Transcript Slide 1

Healthcare Safety Management
For:
Twin State ASHE Meeting
17 August 2012
Lindsey C. Waterhouse
Main Points
•
•
•
•
•
•
Where to get started
Hospitals and Hazard Burden
Exposure, Incident Cause, Incident Prevention
On Regulation and Standards
Safety Culture vs. Safety Climate
The Whole Process – PHEWS – The D-H
Model
• Measuring Program Effectiveness
• Your Thoughts and Questions
Where would you begin?
Developing A Safety Program
Considerations
• What type and size is your medical organization?
• What are your regulatory drivers?
• Joint Commission, OSHA, State Regulations, (Liability)
• Is your goal compliance or risk reduction?
• How/Do you, currently capture injury, illness and near
miss information?
• What are you doing with the information you capture
• What is your organizations incident experience?
• Do you know the exposure profiles of your
hospital/departments?
• What safety/health programs are already in place?
• What is your safety culture/climate?
• What are your resources?
On Perception
• Who is responsible
for occupational
health and safety in
your organization?
• Who is accountable
for OSH Outcomes?
Hazard Burden
INPUT
PROCESS
OUTPUT
OUTCOME
 No injuries
Uncontrolled
Hazards/Risks
The “Hazard
Burden”
Health and Safety Management
System
•Management Programs – Level 1
•Risk Control Systems – Level 2
•Workplace Precautions – Level 3
Positive Health and Safety Culture
 No occupational
ill-health
 No incidents
Hazards/Risks  No lost time
 Employee and
employer satisfaction
 Climate of safety
Controlled
Defining the hazard burden:
• What are the exposure hazards associated with our operations?
• What is the significance of the exposure hazards (high/low)?
• How does the nature and significance of the exposure hazards vary across the different
parts of our organization?
• How does the nature and significance of the exposure hazards vary over time?
• Are we succeeding in eliminating or reducing hazards?
• What impact are changes in our business having on the nature and significance of hazards
• What is the safety climate and staff perception of safety? of hazards?
Hazard Burden Process
Levels
DHMC Examples
• Level 1 – Management Programs
• Obtain senior leadership support for blood borne pathogen injury
reduction
• Level 2 – Risk Control Systems
• Develop and deploy the Agitated Patient Control Program
• Level 3 – Workplace Precautions
• Staff are fit tested on respiratory protection and knowledgeable
of PPE use
DHMC Incidents by Exposure Category CY 2010
160
136
140
121
120
100
80
71
62
60
42
40
33
32
24
20
0
28
22
20
6
10
1
41
34
8
10
1
28
21
1
20 19 17
7
2
19
Example – Nursing Unit Profile
Example - Injury Exposures CY 2010
14
12
10
8
6
4
2
0
13
7
5
4
2
1
1
1
1
1
2
1
Example - Unit Patient Handling
Injuries by Quarter
Q1 2009
7
6
5
4
3
2
1
0
Q2 2009
Q3 2009
Q4 2009
Q1 2010
Q2 2010
Q3 2010
Q4 2010
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1
2009 2009 2009 2009 2010 2010 2010 2010 2011
Q1 2011
Institutional Incident Category
Profile
Assaults By Department CY 2010-2011
16
14
12
10
8
6
4
2
0
At Risk Departments
The following chart indicates the incident rate trend for each “At Risk” Department.
Food/Nutrition/Caf.
Med Specialties Unit
Supply Chain Periop
Heme-Onc Infusion
OR-Periop
Housekeeping
In Pt - Surg- 3W
Neuro - 5W
Food/Nut. - Kitchen
GME Anesthesia
MHO
ICU
Radiology
Psych Care Unit
In Pt - Surg- 4W
DHART
58.5
50.8
54.8
50.8
50.8
37.6
38.6
39.8
52.2
49.4
44.5
42.4
40.5
43.8
45.5
30.1
35.1
35.1
35.0
44.8
38.4
36.7
39.5
41.3
42.1
34.8
39.7
39.7
39.1
40.4
33.2
34.8
39.4
36.6
39.8
35.2
31.7
37.5
39.4
39.3
32.9
31.0
31.0
33.1
37.0
27.8
32.2
32.1
34.2
31.8
21.1
19.5
17.9
25.4
29.2
28.8
28.9
26.5
24.1
24.2
21.2
21.3
23.7
23.7
23.7
15.2
17.7
17.7
20.3
22.7
19.6
22.7
19.8
20.0
20.1
22.8
20.0
19.8
19.6
19.4
Pharmacy
12.8
13.9
17.3
18.3
19.4
Engineering
14.2
17.1
17.1
18.5
18.4
Flat
Flat
Flat
H.R. Heinrich/DHMC
1
42
Lost Time
30
259
300
3000
Recordable
839
Incidents
Exposure, Incident Cause,
Incident Prevention
Basic
Theory of
Accident
Causation
“The actions of people account for 96%
of all injuries” – (DuPont)
“80-90% of accidents are due to human
error” (Heinrich et al, 1980)
“50-90% of accidents according to
statistics are due to human failings”
– Kletz (1990)
Generally Speaking, the research
suggests the distribution of accident
causation to be:
• 15% Unsafe Conditions
• 85% Unsafe Acts (by individuals and
organizations)
Some theorize all accidents are caused by unsafe acts since
unsafe conditions exist only as a result of a failure to act.
