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A Positive Approach to Health and Safety
Health and safety compliance is not fun. Many managers of care services regard it with a toxic mix of feelings including obligation, imposition, and frustration at never seeming to make progress in management of risk, leading to a feeling of personal exposure and stress. When asked, many managers will state that their main concern is that a lack of understanding and compliance by employees places everyone at risk of prosecution.
DirectGov, the UK web portal to government services, has a table of employee responsibilities in respect of health and safety. The list is reproduced below.
Your most important responsibilities as an employee are:
- To take reasonable care of your own health and safety
- If possible avoid wearing jewellery or loose clothing if operating machinery
- If you have long hair or wear a headscarf, make sure it's tucked out of the way (it could get caught in machinery)
- To take reasonable care not to put other people - fellow employees and members of the public - at risk by what you do or don't do in the course of your work
- To co-operate with your employer, making sure you get proper training and you understand and follow the company's health and safety policies
- Not to interfere with or misuse anything that's been provided for your health, safety or welfare
- To report any injuries, strains or illnesses you suffer as a result of doing your job (your employer may need to change the way you work)
- To tell your employer if something happens that might affect your ability to work (e.g. becoming pregnant or suffering an injury) - your employer has a legal responsibility for your health and safety, they may need to suspend you while they find a solution to the problem, but you will normally be paid if this happens
- If you drive or operate machinery, to tell your employer if you take medication that makes you drowsy - they should temporarily move you to another job if they have one for you to do
Inspection and assessment reports often identify problems which indicate that the culture of the organisation under scrutiny is such that employees are not adequately aware of their personal responsibility for their own health and safety, or the health and safety of others. The problem can arise from the traditional approach to Health and Safety (note the capitals). To parody Jeremy Clarkson, this traditional approach comprises an adenoidal trainer boringly harassing hapless employees to constantly look down to avoid trips and slips, while simultaneously looking up to avoid head injuries, ever conscious of the threats from the employer that “it is your fault, you’ve been trained”, coupled with the threat of disciplinary action. No wonder that in many workplaces the mention of Health and Safety (H&S) brings on rolled eyes from the majority of employees, and a gleam in the eye of the occasional barrack-room lawyer.
What characterises organisations which exhibit these problems? Some examples of the kind of problems identified by inspectors and assessors might throw some light on the matter. These include:
Not wearing protective clothing, or not using it properly. For instance carers not using infection barrier equipment, putting themselves at risk of infection, and everyone else for that matter. Appropriate use of latex gloves is becoming ubiquitous after many years of less than ideal practice, but use of barrier aprons can still be a problem. Disposable aprons can be an area where the responsible instruction of the employer comes into conflict with their financial responsibility; employees either use aprons for too long, negating the infection control benefits and completely wasting the costs, or they change them many times, adding to costs. An area of particular concern and cost is around food handling, where multiple changes of aprons can be the norm. However, how many times have we seen employees ripping off and binning aprons, but then not washing hands? It is not an insurmountable problem to devise a working method which combines risk management but minimises costs, but this requires commitment and communication.
Inappropriate load handling is a constant problem. Training is often given, but just as often concentrates on generic issues related to the health of the employee. But lifting and handling problems can just as often be personal to the person being lifted, requiring knowledge of the subject’s health state. Providing the information to deal with this dimension of lifting and handling requires detailed knowledge of the subject, and knowledge of the contents of the care plan.
Clothing and personal adornments are a recurring problem. Inappropriate shoes are often seen, trading comfort for safety. For carers, ear-rings can cause injury by being torn out, rings can harbour infection and also cause trapping injuries, and hard attachments on the chest area can cause injury while lifting and in close contact. For caterers, hand jewellery is an infection risk, and for maintenance staff can be a trapping danger. Long hair and long nails fall into this category of problem, being potentially a “grabbing” risk, and an infection risk for all staff. To avoid a dictatorial approach to this problem – the “all show me your hands” at the start of each shift approach, employees need understand the issues, which in turn requires communication and commitment.
