presented by lynda enos, rn, bsn, ms, cohn-s, cpe ... · 3/17/2016 · the wsi...

1

Presented by Lynda Enos, RN, BSN, MS, COHN-S, CPEErgonomist/Human Factors Specialist, HumanFit, LLC., [email protected]

Co-Chair OCHEwww.hcergo.org

➢The Workplace Safety Initiative (WSI) workplace violence project◦ Background

◦ How the WPV programs were developed

◦ The WPV Toolkit

➢Workplace violence (WPV) in health care

◦ The scope of the issue and current trends in preventing WPV

◦ Components of effective WPV prevention programs

◦ Lessons learned from the WSI

2

1. Identify the key components of a sustainable WPV program

2. Identify common barriers to implementing aWPV program and how to address them

3. Identify tools that can be used to develop ofenhance a WPV program at a health care facility

3

mailto:[email protected]

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwi18ZT7od3KAhVI4mMKHX01BZIQjRwIBw&url=http://blog.research.chop.edu/category/center-for-pediatric-traumatic-stress/&bvm=bv.113370389,d.cGc&psig=AFQjCNGW9YfgMe3FzlfH4qZF9dKpX1y4Kg&ust=1454646301641465


2

4

➢ In 2014 the Oregon Association for Hospitals and Health Care Systems (OAHHS) formed the WSI work group with member hospitals, SEIU 49 and Oregon Nurses Association.

➢Goal: To collaboratively address two of the leading causes of health care worker injury in Oregon i.e., manual patient handling and work place violence.

➢10 Projects at 8 volunteer hospitals statewide

➢The Triple Aim group, which is comprised of Legacy Health, Providence Health & Services, OHSU, Kaiser Permanente NW, the ONA, and SEIU 49, also supported the project.

➢Lynda Enos was the OHS & ergonomics consultant who assisted to facilitate the project and who developed the toolkit.

5

➢Identify and implement evidence-based programs to reduce injuries from patient handling and workplace violence and foster sustainable cultural change.

➢Strengthen relationships with partner organizations around health care worker and patient safety issues.

➢Disseminate lessons learned and tools developed to all hospitals in Oregon to assist implementation of sustainable effective workplace safety programs.

6

3

7

➢ 8 volunteer hospitals are participating in 10 projects

➢ Workplace Violence Prevention & Safe Patient Handling – 5 sites each

➢ Hospital size:o 3 facilities < 50 beds 3 facilities - 50-100 beds o 2 facilities > 100 beds

➢ Location: rural and urban across the state

➢ Starting a WPV program or needing to enhance or revive one

Project Timeline: Fall 2015-May 2017

➢WSI Hospitals Partners for the Workplace Violence Prevention Project

◦ Bay Area Hospital, Coos Bay

◦ Mid-Columbia Medical Center, The Dalles

◦ Harney County Health District, Burns

◦ Providence Portland Medical, Portland

◦ Grande Ronde Hospital and Clinics, La Grande

➢The Oregon Association of Hospitals Research and Education Foundation

➢The WSI inter-organizational committee

8

➢ WSI project lead identified and team/committee formed at each facility

➢ Initial meeting with hospital contact and others/existing committees

➢ Process for data collection and analysis developed

➢ Gap analysis for WPV developed from published evidence-based best practices, relevant standards and regulations

9

4

1. Define the scope of hazards related to violence and the impact on the organization (what, where & cost) – All facilities

a) Review existing policies and procedures

b) Analyze incident, injury & cost data from 2012 to 2016

c) Complete gap analysis of existing programs

d) Conduct staff survey

e) Conduct hazard analysis via facility walkthrough (ongoing)

‘b - e’ are used to evaluate WPV programs afterimplementation

10

2. Identify best approach for program development based on all data collected

3. Obtain management approval & support of the plan

4. Develop program tools as needed

5. Implement the program including any pilot activities

6. Evaluate program process & outcomes

7. Roll out program to other units/tasks as applicable

11

Program

Activities

Source:

