Information Systems Management V

S A F E T Y SYSTEMS

Steps to Designing a S a fe ty M a n a g e m e n t S y s te m B e i n g p r o a c t i v e a n d p r e d i c t i v e , i n s t e a d o f r e a c t i v e , is k e y t o s u c c e s s By Susan E. S a g a rra

T h e a n n u a l A M R

S a f e t y C o m p e t it io n

s im u la t e s s it u a t io n s

E M S p r o fe s s io n a ls

e n c o u n t e r e v e r y day.

E MS agencies have protocols and policies in place to ensure proper care and safety of patients. Agencies can also include p ro g ram s th a t make EMS providers more m indful of their own safety and the behaviors that impact that safety. Developing a safety

management system (SMS) can assist field providers and their supervisors in being proactive, and possibly even predictive, instead of reactive, to the hazardous situations they face in the field.

The creation of an SMS can become an integral p art of the agency's operational procedures, but it takes a com m itm ent from leadership to adm inistra­ tive staff says Ron Thackery, senior vice president of professional services & integration for American Medical Response (AMR).

During the recent EMS World Expo held Septem­ ber 15-19 in Las Vegas, NV, Thackery and others presented ways to create an SMS as part of the EMS Safety Officer workshop that debuted this year.

According to Thackery everyone in an agency must understand the role of safety in order to implement and manage a program. He cautions, however, that one size does not fit all. Leadership, with strong input from employees, m ust analyze individual agency needs and prioritize based on w hat is realistic to implement. "You can’t boil the ocean," says Thack­ ery. "You might have a list of 10 things you want to do but realistically, you can’t do all of them. You have to boil it down to something manageable. Agencies have to pick th eir top needs and be com m itted to implementing the most im portant ones.”

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S A F E T Y SYSTEMS

Thackery and his colleagues at AMR have extensive knowledge in integrating safety into every aspect of providers’ duties. Thackery is responsible for risk manage­ m ent and safety, w ith previous executive oversight for fleet a d m in istra tio n and clinical services. He serves on the board of directors for the National Safety C oun­

cil and chairs the Professional Standards and Research Com m ittee of the American Ambulance Association.

“There are four com ponents to a safety management system,” says Thackery. “The three prim ary ones are safety risk manage­ ment, safety leadership and safety assur­ ance. The fourth is safety promotion, which

is the glue th a t holds it all together. T hat part is how you communicate to the people in the field to behave safely. If you remember the TV show Hill Street Blues, at the end of every roll call they were told, ‘Let’s be care­ ful out there.’ That built a culture of safety in every show. T hat kind of culture can be built w ithin any agency.”

Thackery says the message can vary. In some places the chief or board president signs a mission statement or pledge that the agency is com m itted to safety. O thers may have the entire staff sign the pledge. The statem ent may be fram ed and placed in a heavily traveled area of the agency.

“It’s a pledge saying, ‘This is why I work safe,”’ he says. “A nother idea is to have the staff provide photos of whatever is impor­ ta n t to them in life -a spouse, kids, a pet. It sends a message that they are committed to work safely because of the rem inders th at are posted. It helps build a culture among the staff because people also learn things about each other. Then it is up to leadership to develop policies and program s of what they expect them to do to behave safely.”

In most agencies:

100% of providers have

knowledge of safety issues;

of supervisors have knowledge of safety issues;

of top m anagem ent have knowledge of safety issues.

D id y o u k n o w t h a t 7 4 % o f E M S w o r k e r d e a t h s a r e t r a n s p o r t a t io n - r e la t e d ? *

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Thackery says that the message needs to be changed on a regular basis: “People might become numb to the message. Some organizations update the photos every six months or every year. I try to push people to have something personal and to update with new photos all the time. And really, people who are committed will keep updat­ ing it, and leadership must make sure it happens.”

Thackery says the aviation industry implemented safety management systems in the 1970s. The EMS industry is mim­ icking the aviation industry’s research and policies for its programming.

