Stakeholder Consultation Paper: Potential Healthy and Safe Workplace Indicators for Ontario s Health Care System

Transcription

1 Stakeholder Consultation Paper: Potential Healthy and Safe Workplace Indicators for Ontario s Health Care System January, 2013

2 Introduction It is well known that a healthy work environment is critical to the wellbeing of every health care provider and the health care system. It is essential for the overall satisfaction of health care professionals, for successful recruitment and retention, for quality of patient/client care and to ensure sustainability of the system. There are a number of indicator frameworks available and some are specifically designed to focus on the quality of work life (QWL). However, to date no healthy and safe workplace/qwl indicators have been identified that can be consistently used to capture information and assess the performance of publicly funded health care organizations in Ontario, or in other Canadian jurisdictions. With this groundbreaking project, the Public Services Health and Safety Association is working with a team of local and international experts on indicators to collaboratively develop a set of core, consensus-based healthy and safe workplace indicators for health care organizations. This project capitalizes and builds on the work that has already been done in Ontario and other jurisdictions. Informed by a comprehensive literature review and a jurisdictional scan, the aim of the project is to determine four to six healthy and safe workplace indicators that will allow for the collection, measurement, and analysis of the performance of healthcare organizations. Ongoing stakeholder engagement continues to be a vital component of the project and will be instrumental in reaching consensus on the core indicators. Project Objectives An end result of this project will be a recommended set of core, consensus-based healthy and safe workplace indicators for health care organizations funded by government. The objectives of this project are to: Bring stakeholders together and unite them in addressing an important accountability initiative that when implemented can contribute to achieving workplace injury reductions and healthy and safe work environments Create a shared understanding of the evidence and literature on indicators and their ability to influence workplace injuries and illnesses and work environments Build on past successes and continue to strengthen the relationship between experts, leaders, PSHSA and the healthcare stakeholder community Potential Healthy and Safe Workplace Indicators for Ontario s Health Care System Page 2

3 Continue to raise awareness and reinforce the importance of healthy work environments and a health and safety culture across Ontario s health and community care workplaces Advance the need for healthcare organizations to be accountable for delivering on safe and healthy workplaces by recommending reliable, valid and implementable indicators that will enable performance tracking and improvement over time. Building on existing work, Indicator Steering Committee members met on December 5, 2012 to brainstorm possible indicator frameworks that would be most appropriate and applicable for use in the settings in scope. From a number of presented indicator frameworks, committee members agreed that the Quality Worklife Quality Healthcare framework was highly relevant and, with some modification, has great potential to measure health and safety elements in health care workplaces. Quality Worklife Quality Healthcare (QWQHC) Collaborative The Quality Worklife - Quality Healthcare Collaborative (QWQHC) is a coalition of twelve national healthcare organizations working together to create healthier workplaces and to ultimately improve patient/client and system outcomes. QWQHC is committed to promoting and supporting the use of measurement to improve quality of worklife. QWQHC recognizes the importance of measurement and promotes activities such as: strategically bundling indicators that can be measured to provide meaningful insight for organizational and system leaders to act on, using employee satisfaction surveys to drill down on key issues, and evaluating healthy workplace initiatives and practices to increase the evidence base for effective efforts that contribute to healthy worklife in healthcare. Engaging worklife experts, the Collaborative has identified seven worklife indicators that all health organizations could use regularly to gauge and improve their workplace practices and environments. These indicators are believed to be relevant, practical, feasible, and applicable to all health organizations, and have evidence to support their connection to key outcomes. These worklife indicators included: 1) turnover rate; 2) vacancy rate; 3) overtime; 4) absenteeism; 5) workers compensation lost time; 6) training and professional development; and 7) health provider satisfaction. Potential Healthy and Safe Workplace Indicators for Ontario s Health Care System Page 3

