Aligning Patient & Workforce Safety: An OSHA Presentation

1. Aligning Patient & Workforce Safety:An OSHA Presentation PfP Campaign Event March 18, 2013 3:00 – 4:00 PM ET Affinity Group Breakout Sessions 4:00 – 5:00 PM ET

2. Introduction Paul O'Neill, 72nd Secretary of the U.S. Treasury

3. Aligning Patient and Workforce Safety David Michaels, PhD, MPH Assistant Secretary of Laborfor Occupational Safety and Health

4. Healthcare Is Not a Safe Industry for Its Workforce • Patient lifting/ repositioning • Needlesticks • Violence • Exposure to chemicals • Unique challenges

5. We All Pay the Price • Worker’s compensation costs • Treating patient injuries, too • Overtime, temporary staffing • Turnover, recruiting, retraining • Productivity and morale

6. Connecting Patient and Workforce Safety • Synergies • Challenges • Similar approaches can help • Management systems • Culture of safety • Worker safety improves patient safety

7. 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

8. Injury and Illness Prevention Programs Dorothy Dougherty, OSHA Directorate of Standards and Guidance

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

10. 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

11. Six Core Elements of I2P2 • Management leadership • Set policy, establish goals, provide resources • Lead by example, be visible on safety issues • Employee participation • Build trust, engage workers, spread responsibility • “Few resist their own ideas”

12. 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.

13. Six Core Elements of I2P2Continued • Hazard identification • Baseline inventory of hazards • Mechanisms to ensure ongoing assessment • Hazard prevention and control • Identify, evaluate, and assess feasible options to eliminate, reduce, or control hazards • Monitor and evaluate effectiveness of controls

14. Six Core Elements of I2P2Continued • Education and training • Understand the basics of the I2P2 and how to participate • Identifying, reporting, and controlling hazards • Unique safety competencies • Program evaluation and improvement • Is the program meeting its goals? • Are established procedures being followed? • Make any necessary adjustments using a corrective action process

15. OSHA’s Voluntary Protection Programs • 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 rate 52%

16. A Request for the HENs: • Please read the OSHA White Paper on Injury and Illness Prevention Programs: http://www.osha.gov/dsg/InjuryIllnessPreventionProgramsWhitePaper.html • Please visit the OSHA web page for healthcare workers: http://www.osha.gov/SLTC/healthcarefacilities/index.html • Please share these materials with the hospitals in your network.

17. What Are We Hearing? Monica Barrington, Premier Mitzi Ressmann, Texas Hospital Association Rosalie Weakland, Ohio Hospital Association Lynda Martin, Hospital & Healthcare System of Pennsylvania Wendy Goshert, Ascension Tania Daniels, Minnesota Hospital Association

18. Pursuing a Culture of SafetyOSHA/CMS Pacing Event Bob Williamson Director, Associate SafetyAscension Health March 18, 2013

19. “Every 54 minutes an Ascension Health Associate sustains a work related injury or illness.”

20. A Single Approach to Safety

21. Interventions for a Comprehensive Solution for Associate Safety

22. VPP Pilot Sites • University Medical Center Brackenridge Austin, TX • Baptist Hospital Nashville, TN • St. Vincent’s Medical Center Bridgeport, CT

23. University Medical Center Brackenridge Common Safety Behaviors for Patient & Worker Safety March 18, 2013 Kristina Walker, Sally Pawsat 1

24. Patient & Worker Safety Injury Trends 9

25. 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 3

26. Principles of High Reliability Five Principles of High Reliability Organizations (HROs) Three Principles of Anticipation Preoccupation with Failure Regarding small, inconsequential errors as a symptom that something’s wrong Sensitivity to Operations Paying attention to what’s happening on the front-line Reluctance to Simplify Encouraging diversity in experience, perspective, and opinion Two Principles of Containment Commitment to Resilience Developing capabilities to detect, contain, and bounce-back from events that do occur Deference to Expertise Pushing decision making down and around to the person with the most relevant knowledge and expertise 4

27. 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 6

28. UMCB Injury Prevention Model

29. Saint Thomas HealthPatient Mobilization ProgramDavid Wheeler, System Safety Officer, Emergency Preparedness Coordinator, St. Thomas HealthAmy Williamson, VPP Project Coordinator, St. Thomas Health

30. BH Patient Handling Injuries 2008-2012 $2,697,403 *Average Labor cost based on Average RN & PCT wages, working 12-hour shifts (does not include overtime)

31. BH Patient Admission Weights • NIOSH (National Institute of Occupational Safety and Health) Safe lifting limit for healthcare workers is 35 pounds.

32. 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

33. Risk Tool/Equipment Tags • Risk Tool • Label/tag all portable equipment

34. Patient Benefits… • Improve patient mobilization • Reduced skin breakdown related to shearing forces • Decrease patient falls • Shorten length of stay

35. 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

36. Build the Foundation • Senior Leadership Commitment • “Walk the Talk” • Safety Trumps All • Flatten the Hierarchy • Define the Culture

37. Safety is the key to T.R.U.S.T. TRUST.VINCENT’S

38. Foster Awareness and Empowerment • Behavioral Expectations • Transparency • SBAR Communication • Safety Huddles • Reporting Tools

39. Intentional Focus • Risk Assessment • Gap Analysis • Cause Analysis Review • Policies and Procedures • Protocols

40. Game Changers • 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 Thank You! .

41. “I start with the premise that the function of leadership is to produce more leaders, not more followers.” Ralph Nader 41

42. Questions Bob Williamson Director, Associate Safety Ascension Health (Office) 989.781.8842 (Cell) 989.714.1109 rwilliamson@ascensionhealth.org

43. Summary Tom Jackson National Content Developer

44. 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

45. Upcoming Events(Tentative)

46. Breakout Sessions • 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.