HealthWISE: An ILO WHO Quality Improvement Tool for Health Facilities Claudine Holt, MD, MPH Staff Physician Temple University Hospital Occupational Health Services None Disclosures Objectives At the conclusion of this talk, participants should be able to Describe the HealthWISE tool as a resource for improving workplace safety in health care settings Adapt and apply the WISE methodology to selected occupational hazards and challenges in the health sector Identify the ILO WHO Global Framework for National Occupational Health Programmes for Health Workers 1
Workforce safety is inextricably linked to patient safety. Unless caregivers are given the protection, respect, and support they need, they are more likely to make errors, fail too follow safe practices and not work well in teams. Through the Eyes of the Workforce, Lucian Leape Institute The health and safety of [health]workers is paramount and closely linked to the health of patients. This underpins the quality of care. Prevention of Sharps Injuries in the Hospital and Healthcare Sector Health Workers Defined Health workers are all people engaged in actions with the primary intention of enhancing health Direct providers of care (doctors, nurses, CNAs) Management (financial officers) Support/ancillary staff (housekeepers, cooks, security) Health workers are employed in acute and longterm care facilities, as well as community based, home care, and informal settings 2
Importance of Health Workers Health workers are the gatekeepers of public health Critical role in the prevention and treatment of disease Public health promotion The number of health workers within a country is directly proportional to positive health outcomes i.e. broader immunization coverage and access to primary care Health Workers at High Risk of Injury Number of nonfatal injuries and illnesses in healthcare was 555,700 cases: Ambulatory health: 123,500 Hospitals: 248,100 Nursing and residential care facilities: 184,000 Number of nonfatal injuries and illnesses in other industries: Manufacturing: 502,800 cases Construction: 183,200 cases BLS, Employer Reported Workplace Injuries and Illnesses, 2012 Hazards in the Health Sector Biological (HIV, TB, Hepatitis) Ergonomic (heavy lifting) Psychological (shift work and stress) Chemical Electrical Fire/explosion 3
HealthWISE as a Tool to Improve to Workplace Safety in Health Facilities Introduction to HealthWISE A joint ILO WHO product Based on the ILO s WISE methodology Work Improvement in Small Enterprises Work Improvements in Health Services Promotes action and learning by doing Piloted in hospitals in Senegal, Tanzania and Thailand Introduction to HealthWISE A practical, action oriented tool for health care facilities to improve work conditions, occupational health and safety of workers, and ultimately the quality of care delivered to patients (work performance) Simple, effective and affordable methods 4
Introduction to HealthWISE Consists of an action manual and trainers guide 5 Occupational Safety and Health modules: Controlling hazards and improving safety MSK hazards and ergonomic solutions Biologic hazards and infection control Discrimination, harassment and violence Green workplace 3 Modules on General Working Conditions Recruitment, support, management and retention Work time and family friendly measures Selecting, storing and managing equipment Each module includes individualized checklist 5
How to use HealthWISE How to use HealthWISE Step 1: Obtain permission from the responsible person or body prior to introducing the HealthWISE tool. Step 2: Build a team which is broadly representative. Be aware of existing structures to avoid duplication. Step 3: Prepare and plan. How to use HealthWISE Step 4: Use the checklist Define the issues or workplace area to be assessed. Perform a walkthrough of the work area. Take photos as necessary and take detailed notes of issues that are a cause for concern or that can be used as models of good practice. Interview the staff. Carefully consider each question on the checklist. Write out your ideas for action and improvement. Check the priority box for issues that need to be addressed first and for which you have feasible solutions. Review the checklist the agree on the order of priority for the areas that need to be addressed. Discuss and develop an action plan, starting with the most feasible solutions and achievable goals. Agree on a timetable and assign responsibilities. 6
How to use HealthWISE Step 5: Develop an integrated strategy or action plan to implement improvements. Sample Action Plan How to use HealthWISE Step 6: Monitor and evaluate. 7
