Risk management liaisons boost compliance
May 1, 1996 8 minutes read
Risk management liaisons boost compliance
Employee involvement promotes awareness
To heighten employee awareness of risk management issues, try involving staff from each hospital department in the daily monitoring of key risk management areas like safety, security, infection control, and workers' compensation.
After instituting a hospitalwide risk management/infection control liaison program at Robert Packer Hospital in Sayre, PA, the risk manager sees these advantages:
* Employees are more willing to report problems and incidents and be involved in problem solving.
* Risk management awareness doesn't stop at the door step of risk managers, but expands across all departmental boundaries.
* The program offers expanded responsibility to employees interested in improving their performance reviews.
The risk management/infection control liaison program at Robert Packer Hospital involves voluntary training of staff about risk management, infection control, safety, and other issues and delegating the responsibility for monitoring these areas to the trained volunteers called liaisons, hospital officials say. In addition, the liaisons help promote communication about risk management concerns and reporting within their respective departments.
Hospital sees unanticipated benefits
You may find these unexpected results, experts say:
* Such a program could reveal some surprising reasons for staff deviation from policies and procedures.
* The program also could show an unexpected willingness on the part of hospital staff to help create new and better policies and procedures.
When Lois Allen, RN, CHRM, director of clinical risk management for Robert Packer Hospital, became chair of the hospital's safety committee, she wanted to refocus its efforts. While the committee was staffed with capable members, it was not meeting Joint Commission requirements, Allen says.
After setting a new goal of monthly hospital safety surveys, including semiannual reviews of each department, the safety committee realized that the departments needed more frequent monitoring. Allen and the hospital's infection control practitioner believed daily monitoring would be optimal, but did not have the time or the means to undertake such an endeavor themselves.
Instead, Allen decided to turn the responsibility for monitoring and reporting on risk management, infection control, safety, and other areas to each of the hospital's departments. After a year, she now has 70 hospital staff volunteers participating. With the support of the hospital's administration and managers, she sought volunteers from each department who would assume responsibility for monitoring key risk management indicators and report back to her safety committee. They are now meeting Joint Commission requirements by having regular meetings and posting more key people throughout the hospital. The next official Joint Commission review will be in 1997.
"The whole point of this program is that we [as risk managers] should not be monitoring what is happening out there, Allen says. "That is up to the employees. They should be the safeguard of the patients and other employees and have the know how to do so."
Because the liaison program would create additional work responsibilities for the volunteer liaisons, including attending bimonthly inservice educational programs, the support of each department head was imperative, Allen says. The response from the managers was extremely positive.
Liaisons should be volunteers
Because the goal of the program is staff involvement, it was important to have liaisons who were interested in risk management issues and willing to take on added work. After distributing flyers about the program, its goals, and responsibilities to each department manager, Allen solicited names of interested employees.
The volunteers who were chosen were those who, in addition to showing an interest in risk management, demonstrated a variety of leadership and communication skills, employment retainability, and had the recommendation of their department manager.
Each department has at least two liaisons. It is important to have an alternate, Allen says.
None of the volunteer liaisons are compensated for their additional work, because compensation would contravene a goal of the program, Allen says. But the liaisons' participation in the program is factored into their performance evaluations, which tie into salary increases.
Allen also encouraged the liaisons to be from the staff level because these positions are staffed 24 hours a day, while management typically is not.
'Not my department'
While the program had a tremendous overall reception in terms of participation and hospitalwide interest, Allen found that some of the hospital's departments, like patient accounts, initially did not believe that they were affected by risk management concerns. Once the liaisons from those departments began to attend the training and inservice programs, however, they saw how even administrative departments have risk management concerns, Allen says.
A key aspect of the program was training the volunteers in risk management. After the departmental liaisons were selected, Allen held a day-long training program. Representatives from the hospital's workers' compensation, safety/security, employee health, biomedical hazards, maintenance, and infection control departments all gave presentations to the volunteers about the risk management aspects of their departments.
The liaisons also are expected to attend bimonthly inservices that cover new topics. The inservices must be broad enough to appeal to and be relevant to liaisons from all of the departments, Allen advises. So far, the training programs have addressed topics ranging from incident reporting to latex allergies to hazardous waste containers.
Survey helps pinpoint RM problems
In addition to the training programs, Allen and department heads from the hospital's workers' compensation, safety, and infection control departments created a survey form for the liaisons to use to monitor the status of safety and health protections that are supposed to be in place throughout the hospital. (See sample survey forms, inserted in this issue.)