WPV in

Hospitals: A

toolkit for

prevention

and managing

WPV in health

care. Tool ii

12

5

Endorsed by◦ Oregon Nurses Association◦ Service Employee International Union –

Local 49◦ Oregon Medical Association◦ Oregon Emergency Nurses Association◦ Oregon Chapter of the American

College of Emergency Physicians◦ Northwest Organization of Nurse

Executives Oregon Center for Nursing

13

➢A Toolkit for Prevention and Management of WPV

https://www.oahhs.org/safety

Recommended Resource by the Joint Commission

Purpose of the Toolkit

➢To assist health care leadership and violence prevention(VP) committees and other stakeholders to:

◦ Evaluate the WPV program and individual program practices against current best practices in WPV prevention and management

◦ Identify and engage stakeholders and enhance the culture of worker and patient safety

◦ Develop or strengthen the WPV program plan and policy by identifying processes that can be implemented to identify and manage violence and can address the risk of violence proactively

14

Purpose of the Toolkit

➢A suggested framework and strategies to aid program

implementation, evaluation and sustainability are also

offered.

15

https://www.oahhs.org/safety

6

What makes this toolkit different and valuable?

➢Provides new tools that have been developed and trialed by

the WSI hospitals e.g.

◦ Gap analysis tools

◦ WPV staff survey tool

◦ WPV patient assessment tools

◦ Injury data management and analysis tool

◦ Communications plan

◦ Education and training plan

16

What makes this toolkit different and valuable?

➢Provides a roadmap of all program elements that are

needed to implement comprehensive programs

➢Includes current topic related resources in one location

➢Adds to the body of information about each topic

➢Will facilitate sharing of best practices and reduce the need

to ‘reinvent the wheel’

17

Structure for the Toolkit

➢Web-based

➢Chapter for each program topic with:

◦ Brief overview of topic and instructions for how to use tool(s)provided

◦ References

◦ Other external resources

➢Tools provided in PDF and MSWORD and/or MS Excel

➢Lessons learned incorporated throughout the toolkits

7

1. Understanding WPV in Health Care

2. Getting Started

3. Hazard Identification & Assessment

4. Developing the WPV Program Plan

5. Hazard Control and Prevention

6. Education and Training

7. Implementing the Program

8. Evaluating the Program

9. Program Improvement & Sustainability

10. Additional Resources

Contents/Topic

Background re WSI project and Introduction to the Toolkit

Example of tool(s) provided • Tracking, analyzing and reporting

incident and injury data• WPV Risk for WPV Patient Assessment

Tool

• Gap analysis tool • WPV Incident report

• Employee WPV survey & reports • Education and Training plan*

• Safety and security assessment checklist

• Program Measurement Plan

• Communications plan • Links to dozens of other tools and templates from professional organizations and hospitals through the US- Assigned to each Section by topic

• WPV policy sample & program plan summary template

• Project Charter• Tips for effective committees• Project management tools

• Articles and links to other WPV related resources for• Long Term Care• Home Health/Community Workers• Lateral Violence/Bullying• Domestic Violence

21

8

➢ Biological & Infectious Hazards ◦ Bloodborne pathogens

(Needlestick injuries, etc.)

◦ Tuberculosis

➢ Chemical Hazards◦ Latex

◦ Glutaraldehyde

◦ Ethylene Oxide

◦ Antineoplastics

◦ Volatile organic compounds (VOCs)

➢ Physical Hazards 1. Musculoskeletal

disorders (MSDs) -Patient handling (54%)

2. Slips, trips & falls (approx. 21%)

3. Workplace violence

(13%)

o Noise

o Radiation

22

HumanFit, LLC © 2015-2018.

