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Aligning Patient & Workforce Safety: An OSHA Presentation. PfP Campaign Event March 18, 2013 3:00 – 4:00 PM ET Affinity Group Breakout Sessions 4:00 – 5:00 PM ET. Introduction. Paul O'Neill, 72nd Secretary of the U.S. Treasury. Aligning Patient and Workforce Safety.

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Aligning Patient & Workforce Safety: An OSHA Presentation

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Aligning patient workforce safety an osha presentation

Aligning Patient & Workforce Safety:An OSHA Presentation

PfP Campaign Event

March 18, 2013 3:00 – 4:00 PM ET

Affinity Group Breakout Sessions 4:00 – 5:00 PM ET



Paul O'Neill,

72nd Secretary of the U.S. Treasury

Aligning patient and workforce safety

Aligning Patient and Workforce Safety

David Michaels, PhD, MPH

Assistant Secretary of Laborfor Occupational Safety and Health

Healthcare is not a safe industry for its workforce

Healthcare Is Not a Safe Industry for Its Workforce

  • Patient lifting/ repositioning

  • Needlesticks

  • Violence

  • Exposure to chemicals

  • Unique challenges

We all pay the price

We All Pay the Price

  • Worker’s compensation costs

  • Treating patient injuries, too

  • Overtime, temporary staffing

  • Turnover, recruiting, retraining

  • Productivity and morale

Connecting patient and workforce safety

Connecting Patient and Workforce Safety

  • Synergies

  • Challenges

  • Similar approaches can help

    • Management systems

    • Culture of safety

  • Worker safety improves patient safety

Osha cms partnership

OSHA-CMS Partnership

  • Interagency agreement

  • Develop products in three areas:

    • Injury and illness “factbook”

    • Injury and illness prevention programs (I2P2)

    • Safe patient handling

  • Format under development

  • Goals: build momentum and drive results

Injury and illness prevention programs

Injury and Illness Prevention Programs

Dorothy Dougherty,

OSHA Directorate of Standards and Guidance

Injury and illness prevention programs1

Injury and Illness Prevention Programs*

  • Management system approach applied to occupational safety and health (Plan-Do-Check-Act)

  • Proactive: employers and workers findand fix hazards before someone gets hurt or ill

  • Taps into workers’ unique knowledge of the workplace, hazards that may be present, and how to prevent or control them

  • Helps employers meet their fundamental duties under the OSH Act and comply with OSHA standards

*I2P2 is OSHA’s term for Safety and Health Management Systems

Injury and illness prevention programs2

Injury and Illness Prevention Programs

  • Already in wide use in U.S. industry and abroad

  • Required or encouraged by 34 U.S. states

  • Consensus standards

    • OHSAS 18001 (1999, revised 2007)

    • ANSI/AIHA Z10 (2005, revised 2012)

  • Promoted by OSHA since 1982 (VPP)

  • Flexible framework adaptable to any industry, any size workplace

Six core elements of i2p2

Six Core Elements of I2P2

  • Management leadership

    • Set policy, establish goals, provide resources

    • Lead by example, be visible on safety issues

  • Employee participation

    • Build trust, engage workers, spread responsibility

    • “Few resist their own ideas”

Polling question safety culture

Polling Question – Safety Culture


  • Our hospital has a full-time occupational safety and health specialist on staff.

  • Our staff are authorized to stop any work procedure if they have a safety concern.

  • Top management participates in safety inspections.

  • Departmental managers' performance reviews include an occupational safety and health element.

  • Our hospital has established specific occupational safety and health goals and monitors and reports on our progress toward those goals.

Six core elements of i2p2 continued

Six Core Elements of I2P2Continued

  • Hazard identification

    • Baseline inventory of hazards

    • Mechanisms to ensure ongoing assessment

  • Hazard prevention and control

    • Identify, evaluate, and assess feasible options to eliminate, reduce, or control hazards

    • Monitor and evaluate effectiveness of controls

Six core elements of i2p2 continued1

Six Core Elements of I2P2Continued

  • Education and training

    • Understand the basics of the I2P2 and how to participate

    • Identifying, reporting, and controlling hazards

    • Unique safety competencies

  • Program evaluation and improvement

    • Is the program meeting its goals?

    • Are established procedures being followed?

    • Make any necessary adjustments using a corrective action process

Osha s voluntary protection programs

OSHA’s Voluntary Protection Programs

  • Worksite-based program to recognize outstanding occupational safety and health management efforts

    • Performance-based criteria

    • Site application process

    • Onsite review by OSHA

  • Over 2,300 sites nationally, including 14 hospitals

  • DART case rate


A request for the hens

A Request for the HENs:

  • Please read the OSHA White Paper on Injury and Illness Prevention Programs:

  • Please visit the OSHA web page for healthcare workers:

  • Please share these materials with the hospitals in your network.

What are we hearing

What Are We Hearing?

Monica Barrington, Premier

Mitzi Ressmann, Texas Hospital Association

Rosalie Weakland, Ohio Hospital Association

Lynda Martin,

Hospital & Healthcare System of Pennsylvania

Wendy Goshert, Ascension

Tania Daniels, Minnesota Hospital Association

Pursuing a culture of safety osha cms pacing event

Pursuing a Culture of SafetyOSHA/CMS Pacing Event

Bob Williamson

Director, Associate SafetyAscension Health

March 18, 2013

Aligning patient workforce safety an osha presentation

“Every 54 minutes an Ascension Health Associate sustains a work related injury or illness.”