Application of HealthWISE to Select Hazards Module 2: Musculoskeletal Hazards and Ergonomic Solutions Module objectives Raise awareness about the range of ergonomic risks to health workers Highlight the importance of preventing and controlling such risks Provide practical guidance Module 2: Musculoskeletal Hazards and Ergonomic Solutions 8
Identify the Problem Musculoskeletal disorders (MSDs) are the most prevalent, expensive and preventable workplace injuries in health facilities According to WHO, MSDs account for 1/3 of all occupations injuries and illnesses in industrialized countries Result from a mismatch of job demands and worker capacity Safe patient handling is a priority Risk Factors Static or awkward postures Repetitive motion, quick motion or vibration Lifting heavy objects Poor workplace design Long shifts Cold temperatures Lack of knowledge about safe handling techniques Module 2: Musculoskeletal Hazards and Ergonomic Solutions 9
Work Adjustments to Reduce Lifting, Pushing and Pulling Review patient handling practices Observe and speak with staff Avoid lifting when possible (elimination) Use appropriate engineering controls Increase staff knowledge and skills on patient transfers and handling heavy loads Promote fitness and strengthening core Module 2: Musculoskeletal Hazards and Ergonomic Solutions 10
Work Adjustments to Reduce Strain, Repetition and Poor Posture Build flexibility and adaptability into the layout of the unit Review space allocation, service delivery routes, and building infrastructure Keep passageways clear Provide enough workspace at the bedside Improve workstation design Equipment and controls within reach Optimal visual/spatial layout Work Adjustments to Reduce Strain, Repetition and Poor Posture Avoid repetitive work by Task rotation Variation of tasks Breaks Reduce non neutral positions and improve posture by providing Adjustable height equipment Stable level work surface Platforms and step stools/ladders Chairs with sturdy backrest Head clearance 11
Module 2: Musculoskeletal Hazards and Ergonomic Solutions Increase Worker Knowledge Hazard communication Provide specialized training for those at risk for MSDs Educate employees on any special equipment or devices so they can be utilized appropriately 12
Sample Hazard Communication Module 3: Biological Hazards and Infection Control Module objectives Identify what are biohazards and the risks of transmission Highlight the importance of effective measures for infection control Provide practical guidance Module 3: Biological Hazards and Infection Control 13
Identify the Problem Biohazards exist in all health facilities All health workers are at risk (as well as patients and visitors ) Module 3: Biological Hazards and Infection Control Prevention and Control of Bloodborne Pathogens Availability of sharps containers and safety devices Worker training Incident reporting and data tracking Hazard communication Implementation of universal precautions Biohazards/infection control policy Blood and body fluid exposure policy Provision of PEP and vaccination (with documentation of coverage) 14
Prevention of Sharps Injuries with the Hierarchy of Controls Elimination Use needleless IV systems and devices Jet injectors instead of syringes and needles Administer meds via another route Engineering controls Single use, retractable needles Sharps disposals within reach Prevention of Sharps Injuries with the Hierarchy of Controls Administrative controls Allocating resources for safe devices Establish protocol for control of spills Encourage reporting Monitor effectiveness of infection control and sharps management Set up a committee PPE Spillage Management 15
Module 3: Biological Hazards and Infection Control Understanding Airborne Hazards Understanding airborne microorganisms Understand the factors contributing to outbreaks: Weak TB control program and lack of infection control implementation Inappropriate use of abx resulting in MDR strains Poor public health infrastructure HIV epidemic Population growth Poverty and malnutrition Overcrowded housing with poor ventilation Understanding Airborne Hazards Risk assessment Consider the number of patients with infectious diseases seen HIV status of health workers Amount of procedures with high risk of contact with respiratory secretions Assessment checklist 16
Management of Airborne Exposures with the Hierarchy of Controls Administrative Controls Publicize info on cough etiquette Prompt identification, quarantine and treatment of those infected Reduce patient length of stay if possible Health worker training Prevention and care package for workers Engineering Controls Use mechanical ventilation systems Control the flow of infectious air PPE Module 3: Biological Hazards and Infection Control Comprehensive HIV and TB Program Post exposure testing and prophylaxis Annual TB surveillance and LTBI prophylaxis Voluntary HIV testing and counseling Initiative launched by ILO and UNAIDS in 2013 Consent Confidential Counseling Convenient Connected to care Treatment and preventive services if needed 17