➢ Psychosocial Hazards– Shift work, long hours, and overtime; – Work place violence: patients; families/visitors, – Workplace incivility: management, peerso Lack of respect−A root cause, if not THE root cause, of dysfunctional

cultures− 95% of nurses report it; 100% of medical students; huge

issue for patientso Lack of support

o Lack of appreciationo Non-value add worko Production/time pressures

Hughes 2008; ANA 2013; NPSF 2013

23


➢It’s Never Ok: Occupational violence and aggression against nurses

WorkSafe Victoria

https://www.youtube.com/watch?v=yQUkOx-PUMM

➢Royal Melbourne Hospital, Australia

https://www.youtube.com/watch?v=2nCQzC4KKWk

➢News report from MA Hospital Workers Increasingly Targets Of Patient Violence

https://www.youtube.com/watch?v=N0TWMOcW0Vo

24


https://www.youtube.com/watch?v=yQUkOx-PUMM

https://www.youtube.com/watch?v=2nCQzC4KKWk

https://www.youtube.com/watch?v=N0TWMOcW0Vo

9

➢OSHA defines workplace violence as any act or threat of physical violence, harassment, intimidation, or other threatening disruptive behavior that occurs at the work site. It ranges from threats and verbal abuse to physical assaults (e.g. hitting, kicking, biting, shoving, stabbing, sexual assault etc.) and even homicide.

➢Acts of workplace violence can be perpetrated by staff, patients, visitors, vendors or others.

➢Workplace violence also includes acts of violence by individuals with cognitive impairments, mental illness, or brain injury. The perpetrator’s inability to form “intent” is not a reason to not label behavior as violent.

25


➢Type I (Criminal Intent): Results while a criminal activity (e.g., robbery) is being committed and the perpetrator has no legitimate relationship to the workplace.

➢Type II (Customer/client): The perpetrator is a customer or client at the workplace (e.g., health care patient) and becomes violent while being served by the worker.

➢Type III (Worker-on-Worker): Employees or past employees of the workplace are the perpetrators.

➢Type IV (Personal Relationship): The perpetrator usually has a personal relationship with an employee (e.g., domestic violence in the workplace).

26


27

▪ Healthcare & social assistance workers are nearly five times more likely to be injured & require time away from work as a result of WPV (OSHA, 2016)

▪ Highest rates of WPV usually in the ED.

▪ 50-100% ED nurses reported experiencing verbal or physical violence at work – 2 studies (ENA 2011, Phillips, 2016)

▪ In a large study during the previous year 76.0% nurses experienced verbal or physical violence (Speroni, K.G.,et al, 2014)

▪ Some professionals more at risk - psychiatric aides x 10 higher risk than CNAs

▪ Active Shooter events rare - Between 2000 and 2011, 154 shootings with injury either inside a hospital or on the grounds (Phillips, 2016)

▪ Perpetrator mostly the patient


10

28

➢Numbers likely up to 90% underreported

➢Barriers to reporting:

◦ Perception of what is ‘violence’ by workers

◦ The severity of the incident

◦ Whether someone else reported the incident

◦ The condition of the patient

◦ Fear of retaliation ◦ Perception of what is ‘violence’ by workers

◦ No clear policy

◦ Complicated reporting process

◦ Poor management response, stigma by coworkers, normalizing

➢Is dealing with violence just part of being a health care worker?HumanFit, LLC © 2015-2018.

➢1644 accepted disabling claims (ADCs) for non fatal assaults in all industries

◦ 334 (20%) in nursing and residential care

◦ 170 (10%) in private hospitals

◦ 36 (2%)in Ambulatory health care services

➢Majority claims - nurses aides, orderlies, attendants, nurses

➢Perpetrator - mostly patients

➢Most common event: Hitting, kicking, beating, shoving – 84%

Source: http://osha.oregon.gov/OSHAPubs/2857.pdf


➢WPV in top 5 causes of reported incidents but few cases result in employee injury

➢0-6.6% of OSHA Recordable are related to WPV vs. all OSHA recordable injuries

➢WPV accounts for 0-6.5% of lost time injuries

➢Location of most injuries: Ed; Behavioral Health; Medical and/or Surgical units; ICU; (and Clinic at one facility)

➢Perpetrator: 85%-100% - Patient

➢Type of violence:

◦ In 3 hospitals 60-70% - verbal

◦ In 2 hospitals – 20% verbal (reporting process may be a factor)

