Transcript Slide 1

Managers’ and Supervisors’ Role in
Enhancing the Safety and Health Climate
for Health Care Providers
N. Sue Bruning
University of Manitoba
January 2012
For more information, please contact:
Sue Bruning, Ph.D.
I.H. Asper School of Business
University of Manitoba
Winnipeg, MB R3T0C3
CANADA
Email: [email protected]
Tel: +(204) 474-6566
I
Introduction






Study and Community Initiatives and Research Program
Two Studies – running simultaneously in healthcare and other sectors
Literature on leader and supervisor influences on health and safety
Looking at part of the H&S system – a major driver but not the whole system
Three years from contract to data completion
Thank Yous
–
–
–
–
–
–
Bruce Cielen and Janine Swanson
Terry Goertzen and Randy Lock
Jim Sanford (MCHCU) , Sandi Mowat (MNU) and Pete Walker (MFL)
All of the RHA CEOs
The human resources and health and safety staff that supported the project
The research assistants on the project: Rebecca Jensen, Tristan Bruning, Nicole Barnabe
and Francoise Cadigan
– All of the 2200 managers, supervisors and employees that completed the surveys
All Injury and Time Loss Statistics for the Healthcare
Sector and Time Loss Injuries for the Healthcare
Professions
10000
9000
8000
7000
6000
5000
4000
3000
2000
1000
0
Time Loss
Injuries Healthcare
Professions
Time Loss
Injuries Healthcare Sector
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
All Injuries Healthcare Sector
Research Questions
 What are management and supervisors’ attitudes about and perceived
threats to the safety and health of workers in Manitoba's health care settings?
 What are the workers perceptions about the top management and
supervisors’ attitudes about safety and health in the organization?
 Are management and supervisory factors related to positive health and safety
climate perceptions?
 How are the safety climate perceptions related to employee outcomes,
attitudes, injuries and absences within health care settings?
 What actions should management and supervisors take to improve the health
and safety environment of employees in the healthcare sector?
 How can proposed actions be translated into H&S training for management,
supervisors and health care employees?
Expected Model of Relationships
Employee Safety
and Health
Self Efficacy
(Perceived Control)
Top Management
Attitudes about and
Support of
Health and
Safety Climate
Supervisor
H&S
Attitudes
and Support
Safety Climate
Safety and
Health Threats
Outcomes
Accidents
Illnesses
Injuries
Project Phases
 Phase 1 – Interviews with RHA Chief Executive
Officers, human resource representatives and safety
and health officers of the RHAs (October – November,
2009)
 Phase 2 – Development and administration of the
survey.
– Original proposal
• 3 RHAs, all 11 RHAs participated
• 1000 target – 2200 participated
• 2 years – took 3 years
Major Project Changes
 Web-based survey (1 RHA requested paper and pencil
survey)
 Extended the survey to broader range of employees in
health care units
– Summarize data for total group of respondents and direct
care providers
 Absence information not available from all RHAs –
utilized self-report absenteeism and injury rates
 Result – larger and more diversified sample than
originally planned
Interview Data – Phase 1
 MSIs greatest threat and age related issues
 Violence and aggression is a growing threat
 Mixed in level of inclusion of H&S at Executive
levels
 Mixed in level of development of H&S plans
 All were interested in the study and in
participation
Questionnaires – Phase 2
Senior/Middle Management Questionnaire. The health and safety attitude questions were
adapted from the Strategic Leadership Questionnaire provided by the Worker's
Compensation Board of Manitoba. Sixty-six of the questions were deemed relevant to the
publicly funded health care sector and were adapted to fit the health care environment.
Unit supervisor Questionnaire - views of senior/middle managements support of the health
and safety process and programs within the facility.
Employee Questionnaire. The employee questionnaire consisted of 13 demographic
questions and 157 questionnaire items. The questionnaire scales included:
•
•
•
•
•
•
•
•
•
•
•
•
attitudes about top management support for health and safety of employees
direct supervisor support for health and safety
safety climate (3 scales)
stress
organizational commitment (2 scales)
perceived control
workload
responsibility for others
job satisfaction
workplace injuries, days absent due to injuries and health
psychosomatic complaints
intent to leave
Senior/Middle Management Questionnaire
 Institute of Work and Health – University of Toronto
 Original survey 70 items
– Eliminated 4 items, adapted the items to the health care sector
 Sample Questions:
– Senior/middle managers must be involved with employee health & safety (H&S) issues on a
daily basis.
– Healthcare workers are more responsible for accidents than their supervisors.
– Senior/middle managers should spend the same amount of time in formal and informal H&S
activities.
– Senior/middle managers should only deal with major H&S hazards at the hospital/clinic.
– Minor H&S hazards should be the responsibility of direct supervisors.
 The question examine a number of issues and perspectives on senior/middle
management involvement and support in health and safety
 Would be a great discussion document amongst senior/middle management
to explore support for H&S and how the support should be manifest and
communicated to employees
Unit Supervisor Questionnaire
 Unit Supervisors – small group
 16 questions
 Sample questions:
–
–
–
–
–
Requires each manager to help improve H&S in his/her work unit.
Invests a lot of time and money in H&S training for workers.
Uses any available information to improve existing H&S rules.
Listens carefully to workers' ideas about improving H&S.
Considers H&S when setting work assignment schedules.
Employee Questionnaire – Management Attitudes
 Same 16 items about top management – provides a direct comparison with
unit supervisor attitudes
 16 items about direct supervisor support of health and safety
 Sample items:
–
–
–
–
–
–
Frequently checks to see if we are all obeying the H&S rules.
Discusses how to improve H&S with us.
Uses explanations (not just compliance) to get us to act in a safe and healthful manner.
Emphasizes H&S procedures when we are working under pressure.
Frequently tells us about hazards in our work environment.
Pays attention to H&S rules even when work falls behind schedule.
 Other scales – discussed later
Summary of RHA Data Collection Process
RHA
Date of Administration of
Survey
Assiniboine
January-February, 2011
Brandon
October-Nov, 2010
Burntwood
January-February, 2011
Central
May-June, 2011
Churchill
November, 2010
Interlake
November, 2010
NOR-MAN
May, 2011
N Eastman
November, 2010
Parkland
April, 2011
S. Eastman
March-April, 2011 (mail
survey)
Winnipeg
February-April, 2011
Sample Characteristics




