UNIT 1 MWM.pptx

UNIT-1
HEALTHCARE HAZARD CONTROL
&
UNDERSTANDING ACCIDENTS

Healthcare Hazard Control:
• Introduction,
• Hazard Control,
• Hazard Control Management,
• Hazard Control Responsibilities,
• Hazard Analysis,
• Hazard Control and Correction,
• Personal Protective Equipment,
• Hazard Control Committees,
• Hazard Control Evaluation.
Understanding Accidents:
• Accident Causation Theories,
• Human Factors,
• Accident Deviation Models,
• Accident Reporting,
• Accident Investigations,
• Accident Analysis,
• Accident Prevention,
• Workers‘ Compensation,
• Orientation, Education, and
Training.

INTRODUCTION
• Healthcare is one of the fastest growing
sectors of the US economy, employing
over 12 million workers with women
representing about 80% of the healthcare
workforce.
• Advances in medical technology and
clinical treatment techniques expose
workers and patients to a variety of
potential hazards.
• Occupational Safety and Health
Administration (OSHA)
• Agency of the US Department of
Labor
• President Richard M Nixon – Dec 29,
1970
• Safety issues facing healthcare
organizations include
• needlesticks,
• back injuries,
• slips and falls,
• laser hazards,
• chemical exposures,
• biological hazards,
• workplace violence, and
• community safety issues.

IBFCSM
• International Board for Certification of Safety Managers (IBFCSM) (1976) -
Board of Certified Hazard Control Management (BCHCM).
• MOTTO: Individual Credentials—The Key to Upgrading the Profession
• The board offers qualified working healthcare professionals an opportunity to
earn their credentials.
• Certified Healthcare Safety Professional (CHSP),
• Certified Healthcare Emergency Professional (CHEP),
• Certified Patient Safety Officer (CPSO),
• Certified Hazard Control Manager (CHCM),
• Certified Hazard Control Manager-Security (CHCM-SEC),
• Certified Product Safety Manager (CPSM).

HAZARD
Definition
• IBFCSM defines a hazard as “any solid, gas, or liquid with the potential to cause
harm when interacting with an array of initiating stimuli including human-related
factors.”
Scope
• any activity, behavior, error, event, incident, occurrence, operation, process,
situation, substance, or task with potential to cause human harm, property damage,
risk to the environment, or a combination of all three.
Hazard Closing
• the process of two or more hazards or causal factors attempting to occupy the
same space at the same time.
• Some hazard control professionals refer to this interaction of causal factors as the
accident generation cycle.

HAZARD CONTROL
• Accidents, mishaps, and hazardous exposures can result in injuries,
illnesses, property damage, and work interruptions.
• Companies, businesses, and institutions must make hazard control a
priority organizational function.
• Organizations can unknowingly promote activities that do little to
improve safety-related behaviors or encourage continuous learning
processes.

HAZARD CONTROL
Benefits:
• Proactive hazard control can improve operational efficiency,
organizational effectiveness, and the bottom line.
• The hazard control profession should focus on using
management, leadership, and improvement principles to
prevent accidents, injuries, and other losses.
• Senior leaders must ensure that organizational members
promptly report accidents, hazards, close-call incidents, and
unsafe behaviors.
• Passive hazard control efforts can communicate a general
awareness about the importance of working safely.

HAZARD CONTROL
Implementation
• When organizational leaders and supervisors make people the priority, adherence
to established policies and compliance standards becomes easier to achieve.
• Most experienced hazard control managers understand the importance that
engineering principles play in preventing accidents and injuries.
• Some well-known engineering innovations such as fire prevention technologies
and safer machine designs make workplaces much safer for everyone.
• Effective hazard control managers must use leadership to minimize risky and
unsafe behaviors.

HAZARD CONTROL MANAGEMENT
Definition
• The process of controlling hazards may require developing processes or systems
in terms of written policies, plans, or procedures that can help prevent harm and
loss.
• An uncorrected hazard or hazardous situation could contribute to an event
resulting in property damage, job interruption, personal harm, or adverse health
effects.
• Never consider hazard control as a program but as a function of the organization.
• The hazard control function must connect with organizational structures and
operational philosophies.

Program/Function
• Program comes from
• the French word programme, which means agenda or public notice.
• The Greek word graphein, which means to write. When used with the prefix pro, it
became prographein, which means to write before.
• Many organizations develop written safety programs to satisfy organizational
mandates or to demonstrate visual compliance with regulatory requirements.
• The word function,
• denotes the concept of performance or execution.
• can relate to people, things, and institutions.
• can refer to serving a designated or defined role in some manner.
• can also relate to participation in an ongoing cultural or social system.
• Considering hazard control as a function of the organization elevates its priority in the
minds of everyone.

Seven Values of Hazard Control Management
• Never-ending process
• People focused
• Leadership driven
• Operational priority
• Benefits everyone
• Reduces organizational losses
• Prevents human harm

PROACTIVE VS REACTIVE HAZARD CONTROL
PROACTIVE
• Anticipates, recognizes, and identifies
hazards
• Analyzes and determines risks
• Controls hazards to reduce accident
potential
• Educates and encourages safe
behaviors
• Focuses in preventing losses
• Analyzes to determine root causes
• Operates to open and hidden cultures
• Involves leaders in hazard control
REACTIVE
• Evaluates and investigates past
incidents or accidents
• Uses risk management to control loss
• Satisfied with reducing accident
recurrence es or accidents
• Disciplines unsafe actions and
behaviors
• Accepts some losses if not too severe
• Documents errors and primary causes
• Responsive to formal culture
expectations
• Leaders delegate responsibilities to

TRADITIONAL HAZARD CONTROL ASSUMPTIONS
• Hazard control manager retains responsibilities for solving all
safety- related problems.
• Senior leaders view hazard control as a necessary expense.
• Training and education focuses on documentation and not
human performance.
• Organizational efforts focus on hazards with minimum emphasis
on unsafe behaviors.

