“Establishing a Safety Culture in a Health Care
Environment”
Brian K. Henckel, M.S., C.H.S.P.
Risk Control Services Director
Old Republic Insurance Company
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Purpose of today’s
presentation:
 Introduce concepts of developing a consistent,
permanent, safety culture at your health care
facility
 Concepts go above and beyond existing safety
policies and procedures
 Introduce the “Wheel of Safety”
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What makes a defined Safety
Culture?
 Organization’s thought process- “work related
incidents are avoidable and preventable”
 Day to day management of Safety Program
supports behaviors that lead to “Zero” Incidents
MAIN GOAL: Send all employees home safely each
day!
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Why a zero incident thought process
at your organization?
 If you’re planning for accidents, they will occur
 Change culture to reflect desired outcomes and
behaviors that support long term reduction of
losses
 Reduce Worker’s Compensation premiums and
losses
 Results can lead to better employee morale
throughout the organization
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Financial Impact:
 XYZ Co. Worker’s Compensation losses over last
three years total $1,650,490.00
 At a 6.5% profit margin, what would it take in gross
sales to cover that amount of losses?
$25,392.169.23
(This does not include future experience modification impact or
Indirect Losses (3-4 Times Direct Costs…..)
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NCCI March 2011
What are basic the basic
principles of a zero incident
safety culture?
 Employee safety is as vital to the organization as
patient/resident care (with equal regard)
 Upper Management sets the tone for the culture
change, supporting “Wheel of Safety” concepts
 Mission statement for the organization includes
employee safety (not often seen for hospitals)
 Management assigns safety coordinators to each
location to help enhance cultural change
 Employee safety is not “compartmentalized”
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Ensuring Long Term
Success
 Ownership (Board Members) agrees with the
concept of a zero incident thought process and
supports the program financially
 Ownership (Board Members) holds Upper
Management accountable for successes and
failures
 Management establishes key goals and
accountabilities for the entire organization for
safety
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Ensuring Long Term
Success (con’t)
 Middle Management holds line supervision
accountable for day to day safety
 Safety is part of employees annual review
(considered for pay increases and promotions)
 “Micro-Manage” the Safety Program and Claims-
especially post accident procedures, such as,
transitional return to work, doctor’s visit etc.
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How do we change
culture?
(It takes everyone….)
 Management agrees that there is an ongoing
cultural issue that is driving losses
 Management agrees and commits to implementing
“Wheel of Safety” strategies
 Implement aggressive “initiatives” for those who
do not support nor buy into safety related concepts
 Management must lead by example and
continually assess the morale of the organization
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Human Resources
Employee Retention
 The most important single factor in safety is the
characteristics of the employees that you are hiring
at each facility. Controlling turnover is a key factor
in reducing organization costs including W.C.
Claims
 Vigilance towards solid background checks, license
verification, etc….
 Creative retention rewards for hiring incentive and prolonged
service
 Creating a safe environment also builds morale which can
ultimately reduce turnover
 Strongly encourage health and wellness during employment
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Safety Culture
Implementation Tool
”Wheel of Safety”
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“Wheel of Safety” Concepts
 Based upon the concept of any wheel
having “spokes” and an “axle”
 Management is the “axle”
that drives the wheel
 Safety directives are the spokes that are
added to the wheel to make it turn
efficiently. The more spokes added to the
wheel, the better it turns and the effect on
implementing a culture of safety at your
facility
 Spokes are color coded by priority level
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"WHEEL OF SAFETY"
Prioritizing the Spokes
Blue Zone
Red Zone
AXLE
Green Zone
Prioritizing the Spokes of
the “Wheel”
 Red Zone- Essential for safety program
success
 Green Zone- Highly recommended
 Blue Zone- Above and beyond the
average- striving for excellence
“THE AXLE”
(Management)
 Visible and active Senior Management
leadership ie. “Lead by Example”
 Allocate the proper financial resources for
success
 Assign one individual to coordinate safety
efforts
 Hold supervisors and staff accountable for
defined safety responsibilities
 Encourage employee involvement and
participation in safety related activities
“THE AXLE”- (con’t)
 Establish a written safety program
 Establish short and long term goals, striving
towards the elimination of all accidents
 Schedule ongoing safety performance reviews
 Participate regularly in Safety Committee/Team
meetings
 Accompany employees on location safety
inspections.
“RED ZONE”- Essential
 Management Accountability
 Staff member involvement and recognition
 Communication of safe work practices
 OSHA Reg’s- general orientation & training
 Claim’s Management- accident investigation
 Medical treatment & transitional return to work
 Facilities Management
 Enforcement of safety policies
 Record keeping & data analysis
Accountability-(Supervisor
Specific)
 Develop Supervisory Accountabilities (Department
Specific) based on the following areas:
 New Employee Orientation
 Safety Policy Enforcement
 Departmental Safety Inspections
 Departmental Safety Training/Re-Training
 Accident Investigations
*** These are quantifiable areas to be addressed at
the Supervisors formal performance review.
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Employee Involvement &
Recognition
 Allow staff members the ability to voice their
opinions concerning safety in an “open door”
atmosphere
 Allow for participation in annual safety audits.
 Provide positive reinforcement for safe
acts/usable suggestions and discipline for
unsafe acts, if needed
 Allow staff members to participate in accident
investigations
Communication
 Quarterly written and/or verbal feedback to all
staff members concerning accident data/trends
 Department Managers should provide monthly
refresher “lunch box” sessions on safety topics
 Tools- General Safety, memo’s, bulletin boards,
pay check stuffers, etc.
 Possible anonymous “direct line” system
 Conduct employee perception surveys
 Non verbal communication- Mgmt should,again
“Lead by example”
OSHA Required
Orientation & Training
 All new hires and departmental transfers should be
trained before performing job tasks (Hazard
Communication)
 OSHA compliance programs normally have
training requirements:

