“Establishing a Safety Culture in a Health Care Environment”

Brian K. Henckel, M.S., C.H.S.P.Risk Control Services DirectorOld 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” conceptsMission statement for the organization includes

employee safety (not often seen for hospitals)Management assigns safety coordinators to each

location to help enhance cultural changeEmployee 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. 9

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

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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. ClaimsVigilance 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 turnoverStrongly encourage health and wellness during

employment

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 13

Red Zone

Green Zone

Blue Zone

"WHEEL OF SAFETY"Prioritizing the Spokes

AXLE

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

successAssign one individual to coordinate safety

effortsHold supervisors and staff accountable for

defined safety responsibilitiesEncourage employee involvement and

participation in safety related activities

“THE AXLE”- (con’t)Establish a written safety programEstablish 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”- EssentialManagement AccountabilityStaff member involvement and recognitionCommunication of safe work practicesOSHA Reg’s- general orientation & trainingClaim’s Management- accident investigationMedical treatment & transitional return to

workFacilities ManagementEnforcement of safety policiesRecord keeping & data analysis

Accountability-(Supervisor Specific)Develop Supervisory Accountabilities

(Department Specific) based on the following areas:

New Employee OrientationSafety Policy EnforcementDepartmental Safety InspectionsDepartmental Safety Training/Re-TrainingAccident Investigations*** These are quantifiable areas to be

addressed at the Supervisors formal performance review.

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Employee Involvement & RecognitionAllow 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

CommunicationQuarterly written and/or verbal feedback to all

staff members concerning accident data/trendsDepartment Managers should provide monthly

refresher “lunch box” sessions on safety topicsTools- General Safety, memo’s, bulletin boards,

pay check stuffers, etc.Possible anonymous “direct line” systemConduct employee perception surveysNon verbal communication- Mgmt should,again

“Lead by example”

OSHA Required Orientation & TrainingAll 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 Management- Accident InvestigationEmployees 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

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

Facilities Management

EnforcementCore 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 AnalysisOSHA requirement- 300 Log, 300AAnalysis & 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 RecommendedImplement 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 titleImplement 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 & EducationAny employee experiencing an accident will

be retrained in some fashionPost 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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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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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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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.