healthy work environments qwqhcs 2010 summit healthy workplaces in action: working to delivery...
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HEALTHY WORK ENVIRONMENTS
QWQHC’S 2010 SUMMIT
Healthy Workplaces in Action: Working to Delivery Quality Care
February 25, 2010
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Purpose
• To provide an overview of:
1. The work of HealthForceOntario
2. The importance of HWEs in the health care system
3. The Ministry of Health and Long-Term Care’s (MOHLTC) Healthy Work Environments (HWE) initiative
4. Evidence supporting HWE Initiative
5. Examples of innovative HWE interventions
6. Future directions for HWEs
What is HealthForceOntario?• HealthForceOntario (HFO) is the province’s strategy to ensure that
Ontarians have the right number and mix of qualified health care providers, now and in the future.
• The strategy:
• Identifies and addresses Ontario’s health human resources needs;
• Engages partners in education and health care to develop skilled, knowledgeable providers and creates health care delivery teams that will make the most of their abilities;
• Introduces new and expanded roles to increase the number of providers working in health care and builds on the skills of those already in the system; and,
• Makes Ontario the employer-of-choice for all health care providers.
• MOHLTC and the Ministry of Training, Colleges and Universities are delivering on the HealthForceOntario strategy in partnership with the province’s health care consumers and providers.
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What is a HWE?
• A HWE is a work setting that takes a strategic and comprehensive approach to providing the physical, cultural, social, and job design conditions that maximize the health and well-being of health care providers
Quality Worklife Quality Healthcare Collaborative (QWQHC)
• “….promotes and maintains the physical and mental health of its employees” (Robson, et al., 2000)
• “…culture, climate, and practices in an organization create an environment that promotes employee health and safety…” (Lowe, 2002)
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The Need for HWEs
• 88% of health care workers report insomnia, headaches, depression, weight changes, and panic attacks related to work stress.
• 35% of Ontario nurses report at least one musculoskeletal condition.
• 28% of Ontario nurses report that they were physically assaulted at work over the past 12 months by a patient.
• 46% of Canadian physicians report that they are in advanced stages of burnout.
• Average number of days of work lost due to illness or disability is at least 1.5 times greater for workers in health care than the average for all workers.
• If the average absenteeism rate for health care could be reduced to that of all Canadian workers, it could mean the equivalent of more than 13,700 “extra” full-time employees on the job, including 5,500 Registered Nurses.
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The Need for HWEs
Compared to other occupations, health professionals have the:
Least supportive and healthy workplaces
Least influence on workplace decisions
Lowest ratings of workplace communication
Lowest level of commitment to their employer
Lowest level of trust in their employer
Costs of an Unhealthy Workplace(Shamian, 2003)
3xHeart
Problems
2x-3x Conflicts
2x-3x Infections
2x - 3x Injuries
2x-3x Mental Health Problems
3x Back Pain
5xCertainCancers
2xSubstance
Abuse STRESSHigh
DemandLow Control +High Effort
Low Reward
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Why are HWEs important? (1)
• To help Ontario improve recruitment, retention, and absenteeism• HWEs can help retain older workers who may be considering retirement, as well as
help recruit and retain younger workers who tend to place a higher value on work-life balance, positive work environments, etc.
• To improve patient safety and quality of care• The 2004 Canadian Adverse Events Study suggested that the greatest gains in
patient safety will come from modifying health care professionals’ work environments, creating better defences against adverse events and mitigating their effects when they do occur.
• To support health system sustainability and achieve cost savings• Healthy work environments yield improved health outcomes for employees and
reductions in employer costs related to turnover, lost-time injuries, and absenteeism.