4 Potential Healthy and Safe Healthcare Workplace Indicators The organization of work and the work environment can have a profound effect on employee health, safety and wellbeing. There is a growing body of evidence that points to a relationship between employee and client safety and emphasizes that quality care is dependent upon a healthy and safe workforce and environment. Quality of worklife is an important category of employee-related data that is receiving considerable attention. Quality of worklife as an indicator category is integral in fostering environments to attract and retain skilled health and community care employees. Lowe (2006) indicates that quality of worklife indicators include a broad number of determinants social, psychological, organizational and physical (causes), processes (activities that influence how determinants affect outcomes) and outcomes (effects). There is no clear consensus on which quality of worklife indicators to collect or on their relevance. Employers are beginning to collect a variety of them. Lowe (2006) describes four categories of quality of worklife indicators: 1) workplace safety, employee health and well-being outcomes; 2) organizational performance outcomes; 3) work environment determinants; and 4) organizational culture determinants. The organization should determine its capacity to collect, analyze and communicate quality of worklife indicators. In addition, four Employee/Human Resources indicators have been identified in previous work and include: 1) absenteeism; 2) vacancy rate; 3) overtime; and 4) turnover rate. The following potential healthy and safe workplace indicators are based on best available research evidence (both from Canada and International) as well as the input received from health and safety indicator experts. The potential indicators also build upon the consensus-based work done by the QWQHC Collaborative. The tables presented on the following pages provide details about each potential indicator the rationale for each, the potential measure(s), and applicable notes. Potential Healthy and Safe Workplace Indicators for Ontario s Health Care System Page 4

5 Proposed Indicator #1: Turnover Possible Measure for Turnover rate is an indicator that reflects worklife quality and employee health and safety. This indicator reflects the level of employee satisfaction and a high turnover rate may suggest retention issues. In healthcare, there is an urgent need to support and retain employees because of the staffing shortages and aging workforce. The literature indicates that high turnover rate is indicative of workplace health, safety and culture issues. Burnout has been linked with mental and physical health problems and is associated with high absenteeism rates, high staff turnover rates and low productivity (Grunfeld et. al., 2000). Numerator: Number of employees who have permanently left this organization in the fiscal year separated by reason: A. Resignations (No special incentives) B. Lay-offs (No recall expected)* C. Special workforce reductions** D. Dismissal for cause E. Retirement (No special incentives) Denominator: Average level of employment observed in the fiscal year (Using Stats Canada, Workplace Employer Survey (WES)) * Involuntary lay-offs with enhanced severance packages should be included with Lay-offs. ** Special workforce reductions include resignations and early retirements induced through special financial incentives (i.e. where employees voluntarily leave). Potential Healthy and Safe Workplace Indicators for Ontario s Health Care System Page 5

6 Proposed Indicator #2: Vacancy Possible Measures for Job vacancy rate is an indicator of worklife quality and employee health and safety. Health organizations need to be appropriately staffed in order to improve wait times and provide safe, high quality patient care. Health care and social assistance had the highest job vacancy rate among the largest industrial sectors, at 2.7% in September, up from 1.8% a year earlier. The sector had 46,000 vacancies in September (Stats Canada, 2012). Vacancy rates impact staffing ratios which can negatively impact staffing workloads and potentially contribute to both adverse events and employee illness and injuries. A survey conducted by the College of Nurses of Ontario revealed that stress resulting from increased workloads contributes to physical and verbal client abuse and has led to burnout and poor quality client care (Beardwood et al., 1999). According to Beardwood, Walters, Eyles and French (1999), restructuring in healthcare has led to a number of workforce issues in this sector. Focused mainly on reducing the size of the workforce, restructuring has led to smaller numbers of staff providing care to clients who are sicker. The end result of the work organization changes is poor quality of worklife and patient care. a. Number of positions sitting vacant longer than 6 months/total Number of budgeted positions (Source: Saskatchewan Health Workforce Action Plan) b. Total number of Vacant positions as of today Total number of positions as of today x 100. This method measures the organization s vacancy rates resulting from employee turnover and can be used to calculate the vacancy rate for one position, a class code, a division or the entire organization (Human Resource Metrics, RPCHR, Nothing additional Potential Healthy and Safe Workplace Indicators for Ontario s Health Care System Page 6

