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

News on Australia’s OHS model Act

Safe Work Australia (SWA) has released the latest communique following the Workplace Relations Ministers’ Council meeting on 9 December 2009.  Various amendments have been made to the draft Act following the public submissions period.  Those amendments that SWA consider significant are:

  • adoption of the definition of ‘officer’ in accordance with the Corporations Act 2001 and the definition of ‘due diligence’ to clarify officers’ duties
  • a duty for the persons conducting a business or undertaking (PCBU) to consult not only with workers directly affected by the health and safety matter, but with other duty holders who have a duty in relation to the same matter
  • the requirement for a PCBU to provide training to a health and safety representative (HSR) within three months of a request for training
  • removal of compensation orders as a sentencing option
  • removal of requirements for union right of entry which are already prescribed under the Fair Work Act 2009
  • restructuring of the most serious category of offence to a reckless endangerment offence when a duty holders’ conduct has exposed a person to a risk of death or serious injury of another person
  • monetary penalties, not penalty units, used to ensure consistency between jurisdictions
  • a 14 day timeframe for commencing negotiations between a PCBU and workgroup
  • allowing a PCBU to refuse entry on ‘reasonable grounds’ to a person chosen by the HSR to provide assistance, if no relevant assistance could be provided by the nominated person
  • being subject to a criminal penalty regime, except in relation to right of entry offences in Part 7. Right of entry offences in Part 7 would be subject to a civil penalty regime consistent with that in the Fair Work Act 2009. A framework will need to be established for civil penalties, and
  • penalties for the non-duty of care offences for corporations, ranging from a maximum of $500 000 for serious breaches to a maximum of $10 000 for minor administrative breaches.

Significantly, all the submissions that pushed for the inclusion of a “suitably qualified” OHS professional seem to have missed out.  Clarification or confirmation of this is being sought from Safe Work Australia.

Kevin Jones

UPDATE – 11 December 2009

The Model Work Health and Safety Act has now been posted on the Safe Work Australia website and is available for download HERE

Tripartism and new/old politics

The future of Australian OHS legislation relies on tripatism, discussion and, hopefully, consensus.  In early December 2009, the most recent Liberal Party leader, Tony Abbott, appointed Eric Abetz to the opposition portfolio of workplace relations.  According to a media statement released on 8 December 2009,

“Employment is a vital social and economic portfolio area. Balancing the competing interests to ensure maximum employment levels with acceptable working conditions, is always the challenge”.

“The Coalition fully accepts the verdict of the Australian people at the last election that WorkChoices is dead.  However, in defeating WorkChoices, the Australian people did not vote to reinstate the extremism of some in the Union movement”.

“Labor has deliberately strengthened the hand of Trade Union officials as a clear payback for bank rolling Labor’s election campaign”.

Yes, Abetz and the Liberal Party are not in power at the moment and the political pundits say this may not occur for some years.  But the hard attitude toward the union movement is not likely to help the development of OHS legislative reforms whether in power or opposition.

Kevin Jones

Formaldehyde upgraded to human carcinogen

On 4 November 2009, the United States’ National Toxicology Program (NTP) upgraded formaldehyde to a “known human carcinogen”.  This widely used chemical, principally in wood products, has been suspected of being carcinogenic for some time.

The suspicion was a major reason why, in Australia, Comcare issued a cautionary safety alert on using some shipping containers as converted accommodation.  But the Comcare advice was based, and reasonably so, on a manufacturers’ material safety data sheet (MSDS).

One such MSDS selected at random from the Australian internet sites has this to say about formaldehyde:

Reported fatal dose for humans: 60-90 mL

Oral LD50 (rat): 800 mg/kg

Inhalation LC50 (rat): 590 mg/m3

Low concentrations of formaldehyde may cause sensitisation by skin contact. Formaldehyde vapour is irritant to mucous membranes and respiratory tract. Asthma like symptoms have occasionally been reported following inhalation.

Animal studies have shown formaldehyde to cause carcinogenic effects. In particular, chronic inhalation studies in rats have shown the development of nasal cavity carcinomas at 6 and 15 ppm. These cancers developed at concentrations which produced chronic tissues irritation and would not be voluntarily tolerated by humans. [IPCS Environmental Health Criteria 89, Formaldehyde, World Health Organisation [WHO], Geneva, 1989.]

Some positive mutagenic effects have been reported for formaldehyde. Available animal data do not show embryotoxic or teratogenic effects following exposure to formaldehyde.

The NTP notes that formaldehyde effects have now been identified as having a role in leukaemia and not just localised inhalation-related cancers.

The MSDS is dated 2004 and Australian OHS legislation only requires MSDS to be updated at five-yearly intervals.  Of course they can be updated more frequently should the employer chose or, perhaps if the manufacturer advises them of a reclassification.