HAZARD CONTROL IS GOOD BUSINESS
• Liberty Mutual, in its 2007 Workplace Safety Index, estimated that in 2005, employers
paid almost $1 billion per week in direct compensation costs for disabling workplace
injuries and illnesses.
• Senior leaders must make hazard control a priority function.
• Proactive efforts can help reduce workers’ compensation premiums, injury costs, and lost
productivity.
• Liberty Mutual sent a survey to 100’s of chief financial officers in 2005.
• More than 60% responds - they could document a return on investment (ROI) for
money allocated to hazard control– related initiatives.
• OSHA reports - the average work site participating in the OSHA Voluntary Protection
Program (VPP) documented days away, restricted, or transferred (DART) rates of
52% below the national average for their industrial classification.
• Organizational leaders making hazard control part of a good business initiative must
understand accidents impact their organization in the terms of cost, time,
performance, and morale.
• Proactive hazard control can also help achieve compliance with the myriad of
regulatory requirements placed businesses today.

HAZARD CONTROL RESPONSIBILITIES
• Many organizations with high accident or injury rates fail to outline specific hazard
control responsibilities in their plans, procedures, directives, and job descriptions.
• The concept of responsibility relates to a person’s obligation to carry out assigned duties
in an efficient, effective, and safe manner.
• Senior leaders must ensure
• managers and supervisors understand the importance of their assigned hazard control
responsibilities.
• job descriptions address hazard control responsibilities inherent with each position or
task.
• encourage participation and hold key managers as this will yield hazard control
benefits.
• Senior leaders and hazard control managers must learn to focus on the hazards, behaviors,
and risks that pose the most potential harm.

HAZARD CONTROL RESPONSIBILITIES
Senior Management Responsibilities
• Develop, sign, and publish an organizational hazard control policy
statement.
• Describe key expectations related to accomplishing hazard control
objectives.
• Ensure that all organizational members can explain the major
objectives.
• Develop methods to track progress and provide feedback to all
organizational members.
• Require managers and supervisor to visibly support established
objectives.

HAZARD CONTROL MANAGER RESPONSIBILITIES
• Hazard control objectives must focus on accident prevention, reducing operating costs, and
efficiently using human and other organizational resources.
• When seeking senior leader’s approval for hazard control expenditures, use a well-prepared cost–benefit
analysis document.
• An effective hazard control manager
• serves as a consultant and adviser to managers at all operational levels.
• must persuade management action rather than attempt to correct every hazardous situation.
• learn to compile and disseminate important safety-related information to managers throughout
the organization.
• must teach others about accident prevention principles and solicit their input.
• should anticipate opposition from certain segments within their organization. When dealing with
opposition, use effective human relation and communication skills to persuade others to
support hazard control objectives.
• should know what they know and acknowledge the things they don’t know. However, they must
know where to go to find answers.
• Must acknowledge that many operational managers and supervisors face issues beyond their
control. Understanding this important concept can help hazard control managers gain their
respect.
• Conducting periodic perception surveys can reveal what people in the organization truly think
or believe about hazard control efforts.

HAZARD CONTROL MANAGER RESPONSIBILITIES
• Guide development of hazard control training and educational sessions.
• Serve as the hazard control consultant and information center.
• Provide hazard control–related technical assistance as necessary.
• Provide information about legal and compliance requirements affecting safety &
health.
• Evaluate overall hazard control performance as related to established objectives or
goals.
• Maintain communication with regulatory agencies and professional safety
organizations.
• Oversee accident investigations, hazard analysis, and preparation of reports or
summaries.
• Monitor progress of corrective actions required to address hazards or other safety
deficiencies.

SUPERVISOR INVOLVEMENT
• First-line supervisors occupy a key hazard control position in many organizations. This
position of trust can require supervisors to
• conduct area inspections,
• provide job training,
• ensure timely incident reporting, and
• accomplish initial accident investigations.
• Must possess the knowledge and experience to provide hazard control guidance to those
they lead.
• Must possess little control over factors such as
• hiring practices,
• working conditions, and
• equipment provided to them.
• Must understand the role that human factors can play in accident prevention and
causation. They must ensure that each person they supervise understands the behavior
expectations of the job.
• Must ensure that their subordinates can access all hazard control plans, policies, and
procedures

SUPERVISOR RESPONSIBILITIES
• Enforce work rules and correct unsafe or at-risk behaviors.
• Implement hazard control policies, procedures, and practices in their areas.
• Provide job or task-related training and education.
• Immediately report and investigate all accidents in their work areas.
• Conduct periodic area hazard control and safety inspections.
• Ensure proper maintenance and servicing of all equipment and tools.
• Lead by example and personally adhere to hazard control requirements.
• Conduct safety and hazard control meetings on a regular basis.
• Work with organizational hazard control personnel to correct and
control hazards.
• Ensure all personnel correctly use required PPE.

Healthcare Hazard Control:
• Introduction,
• Hazard Control,
• Hazard Control Management,
• Hazard Control Responsibilities,
• Hazard Analysis,
• Hazard Control and Correction,
• Personal Protective Equipment,
• Hazard Control Committees,
• Hazard Control Evaluation.
• Understanding Accidents:
• Accident Causation Theories,
• Human Factors,
• Accident Deviation Models,
• Accident Reporting,
• Accident Investigations,
• Accident Analysis,
• Accident Prevention,
• Workers‘ Compensation,
• Orientation, Education, and
Training.