7 Proposed Indicator #3: Training and Professional Development Opportunities Possible Measures for Training and professional development indicators can impact employee health & safety and the quality of worklife. Supporting health professionals to learn and develop leads to better staff retention and improves the quality of patient care. When employers promote training and professional development it demonstrates that the employer values employee growth and is willing to invest in their professional development. Professional growth has been shown to affect the quality of worklife in healthcare. Healthcare professionals are more satisfied with their jobs when they are given the opportunity to grow professionally (Argentero et. al., 2007). a. Average training hours per employee b. Average training hours per FTE c. % of employees participating in inservice training sessions and/or off-site education and training programs annually The indicator will need to define what is included (in-house and/or offsite). Potential Healthy and Safe Workplace Indicators for Ontario s Health Care System Page 7

8 Proposed Indicator #4: Overtime Possible Measure for Overtime is a quality of worklife indicator. Overtime can contribute to both adverse events and increased employee injuries. It is well documented in the literature that fatigue is a major contributing factor to errors and workplace accidents. Taub et al. (2006) established the relationship between the detrimental effects of long working hours and poor client care, suggesting that a decline in healthcare professionals health can lead to serious implications on client care. High levels of overtime may reflect inadequate staffing or high levels of absenteeism and may result in workload issues and increased costs. Working overtime can have a negative impact on employee health and safety; predispose employees to more errors and adverse events. Further, client care can be compromised. A study conducted by Laschinger and Leiter (2006) further supports the belief that client safety outcomes are associated with the work environment and that burnout plays an important factor. Nicklin and Graves (2005) cite that Canadian healthcare leaders must act upon the working conditions of nurses, specifically staffing ratios and skill mix, as they have a direct relationship to client outcomes such as satisfaction, morbidity and mortality. Paid Overtime rate = total # OT hours/total hours paid. Note potential inconsistencies tracking OT through the payroll system. Some collective agreements allow staff to take time in lieu of pay it therefore may be difficult to capture this banked time consistently. Potential Healthy and Safe Workplace Indicators for Ontario s Health Care System Page 8

9 Proposed Indicator #5: Absenteeism Possible Measure for Absenteeism is a measure of worklife and well-being of health providers. Health sector employees are absent from work as a result of illness or injury more than any other workers in Canada (on average they reported 13.1 sick days per year compared to 7.8 days for all Canadian workers in 2005). With over 1.5 million people working in Canada s Health and Social Services sector (which equals roughly one in every 10 employed), this high rate of absenteeism represents a tremendous cost. For example, illness and disability in Ontario hospitals and British Columbia health authorities cost an estimated one billion dollars each, annually. High levels of absenteeism also amplify the burden placed on units that are already trying to operate with staffing shortages. (Quality Worklife Quality Healthcare Collaborative, 2007). Absenteeism is a major concern in the health sector. Healthcare workers are absent from work as a result of illness or disability more than any other type of worker in Canada, experiencing 13.1 sick days per year compared to 7.8 days for all other Canadian workers in 2005 (Statistics Canada, 2005). With over 1.5 million people working in Canada s Health and Social Services sector, this equates to approximately one in every 10 employed (Canadian Institute for Health Information, 2006). This not only equates to considerable costs for healthcare employers, but also has detrimental social costs for both the employee and their clients. The social costs to clients and their families for the pain and suffering of complications, additional days in the hospital, and/or the loss of a loved one are also sizable (McClure & Hinshaw, 2002, p. 125). % sick hrs = Sick Leave Hours for all eligible employee groups / Regular paid hours for all eligible employee groups *100 (Source: BC Performance Agreement) Nothing additional Potential Healthy and Safe Workplace Indicators for Ontario s Health Care System Page 9

