate that occupational health and safety is a value and is indicate that occupational health and safety is a value and is required to meet the organization’s mission for achieving required to meet the organization’s mission for achieving patient care excellence.patient care excellence.

• clearly define management OHS responsibilities and clearly define management OHS responsibilities and accountabilities and the method that will be used to accountabilities and the method that will be used to determine compliance.determine compliance.


Show OHS Commitment with TransparencyShow OHS Commitment with Transparency

Craft a written statement signed by all members of the senior Craft a written statement signed by all members of the senior management team outlining its commitment to and management team outlining its commitment to and involvement in corporate OHS initiatives and advertise it involvement in corporate OHS initiatives and advertise it throughout the organization (e.g., via intranet mass throughout the organization (e.g., via intranet mass emailing).emailing).

- Make this “statement” available to the public - Make this “statement” available to the public

through access on the hospital external website.through access on the hospital external website.


The Health and Safety Management SystemThe Health and Safety Management System

Initiate development of an organizational health and safety Initiate development of an organizational health and safety management system (HSMS).management system (HSMS).

Use formal system development guidelines such as those provided in Use formal system development guidelines such as those provided in the CSA Z 1000-06 standard that is based on the Plan-Do-Check-the CSA Z 1000-06 standard that is based on the Plan-Do-Check-Act management structure, and provides a model for identifying Act management structure, and provides a model for identifying occupational health and safety hazards, evaluating associated risks, occupational health and safety hazards, evaluating associated risks, and managing preventative and protective measures.and managing preventative and protective measures.

The primary goal behind the HSMS is to move beyond basic The primary goal behind the HSMS is to move beyond basic legislative compliance and strive towards attaining safety excellence legislative compliance and strive towards attaining safety excellence and due diligence by integrating OHS best practices into all and due diligence by integrating OHS best practices into all management functions of core hospital business activities.management functions of core hospital business activities.

A major underlying feature of the HSMS is A major underlying feature of the HSMS is “continuous improvement”.“continuous improvement”.


Establish a permanent HSMS sub-committee of the JHSC Establish a permanent HSMS sub-committee of the JHSC headed by a senior management team member with the headed by a senior management team member with the mandate to guide the evolution of the System and assure its mandate to guide the evolution of the System and assure its continuous improvement. continuous improvement.

Engage staff and encourage their contributions to the System Engage staff and encourage their contributions to the System by inviting them to join as members of the HSMS sub-by inviting them to join as members of the HSMS sub-committee.committee.

Perform objective annual audit of the HSMS to identify needed Perform objective annual audit of the HSMS to identify needed improvements and subsequently initiate required changes in a improvements and subsequently initiate required changes in a timely manner.timely manner.


Health and Safety CommunicationHealth and Safety Communication

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


Management Safety InspectionsManagement Safety Inspections

Develop a mandatory regular management workplace safety Develop a mandatory regular management workplace safety inspection practice policy. inspection practice policy.

Require managers to submit to the leadership team a written Require managers to submit to the leadership team a written report on the inspection results, including date of risk report on the inspection results, including date of risk remediation measures implemented for identified remediation measures implemented for identified uncontrolled hazards.uncontrolled hazards.


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.


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.


Integrate Hazard Identification and Risk Assessment into all Organizational Activities

Important Concepts for Management to Know

o 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.

o risk is the likelihood that illness, injury or death might result due to the hazard.

o 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.

o a risk matrix with hazard probability and exposure frequency criteria is used to determine risk severity level.


PPrioritizing risksrioritizing 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.

Setting Priorities - Effective Risk ManagementSetting Priorities - Effective Risk Management


The Risk Control ProcessEducate 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:

a) engineering controls: - elimination of hazard. - substituting hazard for one with an acceptable risk level.- isolation of the hazard.

b) administrative controls

c) personal protective equipment


Organizational OHS EducationOrganizational OHS Education Senior management must recognize that a high quality training Senior management must recognize that a high quality training

and education program is a vital component of a successful health and education program is a vital component of a successful health and safety management system.and safety management system.

Achieving OHS safety education program excellence has Achieving OHS safety education program excellence has significant positive financial implications for the organization.significant positive financial implications for the organization.

Considering the importance of successfully achieving effective Considering the importance of successfully achieving effective knowledge transfer and the complexities of safety educational knowledge transfer and the complexities of safety educational requirements for healthcare staff, hiring or contracting a qualified requirements for healthcare staff, hiring or contracting a qualified professional OHS educator is a wise financial investment. professional OHS educator is a wise financial investment.


Organizational Health and Safety Knowledge ManagementOrganizational Health and Safety Knowledge Management““a collaborative effort”a collaborative effort”

Shift concept from simple “safety training” to “safety knowledge Shift concept from simple “safety training” to “safety knowledge management”. management”.

Strive to use web-based technologies for “safety training”.Strive to use web-based technologies for “safety training”.

For adult learning and knowledge acquisition to occur successfully develop For adult learning and knowledge acquisition to occur successfully develop an interactive health and safety workshop education program. The program an interactive health and safety workshop education program. The program should involve a collaborative effort between occupational health and should involve a collaborative effort between occupational health and safety practitioners, clinical educators, infection control instructors, and safety practitioners, clinical educators, infection control instructors, and patient safety experts.patient safety experts.


