good health and safety practices essay

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Part Five: Occupational Health and Safety in Human Resources

19 Good health and safety practices

Good health and safety practices should be a high priority within your organizational culture. In order to retain your staff, a safe and healthy work environment is key. Everybody values a safe work environment, especially young workers. According to WorkSafe BC, “in the past five years in British Columbia, more than 9,400 young workers in the tourism and hospitality industry suffered on-the-job injuries severe enough to keep them from working. The cost to the industry is staggering – almost $20 million and 170,000 days lost from work” (WorkSafeBC, OHS Guidelines, n.d.).

According to WorkSafeBC (Young Worker Safety Can’t Wait, n.d.), it is up to the employer to ensure the health and safety of all employees. To guarantee a safe environment, everyone in your organization should be properly trained and oriented within the scope of the Occupational Health and Safety (OHS) Regulation. This should be a continuous process and part of your ongoing training culture.

Developing and maintaining a safe and healthy work environment can be a time-demanding task; however, the importance of keeping a safe work environment is worth the investment. There are formal regulations and many resources available to assist in the creation and continuation of health and safety within your workplace.

To begin developing an occupational health and safety program in your organization, begin with a risk assessment of your entire workplace, identifying all of the potential hazards to you and/or your employees. Elements in your program should include:

A statement of the employer’s aims, and of the responsibilities of the employer, supervisors, and workers
Provision for regular inspection of premises, equipment, work methods, and work practices, at appropriate intervals, to ensure that prompt action is taken to correct any hazardous conditions found
Appropriate written instructions, available for reference by all workers, to supplement the OHS Regulation
Provision for the prompt investigation of incidents to determine the action necessary to prevent their recurrence
Records and statistics, including reports of inspections and incident investigations, with provision for making this information available to the joint committee or worker health and safety representative, as applicable and, on request, to a prevention officer, the union representing the workers at the workplace or, if there is no union, the workers at the workplace
Provision by the employer for the instruction and supervision of workers in the safe performance of their work
Provision for holding periodic management meetings to review health and safety activities and incident trends, and to determine necessary courses of action

An effective program will:

Identify hazards in the workplace
Control the hazards and eliminate or minimize the potential for workplace injuries or illness
Be monitored to ensure the program meets its goals and WorkSafeBC requirements under the Workers Compensation Act and the OHS Regulation

For more information visit WorkSafeBC .

As part of the Workers Compensation Act , the Occupational Health and Safety (OHS) Regulation applies to all employers and workers within BC. The OHS Regulation contains legal requirements in which all workplaces must comply under the jurisdiction of WorkSafeBC. The OHS Regulation acts as a foundation upon which organizations can build to maintain an effective and safe work environment.

Follow the OHS Regulation Guidelines to determine the legal requirements for your organization. Typically the guidelines are based on the number of workers you have. Whichever situation you fall under within the regulations, it is essential you organize a formal OHS meeting every month, where there must be workers represented. The meeting should focus on existing health and safety matters and how any unsafe conditions and practices will be dealt with. Keep a record of the meetings including when they are held, who attends them, and the general nature of what is discussed. This record should be made available for inspection by a prevention officer when requested.

Research shows that there are clear links between well-thought-out OHS programs and long-term business efficiency. Benefits of a good, updated program include:

Reducing workplace injuries and the costs associated with them
Enhancing your organization’s reputation
Retaining staff
Having a measureable system to continuously verify your current safety practices

In addition to the above benefits, if you choose to participate in the Certificate of Recognition (COR) Program , and your company is in good standing, you could receive incentive payments from WorkSafeBC. The program rewards employers that go above and beyond the legal requirements of the Workers Compensation Act and OHS Regulation by looking at best practices to injury prevention in the workplace.

Here are a few helpful links for information on occupational health and safety:

Watch Your Step: An Employer’s Guide to Preventing Slips, Trips and Falls in the Food & Beverage Industry
WorkSafeBC Injury Prevention Resources for Tourism & Hospitality – Food & Beverage

Human Resources in the Food Service and Hospitality Industry Copyright © 2015 by The BC Cook Articulation Committee is licensed under a Creative Commons Attribution 4.0 International License , except where otherwise noted.

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Essay: Health and safety in the workplace

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Accidents and mishaps are unforeseen circumstances that can affect individuals and groups at any time and in any place. Most accidents are preventable, but the carelessness or negligence of the involved individuals leads to major injuries and grievances. Accidents can also occur in the workplace and seriously affect the ability and health of the involved workers.

The objectives of this essay to discuss the safety and wellbeing of all workers are necessary for the organization not only for consistent productivity but also due to regulatory requirements. Workers and human resources are the necessary components of all organizations due to their role in the effective accomplishment of objectives. Corporations cannot achieve long-term success and sustainable growth in the absence of motivated, safe, healthy, and effective workers. The health and safety of all workers are necessary to ensure the enhancement of productivity and efficiency at all levels and areas. Lack of safety measures can create havoc for the organization and negatively affect the working criterion of an organization. The management has to devise and implement effective safety procedures to reduce hazards and prevent accidents in the workplace. The can motivate the employees through this perspective as employees admire working in organizations that prefer safe working conditions. Employees believe that safer working conditions enhance their ability work because they do not feel scared in troublesome situations. The management should coordinate with all the related stakeholders when they devise policies about safety at workplace, as this would enhance a positive change in an organization. Different legislations also depict that organizations should focus on these perspectives and they should attain self-sufficiency in providing workplace safety.

Introduction

Corporations in the current era focus on the development of employees and they believed in the ideology of benefiting employees through different approaches. Safety at the work force is an important aspect that many organizations of today’s world disregard. Many people face mishaps and accidents in various situations especially due to negligence, recklessness, and carelessness. Many accidents and serious injuries are avoidable and preventable by taking effective safety measures and reducing hazards. For example, drivers and passengers can avoid serious injuries and death by wearing seatbelts while traveling in cars. However, many people fail to realize the importance of seatbelts and face a variety of consequences in the event of an accident. Mishaps and accidents are unforeseen occurrences that can lead to several adverse consequences in the absence of effective safety measures and precautions. Accidents, disasters, and mishaps can also occur in the workplace and affect several employees in the absence of precautions and safety procedures. Certain mediocre organizations do not regard this aspect as important and they do not focus on safety at the workplace. The owners and management of the organization need to implement rules, regulations, procedures, and systems relevant to safety and health. The management also needs to ensure that all workers have ample knowledge and information regarding safety procedures, prevention of accidents, and safe working practices.

Human resources

Human resources are one of the most important assets of the organization with respect to success and growth. The success and growth of the organization depend on the effectiveness and efficiency of the human resources. However, the inefficiencies in human resources caused by any circumstances, occurrences, and events can hinder the accomplishments of the organization. Organizations take all necessary measures to ensure the productivity of all workers and employees to maximize profits and achieve organizational objectives (Blair, 2013 ). The wellbeing, safety, and health of all employees are among the highest priorities of all organizations. Organizations cannot take risk for their respective employees because an occurrence of a negative event would tarnish the credibility of an organization. Safe and healthy workers are more productive as compared to injured or sick employees. Employees that cannot work in safe conditions feel suffocated because of the risks associated with their respective work. Risks and hazards associated with a specific job or organization adversely affect the morale and motivation level of employees. The unsafe or hazardous working conditions have several long-term psychological and physiological consequences for the workers and the organizations. When a negative event occurs in an organization, it sets up the mindset of an employee. Employees would feel that this event would occur again and this would create hurdles in their effective working process. Organizations need to create a safe and healthy working environment for all workers to ensure high levels of motivation and enhancement in efficiency (Stricoff & Groover, 2012).

Safety at Workplace

Workplace safety refers to the prevention of illness, injury, and hazards in the workplace for all employees. Workplace safety involves the creation of a safe and healthy environment for all workers to evade hazards, injuries, and illnesses. Organizations can ensure the efficiency of all workers and circumvent a considerable amount of costs by ensuring workplace safety and health. Organizations develop different strategies through which they set up different work place safety policies and benefit the workers through this. Workplace injuries and illnesses lead to compensation benefits, health insurance costs, hiring temporary replacements, lost work hours, and lawsuits. Lack of concentration would cost severe damage to an organization and they should sort such issues in order to attain proactive benefits. Business can save a considerable amount of costs by creating and maintaining a safe and healthy environment for all workers. Safeguarding the interests and wellbeing of the employees allows organizations to circumvent costs relevant to injuries and illnesses (Legg, Laird, Olsen, & Hasle, 2014). On the other hand, workplace safety instills a sense of commitment and dedication among the employees due to the safety assurance of the organization. The morale and motivation of the workers increase due to the implementation of rules that safeguard the health and interest of the employees. Employees feel that they are safe to work in this place, and through this perspective, they would perform well.

Purpose of Workplace safety

The primary objective of safety in the workplace is to create a safe, healthy, and risk-free environment for all workers. Workplace safety involves the evaluation, analysis, prevention, and elimination of hazardous and dangerous elements from the workplace. Workplace safety programs evaluate and remove the risks and hazards relevant to the safety, well-being, and health of workers and other relevant individuals. Organizations develop health and safety standards due to several reasons including laws, regulatory requirements, organizational policies, and historical occurrences. Certain industries and their associations bind organizations to work for the benefit of their employees and they force organizations to focus on different safety related perspectives. Workplace injuries and illnesses caused by working conditions or environment can lead to lawsuits, high costs, and deterioration of the corporate image. There are instances when employees at times die because of sever working conditions. Employees might got injured because of certain safety and the lack of safety would be the only probable reason of this. Enhanced safety measures and appropriate quality of these measures can reduce this perspective to a considerable level.

Safety at the workplace enables organizations to comply with regulatory requirements and prevent high costs resulting from injuries and illnesses. Several corporations can consider the fact that these safety measures would save their health and medicinal costs that would arise when an employees would hurt him. They should take proactive measures earlier through which people can benefit from these perspectives. The management can maintain high levels of productivity and efficiency by creating a safe and healthy working environment. Conversely, the employees work with dedication due to their perceptions regarding the commitment of the organization with respect to the wellbeing of the workers.

Importance of safety at workplace

Legislative and legal requirements are the most prominent cause of health and safety policies in most organizations. The Occupational and Safety Health Act is the primary law for the assurance of health and safety of all workers throughout the United States. The Occupational and Safety Health Act (OSHA) necessitates the dissemination of standards, rules, and regulations relevant to the safety and health of workers. The government establishes and enforces the standards for the safety and health of all workers and their families through the Act. All public and private organizations have to comply with the rules, regulations, and standards prescribed in OSHA (Jung & Makowsky, 2014). They would face legal complications if they do not comply with such policies and measures taken by the decision makers. However, many organizations develop and implement health and safety procedures to safeguard their interests relevant to organizational objectives rather than legal requirements. The financial and moral aspects of workers’ health and safety have a greater influence as compared to regulatory compliance. Corporations can save considerable costs by avoiding high insurance expenses, lawsuits, and employee replacement costs in the event of injuries and illnesses (Barling & Frone, 2003).

Manpower and Management

The primary objective of all managers is to enhance and promote productivity and efficiency in all areas and functions. However, the managers cannot uphold efficiency and effectiveness in the absence of a safe workplace. The managers need to create a safe working environment and increase the awareness and knowledge of all employees with respect to safe working practices. The employees and workers also need to understand the importance of workplace safety and reduce personal injury through attentiveness and removal of hazards. These safety hazards are negative for the effectiveness of organizations and create a long-term negative impact. The attitude of the employees, management, and employers plays a vital role in preventing accidents and creating a safe working environment. The negligence on the part of the employers and employees can cause a variety of hazards and accidents (Rahim, Ng, Biggs, & Boots, 2014). However, the diligence and commitment of all stakeholders regarding safe work practices leads to the prevention of major accidents and injuries. The employees and management can create a safe workplace through a shared responsibility model for workplace safety and cooperation. Organizations should own this perspective and they should realize the fact that it is their managerial responsibility to focus on this perspective so that employees can remain safe.

Conclusively, a safety plan is necessary and it comprises of certain steps that would develop a safer workplace. Organizations should make sure that everyone else in the workplace is aware of the core problem. People should notify their respective supervisors and they should file any reports if there is a problem. An important aspect is that people should realize that there is a problem as sitting back and holding the problem for a long time would not solve the problem.

Barling, J., & Frone, M. (2003). The Psychology of Workplace Safety. New Jersey: Amer Psychological Assn. Blair, E. H. (2013). Building safety culture. Professional Safety , 58 (11), 59-65. Cobb, E. (2013). Bullying, Violence, Harassment, Discrimination and Stress: Emerging Workplace Health and Safety Issues. New Jersey: CreateSpace Independent Publishing Platform. Jung, J., & Makowsky, M. D. (2014). The determinants of federal and state enforcement of workplace safety regulations: OSHA inspections 1990’2010. Journal of Regulatory Economics , 45 (1), 1-33. Legg, S., Laird, I., Olsen, K., & Hasle, P. (2014). Creating healthy work in small enterprises – from understanding to action: Summary of current knowledge. Small Enterprise Research , 21 (2), 139-147. Mathis, T., & Galloway, S. (2013). Steps to Safety Culture Excellence. New Jersey: Wiley. Rahim, A. N., Ng, H. K., Biggs, D., & Boots, K. (2014). Perceptions of safety, physical working conditions and stress between Malaysia and United Kingdom. International Journal of Business & Society , 15 (2), 321-338. Stricoff, R., & Groover, D. (2012). The Manager’s Guide to Workplace Safety. New York : Safety in Action Press.

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Health Care Comes Home: The Human Factors (2011)

Chapter: 7 conclusions and recommendations.

7 Conclusions and Recommendations

Health care is moving into the home increasingly often and involving a mixture of people, a variety of tasks, and a broad diversity of devices and technologies; it is also occurring in a range of residential environments. The factors driving this migration include the rising costs of providing health care; the growing numbers of older adults; the increasing prevalence of chronic disease; improved survival rates of various diseases, injuries, and other conditions (including those of fragile newborns); large numbers of veterans returning from war with serious injuries; and a wide range of technological innovations. The health care that results varies considerably in its safety, effectiveness, and efficiency, as well as its quality and cost.

The committee was charged with examining this major trend in health care delivery and resulting challenges from only one of many perspectives: the study of human factors. From the outset it was clear that the dramatic and evolving change in health care practice and policies presents a broad array of opportunities and problems. Consequently the committee endeavored to maintain focus specifically on how using the human factors approach can provide solutions that support maximizing the safety and quality of health care delivered in the home while empowering both care recipients and caregivers in the effort.

The conclusions and recommendations presented below reflect the most critical steps that the committee thinks should be taken to improve the state of health care in the home, based on the literature reviewed in this report examined through a human factors lens. They are organized into four areas: (1) health care technologies, including medical devices and health information technologies involved in health care in the home; (2)

caregivers and care recipients; (3) residential environments for health care; and (4) knowledge gaps that require additional research and development. Although many issues related to home health care could not be addressed, applications of human factors principles, knowledge, and research methods in these areas could make home health care safer and more effective and also contribute to reducing costs. The committee chose not to prioritize the recommendations, as they focus on various aspects of health care in the home and are of comparable importance to the different constituencies affected.

HEALTH CARE TECHNOLOGIES

Health care technologies include medical devices that are used in the home as well as information technologies related to home-based health care. The four recommendations in this area concern (1) regulating technologies for health care consumers, (2) developing guidance on the structure and usability of health information technologies, (3) developing guidance and standards for medical device labeling, and (4) improving adverse event reporting systems for medical devices. The adoption of these recommendations would improve the usability and effectiveness of technology systems and devices, support users in understanding and learning to use them, and improve feedback to government and industry that could be used to further improve technology for home care.

Ensuring the safety of emerging technologies is a challenge, in part because it is not always clear which federal agency has regulatory authority and what regulations must be met. Currently, the U.S. Food and Drug Administration (FDA) has responsibility for devices, and the Office of the National Coordinator for Health Information Technology (ONC) has similar authority with respect to health information technology. However, the dividing line between medical devices and health information technology is blurring, and many new systems and applications are being developed that are a combination of the two, although regulatory oversight has remained divided. Because regulatory responsibility for them is unclear, these products may fall into the gap.

The committee did not find a preponderance of evidence that knowledge is lacking for the design of safe and effective devices and technologies for use in the home. Rather than discovering an inadequate evidence base, we were troubled by the insufficient attention directed at the development of devices that account, necessarily and properly, for users who are inadequately trained or not trained at all. Yet these new users often must

rely on equipment without ready knowledge about limitations, maintenance requirements, and problems with adaptation to their particular home settings.

The increased prominence of the use of technology in the health care arena poses predictable challenges for many lay users, especially people with low health literacy, cognitive impairment, or limited technology experience. For example, remote health care management may be more effective when it is supported by technology, and various electronic health care (“e-health”) applications have been developed for this purpose. With the spectrum of caregivers ranging from individuals caring for themselves or other family members to highly experienced professional caregivers, computer-based care management systems could offer varying levels of guidance, reminding, and alerting, depending on the sophistication of the operator and the criticality of the message. However, if these technologies or applications are difficult to understand or use, they may be ignored or misused, with potentially deleterious effects on care recipient health and safety. Applying existing accessibility and usability guidelines and employing user-centered design and validation methods in the development of health technology products designed for use in the home would help ensure that they are safe and effective for their targeted user populations. In this effort, it is important to recognize how the line between medical devices and health information technologies has become blurred while regulatory oversight has remained distinct, and it is not always clear into which domain a product falls.

Recommendation 1. The U.S. Food and Drug Administration and the Office of the National Coordinator for Health Information Technology should collaborate to regulate, certify, and monitor health care applications and systems that integrate medical devices and health information technologies. As part of the certification process, the agencies should require evidence that manufacturers have followed existing accessibility and usability guidelines and have applied user-centered design and validation methods during development of the product.

Guidance and Standards

Developers of information technologies related to home-based health care, as yet, have inadequate or incomplete guidance regarding product content, structure, accessibility, and usability to inform innovation or evolution of personal health records or of care recipient access to information in electronic health records.

The ONC, in the initial announcement of its health information technology certification program, stated that requirements would be forthcom-

ing with respect both to personal health records and to care recipient access to information in electronic health records (e.g., patient portals). Despite the importance of these requirements, there is still no guidance on the content of information that should be provided to patients or minimum standards for accessibility, functionality, and usability of that information in electronic or nonelectronic formats.

Consequently, some portals have been constructed based on the continuity of care record. However, recent research has shown that records and portals based on this model are neither understandable nor interpretable by laypersons, even by those with a college education. The lack of guidance in this area makes it difficult for developers of personal health records and patient portals to design systems that fully address the needs of consumers.

Recommendation 2. The Office of the National Coordinator for Health Information Technology, in collaboration with the National Institute of Standards and Technology and the Agency for Healthcare Research and Quality, should establish design guidelines and standards, based on existing accessibility and usability guidelines, for content, accessibility, functionality, and usability of consumer health information technologies related to home-based health care.

The committee found a serious lack of adequate standards and guidance for the labeling of medical devices. Furthermore, we found that the approval processes of the FDA for changing these materials are burdensome and inflexible.

Just as many medical devices currently in use by laypersons in the home were originally designed and approved for use only by professionals in formal health care facilities, the instructions for use and training materials were not designed for lay users, either. The committee recognizes that lack of instructional materials for lay users adds to the level of risk involved when devices are used by populations for whom they were not intended.

Ironically, the FDA’s current premarket review and approval processes inadvertently discourage manufacturers from selectively revising or developing supplemental instructional and training materials, when they become aware that instructional and training materials need to be developed or revised for lay users of devices already approved and marketed. Changing the instructions for use (which were approved with the device) requires manufacturers to submit the device along with revised instructions to the FDA for another 510(k) premarket notification review. Since manufacturers can find these reviews complicated, time-consuming, and expensive, this requirement serves as a disincentive to appropriate revisions of instructional or training materials.

Furthermore, little guidance is currently available on design of user

training methods and materials for medical devices. Even the recently released human factors standard on medical device design (Association for the Advancement of Medical Instrumentation, 2009), while reasonably comprehensive, does not cover the topic of training or training materials. Both FDA guidance and existing standards that do specifically address the design of labeling and ensuing instructions for use fail to account for up-to-date findings from research on instructional systems design. In addition, despite recognition that requirements for user training, training materials, and instructions for use are different for lay and professional users of medical equipment, these differences are not reflected in current standards.

Recommendation 3. The U.S. Food and Drug Administration (FDA) should promote development (by standards development organizations, such as the International Electrotechnical Commission, the International Organization for Standardization, the American National Standards Institute, and the Association for the Advancement of Medical Instrumentation) of new standards based on the most recent human factors research for the labeling of and ensuing instructional materials for medical devices designed for home use by lay users. The FDA should also tailor and streamline its approval processes to facilitate and encourage regular improvements of these materials by manufacturers.

