'Safety coaches' root out job risks
Program raises safety awareness
On the floors of United Hospital in St. Paul, MN, the people in tan pants and a black scrub top stood for safety. Twice a month, they donned the outfits and walked the halls as "safety coaches," observing practices, investigating injuries, and suggesting solutions.
It is a way to focus attention on safety and to save money. The safety coach program supported other efforts, such as the installation of additional ceiling lifts, and contributed to a reduction of 29 lost workdays and more than $90,000 in workers' compensation claims last year.
"Safety is not very glamorous," says Laura Hirt, a safety coach who is now employee safety and ergonomics coordinator at United, which is part of the Allina Health System. "[The program] really brought a bigger awareness around safety and the importance of it. It also encouraged employees to report their issues and become involved in finding solutions."
The program began in 2006 with 22 safety coaches in a wide range of departments, including: nutrition services, housekeeping, patient transport, surgery, medicine, and oncology. Each coach identified five "problematic" tasks from her or his department and began by researching existing policies and procedures. Their goal was to identify gaps between policy and practice and to suggest improvements that would address hazards.
It is a concept similar to the approach used by the Patient Safety Center at the James A. Haley VA Hospital in Tampa, FL, where "peer leaders" receive special training to help their co-workers with safe patient handling questions.
"We really like to see our unit peer leaders as facilitators of this knowledge transfer. It's another way to educate but it's also a way to empower staff," says Mary Matz, MSPH, Veterans Health Administration patient care ergonomics consultant. "While promoting safe patient handling we also want to promote a culture of safety."
United Hospital began with a broad injury prevention mission, though it later downscaled its safety coach program and is currently focusing on patient handling, the greatest source of injuries to caregivers at United. Now, eight coaches assist in providing hands-on, competency-based training on the patient moving equipment and have become great role models as well as an excellent resource to staff in their departments on patient handling tasks and equipment.
The vision of Hirt and the coaches is to improve employee safety, employee engagement, and patient satisfaction by giving staff the skills to consistently and appropriately use patient moving equipment. Other Allina hospitals also will adopt the safety coach/super-user model, Hirt says.
At United, safety coaches began by investigating their "problematic" tasks. They reviewed injury data and interviewed and observed co-workers, although most of them already had some intuitive knowledge about those tasks from their own daily work environment.
For example, Hirt, a former transport aide, was concerned that transport personnel often didn't find out that a patient was on isolation precautions until after the transport was completed. That lack of knowledge meant the employees weren't wearing the appropriate personal protective equipment.
It was frightening to learn that a transport could have potentially resulted in exposure to an infectious disease. "I was on a personal quest to find some way to solve this dilemma," she says.
Hirt worked on a better way to identify those patients. She also discovered that an existing infection control policy to wipe down the transport carts wasn't being followed consistently. "We worked with the leader of transport to make sure people were washing them down," she says.
Safety coaches in other areas also addressed shortcomings and prompted changes in policy, procedure or equipment. For example, to prevent slips and falls, floors identified as problematic are now hot-scrubbed nightly. To reduce needlesticks that occur when employees feel rushed, the hospital added phlebotomists. The hospital also revised its guidelines for handling chemotherapy waste, among a number of other significant successful changes in practice that were introduced to protect staff, as well as patients.
Being a safety coach made Hirt aware of the job hazards that needed to be addressed. "It was a side of health care I never thought of. There are so many risks," she says. The program demonstrated to employees that something was being done about those risks, and it encouraged them to be more proactive about reporting hazards and protecting themselves, Hirt adds.
"They saw people in the units doing inventories, surveying staff and talking to leaders," she says. They also had management support. Each safety coach was backed by the department "leader," or supervisor, Hirt says.
Today, the safety coaches and super-users help the co-workers use the patient handling equipment. Most importantly, they are good role models for safety, Hirt says.
For a "super-user" or "peer leader" program to be successful, those employees must have sufficient support, advises Matz. For example, the peer leaders should have an opportunity to collaborate and continue their training, she says.
"We recommend that their meetings be held on a regular basis. When you're starting out, it's a good idea to meet every couple of weeks and then when the program is established maybe every month," says Matz.
Those peer leaders also may organize "safety huddles," which are short unit meetings that enable staff to identify problems (such as a near-miss) and solutions. They promote the use of safety equipment. In the San Juan VA hospital, peer leaders created their own video on safe patient handling and they wear 'peer leader' shirts once a month. "They go through the hospital asking if there are any questions on the equipment. It's a good marketing tool," she says.
The peer leaders also need a "champion" someone in the facility who provides coordination of the program. "When facilities attempted to go it alone and have the unit peer leaders lead the other unit peer leaders, it just didn't work," she says. "They diminished their effectiveness."
Matz recommends designating one peer leader per shift for each unit or area. The leadership experience may provide those employees with an opportunity to earn step increases in pay or to be eligible for other leadership roles, she says.
(Editor's note: VA training materials for unit peer leaders are available at www.visn8.med.va.gov/PatientSafetyCenter/safePtHandling/FacilityChampionResources.asp.)
On the floors of United Hospital in St. Paul, MN, the people in tan pants and a black scrub top stood for safety. Twice a month, they donned the outfits and walked the halls as "safety coaches," observing practices, investigating injuries, and suggesting solutions.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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