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Why are HWEs important? (2)Business Case: HWE Effect on Sick Absence
Low Medium High
Days Sick
Health Work Environment (HWE) Index
Self-Reported Sick Days in Last Year
0
1
2
3
4
5
5.4
4.1
2.9
A HEALTHY WORK ENVIRONMENT IS SIGNIFICANTLY RELATED TO LOWER SICK DAYS
Brock UniversityWorkplace Health Research Laboratory
©Metrics@Work and Brock University, WHRL, 2008 Better People Management 9
Why are HWEs important? (3)
Brock UniversityWorkplace Health Research Laboratory
©Metrics@Work and Brock University, WHRL, 2008
Low Medium High
Health Work Environment (HWE) Index
Wake Feeling Refreshed
10%
20%
30%
40%
50%
60%
0%
54.4%
61.9%
69.5%
A HEALTHY WORK ENVIRONMENT IS SIGNIFICANTLY RELATED TO HIGHER EMPLOYEE HEALTH
Business Case: HWE Effect on Individual Health
10Better People Management
Why are HWEs important? (4) Business Case: HWE Effect on Performance
A HEALTHY WORK ENVIRONMENT IS SIGNIFICANTLY RELATED TO HIGHER PRODUCTIVITY
Brock UniversityWorkplace Health Research Laboratory
©Metrics@Work and Brock University, WHRL, 2008
50.00%
55.00%
60.00%
65.00%
70.00%
75.00%
80.00%
85.00%
90.00%
Low HWE Medium HWE High HWE
Self-Reported Job Performance Intentions to Remain
Better People Management 11
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HWE Conceptual Model
Conceptual Model for Healthy Work Environments for Health Care Providers / Workers - Components, Factors, and Outcomes*
*Adapted from: Griffin, P., El-Jardali, F., Tucker, D., Grinspun, D., Bajnok, I., and Shamian, J. (2006). Conceptual Model for Healthy Work Environments for Nurses- Components, Factors, & Outcomes. In Developing and Sustaining Nursing Leadership Healthy Work Environments Best Practice Guidelines (p. 12-15). Toronto, Canada: Registered Nurses' Association of Ontario. (Used with permission of the Registered Nurses’ Association of Ontario, November 2007)
The Ministry’s HWE Initiatives: 2007 to Present
• Appointed two HWE Champions in April 2009.
• Established a HWE Expert Advisory Group.
• Worked with the Ministry of Labour to introduce the Needle Safety Regulation, which mandates the use of safety engineered needles to all health care workplaces.
• Funded the development of a variety of tools and resources to support HWEs in hospitals, long-term care homes, and home care, including:
• $3.5M to support 20 projects in 2007/08 and 2008/09; and• $2.8M to support 18 projects in 2009/10 through the HWE Innovation
Fund grant program.
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The HWE Champions’ RoleThe role of the HWE Champions is to:
• Promote the benefits of HWEs among fellow leaders in the health system and encourage them to implement HWE initiatives in their workplaces, including speaking to LHIN CEOs and health care employers (e.g. hospitals, long-term care homes, home care agencies).
• Speak at key health care conferences, education sessions, etc., and support partners’ efforts to showcase HWE leadership.
• Provide advice to MOHLTC on how to effectively implement HWEs, recognize leaders in HWEs, and build a culture of workplace health safety across the province.
• Collaborate with the HWE Expert Advisory Group to provide advice on HWEs to the government and the health care system.
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The Expert Advisory Group’s Role
The role of the HWE Expert Advisory Group members: • To advise the HWE Champions (and through them, MOHLTC) on the
implementation of the province’s HWE strategy. For example:
• How to enhance knowledge transfer;• Support for change management; • Promoting organizational leadership;• Using technology and social media to support HWEs; • Enhancing interprofessionalism / teamwork; and,• Strategies for successful sectoral outreach.
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The Needle Safety Regulation
• The Needle Safety Regulation was introduced in August 2007 under the Occupational Health and Safety Act to mandate the use of safety-engineered needles in hospitals as of September 1, 2008.
• In October 2007, the regulation was amended to extend it to long-term care homes, psychiatric facilities, laboratories, and specimen collection centres as of April 1, 2009.
• In November 2009, amendments were made to the regulation to extend it to other health care workplaces / services (e.g. public health, home care, physician offices, ambulance services, independent health facilities, etc.) to come into effect on July 1, 2010.
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The HWE Innovation Fund
• The Ministry launched the HWE Innovation Fund Grant Program in August 2009.