HAZARD ANALYSIS
• Organizations can use a variety of processes to analyze workplace hazards
and accident causal factors.
• Hazard evaluations and accident trend analysis can help improve the
effectiveness of established hazard controls.
• Routine analysis enables an organization to develop and implement
appropriate controls for hazardous processes or unsafe operations.
• Analysis processes rely on information collected from hazard surveys,
inspections, hazard reports, and accident investigations.
• Effective analysis can take the snapshots and create viable pictures of
hazards and accident causal factors.

HAZARD ANALYSIS
Change Analysis
• Change analysis helps hazard control personnel identify hazards inherent
in new processes and job related tasks.
• Change analysis must attempt to identify all anticipated hazards and
concerns generated by the change.
Creative Hazard Analysis
• Creative hazard analysis combines innovation with human expertise to
identify, discover, and analyze hazards of a process.
• It should collectively generate a list of what or why questions related to
hazards.
Risk Analysis
• Risk analysis helps hazard control personnel assess the probability that
an uncontrolled hazard could contribute to an accident event with
resulting organizational losses.

HAZARD ANALYSIS
Phase Hazard Analysis
• Prior to transitioning to a new phase, conduct an analysis to identify
and evaluate new or potential hazards.
Process Hazard Analysis
• The analysis must show that each element of the process
• poses no hazard,
• poses an uncontrolled hazard, or
• poses a hazard controllable in all foreseeable circumstances.

Risk Analysis
• Helps to assess the probability of an uncontrolled hazard could
contribute to an accident event with resulting organizational losses.
• Consider the potential severity associated with an adverse event
occurrence.
• Analysis personnel use available empirical data when attempting to
determine probability of a risk-related event.
• Severity consideration become the controlling issue when other factors
indicate a low probability of an event.
• Risk personnel can consider hazards with acceptable risks as safe and
those with unacceptable risks as unsafe.
• “safety first” implies safety becomes primary objective and not job
accomplishment. In very hazardous jobs and operations, a more
appropriate slogan should read, “accomplish the job with safety.”

Phase Hazard Analysis
• Processes work very well for construction projects and other settings with
rapidly changing work environments.
• Considered as a new or unique set of hazards not present during
operations.
• Prior to transitioning to a new phase, conduct an analysis to identify and
evaluate new or potential hazards.
• Use the information gained through analyses to develop action plans that
ensure implementation of appropriate controls.

Process Hazard Analysis
• The OSHA Process Safety Management standard requires completion of a
process hazard analysis for any activity involving the use of highly hazardous
chemicals.
• The OSHA standard applies to entities using (storing, manufacturing, handling, or
on-site moving) of highly hazardous chemicals.
• Process hazard analysis permits employers to accomplish detailed studies to
identify every potential hazard.
• Include all tools and equipment, each chemical substance, and every job-related
task.
• The analysis must show that each element of the process poses no hazard, poses
an uncontrolled hazard, or poses a hazard controllable in all foreseeable
circumstances.
• Apply process hazard analysis during the design and development phases of any
hazardous operation under development.

JOB HAZARD ANALYSIS (JHA)
• Step A: Break the job down—Examine each step in the process for hazards
or unsafe conditions that could develop during job accomplishments
• Step B: Identify hazards—Document process hazards, environmental
concerns, and any anticipated human issues
• Step C: Evaluate hazards—Assess identified hazards and behaviors to
determine their potential roles in an accident event
• Step D: Develop and design hazard controls—Develop or design the best
hazard control based on evaluating each hazard. Coordinate implementation
of all feasible controls
• Step E: Implement required controls—Coordinate and obtain management
approval for implementation
• Step F: Revise and publish the JHA information—Update the JHA and then
communicate implementation actions with the organizational members

JOB DESIGN
• Creating well-designed jobs, tasks, and processes can help
• reduce worker fatigue,
• reduce repetitive motion stress,
• isolate hazardous tasks, and
• control human factor hazards.
• The concept of job design refers primarily to administrative changes that help
improve working conditions.
Designing safe work areas:
• must address workstation layout, tools and equipment, and the body position
needed to accomplish the job.
• reduces static positions and minimizes repetitive motions and awkward body
positions.
• Consider the importance of human factor issues when designing work processes.

HAZARD CONTROLAND CORRECTION
• Organizations must use the concept known as hierarchy of controls to reduce, eliminate, and
control hazards or hazardous processes.
• Engineering Controls, Administrative Controls, Work Practice Controls
• Hazard controls can also include actions such as using enclosure, substitution, and
attenuation to reduce human exposure risks.
• An enclosure keeps a hazard physically away from humans. For example,
completely enclosing high-voltage electrical equipment prevents access by
unauthorized persons.
• Substitution can involve replacing a highly dangerous substance with a less
hazardous one.
• Attenuation refers to taking actions to weaken or lessen a potential hazard. It could
involve weakening radioactive beams or attenuating noise to safer levels.
• The use of system safety methods, traditional hazard control techniques, and human
factors must begin at the initial stages of any design process.
• Passive hazard controls would not require continuous or even occasional actions from
system users.
• Active controls would require operators and users to accomplish a task at some point

Hazard Correction Monitoring System
• Implement a system to report and track hazards correction actions.
• Establish a timetable for implementing hazard controls.
• Prioritize hazards identified by inspections, reporting, and accident
investigations.
• Require employees to report hazards using established processes.
• Provide quick feedback about the status of hazard correction.
• Delegate responsibility for correcting and documenting completion
actions.
• Permit supervisors and experienced employees to initiate hazard
correction actions.

