Safety Action Teams

Concept to Action Engaging the Sharp End through Safety Action Teams... 

Engaging the sharp end of the organization is critical to the success of patient safety. At Children s, front-line staff members developed the concept of safety action teams (SATs) to capture the knowledge and resourcefulness of front-line providers and to better enable them to improve safety at a local level. 

Casey Hooke, advanced practice nurse and creator of the Safety Action Team (SAT) concept, defines SATs as department- or unit-based interdisciplinary work groups that provide a "think tank" for staff to identify safety concerns, process them, and brainstorm new ways to address them (Hooke, 2002). Group membership varies according to individual needs, but SATs strive to include members who represent the continuum of care for the patients they serve. SATs include registered nurses, physicians, pharmacists, respiratory care practitioners, child-life specialists, unit service coordinators, and members of the management team. The group is chaired by a staff leader, or sometimes by two staff leaders who share the responsibility. 

The safety action team focuses on systems, not people. Participants view a ten-minute video. Beyond Blame (see Resources), that educates staff on the basics of... 

Hooke, C. Safety Action Teams Improving Care for Children with Cancer. Journal of Pediatric Oncology Mirsing, 2002, 19 2), 59. 

The toxicity associated with SM is quite profound. The Army s Chemical Defense Equipment Process Action Team estimated in 1994 that a 900 mg-min/m SM vapor exposure would be lethal in 2-10 min, based on animal studies (National Research Council Review, 1997). Fortunately, in the battlefield, lethality has been limited. Only 1-3% of exposed soldiers died from SM exposure after WWI, and mortality mostly was not a direct consequence of SM, but rather the indirect effect of secondary respiratory infections. The 1999 Material Safety Data Sheet, put out by the US Army Soldier and Biological Chemical Command, USA Edgewood Chemical Biological Center, has estimated the LD50 of a skin exposure to sullur mustard as lOOmg/kg. This roughly translates into as little as 7 ml of neat SM (i.e. 8.9 g) spread over the skin resulting in the death of a 80 kg adult (Department of the Army, MSDS, 1999). The cornea, of course, is more sensitive than the skin. Below we review three chief toxic effects of severe SM exposure to the cornea. 

Once a formal safety system is in place, managers are clear on their safety role and responsibilities. They are participants in safety that is facilitated by them being a member of the safety leadership team committee or other safety committee on their level. Their job descriptions also contain their safety dnties, actions, and functions. Often performance ratings are linked to key performance areas that are proactive safety activities, such as scoring 90% or more on monthly honsekeeping inspections, achieving an internal safety audit score of 85%, etc. 

Since 2010 the EUROCONTROL safety culture team has offered an after care service. In practice this means visiting the ANSP some 12-24 months after the survey to see how it is proceeding, how the actions are being implemented and whether they are working. An external visit can sometimes help remind the organisation of its plans and get them back on track. Additionally, if certain actions are not working or are encountering resistance, the survey team may be able to propose alternative solutions that have worked for other ANSPs. 

Concurrent with the use of team EOPs, a continuous state monitoring procedure is used by the safety engineer, providing the major safety actions with an additional degree of redundancy. This procedure provides a direct link with the states and actions to be taken independently of the operational logic diagram used by the control room operators. 

Safety improvement teams and action planning are required elements of the behavior-based process to continually address at-risk behaviors. Team members should periodically review the percentage of safe versus the percentage of at-risk behaviors and other factors to understand where action planning is needed. In many cases, some of the at-risk behaviors can be shaped into safe behaviors through a process of regular observation and feedback. 

The CEO is chair of the Corporate Safety Review Board. The board is made up of all Senior ce Presidents from all divisions. All divisions and departments participate through their safely action teams. Note until the CEO is part of the process, you only have safety change functions. Until you have all divisions inclnded, you only have a partial program. SMS requires everyone to complete all three steps. 

A required outcome of applying the ICAM process is the formation of clear recommendations to address deficiencies in system processes. The investigation team must make recommendations which address all absent or failed defences and all organizational factors identified as contributing factors. The investigation into the RailCorp incident resulted in several Recommended Safety Actions being proposed. Some of these are outlined in Table 12.2 below. 

The safety process was designed much like the process detailed throughout this book and included peer-to-peer observations. All employees were asked to conduct one observation per month. Managers and supervisors conducted observations twice per month. Data were sent from the field locations to the steering committee for review and problem solving. Summaries and trends were sent back to each location for field crews to discuss and plan their own safety action plans. In addition, locally planned celebrations were conducted based on the number of observations made, percentage of employee participation, and team achievements involving safety (there were no formal incentives based on accident statistics). To aid communication, both a newsletter and an online system were utilized that provided information about safety accomplishments and listed ideas and... 

Safety ownership is often viewed as being the exclusive responsibility of specific departments, yet a good safety culture results only from top-level sponsorship and support. Corporate actions and policies must demonstrate this, not just to the workforce in general, but especially to the safety management teams. Inaction or inappropriate actions by corporate management gives rise to a lack of commitment and erosion in morale. 

An overall review of the management of change documentation package should be performed to ensure documentation update items (including material safety data sheets) are addressed and that PHA action items are complete. This can be done by one person but is often best achieved by a PSSR Team. The process needs to account for ... 

The audit team, through its systematic analysis, should document areas that require corrective action as well as where the process safety management system is effective. This provides a record of the audit procedures and findings and serves as a baseline of operation data for future audits. It will assist in determining changes or trends in future audits. 

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