Category: guidance

New guidelines on aggression in health care

WorkSafe Western Australia and the other OHS regulators in Australia have produced a very good, and timely, guideline for the “Prevention and Management of Aggression in Health Services“.

The hazard has existed for many years and hospitals, in particular, are torn between the competing priorities of keeping their staff safe and maintaining  contact with their clients.   Glass screens and wire are effective barriers to violent attacks but it can be argued that such structures encourage aggression by implying that “violence happens here”.

The guidelines, or what the regulators call a “handbook for workplaces” (How does that fit in with the regulatory hierarchy for compliance?), provides good information on the integration of safe design into the health service premises.  But as with most of the safe design principles, as is their nature, they need to be applied from initial planning of a facility and so, therefore, are not as relevant to fitting-out existing facilities.  In health care, it often takes years or decades before upgrades are considered by the boards and safe design is still a new concept to most.

Another appealing element of the guide is that it does not only consider the high customer churn areas such as casualty or emergency.  It is good to see the important but neglected issue of cash handling mentioned even in a small way.

Another positive is the handbook includes a bibliography.  This is terrific for those who want to establish a detailed understanding of the issues and the current research.  For the OHS regulators, it allows them to share the burden of authority.  Just as in writing a blog, by referencing source material the reader understands the knowledge base for the opinions and the (blog) writer gains additional credibility by showing they have formed opinions and advice from the most current sources.

Having praised the bibliography, it is surprising that of all the Claire Mayhew publications and papers mentioned her CCH book “Guide to Managing OHS Risks in the Health Care Industry”, was omitted.

The regulators have often had difficulty determining whether checklists or assessment forms should be included in their guidances.  In Victoria one example of the conflict was in the Manual Handling Code of Practice that included a short and long assessment checklist.  Hardly anyone looked beyond the short version and many thought this undercut the effectiveness of the publication.

The fact is that safety management takes time and business want to spend as little time on safety as possible but still get the best results.  Checklists are an audience favourite and contribute to more popular and widely read guidelines, and broad distribution of the safety message is a major aim.

Interestingly amongst the checklist in this health services aggression publication a staff survey has been included.

(At least) WorkSafe WA has listened to the frustrations of readers who download a PDF version but then have to muck about with, or retype, the checklists.  This handbook is also available as an RTF file for use in word processing.

This is the first OHS publication that has come out from a government regulator with this combination of content, advice and forms.  It is easy to see how this will be attractive to the intended health services sector.

Kevin Jones

A good book of safety solutions case studies

Australia has many safety awards programs.  SafetyAtWorkBlog has reported on some of the practical solutions from the awards and lamented how the prominence of such solutions fades quickly as the mainstream media ignores them.  The blog has also shown examples of a hard copy solutions database that existed in Victoria and Australia for a couple of decades.

The European Union’s Agency for Safety and Health at Work has recently released, online, a publication in support of its risk assessment campaign that shows how safety solutions can be presented and shared without worrying about commercial-in-confidence or intellectual property.

Jukka Takala, Director of EU-OSHA, says in his foreword

“This report supports the campaign by providing information on successful interventions in the workplace illustrating how the hazards identified after a risk assessment can be eliminated or controlled. The report is aimed at those who are responsible for carrying out risk assessments in the workplace and for preparing decisions on risk elimination or control measures.”

The report, “Assessment, elimination and substantial reduction of occupational risks“, also provides a list of some very useful elements for preventative safety

“The employer shall implement the measures (necessary for the safety and health protection of workers) on the basis of the following general principles of prevention:

(a) avoiding risks;
(b) evaluating the risks which cannot be avoided;
(c) combating the risks at source;
(d) adapting the work to the individual;
(e) adapting to technical progress;
(f) replacing the dangerous by the non-dangerous or the less dangerous;
(g) developing a coherent overall prevention policy;
(h) giving collective protective measures priority over individual protective measures;
(i) giving appropriate instructions to the workers”

The report is very useful in its clarification of the role and potential benefits of risk assessment.  Each solution is described, in detail, as a case study and the report includes guarding issues, manual handling and psychosocial hazards.  On the latter category, here is the summary for psychosocial hazards in hospitals

“Stress in hospitals – assessment of psychosocial and physical risks

Hospital work is known to be physically and psychologically demanding.  A pilot project was therefore set up in a hospital with 470 employees to assess workplace risks and organisational aspects.  The workers were exposed to physical strain, risks from chemical and biological agents and psychosocial strain.  They were also stressed by administrative tasks. After the assessment the results were analysed, action plans drawn up and measures implemented.  Risk assessment became a standard part of quality and health management systems, including training.”