COMMON NEVER-EVER HAZARDS
• Obstacles preventing the safe movement of people, vehicles, or machines
• Blocked or inadequate egress routes and emergency exits
• Unsafe working and walking surfaces
• Using worn or damaged tools and equipment or misusing tools
• Failing to identify hazards and provide proper equipment including PPE
• Operating equipment with guards removed or bypassed
• Permitting the presence of worn, damaged, or unguarded electrical wiring, fixtures, or
cords
• Lack of or inadequate warning, danger, or caution sign in hazardous areas

HIERARCHIES FOR CONTROLLING HAZARDS
• Engineering and technological innovation remains the preferred type of hazard
control.
• Substitution results in using a less hazardous substance or piece of equipment.
• Isolation moves either workers or hazardous operations to reduce risks.
• Work practices such as policies or rules can reduce human exposure to the hazard.
• Administrative controls limit human exposures through the rotation and
scheduling.
• Consider PPE when other controls prove inadequate.

PERSONAL PROTECTIVE EQUIPMENT
• OSHA can require PPE to protect the eyes, face, head, and extremities. Examples can
include protective clothing, respiratory devices, protective shields, and barriers.
• When employees provide their own PPE, the employer must ensure its adequacy,
including proper maintenance, and sanitation.
• Employers must select and require the use of PPE that will protect from the hazards
identified in the PPE hazard assessment.
• OSHA requires the employer to verify completion of the assessment through a written
certification that identifies the workplace, certifying person, and assessment date.
• PPE should comply with applicable American National Standards Institute (ANSI)
standards.
• Using PPE can create hazards such as
• heat disorders,
• physical stress,
• impaired vision, and reduced mobility.

Eye and Face Protection
• 29 Code of Federal Regulations (CFR) 1910.133 for OSHA standards
• Employers must provide suitable eye protection
• when flying particles, molten metal, liquid chemicals, acids or caustic
liquids, chemical gases or vapors, potentially injurious light radiation,
or any combination hazard exists in the workplace.
• Protective eye and face devices must comply with ANSI Z-87,
Occupational and Educational Eye and Face Protection.
• Eye protectors must prove adequate against particular hazards with a
reasonably comfortable fit when worn under designated conditions.
• Protectors must demonstrate durability and fit snugly without interfering
with the movements or vision of the wearer.
• Finally, keep eye protectors disinfected and in good repair.

Head Protection
• 29 CFR 1910.135 for information about OSHA head protection.
• Ensure workers wear appropriate head protection that can resist
penetration and absorb the shock of blows.
• Evaluate the need for using protective hats to protect against electric
shock.
• OSHA requires head protection hats
• to meet the requirement of ANSI Z-89.1, Industrial Head
Protection, and ANSI Z-89.2, Requirements for Industrial Protective
Helmets for Electrical Workers.
• Each type and class of head protector must provide protection against
specific hazardous conditions.

Foot Protection
• 29 CFR 1910.136 for OSHA standards addressing foot
protection.
• Select safety shoes made of sturdy materials with impact-
resistant toes.
• Some shoes contain metal insoles that protect against
puncture wounds.
• Additional protection in the form of metatarsal guards can
provide additional protection.
• Today’s safety shoes come in a variety of styles and
materials.
• Classification of safety shoes relates directly to their ability
to meet requirements of compression and impact tests.
• Protective footwear must comply with the requirements
found in the ANSI Z-41.1 Standard.

Arm and Hand Protection
• 29 CFR 1910.137 for OSHA standards addressing arm and hand protection.
• Employers must provide appropriate protection when hazard assessments
reveal engineering and work practice controls cannot eliminate injury risks.
• Potential hazards can include skin absorption of harmful substances,
chemical or thermal burns, electrical dangers, bruises or abrasions, cuts or
punctures, fractures, and amputations.
• Protective equipment can include gloves, finger guards, arm coverings, and
elbow-length gloves.
• Employers must evaluate the use of engineering and work practice controls
before requiring glove use.
• The nature of the hazard and the operations involved will affect the selection
of gloves.
• Require employees to use gloves designed for the specific hazards and tasks.

Body and Torso Protection
• Certain hazards may require the use of body protection
clothing or equipment.
• For example, exposure to address biohazards or chemical
hazards during the mixing of dangerous drugs would
require body protection.
• However, other hazards that could pose a risk to the body
include heat sources, hot metal exposures during welding
operations, hot liquids, and radiation exposures.
• Body protection clothing can vary and could include
gowns, vests, jackets, aprons, coveralls, and full
bodysuits.
• Refer to manufacturer or supplier selection guides for
information on the effectiveness of specific materials
against specific hazards. Inspect clothing to ensure proper
fit and function.

HAZARD CONTROL COMMITTEES
• An effective committee must work hard to interact with all organizational
members to improve their hazard control awareness.
• Top management ultimately must take responsibility for committee successes
and failures.
• Top management must also provide supporting systems, authority, and
necessary resources to help ensure committee success.
• Committee membership must include nonsupervisory and hourly personnel with
representation from key functions, departments, and divisions.
• Committee authority and responsibilities can vary depending on the organization.
• Some organizations refrain from using the term committee and opt to use another
term such as advisory panel.
• Regardless of the term used, committees, teams, and panels can help improve
organizational hazard control efficiency and effectiveness if proactively involved.