Adverse Event Reporting Systems

The committee notes that the FDA’s adverse event reporting systems, used to report problems with medical devices, are not user-friendly, especially for lay users, who generally are not aware of the systems, unaware that they can use them to report problems, and uneducated about how to do so. In order to promote safe use of medical devices in the home and rectify design problems that put care recipients at risk, it is necessary that the FDA conduct more effective postmarket surveillance of medical devices to complement its premarket approval process. The most important elements of their primarily passive surveillance system are the current adverse event reporting mechanisms, including Maude and MedSun. Entry of incident data by health care providers and consumers is not straightforward, and the system does not elicit data that could be useful to designers as they develop updated versions of products or new ones that are similar to existing devices. The reporting systems and their importance need to be widely promoted to a broad range of users, especially lay users.

Recommendation 4. The U.S. Food and Drug Administration should improve its adverse event reporting systems to be easier to use, to collect data that are more useful for identifying the root causes of events

related to interactions with the device operator, and to develop and promote a more convenient way for lay users as well as professionals to report problems with medical devices.

CAREGIVERS IN THE HOME

Health care is provided in the home by formal caregivers (health care professionals), informal caregivers (family and friends), and individuals who self-administer care; each type of caregiver faces unique issues. Properly preparing individuals to provide care at home depends on targeting efforts appropriately to the background, experience, and knowledge of the caregivers. To date, however, home health care services suffer from being organized primarily around regulations and payments designed for inpatient or outpatient acute care settings. Little attention has been given to how different the roles are for formal caregivers when delivering services in the home or to the specific types of training necessary for appropriate, high-quality practice in this environment.

Health care administration in the home commonly involves interaction among formal caregivers and informal caregivers who share daily responsibility for a person receiving care. But few formal caregivers are given adequate training on how to work with informal caregivers and involve them effectively in health decision making, use of medical or adaptive technologies, or best practices to be used for evaluating and supporting the needs of caregivers.

It is also important to recognize that the majority of long-term care provided to older adults and individuals with disabilities relies on family members, friends, or the individual alone. Many informal caregivers take on these responsibilities without necessary education or support. These individuals may be poorly prepared and emotionally overwhelmed and, as a result, experience stress and burden that can lead to their own morbidity. The committee is aware that informational and training materials and tested programs already exist to assist informal caregivers in understanding the many details of providing health care in the home and to ease their burden and enhance the quality of life of both caregiver and care recipient. However, tested materials and education, support, and skill enhancement programs have not been adequately disseminated or integrated into standard care practices.

Recommendation 5. Relevant professional practice and advocacy groups should develop appropriate certification, credentialing, and/or training standards that will prepare formal caregivers to provide care in the home, develop appropriate informational and training materials

for informal caregivers, and provide guidance for all caregivers to work effectively with other people involved.

RESIDENTIAL ENVIRONMENTS FOR HEALTH CARE

Health care is administered in a variety of nonclinical environments, but the most common one, particularly for individuals who need the greatest level and intensity of health care services, is the home. The two recommendations in this area encourage (1) modifications to existing housing and (2) accessible and universal design of new housing. The implementation of these recommendations would be a good start on an effort to improve the safety and ease of practicing health care in the home. It could improve the health and safety of many care recipients and their caregivers and could facilitate adherence to good health maintenance and treatment practices. Ideally, improvements to housing design would take place in the context of communities that provide transportation, social networking and exercise opportunities, and access to health care and other services.

Safety and Modification of Existing Housing

The committee found poor appreciation of the importance of modifying homes to remove health hazards and barriers to self-management and health care practice and, furthermore, that financial support from federal assistance agencies for home modifications is very limited. The general connection between housing characteristics and health is well established. For example, improving housing conditions to enhance basic sanitation has long been part of a public health response to acute illness. But the characteristics of the home can present significant barriers to autonomy or self-care management and present risk factors for poor health, injury, compromised well-being, and greater dependence on others. Conversely, physical characteristics of homes can enhance resident safety and ability to participate in daily self-care and to utilize effectively health care technologies that are designed to enhance health and well-being.

Home modifications based on professional home assessments can increase functioning, contribute to reducing accidents such as falls, assist caregivers, and enable chronically ill persons and people with disabilities to stay in the community. Such changes are also associated with facilitating hospital discharges, decreasing readmissions, reducing hazards in the home, and improving care coordination. Familiar modifications include installation of such items as grab bars, handrails, stair lifts, increased lighting, and health monitoring equipment as well as reduction of such hazards as broken fixtures and others caused by insufficient home maintenance.

Deciding on which home modifications have highest priority in a given

setting depends on an appropriate assessment of circumstances and the environment. A number of home assessment instruments and programs have been validated and proven to be effective to meet this need. But even if needed modifications are properly identified and prioritized, inadequate funding, gaps in services, and lack of coordination between the health and housing service sectors have resulted in a poorly integrated system that is difficult to access. Even when accessed, progress in making home modifications available has been hampered by this lack of coordination and inadequate reimbursement or financial mechanisms, especially for those who cannot afford them.

Recommendation 6. Federal agencies, including the U.S. Department of Health and Human Services and the Centers for Medicare & Medicaid Services, along with the U.S. Department of Housing and Urban Development and the U.S. Department of Energy, should collaborate to facilitate adequate and appropriate access to health- and safety-related home modifications, especially for those who cannot afford them. The goal should be to enable persons whose homes contain obstacles, hazards, or features that pose a home safety concern, limit self-care management, or hinder the delivery of needed services to obtain home assessments, home modifications, and training in their use.

Accessibility and Universal Design of New Housing

Almost all existing housing in the United States presents problems for conducting health-related activities because physical features limit independent functioning, impede caregiving, and contribute to such accidents as falls. In spite of the fact that a large and growing number of persons, including children, adults, veterans, and older adults, have disabilities and chronic conditions, new housing continues to be built that does not account for their needs (current or future). Although existing homes can be modified to some extent to address some of the limitations, a proactive, preventive, and effective approach would be to plan to address potential problems in the design phase of new and renovated housing, before construction.

Some housing is already required to be built with basic accessibility features that facilitate practice of health care in the home as a result of the Fair Housing Act Amendments of 1998. And 17 states and 30 cities have passed what are called “visitability” codes, which currently apply to 30,000 homes. Some localities offer tax credits, such as Pittsburgh through an ordinance, to encourage installing visitability features in new and renovated housing. The policy in Pittsburgh was impetus for the Pennsylvania Residential VisitAbility Design Tax Credit Act signed into law on October 28, 2006, which offers property owners a tax credit for new construction

and rehabilitation. The Act paves the way for municipalities to provide tax credits to citizens by requiring that such governing bodies administer the tax credit (Self-Determination Housing Project of Pennsylvania, Inc., n.d.).

Visitability, rather than full accessibility, is characterized by such limited features as an accessible entry into the home, appropriately wide doorways and one accessible bathroom. Both the International Code Council, which focuses on building codes, and the American National Standards Institute, which establishes technical standards, including ones associated with accessibility, have endorsed voluntary accessibility standards. These standards facilitate more jurisdictions to pass such visitability codes and encourage legislative consistency throughout the country. To date, however, the federal government has not taken leadership to promote compliance with such standards in housing construction, even for housing for which it provides financial support.

Universal design, a broader and more comprehensive approach than visitability, is intended to suit the needs of persons of all ages, sizes, and abilities, including individuals with a wide range of health conditions and activity limitations. Steps toward universal design in renovation could include such features as anti-scald faucet valve devices, nonslip flooring, lever handles on doors, and a bedroom on the main floor. Such features can help persons and their caregivers carry out everyday tasks and reduce the incidence of serious and costly accidents (e.g., falls, burns). In the long run, implementing universal design in more homes will result in housing that suits the long-term needs of more residents, provides more housing choices for persons with chronic conditions and disabilities, and causes less forced relocation of residents to more costly settings, such as nursing homes.

Issues related to housing accessibility have been acknowledged at the federal level. For example, visitability and universal design are in accord with the objectives of the Safety of Seniors Act (Public Law No. 110-202, passed in 2008). In addition, implementation of the Olmstead decision (in which the U.S. Supreme Court ruled that the Americans with Disabilities Act may require states to provide community-based services rather than institutional placements for individuals with disabilities) requires affordable and accessible housing in the community.

Visitability, accessibility, and universal design of housing all are important to support the practice of health care in the home, but they are not broadly implemented and incentives for doing so are few.

Recommendation 7. Federal agencies, such as the U.S. Department of Housing and Urban Development, the U.S. Department of Veterans Affairs, and the Federal Housing Administration, should take a lead role, along with states and local municipalities, to develop strategies that promote and facilitate increased housing visitability, accessibil-

ity, and universal design in all segments of the market. This might include tax and other financial incentives, local zoning ordinances, model building codes, new products and designs, and related policies that are developed as appropriate with standards-setting organizations (e.g., the International Code Council, the International Electrotechnical Commission, the International Organization for Standardization, and the American National Standards Institute).

RESEARCH AND DEVELOPMENT

In our review of the research literature, the committee learned that there is ample foundational knowledge to apply a human factors lens to home health care, particularly as improvements are considered to make health care safe and effective in the home. However, much of what is known is not being translated effectively into practice, neither in design of equipment and information technology or in the effective targeting and provision of services to all those in need. Consequently, the four recommendations that follow support research and development to address knowledge and communication gaps and facilitate provision of high-quality health care in the home. Specifically, the committee recommends (1) research to enhance coordination among all the people who play a role in health care practice in the home, (2) development of a database of medical devices in order to facilitate device prescription, (3) improved surveys of the people involved in health care in the home and their residential environments, and (4) development of tools for assessing the tasks associated with home-based health care.

Health Care Teamwork and Coordination

Frail elders, adults with disabilities, disabled veterans, and children with special health care needs all require coordination of the care services that they receive in the home. Home-based health care often involves a large number of elements, including multiple care providers, support services, agencies, and complex and dynamic benefit regulations, which are rarely coordinated. However, coordinating those elements has a positive effect on care recipient outcomes and costs of care. When successful, care coordination connects caregivers, improves communication among caregivers and care recipients and ensures that receivers of care obtain appropriate services and resources.

To ensure safe, effective, and efficient care, everyone involved must collaborate as a team with shared objectives. Well-trained primary health care teams that execute customized plans of care are a key element of coordinated care; teamwork and communication among all actors are also

essential to successful care coordination and the delivery of high-quality care. Key factors that influence the smooth functioning of a team include a shared understanding of goals, common information (such as a shared medication list), knowledge of available resources, and allocation and coordination of tasks conducted by each team member.

Barriers to coordination include insufficient resources available to (a) help people who need health care at home to identify and establish connections to appropriate sources of care, (b) facilitate communication and coordination among caregivers involved in home-based health care, and (c) facilitate communication among the people receiving and the people providing health care in the home.

The application of systems analysis techniques, such as task analysis, can help identify problems in care coordination systems and identify potential intervention strategies. Human factors research in the areas of communication, cognitive aiding and decision support, high-fidelity simulation training techniques, and the integration of telehealth technologies could also inform improvements in care coordination.

Recommendation 8 . The Agency for Healthcare Research and Quality should support human factors–based research on the identified barriers to coordination of health care services delivered in the home and support user-centered development and evaluation of programs that may overcome these barriers.

Medical Device Database

It is the responsibility of physicians to prescribe medical devices, but in many cases little information is readily available to guide them in determining the best match between the devices available and a particular care recipient. No resource exists for medical devices, in contrast to the analogous situation in the area of assistive and rehabilitation technologies, for which annotated databases (such as AbleData) are available to assist the provider in determining the most appropriate one of several candidate devices for a given care recipient. Although specialists are apt to receive information about devices specific to the area of their practice, this is much less likely in the case of family and general practitioners, who often are responsible for selecting, recommending, or prescribing the most appropriate device for use at home.

Recommendation 9. The U.S. Food and Drug Administration, in collaboration with device manufacturers, should establish a medical device database for physicians and other providers, including pharmacists, to use when selecting appropriate devices to prescribe or recommend

for people receiving or self-administering health care in the home. Using task analysis and other human factors approaches to populate the medical device database will ensure that it contains information on characteristics of the devices and implications for appropriate care recipient and device operator populations.

Characterizing Caregivers, Care Recipients, and Home Environments

As delivery of health care in the home becomes more common, more coherent strategies and effective policies are needed to support the workforce of individuals who provide this care. Developing these will require a comprehensive understanding of the number and attributes of individuals engaged in health care in the home as well as the context in which care is delivered. Data and data analysis are lacking to accomplish this objective.

National data regarding the numbers of individuals engaged in health care delivery in the home—that is, both formal and informal caregivers—are sparse, and the estimates that do exist vary widely. Although the Bureau of Labor Statistics publishes estimates of the number of workers employed in the home setting for some health care classifications, they do not include all relevant health care workers. For example, data on workers employed directly by care recipients and their families are notably absent. Likewise, national estimates of the number of informal caregivers are obtained from surveys that use different methodological approaches and return significantly different results.

Although numerous national surveys have been designed to answer a broad range of questions regarding health care delivery in the home, with rare exceptions such surveys reflect the relatively limited perspective of the sponsoring agency. For example,

The Medicare Current Beneficiary Survey (administered by the Centers for Medicare & Medicaid Services) and the Health and Retirement Survey (administered by the National Institute on Aging) are primarily geared toward understanding the health, health services use, and/or economic well-being of older adults and provide no information regarding working-age adults or children or information about home or neighborhood environments.
The Behavioral Risk Factors Surveillance Survey (administered by the Centers for Disease Control and Prevention, CDC), the National Health Interview Survey (administered by the CDC), and the National Children’s Study (administered by the U.S. Department of Health and Human Services and the U.S. Environmental Protection Agency) all collect information on health characteristics, with limited or no information about the housing context.
The American Housing Survey (administered by the U.S. Department of Housing and Urban Development) collects detailed information regarding housing, but it does not include questions regarding the health status of residents and does not collect adequate information about home modifications and features on an ongoing basis.

Consequently, although multiple federal agencies collect data on the sociodemographic and health characteristics of populations and on the nation’s housing stock, none of these surveys collects data necessary to link the home, its residents, and the presence of any caregivers, thus limiting understanding of health care delivered in the home. Furthermore, information is altogether lacking about health and functioning of populations linked to the physical, social, and cultural environments in which they live. Finally, in regard to individuals providing care, information is lacking regarding their education, training, competencies, and credentialing, as well as appropriate knowledge about their working conditions in the home.

Better coordination across government agencies that sponsor such surveys and more attention to information about health care that occurs in the home could greatly improve the utility of survey findings for understanding the prevalence and nature of health care delivery in the home.

Recommendation 10. Federal health agencies should coordinate data collection efforts to capture comprehensive information on elements relevant to health care in the home, either in a single survey or through effective use of common elements across surveys. The surveys should collect data on the sociodemographic and health characteristics of individuals receiving care in the home, the sociodemographic attributes of formal and informal caregivers and the nature of the caregiving they provide, and the attributes of the residential settings in which the care recipients live.

Tools for Assessing Home Health Care Tasks and Operators

Persons caring for themselves or others at home as well as formal caregivers vary considerably in their skills, abilities, attitudes, experience, and other characteristics, such as age, culture/ethnicity, and health literacy. In turn, designers of health-related devices and technology systems used in the home are often naïve about the diversity of the user population. They need high-quality information and guidance to better understand user capabilities relative to the task demands of the health-related device or technology that they are developing.

In this environment, valid and reliable tools are needed to match users with tasks and technologies. At this time, health care providers lack the

tools needed to assess whether particular individuals would be able to perform specific health care tasks at home, and medical device and system designers lack information on the demands associated with health-related tasks performed at home and the human capabilities needed to perform them successfully.

Whether used to assess the characteristics of formal or informal caregivers or persons engaged in self-care, task analysis can be used to develop point-of-care tools for use by consumers and caregivers alike in locations where such tasks are encouraged or prescribed. The tools could facilitate identification of potential mismatches between the characteristics, abilities, experiences, and attitudes that an individual brings to a task and the demands associated with the task. Used in ambulatory care settings, at hospital discharge or other transitions of care, and in the home by caregivers or individuals and family members themselves, these tools could enable assessment of prospective task performer’s capabilities in relation to the demands of the task. The tools might range in complexity from brief screening checklists for clinicians to comprehensive assessment batteries that permit nuanced study and tracking of home-based health care tasks by administrators and researchers. The results are likely to help identify types of needed interventions and support aids that would enhance the abilities of individuals to perform health care tasks in home settings safely, effectively, and efficiently.

Recommendation 11. The Agency for Healthcare Research and Quality should collaborate, as necessary, with the National Institute for Disability and Rehabilitation Research, the National Institutes of Health, the U.S. Department of Veterans Affairs, the National Science Foundation, the U.S. Department of Defense, and the Centers for Medicare & Medicaid Services to support development of assessment tools customized for home-based health care, designed to analyze the demands of tasks associated with home-based health care, the operator capabilities required to carry them out, and the relevant capabilities of specific individuals.

Association for the Advancement of Medical Instrumentation. (2009). ANSI/AAMI HE75:2009: Human factors engineering: Design of medical devices. Available: http://www.aami.org/publications/standards/HE75_Ch16_Access_Board.pdf [April 2011].

Self-Determination Housing Project of Pennsylvania, Inc. (n.d.) Promoting visitability in Pennsylvania. Available: http://www.sdhp.org/promoting_visitability_in_pennsy.htm [March 30, 2011].

In the United States, health care devices, technologies, and practices are rapidly moving into the home. The factors driving this migration include the costs of health care, the growing numbers of older adults, the increasing prevalence of chronic conditions and diseases and improved survival rates for people with those conditions and diseases, and a wide range of technological innovations. The health care that results varies considerably in its safety, effectiveness, and efficiency, as well as in its quality and cost.

Health Care Comes Home reviews the state of current knowledge and practice about many aspects of health care in residential settings and explores the short- and long-term effects of emerging trends and technologies. By evaluating existing systems, the book identifies design problems and imbalances between technological system demands and the capabilities of users. Health Care Comes Home recommends critical steps to improve health care in the home. The book's recommendations cover the regulation of health care technologies, proper training and preparation for people who provide in-home care, and how existing housing can be modified and new accessible housing can be better designed for residential health care. The book also identifies knowledge gaps in the field and how these can be addressed through research and development initiatives.

Health Care Comes Home lays the foundation for the integration of human health factors with the design and implementation of home health care devices, technologies, and practices. The book describes ways in which the Agency for Healthcare Research and Quality (AHRQ), the U.S. Food and Drug Administration (FDA), and federal housing agencies can collaborate to improve the quality of health care at home. It is also a valuable resource for residential health care providers and caregivers.

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Home — Essay Samples — Nursing & Health — Nursing — Good Health And Wellness

Good Health and Wellness

Categories: Nursing

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Published: Mar 13, 2024

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The importance of good health and wellness, the impact of good health and wellness, achieving and maintaining good health and wellness, the broader implications of good health and wellness.

In addition to physical health , mental and emotional well-being are equally important. Practices such as mindfulness, meditation, and therapy can help manage stress and improve overall mental health.
Building a strong support network and nurturing meaningful relationships also contribute to emotional wellness.
Furthermore, it is essential to prioritize self-care and relaxation. Taking time for oneself, engaging in hobbies, and setting boundaries are crucial for maintaining a balanced and healthy lifestyle.
Lastly, regular check-ups with healthcare professionals and staying informed about one's health are vital for early detection and prevention of illness.

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Measuring best practices for workplace safety, health and wellbeing: The Workplace Integrated Safety and Health Assessment

Glorian sorensen.

1 Dana-Farber Cancer Institute, Boston, MA

2 Harvard T.H. Chan School of Public Health, Boston, MA

Emily Sparer

Jessica a.r. williams.

3 University of Kansas School of Medicine, Kansas City, KS

Daniel Gundersen

Leslie i. boden.

4 Boston University School of Public Health, Boston, MA

Jack T. Dennerlein

5 Northeastern University, Boston, MA

Dean Hashimoto

6 Partners HealthCare, Inc., Boston, MA

7 Boston College Law School, Newton Centre, MA

Jeffrey N. Katz

8 Brigham and Women’s Hospital, Boston, MA

Deborah L. McLellan

Cassandra a. okechukwu, nicolaas p. pronk.

9 HealthPartners Institute, Minneapolis, MN

Anna Revette

Gregory r. wagner, associated data.

To present a measure of effective workplace organizational policies, programs and practices that focuses on working conditions and organizational facilitators of worker safety, health and wellbeing: the Workplace Integrated Safety and Health (WISH) Assessment.

Development of this assessment used an iterative process involving a modified Delphi method, extensive literature reviews, and systematic cognitive testing.

The assessment measures six core constructs identified as central to best practices for protecting and promoting worker safety, health and wellbeing: leadership commitment; participation; policies, programs and practices that foster supportive working conditions; comprehensive and collaborative strategies; adherence to federal and state regulations and ethical norms; and data-driven change.

Conclusions

The WISH Assessment holds promise as a tool that may inform organizational priority setting and guide research around causal pathways influencing implementation and outcomes related to these approaches.

