Workplace Safety

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Keeping a Watch on Process Can Prevent Injury

Deck: 
The entire department observed proper patient-turning technique and safety improved

The 2 North-South medical-surgical units in San Diego were identified as high-injury departments.

One year, the combined team saw 16 patient-handling injuries. Before that, the number was 18. Repetitive back and shoulder injuries were most common. As a result, management was told to eliminate injuries—fast.

The first step in the action plan required staff members to undergo Workplace Safety training on how to conduct safety observations. Each person then conducted three observations a week on teams turning patients and submitted those observations to a collection box in the department. The observations were logged into the Workplace Safety web-tracking tool.

Previously, only charge nurses and managers conducted the observations. But getting everyone involved kept proper patient-handling techniques constantly at the forefront of team members’ minds.

Getting buy-in from staff members was another challenge, so it didn’t feel like another thing on top of their regular workload.

“Make sure you communicate—and with some degree of consistency—to everyone,” nurse manager and RN Erlinda Aquino says. “And hard-wiring it so people understand it’s not just the flavor of the month.”

The UBT adapted a checklist of key things that should be done when turning a patient, such as ensuring a patient’s bed rails have been lowered. Turn-team captains referred to this checklist at every patient turning.

To help morale and maintain safe patient-handling techniques, the UBT set small, attainable goals the department could celebrate.

The team had a pizza party when it reached the first 100 days without an injury, then again after accruing no injuries for the month of July, which historically had been the units’ highest injury month.

“In the beginning, you have to consistently remind people,” says Tess Patiag-Limcuando, RN. “People felt that doing those steps just added to the time, not realizing that it would cost them a whole lot more time if they hurt themselves.”

It was also important to focus on the positive.

“Instead of emphasizing the negative, present it like, ‘I care about you; I want you to be safe.’ Versus: ‘You’re in trouble,’” Aquino says.

Ophthalmology Turns Vision of Safety Into Reality

Deck: 
Identifying the problem areas was a good first step

The San Diego Ophthalmology group had earned the dubious reputation as a high-injury department.

They had a quarterly injury rate of 23.6 and problems ranged from carpel tunnel to back issues. The majority of complaints was caused by sitting at the computer for long periods, typing and doing repetitive motions like using a mouse.

Medical assistants and technicians also frequently complained about having trouble navigating the cluttered, unsafe vision lanes—the small alcoves where nurses and medical assistants evaluate patients before escorting them to exam rooms.

Being flagged a high-injury department, the team was determined to identify the causes of the injuries and how to prevent them from occurring.  

The department took Workplace Safety training and instituted a number of measures to identify and fix potential hazards at all four ophthalmology departments. Those measures included ergonomic evaluations, new chairs and foot rests, and installing stretch break software on all computers.

They conducted regular safety checks and created the “I Spy” program, which has previously injured workers conducting safety observations to identify potential problems. 

The team also revamped the department’s vision lanes.

These often were cramped and potentially unsafe environments with electrical cables stretched across the narrow floor. Computers and blood pressure carts created additional tripping hazards. 

“You had to maneuver around patients and wheelchairs, and generally feel confined, waiting to trip or bend wrong,” says Anna Garcia, a medical assistant and UBT member.

So, they mounted blood pressure machines and KP HealthConnect computers on the walls, instead of using carts. They purchased new chairs for patients, particularly for older patients who have difficulty getting into narrow spots or are in wheelchairs.

By moving power outlets closer to the mounted equipment, electrical cords were no longer in the way. And they painted the walls that ophthalmologists used during eye examinations.  

“The nice thing is if I need to maneuver now, it’s not a move I’m going to regret later on when I get home, when my back is hurting,” Garcia says. 

Ophthalmology went 335 days without an injury.

But keeping workplace safety in everyone’s awareness was a challenge.  

“The equipment makes a difference, but our behavior also makes a difference. It takes a while for that to happen. It doesn’t happen overnight,” Vickie Lance, assistant department administrator says.

Feedback from people outside the UBT also proved invaluable.

“I’ve been in this department for 15 years and I didn’t know there was a problem. Once we saw it on paper, it made a big impact,” Lance said. “And the visual picture of before and after is wonderful. It makes us feel like we’ve accomplished something.”