30


http://osha.oregon.gov/OSHAPubs/2857.pdf

11

➢Demographics

➢Staff definition and frequency of workplace violence

➢Frequency of exposure, types of violence and perpetrators

➢Policy and procedures & management support

31

Training

Incident response

Reporting

Response post incident

Violence prevention –Staff Ideas

Home Health


➢4 hospitals participated

➢N = 1469 responses or 47% aggregate response rate

➢14 - 32.5% of respondents thought that WPV had increased during the time they have worked at the facility

➢34 - 43.9% of respondents thought the incidence of violence had not changed

➢Respondents thought the following were the primary risk factors for violence at the facility:

◦ Drugs and Alcohol and Mental illness

◦ Organizational – wait times; financial; bullying, shift work, training related issues, communication, lack of security

➢12 - 29% of respondents indicated that they see or experience violence at work weekly or monthly.


➢79-88% of WPV incidents experienced in the last year were verbal assaults and 42-53% were physical assaults.

➢About 50% of the respondents said they participated in WPV training, but approx. 25% felt that the training could be improved.

➢Of those who said they have not attended training, 45-60% stated they should receive violence prevention training.

➢78% of respondents stated they know what to do when you witness or are involved in a work place violence incident and that assistance would be provided when requested

33


12

➢The primary reasons that would impact whether staff will

report work place violence incidents or not are:

1. Severity of the incident

2. Condition of the patient

3. Whether someone else reported the incident

4. Fear of retaliation (by patient; family; visitor)

5. The reporting procedure is unclear or time consuming

6. Whether coworkers are supportive or not

7. Which supervisor is on shift

34


Staff Role in Prevention

➢When asked how they could contribute to decreasing the risk of violence in the workplace the main themes from respondents were:◦ Communicating and listening, using non-threatening presence and

de-escalation

◦ Be aware and alert

◦ Attend training

◦ Encourage reporting so there is a documentation trail

◦ Request for security if this does not exist.

◦ Cameras in ER hallway/parking lot; lock system or key card entry system added to the lab door; visitor limitation in ER

➢30-70% of Home Health staff that responded were aware of the requirements of ORS 654.421 related to home health

35


Direct Costs (Largely Workers Comp)

Indirect Costs (e.g., temp and permanent staff replacement costs)

• Impact of psychological stress, PTSD, burnout, presenteeism, etc.

− Increased sick leave & staff turnover

− Lower quality of care

− Decreased efficiency

− ‘Human’ error & accidents

36

• Increased

− Insurance costs

− Property damage

− Litigation

− Security needs –personnel & equipment; modifying facility design

Operational Losses/Costs


13

➢Clinical Risk Factors e.g. substance abuse & mental illness; history of violence

➢Environmental Risk Factors e.g. noise, crowded waiting areas, open access, poorly lit areas

➢Organizational Risk Factors e.g. wait times, communications, staffing, lack of effective training, working alone, working with cash and/or narcotics, lack of situational awareness

➢Social and Economic Risk Factors e.g., financial stress, domestic violence, ethnic conflict, access to weapons

➢"Revolving Door" Syndrome◦ There is a vicious cycle that sometimes links workplace violence, psychiatric

treatment, and the "revolving door":

Workplace Violence Prevention for Nurses CDC/NIOSH, 2012http://www.cdc.gov/niosh/topics/healthcare/default.html


➢Oregon Law - Workplace Violence Against Health Care

Employees or “Safety of Health Care Employees” ORS 654.

412 to 654.423 (Intentional Assault)

◦ Conduct periodic security and safety assessments

◦ Develop and implement an assault prevention and protection

program

◦ Provide assault prevention and protection training

◦ Maintain a record of assaults (OAR) 437-001-0706)

http://osha.oregon.gov/OSHARules/div1/div1.pdf

➢OAR Division 60 (OAR 259-060:0005-0600) ‘Private security

Services Providers Rules’

38


➢Joint Commission has made WPV a priority

• Standard EC.02.01.01 The hospital manages safety and security risks.