During the author’s work as a service quality development advisor, the initially amusing story has been heard of one quality inspector who appears to be unsteady on her feet when moving around the premises. Closer inspection revealed that she was testing each fire door marked “Fire door – keep locked”, and finding most of them unlocked. This reveals two problems; the usual one of employees not being fire aware, but the more serious one of the management not having an effective system of checking critical safety measures. Linked to the unlocked doors is the perennial problem of fire doors being left open at night, and even bedroom doors being propped open “because the service user does not like the door closed”. The root problem here is a failure to carry out a structured risk analysis, identifying the risks and balancing them against other issues such as service user wishes. If staff do not realise that there are risks, and how to deal with them, communication and training are required.
Oxygen storage and usage is a problem area. How many employees manage the risks attendant on the use of aerosols in an oxygen rich atmosphere? Do they realise that the clothing of an oxygen user will be saturated with pure oxygen, and that an ignition source will cause a fast and furious burning of the fabric, with little or no possibility to extinguish the flame? Where do employees have the opportunity to recognise and discuss the issues and how to resolve them?
The list goes on, to include reporting maintenance problems verbally instead of in writing; catering burns caused by not using appropriate catering clothing; office risks from trailing and tangled cables, and poorly fixed and loaded office storage cabinets; inaccurate or dangerous mixing of chemicals; mis-use of garden machinery; ventilation mis-management in the laundry causing increaser fire risk; lack of effective use of PPE in laundries; general untidiness raising slip and trip risk; lazy man’s loads for example multiple tea pots of hot water on a tray; glass disposal; on and on. This is the kind of list which rolls past a manager’s eyes at 3 am on a sleepless night.
The root problem when you look through the list of issues is often the employees’ lack of engagement with risk management, itself caused by boredom with the information and the way it is put over, and a general feeling that H&S is somehow an overlay to daily work. H&S can be seen in these cultures as something you bolt on to the real work, to make it more stressful, a bit like Quality Assurance.
In our occasional stress free and rational moments we all know that the latter point is not the case, but how do we get over it? The answer of course, as with so many management problems, is involvement – involving employees in the analysis of information and the resulting decision making and action. So, set up a Health and Safety Committee! And watch in frustration as the whole workforce back-peddles and finds something more interesting to do.
A different approach which has been shown to work comes from a recognition of what H&S is a part of; general risk management, or even risk management oriented care planning . This is a concept that most care service staff will latch on to; they see minimising risk to the service user as part of their core care responsibility. So, why not launch a Risk Management Group, and invite employees to meet regularly to review issues of risk, discuss how they can be mitigated, be a part of deciding on what actions are necessary and to plan and be involved in the mitigating actions. Users of this approach report that a win win win situation arises. Managers find out what the real risks are, because people report them and properly explain them, because they in turn are dealing with them every day and suddenly have an interesting method of reporting them. Staff realise that the frustration they they have as well, is in fact useful information in resolving the problem. Things get done, because all of a sudden this is not a “H&S issue”, but a part of everyday working which everyone can get involved in sorting out. Records (hopefully in précis form, and not boring pages of verbatim) of data gathering, analysis and action oriented progress suddenly appear, much to the delight of the managers in their relationships with the statutory inspection team, who are looking for exactly this kind of active and all-pervading risk management culture. If managers would like to reward good performance in risk management, they have allies in deciding who to reward and therefore avoid the ever present fear of favouritism.
Try throwing the membership of the group open to disciplines other than care; the group is now able to discuss and resolve the problems and frustrations caused by the gaps between departments. If you are lucky, the whole thing might get so big that you have to split the group into several smaller groups to accommodate everyone who wants to make a difference. Suddenly you have a positive, problem solving, service developing, continuous improvement culture replacing the “dead hand of H&S” culture. In fact, you have a continuous improvement model, which demonstrates that H&S, as well as quality assurance, is not a bolt-on boring activity, but part of everyday life.