Do “Accidents” really happen
by accident?
Accidents are simply “undesirable outcomes” that arise
from discrepancies in the System of Work.
Work System
Management &
Staff
Customer
Demand
Methods &
Process
Environment &
Equipment
Work
Desirable Outcomes
Undesirable
Outcomes
Staff
Injuries
Stressors within the Work
System
Physical Aspects
of work and the
workplace
Customer
Demand
Psychosocial
aspects of work
and how work is
organized
Work related
resources and
opportunities
Reference - Issue brief 4: Work and Health ,
Dec 2008 – Commission to Build a Healthier
America, Robert Wood Johnson Foundation
Exposures to
physical risks
and hazards
Workplace
strain
Physical
and
mental
health
Ability to obtain
nutritious foods,
adequate
physical
activity/exercise ,
adequate sleep
Work-Life Conflict
Home/Personal
Life/External
Work
Psychological demand/decision latitude model
Demand Control Model
1. The social organizational characteristics
of work,and not just physical hazards,
lead to illness and injury
2. Stress-related consequences are related
to the social organization of work activity
and not just its demands
3. Work’s social activity affects stressrelated risks, not just person-based
characteristics
4. The possibility of both “positive stress”
and “negative stress” can be explained
in terms of combinations of demands
and control
5. Provides a simple model - with basic face
validity - to begin discussions on
personal stress response for shop-floor
workers, clerical staff and other lay
people for whom this is a sensitive topic.
A Model for Workplace Health Promotion
Individual Worker Action
O
H
S
P
H
&
W
Workplace Organizational Action
Examples of what workers can do to
help prevent occupational exposures:
Examples of what can be done in the workplace to
prevent job-related injury and illness:
• Learn and follow all safety and health
procedures
• Avoid safety “shortcuts”
• Use Personal Protective Equipment properly
and consistently
• Participate in joint labor management safety &
health programs
• Report any unsafe conditions promptly
Examples of what workers can do to help protect
their own health and well-being:
• Comprehensive injury and illness prevention
programs
• OSHA compliance
• Joint labor-management health and safety
committees
• Hazard control measures, effective interventions
• Case management for injured/ill workers to prevent
further
harm
Examples
of what can be done in the workplace to
support healthy choices:
• Adequate health insurance; insurance that includes
behavioral health services and mental health services
• Coordination of benefits to help improve access and
customer service
• Smoking cessation services
• Exercise programs (on-site, subsidized health club
memberships)
• Nutritious meals/food choices made available
• Information/education (classes, materials,
resources)
• Paid time off for participation in behavioral health
programs
• Employee assistance programs
• Family friendly policies (childcare, eldercare, flextime)
• Participate in classes, programs, or support
groups to address tobacco, alcohol, diet,
exercise, and other problems
• Share information and resources with coworkers and families
• Seek and follow medical advice
Reference – The Whole Worker
Standardized Systems and
Processes
OHSMS/ANSI Z-10
Employer/Supervisor Safety
Responsibilities
#3. Recognize and Control Hazards in the Work
Process (i.e. JSA’s)
•Do you have a safety plan?
•Have you established safety goals and
objectives for your department?
•Are you aware of employee exposure
risks
•What OSHA compliance programs and
requirements apply to your department?
•Is there a safety training plan for your
department?
•Do you continuously analyze work
methods and process to identify/review
hazards and controls?
