Ntombizomonde HEALTH CARE SOLUTIONS Presenter Dr. Nomonde Mabuya MBBCH,MBA,DOH,Bsc. Hons Aerospace medicine & Travel Medicine, CIME The Symbiotic Relationship Healthy Organization • Healthy People The health of the organization drives the health of the workforce and the health of the workforce drives the health of the organization. Business case for change Change management- human rights case and equity case. • Changing employee mindset • Poor health and safety environments at the various Hhealth care facilities for female staff • Changing organizational mindset and NHI readiness environment • Rising medical litigation costs • Increasing workplace OHS awareness • High medical costs • Skills flight , • Retention and Talent management Recruitment and Selection(1) Recruitment • Recruitment procedure to focus on inherent job requirements. • Advertisement should be accesible Selection • Focus on essential functions of the job. • Same selection criteria to be used for all applicants • Selection process should determine whether applicant is suitably qualified • Information about disability may not be asked Terms and conditions of employment • Terms and conditions of employment to be the same as other employees Laws governing Occupational Health Interventions @ the workplace • • • • • • • Constitution Act EEA in 1998 BCEA OHSA LRA COIDA MHSA Relevant Legislation • • • • • OHSA: fitness to work outlined within the regulations of this Act ( Noise, Lead,HCS, HBA etc) LRA: regulates unfair dismissals/unfair labour practices +incapacity/disabled employees EEA: unfair discrimination at work and against the disabled, AA,medical testing BCEA: Night work/shift work and fitness for work (OREP +medical surveillance done (WASP) RTA: Medical fitness to drive company cars/forklift/crane operator Constitution Chapter 2: • Right to privacy • Right to fair Labour practices • Right not be discriminated • (Right to privacy) Is not obsolute,but governed by prescriptions of other Acts, e.g. OHSA, • Health Act(Notifieable diseases)Birth and Death Registration Act. Employment Equity ACT • Code of good practice: key aspects of disability in the workplace • Unfair discrimination • Reasonable accommodation • Confidentiality and Disclosure • Employment benefits EEA • No unfair discrimination due to health status/disability • No enforced medical examinations unless justifiable on medical facts, employment conditions, inherent requirements of tasks or prescribed by law. • Equal access to employee benefits • Applicants for jobs considered the same as incumbents. • coGP: Guideline in the management of people with Disabilities in the workplace: (CCMA,will use code to evaluate procedural fairness of the process followed) BCEA • Protecting the health of pregnant and breast-feeding employees • Section 26 (1) of the BCEA prohibits employers from requiring or permitting a pregnant employee or an employee who is breast-feeding to perform work • that is hazardous to the health of the employee or the health of her child. • This requires employers who employ women of childbearing age to • assess and control risks to the health of pregnant or breastfeeding employees • and that of the fetus or child. • • RESPONSIBILITIES OF THE EMPLOYER • 1.The employer must do the following: • Conduct a risk assessment, which involves identifying hazards. This will include hazards • to the pregnancy or while breast-feeding. • • Implement appropriate measures to eliminate or control the hazards identified. • • Inform employees about the hazards in the workplace. • • Make adjustments to the employees’ current tasks or accommodate them in different posts if the workplace poses a risk to pregnancy or breast-feeding. Notify Occupational Health immediately of the pregnancy of all employees – Who are on medical-surveillance programs; Whose own health or the health of the unborn child may possibly be adversely affected By their work; and Who have any pregnancy or post-delivery complications. RESPONSIBILITIES OF THE EMPLOYEE The employee must do the following: Take reasonable steps to protect her health and safety and that of the unborn child and other employees. Notify the employer as early as possible of the pregnancy. .Some of the well-researched Pregnancy and health effects on theater employees include the following: Early Fetal loss or miscarriages due to excessive exposure to hazardous gases Pre-term labor Small birth weight babies Intra-uterine Growth retardation Still births Congenital malformations High frequency hearing loss OSHA • • • • OH risks identified OH risks managed Employees must be trained in OH risks Risk driven medical surveillance to detect early ill health effects • Measure effectiveness of risk control measures • Reporting of results and trends Employer Costs • Direct costs For an employer the -costs can include: • lost