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OSHA 366 Portland State University Behavior Based Safety Discussion

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Program Development Behavior^Based Safety Improvement opportunities in hospital safety By Don Nielsen and John Austin FEW WORKPLACES ARE AS COMPLEX as hospitals. Not only do hospitals provide a multitude of patient care services, they also require many support services. Hospitals in the U.S. employ more than four million workers—or about 3.4 percent of the total U.S. workforce (USDoL). These workers are exposed to a wide range of potential safety hazards In direct patient care departments and support services departments. The annual rate of injury among hospital workers is 7.7 per 100 full-time employees (BLS). The leading causes of injury in these settings are overextension, falls, contact with objects, exposure to harmful solutions and environmental hazards. Many hospitals have developed general (and in some cases specific) guidelines for preventing accidents and injuries, but these guidelines typically do not require employees to demonstrate mastery of safe behavior. Behavioral approaches to safety have shown substantial improvement of specific safe behaviors in various settings, but few behavior-based research studies have been conducted in hospital facilities; this suggests an opportunity for additional investigation and application. This article identifies potential causes of injuries and offers some suggestions for reducing injuries using behavioral approaches. The Hospital Setting Hospital medical staff provide patient care around the clock. Their services range from emergency procedures to scheduled activities, from fairly routine tasks to complex procedures. Some patients display difficult and even combative behaviors, which can hinder the provision of these services. Further complicating the picture are severe staff shortages being reported by hospitals nationwide. Examination of hospital safety history reveals several national efforts to address hospital employee safety and health problems. In 1958, a report by the American Medical Assn. and American Hospital Assn. identified the basic elements of occupational health for hospital workers (AMA). In addition, the groups reported that hospitals should serve as examples of job safety. In June 1972, NIOSH complet- ed a survey of health programs and services for hospital workers. The survey identified three key deficiencies in U.S. hospitals. 1) Only half of the hospitals had regular employee safety and health education programs. 2) Ordy 39 percent had employee immunization programs for infectious disease control. 3) Only 18 percent of the hospitals trained employees about potential hazards and at-risk activities [NIOSH(b)]. Currently, protection of hospital workers is accomplished through a hodgepodge of approaches. Hospitals are regulated or accredited by various local, state and federal government agencies such as local zoning boards, state health departments, state licensing boards. Joint Commission on Accreditation of Healthcare Organizations, American Osteopathic Assn., OSHA, U.S. Nuclear Regulatory Commission, Food and Drug Administration and Federal Aviation Administration. As a Don Nielsen, M.A., is a researcher result, no single set of safety and health in the fields of behavioral safety and regulations is applied to hospitals and performance management who is their employees [NIOSH(a)]. Some man- pursuing a Ph.D. at Western Michigan datory standards, such as the Needle University (WMU). He holds a B.A. in Stick Safety and Prevention Act, require Psychology from Winona State hospitals to identify and make use of University, as well as an M.A. in safer medical devices (Pugliese and Counseling Psychology and an M.S. Bartley 30). However, hospital employee in Behavior Analysis, both from WMU. safety programs have primarily been John Austin, Ph.D., is an associate developed using information from professor of psychology at WMU, NIOSH and the Centers for Disease where he teaches courses in Control and Prevention [CDC(a); (b)]. performance management and Patient care involves a broad spec- consults with businesses on behavioral trum of services—delivered by various safety and performance improvement departments—designed to maximize a systems. He has a B.A. from the patient’s health and recovery. These University of Notre Dame and an departments include surgery, intensive M.S. and Ph.D. from Florida State care, acute care, nursing, radiology and University. Austin is co-editor of the laboratory. Potential hazards to work- Journal of Organizational Behavior ers in these areas include radiation Management, an editorial board exposure, needlesticks, and exposure to member of the Journal of Applied chemicals and hazardous bodily fluids. 
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