Deming Cycle
OHSMS @ DHMC
Occupational Health and Safety Management System
(OHSMS) at DHMC:
Step 1. Identify workplace hazards and hazardous jobs/work
activities
Use workplace experience - injury/illness exposure data, previous
accidents, staff comments
Step 2. Assign priority (Risk Rank) each hazard and jobs/work
activities having exposure risks
Step 3. Assess the risk to find out exactly what makes it hazardous.
Work through the hazard rankings and hazardous jobs in order
of priority.
Step 4. Control the risk(s) or fix the problem(s)
Use the hierarchy of control concept
Step 5. Evaluate periodically to ensure that OHS risks are being
effectively managed.
Step 1. Identify workplace hazards and
hazardous jobs/work activities
See OHSMS Part A
Ref. #
Identify hazards by:
- Consulting with staff
- Observing work practices
- Reading labels and literature
- Reviewing incident and injury
reports
Examples:
- Carrying heavy materials
- Slippery surfaces/walkways
- Repetitive activities
- Handling/transfer of patients
- Using a hazardous substance
- Unguarded machinery
List and describe the hazards/ hazardous activities
Priority
Step 2. Assign priority (Risk Rank) each hazard
and jobs/work activities having exposure risks
See OHSMS Part A
Found a hazard? Think about:
How severely could it hurt someone? 
How likely is it to hurt someone?

Death, major disability,
or system loss
Very likely ++
could happen immediately/regularly
Compensable injury
involving several lost
work days
Minor incident, first aide,
or
1
2
3
Likely +
Could happen in time, occasionally
2
3
4
Unlikely Infrequent, unlikely to happen, but only rarely
3
4
5
Very unlikely -could happen, but probably never will
4
5
6
The numbers show how important it is to do something:
1 - Do something immediately – 6 - do something when possible.
Exposure Assessment and
Control
Source – Pathway – Receptor
Exposure Model
Control Boundary
Agent, Item, or Interaction
Action or medium
Employee
Pathway
Source
Source Factors
Receptor
Pathway Factors
Air flow patterns
What sources of exposure
What processes generate exposures Potential for chemical
- Inhalation
Potential for sudden/slow release
- Contact
Potential for reactions
- Absorption
Residual contamination
- Ingestion
Reservoirs of infection
7/7/2015
- Repetitive stress
Receptor Factors
Staff Knowledge
Process Controls
Protective Equipment
Staff behavior
Proximity to the work
Exposure Assessments
• The Worksite
Exposure
Assessment (EA)
– A process used to
identify hazards or
stressors in the work
environment
• A systematic collection and
analysis of occupational
hazards and exposure
determinants
7/7/2015
– Breaking down the
work activities and
elements to define:
• Processes
• Work Tasks
• Magnitude, frequency,
duration, variability and
route of exposure to
occupational stressors
OSHA - Job Hazard Analysis
• Define the Process
• Apply the “Tools of
Assessment”
• Break down the process into
each work task/activity
• Define Occupational stressors
present in each task
– (chemical, physical
(ergonomic), biological,
radiological, psychosocial,
and unsafe conditions)
• Consider the potential
routes/sources of exposure
– Inhalation, contact,
absorption, and ingestion
• Quantify the risk posed by
each activity
– Abate worst first
7/7/2015
– Visual Survey
– Interviewing staff and
managers
– Development of process
descriptions
– Inventory of stressors
– Obtaining MSDSs for each
chemical used in the process
– Status of existing controls
– Staff Education and
knowledge
– Review written policies or
operating instructions
– Consider environmental
Impacts
Tenet 4 – Hierarchy of Control
Most Effective
Controls
Examples
1)Elimination
•Design to eliminate hazards; noise,
2)Substitution
•Substitute less hazardous material
•Reduce Energy; pressure, force,
falls, hazardous materials, confined
spaces
temp, noise, amperage
Least Effective
7/7/2015
3)Engineering Controls
•Ventilation; machine guarding;
4) Warnings
•Signs; backup alarms; beepers;
5) Administrative Controls
•Procedures – written SOPs; worker
Personal Protective
Equipment
•Safety glasses; hearing protection;
circuit breakers; platforms/railings;
interlocks; lift tables; conveyors
alarms; horns; labels
rotation; safety equip. inspections;
•Training – Hazcom; confined space
respirators; gloves; safety harness
and lanyard
Prevention through Design
“One of the best ways to prevent and control occupational injuries,
illnesses, and fatalities is to "design out" or minimize hazards and risks
early in the design process.” *
* http://www.cdc.gov/niosh/topics/ptd/
Prevention through Design
Project and Team
• Improve the scope
cleaning process in the
Otolaryngology Clinic.