10 Proposed Indicator #6: Workers Compensation Lost Time Possible Measures for Workers Compensation Lost Time Rate directly reflects employee health and safety in the workplace. Safe work environments lead to healthier staff and safer patient care. Healthcare workers have the greatest risk of workplace injuries and non-compensable illness than many other Canadian occupational groups. MSDs incurred through client care activities such as lifting, transferring and repositioning are the major cause of lost time injuries (Yassi, Gilbert & Cvitkovich, 2005). Violence-related injuries are becoming increasingly prevalent. In Ontario, the healthcare sector had the highest rate of lost time injuries associated with workplace violence as compared to other sector groups in the province, occupying 34% of all workplace violence lost time claims in the province (WSIB, 2008). Possible composite index measure (which would be extracted from WSIB database): a. Average lost time claims accepted per 100 FTEs (200,000 hours) annually (frequency) b. Average number of days lost per 100 FTEs (200,000 hours) annually (severity) c. Number of lost time claims accepted per 100 FTEs (200,000 hours) annually (frequency) d. Number of healthcare (NLT) claims accepted per 100 FTEs (200,000 hours) annually (frequency) e. Number of days lost per 100 FTEs (200,000 hours) annually (severity) (Source: WSIB) Nothing additional Potential Healthy and Safe Workplace Indicators for Ontario s Health Care System Page 10

11 Proposed Indicator #7: Manager/Supervisor Training Possible Measure for Expert advice indicated that a distinction should be made between Training and Professional Development and Manager/Supervisor Training. This would help to capture what the organization is doing to increase the health and safety knowledge and capacity in the workplace specific to managers and supervisors. Supervisors/managers are in a unique position in an organization where they take direction from the employer and give direction to the people they supervise (MOL website, Hence, they play a key role in ensuring the health, safety and wellness of employees. This indicator would be used to measure the direct manager/supervisor training. Numerator: # of managers/supervisors trained in due diligence and in their roles and responsibilities under the Occupational Health and Safety Act Denominator: total # of managers/supervisors Nothing additional Potential Healthy and Safe Workplace Indicators for Ontario s Health Care System Page 11

12 Proposed Indicator #8: Risk Assessment Possible Measure for An Organizational Risk Assessment indicator can reflect the quality of worklife and worker health and safety. It is essential that health and safety programs identify site specific hazards, assess risks, and implement effective controls. Without this, many organizations implement unnecessary and often costly programs and are then disappointed at the lack of change. An integrated approach to the collection, analysis and management of risk is essential in moving to a culture of safety and quality health care outcomes. There are many risk assessment tools and models available and there is no intent to direct the use of a specific tool or model. It is proposed that organizations report annually on the completion of an organizational risk assessment that captures five safety as well as occupational health hazard elements: * Biological health hazards * Chemical health hazards * Physical health hazards (e.g. noise, temperature extremes, radiation, laser, etc.) * Musculoskeletal disorders * Psychological & psychosocial health hazards (e.g. chronic overwork, fatique, shiftwork, traumatic events, workplace violence, etc.) Sources: CSA11 Z1000 Occupational Health and Safety Management; Public Services Health & Safety Association, Health & Safety Management System, 2010; CSA Z1003/BNQ National Standard of Canada for Psychological Health and Safety in the Workplace (2013). Potential Healthy and Safe Workplace Indicators for Ontario s Health Care System Page 12

