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Implementation and Evaluation of a “Safety Culture” in Residential Care Through Involvement of Front-Line Workers*
RS2006-IG10
Final Report Date: November 2007
| Principal Applicant: | Waqar Mughal (Fraser Health) |
| Co-Applicants: | Kelly Duke, Leah Thomas-Olson, Deanna Harrison, Nermin Helal (Fraser Health) |
For more information about this project, please contact Waqar Mughal.
*In partnership with the Workers' Compensation Boards of Manitoba and Saskatchewan
Issue
Healthcare has one of the highest rates of musculoskeletal injuries (MSIs) in B.C. This project developed and delivered interventions to reduce the risk of MSIs in a residential care unit, and assessed the impact on safety culture, attitudes and injury rates. A front-line staff Innovation Team played a leadership role in developing and delivering the interventions, which were modeled on the positive work and safety culture of another residential care unit with low injury rates.
Key findings
- The interventions targeted three areas: better staff access to residents’ ‘Activity of Daily Living’ sheets; communication improvements; and a comprehensive education and training program. These targets were selected by examining how the work and safety culture of the control unit (the “best performer” care unit) differed from the intervention unit.
- After the interventions, staff had more positive perceptions of resource availability, staff morale, and the level of communication and support from management and leadership.
- The project demonstrated that the involvement of front-line workers in the development and delivery of interventions in their own work areas is a meaningful and effective way to improve the work and safety culture in a residential care work environment.
- Injury rates for the intervention unit did not change significantly during the time period examined.
Objectives
- To identify key elements of the positive work and safety culture within a residential care unit known as a “best performer” in workplace injury prevention
- To plan and implement interventions to establish these elements in another residential care unit, with close involvement of the front-line worker Innovation Team in the development and delivery of the interventions
Methods
An Innovation Team was formed with five staff members from the residential care unit for which the interventions would be developed (the intervention unit).
The Innovation Team conducted site visits at the “best performer” care unit (the control unit), to observe how the work and safety cultures and practices of the two units differed.
A pre- and post-intervention survey instrument was designed, informed by the site visit observations as well as existing survey instruments on workplace safety culture and attitudes. The survey instrument was piloted in a residential care unit not involved in the study and further refined. It contained 103 questions covering:
- demographic information
- resident assessment for method of transfer
- equipment
- education and training
- policy and procedure
- work organization/teamwork
- work culture
- safety attitudes
- safety climate
The project team conducted the survey through interviews with staff at the intervention unit and control unit. A gap analysis of the survey data identified the largest differences between the units’ work and safety cultures and practices.
The ten largest differences between the two units’ work and safety culture measures were selected to be addressed through the following interventions:
- A comprehensive health and safety education and training program (including biweekly sessions and relevant topics related to recent injuries)
- Relocation of residents’ Active Daily Living sheets to bedsides for easier staff access
- Communication improvements including weekly email updates from management
The Innovation Team was closely involved in the selection, design and delivery of the interventions.
After the intervention period, another survey was conducted using the same survey instrument. The data were analyzed to identify changes since the pre-intervention period in:
- The intervention unit’s work and safety culture measures
- The gap in work and safety culture measures between the intervention unit and control unit
Pre- and post-intervention injury data were also analyzed.
Results
- The Innovation Team observed that teamwork and work practice expectations were substantially different in the control unit. They found that work culture of the control unit included a shared and consistent expectation of safe work practices, support for teamwork, and encouragement of open communication and respect.
- The pre-intervention survey of staff perceptions showed that the intervention unit staff had significantly more negative perceptions on 76 out of 90 questions than at the control unit.
- Based on the survey findings, three target areas were identified for interventions: relocation of residents’ Activity of Daily Living sheets for easier staff access; communication improvements; and a comprehensive education and training program including biweekly sessions and topic selection based on current issues and recent injuries on the unit floor.
- The number of questions on which Intervention Unit staff responses were more negative than the control unit dropped from 76 out of 90 in the pre-intervention survey to 36 out of 90 in the post-intervention survey.
- The post-intervention survey results showed significant increases in intervention unit staff perceptions of:
- The ability to use the correct size and type of sling
- Frequency of on-unit training for ceiling lifts
- Asking for help from co-workers when in need of assistance
- High staff morale
- Ability to express disagreement with the care coordinators
- Senior leaders listening and caring about concerns
- Management/leadership not knowingly compromising safety concerns for productivity
- There were increases in other training and education items as well but these were not statistically significant.
- Injury rates for the intervention unit did not change significantly between the pre- and post-intervention periods.
Conclusions
The interventions resulted in positive changes in staff perceptions of resource availability, staff morale, and the level of communication and support from management and leadership.
The collaborative approach to developing interventions, involving the Innovation Team (front line staff), Management Team and Workplace Health Team members (project investigators), was successful. The project demonstrated that involving front-line workers in the development and delivery of interventions in their own work areas is a meaningful and effective way to improve the safety culture in a residential care work environment.
Future directions
Further research is needed to compare the effectiveness of this model for initiating change (with front-line workers in leadership roles) with other means of influencing the work and safety culture in residential care work environments.
Studies are also needed on how safety cultures develop over time, including the identification of early indicators of change.