Mind your step

There has been a particular focus on preventing slips, trips and falls in Britain’s workplaces in recent years. And there is good reason for this.
    
Although the consequences of many such incidents are minor, slips, trips and falls can result in serious injuries, even when they happen on the same level.
    
The Health and Safety Executive’s (HSE) Shattered Lives 2009 campaign is one example of the attention which slips, trips and falls are receiving. It is targeting the health sector because 54 per cent of major injuries in healthcare come from slips or trips and in 2007/8 they cost society £72.4million.  
    
Across all industry sectors, nearly 11,000 employees suffered a major injury as a result of a slip, trip or fall on the same level in 2007/08.

A daunting task
As in all employment sectors, those responsible for managing health and safety in a healthcare setting might find themselves overwhelmed by the task, especially if they are new to the role.
    
Preventing slips and trips is one of many issues requiring attention, alongside safer people handling and fire safety to name just two more.
     
The good news is that the underlying principles of health and safety management are really quite straightforward and can be applied to a range of issues – good news for the time-pressured healthcare manager.
     
Essentially, employers have to ensure, “so far as is reasonably practicable”, the absence of risk to the safety and health of employees and others, such as patients and visitors, affected by their undertakings.  

Steps to success
There are certain basic principles which, if implemented effectively, enable organisations to achieve this:

• Have a system in place to manage health and safety. You need to be able to show how you plan, organise, control, monitor and review preventative measures, and you need a “competent person” to help you understand and respond appropriately to your legal duties.
• Identify your main hazards (things that could cause harm). 
• Assess your risks (which have the highest probability and worst consequences?) to make sure your risk control measures are adequate and that they are used and maintained. 
• Safety measures have to be sensible and balanced. You do not need to go over the top. But if necessary, put in place back-up measures such as emergency procedures. Inform, train and supervise employees.
• Do certain things consistently like: consulting your workforce; regular health and safety checks; reporting, recording and investigating accidents and near-misses; providing employees and others with certain basic information. Also make sure you have provided suitable first aid and welfare facilities and have employers’ liability insurance.
• Make time periodically to review performance and feed back lessons learned to improve controls and management arrangements.  

Restating these basic principles is important. Healthcare managers, supervisors and team leaders need to be able to understand what good health and safety management looks like and know how to deliver continuous improvements in performance that comply with health and safety legislation.

Causes of slips and trips
As we have seen, slips, trips and falls can result in serious injuries. But what is causing these accidents? Are workers wearing inappropriate footwear? Are the surfaces underfoot in a poor condition or are they inappropriate for the setting? Are accidents linked to how people are moving around an area, e.g. rushing? Are external factors, such as wet surfaces or obstructions, coming into play?
    
The HSE’s figures for how slip and trip accidents have happened make interesting reading.
    
The provisional figures for 2007/08 reveal that of the 10,910 slips, trips and falls on the same level which caused major injuries, 1,954 were the result of someone tripping over an obstruction and 1,907 happened when someone slipped on a wet surface. These two factors accounted for the largest number of accidents, apart from those that were classified in the general category of having happened in “another way”.
    
The HSE’s website (www.hse.gov.uk/slips/) sets out a range of factors that can cause slip and trip accidents:

• Flooring
• Contamination
• Obstacles
• Cleaning
• People or human factors
• Environment

Reducing risks
When you have carried out the type of risk assessment mentioned above (assessed your risks to make sure your risk control measures are adequate and that they are used and maintained), these factors and their potential for causing people to slip or trip would probably have been identified. The assessment should also have given you some ideas for how to prevent these accidents – the control measures.
    
Remember, you cannot eliminate all risks – you need to implement control measures that are proportionate to the risk in question and a good approach to health and safety balances such control measures sensibly against other needs. For example, no longer serving drinks on a hospital ward would be one way of preventing the accidents that happen when people slip on a drink spillage, but fitting lids to cups or jugs where appropriate or making sure spillages are wiped up quickly are probably more suitable control measures.
    
In addition to spilt drinks, it is interesting to note that the potential for people to slip on a wet surface comes into more than one of the HSE’s factors that can cause accidents, with environmental factors, such as rain coming through an open door or window, or floors that are still damp after mopping being among the other hazards that could catch people out as they are walking around.
    
If risks related to these hazards have been identified in your risk assessment, let’s look in a little more detail at how to prevent the accidents they could cause.

Preventing accidents
First, ask whether you can eliminate the hazard. For example, is there a machine that regularly leaks water that needs to be fixed? Or does a canopy covering an external entrance need to be fitted or repaired?
    
If you can’t eliminate the hazard, ask whether it can be controlled. For example, a good-sized mat at the building entrance means people could dry their feet as they come inside and fitting lids on cups, jugs or other containers could prevent drink spillages.

And if you can’t stop liquids from getting on to the floor, the next best thing is to ensure that spillages are cleaned effectively and quickly. (Remember, the process of cleaning can also create slip and trip hazards).
    
As we also saw in the HSE statistics, people tripping over obstructions on the floor is also a common cause of accidents. Therefore, something as simple as good housekeeping – for example, making sure walkways are kept clear and keeping an eye out for trailing wires – could prevent many accidents.

Changing culture
As with health and safety in general, continuous improvement in preventing slips, trips and falls cannot be achieved by one-off interventions such as requesting that spilt drinks are mopped up quickly. Prevention strategies have to be bedded in deeper than this so they are sustainable.
    
Therefore, before you start looking for hazards, assessing risks and reviewing your precautions, you need to look at whether a robust system – the policies, people and procedures – is in place for managing health and safety on an on-going basis.
    
Underpinning such a system should be a positive safety culture, encompassing everyone from board-level directors and on-site managers, supervisors and team leaders to the frontline workforce.
    
Working together to develop a good health and safety culture has to be a team effort, with ownership and commitment to safety built throughout the workforce. Such commitment and ownership should also extend to other firms, including clients, suppliers or contractors. Remember, cleaning contractors have a crucial role to play in reducing slip hazards, so do make sure they feel a sense of ownership.
    
As well as there being a legal requirement to consult workers and their representatives on health and safety, involving individuals and teams in operational decision-making also makes practical sense. Not only do employees have a wealth of knowledge that should be harnessed to aid the development of safe working practices, but involving them can lead to a better buy-in from the whole workforce.
    
If you’re a healthcare manager, do tap into the expertise of your frontline staff about the slip and trip hazards they encounter on a daily basis and ask for their ideas about how to prevent the accidents that could result. Using their knowledge should enable you to implement control measures that are both proportionate to the risk and workable in relation to the needs of staff, patients and visitors.
    
It is really only through working together to prevent workplace accidents such as slips and trips that significant and sustained improvements can come about and injuries be reduced.

For more information
RoSPA offers a range of health and safety training and audit services for health and social care organisations. For more information, see www.rospa.com/occupationaltraining/industry/healthandsocialcare/
    
See www.hse.gov.uk/slips/ for HSE information about preventing slips, trips and falls.
    
See www.hse.gov.uk/healthservices/ for HSE information for the healthcare sector.