How can we ensure the safety of all in care homes?
We all want to be as safe as we can be, especially when we are at work. There are legal requirements under The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 (RIDDOR) that all organisations must adhere to, but will this keep us safe? HSE states that we “should investigate incidents to ensure that corrective action is taken, learning is shared, and any necessary improvements are put in place”, and it is a Key Line of Enquiry (KLOE) of the Care Quality Commission (CQC) that “lessons [are] learned, and improvements made when things go wrong” (KLOE S6). Logically if we all do this, we can eliminate most incidents, yet we still have them. Why is this the case and what can we do?
Ensuring Safety: What should we be learning from?
The place to start is what should we be investigating. The HSE defines the following:
Accident: an event that results in injury or ill health
Incident: of which there are two kinds:
Near miss: an event not causing harm, but has the potential to cause injury or ill health (in this guidance, the term near miss will include dangerous occurrences)
Undesired circumstance: a set of conditions or circumstances that have the potential to cause injury or ill health, e.g. untrained nurses handling heavy patients
Dangerous occurrence: one of a number of specific, reportable adverse events, as defined in the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 (RIDDOR)
A missed opportunity; introducing Heinrich’s Accident Triangle
Typically, the first and last types get the focus due to the legal requirements, but it has been understood for many years that we have far more near misses than injuries. In fact, the accident triangle, developed by H.W. Heinrich in the 1930s postulates that there are more than 10 times the number of near misses than injuries. This model was developed using large amounts of data across multiple industries, so the ratios may not hold exactly true for care, but the principle does in that, if we focus on near misses and unsafe conditions and acts, we have many times the learning opportunities compared to looking at injuries and accidents alone.
How do we distinguish and action near misses, unsafe conditions and unsafe acts?
Classically a near miss is when something happens that, except for good luck, could have been an accident. We can see this clearly in the example above but what is better is identifying the unsafe condition i.e. the rusty gear and fixing it. We should also identify the unsafe act and condition, so that the crate can always be secured and that nobody walks under the crate when it is being lifted. Both of these rely on the individuals recognising the risk and taking the appropriate action. An example in a care setting would be:
Unsafe condition – water on the floor
Unsafe act – walking through the water
Near miss – slip but stay upright
Accident – falling over
A typical response would be to see the water and wipe it, but is this enough? If we want to avoid the unsafe condition in the future, it is not. We need to understand the cause of the water on the floor (leaking pipe, spillage when carrying water, rain etc) and take appropriate action e.g. fix the leak. You may ask whose responsibility this is? That is an easy one – it is all of our responsibilities to spot and take action on unsafe acts and conditions.
Why we struggle to capture and act on safety risks today
There are many reasons that we do not report and/or take action:
It is too complicated or time-consuming – we are all busy so do not have the time to go through a lengthy or difficult process. We would wipe up the water but not go any further leaving the problem to reoccur in the future
Complacency – we become comfortable with the way things are done and do not recognise the risk. In the lifting gear example, we have always walked under crates being lifted and no one has ever been hurt.
Peer Pressure – when I report near misses or unsafe acts and conditions my colleagues either think that I am trying to get them in trouble because it is something that they have or have not done or am trying to get into management’s good books by reporting every tiny thing.
Culture – Management do not like me reporting lots of potential problems and near misses – they see it as a bad thing and may damage my prospects rather than thanking me!
Embarrassment – I am worried that if I report this issue, I will look foolish because it may not actually be a problem or someone else may have reported it already.
It's not my Problem – this is nothing to do with my job, so it is up to someone else to report and fix it.
What does best practice look like?
Best practice, as always, starts with Culture. A great safety culture can be seen in many ways – these are a few:
Recognising the value of identifying and fixing unsafe acts and conditions
Rewarding individuals who do so.
Individuals take responsibility for the safety of everyone not just themselves.
Individuals will approach others (care givers, care receivers, visitors and other members of staff) when they see an unsafe act and discuss how it can be avoided.
Everybody talks about safety.
Identification and rectification of unsafe acts and conditions is a leading indicator for your safety culture.
The next factor is Recognising Risk. All activity has some level of risk associated with it, we survive by understanding this and behaving accordingly. As humans we all have different tolerances for risk and our own tolerance changes based on the situation. An example of this situational change is when we are driving, and we are late we probably will drive faster and take more chances. We want everyone to have a better understanding of risks and how to manage them. These are some techniques that we can use to raise this risk awareness:
Training/workshops where we are put into situations of increased risk, and we must identify them. This is best done in groups as it highlights the difference in risk tolerance.
Discussing risks regularly at work – during handover for example.
Getting the input of those we care for and their families as they will have a quite different view on risk to us.
Keep a register of known risks in each service and have plans of how to manage each of them
The final factor is having simple tools and processes to identify and mitigate near misses and unsafe acts and conditions. We want to capture these as we see them. In places already committed to digital transformation this can be done using the handheld devices that are often used for delivering care. If these are not available an app can be used on your own phone. The process should be as quick as taking a picture, selecting from a few drop-down lists and adding some text using voice recognition tools. In this way we capture everything in a few seconds of it being spotted.
Unlike accidents, the process following the capture needs to be flexible. The individual may be able to resolve the unsafe condition themselves, such as wiping up a spillage, or reporting to the maintenance team (this can be done through a drop-down list and pushing to your maintenance tool) or there may be nothing that can be done immediately. It is important that we look for root causes so that we do not just treat the symptoms.
This can be done on a routine or ad hoc basis but needs to be someone’s responsibility to ensure this happens. If you work in a multi-location organisation, it is important that all the issue captures are shared. If we are further on our digital transformation, there is a lot of data that can be used to try and pinpoint these root causes.
Will we Ever be Free of Accidents?
This has to be our goal and though our approach to it will likely create great improvements, getting to a perfect ‘0’ is likely untenable for now. However, I do know that if we capture every near miss, unsafe act, and unsafe condition, we can get there.
💡 Final Thoughts:
Ensuring safety is incredibly important for protecting others and ensuring compliance, and this is done by capturing and actioning risks and learning lessons by finding root causes.
Today much focus goes to accidents and dangerous occurrences, but capturing near misses gives care homes a big opportunity to prevent accidents and occurrences before they happen. This is because there are many more near misses than actual events, but they often do precede them.
By changing the culture around risk management, looking out for near misses and unsafe conditions, and then using simple tools and processes to capture them, we can move ever closer towards a care home system that ensures the safety of all staff and residents.
Are you thinking about using digital tech to improve your systems, processes and compliance, but feel concerned about how to orchestrate it smoothly across the board? Don’t worry, Guided Innovation has your back! Book a free, no-obligation chat with our in-house experts today; we’d love to help you and give you more ideas and clarity for your digital journey.