Hazard Survey Teams
• This team functions best when comprised of screened volunteers with no formal
supervisory responsibilities.
• This team can help inspectors conduct walking hazard surveys to identify unsafe
conditions and risky behaviors.
• Provide the team with a pre-tour educational session that informs them of tour
expectations and procedures.
• For example, if the survey will target basic electrical hazards, provide them with
realistic information about how to recognize and document these hazards.
• The team should meet after the survey to discuss and validate the findings.
• The organization can start determining corrective actions.
• Team members should remember what they learned during the survey.

Basic Safety Committee Duties
• Participate in self-inspections and hazard surveys.
• Encourage organizational members to work safely.
• Assist with the JHA processes.
• Provide input for hazard control policies, procedures, and rules.
• Promote hazard control efforts at organizational meetings.
• Assist supervisors with initial accident investigations.
• Communicate employee hazard control concerns to management.

Symptoms of Ineffective Hazard Control
• Managers fail to recognize or acknowledge existence of hidden cultures.
• Organizational members do not view hazard control as operational priority.
• Accident investigations fail to focus on documenting causal factors and root causes.
• Senior managers fail to provide visible hazard control leadership.
• Leaders do not provide sufficient resources to support hazard control efforts.
• Leaders view hazard control as a necessary program but not vital to organizational
success.
• Orientation, education, and training objectives fail to address real-world issues.
• Hazard control managers expected to prevent all accidents and injuries.
• Leaders fail to hold accountable organizational members not supporting hazard control
efforts.

HAZARD CONTROL EVALUATION
• OSHA uses injury and illness rates to assess effectiveness of occupational safety and
health efforts.
• Insurance companies use an experience model to determine good and poor risks for
underwriting workers’ compensation coverage.
• Accident and injury experience does provide a good indicator about the effectiveness of
hazard control initiatives.
• Accident frequency and severity rates alone do not always accurately evaluate
effectiveness of an accident prevention function.
• Placing too much emphasis on injury-producing events but not focusing on potentially
serious close-call incidents can result in unreliable effective assessments.
• It involves assessing 2 steps.
• Areas to Evaluate
• Accreditation standards

AUDIT PROCESS
• Rather than relying solely on injury rates or other post-event assessments,
organizations could use a broader hazard control audit process.
• This management style audit would address several key components of the
accident prevention process.
• The audit forms would help evaluators rate each component against pre-
published standards.
• Evaluators should review policies, plans, and organizational records.
• They should also conduct interviews, personally observe, and use employee
questionnaires to help validate audit scores assigned to each component.
• Organizational leaders must then evaluate all other related initiatives designed to
support the hazard control function.
• Evaluations must assess reporting accuracy and effectiveness of hazard
analysis activities.
• Review hazard surveys and self-inspection reports to determine accuracy and
comprehensiveness.

Improving Hazard Control Effectiveness
• Use hazard analysis to define and pinpoint organizational problems or trends.
• Improve the hazard control function proportionally with improvements made in other
areas.
• Emphasize the importance that safe behaviors and good communication play in reducing
losses.
• Consider hazard control as a production tool that can improve the bottom line.
• Provide off-the-job safety and health education to all employees on regular basis.
• Recognize the existence of covert cultures operating within the organization.

AREAS TO EVALUATE
• Evaluate senior leader commitment by determining time and resources allocated to hazard control
efforts.
• Determine the policies and procedures which enhanced hazard control effectiveness.
• Conduct evaluations to determine how well interfacing staff functions support hazard control efforts
and accident prevention initiatives.
• Review submitted cost–benefit analysis reports to determine accuracy and documentation reliability.
• Review and assess the information included in organizational property damage reports.
• Attempt to compare or benchmark accident and injury data with similar types of organizations or
industries.
• Refer to compliance and insurance inspection to ensure completion of corrective actions of all
recommendations and findings.
• Organizations can also conduct risk measurements by reviewing historical accident and injury
frequency and severity data.
• This retrospective measurement can provide valuable information about exposure sources that
contributed to the injury or illness.
• Knowledge of accident causal factors when connected to specific job and tasks can provide insight
for recognizing potential risk.

ACCREDITATION STANDARDS
• Safety and security risks affect all individuals in the organization including patients, visitors, and
staff.
• Safety risks may arise from the structure of the physical environment or the performance of
everyday tasks.
• Proper security protects individuals and property against harm or loss.
• Safety and security risks associated with the environment of care (EOC) including
(1) safety of patient, staff, and visitors;
(2) security of patients, staff, visitors, and the facility;
(3) hazardous materials and waste;
(4) medical equipment;
(5) utility systems. should be assessed.
• Risks are best identified from
• internal sources using ongoing monitoring of the environment,
• results of root cause analyses (RCA), and
• results of annual proactive risk assessments of high-risk processes and
• credible external sources such as Sentinel Event Alerts.

ACCREDITATION STANDARDS
• Written plans should address the scope and objective of the organization’s risk assessment
and how those risks will be managed.
• The goal is to minimize or eliminate EOC risks.
• By conducting environmental tours every 6 months in patient care areas, evaluation of the
effectiveness of these plans can be identified.
• An annual environmental tour conducted in nonpatient- care areas allows for evaluation
of the effectiveness of activities intended to minimize or eliminate risks in that
environment.
• Evaluate each management plan’s objectives, scope, and performance for effectiveness at
least every 12 months.

ADDRESSING BEHAVIORS
• Supervisors must explain work rules and behavioral expectations to all new or
transferred employees.
Behavior Correction Process
Step 1: Identify the unsafe action.
Step 2: State concern for worker’s safety.
Step 3: Demonstrate the correct and safe way.
Step 4: Ensure the worker understands.
Step 5: Restate concern for personal safety.
Step 6: Follow-up.

