overview’of’h&s’management’in’a’diverse’organisation...
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Overview of H&S Management in a Diverse organisation
Graham Cowan CMIOSH, FIIRSM,RSP, AIEMA, ACIEH, EurOHSM, MIOD
Group Health, Safety & Environmental Director
Our Vision
- Provision of lifestyle advice and services to promote wellbeing and healthy lifestyle
- Provision of health screening and monitoring services
- Provision of Physiotherapy through our Fusion network ( Largest provider of Physiotherapy outside of the NHS)
- Provision of Primary Care GP services through our wellbeing centres and stand alone clinics
- Provision of surgical procedures through our hospital network
- Provision of rehabilitation services through our “Recovery Plus” offering undertaken through our Wellbeing centres and Physio network.
- Our Aim is to provide a truly integrated joined up health & wellbeing service
Nuffield Health look to provide a fully integrated Health and Wellbeing service
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Nuffield Health
• 31 Independent private hospitals
• 6 Healthcare sterile service units (HSSU)
• 6 Stand alone Clinics
• Corporate health and fitness provision for over 200 corporate clients
• 77 Fitness & Wellbeing Centres
• Head office at Epsom
Who we are and what we do
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Challenges of H&S Management
- 77 commercial fitness & wellbeing facilities. 24 with CQC registered services
- Modern facilities often put into an ageing estate
- High churn of staff
- Facilities run within and on behalf of corporate clients
- Inexperienced managers in comparison to Hospital Division
Hospitals
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- 31 hospitals all managed as individual business units responsible for their own growth, development and budgets.
- Modern facilities often put into an ageing estate
- Ever increasing surgical capability and case mix
- Closer working with NHS therefore requirement to report in accordance with their criteria
Wellbeing
GROUP HEALTH, SAFETY & ENVIRONMENT TEAMGENERAL COUNSEL & COMPANY SECRETARYLUKE TALBUTT
GROUP HEALTH, SAFETY & ENVIRONMENTAL DIRECTOR
Group Health, Safety & Environmental ManagerHospitals
Group Health, Safety & Environmental Manager, Wellbeing- Corporate
Group Health Safety & Environmental Manager- Wellbeing
Our Approach
- Develop a system of risk control documents suitable to cover group activities- these included strategic level policies with local divisional SOP as required, Standard approach and methodology to risk assessment. Standard approach to risk reporting even though risk categories may change from division to division.
- Group level system that can be adapted locally depending upon facility and service provision. ( Nuffield Health 10 Folder system)
- Development of Nuffield Health H&S management system training course- delivered to all managers with H&S responsibility.
- Identification and training of local managers/coordinators to manage the system at operational level.
- Monitoring of risks through dashboard reporting system monthly against identified key risk areas.
Change of style from central fed, and monitored system to more reliance on local management.
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Our ApproachDashboard Monitoring
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SiteAudit
H&S Coord Qual
Annual Compliance Monthly DeliverablesNever
Event 15 RAG2013 2014 2015 HS03 L8 HS08 HS29 HS02
Water Quality
Plant Room
Bournemouth 93.9% TBC TBC NEBOSH TBC TBCBrentwood 91.8% 96.0% TBC NEBOSH N/A N/A
Brighton 89.4% 95.9% TBC IOSH N/A N/ABristol 90.0% 90.9% TBC NEBOSH N/A N/A
Cambridge 92.5% TBC TBC NEBOSH N/A N/ACheltenham 90.2% TBC TBC NVQ5 N/A N/A
Chester 93.8% 93.8% TBC IOSH N/A N/AChichester 83.5% 90.2% TBC IOSH N/A N/A
Derby 98.4% TBC TBC NEBOSH N/A N/AExeter 95.4% 90.1% TBC NVQ4 N/A N/A
Glasgow 94.3% 94.7% TBC NEBOSH N/A N/AGuildford 88.4% TBC TBC NEBOSH N/A N/A
Haywards Heath 92.3% TBC TBC NEBOSH N/A N/AHereford 90.0% 93.7% TBC IOSH N/A N/A
Ipswich 95.3% TBC TBC NEBOSH N/A N/ALeeds 89.6% 90.5% TBC NEBOSH N/A N/A
Leicester 93.1% TBC TBC NEBOSH N/A N/ANewcastle uT 95.3% TBC TBC IOSH N/A N/A
North Staffs 90.3% TBC TBC IOSH N/A N/AOxford – Manor 95.4% TBC TBC NEBOSH N/A N/A
