Safety and Service Issues: Managing Risk to Staff. Staff Education September, 2011

Transcription

1 Safety and Service Issues: Managing Risk to Staff Staff Education September, 2011

2 Background: Need identified through CCAC-SP Relations Joint Implementation Committee SWOT Acknowledgment by both CCAC and SP reps that significant variation existed in how challenging client situations were managed Working group comprised of CCAC and SP reps CCC, front line SP staff, CS manager, SP supervisors/coordinators, HR Began work in November, 2010

3 Working Group: Anne Wolnik, Revera (Comcare) (Co-Chair) Jan McGarry, NSM CCAC Cheryl Sellwood, Bayshore Home Health Patricia Wood, Red Crosws Diane Anderson, Red Cross Debbie Roberts, NSM CCAC (Co-Chair) Rose Cheeseman, Saint Elizabeth Peta Taylor, NSM CCAC Nicole Lewis, Revera (Comcare) Sue Groom, NSM CCAC Chrystal Caldwell, NSM CCAC

4 The Issue: In some situations, factors in the care environment pose risk to CCAC and Service Provider staff. Risk to staff is defined to mean any situation or issue which has the potential to cause physical harm or to expose CCAC and/or SP staff to harassment or violence, as defined in the Occupational Health and Safety Act

5 The Goal: To provide CCAC and Service Provider staff with processes and tools which: Mitigate risk and limit escalation; Balance the client s rights and responsibilities with the employees rights and responsibilities Facilitate consistency in approach; Facilitate a shared understanding and mutual respect; Ensure open, transparent communication; Support consistency in documentation and shared reporting; and When appropriate, facilitate the successful transfer of service to a new agency.

6 Guiding Principles: NSM CCAC clients have a right to be treated with courtesy and respect and to have their ethnic, cultural, spiritual and language values respected; NSM CCAC clients have a responsibility to treat their care providers (both CCAC and SP staff) with courtesy and respect, including respecting their ethnic, cultural, spiritual and language values; Responsibility for workplace safety is a shared accountability between the client, the CCAC and Service Provider agencies; Identified risks will be managed in a fair, consistent and proactive way that results in greater awareness, transparency and accountability and limits escalation; All reasonable strategies to mitigate risk to staff, and to the client, will be considered prior to withdrawing service(s).

7 Inputs: All relevant laws, regulations and policies (e.g., AODA, CCAC Client Service Policy, Occupational Health and Safety Act, professional ethical frameworks ) Applicable legal concepts natural justice and estoppel Expert consultation Police, Ministry of Labour Work of other CCACs

8 Definitions: Workplace: any land, premises, location or thing at, upon, in or near which a worker works Occupational Health and Safety Act

9 Definitions: Workplace Harassment: engaging in a course of vexatious comment or conduct against a worker in a workplace that is known or ought reasonably to be known to be unwelcome. Workplace Violence is: (a) the exercise of physical force by a person against a worker, in a workplace, that causes or could cause physical injury to the worker, (b) an attempt to exercise physical force against a worker, in a workplace, that could cause physical injury to the worker, (c) a statement or behaviour that it is reasonable for a worker to interpret as a threat to exercise physical force against the worker, in a workplace, that could cause physical injury to the worker. Occupational Health and Safety Act

10 Definitions: Service Interruption Plan: The plan that has been established by the client and the service provider to minimize client risk should there be an interruption in service.

11 Definitions: Natural Justice: Concerned with procedural fairness and objectivity There are two important aspects to natural justice in common law: The person affected by the decision must be notified of the issue/concern, including the specific details that will be put forward as evidence, and will be provided with an opportunity to respond; and The decision maker must be unbiased and should be able to point to the evidence on which the decision is based

12 Definitions: Estoppel: For the purposes of this framework, the simplest interpretation is that estoppel is a legal term encompassing the concept that a person cannot deny something that has been established as truth either through his actions or inaction Consistency in our actions (CCAC and Service Provider staff) is critical Do what you say!

13 Risk to Staff Framework Process applies to capable and incapable clients For incapable client work with SDM to mitigate risk If SDM not making decisions in best interest of client follow same process, but would likely use different strategies to mitigate risk (i.e. OPGT) Identified risks plotted on risk matrix Determines process to follow 3 levels of risk Level 1: Educate and Monitor Level 2: Engage and Act Level 3: Act and Engage

14 Assessment of Risk Assessed according to two dimensions: Likelihood of the risk occurring and Level of harm that would reasonably be expected should the risk event occur

15 Risk Assessment: Likelihood Very High: Is almost certain to occur High: Is likely to occur Medium: Is as likely to occur as not to occur Low: May occur occasionally Very Low: Unlikely to occur

16 Risk Assessment: Impact is reasonably expected to Critical: Result in physical harm (includes all forms of assault such as pushing, hitting, spitting and sexual touching) or violence, including the threat of physical harm (as defined in the Occupational Health and Safety Act); confirmed illegal activity in the home; evidence of individuals in the home under the influence of alcohol and/or drugs

17 Risk Assessment: Impact is reasonably expected to Major: Human rights violation; health and safety risk with minimal exposure (includes environmental factors leading to slips and falls, unsecured animals); suspicion of illegal activity in the home (not confirmed)

18 Risk Assessment: Impact is reasonably expected to Moderate: Harassment; health and safety risk with prolonged exposure (includes smoking) Minor: Not result in physical harm, harassment or health and safety risk; may be a challenging or unpleasant situation (e.g., bed bugs, lice, animal excrement)

19 Impact Risk Matrix Likelihood Very Low Low Medium High Very High Critical Major Moderate Minor

20 Level 1: Educate and Monitor Issue does not create an unsafe workplace it is unpleasant or challenging Focus on educating staff to minimize concerns and working with client to address issue(s) Issue(s) may escalate to Level 2 or 3 As long as issue(s) remains Level 1, they do not impact client s eligibility for service