INTRODUCTION

Efforts to protect and promote the safety, health, and wellbeing of workers have increasingly focused on integrating the complex and dynamic systems of the work organization and work environment. 1 – 3 The National Institute for Occupational Safety and Health (NIOSH) applies this integrated approach in the Total Worker Health ® (TWH) initiative by attending to “policies, programs, and practices that integrate protection from work-related safety and health hazards with promotion of injury and illness prevention efforts to advance worker well-being.” 4 NIOSH has defined best practices as a set of essential elements for TWH that prioritizes a hazard-free work environment and recognizes the significant role of job-related factors in workers’ health and wellbeing. 5 , 6

Increasingly, others have also emphasized the importance of improvements in working conditions as central to best practice recommendations. 7 – 15 For example, the Robert Wood Johnson Foundation’s efforts have focused on building a culture of health in the workplace. 16 Continuous improvement systems have relied on employee participation as a means of shaping positive working conditions. 17 – 19 In Great Britain, continuous improvement processes are employed through a set of “management standards” that assess and address stressors in the workplace, including demands, control, support, relationships, role, and organizational change. 20 Researchers have reported benefits to this integrated systems approach, including reductions in pain and occupational injury and disability rates; 21 – 26 strengthened health and safety programs; 27 , 28 improvements in health behaviors; 29 – 38 enhanced rates of employee participation in programs; 39 and reduced costs. 28

Assessment of the extent to which a workplace adheres to best practice recommendations related to an integrated systems approach is important for several reasons. Understanding relationships between working conditions and worker safety and health outcomes can inform priority-setting and decision making for researchers, policy-makers, and employers alike, and may motivate employer actions to improve workplace conditions. 40 In turn, identifying the impact of worker health and safety on business-related outcomes, such as worker performance, productivity, and turnover, may help to demonstrate the importance of protecting and promoting worker health for the bottom line. 41 Baseline data with follow up assessments can also provide a means for tracking improvements in working conditions and related health outcomes over time. An important part of the process for evaluating workplace adherence to recommendations and understanding its relationship to worker and business outcomes is the creation of assessment tools that effectively capture implementation of best practice recommendations.

In 2013, the Harvard T.H. Chan School of Public Health Center for Work, Health and Wellbeing published a set of “Indicators of Integration” that were designed to assess the extent to which an organization has implemented an approach integrating occupational safety and health with worksite health promotion. 1 This instrument assessed four domains: organizational leadership and commitment; collaboration between health protection and worksite health promotion; supportive organizational policies and practices (including accountability and training, management and employee engagement, benefits and incentives to support workplace health promotion and protection, integrated evaluation and surveillance); and comprehensive program content. The instrument was validated in two samples, 42 , 43 and has played as useful role in the evolving dialogue around integrated approaches to worker safety, health and wellbeing. 44 , 45 There is a need, however, for building on this work toward assessment of more conceptually grounded and practical constructs that measure the implementation of systems approaches focusing on improving working conditions as a means of protecting and promoting worker safety, health and wellbeing.

This manuscript describes an improved measure that reflects the Center’s conceptual model, which articulates the central role of working conditions in shaping health and safety outcomes as well as enterprise outcomes such as absenteeism and turnover ( Figure 1 ). 2 Working conditions, placed centrally in the model as core determinants of worker health and safety, encompass the physical environment and the organization of work (i.e., psycho-social factors, job design and demands, health and safety climate). The model highlights the potential interactions across systems, guiding exploration of the shared effects of the physical environment and the organization of work. Working conditions serve as a pathway from enterprise and workforce characteristics and effective policies, programs, and practices, to worker safety and health outcomes, as well as to more proximal outcomes such as health-related behaviors. Effective policies, programs, and practices may also contribute to improvements in enterprise outcomes such as turnover and health care costs. Feedback loops underscore the complexity of the system of inter-relationships across multiple dimensions, and highlight the potential synergy of intervention effects.

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Object name is nihms934884f1.jpg

Systems level conceptual model centered around working conditions.

The purpose of this paper is to present a new measure of effective workplace organizational policies, programs and practices that focuses on working conditions as well as organizational facilitators of worker safety, health and wellbeing: the Workplace Integrated Safety and Health (WISH) Assessment. The objective of the WISH Assessment is to evaluate the extent to which workplaces implement effective comprehensive approaches to protect and promote worker health, safety and wellbeing. The policies, programs and practices encompassed by these approaches include both those designed to prevent work-related injuries and illnesses, and those designed to enhance overall workforce health and wellbeing.

Like the Indicators of Integration, this assessment is designed to be completed at the organizational level by employer representatives, such as directors of human resources, occupational safety, or employee health. These representatives are likely to be knowledgeable of organizational priorities, as well as policies, programs and practices related to workplace safety and health. Moreover, these representatives are in the position to influence the cultural and structural re-alignment necessary for integrated approaches. These organizational assessments are increasingly being used by policymakers, organizational leadership, and health and safety committees to guide goal setting and decision making. Organizational assessments such as this one may additionally complement worker surveys that can effectively capture employee practices as well as their perceptions of working conditions.

The WISH Assessment differs from the Indicators of Integration in two important ways: it embraces an increased focus on the central role of working conditions (as illustrated in Figure 1 ), and it expands assessment of best practice systems approaches to include a broader definition of protecting and promoting worker safety, health and wellbeing. This paper also describes the methods used to develop this instrument.

Investigators from the Harvard Chan School Center for Work, Health and Wellbeing, a TWH Center for Excellence representing multiple institutions in the Boston area, developed the WISH Assessment. 46 This instrument measures workplace-level implementation of policies, programs and practices that protect and promote worker safety, health and wellbeing. Accordingly, the intended respondents are organizational representatives who are knowledgeable about existing policies, programs and practices at workplaces, such as executives at small businesses, or directors of human resources or safety departments. Development of the WISH Assessment relied on an iterative process involving a modified Delphi method, extensive literature reviews, and systematic cognitive testing.

Delphi method and literature review

The Center’s conceptual model 2 and related literature provided a guiding framework for the development of the WISH Assessment. As a starting point, we used constructs and related measures included in the Center’s published 1 and validated 42 , 43 Indicators of Integration tool. Based on an extensive review of literature, we expanded and revised the constructs captured by the instrument from four to seven. Next, we reviewed these constructs and their definitions using an iterative modified Delphi process 47 with an expert review panel, including Center investigators. We reviewed the literature to identify extant items for these and similar constructs, placing a priority on the inclusion of validated measures where feasible. To ensure content validity and adequate coverage across attributes for each construct, we reviewed working drafts of the instrument with the Center’s External Advisory Board, as well as members of other TWH Centers of Excellence. 48 Through repeated discussions, iterative review and revisions in six meetings over ten months, the Center members reached consensus related to a set of core domains and related measures. The working draft of the instrument was further reviewed by a survey methodologist, and prepared for cognitive testing. Following three rounds of cognitive testing and revision, as described below, Center investigators again reviewed and finalized this working version of the WISH Assessment.

Cognitive testing methods

The purpose of cognitive testing is to ensure that the items included on a survey effectively measure the intended constructs and are uniformly understood by potential respondents. The process focuses on the performance of each candidate item when used with members of the intended respondent group, and specifically assesses comprehension, information retrieval, judgment/estimation, and selection of response category. 49 , 50 In the development of the WISH Assessment, we tested the instrument through three rounds of interviews.

Data Collection

Participants were asked to fill out the self-administered paper (N=15) or web (N=4) survey and participate in a telephone-administered qualitative interview with a trained interviewer. Participants received the survey 48 hours prior to the interview, and were encouraged to complete the survey as close to the actual interview as possible. They were not explicitly encouraged to consult with others, nor were they told not to.

The semi-structured interviews were conducted using a structured interview guide and retrospective probing techniques. The first round focused on comprehension of key attributes for each item (e.g., concepts of integration and collaborative environments) and of key words or phrases in the context of the question and instrument. Items revised following round 1 were again tested in a second round using the same approach. The focus of round 2 was to assess the adequacy of revisions in addressing the problems identified in round 1. A third round of interviews was conducted to confirm there were no additional problems due to revisions based on round 2. Across all rounds, the interviews concluded with a series of questions about the participant’s overall experience in completing the survey. For example, participants could provide general feedback on the survey content and the time required to complete the survey, and could comment on questions that didn’t fit within the survey or were duplicative. Participants were compensated with a $20 Amazon gift card for their time.

Participants were selected using purposive sampling to ensure diversity across industries and organizational roles, and included directors of human resources, occupational health, safety, and similar positions from hospitals (n=9), risk management (n=2), technology (n=2), transportation (n=2), community health center (n=1), manufacturing (n=1), laboratory research and development (n=1), and emergency response (n=1). Participants were identified through the Center for Work, Health and Wellbeing, and included attendees at a continuing education course and former collaborators on other projects. New participants were included in subsequent rounds of testing in order to ensure that revisions to items from each round adequately addressed the limitations, and that items were appropriately and uniformly interpreted among respondents.

Following each round, feedback was summarized by item. Participant feedback was used to determine if the question wording needed modification. Each item was first considered on its own, and then assessed in terms of its fit in measuring its construct. A survey methodologist made suggested revisions which were then reviewed and discussed by the author team and interviewers to ensure that they retained substantive focus on the construct. We revised items when participants found terminology unclear or when participants’ answers did not map onto the intended construct. An item was removed if it was found to be redundant or did not adequately map onto the intended construct, and its deletion did not compromise content validity. We analyzed data across industry, and also assessed responses specific to the hospital industry, which included the most respondents.

Description of the constructs and measures

We identified six core constructs as central to best practices for protecting and promoting worker safety, health and wellbeing through the Delphi process and literature review. The items included in each construct with their response categories are included in Table 1 . Following the Indicators of Integration, this assessment was designed to be answered by one or more persons within an organization who are likely to be familiar with the organization’s policies, programs and practices related to worker safety, health and wellbeing. Below, we present each construct, including its definition, rationale for inclusion, and sources of the items included.

Workplace Integrated Safety and Health (WISH) Assessment

This brief survey is designed to assess the extent to which organizations effectively implement integrated approaches to worker safety, health and wellbeing. The term “integrated approaches” refers to policies, programs, and practices that aim to prevent work-related injuries and illnesses and enhance overall workforce health and wellbeing.

This survey is meant to be completed by health and safety representatives, either in human resources or in safety, at the middle management level. There are no right or wrong answers–Your responses are meant to reflect your understanding of policies, practices and programs currently implemented within your organization.

1. The following questions refer to leadership commitment. We define the term “leadership commitment” to mean the following: An organization’s leadership makes worker safety, health, and well-being a clear priority for the entire organization. They drive accountability and provide the necessary resources and environment to create positive working conditions.

Response Categories: Please indicate how often you feel your organization or its leaders do each of the following: Not all the time, some of the time, most of the time, all of the time.

a. The company’s leadership, such as senior leaders and middle managers, communicate their commitment to a work environment that supports employee safety, health, and wellbeing.

b. The organization allocates enough resources such as enough workers and money to implement policies or programs to protect and promote worker safety and health.

c. Our company’s leadership, such as senior leaders and managers, take responsibility for ensuring a safe and healthy work environment.

d. Worker health and safety are part of the organization’s mission, vision or business objectives.

e. The importance of health and safety is communicated across all levels of the organization, both formally and informally.

f. The importance of health and safety is consistently reflected in actions across all levels of the organization, both formally and informally.

2. The following questions refer to participation. We define the term “participation” to mean the following: Stakeholders at every level of an organization, including organized labor or other worker organizations if present, help plan and carry out efforts to protect and promote worker safety and health.

Response categories: For these collaborative activities or programs, please indicate how often you believe your organization implements each: not at all, some of the time, most of the time, all of the time.

a. Managers and employees work together in planning, implementing, and evaluating comprehensive safety and health programs, policies, and practices for employees.

b. This company has a joint worker-management committee that addresses efforts to protect and promote worker safety and health.

c. In this organization, managers across all levels consistently seek employee involvement and feedback in decision making.

d. Employees are encouraged to voice concerns about working conditions without fear of retaliation.

e. Leadership, such as supervisors and managers, initiate discussions with employees to identify hazards or other concerns in the work environment.

3. The following questions refer to policies, programs, and practices focused on positive working conditions. We define this term to mean the following: The organization enhances worker safety, health, and well-being with policies and practices that improve working conditions.

Response categories: For each of the following policies or practices, please indicate the degree to which they are implemented at your company: not at all, somewhat, mostly, completely.

a. The workplace is routinely evaluated by staff trained to identify potential health and safety hazards.

b. Supervisors are responsible for identifying unsafe working conditions on their units.

c. Supervisors are responsible for correcting unsafe working conditions on their units.

d. This workplace provides a supportive environment for safe and healthy behaviors, such as a tobacco-free policy, healthy food options, or facilities for physical activity.

e. Organizational policies or programs are in place to support employees when they are dealing with personal or family issues.

f. Leadership, such as supervisors and managers, make sure that workers are able to take their entitled breaks during work (e.g. meal breaks).

g. Supervisors and managers make sure workers are able to take their earned times away from work such as sick time, vacation, and parental leave.

h. This organization ensures that policies to prevent harm to employees from abuse, harassment, discrimination, and violence are followed.

i. This organization has trainings for workers and managers across all levels to prevent harm to employees from abuse, harassment, discrimination, and violence.

j. This workplace provides support to employees who are returning to work after time off due to work-related health conditions.

k. This workplace provides support to employees who are returning to work after time off due to non-work related health conditions.

l. This organization takes proactive measures to make sure that the employee’s workload is reasonable, for example, that employees can usually complete their assigned job tasks within their shift.

m. Employees have the resources such as equipment and training do their jobs safely and well.

n. All employees in this organization receive paid leave, including sick leave.

4. The following questions refer to comprehensive and collaborative strategies. We define this term to mean the following: Employees from across the organization work together to develop comprehensive health and safety initiatives.

Response categories: For the following collaborative or comprehensive policies, programs, or practices, please indicate the degree to which your company implements each: not at all, somewhat, mostly, completely.

a. This company has a comprehensive approach to promote and protect worker safety and health. This includes collaborative efforts across departments as well as education and programs for individuals and policies about the work environment.

b. This company has a comprehensive approach to worker wellbeing. This includes collaboration across departments in efforts to prevent work-related illness and injury and to promote worker health.

c. This company coordinates policies, programs, and practices for worker health safety, and wellbeing across departments.

d. Managers are held accountable for implementing best practices to protect worker safety, health, and wellbeing, for example through their performance reviews.

e. Managers are given resources, such as equipment and trainings, for implementing best practices to protect and promote worker safety, health, and wellbeing.

f. This company prioritizes protection and promotion of worker safety and health when selecting vendors and subcontractors.

5. The following questions refer to adherence. We define the term “adherence” to mean the following: The organization adheres to federal and state regulations, as well as ethical norms, that advance worker safety, health, and well-being.

Response categories: For each of the following statements, please indicate the degree to which you believe your company adheres to or prioritizes standards and regulations: not at all, somewhate, mostly, completely.

a. This organization complies with standards for legal conduct.

b. In this organization, people show sincere respect for others’ ideas, values, beliefs

c. This workplace complies with regulations aimed at eliminating or minimizing potential exposures to recognized hazards.

d. This company ensures that safeguards regarding worker confidentiality, privacy and non-retaliation protections are followed.

e. The wages for the lowest-paid employees in this organization seem to be enough to cover basic living expenses such as housing and food.

6. The following questions refer to data-driven change. We define this term to mean the following: Regular evaluation guides an organization’s priority setting, decision making, and continuous improvement of worker safety, health, and well-being initiatives.

Response categories: Please indicate the degree to which your company does each of the following: not at all, somewhat,mostly, completely.

a. The effects of policies and programs to promote worker safety and health are measured using data from multiple sources, such as injury data, employee feedback, and absence records

b. Data from multiple sources on health, safety, and wellbeing are integrated and presented to leadership on a regular basis.

c. Evaluations of policies, programs and practices to protect and promote worker health are used to improve future efforts.

d. Integrated data on employee safety and health outcomes are coordinated across all relevant departments.

Leadership Commitment , defined as: “Leadership makes worker safety, health, and well-being a clear priority for the entire organization. They drive accountability and provide the necessary resources and environment to create positive working conditions.” This construct was included in our Indicators of Integration; items in the WISH Assessment were adapted from this prior measure, as well as from other sources. 1 , 41 , 51 , 52 Organizational leadership has been linked to an array of worker safety, health and wellbeing outcomes, 53 , 54 including organizational safety climate, 55 , 56 job-related wellbeing, 57 , 58 workplace injuries, 59 , 60 and health behaviors. 61 , 62 This element recognizes that top management is ultimately responsible for setting priorities that define worker and worksite safety and health as part of the organization’s vision and mission. 14 , 16 Leadership roles include providing the resources needed for implementing best practices related to worker safety, health and wellbeing; establishing accountability for implementation of relevant policies and practices; and effectively communicating these priorities through formal and informal channels. 51 , 52

Participation , defined as: “Stakeholders at every level of an organization, including labor unions or other worker organizations if present, help plan and carry out efforts to protect and promote worker safety and health.” Many organizations have mechanisms in place to engage employees and managers in decision making and planning. These mechanisms may be used in planning and implementing integrated policies and programs, for example through joint worker-management committees that combine efforts to protect and promote worker safety, health and wellbeing. 7 , 63 , 64 Employee participation in decision-making facilitates a broader organizational culture of health, safety and wellbeing. Participation also includes encouraging employees to identify and report threats to safety and health, without fear of retaliation and with the expectation that their concerns will be addressed. Items included were adapted from the Indicators of Integration 1 and a self-assessment checklist from the Center for the Promotion of Health in the New England Workplace. 65

Policies, programs and practices that foster supportive working conditions , defined as: “The organization enhances worker safety, health, and well-being with policies and practices that improve working conditions.” These policies, programs and practices are central to the conceptual model presented in Figure 1 . Items include measures of the physical work environment and the organization of work (i.e., psychosocial factors, job tasks, demands, and resources), and are drawn from multiple sources. 1 , 41 , 66 – 69 The focus on working conditions is based on principles of prevention articulated in a hierarchy of controls framework, which has been applied within TWH. 10 , 70 Eliminating or reducing recognized hazards, whether in the physical work environment or the organizational environment, provides the most effective means of reducing exposure to potential for hazards on the job. Policies and processes to protect workers from physical hazards include routine inspections of the work environment, with mechanisms in place for correction of identified hazards, as well as policies that support safe and healthy behaviors, such as tobacco control policies. A supportive work organization includes safeguards against job strain, work overload, and harassment, 7 , 71 – 74 as well as supports for workers as they address work-life balance, return to work after an illness or injury, and take entitled breaks, including meal breaks as well as sick and vacation time. 75 , 76

Comprehensive and collaborative strategies , defined as: “Employees from across the organization work together to develop comprehensive health and safety initiatives.” Measures were adapted from our Indicators of Integration 1 and also relied on recent recommendations from the American College of Occupational and Environmental Medicine. 41 Although efforts to protect and promote worker safety and health have traditionally functioned independently, this construct acknowledges the benefits derived from collaboration across departments within an organization to protect and promote worker safety and health, both through policies about the work environment as well as education for workers. These efforts carry through into the selection of subcontractors and vendors, recognizing their impact on working conditions.

Adherence , defined as: “ The organization adheres to federal and state regulations, as well as ethical norms, that advance worker safety, health, and well-being.” The importance of this construct has been recognized by multiple organizations, whose contributions and metrics were incorporated in the measures included here. 7 , 77 – 79 Employers have a legal obligation to provide a safe and healthy work environment. 7 , 68 There is also significant agreement that any system that includes health and safety metrics must include safeguards for employee confidentiality and privacy. 7 , 41

Data-driven change , defined as: “Regular evaluation guides an organization’s priority setting, decision making, and continuous improvement of worker safety, health, and well-being initiatives.” Building health metrics into corporate reporting underscores the importance of worker health and safety as a business priority. 16 , 80 Feedback to leadership based on evaluation and monitoring of integrated programs, policies and practices can provide a basis for ongoing quality improvement. An integrated system that reports outcomes related both to occupational health as well as health behaviors and other health and wellbeing indicators can point to shared root causes within the conditions of work. 1 , 14

Cognitive testing results

We tested the WISH Assessment in three rounds of cognitive testing with a total of 19 participants. (See Appendix 1 for changes made to the items across the three rounds of testing.) On average, participants completed the self-administered survey in about 10–15 minutes, and the cognitive interviews took an average of 45 minutes. In the first round of cognitive testing, three participants completed a web version of the survey, and five, a paper-and-pencil version. Because we found no differences in concerns raised, the second round used only a paper survey, whereas the third included web respondents to confirm no differences in the final instrument. Changes made to the survey items were based on input from multiple respondents over the three rounds of interviews, and did not rely specifically on input from any one individual.

For items with uniform interpretation, revisions were made if respondents suggested a word or phrase that would clarify the question that investigators felt retained substantive focus. In addition, some items were dropped because they revealed multiple sources of problems, were too difficult to answer, or were identified as redundant. The first round of testing led to the removal of seven items and the modifying of 24 items. The second round of cognitive testing revealed that problems with the question wording remained with 15 questions in the context of the full survey. No additional questions were removed. These specific questions were updated and re-tested among three participants.