Hazard Communication, Blood borne Pathogens, ,
Emergency Evacuation, Respiratory Prot., Personal
Protective Equipment
Claims ManagementAccident Investigation
 Employees are responsible to report claims
immediately to their direct supervisor and
receive the proper medical treatment
 **IMPLEMENT- transitional return to work
or light duty for all injuries per physicians
restrictions
 Communication follow-up is imperative with
treating physician
 Investigate all accidents timely and implement
corrective actions
Facilities Management
 Provide safe physical working conditions for all
employees
 Defined snow and ice removal plan in place
(Prevention of Slip, trip and Falls)
 Emergency evacuation and “worst case scenario”
planning
 Effective housekeeping plan in place
Enforcement
 Core safety policies and procedures should be
enforced uniformly
 Progressive discipline action for safety related
infractions is necessary for consistency in the
organization
 A defined list of Top Ten: most frequent violations
should be communicated repeatedly on an ongoing
basis in an attempt to modify behavior
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Recordkeeping & Data
Analysis
 OSHA requirement- 300 Log, 300A
 Analysis & trending should be completed by
management and communicated to employees
 Data should be reviewed at safety meetings and
departmental meetings as well
 Incident Rates/DART Rates and experience
modification factor should be calculated and
compared to others in same class
Green Zone- Highly
Recommended
 Implement a formal written drug & alcohol
testing program- consider pre-employment,
post-accident & reasonable suspicion
 Implement a safety committee and meet at
least monthly; cover old business, past
accidents/trending & work place inspections
 Conduct an ergonomic analysis of your
workplace, including, developing a formal
Safety Patient/Resident Handling Program
GREEN ZONE- (con’t)
 Create/implement specific preventative
maintenance procedures for patient/resident lifts
 Create separate sub-committees to analyze
specific safety issues (i.e. Safe Patient/Resident
Handling Committee)
 Establish Job Safety Analyses for each job title
 Implement a facility wide Health and Wellness
Program (most important issue of the day)
BLUE ZONE
“Striving for Excellence”
 Formal written Safety Recognition Program
that ties rewards to safe behaviors, ie. Safety
Bingo, Safety Football.
 Supervisor Accountability Programs- Safety
is built into annual performance appraisals- can
affect % of salary increase- (tied to accident
investigations, safety policy enforcement,
safety training, departmental safety audits &
participation in plant wide safety committee
meetings)
BLUE ZONE
“Striving for Excellence” (con't)
 Charge back system in place for either locations
or departments to pay direct costs associated with
W.C. Losses
 Accident Repeater Program implemented for
those who have multiple accidents over a specific
period of time
 Each departmental meeting starts with safety
 Celebrate Successes- impromptu rewards for
accomplishment's or goals obtained
Post Accident Re-Training &
Education
 Any employee experiencing an accident will be
retrained in some fashion
 Post accident retraining will be completed each
and every time an employee has an accident


Example: if there was an issue due to improper
repositioning, that employee will be asked to watch a DVD
on proper repositioning each time the accident occurs- at
the departmental level
Physical Therapy should also be involved in retraining for
all Strains and Sprains associated with Patient/Resident
Transfer or lifting in general
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Re-Training & Education
(con’t)
 Train-the-Trainer is a very effective form of ongoing
training for those conducting training with the
organization
 Anyone with significant injury (lost time) would need
to attend a safety committee meeting within a six
month time frame after the accident


They could share why the accident occurred in their mind
and state what changes they are making to ensure that the
accident does not happen again
They can suggest changes in the environment that would
help lead to the reduction of work related accidents
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SUMMARY
 Cultural change within an organization can be
accomplished
 If you are not controlling Workers Compensation costs,
then they are controlling your organization
 It takes management commitment to implement the
concepts that have been presented today
 Full implementation of the concepts outlined in this
presentation is necessary for the best chance at
success- (Add those Spokes to the Wheel)
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Thank You Very Much!!!!!!!!!!!
ANY QUESTIONS ????
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West Virginia Drug Testing Law
and Regulation- Summary
 It is unlawful in West Virginia to require an employee or job
applicant to pay for medical examinations required by the employer
as a condition of employment. Employers in violation of this
provision shall be penalized for every instance.
 State contractors working on public improvement projects are
required to have a drug or alcohol testing program for their
employees, paid for by the contractor/employer.
 A state Supreme Court decision prohibited random drug testing by
a private employer in West Virginia. However, random testing is
permitted for employees of State contractors, for a period of one year
after previously testing positive or caught adulterating test results, as
par of appropriate disciplinary measures in accordance with a written
drug-free workplace policy.
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WV Drug Testing Laws (con’t)
 Prospective employers for correctional facilities in West Virginia are required
to pass a pre-employment drug screening prior to being hired.
 Employees may not be entitled to receive Worker’s Compensation
benefits for work related injures or death caused by intoxication of the
employee. For this purpose, the employer may require post-accident
blood testing for the presence of intoxicants based upon reasonable
and good faith suspicion.
 Similarly, employees terminated for misconduct, which includes being
intoxicated while a work of being under the influence of any controlled
substance while at work, are disqualified from receiving unemployment
benefits.
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