Make Interdepartmental Collaboration a RealityMake Interdepartmental Collaboration a Reality Promote Promote genuinegenuine collaboration of functional activities between collaboration of functional activities between

the OHS, Patient Safety, Risk Management, and Infection the OHS, Patient Safety, Risk Management, and Infection Control Departments because all these departments should be Control Departments because all these departments should be collectively pointing their noses in the same direction - collectively pointing their noses in the same direction - working towards aggressively reducing staff and patient safety working towards aggressively reducing staff and patient safety risks and associated organizational financial lossesrisks and associated organizational financial losses..


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

New Technologies for Improving Management OHS AccountabilityNew Technologies for Improving Management OHS Accountability


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

How it WorksHow it Works


Promote overall organizational OHS responsibilities by:Promote overall organizational OHS responsibilities by:a) requiring compliance to OHS principles and a) requiring compliance to OHS principles and

practices as a signed condition of employment by all new hires;practices as a signed condition of employment by all new hires;b) embedding basic written OHS requirements into b) embedding basic written OHS requirements into

staff job descriptions;staff job descriptions;c) establishing in-house OHS standards based on c) establishing in-house OHS standards based on

proactive safety leading indicators as an evaluation method in proactive safety leading indicators as an evaluation method in employee annual performance reviews.employee annual performance reviews.

Setting Organizational Health and Safety Responsibility StandardsSetting Organizational Health and Safety Responsibility Standards


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.

What to do >>>>>>


Occupational Stress Management Program

Provide occupational stress management service that has: - stress awareness education - stress coping methods training - stress counseling


POSITIVE FLOW STRATEGIESPOSITIVE FLOW STRATEGIESPromote Staff WellnessPromote Staff Wellness

Develop a staff wellness program and policy that promotes best Develop a staff wellness program and policy that promotes best practice behaviors for staff health and visibly demonstrates that practice behaviors for staff health and visibly demonstrates that management cares about its staff - its most valuable resource.management cares about its staff - its most valuable resource.

Shift Focus to Positive Psychology TrendsShift Focus to Positive Psychology Trends Positive Psychology has three central concerns: positive emotions, Positive Psychology has three central concerns: positive emotions,

positive individual traits, and positive institutions. Positive positive individual traits, and positive institutions. Positive institutions entails fostering a workplace philosophy of justice, institutions entails fostering a workplace philosophy of justice, responsibility, civility, strong work ethic, leadership excellence, responsibility, civility, strong work ethic, leadership excellence, teamwork, purpose, and tolerance.teamwork, purpose, and tolerance.

Recognize Staff OHS AchievementsRecognize Staff OHS Achievements Initiate a formal staff OHS success and achievements recognition Initiate a formal staff OHS success and achievements recognition

program.program.Measure Positive Safety ProgressMeasure Positive Safety Progress

Set expectations and use leading indicators (e.g. # of risk Set expectations and use leading indicators (e.g. # of risk assessments performed; # of management workplace inspections assessments performed; # of management workplace inspections completed and improvements made; HSMS audit non-conformance completed and improvements made; HSMS audit non-conformance items corrected) as a proactive measure of health and safety items corrected) as a proactive measure of health and safety performance. performance.


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.


Adequate Qualified Health & Safety Department StaffingAdequate Qualified Health & Safety Department Staffing

Healthcare Leadership should allocate adequate Healthcare Leadership should allocate adequate human resourceshuman resources for OHS for OHS initiatives that includes staffing of the OHS department to have a sufficient initiatives that includes staffing of the OHS department to have a sufficient number of number of qualifiedqualified health and safety professionals that focus their efforts health and safety professionals that focus their efforts towards hazard risk control and accident prevention activitiestowards hazard risk control and accident prevention activities . .


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


The ConclusionThe Conclusion

The Quality Worklife-Quality Healthcare Collaborative defines a healthy healthcare The Quality Worklife-Quality Healthcare Collaborative defines a healthy healthcare workplace as: workplace as: A work setting that takes a strategic and comprehensive approach to providing the A work setting that takes a strategic and comprehensive approach to providing the physical, cultural, psychosocial and work/job design conditions that maximize physical, cultural, psychosocial and work/job design conditions that maximize health and well-being of healthcare providers, quality of patient outcomes and health and well-being of healthcare providers, quality of patient outcomes and organizational performance. organizational performance.

““A fundamental way to better healthcare is through healthier A fundamental way to better healthcare is through healthier healthcare workplaces. It is unacceptable to work in, receive care healthcare workplaces. It is unacceptable to work in, receive care in, govern, manage and fund unhealthy healthcare workplaces.”in, govern, manage and fund unhealthy healthcare workplaces.”

NOTE:NOTE:Thank you for your interest in and support of Canadian healthcare workplace and 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 patient safety initiatives. Please feel free to use all or any part of this presentation as long as acknowledging the author below is respected.as long as acknowledging the author below is respected.

— — Christopher J. Lipowski, CRSPChristopher J. Lipowski, CRSPPinnacle Enterprises CanadaPinnacle Enterprises Canada

[email protected]://www.mtpinnacle.com/


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/HealthForceOntario

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-Being

Annalee Yassi, MD, MSc, FRCPC

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