It is interesting that a 2004 MSDS still refers to WHO data that is fifteen years old and that the reference is to a non-Australian criterion.  It is accepted that chemical reclassification and research are long processes but what should the updating timeline be now that the US has made this significant re-categorisation?

Perhaps the Australia classifications will gain speed given that the more compatible European re-categorisation of formaldehyde, and other chemicals, was announced overnight.  The EU-OSHA website states

“Formaldehyde was confirmed as carcinogenic to humans. There is sufficient evidence in humans of an increased incidence of nasopharyngeal.”

However the human leukaemia issue was discusses in the evaluation summaries:

“The Working Group was almost evenly split on the evaluation of formaldehyde causing leukaemias in humans, with the majority viewing the evidence as sufficient for carcinogenicity and the minority viewing the evidence as limited.  Particularly relevant to the discussions regarding sufficient evidence was a recent study accepted for publication which, for the first time, reported aneuploidy in blood of exposed workers characteristic of myeloid leukaemia and myelodysplastic syndromes with supporting information suggesting a decrease in the major circulating blood cell types and in circulating haematological precursor cells.  The authors and Working Group felt this study needed to be replicated.”

Given that wood products that contain formaldehyde are used frequently in cabinet-making it is fair to expect MSDSs and OHS guidances on hazardous substances and wood dusts would be reissued and databases updated fairly quickly.  Just as important is the fact that particle boards are commonly sold in hardware and timber outlets in Australia and that Spring and Summer is often the DIY peak.

It is not hard to picture an unscrupulous media outlet generating a panic about the presence of formaldehyde in these products regardless of how the chemical is bound or whether inhalation risks are minimised.

Kevin Jones

OHS criticism needs to aim “at the source”

The e-Editor for the Institute of Occupational Safety & Health, Shaun Gibbons, has commented on the recent speech by David Cameron, the Opposition Leader of England’s Conservative Party.

In this editorial Gibbons says

“Instead of cosying up to the newspapers which perpetuate the myths that somehow health and safety is to blame for much of society’s ills, Cameron should be rounding on the media for its part in falsely reporting on health and safety issues.”

If one takes “health and safety” outside the factory fence and consider it as a social attitude or as a collective term for a range of social perspectives, “health and safety” is crucial, or rather the personal fears generated by our concerns for our own health and safety and for those of our family members are a crucial consideration in how we live and work.

David Cameron is a politician and needs the media to distribute his policies and campaign strategies so he is in his natural element.

The print media, principally, does report health and safety issues in an alarming manner but as sensation, and particularly in England titillation, is what sells newspapers, it seems pointless to blame the media for what they have always done.

It will be impossible to get the media to change their attitudes to health and safety.  The struggles of Australian OHS regulators in doing so has been touched on elsewhere in SafetyAtWorkBlog.  It seems clear that if traditional media cannot be changed in this area, alternate media outlets and mechanisms need to be produced that provide information that is not adequately or appropriately covered elsewhere.  This blog is one example.  IOSH’s website is another.

Gibbons gets closer to the core issue elsewhere in his editorial:

“…seeing through the predictable soundbites which came from his speech last week, Cameron has actually highlighted an important cultural issue that IOSH does welcome: people’s growing confusion and damaged confidence when it comes to managing day-to-day risk. With the fear of litigation at the heart of this debate, the speech did give IOSH the opportunity to make its call for us all to move away from a culture of blame to one that’s based on better ‘risk intelligence’.”

He is right in saying that society has an (increasingly) skewed perception of “day-to-day risk” but he is more correct when identifying that

“the fear of litigation [is] at the heart of the debate.”

IOSH and other safety professional organisations need to get a better understanding of the insurance and legal industries so that they are able to temper some of the extremism from these sectors that is sacrificing long-term cultural and societal health for short-term gain.

SafetyAtWorkBlog’s editor, Kevin Jones, wrote in National Safety magazine about the pernicious growth in the expansion of directors’ and officers’ liabilities insurance policies to cover the legal expenses AND fines from OHS prosecutions.  Either safety organisations are unaware of the impact of these products, do not understand them or do not care, as the silence has been deafening.

Kevin Jones

Recent WorkSafe Victoria prosecutions

Over the last two weeks, WorkSafe Victoria has released over a dozen reports and summaries about prosecutions over OHS breaches.  Some have been highlighted in SafetyAtWorkBlog posts but there are too many for us to cover in detail or to expand upon.

Below is a list of those prosecution summaries

A Bending Company Pty. Ltd. – 8/12/09
Summary: Crush injury

Compass Recruitment Australia Pty Ltd – 8/12/09
Summary: Unguarded Plant/Labour Hire

McCain Foods (Aust) Pty Ltd – 7/12/09
Summary: Lack of isolation procedures, instruction and training

Barro Group Pty. Limited – 7/12/09
Summary: Fatality (crush injury) and a failure to provide and maintain for its employees, a safe working environment that was without risks to health.