The four-page form serves as a simple reminder of precautions that should be in place for each of these four areas. The liaison can actually complete the form or use it as a guide to ensure that all of the protections are in place.
The form breaks down the risk management concerns into four areas: safety and security, risk management, infection control, and workers' compensation. Each of these functions is further divided into easily identifiable indicators.
For example, under the portion of the survey regarding infection control practices, liaisons are supposed to determine whether clean and soiled linens have been separated and whether needle containers are available.
Under the safety and security portion of the survey, liaisons are supposed to ensure that emergency exit signs are in place, that laundry chutes are closed and latched, and that new employees have attended mandatory inservices on safety.
The liaisons are not formally required to complete the surveys, Allen says. Instead, they serve as a reminder of the key risk management concerns the liaisons are supposed to be monitoring. Allen does make rounds of the hospital and collect the survey on occasion to check up on the liaisons. In addition, liaisons are required to attend the inservice meetings. Allen takes attendance at the programs to ensure compliance.
"Their job is not to correct the problem, but to discuss it with their fellow employees, to problem-solve, to enhance risk management," Allen says. "We didn't want them to think that if anything goes wrong that it is their fault. That is not the focus of this program."
When something is out of place, the program empowers the liaisons to take steps to correct it by calling the appropriate department. The bimonthly inservice programs always include a instructions on remedying a problem. If the topic has not been covered, liaisons can call Allen or the appropriate department head.
Allen also has created an e-mail network for the liaisons to provide them with a constant flow of information and to answer questions.
A marked change in attitude
The program already has created a marked change in the hospital employees' attitude toward risk management, Allen says. She points to a hole in a linoleum floor as an example. Previously, all of the staff would notice the hole, but no one would take the steps to call the maintenance department. Now the employees can tell their department liaison about the hole, and the liaison has the authority to call the maintenance department for the repair.
In addition to the constant monitoring and reporting of problems, the program also has encouraged communication among all the departments. Through their meetings and surveys, Allen learned why staff were not complying with hospital policies on gowns. She also learned that staff were not using hazardous waste containers because they were difficult to use.
The liaison program also has encouraged more reporting. Allen attributes the increase in incident reporting to a heightened awareness of risk management, safety, and infection control concerns and to less fear in reporting on the part of hospital staff.
Prior to the program, many staff did not report incidents because they were concerned about job security. Allen came to this realization after a hospital employee complained to OSHA about an odor.
Liaison program offers safe reporting
"The employee felt we were not addressing the problem," Allen says. "In doing our OSHA investigation, we realized that people were going this route because they were worried about losing their jobs if they told their supervisors."
In implementing the liaison program, the safety committee made a concerted effort to emphasize to the volunteers that no one would lose his job over making a report. To encourage widespread reporting, staff can make reports anonymously or can report to a variety of people.
The liaisons also have taken the initiative to correct problems beyond their monitoring responsibilities. For example, the safety committee had a problem with doors being propped open while staff smoked outside. After business hours, the emergency department serves as the only entrance for the hospital and all other doors are supposed to be locked. "We told the liaisons that the accountability issue was theirs to deal with," Allen says.
The liaisons then organized themselves into groups of smokers and nonsmokers and have begun to enforce the after-hours door policy.
The liaison program has been an unqualified success since it was implemented last year. "We've become more proactive with our safety committee. In some instances, we can nip problems in the bud," Allen says.
To continue to show the hospital's support for the program, Allen is creating a list of the liaisons' accomplishments. The list will be published throughout the hospital so the staff know the impact they have made, Allen says.
For risk managers interested in creating a similar program at their hospital, start at the top, Allen advises. The program takes time and money. When she first came up with the idea for the liaison program, Allen immediately sought the administration's support.
The hospital's president was so enthusiastic about the program that he attended the first-day training program and signed certificates of completion for each of the liaisons.
Allen also advises risk managers to get the support of department heads. Most hospital employees are overburdened. Managers and department heads do not want to lose their staff to any outside activities. This program requires the liaisons to take on additional responsibilities and to attend periodic inservice programs.
"This program would have been more difficult to accomplish if we had resistance, but we had 100% participation. Even from the departments that said the program was not applicable to them," Allen says.
It also is important to give feedback to keep the liaisons enthusiastic for their work. "Give feedback so they can see what they've accomplished. It's not what one person has done. It's the whole group. It is what as a group we do to make a difference here." *
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