TOOLS

Integrating Workplace Safety Into UBTs

Format:
PPT

Size:
11 slides

Audience:
UBT co-leads, unit-based teams, Workplace Safety consultants and unit-based team consultants

Best used:
This presentation includes tools on how to integrate workplace safety into the work of unit-based teams. Show the presentation or share the content in meetings and huddles. The following tools and templates are provided:

  • Workplace Safety Checklist
  • UBT/WPS Presentations
  • Path of an Injury
  • WPS Action Plan Template
  • Risk Map
  • Risk Matrix

You also will find guidelines for developing a successful workplace safety plan, plan monitoring and suggestions for ongoing oversight.

Related tools:

TOOLS

10 Proven Practices for Reducing Injuries

Format:
PDF

Size:
8.5" x 11"

Intended audience:
Managers, Workplace Safety staff and unit-based teams working on reducing the number of workplace injuries

Best used:
Share this 11-page presentation of proven safety practices at meetings, in huddles and at other gatherings to accelerate improvement in workplace safety. 

 

Related tools:

Keep It Clean

Deck: 
How EVS departments are building a culture of safety with partnership—and cutting injury rates

Story body part 1: 

The lady who talks to you from inside your GPS has found a new home, it seems, in the robotic carts deployed in the newly rebuilt Los Angeles Medical Center.

Instead of guiding you to your destination, she’s moving linen and trash along the long hallways and underground tunnels. By herself. Her gentle yet firm computerized voice tells workers in a docking room when the cart is ready to be filled, and sensors ensure she doesn’t run anyone over. She even can detect whether there are passengers in the staff elevators and patiently waits for the next empty one.

The robotic carts reduce wear and tear on the muscles and joints of the medical center’s Environmental Services (EVS) attendants. They are just one example of how managers and union members at this Southern California hospital are taking the lead in improving workplace safety for EVS departments.

Historically, EVS is a high-injury department because the job involves a lot of bending, lifting and moving equipment—not to mention working with hazardous chemicals. But the EVS department at Los Angeles Medical Center made such remarkable progress in reducing workplace injuries in 2009, its members earned a special bonus as part of the Performance Sharing Program (PSP). So did the EVS departments in Riverside and in Panorama City, which boasts the lowest injury rate in the region.

“Everyone wants to beat Panorama City,” laughs Manuel Covarrubias, the building services manager there. “It’s a friendly competition.”

But more important than the good-humored rivalry is the confidence these teams inspire in their counterparts. “They know it can be done,” Covarrubias says.

Even Kaiser Permanente’s oft-stated goal of a workplace free of injuries isn’t as far off as might be thought: The EVS department at the Eastside Service area in the Northwest region hasn’t had a single injury for two straight years. Regionwide, the EVS departments improved their collective injury rate by a remarkable 65 percent for the reporting year ending Sept. 30, 2009.

Management and union co-leads on these successful unit-based teams credit specific safety techniques, such as pre-shift stretching, and better equipment, such as microfiber mops and motorized carts. But they also say the communication and team-building skills they use by working in partnership are crucial to building not only systems of safety, but a culture of safety.

What works

Based on the experiences of successful EVS departments in Southern California and the Northwest, here’s what’s working to improve workplace safety.

Conduct safety observations: At Riverside Medical Center in Southern California, the management and labor co-leads of the EVS unit-based team conduct safety observations together. “We walk the units and look for safety hazards,” explains Cora McCarthy, EVS manager.

Evidence from Sunnyside hospital in the Northwest shows the effect this kind of effort can have. After the injury rate jumped up in the first half of 2009, Curtis Daniels, the medical safety coordinator, challenged UBT members to see how many safety conversations they could have to raise awareness of potential hazards. More than 6,000 conversations were reported in one month alone—and during the second half of 2009, the inpatient teams had only two workplace injuries.

By the numbers: The successful teams collect, track and—most importantly—share data, information and tips about workplace safety.

In Southern California, for instance, where there has been a 33 percent reduction of accepted workers’ compensation claims since 2005, the regional Workplace Safety department has built a customized incident investigation database, harnessing data that helps teams spot trends and come up with solutions. The database is only useful because employees are willing to report the injuries they suffer.

“At first, people were afraid,” says Eva Gonzalez, an EVS attendant at Panorama City and an SEIU UHW-West steward. “We assure them there is not going to be a backlash. Incident investigations helped, because people would show us how they got hurt and we let them say what happened. We ask, ‘What do you think we should do differently?’ ”

Ofelia Leon, the day shift supervisor who has worked at Kaiser Permanente for about three years, notes the fear of reporting was not unfounded: “At other (non-KP) hospitals, if you got injured, you got a caution or discipline, so people were afraid to report them.”