One of the particularly interesting element in this program was that one of the first sources of information it used was quality management documentation.  Quality management is one of the most under-utilised sources of OHS and strategic planning data.  As long as quality managers do not perceive quality as a business element above that of safety, environment or any other, as long as they accept that each element is of equal importance in integration of management system, the quality data will be indispensable.

The quality data is followed up by interviews with middle- or line managers, questionnaires and observations.

Of all of the control measures, this organisational change was very clever:

“The administrative tasks, in particular, were perceived by the nurses to be distracting and onerous.  They felt that paperwork kept them away from important care work.  Consequently, administrative tasks were delegated to the night shifts, where there was more time to devote to them as the amount of care work fell at night.”

This looked at workload in a peak/off-peak context that fits with the natural rhythm of the clients.  The paperwork night-shift may be a suitable solution for other workplaces and the night-shift workers may have increased productivity due to the lack of distractions.

EU-OSHA keeps producing reports and publications that call out for a broader readership than Europe and this is a great example.

Kevin Jones

PCBUs have begun appearing

A reader has drawn SafetyAtWorkBlog’s attention to one State regulator in Australia who has already begun to apply the broader definition for “employer” in their OHS guidance material.

In September 2009, the ACT Safety Commissioner published a Guidance on “Safe Structures, Systems and Workplaces“.  In that guidance, the Commissioner refers to

…”New general duties to ensure work safety by managing risk apply to a person:

…carrying on a business or undertaking;…”

This anticipates the definition put forward in Australia’s OHS model Act in relation to PCBUs (Peek-A-Boos).

The matter of a “business or undertaker” was also used in the ACT’s Work Safety Act 2008 (effective from 1 October 2009) throughout the document but with slight variation.  Of most interest here are the definitions of employer, worker and “business or undertaking”:

“employer, of a worker, includes a person who engages the worker to carry out work in the person’s business or undertaking.”

“worker means an individual who carries out work in relation to a business or undertaking, whether for reward or otherwise, under an arrangement with the person conducting the business or undertaking.”

“business or undertaking includes—

(a) a not-for-profit business; and

(b) an activity conducted by a local, state or territory government.”

The logic of such an inclusive term is understandable but needs greater clarity which is likely to some from regulations or supportive documents.

Having a Peek-A-Boo is one thing, let’s just hope that the jargon does not develop to start referring to “undertakers”.

Kevin Jones

Gov’t responds to insulation installer’s death

Recently SafetyAtWorkBlog reported of the death of a worker installing insulation in a domestic home.  A staple for the foil insulation apparently pierced an electrical cable and electrocuted the worker.

The Queensland Government has introduced mandatory provisions to avoid the hazard in the future.  In a media release on 1 November 2009, the Industrial Relation Minister, Cameron Dick,

“… issued a ministerial notice under the Electrical Safety Act 2002 to prohibit the use of metal fastenings for ceiling insulation.”

The ban is effective from 1 November 2009.

It may already be the case, elsewhere in the world, that non-conductive fasteners are used for installing metallic insulation.  If not, the rules introduced by the government should prove useful references.

“The ministerial notice means that installers will have to use nylon or plastic fasteners (which are already in use within the industry), glue or tape to fix foil insulation in ceilings.

As well as banning metal fasteners, the notice also:

  • forces insulation installers to comply with the Wiring Rules with respect to the placement of any type of insulation near recessed downlights
  • makes electrical safety risk assessment training mandatory for all installers
  • forces installers to document their on-site electrical safety risk assessments and keep a record f or five years.”

Such a mandatory rule is clearly a necessary short-term fix but it does little to address the concerns of the Master Electricians Association.  Training and enforcement are the long-term solutions but policymakers must also anticipate the applications of their policies more closely.  New policies should not be announced in an industry that does not have the resources to meet the policy’s aims.