Throughout the cognitive testing process, we found several items to have either ambiguous terminology resulting in non-uniform or restrictive interpretation, inadequate framing of key terms and constructs, or lack of knowledge or perceived ability to provide an answer, resulting in poor information retrieval or mapping to the construct. Items measuring integration or collaboration within an organization were more often identified as problematic; to address this concern, we included a description of these constructs in the survey’s introduction to frame the survey for respondents. Although there was uniform interpretation of items asking about employee’s living wage, some respondents reported they did not have knowledge to provide an accurate answer. Most other items revealed uniform interpretation and no concerns regarding information retrieval or selecting response categories.

Looking at the items by construct, we identified particular concerns with items measuring two domains: “ policies, programs, and practices that foster supportive working conditions” and “adherence ” to norms and regulations. To address these concerns, we revised these items by improving the description of constructs or the terms in the respective sections’ introductions, using less ambiguous wording and integrating appropriate examples as necessary. We found commonalities across the responses in the remaining four domains, and describe our specific remediation process for each of these domains:

Leadership commitment

In round 1, we found a lack of clarity for the concept of “leadership.” For example, one respondent from the health care industry reported that: “[senior leaders and middle managers] should be distinguished and not conflated because there are several layers of management.” As a result, several respondents expressed difficulty retrieving accurate information due to level-specific answers. One respondent from a laboratory research and development company noted “[…] leadership communicate their commitment to safety and health through written policies. If you were to add supervisors – people closer to the front line – it would be different.” We addressed this concern by rewriting the introduction for this domain to clearly define “leadership commitment” and remove mention of leadership levels. However, we retained the wording “[…] such as senior leaders and middle managers, […]” in two items to reflect that organizations have channels through which commitment is communicated or enforced.

Participation

The questions for collaborative participation were largely identified as clear and uniformly interpreted. However, there was lack of clarity regarding who the key stakeholders were, particularly in the introduction. In addition, respondents reported that the introduction was too wordy and had a high literacy bar. Given these concerns and the suggestion that the use of the term “culture” was too academic, so we omitted use of this term. Some respondents expressed difficulty retrieving an appropriate answer due to this lack of clear framing of items in the introduction. We addressed this concern by rewriting the introduction to emphasize the definition of “participation” in the context of an organization’s activities that ensure worker safety and health. Feedback from round 2 found that this helped frame the item set more clearly. However, the word “encourage” in “In this organizational culture, managers encourage employees to get involved in making decisions” was identified as ambiguous. This was changed to “[…] seek employee involvement and feedback […]”.

Comprehensive and collaborative strategies

The most common feedback, expressed among several participants in multiple industries, for items in this domain was difficulty with the concept of “comprehensive,” i.e., that programming should address both prevention of illness and injury and promotion of worker health and safety. To a lesser extent, respondents also found difficulty with the “collaborative” concept. For example, some respondents including those from the hospital industry and in risk management, expressed difficulty responding to an item that included both “prevent” and “enhance,” which were perceived as “two different questions within this question.” We addressed these concerns by more clearly defining the two core constructs in a revised introduction. Moreover, we revised items to retain both “prevent and promote” while more clearly framing the question in context of collaboration. For example, the item “This company has a comprehensive approach to worker wellbeing that includes efforts to prevent work-related illness and injury as well as to enhance worker health” was revised to “This company has a comprehensive approach to worker wellbeing. This includes collaboration across departments in efforts to prevent work-related illness and injury and to promote worker health.”

Data-driven change

For this domain, we found evidence of poor cueing for the concepts of integration and coordination in the context of using data to produce organizational change. For example, several respondents from the hospital industry expressed that they did not understand what was meant by “integrated” in the context of “Summary reports on integrated policies and programs are presented to leadership on a regular basis, while also protecting employee confidentiality,” or “coordinated system” in context of “Data related to employee safety and health outcomes are integrated within a coordinated system.” Remediation focused on clarifying the context and definitions for integration and coordination. First, the introduction was revised to explicitly define data-driven change. Secondly, items were reworded to clarify integration and coordination. For example, “Summary reports on integrated policies and programs are presented to leadership on a regular basis, while also protecting employee confidentiality” was revised to “Data from multiple sources on health, safety, and wellbeing are integrated and presented to leadership on a regular basis.”

Our analyses also underscored commonalities across industries even when these issues seemed industry-specific. For example, comments from several participants suggested that a product-based mission may often dominate concerns about worker safety and health. In healthcare, this may be manifested by prioritizing patient care and safety over worker health and safety, or in other industries by a focus on production or timeline goals. Across industries, there was widespread agreement that Employee Assistant Programs was the primary resource for supporting employees dealing with personal or family issues.

Effective policies, programs and practices contribute to improvements in worker health, safety and wellbeing, as well as to enterprise outcomes such as improved employee morale, reduced absence and turnover, potentially reduced healthcare costs, and improved quality of services. 2 , 40 , 81 – 84 This manuscript presents the Workplace Integrated Safety and Health (WISH) Assessment, designed to evaluate the extent to which organizations implement best practice recommendations for an integrated, systems approach to protecting and promoting worker safety, health and wellbeing. This instrument builds on the Indicators of Integration, previously published and validated by the Center for Work, Health and Wellbeing. 1 , 42 , 43 We have expanded this tool based on the conceptual model presented in Figure 1 , 2 which prioritizes working conditions as determinants of worker safety, health and wellbeing. In addition, the WISH Assessment is designed to measure the extent to which an organization implements best practice recommendations. These constructs have also been used to inform in the Center’s guidelines for implementing best practice integrated approaches. 8

A growing range of metrics are available to assess organizational approaches to worker safety and health. The Integrated Health & Safety Index (IHS Index), created by the American College of Occupational and Environmental Medicine in collaboration with the Underwriters Laboratories, focuses on translating health and safety into value for businesses using three dimensions: economic, environmental and social standards. 41 By focusing on value, this measure has the potential to bolster the business case for health and safety. 41 , 85 The HERO Health and Well-being Best Practices Scorecard in Collaboration with Mercer is an online tool that allows employers to receive emailed feedback on their health and well-being practices. 86 Similarly, the American Heart Association’s Workplace Health Achievement Index provides an on-line self-assessment scorecard that includes comparisons with other companies. 87 The health metrics designed by the Vitality Institute include both a long and short form questionnaire, both with automatic scoring. 88 The Center for the Promotion of Health in the New England Workplace (CPH-NEW) has developed a tool to assess organizational readiness for implementing an integrated approach 11 and is developing a tool that focuses on participatory engagement of workers, with the goal of involving workers in the process of prioritizing health and safety issues and then developing and evaluating the proposed solutions. 89 Other measures of the work environment, such as the Health and Safety Executive Managements Standards Indicator Tool used in the United Kingdom, are designed to be taken by workers and so can provide detailed information on conditions as they are experienced by workers, but do not capture company-level policies and programs. 90 The WISH Assessment, designed to assess a company’s use of best practices for health and safety, is substantially shorter than the IHS Index and the HERO Scorecard, does not require the compilation of metrics and does not use individual employee data. In addition, in comparison to these other measures, the WISH Assessment can be used to guide organizations towards best practices and can be easily completed by organizations that might not have the resources to use the more extensive assessments.

Next steps in the development of the WISH Assessment include validation of the instrument across multiple samples, and design and testing of a scoring system. We validated the Indicators of Integration in two samples and found it to have convergent validity and high internal consistency, and to express one unified factor even when slight changes were made to adapt the measure. 42 , 43 We expect to follow a similar approach in validating this tool and assessing its dimensionality in large samples using factor analysis. Our goal is to design a scoring system that would be appropriate for both applied and research applications. As such, we expect the scoring algorithm to be simple enough for auto-calculation.

This tool may ultimately serve multiple purposes. As a research tool, it may provide a measure of workplace best practices that can be examined as determinants of worker safety and health outcomes. After being validated, the WISH Assessment may be used to explore organizational characteristics that may be associated with implementation of best practices. This instrument also responds to calls for practical tools for organizations implementing an integrated approach and focusing on working conditions. 41 The Center used the Indicators of Integration as part of a larger assessment process in three small-to-medium manufacturing businesses to inform organizations’ priority setting and decision making around the integration of occupational safety and health and health promotion. 91 In-person group discussions with key staff and executive leaders were used to rate each question on the scorecard, resulting in actionable steps based on identified gaps. Similarly, a validated WISH Assessment could be translated into a scorecard to be used to inform priority setting, decision making and to monitor changes over time in conditions of work and related health and safety outcomes. The Center has also applied the constructs defined in the WISH Assessment in its new best practice guidelines, 8 which include suggestions for formal and informal policies and practices ( Table 2 ).

Example Policies and Practices by each WISH construct.

Construct	Formal Policies	Informal Practices


	Physical environment Work organization Psychosocial environment	Physical environment Work organization Psychosocial environment

McLellan D, Moore W, Nagler E, Sorensen G. 2017. Implementing an integrated approach: Weaving worker health, safety, and well-being into the fabric of your organization. Dana-Farber Cancer Institute: Boston, MA. http://centerforworkhealth.sph.harvard.edu/

These indicators describe policies, programs and practices within the control of a specific organization or enterprise, and are most likely to apply to organizations that employ approximately 100 or more employees. The cognitive testing conducted to refine the items included in the WISH Assessment included representatives from organizations in selected settings; the generalizability of these results may therefore be restricted to similar types of organizations. There remains a need for exploring how this measure may function in different industries and across organizations of varying size. Although the purpose of the WISH instrument is to provide a measure that might be broadly useful across industries, we also recognize that each industry faces particular challenges due to the nature of what they do; supplementary questions may be needed to address these industry-specific concerns. Although this measure has not yet been validated, we believe it is important to share it and to explore opportunities for collaboration with other researchers interested in testing its psychometric properties and across populations and settings, in order to further develop this tool. It will ultimately be important as well to develop mechanisms for scoring this instrument, taking account potential weighting across the domains included.

Growing evidence clearly documents the benefits to be derived from integrated systems approaches for protecting and promoting worker safety, health and wellbeing. Practical, validated measures of best practices that are supported by existing evidence and do not place an undue burden on respondents are needed to support systematic study and organizational change. In cognitive testing, we demonstrated that the items included in this instrument effectively assess the defined constructs. Our goal was to create a measure that will be broadly useful and valid across industry, and might contribute to understanding differences and similarities by industry. Thus, the general applicability of this instrument is a strength in that it would allow for comparisons across industries, if so desired by substantive research. We also recognize the potential benefits of industry-specific versions of this instrument which may use this broader instrument as a base set of measures while also expanding on areas that are unique to a given industry. This may help increase understanding of industry-specific health and safety challenges. The WISH Assessment holds promise as a tool that may inform organizational priority setting and guide research around causal pathways influencing implementation and outcomes related to these approaches.

Supplementary Material

Supplemental digital content, acknowledgments.

This work was supported by a grant from the National Institute for Occupational Safety and Health (U19 OH008861) for the Harvard T.H. Chan School of Public Health Center for Work, Health and Well-being.

Conflict of Interest noted: None

10 Effective Strategies to Improve Workplace Safety

Ensuring the safety of employees within a workspace remains a paramount concern for any thriving organization. With the rise in workplace accidents, stakeholders are urged to prioritize and improve workplace safety measures. The incorporation of a safer work environment not only abolishes potential hazards but also significantly boosts employees’ productivity, morale, and overall job satisfaction.

Adopting safety protocols, providing safety training, and installing safety equipment are a necessity. This article underlines the importance of workplace safety and offers resourceful strategies for enhancing the efficiency of safety protocols for a guaranteed safer working environment.

Ideas To Improve Safety In The Workplace

10 Effective Strategies/Ideas to Improve Workplace Safety

Creating a safe work environment is not just a legal duty; it’s a critical component in the long-term success of any business. Improving workplace safety is an ongoing process that requires commitment and proactive strategies. Here are ten steps to enhance safety in the workplace and foster a robust safety culture.

1. Establish a Safety-First Culture

An effective safety culture is the foundation of a safe workplace. This means that every aspect of the work environment, from management to the newest employee, prioritizes safety above all else. To cultivate this culture, businesses must ensure that all employees understand the importance of safety and are trained to follow safety protocols. Regular meetings to review safety rules and discuss prevention can keep workplace safety top of mind.

2. Conduct Regular Risk Evaluations

Regular risk evaluations are crucial in identifying potential hazards. Appoint or nominate a safety captain who is empowered to communicate concerns identified by employees to leadership. This proactive approach ensures that risks are assessed and appropriate measures are taken to mitigate them.

3. Implement Comprehensive Safety Training

Safety training for their positions is essential for all employees. Training should be ongoing and evolve with new safety protocols and technologies. Employees who follow safety policies help keep everyone safe and can prevent work injuries by visiting areas where there’s a high risk for employee injury and ensuring that appropriate safety measures are in place.

4. Improve Workplace Ergonomics

Ergonomics plays a significant role in preventing workplace injuries, especially repetitive motion injuries. Improve workplace ergonomics and develop human performance by consulting with physical and occupational therapists. These professionals can help you screen candidates for physically demanding roles and aid in the return-to-work process for those recovering from injuries.

5. Keep the Workplace Clean and Organized

A messy workplace can lead to accidents and reduce productivity. Ensure that walkways are clear of clutter, cords are securely fastened, and tools are stored properly. Labels and signs can help maintain organization and remind employees of safety practices.

6. Use Labels and Signs Effectively

Labels and signs are simple steps to improve workplace safety. They provide quick, visual reminders of potential hazards and safety procedures. Ensure that these are up to-date and clearly visible in all necessary areas.

7. Provide the Right Tools and Equipment

A safe workplace has the right tools for the job. This includes personal protective equipment (PPE), ergonomic furniture, and safety guards on machinery. Regular maintenance and updates of equipment can also reduce workplace hazards .

8. Encourage Open Communication

It’s your responsibility to create an environment where employees feel comfortable reporting hazards right away and identifying potential areas of concern they may not have noticed. An open-door policy can help facilitate this communication.

9. Prepare for Emergencies

Have emergency plans in place, including evacuation routes, emergency contacts, and access to first aid. Regular drills can help ensure that, in the event of an emergency, everyone knows what to do.

10. Reward Safe Behavior

A way to encourage a strong workplace safety culture is to reward safe behavior. Recognize and reward employees and teams that exemplify safety protocols and contribute to preventing workplace accidents. This positive reinforcement can help keep safety processes at the forefront of everyone’s mind.

By implementing these strategies, businesses can end up not only protecting their employees but also improving overall morale and productivity. Remember, a safe workplace is a productive one, and the steps to improve workplace safety are usually simple and cost-effective. Take five minutes to stretch, report hazards right away, and always keep your workplace safe.

What is workplace safety?

Workplace safety refers to the measures and protocols put in place to protect employees and prevent accidents, injuries, and illnesses in the workplace.

Why is workplace safety important?

Workplace safety is important because it helps protect the well-being of employees, prevents workplace accidents and injuries, reduces healthcare costs, improves productivity, and ensures compliance with occupational safety and health regulations.

How can I improve workplace safety?

There are several effective strategies you can implement to improve workplace safety. These include creating and promoting a strong safety culture, providing adequate training to employees, conducting regular safety inspections, identifying and addressing potential hazards, encouraging open communication about safety concerns, and establishing clear safety protocols.

What is a safety culture?

Safety culture refers to the shared beliefs, attitudes, and values that prioritize safety in the workplace. It involves a commitment to safety from all levels of the organization and encourages employees to participate in promoting and maintaining a safe work environment actively.

How can I develop a safety culture?

To develop a safety culture, you can start by providing comprehensive safety training to all employees, involving them in safety decision-making processes, recognizing and rewarding safe behaviors, promoting open dialogue about safety concerns, and consistently reinforcing safety protocols and practices.

What is the role of the Occupational Safety and Health Administration (OSHA) in workplace safety?

The Occupational Safety and Health Administration (OSHA) is a regulatory agency that sets and enforces safety standards in the workplace. Their role is to ensure that employers provide a safe and healthy work environment for their employees by conducting inspections, issuing citations for safety violations , and providing educational resources and guidance on workplace safety.

How can I protect my employees from work-related hazards?

To protect your employees from work-related hazards, you can conduct regular risk assessments to identify potential hazards, implement appropriate safety measures and controls, provide personal protective equipment (PPE) when necessary, and ensure that all employees are properly trained on how to perform their job tasks safely.

What should I do if an employee is injured or falls ill at work?

If an employee is injured or falls ill at work, it is important to have proper protocols in place to respond promptly. This may include providing immediate medical care if necessary, documenting the incident, investigating the cause, and taking corrective actions to prevent similar incidents from occurring in the future.

How can I encourage employees to report safety concerns?

To encourage employees to report safety concerns, you can create a supportive and non-punitive reporting culture, ensure the confidentiality of reports, provide multiple reporting channels (e.g., anonymous hotlines, suggestion boxes), communicate the importance of reporting, and take prompt action to address reported concerns.

How can a safety program benefit my organization?

Implementing a safety program can benefit your organization in several ways. It can reduce workplace accidents and injuries, improve employee morale and retention, enhance productivity and efficiency, reduce costs associated with healthcare and Workers’ Compensation claims, and ensure compliance with occupational safety and health regulations.

Advancing social justice, promoting decent work ILO is a specialized agency of the United Nations

Topic portal

A safe and healthy working environment is a fundamental principle and right at work . Thus, all Members have an obligation arising from the very fact of membership in the ILO to respect, to promote and to realize, in good faith and in accordance with the ILO Constitution , the principles concerning this fundamental principle and right. Despite this important decision and the significant progress in occupational safety and health (OSH), work-related accidents and diseases still occur too frequently, with devastating impacts on workers, enterprises and entire communities and economies.

2.93 million

workers die each year as a result of work-related factors

395 million

workers worldwide sustain a non-fatal work injury each year

2.41 billion

workers are exposed to excessive heat each year

$361 billion

could be saved globally by implementing improved safety and health measures to prevent injuries from excessive heat in the workplace

An image showing lightning, a tractor, agricultural workers and pollution

Climate change and excessive heat

Impacts on occupational safety and health

Areas of Work

Biological Hazards
Chemical Hazards
Psychosocial Factors
Physical Hazards
National OSH Profiles, Policies and Programmes (coming soon)
Labour administration and Inspection
Occupational Safety and Health Management Systems
Guidelines on occupational safety and health management systems (ILO-OSH 2001)
Micro, Small and Medium-Sized Enterprises (MSMEs)
International Classification of Radiographs of Pneumoconioses
ILO List of Occupational Diseases (revised 2010)
Diagnostic and exposure criteria for occupational diseases - Guidance notes for diagnosis and prevention of the diseases in the ILO List of Occupational Diseases (revised 2010)
Gender
Young Workers

Development Cooperation

Safety + Health for All

The Programme mobilizes development cooperation resources to improve the safety and health of workers worldwide.

Sub programme - The Vision Zero Fund

Social safety nets

ILO/Japan Fund for Building Social Safety Nets in Asia and the Pacific (SSN Fund)

Advancing the Decent Work Agenda in North Africa (ADWA')

Normative instruments

Fundamental
General Scope
Risk-specific
Sector-specific
Codes of practice
The Occupational Safety and Health Convention (No. 155) and its Recommendation (No. 164)
The Promotional Framework for Occupational Safety and Health Convention (No. 187) and its Recommendation (No. 197)

More information

The Fundamental Conventions on Occupational Safety and Health
Understanding the ratification and implementation process of the fundamental Conventions on occupational safety and health
Protocol of 2002 to the Occupational Safety and Health Convention, 1981
Occupational Health Services Convention, 1985 (No. 161) and Recommendation, 1985 (No. 171)
List of Occupational Diseases Recommendation, 2002 (No. 194)
Protection of Workers' Health Recommendation, 1953 (No. 97)
Welfare Facilities Recommendation, 1956 (No. 102)
Radiation Protection Convention, 1960 (No. 115) and Recommendation, 1960 (No. 114)
Occupational Cancer Convention, 1974 (No. 139) and Recommendation, 1974 (No. 147)
Working Environment (Air Pollution, Noise and Vibration) Convention, 1977 (No. 148) and Recommendation, 1977 (No. 156)
Asbestos Convention, 1986 (No. 162) and Recommendation, 1986 (No. 172)
Chemicals Convention, 1990 (No. 170) and Recommendation, 1990 (No. 177)
Prevention of Major Industrial Accidents Convention, 1993 (No. 174) and Recommendation, 1993 (No. 181)
White Lead (Painting) Convention, 1921 (No. 13)
Guarding of Machinery Convention, 1963 (No. 119) and Recommendation, 1963 (No. 118)
Maximum Weight Convention, 1967 (No. 127) and Recommendation, 1967 (No. 128)
Benzene Convention, 1971 (No. 136) and Recommendation, 1971 (No. 144)
Anthrax Prevention Recommendation, 1919 (No. 3)
Lead Poisoning (Women and Children) Recommendation, 1919 (No. 4)
White Phosphorus Recommendation, 1919 (No. 6)
Hygiene (Commerce and Offices) Convention, 1964 (No. 120) and Recommendation, 1964 (No. 120)
Safety and Health in Construction Convention, 1988 (No. 167) and Recommendation, 1988 (No. 175)
Safety and Health in Mines Convention, 1995 (No. 176) and Recommendation, 1995 (No. 183)
Safety and Health in Agriculture Convention, 2001 (No. 184) and Recommendation, 2001 (No. 192)

Codes of practice by topic and sector

Publications

Resilient, Inclusive and Sustainable Supply Chains Asia (RISSC) in Thailand

A global review of the science, policy and practice

Heat at work: Implications for safety and health

Assessment of occupational safety and health qualification systems at the national level

ILO STAT - Statistics on Safety and Health at Work
INTEROSH - ILO Database on Occupational Safety and Health Agencies, Institutions and Organizations around the world
Encyclopaedia of Occupational Health and Safety
LEGOSH - Global database on occupational safety and health legislation
CISDOC - Archived bibliographic database
International Chemical Safety Cards (ICSCs)

Training Courses

The International Training Centre of the ILO (ITC-Turin) provides a variety of free and paid courses online and in-person courses related to occupational safety and health.