A single approach to safety

A Single Approach to Safety

Interventions for a comprehensive solution for associate safety

Interventions for a Comprehensive Solution for Associate Safety

Vpp pilot sites

VPP Pilot Sites

  • University Medical Center Brackenridge Austin, TX

  • Baptist Hospital Nashville, TN

  • St. Vincent’s Medical Center Bridgeport, CT

University medical center brackenridge

University Medical Center Brackenridge

Common Safety Behaviors for Patient & Worker Safety

March 18, 2013

Kristina Walker, Sally Pawsat


Patient worker safety injury trends

Patient & Worker Safety Injury Trends


Key approach for integrating patient worker safety

Key Approach for Integrating Patient & Worker Safety

  • High Reliability Organization (HRO)

    • HRO principles and safety behaviors changed culture

      • Flattens hierarchy permitting anyone to speak up for safety

      • Promotes transparency by providing forum for reporting of near misses/good catches

  • Safety and Health Management System

    • Followed VPP Challenge program to develop

    • Comprehensive SHMS provides foundation and infrastructure

      • Establishes structure, programs and policies

      • Sets clear and consistent expectations

      • Provides accountability for safety


Principles of high reliability

Principles of High Reliability

Five Principles of High Reliability Organizations (HROs)

Three Principles of Anticipation

Preoccupation with Failure

Regarding small, inconsequential errors as a symptom that something’s wrong

Sensitivity to Operations

Paying attention to what’s happening on the front-line

Reluctance to Simplify

Encouraging diversity in experience, perspective, and opinion

Two Principles of Containment

Commitment to Resilience

Developing capabilities to detect, contain, and bounce-back from events that do occur

Deference to Expertise

Pushing decision making down and around to the person with the most relevant knowledge and expertise


Elements of a successful high reliability organization

Elements of a Successful High Reliability Organization

  • HRO raised worker safety to same level of importance as patient safety

    • “Quality care starts with my safety”

  • Strong leadership engagement & visibility

    • Rounding, coffee, thank you notes, daily brief

  • Worker Involvement

    • Safety Coach program

    • Safety concerns & suggestions reporting

      • may be anonymous

    • Safety related goal in worker performance evaluations

    • Safety behaviors


Umcb injury prevention model

UMCB Injury Prevention Model

Aligning patient workforce safety an osha presentation

Saint Thomas HealthPatient Mobilization ProgramDavid Wheeler, System Safety Officer, Emergency Preparedness Coordinator, St. Thomas HealthAmy Williamson, VPP Project Coordinator, St. Thomas Health

Bh patient handling injuries 2008 2012

BH Patient Handling Injuries 2008-2012


*Average Labor cost based on Average RN & PCT wages, working 12-hour shifts (does not include overtime)

Bh patient admission weights

BH Patient Admission Weights

  • NIOSH (National Institute of Occupational Safety and Health) Safe lifting limit for healthcare workers is 35 pounds.

Patient mobilization training at sth

Patient Mobilization Training at STH

  • Changed teaching method from “how to use equipment” to “how to mobilize your patient”

  • Trained 98 Super Users and 826 End Users

  • Positive feedback from staff (97%)

  • Went from 11.5 days between SPH injuries to over 30 since “go-live” on December 3

Risk tool equipment tags

Risk Tool/Equipment Tags

  • Risk Tool

  • Label/tag all portable equipment

Patient benefits

Patient Benefits…

  • Improve patient mobilization

    • Reduced skin breakdown related to shearing forces

    • Decrease patient falls

    • Shorten length of stay

Creating a common platform for patient associate health and safety

Creating a Common Platform for Patient & Associate Health and Safety

St. Vincent’s Medical Center, Bridgeport CT

Joe Laveneziana

Exec. Director Safety, Security and Facilities

Joanne Velardi

Exec. Director Occupational Health, Wellness and Rehabilitation

Build the foundation

Build the Foundation

  • Senior Leadership Commitment

  • “Walk the Talk”

  • Safety Trumps All

  • Flatten the Hierarchy

  • Define the Culture

Safety is the key to t r u s t

Safety is the key to T.R.U.S.T.


Foster awareness and empowerment

Foster Awareness and Empowerment

  • Behavioral Expectations

  • Transparency

  • SBAR Communication

  • Safety Huddles

  • Reporting Tools

Intentional focus

Intentional Focus

  • Risk Assessment

  • Gap Analysis

  • Cause Analysis Review

  • Policies and Procedures

  • Protocols

Game changers

Game Changers

  • Psychiatrist triage

  • Detoxification Protocols

  • Behavioral Response Team

  • SOMA beds

  • Sitter safe rooms

  • Care Partners

  • High Risk Flag

  • Event De-briefings

  • GPS Duress Alarms

  • MOAB/ CPI Training

Thank You!


Aligning patient workforce safety an osha presentation

“I start with the premise that the function of leadership is to produce more leaders, not more followers.”

Ralph Nader




Bob Williamson

Director, Associate Safety

Ascension Health

(Office) 989.781.8842 (Cell) 989.714.1109



Tom Jackson

National Content Developer

Aligning patient workforce safety an osha presentation

Opportunities for PfP Hospitals to Get Ahead of the Curve on Integration of Workforce and Patient Safety:

  • “1000 Hospital” Event prior to role out of OSHA Tools

  • OSHA participation in Affinity Groups

  • Access to OSHA web site

  • VPP Hospital support for hospitals interested in transitioning to alignment of workforce and patient safety

Upcoming events tentative

Upcoming Events(Tentative)

Breakout sessions

Breakout Sessions

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    • Maternal Health

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