Category: psychiatric

Irrational decision-making

Occupational health and safety often gets sidetracked from the main issue of preventing injury and illness at work.   I often hear employers, particularly in small business, complaining that their workers continue to do the wrong thing even though the employers have done everything they can think of.  

Sometimes an approach is offered that seems like a quick-fix to all the safety problems.  The one that always annoys me is behavioural-based safety.  BBS is like the Hydra and reappears regularly in different guises and with different jargon.

A podcast crossed my desktop this morning that provides a different perspective on “why rational people make irrational decisions”.  

The podcast illustrates the conflicts in trying to make the right decision by discussing the decision of a pilot in the Canary Islands who caused a major crash.  The pilot was also the head of safety at KLM Airlines.

The podcast does not focus on workplace safety but the discussion is probably the better for it.

New Guidance on Preventing Fatigue

Australian OHS authorities have been struggling for many years to address issues of fatigue in the workplace.  Partly this has been because the issue of stress and bullying came to dominate the psycho-social agenda.

The transport industry has pushed fatigue into the unavoidable hazard basket.  New South Wales’ experience with this issue has been particularly interesting and continues to do so. France’s experiment with a maximum set of working hours, partly on the grounds of occupational health and safety, has proven to be a brave experiment.  The Australian Trade Unions’ campaign on “reasonable hours” had safety echoes.

But, as with so many long-term OHS initiatives, Australia waited until England’s Health & Safety Executive (HSE) did all the leg work before tailoring fatigue guidelines to its own circumstances. At least this guideline acknowledges the HSE’s work.

On 4 August 2008, WorkSafe Victoria and WorkCover New South Wales published their guidelines on “Fatigue – Prevention in the Workplace”.  As far as it goes, it is a good addition to OHS information and, if its existence is publicised sufficiently, should place fatigue on the radar of OHS professionals.  Prior to this guide, the only fatigue information that WorkSafe produced was concerning fatigue in the forestry industry in March 2004! – hardly something that any other industry would see as relevant to themselves.

It is worth comparing some of the basic concepts that the OHS regulators have put forward.

The differing definitions reflect the perceptions of the OHS regulators, the state of knowledge at the time, the approach taken by the organisation consulted in the development of the guidances, they anticipate the level of resources allocated to the promotion and enforcement of fatigue management.  The contrast between the Victorian “definitions” of 2004 and 2008 are particularly marked.

Guidelines only go so far and then it is up to business to consider the advice and decide what to do.  The success of the new fatigue guideline won’t be in evidence for several years and, of course, that relies on the very dim chance of anyone undertaking an assessment of the guideline at all.

There are several issues that I think should be considered when reading the new guidance:

The role of the second job.

Second jobs, often undertaken by shift workers are assessed, if at all, for potential conflicts of interest.  The impediment in being “fit for work” in the principal employment is never assessed.  This guideline, in a roundabout manner, identifies this risk. 

The need for nightshift.

Often nightshift, or specific shift rosters, are traditional structures.  “This is the way it has always been done”.  The existence of nightshift in every workplace should be reassessed on a regular basis as economic factors change and as knowledge of the extent of harm presented by nightshift accumulates.

Overlap of Human Resources and OHS

I have bleated on for years about the silo mentality of the OHS and HR disciplines.  The demarcations have been eroding for ages in the real world of business and this trend has been increases as more and more psychosocial hazards are placed within the OHS context.  But the HR professional and the OHS professional continue to speak different languages and with competing agenda.

Fatigue cannot be successfully managed without a common understanding between HR and OHS.

Impairment

Impairment has been a concept floating around the trade unions for some time and they have never found the right approach to getting this on the OHS agenda.  Much of the content in the new fatigue guideline is broader than fatigue and deals with interaction with our employees and colleagues.  The guideline clearly identifies issues from outside work that may exacerbate fatigue in the workplace. (That other demarcation between work and non-work hazards does not apply to fatigue)

Fatigue impairs judgement as well as actions.  Mental fatigue is applicable to a broader range of occupations than physical fatigue and reaches into occupations that are not familiar with OHS, such as judges and politicians, whose important decisions must not be impaired.