Ongoing and upcoming events

News and articles.

Request for proposals

Individual Consultant to compile the gap analysis on Botswana’s Occupational Safety and Health (OSH)

Strengthening Social Compliance in Indonesia’s Palm Oil Sector Project

Consultant for Research on Global Social Compliance Tools

Global Strategy on Occupational Safety and Health 2024-2030 and plan of action for its implementation

Following the inclusion of a safe and healthy working environment as a fundamental principle and right at work, the ILO Governing Body endorsed the Global Strategy on Occupational Safety and health 2024-2030 and plan of action for its implementation.

Contact the Occupational Safety and Health and Working Environment Branch (OSHE) for more information.

You may also be interested in

Chemical Safety and the Environment

Annex to the Promotional Framework for Occupational Safety and Health Recommendation, 2006 (No. 197)

Instruments relevant to the Promotional Framework for Occupational Safety and Health

ILO Conventions and Recommendations in the field of Chemical Safety

ILO indicators of progress in implementing SAICM

Research Policy Handbook

Health and Safety: Principles, Responsibilities and Practices

Policy authority.

University Committee on Health and Safety

Operations Council

University Cabinet

Policy Contact

Now in Policy Details

This manual provides information about policies, procedures, and guidelines related to health and safety at Stanford. Topics covered include responsibilities, services provided by the Department of Environmental Health and Safety (EH&S), a variety of topics related to workplace safety (e.g. asbestos, ergonomics), the management of hazardous materials, and how to prevent and handle emergencies.

1. Principles

Safety is a core value at Stanford and the University is committed to continued advancement of an institutional safety culture with strong programs of personal safety, accident and injury prevention, wellness promotion, and compliance with applicable environmental and health and safety laws and regulations.

Stanford University makes all reasonable efforts to:

Promote occupational and personal safety, health and wellness;
Protect the health and safety of Stanford University faculty, staff and students;
Provide information to faculty, staff, and students about health and safety hazards;
Identify and correct health and safety hazards and encourage faculty, staff, and students to report potential hazards;
Conduct activities in a manner protective of the environment, and inform the Stanford community regarding environmental impacts associated with institutional operations; and
Maintain a risk-based emergency management program to reduce the impact of emergency events to the Stanford community.

2. Responsibilities

Adherence to good health and safety practices and compliance with applicable health and safety regulations are a responsibility of all faculty, staff, and students. Line responsibility for good health and safety practice begins with the supervisor in the workplace, laboratory or classroom and proceeds upward through the levels of management. For detailed guidance on individual safety responsibilities under Cal/OSHA, refer to the University’s Illness and Injury Prevention Program (IIPP) .

In academic areas, supervisors include faculty/principal investigators, laboratory directors, class instructors, or others having direct supervisory and/or oversight authority. Academic levels of management are the department chairperson or Independent Lab director, dean, the Dean of Research, and the Provost. Administrative levels of management include managers, directors, and vice presidents. Final responsibility for health and safety policy and programs rests with the President of the University.

The Associate Vice Provost for EH&S and the University Committee on Health and Safety are responsible for recommending University-wide health and safety policies to the President.

The Associate Vice Provost for EH&S is responsible for ensuring overall institutional compliance with applicable policies, statutes, and regulations; monitoring the effectiveness of the safety programs; and providing central health and safety services and support to all areas of the University.

A. Supervisory Responsibilities

University supervisors, including faculty supervisors and Principal Investigators (PIs), are responsible for protecting the health and safety of employees, students and visitors working under their direction or supervision. This responsibility entails:

Being current with and implementing Stanford University health and safety policies, practices and programs;
Ensuring that workplaces, including laboratories, and equipment are safe and well maintained;
Ensuring that workplaces or laboratories are in compliance with Stanford policies, programs and practices, and
Ensuring that employees, students and visitors under their supervision or within their work areas have been provided with appropriate safety training and information, and adhere to established safety practices and requirements.

B. Managerial Responsibilities

University managers, academic and administrative, are responsible for ensuring that:

Individuals under their management have the authority to implement appropriate health and safety policies, practices and programs;
Areas under their management have adequate resources for health and safety programs, practices, and equipment; and
Areas under their management are in compliance with Stanford University health and safety policies, practices and programs.

C. Environmental Health and Safety Responsibilities

Environmental Health and Safety (EH&S) is responsible for:

Reviewing legislation, recommending policies, and monitoring compliance with environmental and health and safety statutes and regulations and University health and safety policies and programs;
Developing institutional safety and compliance programs and assisting schools, departments, faculty, and managers with implementation
Providing guidance and technical assistance to supervisors and managers in the schools, departments, and other work units in identifying, evaluating, and correcting health and safety hazards;
Developing programs for the safe use of hazardous radiological, biological, and chemical substances and lasers;
Providing training materials, assistance, and programs in safe work practices;
Providing guidance on effective emergency management and business continuity programs, and providing emergency response services for incidents involving hazardous materials;
Providing fire prevention, inspection, engineering and systems maintenance services; and
Hazardous waste management and disposal services.

While EH&S is responsible for developing and recommending relevant health and safety policies, institutional policy approval rests with other University authorities,(e.g., President, Provost, Vice Provost and Dean of Research, Faculty Senate, University Cabinet, University Committee on Health and Safety, Committee on Research, Administrative Panels for Research Oversight, etc.) depending on the content of the proposed policies.

D. Faculty, Staff, and Student Responsibilities

Faculty, staff and students are responsible for:

Keeping themselves informed of conditions affecting their health and safety;
Participating in safety training programs as required by Stanford policy and their supervisors and instructors;
Adhering to health and safety practices in their workplace, classroom, laboratory and student campus residences; Advising of or reporting to supervisors, instructors or EH&S potentially unsafe practices or serious hazards in the workplace, classroom or laboratory.

E. Safety Performance

Each individual at Stanford is expected to perform all work safely. Managers and supervisors shall establish and maintain a system of positive reinforcement and escalated discipline to support good health and safety practices. Safety performance shall be a part of every individual’s role and responsibility as well as performance expectation and evaluation.

3. Providing a Safe Workplace

Stanford's program for providing a safe workplace for faculty, staff and students includes: facility design; hazard identification, workplace inspection and corrective action; shutdown of dangerous activities; medical surveillance: and emergency preparedness. In addition to this general institutional health and safety policy, additional hazard specific policies and requirements may apply to different work and learning environments at Stanford and will be found in the Research Policy Handbook and at the EH&S Website.

A. Facility Design

Facilities will be designed in a manner consistent with health and safety regulations and standards of good design. Those University departments charged with primary responsibility for the design, construction, and/or renovation of facilities, together with EH&S shall ensure that there is appropriate health and safety review of facility concepts, designs, and plans.

In case of disagreement between EH&S and the cognizant facilities department, the conflict shall be resolved by the Vice Provost and Dean of Research in consultation with the cognizant vice president or dean and the Provost (or designate). The determination of the Vice Provost and Dean of Research may be stayed by the Associate Vice Provost for EH&S pending a prompt appeal to the President.

B. Hazard Identification and Correction

Stanford University encourages employees and students to report health and safety hazards to their supervisors, managers, or EH&S. Employees and students shall not be discriminated against in any manner for bona fide reporting of health and safety hazards to Stanford or to appropriate governmental agencies. Supervisors shall inform students and employees of this policy and encourage reporting of workplace hazards.

Supervisors, both faculty and staff, shall assure that regular, periodic inspections of workplaces are conducted to identify and evaluate workplace hazards and unsafe work practices.

The frequency of inspections should be proportional to the magnitude of risk posed in the particular workplace.
Means of correcting discovered hazards and/or protecting individuals from the hazards shall be determined and implemented appropriately.
Unsafe conditions which cannot be corrected by the supervisor or manager must be reported to the next higher level of management. Any individual, supervisor or manager who becomes aware of a serious concealed danger to the health or safety of individuals shall report this danger promptly to the Department of EH&S and to the faculty, staff and students who may be affected.

C. Shutdown of Dangerous Activities

The Associate Vice Provost for EH&S has the authority to curtail or shut down any University activity considered to constitute a clear and imminent danger to health or safety. In the event of such curtailment or shutdown, the cognizant dean, director or vice president and the Provost (or designate) shall be immediately notified.

In cases of dispute, an order to curtail or shutdown will remain in effect until the Provost or the Vice Provost and Dean of Research (or their respective designates) determine in writing that the danger has passed or been mitigated or that the order should be rescinded for other reasons.

Should the Associate Vice Provost for EH&S disagree with a determination to restore a curtailed or shutdown activity, the Associate Vice Provost for EH&S may promptly appeal the matter to the President. In the event of an appeal, the order to curtail or shutdown shall be in effect until the President determines otherwise.

D. Providing Medical Surveillance

Stanford University shall evaluate and monitor, through a program of medical surveillance, the health of Stanford University faculty, staff and students who are exposed to certain hazardous materials and situations as defined by law or University policy. Each supervisor is responsible for ensuring that employees and students under their supervision participate in the medical surveillance program as required by University policy. EH&S will monitor medical surveillance program participation. Each University department/school shall administer the program for faculty, staff and students covered by University policy.

E. Emergency Response and Preparedness

EH&S coordinates overall emergency response planning for the institution and provides guidelines for departmental emergency response plans. Every department shall have an individual emergency response plan and shall develop business continuity and contingency plans and implement appropriate mitigation programs to reduce the impact of emergency events.

Schools and departments shall maintain local departmental emergency operations centers and communications capabilities according to guidelines in the campus emergency plan. Multiple departments located within individual buildings will jointly develop comprehensive building-based life safety response plans.

Emergency plans shall include evacuation and assembly procedures, posted evacuation maps, reporting and communication practices, training, and drills.

4. Safety Communication and Training

Safety and compliance required training shall be communicated in a manner readily understandable to faculty, staff and students, in accordance with the communication policy outlined below.

A. Systems of Communication

Managers and supervisors, both faculty and staff, shall establish, implement and maintain a system for communicating with employees and students about health and safety matters. Information should be presented in a manner readily understood by the affected employees and students. Due attention must be paid to levels of literacy and language barriers. Verbal communications should be supplemented with written materials or postings if appropriate. Whenever appropriate, statutes and policies affecting employees and students shall be available in the workplaces.

B. Communication About Hazards

Faculty, staff, and students who may come in contact with hazardous substances or practices either in the workplace or in laboratories shall be provided information concerning the particular hazards which may be posed, and the methods by which they may deal with such hazards in a safe and healthful manner. In areas where hazardous chemicals or physical agents are used, handled, or stored, communication about these hazards shall conform to the Research Policy Handbook EH&S Requirements for laboratory facilities and the Hazard Communication Program for all other campus workplaces.

C. Training

Supervisors, including faculty, shall be experienced, trained or knowledgeable in the safety and health hazards to which employees and students under their immediate direction and control may be exposed, and shall be knowledgeable of current practices and safety requirements in their field.

Faculty, staff and students shall have or be provided the knowledge to protect themselves from hazards in their working and learning environment. Supervisors, both faculty and staff, shall ensure that employees and students have received appropriate training and information regarding:

General health and safety practices of the workplace or laboratory, including emergency procedures;
Job-specific health and safety practices and hazards;
Recognition and assessment of health and safety risks; and,
How to minimize risks through sound safety practices and use of protective equipment; and,
Awareness of appropriate practices to protect the environment.

Training shall occur when:

An employee is hired or student is new to the laboratory;
An employee or student is given a new assignment for which training has not previously been received; and
New hazards are introduced by new substances, processes or equipment.

Faculty, staff and students should, periodically, be retrained or demonstrate an understanding of current standard safety practices and requirements for their areas.

5. Documentation and Recordkeeping

Documentation and records as required by regulation shall be kept to demonstrate compliance with applicable statutes, regulations and policies. Requirements and procedures for such recordkeeping can be found in the Research Policy Handbook and at the EH&S website.

Current Version: 10.01.12

Original Version: 04.01.91

Essay on Good Health And Well Being

Students are often asked to write an essay on Good Health And Well Being in their schools and colleges. And if you’re also looking for the same, we have created 100-word, 250-word, and 500-word essays on the topic.

Let’s take a look…

100 Words Essay on Good Health And Well Being

Importance of good health.

Good health is like a treasure. When we are healthy, we can play, learn, and enjoy life. It means our body is working well, and we feel good. To stay healthy, eating fruits and vegetables, drinking water, and sleeping enough is important.

Exercise for Fitness

Moving our bodies makes us strong and fit. Playing sports, dancing, or even walking are great exercises. They keep our heart healthy and muscles strong. Exercise also makes us feel happy by releasing special chemicals in our brain.

Mental Health Matters

Being healthy is not just about the body but also the mind. Talking about feelings, being kind, and having fun with friends keep our mind healthy. It’s important to relax and not worry too much.

Preventing Sickness

Staying away from germs helps us not get sick. Washing hands, keeping clean, and getting vaccines are ways to fight germs. When we don’t feel well, seeing a doctor is a good idea to get better.

250 Words Essay on Good Health And Well Being

What is good health.

Good health means your body is working as it should, without any pain or illness. When you have good health, you can run, jump, play, and do all your school work without feeling tired or sick. It’s like a well-oiled machine that runs smoothly.

Why is Well Being Important?

Well being is about feeling happy and calm in your mind. It’s just as important as having a strong body. When your well being is taken care of, you can make friends, learn new things, and handle stress better.

Eating Right for Health

To stay healthy, you need to eat all kinds of foods like fruits, vegetables, grains, proteins, and dairy. Imagine your plate as a rainbow, with lots of different colors. Each color gives you different vitamins and minerals to keep you healthy.

Staying Active

Our bodies are made to move. Playing sports, dancing, or just walking your dog are great ways to stay active. When you move, your heart gets stronger and you can concentrate better in class.

Resting Well

Sleep is just as important as food and exercise. When you sleep, your body fixes any damage and gets ready for a new day. Try to get 8-10 hours of sleep each night.

Keeping a Happy Mind

Good health and well being are about balancing eating right, staying active, resting well, and keeping a happy mind. When all these pieces fit together, you can play, learn, and grow every day.

500 Words Essay on Good Health And Well Being

Good health means your body is working as it should, without any pain or sickness. When you have good health, you can play, work, and learn better. Imagine a car that runs smoothly because all its parts are in top shape. Your body is just like that car. When all parts of your body are in good condition, you feel great and are ready to take on the world.

Why is Good Health Important?

Eating right.

Eating right is like putting the best fuel in a car. Fruits, vegetables, grains, protein, and dairy products are all good for you. They give you the energy to run, think, and do all the things you love. Eating too much junk food is like putting sand in your car’s gas tank. It can make you feel tired and can lead to sickness.

Being active is another way to keep your body in good shape. Think of it as taking your car for a drive instead of leaving it in the garage all the time. When you run, play sports, or dance, you make your muscles stronger and your heart happy. Exercise can also make you feel happier because it releases chemicals in your brain that make you feel good.

Rest and Relaxation

Staying clean.

Keeping your body clean is like keeping your car shiny and free of dirt. Bathing, brushing your teeth, and washing your hands can keep germs away. Germs are tiny bugs that can make you sick, so it’s important to stay clean to keep them at bay.

Seeing the Doctor

Going to the doctor is like taking your car for a check-up. The doctor makes sure everything is working right and can help prevent sickness or catch it early when it’s easier to treat. Getting vaccinated is one way doctors help protect you from serious illnesses.

Good health is not just about your body but also about your feelings and thoughts. Talking about your feelings, staying positive, and spending time with friends and family can keep your mind healthy. Just like your body, your mind needs to be taken care of to feel good.

Good health and well-being are like a treasure that helps you live a happy and full life. By eating right, staying active, getting enough rest, keeping clean, seeing the doctor, and taking care of your feelings, you can keep this treasure shining. Remember, taking care of your health is one of the most important things you can do every day!

That’s it! I hope the essay helped you.

If you’re looking for more, here are essays on other interesting topics:

Happy studying!

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Improving patient safety culture – a practical guide

Safety culture can appear nebulous and it can be unclear how to improve it or indeed how the shift occurs. This has led to a broad number of approaches which are associated with improvements in safety culture but are not always successful when they are used in similar or different contexts. In considering the safety culture of where we work we often separate out ‘what’ work we do from ‘how’ we work. This can lead to a disconnect and lead to ‘how’ we work not transferring into the ‘what’ we do.

By considering the ‘what’ and the ‘how’ as two intertwined threads where each is necessary to provide a strong team, we can see that unless we give them equal attention the overall strength of it will weaken.

We hope that this ‘toolkit’ will give teams an understanding of how to craft, create and nurture a positive safety culture and provide a theoretical underpinning to how to shift the culture.

This is the first in a series of safety culture toolkit pieces. We are still learning how to do this, and we invite you to share your experiences of using the toolkit and share what has or hasn’t worked, but most importantly share the ‘how’ of what has made a difference in your teams. This will shape the future work.

We want to work with you to shape this ‘toolkit’ and to learn together to understand how we can make positive changes to our NHS culture.

Dr Matt Hill , National Clinical Advisor, NHS England.

Changing culture takes concerted effort and time and we all need a bit of help along the way. The Improving Patient Safety Culture toolkit provides us with that help. No matter what your job or role is in healthcare this toolkit applies to you.

The toolkit is not a recipe, rather a menu of ingredients and a toolbox to help the reader create a personalised strategy. Like any recipe there are some ingredients that provide the foundation for the rest; a positive approach to safety, a restorative just culture, psychological safety, inclusivity and civility.

Each of these while important on their own when combined can help build the momentum we are seeking, and to spread a positive patient safety culture throughout the NHS.

This toolkit will help you get on the front foot, learn from what works and what doesn’t, and be far more proactive. Desmond Tutu is quoted as saying ‘there comes a point where we need to stop just pulling people out of the river. Some of us need to go upstream and find out why they are falling in’. This toolkit will help you do just that.

Professor Suzette Woodward .

Introduction

Safety culture has been a key and recurring theme in reports where there has been poor care ( Francis Report ; Morecambe Bay ; East Kent ; and Ockenden Report ) and its importance highlighted in responses ( Berwick Review ; Response to Winterbourne View) .

Its ubiquity has hampered our understanding of what it is, and it has become apparent that it means different things to different people, and at different hierarchical levels. Without a common understanding of what we perceive safety culture to be, it is difficult to understand how to create a positive shift.

The nebulous nature of culture and focusing on where the culture is less positive have not allowed us to consider what we are trying to achieve in focusing on it.

Taking an appreciative approach:

“A positive safety culture is one where the environment is collaboratively crafted, created and nurtured so that everybody (individuals, teams, patients, service users, families and carers) can flourish to ensure brilliant safe care.”

Prof Seligman on PERMA – YouTube

The NHS Patient Safety Strategy starts to explore how culture is crafted where the “importance of individuals day-to-day behaviour” and how we interact with each other in the moment is increasingly recognised as creating the local culture. These local relational interactions are complex and we do not routinely consider how we are working alongside what work we are doing. Understanding the complexity in these interactions and considering culture as a dynamic social construct can give us useful insight into how interventions which are associated with improvement in culture have their effect, and why they may not work in different contexts.

How does culture shift?

Seeing culture as a dynamic social construct focuses our attention on to our interactions with those in our team and other teams. This emphasises the importance of how we create the space to optimise the relational aspects of the work. In structured parts of work we have traditionally focused on, and measured, process metrics e.g. that teams are meeting, who is there and how long it takes, and not considered the quality of how we work together. It is often only when outcomes are poor or relationships break down that we try to understand how a team is working together.

When we consider how we can influence these social interactions and amplify the relational opportunities there are three elements:

Space/time: We need to create time for teams to come together. These may be structured parts of the working day (eg briefings, huddles, ward rounds) or more informal (e.g. coffee room, corridor conversations, cafe).