Employees also get regular updates about their progress toward their workplace safety goal. “We share information and let our members know where we’re at and where we need to be,” says Edwin Pierre, a 26-year EVS worker at LAMC. A huddle at the beginning of each shift includes a safety tip shared by an employee —creating a climate where workers get accustomed to speaking up and gain confidence that their voices are being heard.

Floor it, safely: To reduce injuries from lifting bulky mop buckets, EVS departments are buying more efficient microfiber mops that don’t require as many trips to empty, are wringerless, and use less water and cleaning solution. To keep those long hallways at LAMC clean while keeping workers safe, the EVS department replaced autoscrubbers with “chariots” that workers ride. “They have improved quality and morale, as well as safety,” says Abraham Villalobos, the hospital’s director of Environmental Services.

Maximize the micro: Microfiber is not just for mops. EVS departments in the Northwest now are using microfiber dusters with extendable handles proven to reduce worker strain. The new dusters also clean 45 percent faster than traditional methods and reduce chemical and water consumption up to 90 percent.

Tamper with hampers: The lids on trash cans and hampers were falling on workers’ arms and causing injuries—so the Panorama City EVS department bought new bins with hydraulic lids. They also put signs above hampers asking staff members not to overload the bins, because too-heavy loads were causing lifting injuries.

In a similar vein, “when needlestick injuries were up, we brought it to the table,” says Rosemary Mercado, an EVS attendant at Panorama City. The unit-based team decided to coach workers to hold the bags away from their bodies when taking them out of the laundry hampers. And they borrowed an idea from colleagues at nearby Woodland Hills Medical Center: They moved the hampers away from the sharps containers.

Take your time, take time off: “Be careful and take your time,” is the advice from Rebeca MacLoughlin, a housekeeper in the Northwest for seven years. Mindful of the link between fagtigue, morale and injuries, building services manager Manuel Covarrubias in Panorama City encourages employees to take time off when they seem to be getting sluggish. “I look for ways to cover people during summer to ensure people with less seniority can get some time off when they really want it,” he says.

Starting with stretching: Without exception, every EVS department that’s been successful at reducing the injury rate starts every shift with stretching. “Sometimes we dance and make it fun,” says Ofelia Leon, the day shift supervisor at Panorama City. The dance music of choice at LAMC is Michael Jackson. “I mean, who can’t dance to Michael Jackson?” wonders Pierre, the Pierre, the LAMC EVS attendant.

The bottom line: Investigating incidents, sharing safety tips, having on-the-spot conversations about working safely: These things are possible in large part because of the communication and team-building foundation fostered by the Labor Management Partnership.

'Our opinons matter'

Before, “It was just coming to work, doing whatever, and then leaving,” says Sandra Pena, the EVS labor co-lead at Riverside and United Steelworkers Local 7600 member.

“Now, it’s like there’s feedback back and forth all the time. It’s more of a team.”

“It makes you feel good as an employee to make improvements,” says Eva Gonzalez of Panorama City. “We know our opinions matter. We know we are not talking to the wall.”

Dilcie Parker, the labor co-lead at the LAMC EVS department, recalls how things were in 1999, when partnership started taking hold at her facility. “When we first began meeting, it was, ‘You sit on that side of the table, I sit on this side.’ I once arrived at a meeting and said, ‘I don’t sit next to management.’ You could feel the hate in the room.”

Management co-lead Villalobos doesn’t disagree. “Before, we couldn’t stand each other,” he says. “There was screaming.”

The turnaround, both say, came as a result of the LMP training the whole team received—from mapping root causes to issue resolution—and persistence.

“We started seeing the benefits in better quality and better attendance,” says Abraham Villalobos. “The reduction in injuries didn’t just happen this year. It’s about understanding the things we need. If we don’t get along, we can’t come up with projects to work on.”

This doesn’t mean everyone is holding hands and singing “Kumbaya.”

“There are still issues we disagree about,” says Parker. “But before, we used to get nothing solved. Now, issues get solved and they are off the table.” Recently, Parker, Villalobos and the team were in a meeting, crammed together in a tiny conference. The woman who once refused to even sit next to a manager found herself saying, “Look, Abraham, we’re actually touching.”

For information about EVS teams in Southern California, contact Dave Greenwood, workplace safety program director, at Dave.B.Greenwood [at] kp.org; for more information about workplace safety for EVS teams in the Northwest, contact Lori Beth Bliss, regional EVS manager, at Lori.B.Bliss [at] kp.org.

 

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