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
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Introduction
Paul O'Neill,
72nd Secretary of the
U.S. Treasury
Aligning Patient and
Workforce Safety
David Michaels, PhD, MPH
Assistant Secretary of Labor
for Occupational Safety and Health
Healthcare Is Not a Safe Industry
for Its Workforce
• Patient lifting/
repositioning
• Needlesticks
• Violence
• Exposure to
chemicals
• Unique challenges
We All Pay the Price
 Worker’s compensation costs
 Treating patient injuries, too
 Overtime, temporary staffing
 Turnover, recruiting, retraining
 Productivity and morale
Connecting Patient and
Workforce Safety
 Synergies
 Challenges
 Similar approaches
can help
– Management systems
– Culture of safety
 Worker safety
improves patient
safety
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
Injury and Illness
Prevention Programs
Dorothy Dougherty,
OSHA Directorate of Standards
and Guidance
Injury and Illness Prevention
Programs*
 Management system approach applied
to occupational safety and health
(Plan-Do-Check-Act)
 Proactive: employers and workers find
and 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
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
Six Core Elements of I2P2
1. Management leadership
–
Set policy, establish goals, provide resources
–
Lead by example, be visible on safety issues
2. Employee participation
–
Build trust, engage workers, spread responsibility
–
“Few resist their own ideas”
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.
Six Core Elements of I2P2
Continued
3. Hazard identification
–
Baseline inventory of hazards
–
Mechanisms to ensure ongoing assessment
4. Hazard prevention and control
–
Identify, evaluate, and assess feasible options to
eliminate, reduce, or control hazards
–
Monitor and evaluate effectiveness of controls
Six Core Elements of I2P2
Continued
5. Education and training
–
Understand the basics of the I2P2 and how to participate
–
Identifying, reporting, and controlling hazards
–
Unique safety competencies
6. Program evaluation and improvement
–
Is the program meeting its goals?
–
Are established procedures being followed?
–
Make any necessary adjustments using a corrective action
process
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%
A Request for the HENs:
1. Please read the OSHA White Paper on Injury and
Illness Prevention Programs:
http://www.osha.gov/dsg/InjuryIllnessPreventionProgramsWhitePaper.html
2. Please visit the OSHA web page for healthcare
workers: http://www.osha.gov/SLTC/healthcarefacilities/index.html
3. Please share these materials with the hospitals in your
network.
What Are We Hearing?
Mitzi Ressmann, Texas
Hospital Association
Tania Daniels,
Minnesota Hospital
Association
Rosalie Weakland,
Ohio Hospital
Association
Lynda Martin,
Hospital & Healthcare
System of Pennsylvania
Monica Barrington,
Premier
Wendy Goshert,
Ascension
Pursuing a Culture of Safety
OSHA/CMS Pacing Event
Bob Williamson
Director, Associate Safety
Ascension Health
March 18, 2013
“Every 54 minutes
an Ascension
Health Associate
sustains a work
related injury or
illness.”
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A Single Approach to Safety
20
Interventions for a
Comprehensive
Solution for Associate Safety
21
VPP Pilot Sites
• University Medical
Center Brackenridge
Austin, TX
• Baptist Hospital
Nashville, TN
• St. Vincent’s
Medical Center
Bridgeport, CT
22
University Medical
Center Brackenridge
Common Safety Behaviors for Patient & Worker Safety
March 18, 2013
Kristina Walker, Sally Pawsat
© Seton Healthcare Family
1
Patient & Worker Safety Injury Trends
© Seton Healthcare Family
9
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
© Seton Healthcare Family
3
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
© Seton Healthcare Family
4
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
© Seton Healthcare Family
6
Error/Injury Prevention Model
Focus Areas
UMCB Injury DRAFT
Prevention Model
Culture
Perceptions
Beliefs
Perception Surveys
Intentional Rounding
Feedback/Comment
Cards
·
Activities
·
·
·
Measurements
·
Metrics· Observations
· Survey Results
© Seton Healthcare Family
Physical
Conditions
Systems
High Reliability
· Commitment to
Resilience
· Deference to
Experience
· Preoccupation
with failure
· Sensitivity to
Operations
· Reluctance to
Simplify
Accreditations
· Joint Commission
· Magnet
· Chest Pain
· Stroke/Spine
· VPP/SHMS
Metrics· Mock Surveys/
Tracers
· Self Assessments
·
·
·
·
·
EOC Rounds
Quarterly Area
Inspections
Preventive
Maintenance
Medical Equipment
Management
Life Safety
Behavior
Involvement
·
·
·
·
·
·
·
·
·
·
·
Metrics· Round/Inspection
completion
· Corrective Action
Completion
Good Catches
Behavior
Observations
Peer Coaching/Peer
Checking
Hand off
Rounding
Safety Coaches
Fall Champions
Safe Patient Handling
(SPHR)
Daily Brief
Training/
Competencies
Education Fairs
Metrics· Observations
· Participation
Incident
Error
·
·
·
SERTs (Serious
Event Review)
RCATs (Root Cause
Analysis
72 hour event follow
up
Metrics· Serious Event Rate
· TCIR
· DART
· Falls
· Readmission Rate
· Core Measures
Saint Thomas Health
Patient Mobilization Program
David Wheeler, System Safety Officer,
Emergency Preparedness Coordinator, St.
Thomas Health
Amy Williamson, VPP Project Coordinator, St.
Thomas Health
BH Patient Handling Injuries
2008-2012
Facility
Injuries
Days Lost
Days
Restricted
Total
Replacement
Labor Cost*
Total Cost of
Claim
2008
39
127
1,563
$419,796
$247,021
2009
30
150
1,432
$392,969
$197,474
2010
18
175
678
$211,885
$697,336
2011
10
47
237
$70,546
$242,633
2012
21
152
139
$72,284
$145,460
TOTALS
118
651
4,049
$1,167,480
$1,529,923
$2,697,403
*Average Labor cost based on Average
RN & PCT wages, working 12-hour shifts
(does not include overtime)
BH Patient Admission Weights
2010
2011
35
40
300-499 lb
2,248
2,677
200-299 lb
19,939
23,778
Total Admissions
67,481
78,913
500+ lb
 NIOSH (National Institute of Occupational Safety and Health)
Safe lifting limit for healthcare workers is 35 pounds.
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
Risk Tool/Equipment Tags
 Risk Tool
 Label/tag all portable
equipment
Patient Benefits…
 Improve patient mobilization
 Reduced skin breakdown related to
shearing forces
 Decrease patient falls
 Shorten length of stay
St. Vincent’s Medical Center, Bridgeport CT
Joe Laveneziana
Exec. Director Safety, Security and Facilities
Joanne Velardi
Exec. Director Occupational Health, Wellness and
Rehabilitation