working time • loss of trained and experienced staff • payment for sickness absence • payment for replacement staff and their training • compensation awards. Indirect costs • • • • • • • • Training and development Production loss Workman’s compensation payments and levies Medical aid contributions Disability fund contributions Pension fund contributions Reputational damage CCMA high case loads Fitness-to-Work Knowledge and understanding Of the job is it relates to health Knowledge and understanding of the employee’s health Working Conditions Medical Findings + + Health Standards Clinical Opinion Judgment of Fitness-to-Work at a Specific Job Health Requirements Job Categories & Risk Lo w Liable Occupations Critical Occupations General Occupations High Risk Occupations Exposure Risk High Role in Injury on Duty management Employee injured Supervisor complete WCL2 Receives first aid on site Supervisor gives WCL2 to service provider and send WCL2 to Regional COID Administrator Supervisor arrange for transfer to hospital or doctor COID Administrator •Manage COID reporting •Notifies Ntombizomonde Dr / Hospital treat employee and schedule follow up examinations Ntombizomonde Health Care Solutions: •Coordinate early return to work •Evaluate fitness to return to work •Case management •NO TREATMENT/Prescriptions given Role in Occupational Disease management Employee possible OD Obtain exposure data OMP diagnose Occupational disease OMP report to COID administrator Incident analysis Employee identified with possible disease Need exposure data to determine work relatedness COID Administrator •Manage COID reporting •Notifies Ntombizomonde Ntombizomonde Health Care Solutions: •Notify COID administrator •Coordinate early return to work •Evaluate fitness to return to work •Case management Issues to be covered in Workplace Policies and programs • • • • • • • • • • • • Recruitment and Selection Medical and Psychological testing Immunization policy Good infection control practices Reasonable accommodation for pregnant females & their appropriate Placement Training and career development Retaining People with disabilities Health and safety policy & Facilities security measures Worker’s compensation Confidentiality and disclosure of medical information Employee benefits Record keeping OHS Services Health and Wellness Primary Health care Case management of: • Chronic diseases • Medical aid • Specialist referral • Patient Curative care • Health profile of organisation Occupational health Occupational medicine Occupational hygiene Utilise occupational Hygiene information for risk based medical surveillance program Emergency preparedness and response • • • • • • • • • • • • Risk Assessment Job specifications Medical Surveillance Biological monitoring Corrective and preventive actions Inspections Incident analysis Injury on duty and occupational disease management Training Medical incapacity management Absenteeism Executive health Integrate with: • Emergency • First aid /Ambulance services • Evacuation services Wellness Integrate with: • Employee assistance programmes • Stress management • Trauma management • Drug and alcohol abuse • Chronic disease management • HIV/Aids management • Lifestyle diseases • Tuberculosis prevention • Health promotion • Voluntary Screening • Wellness campaigns • Wellness score card Advantages of OHS on site Reduced staff turnover and the retention of valued staff. • Reduction of recruitment, training and induction costs. • Helps to promote job satisfaction and enhances work relationships • Reduces potential injuries and acquired occupational diseases. • Increases quality service delivery and productivity • It promotes employee’s loyalty to the organization • It assists in reducing absenteeism and excessive sick leave • Reduces temporary or permanent loss of employees • Assists in rehabilitation of the injured or sick employee into the workplace • The promotion of employee’s morale. • It assists in the prevention of too much time away from the workplace through utilization of the on-site service. • On-site care and counseling provides for legal requirements. • Reducing medical expenses and legal claims. Health Assessments interface with other health programs Types of medical examinations Pre-employment / Initial Periodic / Transfer / Post illness/ Post absenteeism Exit medical Health assessments supporting fitness for duty of HCW & Females safety workers Fitness for duty Initial recruitment Assess initial Fitness for Duty Periodic Health Assessment Supported identification of physical and psychological health issues likely to affect safety Triggered Health Assessment Achieves early intervention and appropriate management of health problems likely to affect safety. Triggers include: •Scheduled review assessments •Prolonged or recurrent sick leave pattern •Traumatic workplace