88% female
79% married/partnered
.82 Average number of work related injuries
5.3 average days of absence due to work injuries
RHAs and Response Numbers
RHA
Response
%
Assiniboine
271
12.5%
Burntwood
123
5.7%
Central
98
4.5%
Churchill
13
.6%
Interlake
175
8.1%
North Eastman
56
2.6%
Parkland
103
4.8%
South Eastman
319
14.7%
Brandon
343
15.8%
Winnipeg
559
25.8%
Total
2165
100%
#
Job Categories
Response
1
2
3
4
5
6
Aide: physio/rehabilitation
Health Care Aide
LPN
Nurse
Nurse Specialist/practitioner
Recreation/pastoral care
15
186
87
431
40
32
.7%
8.6%
4%
19.9%
1.8%
1.5%
7
Therapist: occupational/physio/respiratory/speech
148
6.8%
8
9
10
11
Mental health/social worker
Unit supervisor
Senior/Middle manager
Other (please specify)*:
12 Admin Position - Patient Contact
13 Admin Position - Management
14 - Admin Position - Staff Support
15 - Skilled - Non-medical
16 - Skilled - Medical
17 - Home care
18 - Pharmacist
11 - Unclear
Total
137
56
200
837 (46%)
6.3%
2.6%
9.2%
2169
Other Subcategories
164
116
243
77
98
42
37
60
837
* The study was expanded to a broader set of employees. The following job categories were the additional
participants surveyed.
%
7.6%
5.3%
11.2%
3.5%
4.5%
1.9%
1.7%
2.8%
100%
Age Distribution of Sample
20
18
16
14
12
10
8
6
4
2
0
<25
26-30 31-35 36-40 41-45 46-50 51-55 56-60 61-65
>65
Highest Level of Education
40
35
30
25
20
15
10
5
0
Tenure Distribution of Sample
25
20
15
10
5
0
Job tenure
Facility tenure
Healthcare Experience
Self-Reported Workplace Injuries
70
60
50
40
30
20
10
0
zero
1
2
3
4
5 or more
Senior/Middle Manager attitudes
 Emphasized the importance of a focus on employee health and
safety;
 Expressed the need for Senior/Middle managers to be engaged
in H&S activities;
 Shared attitudes about effective improvement of the health and
safety environment;
 Identified opinions about the prospects of eliminating health and
safety issues within healthcare environments;
 Highlighted positive benefits from improved safety and health.
Views from Unit Supervisors about Top Management
Support of Health and Safety
 The most positive attitudes were
–
–
–
–
–
Top management's requirement for managers to improve the H&S of their units
Use of available information to improve H&S rules
Quick responses to H&S issues/problems
Emphasis on continuous improvement
Attempts to gather ideas from employees about how to improve H&S and other areas.
 The average responses to the questions about top management support for
health and safety were above 3.5 (out of 5) for 12 of the 16 items.
 Total scale average Top Management Support of Health and Safety. The
average score on the scale was 3.65.
Views from Employees about Top Management
Support of Health and Safety
 Employee attitudes were generally less positive than direct supervisors were
about Top Management Support of Health and Safety
 Employees most positive responses were that
–
–
–
–
–
Top management requires managers to improve health and safety within their work units
Use available information to improve existing H&S rules
Reacts quickly to solve the problem when told about H&S hazards
Provides the necessary H&S equipment for healthcare workers
The averages of the responses are just over the midpoint of the scale and hover at the midpoint for the direct care workers.
The lowest rating was on whether top management regularly hold H&S
awareness events (e.g. presentations, ceremonies). These data from
employees would question whether top management's intended messages
about their health and safety priorities have been effectively communicated to
employees.
 Overall, the non-supervisor employees view top management support of health
and safety slightly above the midpoint on the scale

