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Patient safety and the work environment GUIDELINES FOR IMPROVED PATIENT SAFETY AND A BETTER WORK ENVIRONMENT
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Patient safety and the work environmentGUIDELINES FOR IMPROVED PATIENT SAFETY AND A BETTER WORK ENVIRONMENT
1Patient safety and the work environment
ForewordThese guidelines represent an attempt by the Swedish Association of Local Authorities and Regions to promote greater integration of patient safety and work environment management by describing and illustrating similarities between the two laws regulating these topics. There are clear similarities in the areas of annual monitoring, risk assessments, interventions, action plans, investigations and reporting.
Certain provisions of the Swedish Work Environment Authority Directives, however, do not have any counterpart in the Patient Safety Act – among them are requirements that employers, employees and safety representatives cooperate with each other. The Patient Safety Act, on the other hand, includes a requirement that patients and their families be given the opportunity to participate in patient safety management.
Our hope is that these guidelines will help organisations design high quality, effective and systematic patient safety and work environment management.
Feedback to the organisation and systematic monitoring are the two areas that most frequently need improvement.
Stockholm, February 2016
Agneta Jöhnk Head of the Division of Employer Policy
Hans Karlsson Head of the Division of Health and Human Services
32 Patient safety and the work environment Patient safety and the work environment
Background and purposeCare providers for counties, regions and municipalities, as well as employers and Pactaaffiliated businesses, are responsible for ensuring safe and healthy work environments and a high level of patient safety throughout the healthcare system and related organisations. Systematic, wellfunctioning patient safety and work environment management are the foundation of ensuring patient safety and healthpromoting workplaces.
Systematic patient safety management demands that the care provider plan, manage and monitor the organisation, take all necessary measures to prevent carerelated injuries, investigate incidents that have caused or could have caused such injuries, and write a patient safety report.
Systematic work environment management demands that the employer devise a system for preventing health problems and accidents in the organisation and maintaining a satisfactory work environment in other respects. The employer must allocate work environment duties, ensure the adoption of procedures for risk assessment, take action to minimise risks and monitor the work environment efforts on an annual basis.
”Integration of patient safety and work environment management offers the potential for synergies that contribute to efficiency, holistic approaches and full participation of everyone concerned.”
54 Patient safety and the work environment Patient safety and the work environment
Systematic patient safety and work environment management
The purpose of these guidelines is to promote greater integration of patient safety and work environment management.
Although the two spheres have previously been addressed separately, the laws that govern them exhibit many similarities. Integration of patient safety and work environment management offers the potential for synergies that contribute to efficiency, holistic approaches and full participation of everyone concerned. Such a strategy also provides a more reliable basis for making decisions that affect each of the spheres.
Tips!
> Systematic Work Environment Management (Swedish Work Environment Authority Directives 2001:1)
> Patient Safety Act (Swedish Code of Statutes 2010:659)
The Patient Safety Act stipulates that care providers are to pursue sys tematic patient safety management. Employers are to assume responsibility for the work environment and ensure that the management effort is integral to the activities of the organisation.
Systematic patient safety and work environment management and the Plan, Do, Study, Act cycle.
Integrated management generates synergies.
ActAnnual follow-up monitoringSelf-monitoringAnnual patient safety report
StudyAdopt measuresDraw up action plans
PlanAllocate work environment dutiesAllocate organisational responsibilityfor patient safety
DoRisk assessments/risk analysesInvestigate health problems, accidents, near accidents/exceptionsInvestigate incidents/exceptionsaccInves
Some of the similarities between the requirements to which patient safety and the work environment are subject
Patient safety Work environment
Allocate organisational responsibility Allocate work environment duties
Implement self-monitoring Write a patient safety report
Perform annual monitoring
Perform risk analyses Perform risk assessments
Adopt measures Adopt measures
Draw up action plans Draw up action plans
Investigate incidents or exceptions that have caused or could have caused a care-related injury
Investigate health problems, accidents, near-accidents and exceptions
Report incidents or exceptions that have caused or could have caused a serious care- related injury
Report serious accidents and near-accidents, as well as harmful consequences
76 Patient safety and the work environment Patient safety and the work environment
GuidelinesAllocation of work environment duties and organisational responsibility for patient safety management
WHAT THE LAW SAYS
Pursuant to Chapter 3, Section 9 of the Patient Safety Act (Swedish Code of Statutes 2010:659)The care provider shall document allocation of organisational responsibility for patient safety management.
Pursuant to Section 6 of Systematic Work Environment Management (Swedish Work Environment Authority Directives 2001:1) The employer shall allocate duties throughout the organisation such that one or more managers, supervisors or other employees are delegated the responsi bility for promoting prevention of risks and ensuring a satisfactory work environment.
