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From worker safety to patient safety

Many of us grew up under the “shadow of the mushroom cloud” and have strong suspicions towards radiation of any kind but the OHS achievements of those working with radiation should be acknowledged.

In the latest edition of the IAEA Bulletin (May 2009) this achievement is clearly summarised as it relates to those in medical radiation.

The early emphasis on staff protection did pay rich dividends in terms of making staff safer. Currently, most (nearly 98%) of those who work with ionizing radiation in any area of medical practice receive a radiation dose that is lower than what they get from natural radiation sources — the so-called background radiation, e.g., cosmic radiation, radon, radiation from building material, earth, food, etc. Background radiation depends on the place you live, but typically is 1 mSv to 3 mSv per year, although in some places can be up to 10 mSv. The dose limit for staff currently recommended by the International Commission on Radiological Protection (ICRP), and adopted by the IAEA and most countries with few exceptions, is 20 mSv/year, expressed as 100mSv over a period of five years. Such has been the success of occupational radiation protection programmes that not even 0.5% of staff members who work in medical facilities (or in any nuclear facility) reach or exceed the dose limit.”

The siginifcance of the article from which this paragraph is taken comes from the next sentence:

“Since there are no dose limits for patients, many may incorrectly assume that there are no controls on patient exposure.”

The article by Madan M Rehani, and thankfully available online, discusses the possibility of introducing an ongoing monitoring system that records the cumulative exposure to radiation by patients. The smart card project launched by the International Atomic Energy Agency will be one to watch as there could be applications of such a system to other occupations and work-related hazards.

The importance of such a program is high as Rehani writes:

“The risk of cancer from radiation doses imparted through a number of CT scans is not insignificant. Most other radiation effects (such as skin injury, just to name one) can be avoided rather effectively, but this is not true for the risk of cancer. There are estimates of few million excess cancers in the USA over the next two to three decades from about 60 million CT scans done annually.”

Kevin Jones

Why isn’t safety and health a continuum in a worker’s life?

Several years ago I attended a safety seminar hosted by Seacare. Maritime safety is not part of my “brief” but safety is, and I was seeking alternate perspectives on my specialist area. Seacare conducted a session where the treatment and management of an injured worker was work-shopped from incident to return-to-work.

It was the first time I had seen a panel of experts deal with the life of a worker across the injury management continuum. The session showed the necessity to communicate across several disciplines and to always keep the focus on the injured worker. I had never seen a better example of risk management in relation to an employee’s welfare.

If only the real world was as organised.

WorkLife Book Covers 003 Work/life balance in Australia is skewed towards those workers who have young families or a role as a carer. This is due to work/life balance evolving from the feminist and social concepts of the 1970s and in response to the increased number of women in paid employment. Barbara Pocock sees these matters in the 1970s as themselves a reaction to the “male-dominated employing class” that, in one exampled, believed that 3 month’s long-service leave was more important than maternity leave. (p212, The Work/Life Collision)

Work/Life Balance Origin

(Wikipedia has a peculiar article on work/life balance that has some interesting points and reference links but then undoes its good work by relying on a couple of major sources and many of them are commercial consultants. That the Australian work in this area is not referenced, indicates a major deficiency. Please note that the concept of balancing work life and non-work life existed well before “work/life balance” was first used. SafetyAtWorkBlog would point the concept’s origin to around the same time as Australia’s introduction of the eight hour day in the mid-1800s or even earlier with Robert Owen in the UK calling for a 10-hour day.)

In the 2000s the emphasis remains not on work/life balance but work/family. As a result, work/life balance will remain an issue handled in the management silo of human resources and being seen as relevant to a lifestage of an individual rather than the individual themselves. There is also an inherent gender bias that could be minimised if the silo was removed.

The Seacare workshop illustrated for me that an injured worker is managed by different silos throughout their rehabilitation. Wherever possible the employer outsources this management to experts in OHS, trauma counselling, medicine, physiotherapy, return-to-work coordinators, and other specialists. The common element through all of these silos is the individual and that person’s health.

OHS & Work/Life Conflict

Occupational health and safety has a big advantage over work/life balance in that it focuses on the individual first. Employers must provide for the health and safety of the worker and, by and large, employers get the safety obligation right. This part of the process has long-established practices based principally on engineering solutions – stopping things falling on a worker, stopping the worker falling into machinery, stopping the inhalation of toxic dust – effectively “blue collar” solutions to “blue collar” hazards.