What we talk about: We will pay attention to the aspects of work that we talk about and in doing so, what we value becomes explicit. By focusing on the balance between how we ensure brilliant and safe care and what the individuals and team need to flourish allows teams to consider how work is sustainable. There is a ripple effect from these conversations into others as teams make sense of their work.

How we talk and work together: The “values based enactment” of how we speak and behave towards each other is crucial in crafting the conditions where we can all flourish and ensure brilliant care. To do this, we need to routinely reflect as a team on how we are working together, and invite and value the perspectives of others within the team to understand how each of us feels and the impact that our behaviour has on others. In doing so we can create the conditions where we all feel included, invited to contribute, safe to speak up and that our contributions will be explicitly valued and appreciated.

Recent research by Dr Nicola Mackintosh et al found that the:

“Fidelity of function of interventions is linked as much to the supporting social structures as the form of the intervention itself.”

This focuses our thoughts on the social connectedness, peer learning and the importance of the relations between members .

As you use the tools within this toolkit we encourage you to focus on ‘how’ the practices and interventions are done and consider the relational elements of the work and the extent to which they embody positive values, alongside the practices and interventions that you use in your teams.

What are the key elements of positive safety culture?

All of these are valuable approaches to shifting the culture but we are starting the toolkit with those in bold.

We explore how we can craft, create and nurture the conditions (in alignment with the People Promise ) to support the key elements of a positive safety culture :

Individuals and team flourishing

Communication
Just culture

Psychological safety

Promoting diversity and inclusive behaviours.

Staff well being
Organisational development

Brilliant, safe care and experience

Continuous learning and improvement
Safety I and Safety II
Learning from excellence
National Patient Safety Improvement Programmes
Appreciative inquiry
Patient centred collaboration

Teamwork and communication

What is it.

Teamwork in healthcare can be thought of as two or more people interacting to deliver safe, high quality care, wherever that is be it in primary care, social care, mental health or acute hospitals. Good communication is essential to this. It should be open, respectful, honest, two-way and inclusive across disciplines and professional groups. Good communication is also about curiosity and seeking to understand the perspectives of others.

Why is it important?

A breakdown in communication between healthcare staff has been identified as the most common cause of safety problems. When communication in teams is poor, it’s easy to feel your colleagues are being uncooperative, that your voice isn’t being heard, and that you aren’t being valued. But when teamwork and communication is good, you feel that you’re listened to and that concerns you raise about safety are quickly dealt with. Team members feel motivated and empowered to put forward safety ideas to the team and get them sorted.

What does good look like?

Professor Amy Edmondson has studied what “good” looks like when people come together to work as a team, often for the first time. She calls this ‘teaming’ and describes four steps to do it well (see Top Tips below), which are particularly helpful if you’re working in constantly changing teams. The approach helps break down silos and creates opportunities to develop new solutions for complex problems.

Working together as a team

Adapted from Extreme Teaming: How to Deliver Integrated Care

Aim high : set a clear, ambitious, compelling, meaningful vision which inspires people by focusing on the things that matter to the team

Team up : value the diversity of the team as this will lead to a greater ability to achieve breakthroughs

Fail well : identify opportunities for intelligent failures that provide information on how to improve approaches and systems next time round

Learn fast : maximise learning from mistakes – apply focus, discipline and structure when reviewing them.

Safety culture discussion cards

Having informal conversations with colleagues about safety and risk within services is a great place to start. The NHS Scotland safety culture discussion cards , originally developed by Steven Shorrock, are a great resource.

Remember, receiving feedback is hard for anyone if it feels negative. Taking a positive approach to giving feedback to colleagues, delivered empathetically, helps to reduce anxiety and contributes to a continuous learning cycle.

Taking a structured approach to the communication of safety-critical information (tools such as SBAR – the Situation, Background, Assessment, Recommendation ) in specific circumstances can be helpful, but imposing a structure in all circumstances may not always be the right approach.

Approaches like safety huddles – regularly scheduled, short meetings to discuss safety – can be an effective way to communicate key information, improve cohesion, build relationships and reinforce shared values and purpose.

Case study: Huddling up for safer healthcare – Yorkshire and Humber AHSN

Yorkshire and Humber Patient Safety Collaborative’s ‘ Huddle Up for Safer Healthcare ’ (HUSH) programme supports and coaches frontline teams to implement safety huddles and deliver sustained improvements in care.

A safety huddle is a short, multidisciplinary briefing, held at a predictable time and place, and focused on the patients most at risk. Effective safety huddles involve agreed actions, are informed by visual feedback of data and provide the opportunity to celebrate success in reducing harm.

The original HUSH focus was falls prevention, and has stopped more than 6,000 falls happening, equating to an estimated £15 million in avoided healthcare costs.

From its work helping teams address their safety priorities, the Patient Safety Collaborative now has evidence of effectiveness in addressing pressure ulcers, deteriorating patients, nutrition and hydration; and for mental health teams, seclusion, self-harm and violence and aggression.

Hear more about safety huddles in Yorkshire and Humber on the Improvement Acadamy YouTube channel .

Top tips:

Conducting safety huddles.

Taken from the Culture Change Toolbox :

Identify a team or small group of staff that is willing to try something new. Host a trial safety huddle during one shift.
Start by explaining the purpose of the huddle. Consider how we optimise care by discussing safety concerns of the past, present and future and examples of excellent care as well. Emphasise that it’s about learning and improving safety, not about blame.
Think about some example issues to bring up at the first huddle. At first, it might not be clear to everyone what sort of topics they can talk about.
Keep it short . Five minutes is reasonable.
Thank everyone for their participation and be clear about next steps. Will someone follow up on the issues raised? Will there be another huddle? What changes can we make to the structure of the huddle to make it more effective?
Adjust the structure of the huddle using this first group, then expand to have them more often or with more staff. Aim to include all team members eventually and determine how often you would like to hold safety huddles in your work area.
Be transparent with follow-up. Share the outcomes of the huddle using email, meetings, posters or personal conversations. Acting on the information shared during safety huddles sends a powerful message that safety matters.
Invite other team members to host them once the huddles happen regularly, so that they can take place without requiring the original facilitator.

Three change ideas to try:

Use structured feedback.

Space/time: This can be done throughout our work and can be very quick to do, and have a big effect. Especially if it is positive feedback that is being shared.

What: Feedback is a key ingredient of the learning cycle. Give each other positive feedback, and the reasons why. Use a structured approach to giving constructive feedback, such as the Situation, Behaviour, Impact (SBI) approach: eg Situation: ‘When you were with that patient/relative/colleague in the…’ This needs to be a specific context. Behaviour: ‘I noticed that you did… ‘ This needs to describe what you observed without being judgemental. Impact: ‘It had a real impact on me and made me feel… ‘ ‘I noticed how the patient/relative/colleague responded to you and I noticed that they did… ’

How: Think kindly about the other person and, with respect and care, give them a clear description of what you observed at each stage of the feedback.

Teach or treat: This is from the Each Baby Counts group

Space/time: These learning conversations can occur at any time when clinical concerns are escalated or another opinion is sought.

What: When a concern about a patient/service user is raised the response from the senior member of staff is framed as either Teach or Treat. If the senior member of staff is happy with the current management then they can respectfully explain their rationale so that each is clear about the other’s perceptions. If they believe that new treatment is required then this can be taken in a timely fashion.

How: This encourages staff to have a ‘respectful, learning conversation’ at times of escalation. This flattens the hierarchy and supports team members to feel that they have been heard and their contribution valued. This helps to support learning and mutual trust through enhanced relationships.

Initiate safety huddles

Use resources including the “Yorkshire Safety Huddles Manual” to initiate safety huddles, starting with a single team.

Space: Create a time in the day when safety huddles can occur.

What: Any aspect that affects safety can be discussed. Consider the importance of the conversation in developing the social relationships between team members, as well as what is discussed.

How: Starting with everyone introducing themselves (even if we think we know everyone) flattens the social hierarchy and makes it more likely that everyone will feel able to speak later and contribute to the huddle and allow all forms of expertise to be valued and heard.

Read about the Innovation Agency’s Coaching for Culture programme , which included accredited coaching training for team leaders, use of a team culture diagnostic, and use of practical quality improvement (QI) skills to support the development of safe, high-quality, and compassionate services in the North West.

Just and restorative culture

A just culture is about creating a culture of fairness, transparency and learning. It recognises that success or mistakes are the product of many factors and focuses on changing systems and processes to make it easier for people to do their jobs safely. It is about ensuring everyone is confident they will be treated fairly when something goes wrong.

NHS Resolution develop this idea further by saying that “ What we need is a restorative just culture (Dekker, 2018) that is about repairing and building trust and relationships when things have not gone as planned. This means we need to develop working practices that move people away from fear and blame, including tackling incivility and bullying, and addressing the health and wellbeing needs for staff to help them work safely. Ensure everyone’s needs are met, no matter who they are. Treat everyone fairly, no matter what their background is, and help them speak up.” ( Being Fair, NHS Resolution )

Sydney Dekker described a restorative culture as one that looks to the future by exploring what needs to be done and who should do it. There are three questions:

Who is hurt?
What do they need?
Whose obligation is that?

“A just and learning culture is the balance of fairness, justice, learning – and taking responsibility for actions. It is not about seeking to blame the individuals involved when care in the NHS goes wrong. It is also not about an absence of responsibility and accountability.”

Being Fair, NHS Resolution

Underpinning this approach are the practical applications taken in Being Open and the subsequent Duty of Candour publications.

Shifting to this approach is not just about using the NHS Just Culture Guide but is a wholesale shift of approach, supported by the Patient Safety Incident Response Framework (PSIRF) – “a system designed for safety and learning rather than performance management”.

Importantly it is recognised in PSIRF that the NHS Just Culture Guide is:

Used only when there is reason to believe the deliberately malicious, negligent or incompetent actions or decisions of an individual contributed to an incident, and not routinely whenever an incident is reported or a Patient Safety Incident Investigation is conducted.
Managed completely separately from any activity to examine an incident for the purposes of learning and improvement.

The use of the NHS Just Culture Guide in these situations will also help to “reduce the role of unconscious bias when making decisions and will help ensure all individuals are treated equally and fairly no matter what their staff group, profession or background. This has similarities with the approach being taken by a number of NHS trusts to reduce disproportionate disciplinary action against black, Asian and minority ethnic staff.

Case study: Duty of candour community of practice – Health Innovation Network South London

Duty of candour is a statutory requirement in the NHS when a patient experiences harm while receiving healthcare. It ensures patients and staff understand how things may have gone wrong and reassures everyone involved that lessons have been learned.

The Health Innovation Network South London created a community of practice (CoP) to support staff to share and learn best practice when dealing with difficult situations. The community brings clinicians, managers and patient groups together. It has created a set of generic training materials that are used across the area, promoting consistency and tackling difficult aspects of Duty of Candour, such as how practitioners say sorry to patients when things go wrong.

The CoP is still going strong and has proved an effective forum for sharing concerns and making decisions. There is a genuine passion from the professionals who attend about sharing their experiences and effecting positive change within their organisations.

Find out more information on the Health Innovation Network South London website .

Case study: Supporting team health: A simple framework and a tale of three teams

Jo Davidson, Associate Director Organisational Effectiveness and Learning and Melissa Holt, Strategic Organisational Effectiveness Lead.

More than two years responding to COVID has reinforced the significance that great teamwork has on both staff wellbeing and the safety, quality and experience of care they provide. NHS organisations are full of people caring for others but what happens when those teams, become stuck in conflict, toxicity or resistance to change? These sorts of comments are not common to any one organisation, the experiences by these teams are all to common across the health service.

This piece tells the story of three such teams, brought back to health with the use of a simple tool – The Mersey Care “Team Canvas”, and how that tool has been used to facilitate team health and culture across the Trust. It includes how it has been designed and implemented to integrate with our clinical assessment, improvement and accreditation processes which enables us to track and measure improvement and demonstrate the impact not just to our colleagues, but importantly to our patients.

This excerpt provides detail in relation to just one of the OD interventions that have been designed and developed to support a Restorative, Just and Learning Culture at Mersey Care NHSFT, all of which are described within the recent publication of ‘ Restorative, Just Culture in Practice ’.

“Managers don’t trust us, we’re closest to the patients and yet when we put ideas forward, no one listens, we’re the bottom of the pile” Team A

“In this team I’ve lost my confidence and any sense of feeling valuable or valued” Team B

“Changes are not discussed. They are dictated, regimented and we are told – not asked” Team C

1. Consider how to adapt and use the Just and Learning Culture Charter in NHS Resolution ‘Being Fair’:

Space/time: Use a team meeting to discuss what a just and learning culture means to your team, and what their experiences have been. The shift to a just and learning culture requires a continuous approach that is anchored in the elements of a Just and Learning Culture Charter. The key purposes of transparency, fairness, learning are underpinned by the principle that patients and families involved in a patient safety incident need to be looked after and have their questions answered.

What: In the discussion ask what the people’s experiences have been when things have gone wrong and how they felt and how they thought it was for the patient and families. There is a need for a shift in the language that we use and the approach to incidents that focus on the learning – what happened not who was involved.

How: Consider how to involve everyone in the discussion so that all the perspectives are heard and the process supports the principles of openness, honesty and transparency.

2. Recognise staff as the victims of unsafe systems too:

Staff who are involved in an unanticipated adverse patient event, caused by systemic issues, including human factors, can be traumatised by the event.

Resources to support second victims are available through the Improvement Academy’s dedicated Second Victim Support website.

3. Use the NHS Just Culture Guide:

This is a way to ensure that everyone is treated fairly in the event of an incident of harm. The NHS Just Culture Guide is a tool to support individuals to treat staff fairly, consistently and constructively if they have been involved in a patient safety incident and to help to prevent unconscious biases.

Psychological safety was first described by Amy Edmondson who defined it as:

“A shared belief held by members of a team that the team is safe for interpersonal risk taking.”

It describes the ability of members of a group to feel free to speak up, ask questions, report errors, raise concerns and ask for feedback without fearing the consequences and being judged. We learn early in life about making mistakes and the feelings of embarrassment and awkwardness it provokes. As adults we naturally avoid these awkward situations. When discussing safety, it’s important to create conditions in which we feel safe to take what can feel like personal risk, saying for example, “I made a mistake” or ‘this didn’t go as planned”, without fear of judgement.

Psychological safety in a team does not happen by chance – it needs to be actively created and nurtured. The feeling of inclusivity and trust are key to crafting the conditions where diversity of thought in ethnicity, gender and age is welcomed and valued as it leads to a more complete picture and better care.

It does not mean that we will always agree and that teams will be free from conflict, but that by feeling valued we can all contribute our ideas to a find a better solution.

In the book The Four Stages of Psychological Safety , Timothy Clarke describes how teams move through each stage:

Stage 1 Inclusion Safety: Team members, whatever their age, sexuality, ethnicity or race, feel that they are included and valued and that they are appreciated by the team.

Stage 2 Learner Safety: Team members are able to admit that they don’t know things and are able to ask questions and start to try new things.

Stage 3 Contributor Safety: Team members are able to voice their own ideas without fear of being ridiculed or embarrassed. Stage 4 Challenger Safety: Team members are able to question the thoughts of others in the team including those with power.

In ‘The Fearless Organisation’, Amy Edmondson describes three ways to help to create psychological safety in healthcare .

Set the stage

Set expectations about failure, uncertainty and interdependence to clarify the need for voice
Identify what’s at stake
Why it matters
For whom it matters
Shared expectations and meaning

Inviting participation

Acknowledge gaps
Ask good questions
Model intense listening
Create forums for input
Provide guidelines for discussion
Confidence that voice is welcome

Responding productively

Acknowledge
Thank people
Look forward
Discuss, consider and brainstorm next steps
Sanction clear violations
Orientation toward continuous learning
Try using a survey to measure psychological safety in your team to understand and then discuss the different perceptions within the team.
Leaders and team members sharing their stories about when things went wrong for them, and what they learnt.
National Staff Survey and National Quarterly Pulse Survey results are available on the Model Health System – start a discussion about the team’s results.

Consider using the King’s Fund ABC (Autonomy, Belonging and Contribution) Framework which links the questions to these topics. This is a good way to start a conversation about the results.

Psychological Safety Survey

If you make a mistake in this team, it is often held against you.
Members of this team are able to bring up problems and tough issues.
People on this team sometimes reject others for being different.
It is safe to take a risk on this team.
It is difficult to ask other members of this team for help.
No one on this team would deliberately act in a way that undermines my efforts.
Working with members of this team, my unique skills and talents are valued and utilised.

Amy Edmondson. The Fearless Organization. Wiley, 2019

The NHS People Plan states that:

“The NHS was established on the principles of social justice and equity. In many ways, it is the nation’s social conscience, but the treatment of our colleagues from minority groups falls short far too often. Not addressing this limits our collective potential. It prevents the NHS from achieving excellence in healthcare, from identifying and using our best talent, from closing the gap on health inequalities, and from achieving the service changes that are needed to improve population health.”

Inclusion is the degree to which a person perceives that they are an esteemed member of the work group through experiencing treatment that satisfies their needs for belongingness and uniqueness. Team environments that promote inclusivity and psychological safety of their members usually achieve the best patient safety outcomes. Such teams model behaviours characterised by civility, inclusivity, trust, respect and professional courtesy. They offer team members the chance to thrive and be themselves and foster diversity, equality and fairness. Such environments value and encourage continuous input from patients, carers and families into the design and delivery of their services.

There is strong evidence that where an NHS workforce is representative of the community that it serves, patient care and the overall patient experience is more personalised and improves. Yet it is also clear that in some parts of the NHS, the way a patient or member of staff looks can determine how they are treated. Undermining, humiliating and discriminating behaviours increase fear and decrease team psychological safety and learning. Celebrating difference and diversity in all forms stimulates learning and creativity, if harnessed in the right way. Civility between health and care staff in the work environment matters because it reduces errors and stress and fosters excellence.

Patients, carers and families are in a unique position to provide new ideas and insights and to identify safety and care quality concerns that insiders may have ceased to notice long ago. They may also spot team issues and behaviours that are unsafe.

Inclusive teams recognise and celebrate diversity and difference both for team members and their patients. Inclusive teams promote equity and fairness for everyone, no matter your ethnicity, age, gender, sexuality, religion or power.

They hunt the good stuff – the things that unite and energise you and which give you shared common purpose.

Diversity of thought is paramount.

Encourage patients, carers and families in all their diversity to be at the centre of your plans and involved in co-creating them.

Support staff wellbeing and joy in work

The Institute for Healthcare Improvement (IHI) has developed a range of resources, including a Conversation and Action Guide to support staff wellbeing and joy in work after the COVID-19 pandemic.

Reverse mentoring

It can be difficult to understand how it feels to be different members in a team. By partnering with a more junior member of a team from a different diverse background, a leader can spend time with them to understand the different perceptions that they have and understand ‘work as done’ rather than ‘work as imagined”’.

Always events

Implement the Always Event methodology – aspects of the patient and family experience that should always occur when patients interact with healthcare professionals and the system – as a means of consistently putting patients at the heart of the care provided.

Seema Srivastava is a geriatrician and Associate Medical Director at North Bristol NHS Trust. Here she discusses how responding to the COVID-19 pandemic provided an opportunity to engage with Black, Asian and Minority Ethnic staff at the hospital.

One of the most worrying findings in the research and reviews into COVID-19 is how it has disproportionately affected some groups more than others in our society, particularly people from ethnic minority backgrounds. In April, during the height of the pandemic, we realised there was an urgent need to find out how this was affecting staff at North Bristol NHS Trust, particularly those from ethnic minorities.

We wanted to understand how people were feeling at this time and what we could do to create a space that felt safe, where people felt cared for, and which would build on a safety culture that recognised and addressed this inequality.

Supported by Jackie Marshall, the Trust’s Director of People, we arranged a series of virtual listening events to hear from staff from ethnic minorities, listen to their lived experiences and ask what meaningful actions we could take. They were held as open forums for any member of staff, regardless of their role or level in the trust.

We knew that not everyone would be able to attend virtual meetings, so we also ran face-to-face sessions in a large marquee with social distancing in place. Between April and June, we held 11 events in total and around 240 staff attended, giving rich insight into the issues they were facing. Some staff had been unwell with COVID-19 themselves; others knew friends or family members who had sadly died.

Themes emerging from these events included worries about PPE and access to health risk assessments. This led to immediate improvements, with some of the attendees co-designing an updated risk assessment process, to enable better safety and better conversations between managers and staff.

These sessions also coincided with the Black Lives Matter movement, and they became a platform for people to share their feelings and experiences about the impact of racial injustice in their daily lives. While the trust had held staff engagement events before, it had never attempted something on this scale. As the hospital employs over 9,000 people, they are really important to create safe spaces for listening.

The existing BAME network has also increased its membership, and we are contributing to conversations about wellbeing as part of the trust’s ‘People Strategy’.

We found COVID-19 has brought many existing issues to the surface, but it’s also given us the time and permission to address them in a way we haven’t before. I hope we can maintain this momentum and build on the framework we’ve created to ensure a safer culture for staff in future.