ACCIDENT
Definition
• An accident is an unplanned event that interferes with job or task completion.
Common Myths about Accidents
• Accidents result from a single or primary cause.
• Accidents must generate injury or property damage.
• Accidents occur when random variables interact.
• Accidents can result from an act of God or nature.
• Accident investigations must determine fault.

ACCIDENT CAUSES
• System thinking views hazards and causal factors as moving in logical sequences to
produce accident events.
• Traditional approaches to accident prevention simply classify causal factors as unsafe acts
and unsafe conditions.
• Hazard control personnel should use root cause processes to discover, document, and
analyze accident causal factors.
• Accident investigations and RCA should focus on discovering information about system
operation, deterioration, and original design errors.
• System-related hazard control efforts focus on unsafe system conditions and the
interaction of human factors with these and other hazards.
• The accident generation cycle can result in property damage, personal injuries, or both.
• System thinking promotes the concept of providing separation between an individual and
potential operational hazards.

ACCIDENT CAUSATION THEORIES
Henri Heinrich’s Five-Factor Accident Sequence
• Heinrich attributed 10% to unsafe conditions and he classified 2% as unpreventable.
• An individual’s life experiences and background could predispose them to take risks during job or
task accomplishment.
• Removing a single causal factor from a potential situation could result in preventing an accident.
• Interrupting or breaking the accident cycle by preventing unsafe acts or correcting an unsafe
condition could reduce accident risks for individuals engaging in risky behaviors.
• Heinrich proposed an accident sequence in which a single causal factor could actuate the next step
in the cycle process.
• The accident occurrence then resulted in personal injury and/or property damage.
• pointed to what we now refer to as multiple causation theory.

1. MULTIPLE CAUSATION THEORY
• Accidents result from various hazard factors as primary and secondary causes, while others use the terms such
as
• immediate and contributing causes,
• surface and root causes, or
• causes and sub-causes,
• multiple and complex causal factors.
• Causal factors seldom contribute equally in their ability to trigger an event or contribute to accident severity.
• Human factors such as
• an unsafe act,
• error,
• poor judgment,
• lack of knowledge, and
• mental impairment can interact with other contributing factors creating an opportunity for an accident to
occur.

2.BIASED LIABILITY THEORY
• Biased liability promotes the view that once an individual becomes involved in an
accident, the chances of that same person becoming involved in a future accident
increases or decreases when compared to other people.
• The accident proneness theory promotes the notion that some individuals will
simply experience more accidents than others because of some personal tendency.

3.ACCIDENT PYRAMID
• Heinrich believed that unsafe acts led first to minor injuries
and then over a period of time to a major injury event.
• The accident pyramid proposed that 300 unsafe acts produced
29 minor injuries and 1 major injury.
• some recent studies challenge the assumed shape of the
equilateral triangle used by Heinrich.
• Some professionals now believe the actual shape of the
model would depend on organizational structure and culture.

4.PREVENTION OF FATAL EVENTS
• The March 2003 edition of the journal of Professional Safety contained an article entitled
Severe Injury Potential.
• The article, authored by Fred Manuele, suggested that accident prevention efforts should
focus more on preventing fatal events.
• He highlighted some specific examples that lead to fatalities in industrial settings.
• His list included not controlling hazardous energy, no written procedures for hazardous
processes, failing to ensure physical safeguards, using unsafe practices for convenience
(risk perceived as insignificant), and operating mobile equipment in an unsafe manner.

HUMAN FACTORS
• Hazard control personnel and top management must recognize that human behavior can
help prevent and cause accidents.
• Understanding human behaviors can pose a challenge to most individuals.
• Behavior-based accident prevention efforts must focus on how to get people to work
safely.
• Hazard control managers, organizational leaders, and frontline supervisors deal with
human behaviors on a daily basis.
• The definition of behavior-based hazard control could read as follows: “the application of
human behavior principles in the workplace to improve hazard control and accident
prevention.”
• Organizational issues such as structure and culture along with personal considerations
impact individual Behavior(Management styles, the nature of work processes, hazards
encountered, organizational structure, cultures, and education or training).

HUMAN FACTORS
• The term human factors covers a wide range of elements related to the interaction
between individuals and their working environment.
• Human factors can refer to
• personal goals, values, and beliefs that can impact an organization’s
expectations, goals, and objectives.
• Hazard control efforts must address factors that impact human conduct or behavior.
• Organizations must ensure all members possess the knowledge, skill, and opportunity to
act in preventing accidents.
• Motivation to act responsibly relates to a person’s desire to do the right thing.
• Flawed decision-making practices and poor work practices can create atmospheres
conducive to human error.
• Causal links between the accidents and unseen organizational factors may not appear
obvious to most investigators.
• However, these factors could easily interact with trigger mechanisms to contribute to
accident events.

UNDERSTANDING HUMAN ISSUES
• Consider character as the moral and/or ethical structure of individuals or
groups.
• Belief refers to a mental act and habit of placing trust in someone or
something.
• Base value with what people believe and things with relative worth or
importance.
• Define culture as socially accepted behaviors, beliefs, and traditions of a
group.
• Consider attitude as a state of mind or feeling about something.
• Behaviors relate to the open manifestation of a person’s actions in a given
situation.