Plymouth 95.0% 93.2% TBC NEBOSH N/A N/AShrewsbury 97.0% TBC TBC IOSH N/A N/A
Taunton 90.2% 91.7% TBC NEBOSH N/A N/ATees 96.0% 97.0% TBC IOSH N/A N/A
Tunbridge Wells 93.3% TBC TBC IOSH N/A N/AVale 94.0% 96.8% TBC IOSH N/A N/A
Warwickshire 95.5% TBC TBC NEBOSH N/A N/AWessex 89.1% BSI TBC IOSH TBC TBCWoking 93.8% TBC TBC IOSH N/A N/A
Wolverhampton 90.0% 92.5% TBC NEBOSH N/A N/AYork 98.1% 98.3% TBC NEBOSH N/A N/A
Integration of H&S into Group Governance
- The term Governance was associated within the business as clinical and it was difficult to get adequate engagement within the Wellbeing Division
- Originally H&S was part of the Group Clinical Directorate
- Quality & Safety has helped to integrate reporting and monitoring throughout the business
- The CQC reporting format is now used as our Group Quality report:
- Safe, Effective, Caring Responsive, and Well Led
- The previous central Governance committees have been re named
- Hospitals Quality & Safety Committee
- Wellbeing Quality & Safety Committee
- Group Quality & Safety Committee
- Board Quality & Safety Committee
- Expert Advisory Groups are used to support reporting and monitoring – EAG HSE, Infection Prevention, Safeguarding
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Due to the diverse nature of our business we have rebadged Governance into Quality and Safety
Use of internal seminars and Workshops to facilitate change
Cascading the messages
- It is important that when facilitating change and a new approach, that the business is taken along on the journey as opposed to the outcome being delivered to the business.
- Good explanation and rationale is required in order to engage with all levels of the business.
- The business needs to share your enthusiasm and drive in order to facilitate the new approach.
- It is equally important to highlight previous shortfalls and the benefits of the newer approach, as rationale for change
- Support in the change management is important, and this may be extensive in some areas but quite light touch in others.
Remember- just because you have told people does not mean they are briefed and on-board
You may well have to reinforce the message again and again.
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External Monitoring
- CQC- Principal Regulator- Hospitals and Wellbeing.
- HSE- Hospitals-We have a principal inspector relationship with the HSE
- EHO ( Local Authority) Food in Hospitals but predominantly Wellbeing activity- we have a primary authority arrangement in place with Bristol City Council ( Moving to Warwickshire in 2015)
- Fire Authority – Group- we have a primary authority arrangement in place with Hampshire Fire & Rescue
- We also hold external accreditations:
- OHSAS 18001- BSI
- ISO 27001- BSI
- ISO 9001 & ISO 14001 are both in progress
Due to the diversity and nature Nuffield are regulated through several agencies.
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Some challenges on our JourneyCriminal Prosecution Fitness & Wellbeing Division Cannock
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The circumstances leading to this prosecution are that on Saturday 7th March 2009, A Honeywell engineer was undertaking somemaintenance work in the pool plant room at Cannock. During the activity the engineer noticed that the chemical tanks located withinthe pool plant room were running low, and he decided to fill them. This is a task that is regularly and contractually undertaken byHoneywell engineers as part of the contract with Nuffield Health.
The Engineer inadvertently poured the wrong chemical into the tank and due to the chemical reaction Chlorine gas was produced andreleased.
The swimming pool and fitness centre were evacuated and 10 people including some children were taken to hospital with respiratorydistress. Nobody however was detained in hospital overnight.
Nuffield Health appeared at Stafford Magistrates court with the co- accused Honeywell services.Both companies were fined £15k plus costs
The investigation and management of the prosecution gave me the platform to effect change within the Wellbeing division and movefrom a central fed H&S management system to a more inclusive local accountability for H&S management.