The mental health of the worker was not a big concern. This is partly because in most of Australia, legislation only ever related to health and safety, and rarely to welfare. Where welfare was a legislated consideration for the management of workers, the social context of the worker was acknowledged myuch earlier and work/life issues began to grow.

The regrettable element of this evolution was that “health” remained a narrow workplace definition instead of embracing the “welfare” or mental health of the worker. If health had been supported by a definition that included welfare in all Australian States’ OHS legislation, the mental health needs of workers and the social contexts of worker management would have been discussed much earlier and in parallel.

Work/Life Balance Awards – A Missed Opportunity

An example of the divergence and the need, in my opinion, to reintegrate work/life balance and occupational health comes from some correspondence I have had with the organisers of the National Work/Life Balance Awards in the Australian Department of Education, Employment and Workplace Relations (DEEWR). Until very recently, these awards were called the National Work and Family Awards.

DEEWR includes in its structure Safe Work Australia, the organisation responsible for monitoring OHS across the country. It seemed odd to me, from the big holistic picture, that DEEWR has not included Safe Work Australia in the judging panel for the 2009 Work/Life Balance Awards. DEEWR advised me that it believes the OHS experience of two of the judging panel, the Australian Council of Trade Unions and the Australian Chamber of Commerce and Industry, was sufficient. Perhaps but why not draw on the OHS expertise of one’s own staff as well?

It also seemed odd that one organisation would conduct two national awards programs – the National Work/Life Balance Awards and the Safe Work Australia Awards. DEEWR advised me that

“The [National Work/Life Balance Awards] recognise organisations that are outstanding in achieving positive outcomes through the implementation and communication of work-life balance policies, practices and initiatives which meet the needs of both the employer and its employees. The Safe Work Australia Awards focus on OHS more broadly and recognise businesses and individuals for their outstanding efforts in OHS and for making safety a high priority in their workplace.”

If the Safe Work Australia Awards focus on “OHS more broadly” why not have one set of awards that acknowledges both the work and social contexts of employees? This is harder to answer when

“Applicants for awards must consent to an assessment to determine whether they have complied with the Fair Work Act 2009, the Workplace Relations Act 1996 and any relevant state or territory legislation, award or other industrial instruments” [my emphasis]

This would surely include the OHS legislation of each State and the Commonwealth.

DEEWR does not involve any of the state OHS regulators in the awards process. The judging panel does not analyse the workers’ compensation premium awards rates of award contenders. State regulators could surely provide a useful perspective as it is mostly under their jurisdictions that businesses are prosecuted for OHS breaches. Worker’s compensation premiums are used by all regulators as a major (sometime the only) indicator of safety performance and for targeting of enforcement programs. The judges of the National Work/Life Balance Awards do not.

OHS professionals and return-to-work coordinators acknowledge that the non-work life and mental health of workers are important elements in regaining a fully-functional employee.

DEEWR made the decision to rebrand the awards to Work/Life instead of “work and family”. This does not reflect the complex interrelations of the social and individual contexts of the health and safety of individual workers.

DEEWR is coordinating the reforms of laws into both OHS and workers compensation. The Australian Government is working on legislative harmonisation across all legislative jurisdictions in workplace health and safety. These OHS laws are likely to extend employer obligations well beyond workers to the public and those potentially affected by work practices..

However DEEWR is missing a major opportunity to set the agenda for the future by acknowledging that the impacts on an individual of the work life and the home life should be managed across the social and employment disciplines.

Kevin Jones

The images included in this posting show some of the many terrific books dealing with, or mentioning, work/life management.

Who is all this OHS harmonisation for?

The public comment phase of Australia’s review of its OHS law harmonisation process begins in September 2009. To a large degree it is at this stage that the stakeholders can start refining their horse-trading. It will also be interesting to watch as the distraction of the new industrial relations legislation has gone since that law was introduced.

Safe Work Australia is using the traditional limited consultative troika – government, employers and unions, and will need to give public submissions considerable weight to balance interests.

Two of the employer groups have already started setting out some guidelines and expectations.

A statement from the CEO of the Minerals Council of Australia (MCA), Mitchell Hooke, was released on 14 August 2009. The only new element of the media release was

“The MCA has called for the National Mine Safety Framework to form the basis of national minerals-industry specific regulation within the Model OH&S Act.”

One of the aims of the harmonisation movement is to minimise regulations for specific industry sectors.

The Australian Chamber of Commerce & Industry was more expansive in its statement of 5 August 2009. The ACCI overstates the cost burden of OHS legislation in each State. The Model OHS Law Review Panel found overwhelming similarities between the legislations but acknowledged that the variations would be difficult to resolve.

