A Proactive Approach for Managing Healthcare Health and Safety “Raising the Bar on Leadership Effectiveness and Achievi

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 FailureFinancial 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.

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 Why a Healthy Healthcare Work Environment is Important

The Value of Organizational Culture • An organization’s 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.

 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.

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

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.

 To achieve patient care excellence, improving the quality of occupational health and safety must be a 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 Vision • Develop and communicate a robust occupational health and safety (OHS) policy that states senior management’s commitment to industry best practices for achieving safe working conditions for all members of the organization.

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 organization’s mission for achieving patient care excellence. • clearly define management OHS responsibilities and accountabilities and the method that will be used to determine compliance.

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.

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”.

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.

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.

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.

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 • 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.

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.

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

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.

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.

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.

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.

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.

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.

Healthcare Staff Psychosocial Stressa 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. >>> Whatto do

Occupational Stress Management Program Provide occupational stress management service that has: • - stress awareness education • - stress coping methods training • - stress counseling

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.

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 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.

The Challenge It is logical and prudent to consider that a typical healthcare organization’s 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.

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@mtpinnacle.com http://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 ColumbiaHealth 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-BeingAnnalee Yassi, MD, MSc, FRCPC

A Proactive Approach for Managing Healthcare Health and Safety “Raising the Bar on Leadership Effectiveness and Achievi