Elements of Performance for EC.02.01.01 A

• Sentinel Event (Alert 59)

• The Joint Commission has linked to our toolkit on their WPV resource page

➢ DNV GL Healthcare USA, Inc,

➢ Workplace Safety and Health: Additional Efforts Needed to Help Protect Health Care Workers from Workplace Violence

GAO-16-11: Published: Mar 17, 2016. Publicly Released: Apr 14, 2016. http://www.gao.gov/products/GAO-16-11

➢ Dec 2016 - April 2017 Fed OSHA Request for informationConsidering standard to prevent workplace violence in healthcare, social assistance

https://www.regulations.gov/document?D=OSHA-2016-0014-0001

39


http://www.cdc.gov/niosh/topics/healthcare/default.html

http://osha.oregon.gov/OSHARules/div1/div1.pdf

http://www.gao.gov/products/GAO-16-11

https://www.regulations.gov/document?D=OSHA-2016-0014-0001

14

➢What Has Culture Got to Do With It?

40


➢Patient safety focus vs. worker safety

➢Constantly competing and changing financial priorities

➢Lack of systems approach to services provided (silos)

➢Lack of C-suite knowledge about the true costs of WPV related injuries to staff, patients and the organization

➢Problem solving approach = blame the worker (human error)

41


➢Lack of:

◦ Systematic studies and validated program tools

◦ Evidence about the effectiveness of interventions (security equipment, training, policies & procedures etc.)

◦ Awareness of resources available

◦ Knowledge about effective worker training

➢Poor reporting systems and lack of reporting

➢ Intense focus of healthcare organizations on customer service

➢Weak social service and law enforcement approaches to mentally ill patients

➢Need for expert in safety/security to conduct walkthrough assessments

➢Need for standardized patient identification programs

42


15

43



44Creating a Culture of Worker & Patient Safety in Health Care

▪ The Joint Commission 2012

▪ ANA InterprofessionalSPHM Standards

▪ OSHA working IHI

▪ ANA - End Nurse Abuse Initiative

“Workforce safety is inextricably linked to patient safety. Unless caregivers are given the protection, respect, and support they need, they are more likely to make errors, fail to follow safe practices and not work well in teams.”

Through the Eyes of the Workforce: Creating Joy, Meaning, and Safer Health Care. The Lucian Leape Institute at the National Patient Safety Foundation Feb 2013http://www.ihi.org/Topics/Joy-In-Work/Pages/default.aspx

➢Requires health care organizations to shift to a culture that is

Just

Open

Promotes Reporting

Encourages Learning &

Stays Informed

= High Reliability Organization

45

http://www.ihi.org/Topics/Joy-In-Work/Pages/default.aspx

16

➢Meaning: The sense of importance of an action

➢Joy: The emotion of pleasure, feeling of success, and satisfaction as a result of meaningful action

➢Workforce Safety: Physical and psychological freedom from harm, neglect, and disrespect – a precondition to Joy and Meaning

National Patient Safety Foundation 2013

46


Workers should be able to answer ‘Yes’ ask the following:

1. Am I treated with dignity and respect by everyone, every day, in each encounter, without regard to race, ethnicity, nationality, gender, religious belief, sexual orientation, title, pay grade, or number of degrees?

2. Do I have what I need: education, training, tools, financial support, encouragement, so I can make a contribution to this organization that gives meaning to my life?

3. Am I recognized and thanked for what I do?

National Patient Safety Foundation 2013

47


1. Establish a goal of zero harm (physical and psychological) for your workforce.

2. Create a learning system in which every member of your workforce learns, understands, and demonstrates respect and safe behaviors with a commitment to 100% compliance

3. Create a real-time, transparent, timely measurement system to measure physical and psychological harm.

4. Create a multidisciplinary, reliable process for responding to physical and psychological harm involving all relevant departments and disciplines (Patient Safety, Risk Management, Quality, Occupational Health, Employee Assistance, Human Resources, Clinical Leadership, and others).

