The Leading with Safety process

Precisely how these steps are undertaken depends on a variety of factors peculiar to the institution and its leadership Does the healthcare organization have one location or many How large is it What is its organizational structure Is the objective of the safety initiative to achieve broad improvement across the organization or to pinpoint certain areas  

Phase I of the Leading with Safety process belongs exclusively to leadership much (but not all) of phase II can be delegated. 

Thomas R. Krause, Leading with Safety (New York Wiley Sons, 2005) and Thomas R. Krause and Thomas Weekley, Safety Leadership A Four-Factor Model for Establishing High-Function-ing Organizations, Professional Safety (November 2005) pp. 34-40. 

Phase I starts by giving organizational and professional leaders (who should include the board, administrative leadership, and key leaders from nursing, the physician group, pharmacy, operations/ building management, and safety) a way to speak, understand, and consider how safety works in the organization. 

Step I Gain leadership alignment on patient safety as a strategic priority. Step 2 Develop a patient safety vision. 

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Step 5 Engage the organization in the Leading with Safety process. 

After we discuss each of the phase II steps we will present a case history that touches on some highpoints of the Leading with Safety process and makes use of the tools we have presented in this book. 

In addition, a regular and systematic review, led by the senior leadership team, is a necessary sustaining mechanism. The review process looks at the implementation of each step in the Leading with Safety process and ensures its integrity. 

Thomas R. Krause, Employee-Driven Systems for Setfe Behavior, Van Nostrand Reinhold, New York, 1995 Thomas R. Krause, The Behavior-Based Safety Process, 2nd ed.. Van Nostrand Reinhold, New York, 1997 Thomas R. Krause, Leading with Safety, Wiley-Interscience, Hoboken, NJ, 2005. 

Thomeis R. Krause, Ph.D., is chairman of the board and co-founder of Behavioral Science Technology, Inc. (BST). He is the author of several books, including Leading With Safety, The Behavior-Based Safety Process, and co-author of Taking the Lead in Patient Safety. Tom consults with senior executives on leadership, culture and behavior change in the service of safety improvement. 

The Safety Design and Implementation Team is chartered by the Medical Center to plan, develop, implement, and supervise the installation and initiation of our Leading with Safety culture improvement process under the direction and oversight of the Safety Senior Leadership Team. The results of the team s work will be reported to the Medical Center s senior leadership and to the risk management committee of the board of directors/trustees. 

There are a variety of process safety risks one needs to assess with chemical processes. In general, these risks will lead to an evaluation of the potential for the process to have precipitous changes in temperature and or pressure that lead to secondary events such as detonations, explosions, over pressurizations, fires, and so forth. The most cost-effective way of avoiding these sorts of risks is through the adoption of inherent safety principles. Inherent safety principles are very similar to and complementary to pollution prevention principles, where one attempts to use a hierarchy of approaches to avoid and/or reduce the risk of an adverse event. The reader is referred elsewhere to a more complete treatment of this important area of process design. ... 

Commercially, lead azide is usually manufactured by precipitation in the presence of dextrine, which considerably modifies the crystalline nature of the product. The procedure adopted is to add a solution of dextrine to the reaction vessel, often with a proportion of the lead nitrate or lead acetate required in the reaction. The bulk solutions of lead nitrate and of sodium azide are, for safety reasons, usually in vessels on the opposite sides of a blast barrier. They are run into the reaction vessel at a controlled rate, the whole process being conducted remotely under conditions of safety for the operator. When precipitation is complete, the stirring is stopped and the precipitate allowed to settle the mother liquor is then decanted. The precipitate is washed several times with water until pure. The product contains about 95% lead azide and consists of rounded granules composed of small lead azide crystals it is as safe as most initiating explosives and can readily be handled with due care. 

An H RA involves a review of the process design and its control, operation, and maintenance practices. The review is conducted by a multidisciplinary team with expertise in the design and operation of the process unit. The team uses a systematic screening process to determine how deviations from normal operation lead to process hazards. The H RA identifies areas where the process risk is too high, requiring the implementation of safety functions. The team s objective is to reduce the risk to below the owner/operator s risk criteria. 

The research described in this thesis deals with safety management in complex and high-risk organizations. Companies in the chemical process industry handling hazardous substances are chosen as the subject of study. In particular this thesis will focus on the current safety indication process, and how this safety indication process works and its shortfalls. An unreliable indication process, leads automatically to wrong reactions and measures to prevent possible accidents. Increased understanding of this process helps in providing a better basis from which effective measures to prevent accidents can be derived. 

In order to reflect these lead times, the concept of a timestamp is introduced. Timestamp is used in computer science documenting the system time when a certain event or transaction occurs e.g. for logging events (N.N. 2007). In the context of future inventory value planning, the time-stamp marks the period, when the first raw material has reached a certain stage in the value chain network included into a specific product. In the example illustrated in fig. 57, the raw material is processed in the same period to be converted into product 1. Therefore, all four value chain steps indexed from one to four occur in the same period and have the same time-stamp one. Conversion into product 2, however, requires additional time caused by production lead times, safety inventory and/or transportation time, that the steps indexed with five and six have a time stamp of two. The timestamp reflects that the inventory value of product 2 is not based on the raw material costs from the same period but based on the raw material costs from the previous period in order to reflect the lead time. Consequently, value chain indices and timestamps are defined for all steps and can cover multiple periods reflecting that raw materials in a global complex multi-stage value chain network can take several months, until they are sold as part of a finished product to the market. 

A prisoner can be compelled to take psychiatric medication in only two circumstances. First if he suffers from a serious mental illness that renders him mentally incompetent to make his own medical decisions, prison medical authorities are permitted to forcibly treat the prisoner, so long as the treatment is in the best interests of the prisoner and complies with due process. Second, a prisoner whose mental illness leads him or her to engage in dangerous behavior that threatens to harm other prisoners or prison staff, may be forcibly treated with psychotropic medication.This ruling is based on the unique safety and security issues within prisons. 

The Secret to Measuring Process Safety Performance Combine Process Incident Data with Leading Indicators, Steve Arendt... 

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