 

Fatigue should not be one of the workplace hazards that are increasing shuffled off into the miasma that is work/life balance and wellness.  It relates directly to the traditional areas of OHS but can only be controlled by non-traditional approaches.  There lies the challenge.

Safety – on the fringe again

The Australian government has established an Australian Social Inclusion Board.  This is what the government says is the purpose and challenges of the Board:

This social exclusion is a significant barrier to sustained prosperity and restricts Australia’s future economic growth.

Promoting social inclusion requires a new way of governing. Australia must rethink how policy and programs across portfolios and levels of government can work together to combat economic and social disadvantage.

The Australian Social Inclusion Board which brings together leaders from around the country, will be instrumental in meeting this challenge.

Tackling disadvantage involves generating effective, practical solutions at the level of government, local communities, of service providers, employers and of families and individuals themselves.

The Australian Social Inclusion Board will consult widely and provide views and advice to the Government.

I am glad that consultation will be broad.  Narrow consultation, even in a tripartite structure, is often found to be too narrow and anti-inclusion.  It is acknowledged that as good as broad consultation is, change and influence comes from having a seat at the table.  I find it disappointing that an independent voice for occupational safety and health is not at the table given the higher rate of death and injury in workplaces of young workers, workers from outside Australia and workers with a poor command of the English language.

It would have been good to see the Australian government look beyond an artificial demarcation of work and non-work.  The OHS profession and OHS legislation dumped this demarcation several years ago when we started to deal with psycho-social hazards in the workplace and the impact of workplace hazards on non-work activities.

If there is not a seat at the table, given that the Minister for Social Inclusion is also the Minister for Employment and Workplace Relations and that the board’s Chair, Ms Patricia Faulkner  had an OHS role in the early 1990’s, I would expect safety (both occupational and non-occupational) to be a fixture on the board’s agenda.

Gaining Political Mileage Out of “handcuff(ed) psychiatric patients”

The New South Wales Liberal Party has released an email from the Pialla Mental Health Nursing Staff to WorkCover detailing their “security” concerns. The original email is available HERE.
The Liberals are making as much political mileage out of this issue as they can. 

Many media reports in Australia have said that some patients have been handcuffed to beds. Below is a typical media report:

Psych patients ‘handcuffed’ to beds
Staff at a Sydney hospital have been forced to handcuff psychiatric patients to beds in the emergency department for up to 36 hours because of a lack of space in the mental health ward, the NSW opposition claims. (The full article is available from http://au.news.yahoo.com/080507/2/p/16rjd.html)

The original email from staff makes no mention of handcuffs.  Indeed there is no mention of restraints of any kind.

The NSW Liberal’s media release (available HERE) states

The NSW Opposition has revealed staff at Nepean Hospital have been forced to handcuff and sedate psychiatric patients in the emergency department for up to 36 hours because of a chronic shortage of mental health beds, NSW Opposition Leader Barry O’Farrell and Shadow Minister for Health Jillian Skinner said today………..

“When patients are being handcuffed in busy emergency departments and staff express no confidence in the Iemma Government’s ability to respond to their concerns, you know the Minister is asleep at the wheel,” Mr Aplin said.

The disheartening thing about these sorts of statements that receive considerable media attention is that the original, perhaps, legitimate claims by overworked and under-resourced staff get forgotten.  I encourage you to read the original email and ignore the political hyperbole.
It is reported elsewhere that

“A spokesman for WorkCover said inspectors had visited staff at Pialla twice since the letter was sent and they would have continuing involvement with the ward.
Health Minister Reba Meagher said she had been informed WorkCover were satisfied with safety measures at the hospital.”

This is not to say that everything is now allright but it does show that issues raised are being addressed.

Importantly, most of these emails address the frustration at lack of communication and consultation, or that management is not taking staff safety concerns seriously.  This desperate letter from Pialla’s Mental Health Nursing Staff is a classic example.

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