Kevin Jones

Getting the OHS message out there

Next week in Australia is Safe Work Australia Week in which each State jurisdiction undertakes information and promotional activities in support of occupational health and safety.

In Sydney, the Safety Institute of Australia (SIA)  is hosting a Safety Conference.  A major theme, understandably, is Australia’s OHS law harmonisation and there are excellent speakers at the conference on the topic.

There has always been an operational tension between the conferences and the trade shows that accompany most of the Safety Institute conferences even though there is a contract between the SIA and Australian Exhibitions & Conferences, the trade show owners.  The tension is over which event gets priority in promotions.  Effectively this differs depending on promotional target but for years it has been possible to attend a trade show without having any idea that a conference may be in the room next door.

This year the trade show, technically “The Safety Show“, is offering free workshops on the harmonisation laws to show attendees with speakers from a law firm, amongst others, who is also hosting a panel discussion in the conference .  Why would one run a free event that competes with a partner’s conference for which the daily attendance fee is $A500???!!!

Admittedly, the conference is likely to include more detailed examinations of the laws as there is more time and many of the speakers are lawyers or academics specialising in the area but if one’s charter is to promote health and safety awareness and to advance the science and practice of safety, as the SIA states, is this appropriately met by speaking to a group of maybe 400 conference attendees or a potential 10,000 trade show visitors?

Kevin Jones

Working in heat – still contentious

Australians associate working in hot conditions as outside work although the occupational hazard of heat is just as relevant in bakeries and foundries.  OHS regulators and safety lobbyists often try to include too much in their heat-related strategies – heat stress, skin cancer, hydration, dust, and a range of other hazard combinations related to specific industries.

What the community and many workers want is a defined unsafe temperature limit.  Some will remember being allowed to take their school ties off when the temperature reached 38 degrees Celsius (100 degrees Fahrenheit).  But OHS legislation, more often than note, focuses on the system of work and this allows for work in excessive temperatures as long as the system can ensure this is safe.

Legislatively, this position is understandable but it is not what people want or expect.

The issue was raised recently at the Trade Union Congress in September 2009 in England in a discussion on working temperatures.  Pauline Nazir, representing the Bakers, Food and Allied Workers’ Union, said

“The question is why there is no maximum temperature and why has the Health and Safety Executive and the Government have consistently dodged calls for similar protection for those who work at the higher levels of temperature?  It is a big question for a big organisation, but one that the Health and Safety Executive has failed to answer logically despite years of pressure.  While they have failed to act, workers suffer the consequences, year in and year out.

It seems illogical that we have regulations that limit the temperatures at which cows and pigs can be transported around the country, but offers no protection other than the general health and safety legislative offerings.  It is true that if you move livestock in Britain, there is a maximum level of 35 degrees Centigrade within the carrier, but poor old human beings can regularly carry out physical and strenuous work at temperatures that far exceed these levels.  Why have we failed to get the Health and Safety Executive to act?”

Pages from guidance 1rking -346317709n 2.945398e-266at3The variety of factors contributing to excessive heat at work is probably the reason for lack of progress on the hazard.  There are many organisations advocating prevention of harm from working in heat but they all have their own funding models, costs, agendas and “sub”hazards.  Nazir’s call for the Health & Safety Executive to do something sounds unfair but the common activity she is referring to is working in heat so it is not unreasonable to expect an OHS regulator to coordinate resource and, perhaps, research.

Coordinated safety action is expected of business operators to ensure these hazards are controlled but that operator would need to read up to a dozen brochures, codes, guidances or policy statements to get close to achieving a situation that employees would consider safe.

It may never be appropriate for an OHS regulator to state a defined (un)safe temperature (the hygienists would argue safe working conditions) but what can be achieved is guidance that pulls together the multiple hazards and control measures so that achieving a safe workplace is as easy as can be.

WorkSafe Victoria has started along this path with a (thin) guidance and more generic terms of discomfort and illness but there is a need for a much more comprehensive guide.

Kevin Jones

UPDATE: 9 October 2009

A reader has pointed out a podcast by the Canadian Centre for Occupational Health and Safety from the July 2009 that explains some of the justification for not issuing a specific working in heat benchmark.

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