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S A F E T Y SYSTEMS

Steps to Designing a S afe ty M an ag em en t System B e in g p r o a c t i v e a n d p r e d ic 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. Sagarra

T he annual A M R

S a fe ty C o m p etitio n

s im u la te s s itu a tio n s

EM S p ro fess ionals

en co u nte r every day.

E MS agencies have protocols and policies in place to ensure proper care and safety of patients. Agencies can also include programs that make EMS providers more mindful 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 part of the agency's operational procedures, but it takes a commitment from leadership to administra­ 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, must analyze individual agency needs and prioritize based on what 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 their top needs and be committed to implementing the most important 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 ment and safety, with previous executive oversight for fleet adm inistration and clinical services. He serves on the board of directors for the National Safety Coun­

cil and chairs the Professional Standards and Research Committee of the American Ambulance Association.

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

is the glue that holds it all together. That 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. That kind of culture can be built within 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 committed to safety. Others may have the entire staff sign the pledge. The statement may be framed and placed in a heavily traveled area of the agency.

“It’s a pledge saying, ‘This is why I work safe,”’ he says. “Another idea is to have the staff provide photos of whatever is impor­ tant to them in life-a spouse, kids, a pet. It sends a message that they are committed to work safely because of the reminders that 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 programs 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 management have knowledge of safety issues.

D id y o u k n o w th a t 7 4 % o f E M S w o rk e r d e a th s a re tra n s p o rta tio n -re la te 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

For M o re In fo rm a tio n C irc le 2 5 on R e a d e r S e rv ic e C ard

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.” -Ron Thackery

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SAFETY SYSTEMS

SMS can focus on environmental sustain­ ment, contractor safety, off-duty safety, fit­ ness for duty, physical agility testing, drug/ alcohol testing and medical monitoring (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 current environment to identify potential future problems.

"A lot of agencies manage safety in a reac­

A M R holds an annua l e v e n t In Denver

w h e re p ro v iders co m p ete in a s a fe ty

and skills co m p e titio n th a t s im u la te s

s itu a tio n s EM S pro fess ion a ls en co u nte r

e v ery day. “T he A M R N a tio n a l S a fe ty

C o m p e titio n is n o t o n ly a v e ry p res tig iou s

e v e n t fo r our careg ivers , it also instills

a cu ltu re o f s a fe ty and an em phasis on

clin ical exce llen ce ,” says T hackery .

“ T h e c o m p e titio n includes a t im e d d riv ing

course th a t m easures th e ir a b ilitie s

to s a fe ly and e ff ic ie n t ly o p e ra te an

am bu lan ce , tw o v e ry d if f ic u lt p a tie n t

en co u nte rs and a clin ical sk ills se c tio n .”

W h ile th e crew s have a lo t o f fu n and

tru ly en jo y th e c o m p e titio n , th e y also

u n d ers tan d th e im p o rtan ce o f focusing

on s a fe ty and clin ical exce llence. “ The

crew s all ta k e hom e s o m e th in g th e y

have learned and th e n th e y pass it on to

th e o th e r te a m m em b ers in th e ir local

o p e ra tio n ,” says Thackery . “ I t ’s th a t

ty p e o f c o m m itm e n t to lea rn in g and

excellence th a t ensures our crew s provide

o u ts ta n d in g p a tie n t care e v ery 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 within the agency. Thackery says that in most agencies, the paramedics and EMTs have 100% knowledge of problems and safety issues; supervisors have 74% knowl­ edge; mid-level management has just 9% knowledge; and top management has just 4% knowledge.

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So how does an EMS agency go about analyzing its needs and then im plem ent­ ing and m aintaining a safety management system? Thackery said agencies should fol­ low the ideas in the four pillars of an SMS:

Safety Policy: E stablishes senior management’s commit­ m ent to continually improve safety, defining the methods, processes and organizational s tru c tu re needed to m eet

safety goals. It requires: • C om m itm ent of the team to achieve

high standards and compliance. This also involves ethical decision-making and pro­ moting a culture of safety.

• Transparency in managing safety. • D ocum ented policies/processes. • Open reporting. • Any policy, program or initiative must

pass two tests: Will it mitigate risk if used as designed, and will the system adversely impact productivity, safety, efficiency and privacy?2 Safety Risk M anagement:

D eterm ines the need for, and adequacy of, new or revised risk controls. The agency must identify hazards and assess, analyze and control the risks.3 Safety Assurance: Evaluates the continued effectiveness of im plem ented risk control strategies and supports the identification of new hazards. T his ensures resu lts m eet

expectations and compliance, and facili­ tates inform ation gathering (via audits/ evaluations, employee reporting and data analysis). Periodic assessment of the system is required.

4 Safety Promotion: Includes training, com m unication and other actions to create a posi- tive safety cultu re w ith in all

© f l l l P levels of the workforce. This phase is the glue that “bonds”

all safety activities. It involves advocating for a strong safety culture; com m unica­ tion (includes awareness, lessons learned, social media); training and education; and eliciting input, ideas and feedback from everyone.

“The four categories give agencies the ability to put together the ir own SMS,” says Thackery. “They need to th ink about what they want to do in their own agencies. They also have to build a process so that people are willing to come forward about things they see and get employees to become engaged in order for it to work.” ®

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

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