13 Proposed Indicator #9: Employee Engagement Climate An Employee Engagement Climate Survey provides insight into employee health and safety as well as the quality of worklife. High-performing organizations have healthy and engaged employees. A physically and psychologically healthy workplace is one where workers are able to deliver high quality care and one in which worker health and patient care quality are mutually supportive. According to Yassi and Hancock (2005), an organizational culture and safety climate are important determinants of both caregiver well-being and client safety. Research indicates that sustainable engagement is the sum of three distinct elements: 1) Traditional engagement, or employees' willingness to give effort to their employer; 2) Enablement - having the tools, resources, and support to get work done efficiently; 3) Energy, defined as a work environment that actively supports physical, emotional and interpersonal well-being (Source: Towers Watson). Note that other jurisdictions have used employee engagement survey tools which have included questions related to occupational safety, QWL, wellness, occupational health, and psychological safety and health. For example, the UK s National Health Service Staff Survey is a mandatory survey for organizations funded by the National Health Service (NHS). The NHS administers the annual staff survey and participation by individual staff is voluntary. Questions in the survey touch on a number of employee-related topics, including occupational health and safety, infection control and hygiene, errors and incidents, violence and harassment, and health and well-being. The 2011 survey involved 366 NHS organizations in England. More than 250,000 NHS staff were invited to participate and responses were obtained from 135,000 staff (54% response rate). Survey results are reported publicly for individual NHS organizations and are benchmarked against peer organizations. In the survey, particular attention was given to staff health, well-being and safety, as well as professional development. The list of proposed questions for measuring this indicator (noted below) are primarily based on the work done by the Institute for Work and Health (IWH), i.e., Ontario Leading, formerly known at the 5000 Firms Study, and the Organizational Performance Metric (OPM) study. Researchers at IWH Potential Healthy and Safe Workplace Indicators for Ontario s Health Care System Page 13

14 Proposed Indicator #9: Employee Engagement Climate have been working on validating the 8-item OPM tool and examining whether the tool can predict/measure a firm s workplace injury and illness experience based on an assessment of its health and safety policies and practices. To date, the 8-item Leading Indicator Questionnaire (LIQ) is the best available tool to measure and predict an organization s health and safety performance. Possible Measures for Proposed questions to include in an Annual Employee Survey: 1. I feel that I can trust this organization. 2. My organization considers employee safety and health at least as important as patient safety in the way work is done. 3. Formal safety audits at regular intervals are a normal part of our business. 4. Everyone has the tools and/or equipment they need to complete their work safely. 5. Employees are involved in decisions that affect their health and safety. 6. Everyone at this organization values ongoing safety improvement. 7. There is clear and effective communication for workers and supervisors to do their jobs properly. 8. Workers and supervisors have the information they need to work safely. 9. There is an effective joint health and safety committee in place, where applicable. Sources: o Graham Lowe, How Employee Engagement Matters for Hospital Performance o Accreditation Canada Worklife Pulse Tool o NRC Picker Canada Employee Core Engagement Tool o Guarding Work Survey (FREE) Potential Healthy and Safe Workplace Indicators for Ontario s Health Care System Page 14

15 Proposed Indicator #9: Employee Engagement Climate o IWH 8 item leading indicator metric from OPM study. o 8 question modified climate survey tool published in OOHNA Journal 2008 Other considerations: o Scales for questions should use a 5 point Likert scale (1=strongly disagree, 2 = disagree, 3 = neither agree nor disagree, 4 = agree, 5 = strongly agree). o Employee participation rate should be at least 95% or better, along with representation from each department/unit within the organization. o Average scores for each question should be determined. o The 8 questions could be combined into a single engagement score on employee health and safety climate by summing and dividing by 8. o Score would indicated the following: High engagement = 4 to 5; Medium Engagement = 3 to 4; Low engagement =1 to 3 (Note: organizations may need to develop action plans to address questions where they did not achieve averages at the high engagement level ). o Examples of providers of employee engagement tools include, but are not limited to: Accreditation Canada, NRC Picker Canada, Guarding Minds at Work, Towers Watson, Hay Group & Mercier. Project Background/Planning Information Additional project background and planning information can be found at the following link: Potential Healthy and Safe Workplace Indicators for Ontario s Health Care System Page 15