Transcript Document

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
Christopher Lipowski, CRSP
2010
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.

Christopher Lipowski, CRSP
2010
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
Christopher Lipowski, CRSP
2010
A Recipe for Healthcare Failure
Financial 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.
Christopher Lipowski, CRSP
2010
Why a Healthy Healthcare Work Environment is Important
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
Christopher Lipowski, CRSP
2010
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.
Christopher Lipowski, CRSP
2010
 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.
Christopher Lipowski, CRSP
2010
THE HEALTHCARE SAFETY BALANCE
 Healthcare “safety culture” recognizes and
emphasizes the importance of occupational
healthcare provider safety and patient safety
equally.
Christopher Lipowski, CRSP
2010
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.
Christopher Lipowski, CRSP
2010
 To achieve patient care excellence, improving the
quality of occupational health and safety must be a
senior management priority.
Christopher Lipowski, CRSP
2010
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.
Christopher Lipowski, CRSP
2010
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.
Christopher Lipowski, CRSP
2010
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.
Christopher Lipowski, CRSP
2010
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.
Christopher Lipowski, CRSP
2010
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.
Christopher Lipowski, CRSP
2010
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.
Christopher Lipowski, CRSP
2010
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”.
Christopher Lipowski, CRSP
2010
 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 subcommittee.
 Perform objective annual audit of the HSMS to identify
needed improvements and subsequently initiate required
changes in a timely manner.
Christopher Lipowski, CRSP
2010
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.
Christopher Lipowski, CRSP
2010
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.
Christopher Lipowski, CRSP
2010
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.
Christopher Lipowski, CRSP
2010
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.
Christopher Lipowski, CRSP
2010
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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.
Christopher Lipowski, CRSP
2010
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.
Christopher Lipowski, CRSP
2010
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:
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
Christopher Lipowski, CRSP
2010
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.
Christopher Lipowski, CRSP
2010
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.
Christopher Lipowski, CRSP
2010
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.
Christopher Lipowski, CRSP
2010
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.
Christopher Lipowski, CRSP
2010
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.
Christopher Lipowski, CRSP
2010
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.
Christopher Lipowski, CRSP
2010
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
>>>
Christopher Lipowski, CRSP
2010
Occupational Stress Management Program
Provide occupational stress management service that has:
 - stress awareness education
 - stress coping methods training
 - stress counseling
Christopher Lipowski, CRSP
2010
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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.
Christopher Lipowski, CRSP
2010
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.
Christopher Lipowski, CRSP
2010
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.
Christopher Lipowski, CRSP
2010
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 postincident 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.
Christopher Lipowski, CRSP
2010
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, CRSP
Pinnacle Enterprises Canada
[email protected]
http://www.mtpinnacle.com/
Christopher Lipowski, CRSP
2010
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 Guideline
Registered 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 Management
Canadian Standards Association
Creating a Safe and High-Quality Health Care Environment
Patricia 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
Christopher Lipowski, CRSP
2010