A study of leading indicators for occupational health and safety management systems in healthcare.

BACKGROUND: In Ontario, Canada, approximately $2.5 billion is spent yearly on occupational injuries in the healthcare sector. The healthcare sector has been ranked second highest for lost-time injury rates among 16 Ontario sectors since 2009 with female healthcare workers ranked the highest among all occupations for lost-time claims. There is a great deal of focus in Ontario's occupational health and safety system on compliance and fines, however despite this increased focus, the injury statistics are not significantly improving. One of the keys to changing this trend is the development of a culture of healthy and safe workplaces including the effective utilization of leading indicators within Occupational Health and Safety Management Systems (OHSMSs). In contrast to lagging indicators, which focus on outcomes retrospectively, a leading indicator is associated with proactive activities and consists of selected OHSMSs program elements. Using leading indicators to measure health and safety has been common practice in high-risk industries; however, this shift has not occurred in healthcare. The aim of this project is to conduct a longitudinal study implementing six elements of the Ontario Safety Association for Community and Healthcare (OSACH) system identified as leading indicators and evaluating the effectiveness of this intervention on improving selected health and safety workplace indicators. METHODS: A quasi-experimental longitudinal research design will be used within two Ontario acute care hospitals. The first phase of the study will focus on assessing current OHSMSs using the leading indicators, determining potential facilitators and barriers to changing current OHSMSs, and identifying the leading indicators that could be added or changed to the existing OHSMS in place. Phase I will conclude with the development of an intervention designed to support optimizing current OHSMSs in participating hospitals based on identified gaps. Phase II will pilot test and evaluate the tailored intervention. DISCUSSION: By implementing specific elements to test leading indicators, this project will examine a novel approach to strengthening the occupational health and safety system. Results will guide healthcare organizations in setting priorities for their OHSMSs and thereby improve health and safety outcomes.

Mitochondrial diabetes in mice expressing a dominant-negative allele of nuclear respiratory factor-1 ( Nrf1 ) in pancreatic ß-cells.

Genetic polymorphisms in nuclear respiratory factor-1 ( NRF1 ), a key transcriptional regulator of nuclear-encoded mitochondrial proteins, have been linked to diabetes. Homozygous deletion of Nrf1 is embryonic lethal in mice. Our goal was to generate mice with ß-cell-specific reduction in NRF1 function to investigate the relationship between NRF1 and diabetes. We report the generation of mice expressing a dominant-negative allele of Nrf1 (DNNRF1) in pancreatic ß-cells. Heterozygous transgenic mice had high fed blood glucose levels detected at 3 wks of age, which persisted through adulthood. Plasma insulin levels in DNNRF1 transgenic mice were reduced, while insulin sensitivity remained intact in young animals. Islet size was reduced with increased numbers of apoptotic cells, and insulin content in islets by immunohistochemistry was low. Glucose-stimulated insulin secretion in isolated islets was reduced in DNNRF1-mice, but partially rescued by KCl, suggesting that decreased mitochondrial function contributed to the insulin secretory defect. Electron micrographs demonstrated abnormal mitochondrial morphology in ß- cells. Expression of NRF1 target genes Tfam , T@1m and T@2m , and islet cytochrome c oxidase and succinate dehydrogenase activities were reduced in DNNRF1-mice. Rescue of mitochondrial function with low level activation of transgenic c-Myc in ß-cells was sufficient to restore ß-cell mass and prevent diabetes. This study demonstrates that reduced NRF1 function can lead to loss of ß-cell function and establishes a model to study the interplay between regulators of bi- genomic gene transcription in diabetes.

A biopsychosocial perspective on the management of work-related musculoskeletal disorders.

This article provides an overview of current literature about workplace-related musculoskeletal disorders from a biopsychosocial perspective. The authors conclude that disability management and early intervention efforts can only be meaningful within the context of targeted interventions, including mechanisms for psychosocial screening. In addition, they suggest that return to work should be considered an integral, rather than superficial, contribution to the rehabilitative process.

Leading Indicators in Occupational Health and Safety Management Systems in Healthcare: A Quasi-Experimental Longitudinal Study.

OBJECTIVE: To evaluate the feasibility of implementing interventions guided by six leading indicators, and the effectiveness of these interventions on improving employee's perception of their organization's health and safety climate. METHOD: A quasi-experimental longitudinal design was used in two hospitals. Occupational health and safety management systems (OHSMS) were assessed using the Leading Indicator Assessment Tool. To address the gaps identified in the assessment, tailored interventions were developed, pilot tested, and evaluated. Data were collected pre- and post-interventions. RESULTS: Interventions were developed to improve three leading indicators: senior management commitment, employee involvement, and communication. Overall, both sites supported using leading indicators to guide proactive interventions. Employees' perceptions of the health and safety climate improved at one site only. CONCLUSIONS: The results suggest the utilization of leading indicators to assess an organization's current OHSMS, identify areas for improvement, and implement tailored interventions is feasible to support a culture of safety in healthcare.