ERROR
• An essential component of accident prevention relates directly to understanding the nature, timing,
and causes of errors.
• Error, as a normal part of human behavior, many times becomes overlooked during accident
investigations and analysis processes.
• Errors can result from attention failure, a memory lapse, poor judgment, and faulty reasoning.
These types of errors signify a breakdown in an individual’s information-processing functions.
• When categorizing errors, attempt to differentiate between those occurring during accomplishing
skilled behavior tasks and those related to unskilled tasks such as problem solving.
• Rule-based errors can occur when behaviors require the application of certain requirements.
• Process errors occur when individuals lack an understanding of procedures or complex
systems.
• Knowledge-based errors occur when an individual lacks the skill or education to accomplish a
certain task correctly.
• Planning errors occur when individuals fail to use a proper plan to accomplish a task.
• Finally, execution errors occur when using a correct plan but an individual fails to execute the
plan as required

COMMON UNSAFE ACTS
• Not following established job procedures
• Cleaning or repairing equipment with energy hazards not locked out
• Failing to use prescribed PPE
• Failing to wear appropriate personal clothing
• Improperly using equipment
• Removing or bypassing safety devices
• Operating equipment incorrectly
• Purposely working at unsafe rates or speeds
• Accomplishing tasks using incorrect body positions or postures
• Incorrectly mixing or combining chemicals and other hazardous materials
• Knowingly using unsafe tools or equipment
• Working under the influence of drugs or alcohol

MOTIVATING PEOPLE
• Motivating individuals to work safely requires the use of various approaches depending
on the situation.
• Little evidence exists that supports using punitive measures to motivate safe behaviors.
• The use of good human relations and effective communication skills can help improve
individual motivation.
• The development of policies, procedures, and rules can never completely address all
unsafe behaviors.
• Taking risks depends on individual perceptions when weighing potential benefits against
possible losses.
• Some professionals believe that providing incentives to work safely coupled with
appropriate feedback can enhance hazard control efforts in at least the short term.
• Employee incentives with tangible rewards can also cause some individuals not to report
hazards, accidents, and injuries.

ACCIDENT DEVIATION MODELS
• Accident or mishap deviation models as used in system safety processes can permit
analysis of events in terms of deviations.
• The value assigned to a system variable becomes a deviation whenever it falls outside
an established norm.
• When measuring system variables, these deviations can assume different values
depending on the situation.
• A deviation from a specified requirement could result in a human error for failure to follow
procedures. Therefore, we must consider incidental factors as deviations from an
accepted practice.
• An unsafe act relates to a personal action that violates or deviates from a commonly
accepted safe procedure.
• Time functions as the basic dimension in a system deviation model since incident
analysis becomes a linear process rather than focusing on a single incident or a series of
causal factors.
• Consider appropriate prevention measures by focusing on prior assessments and
evaluations of the entire system.
• Passive protection controls would use relevant automatic protection innovations.
• Active protection control would require constant repetitive actions on an individual. Active

ACCIDENT DEVIATION MODELS
• Always stress the importance of behavior change or modification rather than any
need for additional education.
• An effective approach to behavior modification may also require actions such as
redesigning equipment or modifying physical environments to achieve the
practice of safe behaviors.
• When top management demonstrates concern and commitment to the hazard
control, individuals will more likely support organizational initiatives.
• The accountability factor for individual performance can serve as a key motivator
for many individuals.
• Top management should continually remind everyone that the organization views
hazard control as a priority function.
• Recognize and reward individuals for supporting hazard control efforts.
• Promote the use of toolbox talks, personal coaching, and supervisory
involvement to promote hazard control.

PROMOTING EMPLOYEE INVOLVEMENT
• Develop an open-door policy to provide employee access to managers.
• Develop an easy-to-use accident, injury, and hazard reporting system.
• Require supervisors to conduct periodic safety meetings.
• Develop off-the-job safety and health education objectives.
• Encourage employee participation in job hazard analyses.
• Disseminate hazard control and accident information in a timely fashion.
• Place emphasis on people and less emphasis on compliance.
• Solicit employee suggestions on using hazard control resources and funds.
• Mandate hourly employee representation on the hazard control committees.
• Conduct special shift worker education and training sessions.
• Conduct periodic organizational perception surveys about hazard control efforts.

ACCIDENT REPORTING
• The timely and accurate reporting of accidents and injuries permits an organization to collect and
analyze loss-related information.
• This information can help determine patterns and trends of injuries and illnesses.
• Organizations should encourage reporting by all members.
• The reporting process should focus on the importance of tracking hazards, accidents, and injuries,
including any organizational trends.
• Educate all personnel to understand the need for maintaining a systematic process that accurately
and consistently provides updated information.
• The system must not only permit data collection but provide for a means to display any measure of
success or failure in resolving identified hazards.
• Maintain records that enable managers at all levels to access data. Information made available to
managers can assist them with changing policies, modifying operational procedures, and providing
job-related training.

ACCIDENT REPORTING
• Senior leaders must ensure the use of a system that meets the needs of the organization.
• Many vendors now offer accident/injury reporting and tracking software.
• Many of these processes permit the creation and printing of electronically generated
reports.
• Using electronic reporting can help the organization save time and money.
• Make all the forms accessible on your internal computer network.
• Electronic reporting will encourage people to conform to your expectations and report
near misses, accidents, and injuries in a timely manner.
• A sample of a completed form will help illustrate and remind users what information you
need from them.
• Include a phone number and e-mail address for the person who can answer questions as
they arise.
• Provide instructions for where and how to submit the report once completed.