The following quote from the ACCI statement illustrates the value of the ACCI perspective and also its major shortcoming.

“However, harmonisation of legislation is not of itself the solution to the compliance burden problem, but rather it will be the final content and quality of the model legislation and the approach to its implementation and enforcement that will be the critical determinants as to whether or not productivity gains are in fact realised in practice.”

It is accurate to say that the success of the legislation will be gauged by its implementation and enforcement. However, the conservative ideology of the ACCI is on show when it states that the harmonisation is intended to provide productivity gains. OHS legislation’s first aim should always be to improve the safety and health of the workforce which, in turn, increases productivity.

ACCI and other employer associations too often jump the safety element and go straight to productivity yet it is the safety of employees that is by far the greatest value that employers share with the community and the unions. Elsewhere in the ACCI statement, the importance of safety is acknowledged but the communication of priorities is muddled.

The ACCI also says “OHS laws should never be used as a vehicle to drive other agendas,” and then goes on to push issues of industrial relations and union behaviour that are not the core focus of the OHS model legislation process.

The ACCI statement closes on a more philosophical approach to OHS. It talks about “cooperative development”, “safety culture” and “continued engagements” but its own cooperation can be seen as conditional in the majority of the statement.

There is one statement that all involved in OHS law reform should consider. The ACCI states that practical and easily understood regulation is required.

“This is particularly important for the majority of employers who operate only in one jurisdiction and who will not receive a direct productivity benefit under harmonisation but who will bear the cost of understanding and complying with a new OHS Act and regulations.”

Not much will change for those companies who operate in a single State of Australia. It is also useful to note that the vast majority of businesses in Australia are small- and micro-businesses for whom all of this national hoo-ha is almost totally irrelevant.

The Australian Bureau of Statistics said in a webpage that was updated in September 2008 that

“Small businesses comprise the vast majority of Australian businesses. The importance of the small business sector to the Australian economy is recognised by researchers, government and policy makers as well as the business community as a whole. It is acknowledged that the characteristics and business drivers of small business are potentially very different to those of larger businesses and as such require specific, targeted policy initiatives. Central to the development of effective policy initiatives is a sound understanding of the nature and characteristics of this sector of the business economy.”

The employer associations do not represent the largest employment sectors in Australia – small businesses, micro-businesses and home-based businesses. Nor do the trade unions. So who exactly are the biggest beneficiaries of this whole OHS harmonisation process?

Kevin Jones

Forest not required – indoor air quality and plants

Ever since modern offices have relied on air conditioning for ventilation, indoor air quality has been a contentious occupational issue from other people’s smells to thermal comfort to photocopier toner dust.

The prominence of air quality in offices as an OHS issue can be illustrated by a paragraph from the 1997 edition of Officewise when cigarette smoke remained a real hazard. No mention was made of plants.

Air in offices may be contaminated by several different

sources, including odours and micro-biological and

chemical contaminants. In an office environment, the

quality of the air is often controlled through an air

conditioning system. A building’s air conditioning

system may be considered as its lungs. The function

of such a system is to draw in outside air, filter, heat,

cool or humidify it and circulate it around the building.

The system expels a portion of the air to the outside

environment and replaces this expelled portion with

fresh or outside air.

“Air in offices may be contaminated by several different sources, including odours and micro-biological and chemical contaminants. In an office environment, the quality of the air is often controlled through an air conditioning system. A building’s air conditioning system may be considered as its lungs. The function of such a system is to draw in outside air, filter, heat, cool or humidify it and circulate it around the building. The system expels a portion of the air to the outside environment and replaces this expelled portion with fresh or outside air.”

Continue reading “Forest not required – indoor air quality and plants”

Learning Lessons from the Santika Nightclub Fire

For many years SafetyAtWorkBlog and its forerunner Safety At Work magazine reported on various tragic fires in crowded nightclubs around the world. Several in recent memory include the 2003 Rhode Island fire that killed 100 patrons and for which, according to an Associated Press report from the time,

Superior Court Judge Francis Darigan Jr sentenced 29-year-old Daniel

Biechele to 15 years, but suspended 11 years of that sentence, and

also ordered three years of probation.

“Superior Court Judge Francis Darigan Jr sentenced 29-year-old Daniel Biechele to 15 years, but suspended 11 years of that sentence, and also ordered three years of probation.”

A brief report on the Rhode Island fire is in the OSHA media archives.