“It became popular in the EMS profes­ sion in the past decade because the air-med side kept having crashes,” says Thackery. “We decided we needed to have a frame­ work with a tie to EMS. Agencies have a process and policies, a way to manage their dispatching, billing, etc. It makes sense to include a program and policies for safety. When they do it, it just becomes a part of the overall way they run the agency.”

The concept is rooted in behavior-based safety and relies heavily on Herbert Hein­ rich’s Pyramid of Safety. Heinrich was an industrial safety pioneer from the 1930s who worked for Travelers Insurance Co. Heinrich’s research is claimed as the basis for the theory of behavior-based safety, which holds that as many as 95% of all workplace accidents are caused by unsafe acts. Heinrich came to this conclusion after reviewing thousands of accident reports.

According to Thackery, changing behav­ iors to create a culture of safety in the EMS industry requires a commitment to improve provider safety, which results in improved patient safety and, ultimately, improved community safety. The foundation of an SMS includes fostering a culture of safety, coordinated support and resources, safety data, education initiatives, safety standards and requirements for reporting and investi­ gating incidents that affect safety.

An SMS should examine how paramed­ ics are lifting patients, driving ambulanc­ es, fatigue levels (analyzing hours of ser­ vice), infection control protocols, hazmat responses, machinery operations and work­ space ergonomics. Thackery also says an

F o r M o r e I n f o r m a t i o n C irc le 2 5 o n R e a d e r S e rv ic e C a rd

E M S W O R L D . c o m | NOVEMBER 2015 2 9

“A LOT OF AGENCIES MANAGE SAFETY IN A REACTIVE MODE; BUT THEY CAN DEVELOP SYSTEMS TO BE PRO-ACTIVE OR EVEN PREDICTIVE.” -R on Thackery

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SAFETY SYSTEMS

SMS can focus on environm ental sustain­ ment, contractor safety, off-duty safety, fit­ ness for duty, physical agility testing, drug/ alcohol testing and medical m onitoring (of employees, but also communicable diseases

ABOUT THE AUTHOR

Susan E. Sagarra is a writer, editor and book author based in St. Louis, MO.

in the community, such as Ebola). Thackery says there are three approaches

to managing safety issues: 1. Reactive (past): Respond to events that

have already occurred, such as incidents and accidents;

2. Proactive (present): Actively identify hazards through the analysis of the orga­ nization’s processes;

3. Predictive (future): Analyze system processes and cu rre n t en v iro n m en t to identify potential future problems.

"A lot of agencies manage safety in a reac­

A M R h o ld s a n a n n u a l e v e n t In D e n v e r

w h e r e p ro v id e r s c o m p e t e in a s a f e t y

a n d s k ills c o m p e t it io n t h a t s im u la t e s

s it u a t io n s E M S p ro fe s s io n a ls e n c o u n t e r

e v e r y d a y . “ T h e A M R N a t io n a l S a f e t y

C o m p e t it io n is n o t o n ly a v e r y p r e s tig io u s

e v e n t f o r o u r c a r e g iv e r s , i t a ls o in s tills

a c u lt u r e o f s a f e t y a n d an e m p h a s is on

c lin ic a l e x c e lle n c e ,” s a y s T h a c k e r y .

“ T h e c o m p e t it io n in c lu d e s a t im e d d r iv in g

c o u rs e t h a t m e a s u r e s t h e i r a b ilit ie s

t o s a f e ly a n d e f f i c i e n t l y o p e r a t e an

a m b u la n c e , t w o v e r y d i f f i c u l t p a t ie n t

e n c o u n te r s a n d a c lin ic a l s k ills s e c t io n .”