Civility is essential for individuals and teams to fulfil their potential and “civil work environments matter because they reduce errors, reduce stress and foster excellence.” It “creates that sense of safety and is a key ingredient of great teams.”

The Civility Saves Lives campaign promotes the importance of respect, professional courtesy and valuing each other. The campaign aims to raise awareness of the negative impact that rudeness (incivility) can have in healthcare, so that we can understand the impact of our behaviours. Patients, carers and families notice incivility between team members, which can lead to increased feelings of fear and vulnerability, and a poorer patient experience. The campaign includes examples of how teams have sought to make patients active participants in fostering a positive safety culture.

There is also a NHS England Civility and Respect Toolkit with a number of resources within it to support teams.

Space/time : Add the topic of civility to a team meeting.

What : Use the infographics to start a discussion or watch a video . Discuss what team members experiences of civility and incivility are and how they have felt when these have occurred.

How : Discuss what clear standards and expectations the team have and role model respect and care for others to enable meaningful and respectful connection and participation.

Acknowledgements

The following people contributed to this practical guide, and we would like to express our gratitude to them:

Joanna Pendray, Susanne Smith, Suzette Woodward, John Illingworth, Matt Hill, Paul Wastell, Bernard Allen, Lee Gridley, Sarah Papworth-Heidel, Sarah Tilford, Hester Wain, Heather Pritchard, Chloe Morales-Oyarce, Caroline Angel, Peter Jeffries, Nathalie Delaney, Phil Duncan, Sarah Speck, James Nicholls, Jane Reid, Alison Lovatt, Seema Srivastava, Joanne Crawford, all of the NHS and AHSN teams who kindly shared their work in the case studies and throughout the guide, and the National Patient Safety Team at NHS England.

Importance of Cleanliness Essay

500 words essay on importance of cleanliness.

Each one of us enjoys living in a clean environment. We all have the ability to maintain cleanliness as it is not a tough task. Cleanliness is a habitual process that we must do on a daily basis. For instance, personal hygiene and environmental cleanliness are equally important to lead a happy life. The importance of cleanliness essay will explain this in further detail.

Importance of Cleanliness

Cleanliness is a very essential component of human life in both physical and spiritual terms. Spiritual cleanliness refers to following the beliefs and rituals of your religion. On the other hand, the physical one is essential for the well-being of and existence of humanity.

It is essential to lead a healthy and well life. In fact, health and cleanliness are related to each other. To get good health, one must practice hygiene. It is essential to practice maintaining good health and prevent diseases .

Moreover, equally important is the cleanliness of our environment. When you maintain cleanliness, you can prevent disease and lead a healthy life. Health professionals advocate hygienic practices to prolong the lives of individuals.

Moreover, when the environment is clean, safety is enabled. For instance, we must ensure no spilling of water to prevent people from falling. Similarly, clearing bushes around homes will offer safety from harmful insects and animals.

Further, we must not only clean the environment but organize the environment carefully. In other words, put away harmful objects to prevent accidents. Similarly, in the food industry, cleanliness is of the utmost importance.

It ensures the well-being of the consumers. Most importantly, cleanliness enables the extension of a lifespan of an object. When you keep the metallic objects free from dust and rust, they will have a longer shelf life.

Thus, we see how cleanliness is important in every sphere of life. Whether it is living or inanimate objects, everything requires cleanliness. Moreover, it is also a moral virtue that makes people admirable.

Get the huge list of more than 500 Essay Topics and Ideas

How to Maintain Cleanliness

There are many ways through which one can maintain cleanliness and keep themselves and the environment happy. A major way of maintaining cleanliness is brushing and bathing regularly.

Similarly, it is also important to wash hand as often as possible, mostly before and after meals. With the onset of the coronavirus, it has become even more important to wash our hands repeatedly.

Further, we must keep our nails trimmed and eat healthy food. Moving on to environmental cleanliness, we must clean the mess in our surroundings regularly. Try your best to avoid plastic bags and littering around by throwing garbage carelessly.

It is essential to effectively dispose of waste and wastewater . Most importantly, adopt reusing and recycling techniques to monitor pollution levels. Thus, we must practice all this and more to ensure cleanliness.

Conclusion of Importance of Cleanliness Essay

We must all do our bit to maintain cleanliness in our life. There are many initiatives launched by the government to practice cleanliness but it won’t work unless all of us do. It helps in inculcating good habits in citizens of the country. Along with practising it ourselves, we must also stop others from disturbing cleanliness.

FAQ of Importance of Cleanliness Essay

Question 1: What is the importance of cleanliness?

Answer 1: Maintaining cleanliness is a vital part of healthy living as it helps to improve our personality by staying clean externally and internally. It is everybody’s responsibility and one should keep themselves and their surroundings clean and hygienic.

Question 2: What are the effects of cleanliness?

Answer 2: Cleanliness has many positive effects on everyone. It directly impacts the ability to learn and has a significant effect on the mind of students. When there is a dirty environment, it may increases levels of stress. Moreover, cleanliness keeps one happy.

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Improving and Maintaining Health and Well-Being Essay

To find inspiration for your paper and overcome writer’s block
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Personal Insights and Relevance to Nursing Practice

Advantage for the future practice, relevance to mnc code, reference list.

Improving and maintaining health and well-being is the personal responsibility of each person. There might be a lot of activities one could undertake to contribute to their physical and mental health. For this reflective account, I chose interventions such as yoga and dieting. Yoga is popular among those who monitor the body’s health and strive for inner harmony. This ancient practice is based on a combination of physical and spiritual development. Yoga practitioners strive to grow spiritually and improve themselves. On the other hand, the body’s most vital instinct—necessary for maintaining life—is the gratification of hunger. First of all, the food we eat creates the cells and tissues that make up our entire body. Second, eating provides the body with the energy it needs to function. Therefore, dieting—including what we eat, in what quantity, when, and how—depends on our health.

Doing yoga and healthy dieting have impacted my understanding of my health. I have noticed that when I implement these activities as habits in my life, I start to notice improvements in my well-being. I feel more energetic, and my immune system becomes stronger. People who practice yoga regularly note that the body becomes strong and flexible, and the mind calms down. When I do yoga every day for a minimum of one hour, I feel my muscles are stronger, and my mind is calmer. In the past, I have suffered from high-stress levels; however, yoga helps me manage such problems. The main thing in yoga is to find harmony and peace of mind, and breathing exercises and meditation techniques help with this. Improved well-being, a sense of peace, and a positive attitude – are just a small part of the positive results that yoga gave me.

It is believed that the improvement of the body is a complex result of physical activity, mental work, and lifestyle changes. Yoga classes positively affect all life support systems of the body. The study held by Hilcove et al. (2021) showed that yoga interventions helped nurses decrease and control stress levels. Mindfulness-based yoga helped participants to prevent burnout and positively affected their well-being (Hilcove, 2021). Another research that was handled by Kim (2020) revealed that yoga intervention helps to solve problems with “chronic nonspecific lower back pain in nursing practice” (Kim, 2020, p. 7). Yoga programs are considered a tool for managing pain relief (Kim, 2020). The activity is also beneficial for the lungs and is recommended for patients with lung problems (Kupershmidt and Barnable, 2019). Thus, implementing yoga intervention in the nursing practice is an effective way to improve the well-being of the patients.

After the first weeks of classes, you can feel the benefits of yoga. It allows you to learn to feel your body, manage your health, and expand the range of your lungs. At the same time, the physical activity allows us to see quick results. Classes have practically no contraindications or age and gender restrictions. Initial data and level of preparation do not matter. Now joint lessons with children, couples, and wellness sessions for the older age category are popular. If a beginner pursues not only the goal of losing weight and getting a beautiful body but also accepting himself and his needs, learning to live in harmony with the mind and shell, then yoga will give him this.

Adding healthy dieting to yoga made me see an even bigger positive effect on my well-being. Because yoga aims to teach mindfulness, I have become more conscious of my diet. Drinking more water and cutting out junk helped improve my health conditions. The body needs to consistently consume a variety of nutrients, including proteins, carbs, fats, water, minerals, and vitamins in the right amounts and proportions. The risk of contracting certain diseases increases when specific nutrients are either insufficient or excessive. Healthy eating helps build up mental and physical vitality, enables weight maintenance without harsh restrictions, and aids in the prevention and treatment of diseases. Healthy eating and dieting are an important part of a healthy lifestyle.

Of course, the role of dieting in nursing practice can not be underestimated. Distinct types of patients with different health problems require specific diets. The study provided by Kurnia and Yulia (2021) showed that nutritional education is crucial for patients with diabetes and their families. Food affects the sugar levels in the blood, and thus, people who suffer from diabetes should pay attention to their food choices (Kurnia and Yulia, 2021). Dieting helps control many aspects of the human body and thus plays an important role in patient care. A complex relationship and interdependence exist between substances that enter the body with food. For example, calcium is needed to build and maintain bones. In turn, calcium can be absorbed in the body only in the presence of vitamin D (Riccio and Rossano, 2018). For calcium to function, phosphorus and magnesium are required; they act only in the presence of copper and zinc. Nutrition is one of the important factors of human health that provides adequate growth and development in childhood, high performance of the adult population, and active longevity of the elderly and old people.

The information I have gained from this activity will be useful for my future practice. Now, when I have explored the benefits that yoga and dieting interventions can bring, I will try to implement them when relevant. Nurses are responsible for contributing to the well-being of their patients. That is why it was highly motivational for me to analyze how specific activities affected my health and lifestyle. Moreover, these and many other interventions may demonstrate positive results systematically and properly. A person’s well-being depends on what activity they undertake in their everyday life. Both yoga and dieting interventions showed to have positive results on my health, and I hope it will be the same for my future patients.

This reflective account is relevant to the MNC code and its distinctive themes. Generally, the code includes four themes referred to prioritizing people, practicing effectively, preserving safety, and promoting professionalism and trust (NMC Code, 2022). I want to discuss effective practice and promoting professionalism and trust. For instance, yoga and dieting are related to the ‘practice effectively’ theme. When yoga is practiced regularly, it brings more results for the body and mind. Accordingly, when dieting options are made correctly, they will be more effective and beneficial for the patient’s health. ‘Promote professionalism and trust theme is also connected with the two interventions as patients should trust the process. Health care professionals should educate patients about the efficiency of the activities they implement to be aware of the purpose of these particular interventions.

Kurnia, D. A. and Yulia, Y. (2021) ‘Understanding food selection and dieting patterns: type 2 diabetes mellitus patients and their families.’ International Journal of Endocrinology (Ukraine) , 17(6), 456-458.

Hilcove, K., et. al. (2021) ‘Holistic nursing in practice: Mindfulness-based yoga as an intervention to manage stress and burnout.’ Journal of Holistic Nursing , 39(1), 29-42.

Kim, S. D. (2020) ‘Twelve weeks of yoga for chronic nonspecific lower back pain: a meta-analysis.’ Pain Management Nursing , 21(6), 536-542.

Kupershmidt, S., and Barnable, T. (2019) ‘Definition of a yoga breathing (pranayama) protocol that improves lung function.’ Holistic Nursing Practice , 33(4), 197-203.

Riccio, P., and Rossano, R. (2018) ‘Diet, gut microbiota, and vitamins D+ A in multiple sclerosis.’ Neurotherapeutics , 15(1), 75-91.

NMC Code. (2022) The Nursing and Midwifery Council.

Nurse Participation in Policy-Making
Nurses’ Participation in Policy Reviews
Yoga and Stress Reduction
Sugar Substitutes in Keto Dieting
The Disconnect Between Tradition and Contemporary Practice in Yoga
Quality Outcomes and Reduce Costs in Stroke Care
Project Communication in a Nursing Setting
Improving Health Care Delivery: Teenage Pregnancy
The New Graduate Nurse Residency™ at Merakey
Nursing: Working With Aggressive Mentally Ill Patients
Chicago (A-D)
Chicago (N-B)

IvyPanda. (2023, September 24). Improving and Maintaining Health and Well-Being. https://ivypanda.com/essays/improving-and-maintaining-health-and-well-being/

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IvyPanda . 2023. "Improving and Maintaining Health and Well-Being." September 24, 2023. https://ivypanda.com/essays/improving-and-maintaining-health-and-well-being/.

1. IvyPanda . "Improving and Maintaining Health and Well-Being." September 24, 2023. https://ivypanda.com/essays/improving-and-maintaining-health-and-well-being/.

Bibliography

IvyPanda . "Improving and Maintaining Health and Well-Being." September 24, 2023. https://ivypanda.com/essays/improving-and-maintaining-health-and-well-being/.

Open access
Published: 26 May 2022

Structural changes in the Russian health care system: do they match European trends?

Sergey Shishkin ORCID: orcid.org/0000-0002-0807-3277 1 ,
Igor Sheiman ORCID: orcid.org/0000-0002-5238-4187 2 ,
Vasily Vlassov ORCID: orcid.org/0000-0001-5203-549X 2 ,
Elena Potapchik ORCID: orcid.org/0000-0001-7004-3100 1 &
Svetlana Sazhina ORCID: orcid.org/0000-0002-2023-3384 1

Health Economics Review volume 12 , Article number: 29 ( 2022 ) Cite this article

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In the last two decades, health care systems (HCS) in the European countries have faced global challenges and have undergone structural changes with the focus on early disease prevention, strengthening primary care, changing the role of hospitals, etc. Russia has inherited the Semashko model from the USSR with dominance of inpatient care, and has been looking for the ways to improve the structure of service delivery. This paper compares the complex of structural changes in the Russian and the European HCS.

We address major developments in four main areas of medical care delivery: preventive activities, primary care, inpatient care, long-term care. Our focus is on the changes in the organizational structure and activities of health care providers, and in their interaction to improve service delivery. To describe the ongoing changes, we use both qualitative characteristics and quantitative indicators. We extracted the relevant data from the national and international databases and reports and calculated secondary estimates. We also used data from our survey of physicians and interviews with top managers in medical care system.

The main trends of structural changes in Russia HCS are similar to the changes in most EU countries. The prevention and the early detection of diseases have developed intensively. The reduction in hospital bed capacity and inpatient care utilization has been accompanied by a decrease in the average length of hospital stay. Russia has followed the European trend of service delivery concentration in hospital-physician complexes, while the increase in the average size of hospitals is even more substantial. However, distinctions in health care delivery organization in Russia are still significant. Changes in primary care are much less pronounced, the system remains hospital centered. Russia lags behind the European leaders in terms of horizontal ties between providers. The reasons for inadequate structural changes are rooted in the governance of service delivery.

The structural transformations must be intensified with the focus on strengthening primary care, further integration of care, and development of new organizational structures that mitigate the dependence on inpatient care.

In the last two decades, health care systems in the European Union countries have faced global challenges, including aging populations, a substantial rise in chronic and multiple diseases, the emergence of new medical and information technologies, and a growing citizen awareness of the role of a healthy lifestyle in disease prevention [ 1 ]. The responses of health systems to these challenges included structural changes in their organization with a focus on the promotion of healthy lifestyles and disease prevention, the growing scale of screening for early disease detection, strengthening primary care, changing the role of the hospitals, the development of chronic disease management programs, etc. [ 2 , 3 ]

Studies of these trends address mostly Western countries. Much less attention has been paid to the post-Soviet countries. In this paper, we study structural changes in the health care in Russia. Russian health care has inherited the Semashko model of health care organization. Its main distinction is state-centered financing, regulation, and provision of health care. The model has specific forms of provider organization, for example, outpatient clinics (polyclinics) with a large number of various specialists, the separation of care for adults and children, and large highly-specialized hospitals [ 4 ].

The Soviet and post-Soviet health systems have been underfunded. Public health funding in the 1990s dropped almost by one third in real terms [ 5 ]. The organization of medical care in the 1990s has not changed significantly relative to Soviet times, and the system has adapted through the reduction in the volume of services and increased payments by patients, frequently informal [ 6 ]. The surge in oil prices after 2000 allowed health funding to increase and while encouraged noticeable changes in service delivery.

The changes in the Russian health system have been discussed in the literature mostly focusing on specific sectors and health finance reforms [ 5 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ]. But these changes in different sectors were not analyzed together, from a single methodological position, as changes in the structural characteristics of the Russian health care system, i.e. the changes in the ratio of different types of medical care, in the structure of medical service providers, in functionalities and modes of their interaction.

The objective of this paper is to explore the entire complex of structural changes over the past two decades in comparison with European trends. What were the structural changes in European health care systems, what were they like in Russia, and how can their differences be explained?

Study design

We followed a six-step methodological framework. The first stage involved designation of the types of medical care and the types of structural changes for identification and comparison. We considered four main areas of medical care delivery: preventive activities, primary care, inpatient care, long-term care. We focused on three different dimensions of structural changes: i) changes in the organizational structure of medical service providers; ii) changes in the structure of their activities (in its types and in their coverage of the population / patients); iii) changes in the organization of interaction between different service providers.

The second stage consisted of identifying for each type of medical care the changes in these three dimensions in the last twenty years before the COVID-19 pandemic. We described the changes that met two criteria: 1) these changes are assessed in the OECD, WHO, and World Bank reviews, and other review publications on this topic as the most noteworthy characteristics of the development of European health care systems, and 2) they have spread in a large number of European countries.

The changes identified according to the formulated criteria cover not all dimensions of structural changes for each type of medical care. For preventive activities, there are changes in the types of activities and in their coverage of the population. In primary and inpatient care, there are changes in the organizational structure of service providers, in the structure of their activities, and in the organization of interaction with other providers. In long-term care, there are changes in the structure of developed activities and their coverage of the population.

To describe the ongoing changes, we use both qualitative characteristics and, if possible, quantitative indicators that highlight them to the greatest extent.

The third stage involved detection of structural changes in four main areas of medical care delivery in Russia. We used the results of our previous studies and conducted an additional search for data characterizing structural changes in health care, using new statistical data, evidence derived from our survey of physicians and interviews with top managers in medical care system.

On the fourth stage we compared the identified structural changes in European health care systems (HCS) with the changes taking place in Russian health care. We identified the presence or absence of similar types of structural changes and the differences between them. The fifth stage was the consideration of the driving forces of structural changes in the Russian health care system. The sixth stage included discussion of the reasons for the distinctions with European developments.

Data sources

To identify the main structural changes in medical care delivery during last twenty years we searched the literature addressing both European HCS and Russia in the all aspects of changes of health care system indicators, better classified by MeSH term “health care reform”. We searched MEDLINE using the query: (russia OR europ* OR “european union” OR semashko) AND health care reform [mh] AND 2000:2021[dp]). All 788 findings were checked manually and 86 were relevant. We also used sources snowballed from these reports and the grey literature related to Russian health care, including those in limited circulation, unpublished documents, memorandums, and presentations from our personal collections covering more than twenty years.

We also used data from an online survey of 999 primary care physicians (further – survey) conducted by the authors in April–May 2019. The respondents representing 82 out of 85 regions of the Russian Federation were asked about implementation of the national prophylactic medical examination program. We also interviewed four leading specialists of the national Ministry of Health on the criteria for the inclusion of the components into the program.

To identify the driving forces of structural changes in the Russian health care system, we used materials from 10 interviews on the issues of implementing state health care programs that we conducted in 2019 with current and former top-managers in the federal government and in five regional governments. We also used the grey literature as well as published reports.

We used statistical data from the international databases of OECD [ 18 ], WHO [ 19 ], World Bank [ 20 ], as well as the Russian sources — the Federal State Statistics Service [ 21 ] and the Russian Research Instuitute of Health [ 22 ]. The data was analyzed for the period from 2000 to the latest date with available data for both EU member states and Russia. To ensure the comparability of the composition of countries in different years, the analysis of the dynamics of some indicators was limited to EU 19 members, i.e. excluding Cyprus, Greece, Croatia, Bulgaria, Luxemburg, Malta, Netherland, Poland, and Romania. The averages for EU 19 estimates are based on population size-weighted averages. If the studied publications and databases did not contain the necessary indicators, we made our own estimates.

Each section of the paper contains a brief description of the main trends in the European countries, and then provides a comparative analysis of the corresponding changes in Russian health care. The comparison is followed by a discussion of the driving forces and the limitations of structural changes in Russia compared to the main European trends. We limited our analysis to the pre – COVID-19 pandemic years.

The development of preventive activities

European hcs.

Most of them have implemented health check-ups, and population and opportunistic screenings for the early detection of diseases. These activities are viewed as a way to improve outcomes by ensuring that health services can focus on diagnosing and treating disease earlier [ 23 ]. The population covered by screenings is high and growing. In Germany 81% of population between 50 and 74 years in 2014 had been tested for colorectal cancer at least once, in Austria 78%, France 60%, Great Britain 48% [ 24 ].

The impact of these activities on health outcomes depends on the selection of preventive services, as well as on their implementation in specific national contexts. The selection of preventive services is increasingly based on research into their potential impact on mortality and other health indicators, as well as their cost effectiveness, with some services being declined because of their inadequate input into health gains [ 25 ]. It is particularly important that screenings are focused on socially disadvantaged groups with the highest probability of disease identification and the expected benefits of their management. Therefore, screening programs are based on the evaluation of local needs. Physicians have discretion in the choice of patients for screenings, depending on their importance for specific groups of the population, and individual risks and preferences.