15 Minute Exercise Use the HealthWISE checklist to address a unique problem facing workers in your facility (5 minutes) Generate an short action plan (5 minutes) Discuss with 2 3 people around you (5 minutes) ILO WHO Global Framework for National Occupational Health 18
ILO WHO Global Framework for National Occupational Health Internship at ILO Headquarters in Geneva, CH Grant through the Council of Women World Leaders Project: To draft an implementation guideline based on the ILO WHO Global Framework Development of the Framework The ILO WHO Global Framework for National Occupational Health Programmes for Health Workers was developed in 2010 Goals: Strengthen health systems Improve the design of health care settings Improve the health and safety of health workers Increase patient safety and the quality of patient care Support a healthy and sustainable community Target Audience Policy makers and key stakeholders responsible for the health and safety of the health workforce in both public and private health sectors at the national and workplace levels Ministries of Health, Labour and Education Hospitals, clinics, acute and long term care facilities HIV and TB control programmes Trade unions Occupational health MDs, NPs,RNs, pharmacists, etc. The health sector workforce 19
THE GLOBAL FRAMEWORK:KEY ELEMENTS Focal Point & Joint Labour Management Committee Policy Access to OSH services Education and Training Identification of hazards & managing risks Immunization against Hep B & other preventable diseases Exposure & incident reporting Diagnosis, treatment, care & support for HIV, TB, Hep B & C Information Systems Compensation for work related disability Research on OSH issues Greening Health Sector Initiatives 58 Resources MOC Questions 1. Which of the following in NOT a core WISE principle for management worker collaboration? a. Encouraging exchange b. Promote learning by doing c. Focus on failures and near misses d. Build upon local practice and available resources 20
MOC Questions 1. Which of the following in NOT a core WISE principle for management worker collaboration? a. Encouraging exchange b. Promote learning by doing c. Focus on failures and near misses d. Build upon local practice and available resources MOC Questions 2. Which of the following is the first step in a sequence of actions to utilize a planned approach to get the most out of the HealthWISE tool? a. Create your team. b. Prepare and plan. c. Monitor, review and make additional improvements. d. Obtain authorization. e. Apply the action checklist. MOC Questions 2. Which of the following is the first step in a sequence of actions to utilize a planned approach to get the most out of the HealthWISE tool? a. Create your team. b. Prepare and plan. c. Monitor, review and make additional improvements. d. Obtain authorization. e. Apply the action checklist. 21
MOC Questions 3. Which of the following is NOT one of the 13 key areas covered in the ILO WHO Global Framework? a. Ensure vaccination for preventable diseases is provided for Health Workers at no cost. b. Promote incident reporting by eliminating barriers and determining who is responsible for an event so disciplinary action can be taken. c. Utilize information systems to collect, track analyze and report data so it can be acted upon. d. Provide appropriate periodic education and training for workers depending upon function. e. Utilize initiatives to make jobs more "green" and safe. MOC Questions 3. Which of the following is NOT one of the 13 key areas covered in the ILO WHO Global Framework? a. Ensure vaccination for preventable diseases is provided for Health Workers at no cost. b. Promote incident reporting by eliminating barriers and determining who is responsible for an event so disciplinary action can be taken. c. Utilize information systems to collect, track analyze and report data so it can be acted upon. d. Provide appropriate periodic education and training for workers depending upon function. e. Utilize initiatives to make jobs more "green" and safe. MOC Questions 4. Biological hazards and exposure to microorganisms account for the biggest percentage of work related injuries among health workers? True or False 22
MOC Questions 4. Biological hazards and exposure to microorganisms account for the biggest percentage of work related injuries among health workers? True or False MOC Questions 5. Due to their size and scope, controlling hazards in health settings often require innovative and costly solutions. True or False MOC Questions 5. Due to their size and scope, controlling hazards in health settings often require innovative and costly solutions. True or False 23
Questions? 24