A big investment

It’s a practical necessity to keep your hospital, clinic or other premises a safe and healthy place for your most valuable asset – your people!

When you got out of bed this morning, did you think about the steps you needed to take to make breakfast? When you got into the car, did you consider the dangers of reversing out of your drive? As human beings, we are all risk assessing intuitively, one way or another, pretty much all of the time.
    
It’s really not difficult to do, although obviously in the healthcare environment there are some issues where you’ll need expert advice. However, it’s definitely not something you or your staff should shy away from. You should be encouraging your staff to actively risk assess for themselves, and I’ll point out how you can do this in a minute.
    
Let me deal with a few myths first. Risk assessment is not about drowning you in paperwork and it’s not about preventing people having fun. Done properly, a risk assessment is a critical tool for any organisation to understand the hazards its people face, and how to minimise the risk of them being hurt. So it’s surely something that’s worth spending a good amount of time on.

Formal risk assessments
Formal risk assessments are required as part of the Management of Health and Safety at Work Regulations (1999) but risk assessment should be an integral part of healthcare and a way of making sure that patients are provided with a safe service and it also forms the basis of clinical governance. At an organisational level, risks can be controlled by referring to guidance such as the Core Controls Assurance Standards in England and the new Standards for Better Health.
    
According to the Community Practitioners and Health Visitors Association a risk management strategy should not only cover all aspects of patient safety including infection prevention and control but also systems to learn from complaints, minimise negligence claims and report and investigate incidents.
    
At an operational level, in the ward, department or clinic, risks can be managed as part of a cyclical process by asking these questions:

• What could go wrong?
• If it did how bad would it be?
• How often could this happen?
• What action do we need to take to make it safer?    

It may not be possible to eliminate all risks but the aim of risk assessment is to be proactive in reducing risks to the lowest level that is “reasonably practicable”.   
    
In practice, every ward, department or clinic is unique, and each will have a different architecture, lay out, staff mix, work load, clinical practice but where you need to take action, the HSE offers some useful principles.

Patient contact
Perhaps the most important form of risk assessment is where a nurse or practitioner comes into contact with the patient. It’s here where being able to do a last-minute risk assessment is so important – but it’s a good principle to adopt regularly in any workplace. It’s something that the emergency services also regularly adopt (calling it dynamic risk assessment) which helps them to decide whether to, for instance, give chase to a speeding motorist or enter a burning building.
    
This is a quick mental check that could be applied to many procedures. In industry it is used in high risk operations where technicians are encouraged to pause and ask themselves a set of five questions at regular intervals:

• How can I hurt myself?
• How could I hurt somebody else?
• How could they hurt me?
• What do I need to do to make sure nobody gets hurt?
• Am I doing it?    

Using such a tool encourages a safety culture and highlights the individual’s responsibility to promote that culture. What risk assessment is really about and why it is so important is that it creates a new context, it’s a meeting place between professional carers and safety expertise. It is a problem solving approach that focuses on those who are actually getting hurt and challenges the status quo as to what is and is not acceptable risk.

Remember the ‘health’
Many organisations often forget that health and safety is not just about preventing accidents or injuries. It’s also about ensuring that people’s work helps them to remain healthy. Work should not leave people with chronic illness or diseases, however, the sad fact is that it does.
    
Health and social care professionals have a statistically higher rate of ill health than other occupations and suffer significantly more musculoskeletal disorders. Their rates of stress, anxiety and depression are also statistically significantly higher than the rate across all industries and there are also high prevalence rates. Slips and trips account for 2,000 serious accidents in the healthcare sector each year.
    
Think about the activities that involve lifting or pulling that might cause musculoskeletal disorders. Violence and aggression that your staff may face is not only a safety problem, it could also have resulting health effects in the sense of trauma or psychological problems. You need to be prepared to deal with this too.
    
Stress is another major issue across all industries. You can help reduce this by ensuring staff have adequate time to take breaks and eat their meals – do not let them eat “on the run”. Alcohol should be avoided, particularly in the healthcare setting. Encourage them to focus on one job at a time and try to stop rushing and being available to everyone and encourage your staff to make time for exercise and relaxation. Finally, don’t force staff to work extra bank shifts as this is more likely make them become ill, when they are already exhausted.
    
Your organisation should have a policy on how to deal with stress related ill health. If you or a member of your team is experiencing stress related ill health it is important to seek help to understand the situation and provide support. A plan can then be developed to deal with the causes of the stress and consider whether this is actually a wider organisational issue. The HSE has some relevant case studies of interventions in the health care sector.
    
It’s also worth getting your staff vaccinated to immunise them against flu, Hepatitis A, B and other common infections. Hand washing is critical in the health sector as this reduces the spread of infection, so it’s important for your staff to know how to do this properly. Getting it wrong can be deadly.

The financial incentive
Ill health costs the health and social care sectors over £200 million each year. The cost of injuries in the sector is estimated at £100 million. This total is made up of sick pay, compensation, insurance, administration and recruitment, and damage to equipment, goods and materials.
    
The cost to society is even higher as it includes loss of output, the cost of treatment, investigation costs if applicable, and Department for Work and Pensions administration costs.
    
For the individual there are lost earnings to take into account and the extra expenditure that is incurred when you are ill, for example the cost of prescriptions and travel to hospital appointments in addition to the human cost of suffering the illness or injury. So, if you are interested in keeping your budgets on track and your services working it makes sense to conduct thorough risk assessments of the health hazards that exist in your workplace.

Everybody's business
Make sure your staff know about and adhere to safety procedures. Ensure everyone knows how to wash their hands correctly and when they should do so. If your policy says that staff need to wear gloves make sure they do so and discipline those who persistently breach the policy.
    
In the healthcare sector, everyone has to work as a team. Health and safety is not something that can be left to just a few people. One person’s misdemeanour or mistake can potentially have dreadful consequences for many other people. So, look out for each other – getting a mentality that says ‘all for one and one for all’ really does help make your organisation a safer and healthier place!