Address the following questions
Patient safety Yes No
Has organisational responsibility for patient safety been documented in the administrative system?
Work environment
Has allocation of responsibility for work environment duties been documented in the administrative system?
Tips!
> An employer that runs a large organisation must allocate work environment duties among various individuals or positions in order to properly discharge its work environment responsibilities. Patient safety management should be allocated in the same manner. The two responsibilities can be coordinated when it comes to risk assessments, risk analyses, selfmonitoring and other tasks.
> Authority, resources and skills identified in the allocation of duties shall be in reasonable proportion to the patient safety and work environment goals of the organisation.
Risk assessment and analysis
WHAT THE LAW SAYS
Pursuant to Chapter 3, Sections 1-2 of the Patient Safety Act (Swedish Code of States 2010:659)The care provider shall plan, manage and monitor the organisation such that the requirement for satisfactory care pursuant to the Medical Services Act and Dental Services Act is met.
Caregivers shall adopt all measures required to prevent carerelated injuries.
Pursuant to Section 8 of Systematic Work Environment Management (Swedish Work Environment Authority Directives 2001:1)The employer shall regularly review working conditions and assess risks in order to ensure that nobody suffers health problems or accidents at the workplace. When planning changes to the organisation, the employer shall assess any risks of health problems or accidents that may need to be addressed.
The risk assessment shall be documented in writing. The assessment shall specify the risks that have been identified and whether or not they are serious.
Address the following questions
Patient safety Yes No
Have risk analysis procedures been drawn up and adopted?
Have written procedures been adopted for responsibility and methods of documenting risk analyses?
Work environment
Have procedures been adopted for assessing risks at the workplace?
Have written procedures been adopted determining how and where risk assessments are documented?
98 Patient safety and the work environment Patient safety and the work environment
Tips!
> A strengths, weaknesses, opportunities and threats (SWOT) analysis of the organisation will serve as a useful aid. Such an analysis provides a structured approach to gaining an overview of the current situation and potential for improvement.
> Identifying and minimising risks is important to preventing them from becoming embedded in the organisation. Possible preventive measures may include changes to processes, procedures, work structures and physical premises, as well as coordination among various departments.
> Employees, the safety representative, the patient safety coordinator and/or a nurse with medical authority should participate in the risk assessment and analysis effort.
> A risk analysis or assessment must take both patient safety and the work environment into consideration.
A ward at Mälarsjukhuset Hospital in Sörmland performed a risk analysis prior to adding new beds. The analysis was performed in collaboration with the patient safety and human resource departments. Among the areas of risk identified were stress, skills, cooperation, communication, ergonomics, and needlestick and sharps injuries, as well as availability and design of tools and instruments. Based on the success of the project, the hospital now performs risk analyses from the perspective of patients and employees.
Health problems, accidents, near-accidents, exceptions and incidents that have caused or could have caused a care-related injury
Risk analysis is inte gral to successful management.
WHAT THE LAW SAYS
Pursuant to Chapter 3, Section 3 of the Patient Safety Act (Swedish Code of Statutes 2010:659)The care provider shall investigate incidents in the organisation that have caused or could have caused a carerelated injury. The objectives of the investigation shall be to 1. make every effort to describe the course of events and the factors that affected it 2. provide data for decisions concerning adoption of measures designed to prevent the recurrence of similar incidents or limit the impact of such incidents if they cannot be eliminated entirely
A similar obligation to investigate is incumbent upon anyone who runs anorganisation as specified in Chapter 7, Section 7 with respect to incidents that have caused or could have caused the type of serious injury referred to in Section 6.
Pursuant to Section 9 of Systematic Work Environment Management (Swedish Work Environment Authority Directives 2001:1)In the event that an employee suffers health problems or an accident at the workplace and a serious nearaccident occurs, the employer shall conduct an investigation to determine the cause such that such health problems and accidents will be prevented in the future.
Address the following questions
Patient safety Yes No
Have written procedures been adopted for investigating incidents in the organisation that have caused or could have caused a care-related injury?
Work environment
Have written procedures been adopted to investigate whether employees have suffered health problems or an accident at the workplace and whether a serious near-accident has occurred?
Tips!
> Taking both patient safety and the work environment into consideration may be important when investigating an incident.
1110 Patient safety and the work environment Patient safety and the work environment
Reporting serious accidents and near-accidents, as well as incidents that have caused or could have caused a serious care-related injury
WHAT THE LAW SAYS
Pursuant to Sections 5-7 of the Patient Safety Act (Swedish Code of States 2010:659)Section 5 The care provider shall notify the Health and social care inspectorate (IVO) of incidents that have caused or could have caused a serious carerelated injury. Notification shall be submitted promptly after the incident has occurred.
