Historically, in healthcare, safety committees and safety officers have focused on environment of care issues (mainly fire safety) and general compliance with OSHA regulations. To most frontline healthcare workers safety means knowing about material safety data sheets and what to do if the fire alarm sounds. Anything beyond that was the safety officer or facilities manager's responsibility. Even though healthcare workers sustain a very high rate of back injuries and cumulative injuries, little coordinated attention has been paid to true employee safety and injury prevention at most hospitals.
This section will describe how a safety management audits can be used by a corporate safety program to generate a high level of organizational awareness, accountability, and activity around employee safety and injury prevention. This will be followed by a detailed case study of how our organization developed and implemented a safety management audit tool.
In order to affect sustainable changes in large organizations, particularly in industries where employee safety has not been a priority, it is essential that structured measurements (management audits) are used to:
Present a business case for change to executive leadership;
Guide leadership on the actions necessary to be successful;
Provide a roadmap and monitoring device to track improvements.
Because management decisions in healthcare are highly cost driven it is essential that safety professionals provide their executive with a strong business case for safety improvements. The business case must grab the executive's attention in a way that will cause them to change their behavior and commit some of their attention to safety and injury prevention. There are three key elements in building a business case and measuring safety change at the corporate level:
injury rate data;
injury cost data; and
management indicators.
There are significant benefits in using these types of data in combination. I will touch on the pitfalls and summarize with the benefits.
Injury Rates: Injury data allows you to make comparisons between your business units and with outside organizations in your industry. The Bureau of Labor and Statistics reports annual industry specific injury rates (1). However injury data alone may not reveal the entire picture. Pitfall: a facility with high injury rate data may be tempted to attribute their rate to a hypersensitive reporting process or some other recordkeeping artifact rather than true employee injuries.
Cost Data: Cost data also allows you to make comparisons between facilities and with outside organizations. The Risk and Insurance Management Society is an organization that reports annual industry specific injury cost information that allow your organization to benchmark against others (2). In addition to the easily measure direct costs of employee injuries, it's important to include a description of indirect costs when presenting to executive leadership. We generally assume that indirect costs are 3–5 times our measurable direct costs. Pitfall: a facility with high cost data may be tempted to shift attention to post-injury care, return to work programs, or claims management.