Views from Employees about Direct Supervisor
Support of Health and Safety
 Employee attitudes are less positive (statistically significant) about Direct
Supervisor support of health and safety than of top management
 Employees most positive responses were that
– Direct supervisors' insist that H&S rules are followed when dealing with patients
– Overall, the total scale resulted in an average at the midpoint for both groups
– These data suggest that as a group, the direct supervisors are perceived to provide modest
support to employee health and safety issues.
Management and Supervisor Attitudes
 Management and Supervisor Attitudes about
Health and Safety are related to employee:
–
–
–
–
–
–
–
–
Commitment to remain in the organization
Affective Commitment
Job satisfaction
Intention to leave
Psychosomatic complaints
Self reported health
Self reported absences
Workplace injuries
Health and Safety Climate
 Health and safety climate (job, coworker and
program), in particular views about job safety
and the safety program are related to:
–
–
–
–
–
–
–
Affective Commitment (job and program)
Job satisfaction (job and program)
Intention to Stay (program)
Psychosomatic complaints (job)
Self reported health (job)
Self reported absences (program)
Workplace injuries (job)
Summary of Key Attitudes from the Strategic
Leadership Questionnaire





Improved communication and support from top management for the positive development
of health and safety policies and practices for employees. Suggestive in the responses and
as evident in the research literature, the health and safety of patients and employees within the
healthcare sector are interdependent. Positive practices in one domain tend to reinforce positive
practices in the other.
Top managers and supervisors who are engaged in the development of a positive health
and safety program and climate are related to more positive employee health and safety
outcomes. Engagement involves the setting of policies, the inclusion of health and safety
information in top management meetings, the visibility and support of health and safety initiatives,
inclusion of health and safety performance of units in managerial performance appraisals are
examples of strategies that can improve health and safety performance.
Managers recognize that while health and safety incurs costs, there are also significant
returns in declines in accident, injury and illness rates, as well as, in positive impacts on
the work environment. What can and should be done to better document these relationships?
Dispersed responsibility with positive health and safety attitudes and behaviours generally
lead to the most positive returns (according to the research literature).
Accidents and injuries are not primarily chance events. Managers who view the health and
safety environment as one where actions and behaviours can reduce hazards and risks will tend
to focus on controllable threats to health and safety.
Recommended Actions
 Summarize the results of the study findings for different groups of health care
providers and employees working in health care settings. These groups should
include senior and middle managers, health care professionals and support
personnel.
 Dissemination of the managerial implications of the results through various
practitioner journals, including various RHA publications.
 Presentation of the results to various audiences to encourage dialogue and
discussion, such as SAFE Healthcare conference in Manitoba.
 Development of more health and safety climate training modules/tools/materials
for online, continuing education use for medical professionals.
 Provide information for web portals for different provincial healthcare websites
related to safety climate information in health care.
 Increase the academic knowledge of health and safety climate in health care by
dissemination of the results in academic journals and at professional conferences.