Along with the notification or shortly thereafter, the care provider shall submit the investigation of the incident required by Section 3, Paragraph 1 to the Health and social care inspectorate (IVO).
Section 6 A care provider or facility as specified in Chapter 7, Section 7 shall promptly notify the Health and social care inspectorate (IVO) concerning the occurrence or risk of occurrence of any serious injury that is not carerelated and that is due to safety hazards.
The care provider or facility shall submit the investigation of the incident required
in Section 3, Paragraph 2 to the Health and social care inspectorate (IVO) along with or shortly after notification.
Section 7 A caregiver shall promptly notify the Health and social care inspectorate (IVO) of any reasonable grounds for believing that a licensed healthcare professional who is affiliated or has been affiliated with the caregiver may be endangering patient safety.
Pursuant to Section 2 of Systematic Work Environment Management (Swedish Work Environment Authority Directives 2001:1)The employer shall promptly notify the Work Environment Authority of any accident or other harmful consequences at the workplace that have caused death or severe personal injury, or that have simultaneously affected more than one employee. The same applies to near accidents that have seriously endangered life or health.
Address the following questions
Patient safety Yes No
Have written procedures been adopted for notifying the Health and social care inspectorate (IVO) of events that have caused or could have caused a serious care-related injury?
Have written procedures been adopted for notifying the Health and social care inspectorate (IVO) when someone has suffered or been at risk of suffering a serious injury that is not care-related but is due to safety hazards?
Have written procedures been adopted for notifying the Health and social care inspectorate (IVO) of a licensed caregiver who is deemed to represent a potential hazard to patient safety?
Work environment
Have written procedures been adopted for immediately notifying the Work Environment Authority of serious accidents and near-accidents?
Tips!
> Notification pursuant to the Work Environment Ordinance does not take the place of reporting an occupational injury to the Social Insurance Agency. In Sweden both agencies must be notified.
> An accident may cause anything from a mild to severe injury. A state of shock or other psychological injury may also stem from an accident.
> See illustrative examples at www.suntarbetsliv.se. > Pursuant to Section 2 of the Work Environment Ordinance, needlestick and sharps injuries that involve known or strong suspicion of infected blood are among nearaccidents that occur in the healthcare system.
1312 Patient safety and the work environment Patient safety and the work environment
Adopt measures
WHAT THE LAW SAYS
Pursuant to Chapter 3, Section 2 of the Patient Safety Act (Swedish Code of Statutes 2010:659)Caregivers shall adopt measures required to prevent carerelated injuries. A timetable shall be determined for measures that cannot be adopted immediately.
Pursuant to Section 10 of Systematic Work Environment Management (Swedish Work Environment Authority Directives 2001:1)Immediately or as soon as possible, the employer shall adopt measures required to prevent health problems and accidents at the workplace. The employer shall also adopt any other measures that are needed to ensure a satisfactory work environment.
Nolan’s improvement model.
Systematic working methods generate favourable results.
Address the following questions
Patient safety Yes No
Have written procedures been adopted for taking measures required to prevent care-related injuries?Work environment
Have written procedures been adopted for taking measures required to prevent health problems and accidents at the workplace?
Tips!
> Written procedures for declining work environment duties when skills, resources or authority are insufficient, shall be adopted.
> An organisation must have tools, methods and improvement skills for adopting measures required to prevent health problems.
> Nolan’s improvement model is a useful aid in structuring a change effort by means of setting targets, monitoring progress over time, identifying ideas for new working methods and experimenting with the ideas in real time on the basis of the Plan, Do, Study, Act (PDSA) wheel.
A typical area for improvement
Karlskoga Hospital has been working for many years on a systematic approach to raising awareness about gentle transfer methods to minimize the risk of bedsores and stress injuries. The results have been excellent.
Action plan/timetable
WHAT THE LAW SAYS
Pursuant to Chapter 3 Section 2 of the Patient Safety Act (Swedish Code of Statutes 2010:659)Caregivers shall adopt the measures required to prevent carerelated injuries. A timetable shall be determined for measures that cannot be adopted immediately.
Pursuant to Section 10 of Systematic Work Environment Management (Swedish Work Environment Authority Directives 2001:1)Measures that cannot be adopted immediately shall be incorporated into a written action plan. The plan shall specify when the measures are to be adopted and who shall be responsible for ensuring their adoption.
Address the following questions
Patient safety Yes No
Have written procedures been adopted for drawing up a timetable of measures required to prevent care-related injuries?
Work environment
Have written procedures been adopted for incorporating methods of preventing health problems and accidents at the workplace into an action plan?
