Academic hospitals in the Toronto region collaborate to optimize occupational health and safety.

In March 2020, as the COVID-19 cases began to rise in Ontario, Canada, the central role of Occupational Health and Safety (OHS) to ensure the well-being of hospital workforce became highly visible. While Ontario's hospitals concentrated efforts to meet each challenging and uncertain wave stressing the system, it was apparent that there is a lack of consistency in best practices and policy response across the healthcare sector. Additionally, the unprecedented pressure on healthcare workforce as they attempted to meet the pandemic's new surging demands resulted in workforce shortages and increased levels of burnout, making it difficult to engage, support, and retain the staff necessary for delivering highest quality of services. The Toronto Academic Health Science Network (TAHSN), a dynamic consortium of 14 healthcare organizations, established a collaborative to implement an integrated effort and align on structure, processes, and standards that will increase strength and defensibility of TAHSN programs. To foster community building, identify areas of common concern, and co-create practices during and beyond the COVID-19 pandemic, a structured network of 14 OHS Directors across the healthcare organizations was established. This article discusses the origin of the TAHSN collaborative, the thriving community vision for partnership, and the case study methodology used to combine capabilities to showcase innovation and excellence in care together.

Prevention of respiratory outbreaks in the rehabilitation setting.

BACKGROUND: Respiratory viral (RV) outbreaks in rehabilitation facilities can jeopardise patient safety, interfere with patient rehabilitation goals and cause unit closures that impede patient flow in referring facilities. PROBLEM: Despite education about infection prevention practices, frequent RV outbreaks were declared each year at our rehabilitation facility. METHODS: Before and after study design. The primary outcome was the number of bed closure days due to outbreak per overall bed days. Process measures included delays in initiation of transmission-based precautions, RV testing and reporting of staff to occupational health and safety (OHS). Balancing measures included the number of isolation days and staff missed work hours. INTERVENTIONS: Based on comprehensive analysis of prior outbreaks, the following changes were implemented: (1) clear criteria for initiation of transmission-based precautions, (2) communication to visitors to avoid visitation if infectious symptoms were present, (3) exemption of staff absences if documented due to infectious illness, (4) development of an electronic programme providing guidance to staff about whether they should be excluded from work due to infectious illness. RESULTS: The number of bed closure days due to outbreak per overall bed days dropped from 2.8% to 0.5% during the intervention season and sustained at 0.6% during the postintervention season (p<0.001). There were fewer delays in initiation of droplet and contact precautions (28.8% to 15.5%, p=0.005) and collection of RV testing (42.9% to 20.3%, p<0.001), better reporting to OHS (9 vs 28.8 reports per 100 employees; p<0.001) and fewer isolation days (7.8% vs 7.3%; p=0.02) without a significant increase in missed work hours per 100 hours worked (4.0 vs 3.9; p=0.12). CONCLUSION: This Quality Improvement study highlights the process changes that can prevent respiratory outbreaks in the rehabilitation setting.

Measuring relational security in forensic mental health services.

Aims and method Relational security is an important component of care and risk assessment in mental health services, but the utility of available measures remains under-researched. This study analysed the psychometric properties of two relational security tools, the See Think Act (STA) scale and the Relational Security Explorer (RSE). Results The STA scale had good internal consistency and could highlight differences between occupational groups, whereas the RSE did not perform well as a psychometric measure. Clinical implications The measures provide unique and complimentary perspectives on the quality of relational security within secure services, but have some limitations. Use of the RSE should be restricted to its intended purpose; to guide team discussions about relational security, and services should refrain from collecting and aggregating this data. Until further research validates their use, relational security measurement should be multidimensional and form part of a wider process of service quality assessment.