W h i l e t h e c re w s h a v e a lo t o f f u n a n d

t r u l y e n jo y t h e c o m p e t it io n , t h e y also

u n d e r s t a n d t h e im p o r t a n c e o f fo c u s in g

o n s a f e t y a n d c lin ic a l e x c e lle n c e . “ T h e

c re w s a ll t a k e h o m e s o m e t h in g t h e y

h a v e le a r n e d a n d t h e n t h e y p ass i t o n to

t h e o t h e r t e a m m e m b e r s in t h e i r loc al

o p e r a t io n ,” s a y s T h a c k e r y . “ I t ’s t h a t

t y p e o f c o m m it m e n t t o le a r n in g a n d

e x c e lle n c e t h a t e n s u re s o u r c re w s p r o v id e

o u t s t a n d in g p a t i e n t c a re e v e r y d a y .”

tive mode,” says Thackery. “An employee gets injured and the agency reacts. But they can develop systems to be pro-active or even predictive.”

However, that requires leadership to be more in tune with what is affecting safety w ithin the agency. Thackery says th a t in most agencies, the paramedics and EMTs have 100% knowledge of problem s and safety issues; supervisors have 74% knowl­ edge; mid-level m anagem ent has just 9% knowledge; and top management has just 4% knowledge.

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So how does a n EMS agency go a b o u t an aly z in g its n eed s an d th e n im p le m e n t­ ing an d m a in ta in in g a safety m anagem ent system ? T hackery said agencies should fol­ low th e ideas in th e fo u r pillars o f an SMS:

S a fe ty P o licy : E sta b lis h e s senior m anagem ent’s com m it­ m e n t to c o n tin u a lly im prove safety, d efining th e m ethods, processes an d o rg an izatio n al s t r u c t u r e n e e d e d to m e e t

safety goals. It requires: • C o m m itm e n t o f th e te a m to achieve

high sta n d a rd s and com pliance. T h is also involves eth ical decision-m aking an d p ro ­ m oting a c u ltu re o f safety.

• T ran sp aren cy in m anaging safety. • D o cu m en te d policies/processes. • O p en rep o rtin g . • Any policy, program or initiative m ust

pass tw o tests: W ill it mitigate risk if used as designed, and will the system adversely impact productivity, safety, efficiency and privacy?2 S a fety R isk M an agem en t: D eterm in es th e need for, and ad eq u acy of, new o r revised

risk controls. The agency m ust id en tify h a z a rd s an d assess, analyze an d control th e risks.3 Safety A ssurance: Evaluates th e c o n tin u e d e ffectiv en ess of im p le m e n te d risk c o n tro l stra te g ie s an d s u p p o r ts th e identification of new hazards. T h is e n s u r e s re s u lts m e e t

e x p e c ta tio n s an d co m pliance, a n d facili­ ta te s in fo rm a tio n g a th e rin g (via a u d its/ evaluations, em ployee re p o rtin g an d data analysis). Periodic assessm ent of th e system is required.

4 Safety P rom otion : Includes tra in in g , c o m m u n icatio n and o th e r actions to create a posi- tive safety c u ltu re w ith in all

© f l l l P levels of th e w orkforce. T h is phase is th e glue th a t “b o n d s”

all safety activities. It involves advocating for a s tro n g safety c u ltu re ; c o m m u n ic a ­ tio n (includes aw areness, lessons learned, social m edia); tra in in g an d education; and elic itin g in p u t, ideas a n d feed b ack from everyone.

“T h e four categories give agencies th e ab ility to p u t to g e th e r th e ir ow n SM S,” says Thackery. “T hey need to th in k ab o u t w hat they w ant to do in th e ir ow n agencies. T hey also have to build a process so th a t people are w illing to com e fo rw ard ab o u t things they see and get employees to become engaged in o rder for it to w ork.” ®

MAKE SURE YOUR NEXT LIFT ISN’T YOUR LAST 62% o f EMS w o rkers’ back injuries are as a result o f p a tie n t lifting.

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F o r M o r e In f o r m a t i o n C irc le 2 6 o n R e a d e r S e r v ic e C a rd

E M S W O R L D . c o m | NOVEMBER 2015 31

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