National Patient Safety Foundation 2014http://www.ihi.org/Topics/Joy-In-Work/Pages/default.aspx

48


http://www.ihi.org/Topics/Joy-In-Work/Pages/default.aspx

17

Program Foundation and Management

A. Management LeadershipEnsuring Ownership and Accountability - Just Culture/HROs

B. Employee Participation

C. Written Policies

D. Program Management◦ Program Champion◦ Program Manager & Committee/Team◦ Program Plan

E. Communications/Social Marketing

F. Hazard Identification/Assessment◦ Injury/Incident Data Analysis & Worker/Patient Surveys◦ Gap Analysis◦ Assessment of the Physical Work Environment and Practices

49

Multifaceted programs are more effective than any

single intervention


Facility Culture and Accountability

➢Senior Leadership

◦ Has knowledge about WPV and their role and responsibilities within the WPV program

◦ Declares violence prevention a priority.

◦ Communicates and demonstrates to employees that worker safety and security are as important as patient safety.

◦ Aligns WPV efforts with quality and safety plans

◦ Facility leaders assign responsibility and accountability for the implementation and maintenance of the program.

50


Facility Culture and Accountability

➢A comprehensive workplace WPV policy is developed, communicated, implemented & evaluated

➢Ongoing resources (e.g., time, materials, funding) are provided for:◦ Identifying and mitigating hazards and risks◦ A facility champion & project coordinator◦ WPV committee◦ Effective worker training

◦ On-going evaluation of the program & proactive facilities design

➢Front line caregivers are engaged in devising the solutions to a safer workplace and their efforts are recognized

51




18

52

Facility Leaders Set Clear Safety Goals & Expectations

➢Employees are aware that violence are not an accepted part of their job.

➢Patients/visitors are made aware that violence will not be accepted

➢Management at all levels support employees in the event of patient, family, provider, or caregiver refusal to follow violence prevention or security protocols.

Sustainable & Effective WPV Programs

Management Leadership


Roles and responsibilities of all employees within the program are clearly communicated

➢Roles and responsibilities of all employees within the WPV program are clearly communicated such as:

◦ The consistent and appropriate use of violence prevention practices procedures such as, patient assessment protocols

◦ Expectations for reporting all incidents of WPV are clearly communicated on an ongoing basis and a user-friendlyprocess for reporting is provided

53




Roles and responsibilities of all employees within the program are clearly communicated

➢The facility has a clearly defined and communicated process for speaking up if a potential safety issue related to WPV has been identified by employees.

➢Leadership supports the reporting of safety issues/concerns i.e. ‘blame-free’ reporting and support systems are in place for employees

➢Improvements made e.g. post incident or proactively are communicated to employees

54




19

➢Build effective communications/social marketing processes

➢Provide meaningful data tracking and trending/

cost benefit modeling

➢ Investigate every report as if a medical error

➢Be involved in ‘After Action Reviews’ (root cause analysis) of

occupational injuries and near miss events

➢ Implement executive rounding & safety huddles

➢Ensure proactive safety audits are conducted

➢Consider WPV prevention in remodel and new build projects

(Enos, WSHA, 2014, NPSF, 2013)

55


Ongoing Worker Engagement or Reengagement

Participation in:

1. The safety/violence prevention planningprocess

2. Identifying safety/violence related hazards

3. Reporting an injury, hazard, or concern, including near misses

4. Identifying safety solutions, WPV safety equipment and processes

5. WPV/safety audits & walkthroughs

6. Education and training

56


Ongoing Worker Engagement or Reengagement

Participation in:

7. Safety champion/coaching programs

8. ‘Safety’ huddles for training, feedback and kudos

9. Executive/management rounding

10.Security/physical safety considerations in new

building or remodeling projects

11.Evaluating and updating the program

12.Participating in the WPV committee

57


20

Secondary Controls:

2. Work Practice changes

3. Administrative Controls -Policy & Procedures

4. Warnings

5. Training

6. Personal Protective equipment

Primary Controls:1. Engineering or Design

Controls • Elimination • Substitution• Isolate user from

the hazardAnticipate and design to mitigate foreseeable misuse of a product/equipment etc., by the user.