It is increasingly common for a screening program to include follow-up management of any detected illnesses, with the implication that policy makers design such programs as a set of interrelated preventive and curative activities [ 26 ].

The original Semashko model and the current legislation prioritize preventive activities, while their implementation has been limited by the chronic underfunding of the health system. In the 2000s, the priority of prevention campaigns was revitalized in the form of a national prophylactic medical examination program (Prophylactic Program, called Dispanserization) that is a set of health check-ups and screenings. The major expectation from this Prophylactic Program is the same as in European HCS [ 27 ].

To supplement the analysis of the Prophylactic Program, we analyzed the evidence base for the components of the program and interviewed leading specialists of the federal Ministry of Health on the criteria for the inclusion of the components into the program. We found that some screenings were not evidence based and effect on the population health and/or health of participants is small [ 28 ]. The screening package of the dispanserization was expanded and reduced couple of times, but still number of ineffective screenings are included in the package (electrocardiography (ECG) screening of healthy subjects, prostate specific antigen (PSA) screening of middle age and adult men, urinalysis and routine blood tests, mammography from age 40 etc.).

Primary care physicians play a major role in conducting screenings and check-ups as well as subsequent interventions. There are also public health units responsible exclusively for these preventive activities in big polyclinics. Polled in 2019, primary care physicians responded that in 11% of polyclinics check-ups are carried out in these departments only, and in 24% of primary care organizations the check-ups are conducted by district physicians as well as by staff of these preventive units.

Under the current Prophylactic Program, people over 40 are supposed to have a set of check-ups annually; those 18–39 every three years. Most children go through physicals only. The official estimates of the coverage of the eligible population in the Prophylactic Program are around 100% [ 29 ], while service providers are less optimistic. According to the survey, more than half of the respondents reported that this share was less than 60%, while 17.4% reported less than 20% [ 27 ].

An important shortcoming of the Prophylactic Program design and implementation is the gap between its major objective and the capacity of primary care. The shortage of primary care physicians does not allow the target groups to be provided with all preventive services. Physicians have to distort the service to their registered population and to underprovide the follow-up care of detected cases. The lack of a systematic approach, less focus on local conditions, and the lack of a professional autonomy of providers are the major distinctions between Russian prevention campaigns and similar activities in Europe.

The Prophylactic Program is built on the presumption that preventive activities should include the follow-up management of any detected conditions. There is some evidence, however, that this is not taking place: according to our survey, a half of primary care physicians are unaware of the results of check-ups and screenings. The reported coverage and quality of the follow-up management of identified cases are low: a half of the respondents indicate that less than 60% of patients with identified diseases become objects of the follow-up disease management. Only 7.7% of respondents indicate that a set of disease management services corresponds to a pattern of dispensary surveillance issued by the federal Ministry of Health. The majority reports that these requirements are met only for some patients or are not met at all.

Disease management of newly identified chronic and multiple cases is focused on process rather than outcome indicators. The information on the latter is very fragmented. According to our survey, a decrease in the number of disability days of chronic patients is reported by only 14% of physicians. More than a half of respondents are unaware of the number of emergency care visits and hospital admissions of their chronic patients.

Strengthening primary care

There is a trend of multi-disciplinary primary care practices or networks development and promotion of teamwork and providers coordination in response to the growing complexity of patients. In Spain, France, and the UK it is increasingly common for large general practices to serve more than 20,000 people and provide a wider spectrum of services than in traditional solo and group practices. These emerging extended practices include pharmacists, mental care professionals, dieticians, and sometimes 2–3 specialists [ 30 , 31 ]. The role of nurses is also expanding. Most advanced nurses independently see patients, provide immunizations, health promotion, routine checks for chronically ill patients in all EU member states [ 32 ]. Related to these extended practices is the growing concentration of primary care providers via mergers and reconfigurations that increase the size of the units. The major benefits are economies of scale and scope through staff sharing and better integrated care.

There is also a general trend to strengthen the links with the local community, social care and hospitals [ 32 ]. Primary care providers are increasingly involved in chronic disease management programs together with other professionals in and out of general practices. Links with hospitals are developing beyond simple referral systems [ 33 ].

The trend of multidisciplinary practices development has greatly affected Russian health care. However, this trend in Russia differs significantly from the European HCS. It began in the 1980s, when large numbers of specialists were employed by polyclinics, which are the major providers of both primary care and outpatient specialty care. Today, large urban polyclinics employ 15–20 categories of specialists, and polyclinics in small towns 3–5 categories. The generalist who serves for the catchment area (district doctors) is limited in the scope of services they provide. Multidisciplinary practices are built through employing new specialists, while in European countries mainly through nurses and other categories of staff. Specialists in Russian polyclinics do not supplement, but essentially replace district doctors: they accounted for 66% of visits in 2019. Footnote 1

The scope of district doctors’ services is limited: at least 30–40% of initial visits end with referrals to a specialist or to a hospital, while in Europe only 5–15% [ 35 , 36 ]. Gatekeeping is promoted, but district doctors are overloaded and not interested in expanding the scope of their services. Specialists in polyclinics have insufficient training and poorly equipped, e.g. urologists do not do ureteroscopy and ophthalmologists do not practice surgery.

Since the 1990s, some regions started replacing district doctors and pediatricians with general practitioners. But this initiative has not been supported by the federal Ministry of Health, therefore the institution of a general practitioner is not accepted throughout the country. Currently, the share of general practitioners in the total number of generalists serving a catchment area is only 15% (Fig. 1 ). The model of general practice is used only in some regions. The main part of the primary care in the country is provided by district doctors and pediatricians, whose task profile remains narrower than that of general practitioners. The division of primary care for children and adults is preserved. The family is not a whole object of medical care. This division is actively defended by Russian pediatricians with references to specific methods of managing child diseases.

Distribution of generalists in Russia by categories in 2000, 2019. Source: Calculated from RRIH [ 22 , 37 ]

The prevailing trend in all European HCS is to increase the role of nurses. In Russia, the participation of nurses in medical care is limited to fulfilling doctors’ prescriptions and performing ancillary functions.

The transformation of inpatient care

Due to increased costs, technological advances in diagnosis and treatment, there were changes in patterns of diseases and patients treated in hospitals. A substantial amount of inpatient care has been moved to outpatient settings with a respective decrease in bed capacity. This is an almost universal trend in European HCS [ 19 ].

Hospitals continue to be centers of high-tech care, which concentrate most difficult cases and intensify inpatient care with a corresponding decrease in the average length of stay. These changes have been promoted by the move to diagnostic related groups based payment systems and a growing integration with other sectors of service delivery.

In many European countries, most hospitals no longer act as discrete entities and have become units of hospital-physician systems which are multi-level complex adaptive structures [ 3 ]. A new function of hospital specialists is their involvement in chronic disease management in close collaboration with general practitioners, outpatient specialists, and rehabilitative and community care providers [ 38 ].

Over the past two decades the treatment of relatively simple cases and preoperative testing have gradually moved to day care wards and polyclinics. In annual health funding, the federal government sets decreasing targets of inpatient care which are obligatory and which regions use to plan their inpatient care. However, inpatient care discharges per 100 people have been almost stable (21.9 in 2000 and 22.4 in 2018) in contrast to the EU 19 members Footnote 2 (18.4 in 2000 and 16.9 in 2018) [ 18 ]. The pressure of decreasing targets resulted in a drop in the average length of hospital stays (Fig. 2 ) and the total bed-days per person (Fig. 3 ). These indicators, along with bed supply (Fig. 4 ), decreased even faster than in the EU.

Average length of stay in hospital in EU members and Russia (days). Note: Calculated for EU 19 member states (see Methods). The EU 19 average length of hospital stay estimates are calculated as the sum of the products of inpatient care discharges by the average length of stay for each country, weighted average by the total inpatient care discharges. Source: OECD Health Statistics [ 18 ]

Number of bed-days per person in the EU and Russia. Note: Calculated for EU 19 member states (see Methods). EU 19 estimates are calculated as the sum of the products of inpatient care discharges by the average length of stay for each country weighted by the total population. Source: OECD Health Statistics [ 18 ]

Hospital beds per 1000 people in the EU and Russia. Note: Calculated as the average for all EU 28 members weighted by the total population. Source: World Bank [ 20 ]

At the same time, the intensity of medical care processes in hospitals in Russia remains significantly lower than in European countries. An indicator of this is the gap in the number of hospital employees per 1000 discharged (Table 1 ).

Over the past 20 years, significant efforts have been made to deploy day wards, both in hospitals and polyclinics, to reduce the burden on hospitals. As a result, the proportion of patients treated in day wards in the total number of patients treated in hospitals increased from 7.6% in 2000 to 20.8% in 2016 [ 21 ]. However, there is fragmentary evidence that this figure is still noticeably lower than in Europe. The share of cataract surgery carried out as ambulatory cases varies in most European countries between 80 to 99% [ 24 ] but is negligible in Russia.

Despite these positive trends, the health system remains hospital centered. The number of bed-days per person remains nearly twice as high as the EU average (Fig. 3 ).

An important trend is the increasing concentration of hospitals. The number of hospitals halved between 2000 and 2018, mostly due to mergers, but also due to the closures of inadequately equipped hospitals. This process has led to an increase in the average size of hospitals from 156 beds in 2000 to 223 beds in 2018 [ 21 ]. This figure is higher today than in Western countries with large territories. The average hospital size in France was 130 beds in 2018 and in Germany 215 beds in 2017 [ 18 ]. In Russia, with its very low population density, the reduction in the number of small rural hospitals resulted in some accessibility problems.

At the same time, the incorporation of previously independent polyclinics into hospitals is under way. The proportion of independent polyclinics in the total number of polyclinics has decreased from 35% in 2000 to 19% in 2014 [ 36 ].

The development of long-term care

Over the last 20 years, most European countries have increasingly developed the public provision of long-term care. The number of nursing and elderly home beds per 100,000 people in the EU increased from 581.7 in 2000 to 748.3 in 2014 [ 19 ], although the pace of changes, the coverage of citizens in need of long-term care, and its organization and funding differ substantially across countries [ 39 ]. Many countries control costs by keeping people in their homes longer and shifting the responsibility for non-institutional forms of care to communities [ 40 ]. An expected outcome of investment in long-term care is the reduction of informal care utilization.

Compared to European HCS, long-term care is underdeveloped in Russia. The number of nursing care beds declined from 14.7 per 100,000 people in 2011 to 10.6 in 2019 [ 22 ]. The share of citizens over working age and people with disabilities receiving outpatient and inpatient care within the long-term care system in the total number of citizens over working age and people with disabilities in need of long-term care, was only 2.9% in 2019 [ 41 ].

In contrast to the European HCS, Russia has not built a strong long-term care sector with the capacity to reduce the workload of acute inpatient care settings. Hospitals have to keep some patients longer resulting in a relatively higher length of stay. Palliative care as another sector of the long-term care which started to develop only a few years ago.

Driving forces and tools of structural changes in the Russian health care system

These changes have been driven by the federal and regional governments. They use two main tools to manage structural changes: 1) setting health care targets for the entire country and for regions, and 2) implementing vertical health care programs.

Since 1998, the federal government has annually approved a program of benefit packages for health (the Program). It sets targets for the utilization of medical care for each sector of service delivery, as well as unit cost targets. The Program is designed to balance the volumes of care with the amount of public funding. The annual versions of the Program gradually reduced the targets for inpatient care to encourage a shift to outpatient care. The federal targets are used in regional health planning. In the first decade of using the Program, the changes in the actual volume of medical care were small, but in the second decade, pressure from the federal center on the regions increased, and the gap between the federal targets and the actual utilization of care has noticeably narrowed (Table 2 ).

The development of the legislation on the delimitation of responsibility between levels of government, carried out in the last two decades, has consistently strengthened the regional governments role in restructuring medical care delivery. In 2012, almost all resources of health care governance were transferred from the municipal to the regional level (including the governance of primary health care. During the period 2000–2019 the number of public hospitals has decreased by 2.2 times, the number of hospital beds by 1.5 times, polyclinics 1.3 times, feldsher-obstetric posts 1.3 times. Footnote 3

When oil prices increased, the federal government poured additional resources into vertical programs. They are administered by the federal Ministry of Health and regional governments. The major programs: the ‘Priority national health project’ (2004–2012), the Prophylactic Program (2008 – ongoing), and regional programs for the modernization of health care (2011–2013). All additional and some basic resources are earmarked in an attempt to develop the highest priority activities: preventive care, obstetric care, cardiovascular surgery, oncology, etc.

The role of the centralized administration of these priority programs is controversial. The federal government initiated them, provided regions with additional funding, and made the program’s targets a priority of health policy. According to interviews with federal and regional officials, the implementation of programs is heavily controlled by the federal government: practically all decisions on specific activities, target indicators and resource allocation are approved on the federal level. The Russian regions have low flexibility to respond to local needs such as variation in disease incidence, the capacity of health care, or vulnerable population groups.

Structural changes in the provision of inpatient care were prompted by the introduction of a diagnostic related groups based payment system in the early 2010s. This was initiated by the federal government and implemented with the participation of the World Bank experts. It makes more profitable for hospitals to reduce the duration of hospitalizations and to complicate the structure of inpatient treatment [ 44 ].

We found that despite significant differences in health care organization, some structural changes in Russia have followed the general European trends. A similar rise in the coverage of the population with screenings is underway in Russia. There is a clear tendency to replace some inpatient care with day care. The volume of inpatient care is reducing —mostly due to a significant decrease in the length of stays, while the rate of hospital admission remains relatively stable. As in the most European HCS, the concentration of medical organizations and the formation of large outpatient and inpatient complexes is developing.

However, there are some substantial differences: the development of prevention programs is relatively less focused on the most vulnerable target groups and on local needs; primary care specialization is much stronger than in European HCS; the role of first contact generalists is waning; the worldwide tendency of increasing the role of nurses is almost invisible in Russia; long-term care is starting to develop but is still at a very low level and palliative care is in its infancy; integration in the health system are much less pronounced—both at the level of individual medical organizations and between health sectors.

The reasons for these differences are rooted in the specific features of health governance in Russia.

The Semashko model, by virtue of its genesis, reproduces the state administration patterns of a planned economy. The main driving force of changes is the bureaucracy. Its managerial activities are guided by the mechanism described by J. Kornai: ‘postponement, putting out the fire, postponement’ [ 45 ]. The governance focuses on mobilizing and distributing available resources to solve or mitigate the most pressing problems - ‘fire fighting’. This is what determines the fragmentation of structural changes in Russian health care compared to structural changes in European countries.

Materials of interviews with heads of federal and regional health authorities suggest that in the existing governance system each of its levels must demonstrate the success of its activity exclusively to the higher levels of management. It is easier to achieve success when solving problems of optimizing the volume of medical care and the organizational structure of medical institutions, and much more difficult when solving problems of improving the efficiency of all elements of medical care system, which requires changes in their functionality and ways of interaction. It requires more financial resources and better management at all levels of health governance.

A number of deeply rooted limitations for carrying out structural transformations in Russian health care can be highlighted.

Firstly, the low capacity of primary care providers and to some extent the unwillingness of patients to replace inpatient care with outpatient treatment prevents a shift of patients from hospitals to polyclinics.

Secondly, a feature of the Russian health care system is the weak development of horizontal links between medical organizations related to different levels of medical care, and between medical workers within medical organizations working in different departments [ 36 , 46 , 47 ]. The interaction of different providers is carried out mostly through vertical channels. This is a serious obstacle to the development of horizontal integration [ 36 ].

Thirdly, democratic institutions for the development of health care are historically underdeveloped in Russia and this influences the choice of health policy priorities. According to interviews with heads of regional health authorities, the role of local communities is negligible, and the role of the medical community is marginal. Professional organizations are rarely involved in decision-making on health issues. The input of public councils to government bodies is largely imitative. Information about the activities of the system as a whole and of individual medical organizations is restricted for public use. This enables health authorities to focus on achievements in their reports, while hiding shortcomings. Feedback from patients, and society as a whole, is poorly expressed.

Conclusions

Russian health care, whose genetic basis was the Soviet Semashko model, after a difficult ‘survival’ period in the 1990s, underwent significant structural changes over the next two decades. To a large extent, the directions of these changes have coincided with European trends. The prevention and the early detection of diseases have developed intensively. The reduction in hospital bed capacity and inpatient care was accompanied by an intensification of inpatient treatment and a decrease in the average length of stay. Russia has followed the European trend of service delivery concentration in hospital-physician complexes, while the increase in the average size of hospitals is even more substantial. Structural changes in primary care are much less pronounced. The resources and competences of providers and the governance of primary care are still not enough to abolish the hospital-centered model of service delivery. Russia has intensively implemented vertical health care programs to develop the priority activities, but still significantly lags in the level of development of horizontal ties among services providers.

Specific structural changes in Russia are rooted in the organization and governance of service delivery. The interests of federal and regional bureaucracies, which act as the main drivers of changes, are pushing them to prioritize the changes in volumes of medical care and organizational structure of health care providers and not spend a lot of effort on improving their functionality and modes of interaction between providers of medical care. An important role is also played by the low capacity of primary care units to provide quality care.

To respond effectively to modern global challenges, reduce mortality, and improve the health of the population, structural transformations in Russian health care must be intensified with the focus on strengthening primary care, the further integration of care, and an accelerated development of new structures that mitigate the dependence on inpatient care.

Availability of data and materials

The data used and analysed during the current study are publicly available.

Calculated using data from [ 34 ].

See Methods.

Calculated using data from [ 21 ].

Abbreviations

European Union

Health Care System

Organization for Economic Co-operation and Development

World Health Organization

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Acknowledgements

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Sergey Shishkin – DSc in Economics, Director, Centre for Health Policy, HSE University.

Igor Sheiman – PhD in Economics, Professor, Health Economics and Management Department, HSE University.

Vasily Vlassov – DSc in Internal Diseases, Professor, Health Economics and Management Department, HSE University.

Elena Potapchik – PhD in Economics, Leading Research Fellow, Centre for Health Policy, HSE University.

Svetlana Sazhina – MPA, Leading Analyst, Centre for Health Policy, HSE University.

The study was funded by the grant provided by the Ministry of Science and Higher Education of the Russian Federation (Grant Agreement No. 075–15–2020-928).

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Sergey Shishkin, Elena Potapchik & Svetlana Sazhina

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Sergey Shishkin conceptualized, designed the study and supervised the work. All authors collected, analyzed and interpreted the data. Elena Potapchik, Svetlana Sazhina made statistical analysis. Sergey Shishkin, Igor Sheiman and Vasily Vlassov wrote a first draft of the manuscript. All authors critically reviewed the draft. All authors read and approved the final manuscript.

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Shishkin, S., Sheiman, I., Vlassov, V. et al. Structural changes in the Russian health care system: do they match European trends?. Health Econ Rev 12 , 29 (2022). https://doi.org/10.1186/s13561-022-00373-z

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DOI : https://doi.org/10.1186/s13561-022-00373-z

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19 Good health and safety practices

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Measuring best practices for workplace safety, health and wellbeing: The Workplace Integrated Safety and Health Assessment

Emily Sparer

Daniel Gundersen

Jack T. Dennerlein

Dean Hashimoto

Jeffrey N. Katz

Deborah L. McLellan

Anna Revette

Conclusions

INTRODUCTION

Delphi method and literature review

Cognitive testing methods

Data Collection

Description of the constructs and measures

Cognitive testing results

Leadership commitment

Participation

Comprehensive and collaborative strategies

Data-driven change

Supplementary Material

10 Effective Strategies to Improve Workplace Safety

10 Effective Strategies/Ideas to Improve Workplace Safety

1. Establish a Safety-First Culture

2. Conduct Regular Risk Evaluations

3. Implement Comprehensive Safety Training

4. Improve Workplace Ergonomics

5. Keep the Workplace Clean and Organized

6. Use Labels and Signs Effectively

7. Provide the Right Tools and Equipment

8. Encourage Open Communication

9. Prepare for Emergencies

10. Reward Safe Behavior

What is workplace safety?

Why is workplace safety important?

How can I improve workplace safety?

What is a safety culture?

How can I develop a safety culture?

What is the role of the Occupational Safety and Health Administration (OSHA) in workplace safety?

How can I protect my employees from work-related hazards?

What should I do if an employee is injured or falls ill at work?

How can I encourage employees to report safety concerns?

How can a safety program benefit my organization?

Areas of Work

Development Cooperation

Normative instruments

Publications

Ongoing and upcoming events

You may also be interested in

Health and Safety: Principles, Responsibilities and Practices

Policy Contact

1. Principles

2. Responsibilities

A. Supervisory Responsibilities

B. Managerial Responsibilities

C. Environmental Health and Safety Responsibilities

D. Faculty, Staff, and Student Responsibilities

E. Safety Performance

3. Providing a Safe Workplace

A. Facility Design

B. Hazard Identification and Correction

C. Shutdown of Dangerous Activities

D. Providing Medical Surveillance