Senior Leadership Commitment
“Walk the Talk”
High
Reliability
Safety Trumps All
Flatten the Hierarchy
Reward
Define the Culture
and
Recognize
Safety First
Just
Culture
Reluctance
to Simplify
BEHAVIORS
I commit to...
ERROR PREVENTION TOOLS:
T Think twice
•Use S.T.A.R. (Stop, Think, Act, Review)
R Recognize and
•Publicly celebrate and recognize on-the-spot
reward
U Utilize each
other
S Speak up for
safety
T Teamwork
•Include patients and families
•Validate and Verify (trust your instincts)
•Practice peer checking and peer coaching
•Use SBAR (Situation, Background, Assessment,
Recommendation)
•Use CUSS (“I’m Concerned; I’m Uncomfortable; This
is a Safety issue; We need to Stop”)
•Practice 200% accountability (know and follow
policies and advocate for compliance)
•Stop and Resolve when unsure or concerned
•Use direct (person-to-person) communication
TRUST. VINCENT’S





Behavioral
Expectations
Transparency
SBAR Communication
Safety Huddles
Reporting Tools





Risk Assessment
Gap Analysis
Cause Analysis Review
Policies and Procedures
Protocols










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!
“I start with the premise that the function
of leadership is to produce more leaders,
not more followers.”
Ralph Nader
41
41
Questions
Bob Williamson
Director, Associate Safety
Ascension Health
(Office) 989.781.8842 (Cell) 989.714.1109
rwilliamson@ascensionhealth.org
Summary
Tom Jackson
National Content Developer
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
Upcoming Events
(Tentative)
DATE
3/19/13
3/25/13
4/1/13
4/8/13
4/9/13
4/15/13
4/22/13
4/23/13
4/29/13
Key
Campaign Events
Topical Events
Hospital Events
Time (EST)
3:00-4:30
3:00-4:00
4:00-5:00
4:00-5:00
3:00-4:30
NCD Pacing Event/Affinity Group Meeting
Medication Safety Affinity Group Meeting with Rural Affinity Group and Readmissions Affinity Group
Campaign Event – Formative Evaluation HEN Reports
Product Safety and Resource Management Affinity Group Meeting
Patient and Family Engagement Affinity Group Meeting
Hospital Event: Preventing Medication Related Readmissions - No breakouts possible with 5,000
hospital event.
3:00-4:00
4:00-5:00
4:00-5:00
12:00-1:00
3:00-4:00
4:00-5:00
3:00-4:00
4:00-5:00
4:00-5:00
3:00-4:30
3:00-4:00
4:00-5:00
4:00-5:00
Campaign Event –
Rural Affinity Group Meeting
Procedural Harm Affinity Group Meeting
Harm Across Board Affinity Group Meeting
Campaign Event Maternal Health Affinity Group Meeting
Campaign Event Product Safety and Resource Management Affinity Group Meeting
Patient and Family Engagement Affinity Group Meeting
Medication Safety Affinity Group Meeting
Campaign Event Readmissions Affinity Group Meeting
Provider Affinity Group Meeting
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.
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