Mo

st E

ffec

tive

Least Effective

58

Adapted from NIOSH, 2018


G. Hazard Abatement (Not all inclusive) Refer to resources provided

I. Engineering Controls e.g.,• Controlled access to buildings

• Security/silent alarm systems

• Exit routes including safe rooms for emergencies

• Monitoring systems and natural surveillance

• Improve lighting indoors and outdoors

• Noise barriers

• Metal detector systems

• Barrier protection to work areas

• Design of patient areas for de-escalation; comfort to reduce stress

• Furniture, materials and maintenance • Travel vehicles are properly maintained; barriers are present

59


II. Administrative and Work Practice Controls • Incident Reporting

• Identifying and Tracking Patients/Visitors at High Risk for Violence

• Employees Working Alone or in Secure Areas

• Entry Procedures

• Transportation Procedures

• Security Personnel & Rounding

• Incident Response & Post Incident Procedures

• Incident Investigation

• For Home Care Employees

H. Education & Training

I. Ongoing Program Evaluation & Proactive Hazard Prevention

60


21

➢Oregon rules - DIVISION 60 PRIVATE SECURITY SERVICES PROVIDERS RULES http://arcweb.sos.state.or.us/pages/rules/oars_200/oar_259/259_060.html

➢Department of Public Safety Standards and Training (DPSST) http://www.oregon.gov/DPSST/PS/Pages/index.aspx

➢Non-armed and armed security

➢Must be a separate job function

➢Private Security Executive Managers

➢Consider the:

◦ Who - employee vs. contract

◦ Job description/functions inc. shift & location coverage

◦ New hire orientation; initial and ongoing training

◦ Armed or non-armed

61


Challenges

➢Staff turnover –

◦ Leadership and committee members impacting project

completion

◦ Turnover in health care hugely impacts sustainability and

management of these programs

➢Competing priorities for budget, time and resources vs other non

worker safety projects e.g.,

◦ WPV security related equipment and personnel

◦ Staff training (initial and ongoing)

◦ Staff to provide training

◦ Lack of internal expertise

62


Addressing the Challenges

➢Obtaining executive commitment and mid level management

buy-in through improved education about the topic; relevant

data collection, analysis and presentation

➢Having a dedicated program manager and interdisciplinary

team to facilitate the program

➢Spending time on understanding safety culture and program

gaps and identifying and prioritizing needs/developing a

program plan and a business case etc.

63


http://arcweb.sos.state.or.us/pages/rules/oars_200/oar_259/259_060.html

http://www.oregon.gov/DPSST/PS/Pages/index.aspx

22

Addressing the Challenges

➢Engaging direct and non direct care staff – changing culture (behaviors)

➢Understanding that one person cannot be responsible for the whole program and change culture etc.

➢Program efforts must be proactive and linked to organizational goals/mission etc.

➢Program development cannot be ‘forced’ or ‘rushed’ – changing culture takes time

➢Worker safety/WPV must be considered in building design (new or remodel)

64


➢Have a good validated patient assessment tool; policy and incident reporting template

➢Sharing tools/processes/policies - networking invaluable

➢Cost of purchased training programs high and ?effectiveness

➢Need for:

◦ Expert in safety/security to conduct walkthrough assessments (law enforcement, OROSHA, Work Comp & Gen Liability Insurance carriers)

◦ Patient ‘risk for violence’ assessment and response tools/processes

◦ Effective ‘user friendly’ processes to encourage staff to report all incidents not just when injured/just part of the job

◦ Effective cost effective and customized training for all staff (transfer of training)

◦ Zero tolerance policies and training that include ORS requirements

65



➢Have a plan, set measurable goals and evaluate them often

➢Use economic modeling to show program return on investment

➢Start small, test pilot and demonstrate successes

➢Choose evidence-based interventions and use existing resources.....don’t reinvent the wheel

➢Don’t forget to involve all stakeholders including patients & families

➢Plan for program sustainability - proactive building design & incorporate leading measures to solicit leadership support and Maintain management support and employee engagement

➢Market & communicate the program and your successes

➢Treat patient and employee safety with equal emphasis

66


presented by lynda enos, rn, bsn, ms, cohn-s, cpe ... · 3/17/2016 · the wsi...

Documents