Tips!
> A managementunion coordinating team or safety committee shall draw up an action plan for the work environment. Consideration of an action plan for patient safety is also recommended at such sessions.
> The action plans should be communicated to all employees with work environment or patient safety duties.
1514 Patient safety and the work environment Patient safety and the work environment
Self-monitoring and annual monitoring
WHAT THE LAW SAYS
Pursuant to Chapter 3, Section 10 of the Patient Safety Act (Swedish Code of Statutes 2010:659)No later than each March 1, the care provider shall prepare a patient safety report specifying1. performance of patient safety
management for the previous year2. measures adopted to improve
patient safety 3. results achieved
Pursuant to Section 11 of Systemat-ic Work Environment Management (Swedish Work Environment Authority Directives 2001:1)The employer shall monitor systematic work environment management on an annual basis. Any deficiencies shall be corrected.
Monitoring shall be documented in writing if the organisation has ten or more employees.
Address the following questions
Patient safety Yes No
Does the administrative system contain procedures for monitoring systematic patient safety management?
Work environment
Does the administrative system contain procedures for annual monitoring of systematic work environment management?
Tips!
> Selfmonitoring refers to an organisation’s own systematic monitoring and evaluation of the organisation, as well as verification that the process is conducted in accordance with the procedures and routines specified in the administrative system. One possible success factor is joint selfmonitoring or annual monitoring of patient safety and the work environment.
> Among possible sources of data for selfmonitoring or annual monitoring are employee satisfaction surveys, sickness absence data, documentation from safety rounds and inspections, exception reports, open comparisons, point prevalence studies, patient surveys, carerelated injury assessments, patient safety culture surveys, complaints and reports of dissatisfaction or problems.
> Work Environment Authority checklist of systematic work environment management, www.av.se/sam/sjalvskattning. In Swedish.
ANALYSIS
employee health and satisfaction
surveyspatient safety culture surveys
care related injury assessments
documentation fromsafety rounds exception reports
complaints, reports of dissatisfaction
ANALYSIS
employee health and satisfaction
surveyspatient safety culture surveys
care related injury assessments
documentation fromsafety rounds exception reports
complaints, reports of dissatisfaction
Possible sources of information for self-monitoring
16 Patient safety and the work environment
Differences between patient safety and the work environmentCertain provisions of the Work Environment Act do not have any counterpart in the Patient Safety Act – among them are requirements that employers, employers and safety representatives cooperate with each other.
The employer and trade unions at municipalities and counties, as well as businesses affiliated with Pacta, have entered into an agreement concerning Renewal – Work Environment – Cooperation (FAS 05). The purpose of the agreement is to ensure that patient safety and the work environment are integral to organisational improvement efforts. The agreement supports employers, trade unions and employees that collaborate to ensure a well functioning organisation, as well as a safe and healthy work environment that promotes equality and diversity at all stages of life.
Healthcare professionals can also contribute to organisational improvement efforts by meeting their obligation to notify the employer of risks for carerelated injuries, as well as incidents that have caused or might have caused them.
The Patient Safety Act also includes the requirement that patients and their families be given the opportunity to participate in patient safety management. This provision is not part of the Work Environment Act.
Safety committees or managementunion coordinating teams that also serve as such committees pursuant to local agreements shall deal with work environment matters. The provisions concerning coordination, safety representatives and safety committees shall be in force regardless of whether or not collec tive agreements for cooperation and the work environment have been entered into.
The agreement provides support.
Information about content:Agneta Andersson, [email protected] Ned Carter, [email protected] Estling, [email protected]
Work group: Agneta Andersson, Pia Gellerstedt, Elisabeth Dannberg, Folke Lindgren, Kerstin Norman, Marie-Louise Johansson, Mona Lindqvist, Ned Carter, Per Skude, Ulla Olsson.
More information at www.skl.se
© Swedish Association of Local Authorities and Regions, 2016Order no: 5417Photo: Rickard L. Eriksson, Lars Forsstedt Thomas Henrikson, Pia NordlanderIllustrations: Valja InfodesignProduction: Advant ProduktionsbyråPrint: LTAB, 2016
The goal of these guidelines is to improve the integration of systematic patient safety activities with work environment efforts by describing and exemplifying similarities in relevant laws and regulations. There are clear similarities in areas such as requirements for annual followups, conducting risk analyses and evalutations, requirements for investigating and reporting incidents and injuries, preparing action plans and adopting countermeasures.
Order or download at webbutik.skl.se Order no: 5417
Postal address: 118 82 Stockholm, SwedenVisiting address: Hornsgatan 20, Stockholm
Telephone: +46 (0)8-452 70 00www.skl.se
