Missed Opportunities to Prevent Workplace Injuries and Fatalities.

Prevention efforts, especially in high-income countries, have reduced work-related death and injury. Despite this, the global incidence of workplace fatalities remains unacceptably high with approximately 317 million incidents occurring on the job annually. Of particular concern is the occurrence and re-occurrence of incidents with a similar cause and circumstance, such as fatalities occurring in agriculture and transport industries. Efforts to reduce workplace fatalities include surveillance and reporting, investigation, and regulation. Challenges remain in all three domains, limiting the prevention of work-related injuries and deaths. In this commentary, the nature of these challenges and recommendations on how to overcome them are described. Examples of incidents of workplace injury and death, as well as injury prevention efforts are provided to ensure contextual understanding. Reflecting on the present enhances key stakeholders, policy and decision-makers' understanding of the opportunities to reducing harm and the associated human, and economic and legal costs.

Workplace-based clinical leadership training increases willingness to lead.

PURPOSE: The purpose of this paper is to reflect upon a workplace-based, interdisciplinary clinical leadership training programme (CLP) to increase willingness to take on leadership roles in a large regional health-care centre in Victoria, Australia. Strengthening the leadership capacity of clinical staff is an advocated strategy for improving patient safety and quality of care. An interdisciplinary approach to leadership is increasingly emphasised in the literature; however, externally sourced training programmes are expensive and tend to target a single discipline. DESIGN/METHODOLOGY/APPROACH: Appraisal of the first two years of CLP using multiple sourced feedback. A structured survey questionnaire with closed-ended questions graded using a five-point Likert scale was completed by participants of the 2012 programme. Participants from the 2011 programme were followed up for 18 months after completion of the programme to identify the uptake of new leadership roles. A reflective session was also completed by a senior executive staff that supported the implementation of the programme. FINDINGS: Workplace-based CLP is a low-cost and multidisciplinary alternative to externally sourced leadership courses. The CLP significantly increased willingness to take on leadership roles. Most participants (93 per cent) reported that they were more willing to take on a leadership role within their team. Fewer were willing to lead at the level of department (79 per cent) or organisation (64 per cent). Five of the 11 participants from the 2011 programme had taken on a new leadership role 18 months later. Senior executive feedback was positive especially around the engagement and building of staff confidence. They considered that the CLP had sufficient merit to support continuation for at least another two years. ORIGINALITY/VALUE: Integrating health-care professionals into formal and informal leadership roles is essential to implement organisational change as part of the drive to improve the safety and quality of care for patients and service users. This is the first interdisciplinary, workplace-based leadership programme to be described in the literature, and demonstrates that it is possible to deliver low-cost, sustainable and productive training that increases the willingness to take on leadership roles.

Application of a public health framework to examine the characteristics of coroners' recommendations for injury prevention.

OBJECTIVES: Exploring the characteristics of recommendations generated from medicolegal death investigations is an important step towards improving their contribution to injury prevention. This study aimed to: (1) quantify coroners' recommendations; and (2) examine the nature of these recommendations according to public health principles of injury causation and prevention. METHODS: Deaths where coroners' recommendations were and were not made in the State of Victoria, Australia during the period 1 July 2000 to 30 June 2005 were compared by sex, age group and underlying cause of death. The nature of recommendations made was examined retrospectively using a derived model based on principles of injury causation and prevention, comprising seven elements: (1) priority population; (2) risk/contributing factors; (3) countermeasure; (4) level of intervention; (5) strategy for implementation; (6) organisation; (7) time frame for implementation. RESULTS: Coroners' recommendations were relatively rare, made in only ∼6% of external-cause deaths. When coroners did make recommendations, they were statistically significantly more likely for persons aged 0-14 years and deaths resulting from transport crashes, complications of medical and surgical care, drowning and inanimate mechanical forces. Of the coroners' recommendations, ∼70% included at least four of the model's seven elements. The elements 'countermeasure' and 'level of intervention' were most commonly specified by coroners (∼95%) in their recommendations. CONCLUSIONS: This study shows that highly evolved medicolegal death investigation systems may not draw systematically from the scientific research evidence base to inform the formulation of coroners' public health and safety recommendations. To maximise its contribution to fatal injury prevention, the medicolegal death investigation may benefit from incorporation of a public health perspective.