• Otolaryngology: Annette Tietz &
Shelia Keating
• CSR: Charlotte Owen & Tom
Green
• Engineering: Andrew Houghton
& Susan Donnelly
• IP: Eileen Taylor & Lori Key
• Safety & Environmental:
Lindsey Waterhouse
• PMO: Bob Sadlemire, Cathy
Proper, & Hebe Quinton
Process Steps:
1.
2.
3.
4.
5.
6.
7.
8.
Define the problem
Develop a solution process
‘Walk’ the process
Get help
Get approval
Construction
Training and qualification
Implementation
Document, document, document & communicate.
Design Considerations
• Flow path of endoscopes – Patient safety
• Countertop height – Ergonomic concern
• Ventilation – Staff & visitor safety
• PPE use & storage – Staff safety
• Eye wash station – Staff safety
• Hazardous material storage & waste disposal
• The ‘4th sink’ – Minimize spills
• Electrical safety – bad things happen when water & electricity mix.
Final Layout
Final Thoughts
• A patient safety project expanded into an
employee safety project.
• Our goal became to set up templates and
standards for future projects
• Think about patient safety, employee
safety, and the impact on the environment
during the design phase.
•
Other Exposures and
Liabilities
• Multiple regulatory
Healthcare OSH
impacts, and therefore
prevention needs,
exceed those of
general industry
•
•
•
•
•
Employees
Patients
Visitors
Contractors
Consultants
and standards setting
organizations with
various possible
impacts
•
•
•
•
•
•
•
OSHA
EPA
NRC
State DOL
CMS
Joint Commission
CDC
Contractors and Consultants
• Multiemployer
Worksites
• The ability for
contractors to be
exposed and their
ability to expose our
staff, patients and
visitors
• Case of Annheuser
Busch vs The Hub
Tavern
• Best Practice
• Contractor awareness
of our exposure
hazards
• How to respond in the
event of an emergency
• HASP development for
each project or major
activity conducted
• Clear contracts
defining contractor
liability
• Hard stops and
penalties for unsafe
On Compliance, Regulation,
and Risk
Regulation
• Next to nuclear power and nuclear weapons
manufacturing plants, hospitals are probably
the most regulated industry in the nation
• OSHA regulates hospitals under “General
Industry”; 29 CFR 1910 series of regulations,
directives and interpretations.
• Example – General Medical and Surgical
Hospitals
• SIC 8062
• NAICS Code 622110
Regulation
Our Industry
OSHA priorities
• ~11 million (2008)
• 3.6m in hospitals
• 7.3m outside of
hospitals
• ~7 million covered
workplaces
• Imminent danger
• Fatalities and catastrophes
• 1+ deaths / 3+ in-patient
hospitalizations
• Complaints
• Referrals from other agencies /
media coverage
• Follow-ups
• Planned/ Programmed
• High-hazard or high incident
rates
• OSHA Inspection priorities
• 1 inspector / 66,258
covered employees
Ref. Scott Harris, PhD, MSPH; OSHA In Healthcare, Out of Sight & Out of Mind
Ref. Scott Harris, PhD, MSPH; OSHA In
Healthcare, Out of Sight & Out of Mind
Ref. Scott Harris, PhD, MSPH; OSHA In
Healthcare, Out of Sight & Out of Mind
Ref. Scott Harris, PhD, MSPH; OSHA In
Healthcare, Out of Sight & Out of Mind
Compliance Priorities
• Recordkeeping
• Non-compliance with voluntary Infection control practices
(hand washing, use of gloves, face masks, and respirators)
• Bloodborne Pathogens
• Musculoskeletal Injuries
• Hazard Communications
• Injury and Illness Documentation
• Electrical Safety
• Control of Hazardous Energies
Compliance and Risk
• 2011 D-H Joint
Commission Survey
• Case of the Un-safe
Eyewash
Safety Culture vs. Safety
Climate
“A Culture of Caring”
Dartmouth-Hitchcock
Proprietary and Confidential
Injury History may not be a good
indicator of Future Injury Susceptibility
• Won award in 2008 for safety
performance.
• On the day of the disaster, BP
and Transocean managers
were on board to celebrate
seven years without a losttime accident.
• Interestingly, industry financial
analysts weren’t fooled, in
2008 and 2009, industry
surveys ranked Transocean
last among deep-water drillers
for "job quality" and second to
last in 'overall satisfaction'.