ACCIDENT REPORTING
• Electronic submission will save paper and retyping or scanning.
• Input and track all safety incidents across your organization through one centralized online portal
accessible to all employees and locations.
• New technology lets users easily create their own online forms.
• Customize fields and drop-downs to build an incident reporting form unique to your organization’s
needs.
• They can create incident reports sorted by employee, workgroup, unit or department, type of
injury, or body part.
• Report incident frequency and severity rates and easily disseminate using an appropriate electronic
format. Customizable dashboards provide instant access to safety incident metrics from across your
organization providing real-time data and analysis needed to drive continual improvement.
• Manage the entire accident life cycle of incident reporting, responding, investigating, taking
corrective action, tracking, and developing summary reports.
• Technology makes reporting and analysis easier and quicker than ever before.
• Organizations can no longer make excuses for not accurately collecting, tracking, and evaluating
accident, hazard, and injury information.

ACCIDENT INVESTIGATION
• A successful accident investigation must first determine what happened. This leads to
discovering how and why an accident occurred. Most accident investigations involve
discovering and analyzing causal factors.
• Conduct accident investigations with organizational improvement as the key objective.
Many times an investigation focuses on determining some level of fault.
• The immediate causal factors reveal details about the situation at the time of occurrence.
• Identifying and understanding causal factors must include a strong focus on how human
behaviors contributed to the accident.
• Using sound investigational techniques can help determine all major causal factors.
• Investigations should seek to find out what, when, where, who, how, and most of all why.
• Provide investigators with all the necessary tools and equipment to conduct a thorough
investigation.
• Investigators must also seek to identify any failures of organizational-related
management, Evaluate all known human, situational, and environmental factors.
• Determine what broken equipment, debris, and samples of materials need removal from
the scene for further analysis.

Classifying Causal Factors
• Initially documenting and classifying causal factors in one of the following three
categories.
• The first category relates to operational factors such as unsafe job processes, inadequate
task supervision, lack of job training, and work area hazards.
• The second category relates to human motivational factors including risky behaviors, job-
related stress, poor attitudes, drug use, and horseplay.
• The third category relates to organizational factors including inadequate hazard control
policies and procedures, management deficiencies, poor organizational structure, or lack
of senior leadership.

Interviewing Witnesses
• Interview witnesses individually and never in a group setting.
• If possible, interview a witness at the scene of the accident. It also may be preferable to carry out
interviews in a quiet location.
• Seek to establish a rapport with the witness and document information using their words to
describe the event.
• Put the witness at ease and emphasize the reason for the investigation.
• Let the witness talk and listen carefully and validate all statements.
• Take notes or get approval to record the interview.
• Never intimidate, interrupt, or prompt the witness.
• Use probing questions that require witnesses to provide detailed answers.
• Never use leading questions.
• Ensure that logic and not emotion directs the interview process.
• Always close the interview on a positive note.

ACCIDENT ANALYSIS
• Analysis processes rely on information collected from hazard surveys, inspections, hazard
reports, and accident investigations.
• This analysis process can provide a snapshot of hazard information. Effective analysis
can then take the snapshots and create viable pictures of hazards and accident causal
factors.
• A good accident analysis should create a word picture of the entire event. Refer to photos,
charts, graphs, and any other information to better present the complete accident picture.
• The final analysis report should include detailed recommendations for controlling hazards
discovered during the investigation and analysis.

ACCIDENT ANALYSIS
Poor supervision
• Lack of proper instructions
• Job and/or safety rules not enforced
• Inadequate PPE, incorrect tools, and improper equipment
• Poor planning, improper job procedures, and rushing the worker
Worker job practices
• Use of shortcuts and/or working too fast
• Incorrect use or failure to use protective equipment
• Horseplay or disregard of established safety rules
• Physical or mental impairment on the job
• Using improper body motion or technique

ACCIDENT REPORTS
• When preparing an accident investigation report, use the analysis results to make specific and
constructive recommendations.
• Never make general recommendations just to save time and effort.
• Use previously drafted sequence of events to describe what happened.
• Photographs and diagrams may save many words of description.
• Identify clearly if evidence is based on facts, eyewitness accounts or assumptions. State the
reasons for any conclusions and follow up with the recommendations.
• An accident analysis process must consider all known and available information about an event.
• Clarify any previously reported information and verify any data or facts uncovered during the
investigation.
• Review and consider witness information and employee statements or suggestions.

WORKERS’ COMPENSATION
• Workers’ compensation laws ensure that employees injured or disabled on the job receive
appropriate monetary benefits, eliminating the need for litigation.
• These laws also provide benefits for dependents of those workers killed because of work-related
accidents or illnesses.
• The state or the National Council of Compensation Insurance (NCCI), an independent rating
organization, normally determines basic rates paid by employers.
• Factors affecting rates can include
(1) company or fund quoting the coverage,
(2) classification code(s) of the employer,
(3) payroll amount for the work force covered, and
(4) experience rating.

ORIENTATION,EDUCATION, TRAINING
• Orientation relates to the indoctrination of new employees into the organization.
• Orientation can be defined as the process that informs participants how to find their way within the
organization.
• Usually safety and hazard control topics only make up a portion of any new employee orientation
session.
• When implementing an effective hazard control education and training function, consider the
following
• elements:
(1) identify needs,
(2) develop objectives,
(3) determine learning methods,
(4)conduct the sessions,
(5) evaluate effectiveness, and
(6) take steps to improve the process.

ORIENTATION,EDUCATION, TRAINING
• Some ways to evaluate training can include the following:
(1) student opinions expressed on questionnaires,
(2) conducting informal discussions to determine relevance and appropriateness of training,
(3) supervisor’s observations of individual performance both before and after the training,
(4) documenting reduced injury or accident rates.

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