Alan Mance Motors (Melton) Pty Ltd – 1/12/09
Summary: Explosion

Victorian State Emergency Service Authority – 30/11/09
Summary: Fatality, Volunteers, Employer, Drowning

Dynamic Industries Pty Ltd – 25/11/09
Summary: Fall from height – Fatality

The Inflatable Event Company Pty Ltd – 25/11/09
Summary: Failure to inform, instruct, train and supervise

Transglobal Shipping & Storage (Vic) Pty Ltd – 25/11/09
Summary: Forklifts, Failure to comply with a Prohibition Notice

Andrew Irvine – 25/11/09
Summary: Fall from height – fatality

Canningvale Timber Sales Pty Ltd – 25/11/09
Summary: Unguarded Plant

John Mavros – 25/11/09
Summary: Unguarded Plant

Shane Grigg -v- The Precast Company Pty Ltd – 16/11/09
Summary: Fail to provide suitable employment

Self development course contributes to a workplace suicide

What would you do if a work colleague strips, screams, acts “like a child having a tantrum”, starts to sing and then jumps out of a window to her death?  That is the situation that was faced by staff at the Sydney office of the Royal Australasian College of Physicians in December 2005.

Only days earlier, 34-year-old Rebekah Lawrence, had participated in a self-development course called “The Turning Point” conducted by Zoeros P/L trading as People KnowHow.  The course, according to one media report, the course included a session called “The Inner Child”

“in which those taking part were encouraged to develop a dialogue between their child and adult selves.”

Lawrence’s actions just before her death mirrored some of the course teaching.

PeopleKnowHow’s website has closed down with an announcement that all of its courses are under review.  Other organisations that provide similar courses are running for cover.  Transformational Learning Australia has said it

“…no longer has a professional relationship, affiliation or any other connection with People Knowhow.” [emphasis added]

TLA also says any relationship ended in 2005.  That the company has felt it necessary to make a media statement about the end of the relationship shows the extent of the effect of Rebekah Lawrence’s death on this industry sector.

TLA goes on to say that

Our organisation does not accept participants who have a recent history of chronic mental illness, participants under the care of a treating professional who have not obtained that professional’s consent to participate, or people who demonstrate a propensity towards psychological fragility or a significant lack of cohesion during the introductory sessions of the program.”

The New South Wales Coroner found that in the absence of any history of psychosis in Rebekah Lawrence that,

The evidence is overwhelming that the act of stepping out of a window to her death was the tragic culmination of a developing psychosis that had its origins in a self-development course known as ‘The Turning Point’ conducted by Zoeros Pty. Ltd, trading under the name of ‘People Know-How” on the 14, 16, 17 and 18 December 2005.

The full coronial findings are difficult to read due to the personal details of Lawrence’s life, her relationship with her husband David and the general picture of her personality that comes through.   An upsetting and enlightening interview with David Booth is available online from earlier in the investigation process.

The findings also provide considerable detail to the components of the course that Lawrence undertook.  There is a greater level of detail than would be expected to be known by someone signing up for such a course and this is where the lessons can be learnt for the OHS professional and safety manager.

It has become common in many corporations who are trying to improve or introduce a positive workplace culture, to supplement their own efforts with “self-help” or “self-awareness” courses.  Lawrence’s death has highlighted the lack of regulation or accountability in some sectors of this industry.  This also highlights the need for people managers to thoroughly investigate such courses to ensure that good intentions are not likely to increase the risk of harm or damage to the employees who participate.

An audio report on the Coroner’s findings is available online.

Counselling Services

Many workplaces often provide access to counselling services through schemes such as Employment Assistance Programs.  The Coroner’s recommendations have some direct bearing on the issue of “counsellors”.

“The Executive Director of the Australian Psychological Society, Professor Lynne Littlefield pointed out that there are no legal restrictions in Australia for practising under the title ‘psychotherapist’ or under the title ‘counsellor’ and therefore no public safeguards against untrained or incompetent practitioners in this field.

Professor Littlefield pointed out that although there were many skilled counsellors and psychotherapists, there were also many whose competence is questionable and without any regulating mechanisms to stipulate the required training and levels of competence, there was no way of protecting the public from these poorly trained practitioners.”

Rebekah Lawrence’s death is receiving considerable media coverage in Australia at the moment and the New South Wales Government is carefully considering the Coroner’s recommendations concerning the regulation of some areas of the self-development industry.  Employers and safety professionals are going to have a very different set of criteria shortly from which such workplace-related courses need to be evaluated.

One media report has indicated the start of the ramifications of this unfortunate death:

“The NSW Health Minister, Carmel Tebbutt, said she had asked her department for ”urgent advice” on the case and would consider the coroner’s recommendations. A code of conduct for counsellors and psychologists had already been implemented and the Health Care Complaints Commission now monitored practitioners.

The Royal Australian and New Zealand College of Psychiatrists called for closer monitoring and accountability of self-help and psychotherapeutic courses.”

Kevin Jones

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