21 Safety and Service Issues Risk to Staff Level 1 Educate and Monitor Service issue(s) identified by service provider (SP) Risk identified by CCAC for active client. Service provider (SP): contact client to discuss issue(s) Assess risk level Validation of risk level CCC: contact client to discuss issue(s) Education to client and SP staff as indicated Validation of risk level Document and forward to CCAC using SPR, TPR, NPR. Include description of issue(s)/ concern(s), discussion(s) with client and agreed upon plan Education to client as indicated No CCCis the concern of relevance to other providers? Yes CCAC to notify other providers Monitor situation Support staff No Does service issue(s) reoccur? Yes Continue with plan Reassess risk level No Does the issue(s) remain risk level 1 Yes CCC to consult CS manager Go to appropriate risk level process Determine participants for face to face meeting Conduct face to face meeting with client to discuss ongoing issue(s)/concern(s) and update action plan Follow up with letter summarizing issue(s) and service agreement (signature required) Service agreement Cover letter Monitor situation Support staff If agency s ability to serve is compromised resulting in service gaps, consider options: Add second agency o Arrange conference for successful addition of second agency Transfer all service to new agency o Arrange conference for successful transition to new agency Return to waiting list for unmet service needs o Establish task trigger for reassessment of needs and risk

22 Level 2: Engage and Act Issue does create an unsafe workplace Impact is not imminent; risk increases with exposure Services continue while CCAC and SP staff work with client to mitigate risks Progressive action which can include discharge if risks cannot be mitigated (e.g., safe workplace established)

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24 Level 3: Act and Engage Issue is reasonably expected to result in imminent harm to staff Services are held until risks can be mitigated If risk(s) cannot be mitigated, client will be discharged If risk(s) can be mitigated service will be provided If risk(s) reoccur, client will be discharged

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26 Critical Success Factors Staff aware of their responsibilities to assess risks in their environment and to respond appropriately Confidence/empowerment in addressing identified issues- may require coaching/scripts etc. Consistency in messages to clients and in approach to managing issue(s)

27 Toolkit Policies Risk Assessment Matrix Process Maps Client Letter Templates Guide to Conducting a Safe and Effective Multidisciplinary Conference Service Agreement Template Safety and Service Issues Case Review Request Form and Documentation Template Discharge letter template include conditions to be met for re-admission Guidelines for contacting police (to be developed) Conflict Resolution

28 Policies General Introduction to Safety and Service Issues Management Safety and Service Issues- Managing Risk to Staff Safety and Service Issues Case Review Withholding or Withdrawal of Service All framework related documents, tools, policies will be on Online Forms or Sharepoint under PM&A by Oct. 3 rd.

29 Role Expectations: SP Staff Is aware of responsibilities to assess risks in their environment and to respond appropriately Takes immediate, appropriate steps to address concern(s) Takes appropriate steps to protect own safety Reports unresolved safety and/or service issues to supervisor/manager in a timely manner (immediately for Level 3 and at end of shift for Level 1 or 2) Is consistent in approach to managing issue(s)

30 Role Expectations: SP Agency If SP agency first to be aware of issue > contacts client to discuss issue(s)/concern(s) and explores strategies to resolve Ensures immediate risks are managed and external agencies are appropriately notified (e.g., police, CAS ) Determines risk level using Risk Assessment Matrix Notifies the CCAC of identified issues (immediately for Level 3 and same day for Level 1 or 2) Manages issue(s) in accordance with appropriate process

31 Role Expectations: CCC Intake For new clients, assesses safety risks at admission and discusses any identified issues with client (e.g., smoking, animals, firearms) Consults Client Service Manager if concerns remain re: safety of staff For clients with previous CCAC admissions, reviews safety codes If coded Discharged Due to Risk to Staff, reviews discharge letter to determine if risk issues have been addressed If risk issues remain unresolved, consults Client Service Manager regarding eligibility and next steps

32 Role Expectations: CCC Community Contacts Client Service Manager when safety/service issue(s) is identified With the manager, determines risk level using Risk Assessment Matrix Reports Level 2 and Level 3 risks using the ETMS Manages issue(s) in accordance with appropriate process Arranges and facilitates multidisciplinary conference Requests Safety and Service Issues Case Review

33 Role Expectations: CCC Community Provides client with copy of service agreement and relevant cover letter; ensures letter is copies to primary care provider and all members of team Maintains open, transparent communication with client and all service providers Explores all reasonable strategies to mitigate risk(s) prior to considering a finding of ineligibility When client is discharged due to risk to staff, ensures appropriate safety code is added to client database (CHRIS)

34 Role Expectations: Client Service Manager Ensures that immediate risks are managed and other external agencies are appropriately notified Reviews safety issue(s) and determines risk level using Risk Assessment Matrix Supports CCC in management of issue(s) in accordance with appropriate process Engages Senior Director Client Services and/or Senior Director PM&A as appropriate

35 Role Expectations: Manager on Call For Level 3 issues only CCAC Manager on Call to be notified after business hours (i.e., between 8:30 pm and 8:30 am) Manager reviews issue(s) and determines if other SP at risk Notifies other SP agencies as appropriate Ensures other external agencies are appropriately notified

36 In the event that a CCAC or Service Provider staff is threatened or harmed in any way, they are to: Leave the situation immediately Seek medical attention, if required Contact police (Call 911) as appropriate Immediately notify their Manager or the Manager on Call

37 Implementation Go live October 3 rd E-Learning module TBD (orientation) What you need to Know: Identify risk, go to your manager to discuss and review framework. We are all learning! At team meetings case scenarios will be reviewed