• The purpose of the HWE Innovation Fund is to identify, develop and disseminate HWE tools and leading practices
• There are four areas of focus for the HWE Innovation Fund which are:• Workplace violence prevention• Worker safety• Respect in the workplace• HWE leadership development
• The 18 projects that were selected for funding covered a broad range of health care environments including hospitals, long-term care homes, community care, family health teams, CCACs, LHINs, mental health facility, and geographically across Ontario.
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Other HWE Tools
• RNAO Best Practice Guidelines
• CREW (Civility Respect and Engagement in the Workplace)
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RNAO Healthy Work Environment Best Practice Guidelines
Workplace ViolenceLeadership
Effective Teams
Safety and Wellbeing
Staffing and Workload
Professionalism
Cultural Diversity
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CREW Intervention Outcomes in VA system
20Veteran Healthcare Administration (VHA) developed CREW
• Implemented in VHA 150 facilities across the USA.
• Units grouped into those with High, Medium and Low civility
• Changing Low Civility units to Medium or High Civility units has a significant financial impact on:
• Sick leave• Equity/Discrimination Suits• Patient Satisfaction
Osatuke, K., Mohr, D., Ward, C., Moore, S.C., Dyrenforth, S., & Belton, L. (in press). Civility, Respect, Engagement in the Workforce (CREW): Nationwide Organization Development Intervention at Veterans Health Administration. Journal of Applied Behavioral Science.
Authorized to Act
Accountable
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Low Civility Medium Civility High Civility
Average Cost of Sick Time Per employee Per Year
$0$150$300$450$600$750$900
$1050$1200$1350$1500$1650
$1673$1603
$1436
Low Civility Medium Civility High Civility
Average Cost of Equity/Discrimination Complaints Per Setting Per Year
$0
$20000
$40000
$60000
$80000
$100000
$115,000
$95,000
$56,000
Low Civility Low Moderate High Civility
Unit Civility and Patient Satisfaction
High Moderate
71.30
79.9479.0274.88
0
10
20
30
40
50
60
70
Equity/Discrimination Complaints
Financial Impacts and Patient Satisfaction from
VHA
Patient Satisfaction
Sick Time
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Relationship of Workplace Civility to Employee Outcomes with VHA22
High CivilityMedium HighMedium LowLow Civility0
0.5
1
1.5
2
2.5
3
3.5
4
2.9
3.58
4.06
4.47
High CivilityMedium HighMedium LowLow Civility0
0.5
1
1.5
2
2.5
3
3.5
4
2.54
3.14
3.65
4.18
Employee Satisfaction Intent to Stay
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CREW CANADA
Funded by the C
anadian Institutes for H
ealth Research
Michael P. Leiter, PhD
Centre for Organizational Research
Acadia University
Heather Laschinger, RN, PHD
University Of Western Ontario
Arla Day, PHD & Debra Gilin-Orr, PHD
St. Mary’s University
http://cord.acadiau.ca
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CompanionMentoring
Commitment People Values
AssessmentTrainingCommunityImplementation
Civility Sessions Mentoring
Evaluation
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Crew Process
Coworker Incivility
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CREW significantly decreased co-worker incivility.
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Exhaustion26
CREW significantly decreased exhaustion.
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Intention to Quit27
CREW significantly decreased intentions to quit.
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Absences
CREW significantly decreased absences per month.
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Nurses’ Trust in Management
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CREW significantly increased trust in management
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Nurses’ Empowerment Subscale: Support
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CREW significantly increased access to support.
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CREW Absences
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34%
REDUCTION
Financial Impact
Approx. Costs Approx. Savings w/ CREW
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Conclusion
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• It Improves Civility and Lowers Incivility
• It Improves the Downstream States:• Exhaustion
• Attitudes Towards Work
• Evaluation of Worklife
• It Improves Career Activity• Missed Days• Intention to Quit
http://www.Workengagement.com
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CREW WORK
S
What Can Be Done – One Hospital’s Story
The TEGH Experience
• Hospital began major focus on healthy workplace in 2005 following staff satisfaction survey that showed significant room for improvement.
• The approach to a healthier work environment involved a number of different tracks covering wellness, workplace safety, violence reduction, training and development, and regular measurement to name a few.
• Moved from below average staff engagement scores to top performer scores over 4 years.