I also initiated a full upgrade of Nuffield pool plant rooms to reduce the likelihood of re occurrence. A programme to upgrade thechemical dosing systems across the estate costing over £3million was implemented and took 3 years to complete.
Cannock
Bunding of Chemical Container
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Cannock Improvements
New Dosing system
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Some challenges on our Journey
- The HSE is prosecuting Nuffield Health for one offence alleging a breach of Section 2(1) of the Health and Safety at Work etc. Act 1974. (HSWA). Section 2(1) of HSWA requires employing organisations to conduct their undertakings in such a way as to ensure, so far as is reasonably practicable, that persons in their employment are not exposed to risks to their safety.
- A staff member slipped on a wet floor and sustained a fractured patella ( RIDDOR)
- The Case Summary sets out the key facts and matters the HSE intend to prove. The main allegations made against Nuffield Health can be summarised as follows:
- Nuffield Health failed to carry out a suitable and sufficient risk assessment for the wet-mopping of floors at the hospital.
- The Case Summary refers to two Nuffield Health risk assessments: (1) Ward Department Gen Risk Assessment;; and (2) Housekeeping Department Gen Risk Assessment. These are criticised for failing to consider all the risks resulting from wet-mopping, safest cleaning times i.e. quieter periods, suitable cleaning methods such as floor drying and use of anti-slip footwear.
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Criminal Prosecution Nuffield Ipswich Hospital
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Some challenges on our Journey
- Nuffield Health failed to implement systems of work for the wet-mopping of floors at the hospital, that were safe and without risk to health.
- The Case Summary criticises the system of work including that the Clinic room floor had been wet-mopped daily at between 8:30am - 08:45am this being the room’s busiest time, floors were left to air-dry after wet- mopping, no floor drying operation was undertaken and employees were not provided with anti-slip footwear.
- Nuffield Health failed to provide adequate instruction and training for employees regarding the control of risk resulting from wet-mopping of floors within the hospital.
- The Case Summary provides that employees were not provided with copies of slips and trips risk assessments, they did not receive any instruction or training on the sequence of mopping rooms and it is alleged that generally housekeepers were not suitably trained or supervised in accordance with all the slips, trips and falls requirements of the Housekeeping Risk Assessment.
Criminal Prosecution Nuffield Ipswich Hospital
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Some challenges on our Journey
- Nuffield Health Appeared at Ipswich Magistrates court and were fined £5K plus costs
- Corrective actions implemented:
- All Hospital H&S coordinators trained to NEBOSH General Certificate level
- Hospital floors surface roughness tested annually
- HSE surface roughness test risk assessment toolkit used
- Risk assessments implemented and monitored
- Policy on Slips Trips and falls updated and monitored as Key Risk area
- Floors are cleaned using wet/dry scrubbers to minimise the wet floor situation.
Criminal Prosecution Nuffield Ipswich Hospital
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Some challenges on our JourneySummary of Lessons Learnt
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Facing a prosecution or enforcement action is not easy or pleasant for the organisation or individualsconcerned, however it is important to utilise the additional leverage and focus it presents to implementrobust measures and controls in order to re establish the safe culture.
• Look for engineering, process and people issues to address the likelihood of re occurrence
• Solutions have to be well thought out and researched and mindful of cost and other logistical issues, butgenerally the executive will value input, robust business case submission and longer term benefits.
• Don’t always look to compare “us with the industry standard” look to develop and implement the bestmeasures in line with your strategic goals and objectives.
• Be sure of your ground and present the case taking into consideration all of the above.
The Future
- Current and future developments:
- Increased marketing – TV Advert
- Electronic reporting system allowing the central resource to review data from operational sites
- ISO 14001 Accreditation
- Completion of our first truly integrated facility at Manchester University
- Further wellbeing acquisitions to increase footprint
- Development of Nuffield Health staff through our Learning Academy- Professional and leadership training
- Continued development of internal H&S team ( CPD, involvement with external bodies, PWTAG, British Safety Council, IOSH)
- Upgrading of our current estate- (Cambridge Hospital)
Nuffield are always looking to be forward thinking
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“We do it because we are Nuffield”
THANK YOU