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.

The cooling profile of hot-cooked mussels stored in domestic insulated coolers amongst food vendors in Prince Edward Island, Canada.

It is common during outdoor events on Prince Edward Island, Canada for vendors to store hot-cooked mussels in domestic coolers. Provincial legislation states that hot product should be maintained at a minimum of 60 °C. A study was conducted to ascertain how long mussels could be stored before the temperature decreased to less than 60 °C. Hot, cooked mussels were placed into coolers and the temperature measured every 10 min for 4 h. It was found that when the cooler was unopened, the mean temperature dropped to less than 60 °C in 56 min. For coolers opened every 10 min, the mean temperature decreased to less than 60 °C in 38 min. For coolers opened every 10 min with mussels removed, the mean temperature decreased to less than 60 °C in 52 min. It was concluded that mussels should not be stored for more than 30 min and temperature should be regularly monitored.

Setting priorities: Testing a tool to assess and prioritize workplace chemical hazards.

BACKGROUND: Workplace Hazardous Materials Information System (WHMIS) training is obligatory for Ontario workplaces. The purpose of this training is to help workers understand the health and safety issues associated with using chemicals, including how to understand the information contained in the Safety Data Sheets (SDSs) that come with all chemicals. However, many workers still do not know how hazardous workplace chemicals can be and they find it difficult to objectively determine the level of hazard posed by the chemicals they use. OBJECTIVE: A team of researchers, unions, and health and safety associations created a tool for Joint Health and Safety Committees (JHSC) of small and medium-sized businesses to help them identify, assess and prioritize the health hazards posed by workplace chemicals using SDSs as the primary source of information. METHODS: The team recruited the JHSCs of six workplaces to pilot the usefulness of the Chemical Hazard Assessment and Prioritization (CHAP) tool. The CHAP tool helps workplaces rank their chemicals within one of five hazard levels using information contained in SDSs. RESULTS: Despite a difficult recruitment process, the participating JHSCs thought the CHAP process of assessing and prioritizing their workplace chemicals was useful. It raised their awareness of chemical hazards, increased their understanding of SDSs, and helped them prioritize their chemicals for improved control measures. CONCLUSIONS: Small and medium-sized businesses found the tool to be useful, but suggested that an electronic version would be easier to use.

With a little help from our friends: Collaborative research partnerships in three workplace-based occupational disease research projects.

BACKGROUND: Research conducted in collaboration between academic and non-academic partners (known as integrated knowledge translation [iKT]) in the field of occupational health and safety needs to be evaluated. OBJECTIVE: This study examined three collaborative workplace-based intervention projects that focused on reducing exposure to occupational carcinogens. Practice, policy and advocacy intermediary organizations partnered with multidisciplinary groups of researchers. This evaluation study sought to understand the characteristics of successful and unsuccessful iKT partnerships from the perspective of the intermediaries. METHODS: Researchers conducted face-to-face interviews with 21 intermediaries and used a thematic-driven "framework analysis" method to analyze the interviews, based upon an evolving conceptual framework. RESULTS: Seven enablers and barriers of collaboration were identified. Enablers included having: adequate capacity; defined project roles; the right partners; an inclusive project leader; mutual respect; good communication; and shared values and priorities. Lacking these was considered a barrier. Seven outcomes were identified as: improved relevance and quality of the research; learning about each others' "world"; building contacts; improved use of research in practice and policy; dissemination of the research; development of trust and goodwill; and continued collaborations. CONCLUSIONS: Recommendations for future collaborative studies include: spend time defining roles, responsibilities, and expectations; ensure practitioners have the time and resources, and the commitment to the project; and choose representatives from the organizations with the necessary skills or decision-making mandate.

Solar Ultraviolet Radiation Exposure among Outdoor Workers in Three Canadian Provinces.

INTRODUCTION: Solar ultraviolet radiation (UVR) exposure places outdoor workers at risk of skin cancer and exposure is difficult to control. In response, the Sun Safety at Work Canada (SSAWC) project was undertaken (2014-2016). The purpose of this substudy was to characterize the UVR exposure levels of outdoor workers in the SSAWC project. METHODS: Thirteen workplaces in the provinces of British Columbia, Ontario, and Nova Scotia participated in an exposure monitoring campaign (late summer/early fall 2016). Study participants were workers from power utilities and municipalities. Participants wore a UVR measurement badge (light-sensitive polysulfone plastic) on their wrist, shoulder, or hardhat. Badge calibration and absorbance measurements were performed in the AusSun Research Lab. Personal UVR doses are presented as standard erythemal doses (SED) and compared with the internationally recommended exposure limit (1.3 SED), as well as to the total available UVR by date. Generalized linear models were used to examine determinants of solar UVR for personal UVR dose (for both SED and percent of ambient UVR). Models considered badge placement, date, province, industry, main job task, and the hours spent outdoors. RESULTS: Mean personal UVR dose of participating workers was 6.1 SED (nearly 5× the recommended limit). Just 14% of workers experienced 'acceptable' levels of solar radiation; 10% were exposed at >10 times the limit. In univariate analyses, workers in Ontario had the highest levels (mean 7.3 SED), but even in the lowest exposed province (British Columbia), the mean personal UVR dose was 4.5 SED. Utility workers had double the exposure of municipal workers (10.4 and 5.5 SED, respectively). In the determinants of exposure models, the differences by province were muted, but utility line workers and those in general maintenance had higher predicted exposures. Those who wore their badge on their hardhat also had higher values of SED in the fully adjusted determinants models. CONCLUSIONS: Solar ultraviolet overexposure among outdoor workers is a concern, even in a country like Canada with relatively low ambient UVR. Implementation of sun safety programs should be supported in an effort to reduce exposure in this vulnerable group of workers.

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.

Sun Safety at Work Canada: a multiple case-study protocol to develop sun safety and heat protection programs and policies for outdoor workers.

BACKGROUND: CAREX Canada has identified solar ultraviolet radiation (UV) as the second most prominent carcinogenic exposure in Canada, and over 75 % of Canadian outdoor workers fall within the highest exposure category. Heat stress also presents an important public health issue, particularly for outdoor workers. The most serious form of heat stress is heat stroke, which can cause irreversible damage to the heart, lungs, kidneys, and liver. Although the need for sun and heat protection has been identified, there is no Canada-wide heat and sun safety program for outdoor workers. Further, no prevention programs have addressed both skin cancer prevention and heat stress in an integrated approach. The aim of this partnered study is to evaluate whether a multi-implementation, multi-evaluation approach can help develop sustainable workplace-specific programs, policies, and procedures to increase the use of UV safety and heat protection. METHODS/DESIGN: This 2-year study is a theory-driven, multi-site, non-randomized study design with a cross-case analysis of 13 workplaces across four provinces in Canada. The first phase of the study includes the development of workplace-specific programs with the support of the intensive engagement of knowledge brokers. There will be a three-points-in-time evaluation with process and impact components involving the occupational health and safety (OHS) director, management, and workers with the goal of measuring changes in workplace policies, procedures, and practices. It will use mixed methods involving semi-structured key informant interviews, focus groups, surveys, site observations, and UV dosimetry assessment. Using the findings from phase I, in phase 2, a web-based, interactive, intervention planning tool for workplaces will be developed, as will the intensive engagement of intermediaries such as industry decision-makers to link to policymakers about the importance of heat and sun safety for outdoor workers. DISCUSSION: Solar UV and heat are both health and safety hazards. Using an occupational health and safety risk assessment and control framework, Sun Safety at Work Canada will support workplaces to assess their exposure risks, implement control strategies that build on their existing programs, and embed the controls into their existing occupational health and safety system.