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What Can Be Done – One Hospital’s Story
The TEGH Experience – Wellness
• TEGH Fitness Centre opened in February 2005.
• Wellness Centre opened in June 2007.
• Programming has very broad range spanning:
• Yoga • Spinning• Photography• Massage• Running Club• Etc.
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What Can Be Done – One Hospital’s Story
The TEGH Experience – Wellness
• Mental Wellness Strategic Plan developed in 2009.
• Wellness programs need not be a major investment – broad programming at TEGH supported by .6 FTE.
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What Can Be Done – One Hospital’s Story
The TEGH Experience – Workplace Safety
• Historically TEGH had a very poor track record for injuries and lost time.
• Focused program to reduce injury and speed return to work.
• Strategies to reduce injuries included:
• Becoming the first hospital to go needleless• Lift training• More robust return to work and modified work programs• Improved accident investigation process.
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What Can Be Done – One Hospital’s Story
The TEGH Story – Workplace Safety
• Lost time rate dropped from 2.42 to 1.36, .14 below peer group average.
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What Can Be Done – One Hospital’s Story
The TEGH Story – Violence Reduction
• Violence towards health workers has gone on for years.
• Has been an unspoken problem.
• There are misperceptions around issues of capacity and violence within and outside of healthcare.
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Weapon risks are real…
What Can Be Done – One Hospital’s Story
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…and extensive
What Can Be Done – One Hospital’s Story
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What Can Be Done – One Hospital’s Story
The TEGH Story – Violence Reduction
• Started in December 2006 by pulling together a working team including staff, management, organized labour, OSACH.
• Program includes a number of elements such as:
• Policy• Signage• Threat Assessments• Employee Training• Communications system• Incident tracking and analysis system• Flagging system for violent patients
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Is the Program Working? Example Statistics
• Employee Survey Results – Personal security and safety in the workplace positive scores
• 2004/05 - 72.9%• 2006/07 - 79.2%• 2007/08 - 82.5%
Preventing Workplace Violence
What Can Be Done – One Hospital’s Story
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What Can Be Done – One Hospital’s Story
The TEGH Story – Training and Development
• Moving towards a distributed leadership model leading to greater staff empowerment through 1001 Leaders Program.
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What Can Be Done – One Hospital’s Story
The TEGH Story – Measurement
• Used standardized survey instrument to monitor progress and compare to other like employers.
• During first four years survey administered quarterly. Now reducing frequency for ongoing monitoring.
• Survey results openly shared along with action plans.
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What Can Be Done – One Hospital’s Story
The TEGH Story – Key Lessons/Enablers/Reflections
• Healthy workplace initiatives are not a luxury.
• Demonstrate value through clear business cases that show a clear and measurable value proposition e.g. reduced lost time, absenteeism etc.
• Link initiatives to patient safety.
• Ensure that leadership is engaged and active.
• Always present solutions and not problems.
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What Can Be Done – One Hospital’s Story
The TEGH Story – Key Lessons/Enablers/Reflections
• Engage partners in organized labour.
• Challenge will be to hold, or not erode significantly, gains made as Hospital works through the impact of current fiscal environment.
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Future Directions for HWEs
• Working with the HWE Champions and HWE Expert Advisory Group, the Ministry plans to move forward with a Healthy Work Environments Strategy that will:
• Continue to develop and disseminate leading practices in HWEs, building on the HWE initiatives that have already been completed.
• Promote leadership on HWEs by recognizing and celebrating champions who encourage fellow leaders to implement initiatives in their organizations.
• Incorporate HWE indicators into existing accreditation programs, accountability agreements, and data collection mechanisms.
• Support the development of a culture of health, safety, and wellness in the health care sector in Ontario.
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Our Website and E-Mail Addresses
• We have established a HWE web page on the HealthForceOntario website at:
http://www.healthforceontario.ca/WhatIsHFO/hwe.aspx
• The HWE Champions can be reached by e-mail at:[email protected]
• The general e-mail for the Ministry’s HWE initiative is:[email protected]
• You can reach the Ministry’s HWE team directly through the following e-mail addresses:
[email protected]@ontario.ca
[email protected]@ontario.ca
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