In March 2006, Safety At Work included an AFP report saying

“The municipal council has impeached Buenos Aires Mayor Anibal Ibarra after finding him guilty of dereliction of duty following a December 30, 2004 nightclub fire that killed 194 people.”

An earlier report on the mayor’s response is include at the CrowdSafe website.

Engineering and design company ARUP have provided SafetyAtWorkBlog with an article that analyses recurring elements of nightclub fires using the Santika fire in Bangkok from 1 January 2009 as a most recent incident. Below is the introduction to the article which can be found in full in the pages listed above.

Our thanks to ARUP for the terrific article.

Kevin Jones

LEARNING LESSONS FROM THE SANTIKA NIGHTCLUB FIRE

by Dr Marianne Foley and Travis Stirling, Arup Fire, Sydney

In the early hours of New Years Day 2009, fire engulfed Bangkok’s Santika nightclub, killing 64 people and injuring more than 200. Our knowledge of the events of that night is based on media reports and publicly available information, and the precise cause of the fire is still unclear. However, we do know that there are strong correlations between this and many similar tragedies at entertainment venues dating back as far as the first half of the twentieth century. While we wait for the results of the official investigation and coronial enquiries, it’s timely to ask questions about these fires. Why do they happen over and over again? Why do so many people lose their lives? What lessons can be learnt? And what practical measures can be implemented to stop them happening?

RECURRING MISTAKES

Arup’s analysis of case studies has revealed six themes that commonly contribute to the severity of high-fatality nightclub fires: insufficient exits, the presence of highly flammable materials, a lack of good fire safety systems, confusing environments, pyrotechnics and open flames, and buildings used inappropriately and maintained poorly. By addressing each of these themes, we aim to provide design solutions that could mitigate the risk of future nightclub disasters.

[The themes in the full article are

Insufficient exits

Highly flammable materials

Fire safety systems

Confusing environments

Pyrotechnics and open flames

Buildings used inappropriately or maintained poorly]

Vehicles are workplaces too

Radical Concept 1 – A vehicle can be workplace

Today the Australasian New Car Assessment Program (ANCAP) urged fleet managers to consider OHS obligations in their choice 0f work vehicles. ANCAP said

“Our understanding of the OH&S principles is that there is an obligation on companies and fleet managers to ensure a safe workplace.

“Vans certainly constitute a workplace under the legal definition. We would urge fleet purchasers to examine the legislation and then factor safety into their fleet purchasing policies.”

But in practice this creates enormous challenges for the fleet manager who may only have chosen vehicles in the past that were fit-for-purpose without considering the needs of the driver.

Only recently have steps been added to trucks to allow for easier access to goods on the rear trays. When technology became affordable tilt-down hydraulic ramps were installed, although these have their own work hazards. In both of these examples the changes occurred outside the cabin and related to accessing the transportable products. Looking after the physical and psychological needs of the driver as a worker is different.

For instance, emergency fire appliances in Australia have had substantially improved design over the last ten years. Many of the features are for the benefit of drivers and passengers, such as flip-out steps for when the vehicle is stationary or special seating to allow for personal protective clothing. But the cost of each of these new “safer” vehicles is such that the introduction is phased in and most likely as replacement vehicles. This process could take years. How can a workplace justify allowing only some workers to use “safer” workplaces? The churn of vehicles could establish an inequitable safety standard ion the workplace.

ANCAP’s argument seem to be that a fleet manager who chooses a vehicle that does not have the highest level of safety available are not providing a safe workplace. We could be back to determining what is reasonably practicable.

Radical Concept 2 – A road can be considered a workplace.

Some bus drivers consider their regular route to be a workplace. To some extent this is supported by the road traffic authorities who only allow certain speed control mechanisms on the roads that have bus traffic, such as speed islands rather than speed humps. Although this may be due to the needs of not knocking the passengers around as well.

Regardless of the whether it is passenger safety, pedestrian safety or public liability insurance that creates these design decisions, bus drivers take some “ownership” of their routes.

Important Consideration 1 – Vehicles have drivers

A lot of attention has been given to driver distraction and how drivers drive. Not only are there distractions from within the cabins from passengers, radios, phones, cigarette smoking and a range of driving activities, the relationship between external signage and driver response has also been high.

The complexity of the distraction issue can perhaps be summarized by a couple of recent links. In July 2009 a roadside memorial to a fatality itself is identified as having contributed to a fatality. Research in the United States has begun on the impact of roadside memorials but at the moment the jury is out.