incidents •Reports from peers/supervisors •At request of worker Service delivery methods Mobiles Clinics Satellite Clinics Fixed Clinics Types of Workplace hazards • Biological hazards e.g TB, Hep B,HIV and AIDS Ebola, • Chemical hazards e.g: theatre staff hazardous gases and drugs that can lead to reproductive toxicity, birth defects, miscarriages, still births • Ergonomics- lifting, pulling, awkward positions, climbing mainly lead to Musculoskeletal problems • Physical hazards; Radiation, ionizing and non ionizing radiation. Noise • Security of Health care facilities: e.g Rape cases and night wok • Psychological e.g shift work & long working hours, night work, long working hours • Fumes and gases • Tripping and slipping hazards Job profiles with exposure to hazardous drugs • Laboratory workers • Pharmacists and pharmacy technicians • Nurses • Doctors and their assistants • Home health care workers • Theatre staff • Veterinarians &Veterinary Technicians • Environmental service staff( support staff) e.g laundry,house keeping, maintenance workers. • Ambulance doctors & evacuation teams Exposure to hazardous drugs and chemicals • Skin contact • Inhalation • ingestion or injection Risk based Medical surveillance program • Health questionnaire including- chronic disease and lifestyle disease • Medical history including reproductive history and occupational history. • Physical examination • Vision screening, Spirometry, CXR, audiometry • Biological monitoring- Hep B titres TB, HIV ? • Psychosocial disorders Medical surveillance matrix Standardise Occupational Health File Medical incapacity Injury on duty / occupational diseases Medical examination forms Certiﬁcates of ﬁtness, Exit certiﬁcate Minimum medical requirement Risk proﬁle (O Hygiene) Physical ability requirement Employee risk proﬁle NHS – Risk Register and Management plan On track No. 1 INITIATIV E TARGE T DATE RISK IDENTIFIED Blood borne pathogensHep B HIV TB pandemic flu Annual 85% and 2 Ongoin Psychological hazardsg monotonous work, high work loads 3 Clinic environmental issues such as : OHS clinical poor ergonomic chairs provided hazards by employers, poor air quality at Ongoin g client sites, No air conditioners 4 % COMPLET E Long working hours and high case loads per site due Ongoin poor appointment scheduling at the g clinics 90% STAT US Caution Behind schedule COMMENTS Clinical staff to receive three doses of Hepatitis B vaccinations every 5 years after testing Hep B Titres Pre-employment certificates to be enforced by NHS managemnt COIDA letter of good standing to be displayed at the clinics Keep PEP pack at all clinics Rotate the clinic staff to other clinics Encourage attendance of CPD and SASHON workshops 85% Post contract award- NHS management must insist on Occupationlal hygiene surveys to be done at the Various clinic sites to ensure compliance to Environmental Regulations 80% Enforce clinic appointmnet systems with the regional managers to manage long workinh hours and a high case load Incapacity Cases and ill health cases • Mostly referred by Line managers from all the regions • Sick leave exhausted, chronic disease advise, • Night shift assessment • Accommodation and Work Restrictions advice • Extension of special sick leave cases • Temporary disability benefits and long term disability benefits • Medical boarding • RTW plans post: injury and illness Sick Leave indicators – Sick Absenteeism Rate=Total number of potential working days lost due to sick leave absenteeism. Norm<2% – Absence Frequency Rate=The average number of sick leave incidence per employer within the Company. Average incidents=2-3days – Absence severity Rate=severity of sick leave incidents, and the more serious the illness, the longer the absenteeism. Good marker of the health status of the employees within the Record keeping Auditing OH Services Monitoring performance is a constructive process that offers the opportunity to adjust activities to match changing demands and to ensure that resources are being used to maximum effect. Setting benchmark standards Observing and recording practice Comparing practice against the predetermined benchmarks Drawing conclusions from the comparison Deciding on action to be taken arising from the analysis Implementing the changes Repeating the cycle Live well Champions survey & Wellness weeks : What can be achieved • Great collaboration with 164 champions worldwide was critical to the success of the initiative • Internal health Expertise was leveraged (e.g. core team composed of representatives from Basel, Mannheim, SSF, Indianapolis, Sao Paolo, Rio de Janeiro, Welwyn). • The initiative delivered within budget. • The Initiative was well received by Roche employees across the sites. • The topics and structure of the week was effective. • The Live Well visuals and branding had a great positive impact.