49
BP Deepwater Horizon
April 20, 2010 Explosion and Fire
11 workers killed
16 workers injured
Proprietary and Confidential
What Experts in the Safety Industry
Suggests to be the Next Frontier..
“Research suggests that employees’
perceptions of management and the
company’s commitment to safety and
health directly affect the reduction of
injuries over time.”
- Blair and O’Toole, Leading Measures,
Professional Safety, August 2010
50
Proprietary and Confidential
What is Safety Climate?
Dov Zohar, PhD (1980) first introduced the
concept of “Safety Climate”:
– Employees’ shared perceptions of the
safety policies, procedures, and
practices
– Overall importance and true priority of
safety at work
– A “snapshot” of the prevailing state of
safety within an organization
– A measure of the organizational and
psychosocial precursors to safety
performance
51
Proprietary and Confidential
Meta-Analysis by Christian et al.
(2009) Combined Results of 202 Studies
Safety Climate is one of the best leading indicators
of future injury
Leading indicator
Lagging indicator
Figure 2. Maximum-likelihood parameter estimates for the hypothesized model.
Statistics are standardized path coefficients. p .001.
52
Proprietary and Confidential
Safety Climate Dimensions
Numerous safety climate “dimensions” have been
documented in the research:
 Management commitment,
 Safety training programs,
 Management attitudes toward
safety,
 Effects of safety conduct on
promotion,
 Level of risk at work place,
 Pace of work,
 The status of safety officers,
53







Status of safety committee,
Physical risk,
Individual attitudes towards safety,
Safety communication,
Equipment,
Training,
The safety of the workers’
immediate physical environment,
 Etc., etc., etc.
Proprietary and Confidential
Safety Climate Dimensions
According to the scientific literature, the #1
Dimension is:
“Management commitment to safety”
– management concern for employee
well-being
– management attitudes toward safety
– workers' perception that safety is important to
management
• All other “dimensions” of safety climate are
secondary (Zohar, 2008).
54
Program Integration;
The Whole Process – PHEWS
– The D-H Model
Integration
• Recognition of Hazard
• Workplace Exposure
Burden
Assessment
• Exposure Profiles and
• JHA/JA
Exposure Groups
• Source Pathway Receiver
• Wellness indicators
• Prevention Through
• OHSMS – ANSI/AIHA Z10
Design
• Employee recognition and • PHEWS
OHS&W communication
• Unit Based Solutions
• Institutional Solutions
• Outcomes Tracking
Agitated & Potentially
Violent Patients
D-H Occupational
Health Safety and
Wellness System©
D-H Falls
Reduction
Risk Control Systems
SWAT
Supervisor Safety
Course .
Quality
Council
GO and E-Learning
ERGO/BIRT
EoC and
QPSS
EROI/Yikes
Workability
CGPs
Nursing Shared
Governance
PHEWS
Occ Med
EHS Steering
Com
Deputy
Chairs
Unit Safety
Committees
Chair
At Risk Depts.
Health Coaching
SEP
Chaplaincy
EAP
HR Benefits
D-H Partners
Bloodborne Pathogens
Slips and Falls
Ergo – Rep Stress
Patient Handling
LW/WW and
Support Services
Ergo Mat. Handling
Assaults
D-H Hazard Burden
Thank You!
Your Thoughts and Questions?
Outcomes Tracking
• Incident Investigations
• Validation of Safe
Behaviors
– OSH process audits
• Education and risk
reduction
preparedness
• Institutional Indicators
–
–
–
–
–
OSHA IR
Lost Days
Incident Reduction
Loss Costs/Rates
EMR
HOUSEKEEPING SUPERVISORY SAFETY CHECKLIST
Dec-10
BODY MECHANICS
YES
1.)
2.)
3.)
4.)
Safety Checklist
NO
18
18
18
17
1
1
2
BODY MECHANICS YES
19
18 18 18
PROPER EQUIPMENT USE
5.)
6.)
7.)
8.)
9.)
10.)
11.)
15
19
18
17
19
15
18
19
19 19 19
18
17
4
BODY MECHANICS NO
18
18 18 18 18
17
15
17
15
14
14
11
2
PROPER PPE USE
12.)
13.)
14.)
15.)
16.)
18
18
18
18
14
5
4
1
GENERAL SAFETY
17.)
18.)
19.)
20.)
21.)
22.)
2
5
14
11
17
19
19
19
1
1
1
1
2
1
1
1