“Our results showed that the number of red light violations was reduced by 16.7% in the 6 weeks after the installation of the mock memorials compared to the 6 weeks before whereas the number of violations at two comparison sites experienced an increase of 16.8%.”

Managers, fleet and OHS, also need to assess the suitability of their workers for driving and consider the following matters.

Companies have an obligation to induct new workers. Do companies induct new drivers on their vehicles or is a valid driver’s licence deemed sufficient?
Is a driving licence a certificate of competence?
Is a worker’s driving record considered when employing them? Would one employ a driver whose record shows a propensity for speeding?
Are driving applicants asked whether there is a history of road rage?
How many demerit points are left on their licence when employed?
For car driving the same licence is used for personal vehicle use and driving work vehicles. What would happen if the worker has their driver’s licence suspended thereby ending their capacity to drive for work?
It would be necessary to clarify in what circumstance transport accident insurance applies and when injuries relate to workers’ compensation?
Who should investigate a traffic incident involving work vehicles – the OHS regulator, police or some other authority?
Are traffic incident statistics collected for work-related vehicles?

Perhaps ANCAP could begin looking not only at the design of vehicles and additional safety features but also how these matters affect a driver’s perception of their own safety. Does the elevation of the driver compared to other vehicles change the way the driver drives? Could the safety features encourage the driver to drive recklessly? Is technology deadening the driver’s instincts?

Similar questions have been posed in the occupational field for decades in relation to the operation of plant, the safe design of workplaces and the types and locations of safety signage. Now these concepts must be considered for the mobile workplace. Many will find this process challenging with some thinking that it is just another grab by the OHS “fascists”.

The issues do need considerable discussion in workplaces. The recent WorkSafe Victoria “Guide to safe work related driving” is a good starting point but for the development of appropriate policies and, more importantly, to affect cultural change on the matter, companies require an elaboration by traffic authorities and from groups like ANCAP.

Kevin Jones

Do health professionals make the best OHS leaders?

David Michaels has been nominated by President Obama as the new Assistant Secretary for the Occupational Safety and Health Administration in the Department of Labor. (A brief profile of Michaels is available HERE.) A posting at a US Workers’ Compensation website links through to a discussion on the potential impacts of the Michaels’ appointment.

There are several telling quotes in the podcast. Sidney Shapiro, a law professor at Wake Forest University, says that OHS achieves more when run by someone with a health professional background.

“…I think it’s important that we know that David Michaels is a health professional. And I think OSHA’s done best when it’s had administrators from the public health community. It is, after all, a public health agency. More times than many of us would wish, it’s been headed by someone who’s been an adamant critic of OSHA and has come from industry or been an industry lawyer.”

Whether this position can be applied to regulators in other jurisdictions is an interesting question.

The Chair of the UK HSE Board, Judith Hackett, has a background in petrochemicals. The CEO of the HSE, Geoffrey Podger, has a background in the civil service, health and food safety. The chair of the Safe Work Australia Council, Tom Phillips was the former CEO of car manufacturer, Mitsubishi, and has served on a range of industrial company boards in South Australia. The Chair of WorkSafe BC board, Roslyn Kunin, harks from human resources and the labour market. Greg Tweedly CEO of WorkSafe Victoria has a background in insurance and compensation. Nina Lyhne of WorkSafe WA comes from road safety and compensation.

This unrepresentative sample shows a mix of experience and not all from health promotion. If the list was comprehensive, it would be interesting to see if Shapiro’s comments stack up and to see how many trade union officials have moved to “the top” or will simply remain “on the board”.

The Living on Earth podcast includes the following quote from Michaels from some time ago:

“What polluters have seen is that the strategy that the tobacco industry came up with, which essentially is questioning the science, find the controversy and magnify that controversy, is very successful in slowing down public health protections. And so the scientists who used to work for the tobacco industry are now working for most major chemical companies. They don’t have to show a chemical exposure is safe. All they have to do is show that the other studies are in question somehow. And by raising that level of uncertainty, they throw essentially a monkey wrench into the system.”

This statement could generate optimism for OSHA’s future but there are many examples of the views of environmentalists changing once they move into the corporate world. Politicians like Australia’s Minister for the Environment, Peter Garrett, is an obvious recent Australian example. Harry Butler in the 1970s was roundly criticised for “selling out” to the petrochemical industry.

However, the appointment of David Michaels pans out, it will be an interesting one to watch, particularly if the US Democrats can stay in power for more than Obama’s two terms.

Kevin Jones

Category: research

From worker safety to patient safety

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