Overview

From July 1, 2014 to June 30, 2017, the Ministry of Labour (MOL) conducted a three-year health care enforcement initiative, which focused on hospitals, homes for nursing care (long-term care homes), homes for residential care (retirement homes), group homes, nursing services, professional offices and agencies as well as treatment care and specialized services.

A total of 2,525 field visits were conducted to 908 workplaces and 6,051 orders and requirements (including 62 stop work orders) were issued under the Occupational Health and Safety Act (OHSA) and its regulations.

Inspectors checked for compliance with safety laws and focused on the internal responsibility system (IRS). They also looked at the five most serious hazards and contributors to lost-time injuries and illnesses in the health care sector, which were identified as:

  • musculoskeletal disorders
  • exposures
  • slips, trips and falls
  • workplace violence
  • contact-with and struck-by injuries

Additional goals of the initiative were to visit every hospital in Ontario and to engage with the senior executives at these workplaces to ensure they were aware of the initiative and the results from the field visit(s) that were carried out at their organization.

Background

A key to workplace health and safety in Ontario is the internal responsibility system (IRS). One of the primary purposes of the OHSA is to facilitate a strong IRS in the workplace. IRS was identified by field staff and by external stakeholders as an issue where there were opportunities for improvement within the health care sector. The goal of the initiative was to conduct an evaluation of the IRS, and to conduct inspections with a focus on the most serious hazards and contributors to lost-time injuries andillnesses in the sector in an effort to:

  • raise awareness of the importance of the IRS
  • check that employers identify and control hazards
  • address and remedy non-compliance with the OHSA and its regulations
  • promote improved health and safety for health care workers
  • engage senior executives of hospitals with regional MOL leadership
  • promote partnerships with the health and safety associations, specifically the Public Services Health & Safety Association (PSHSA)

Engagement of senior management in health and safety is instrumental in promoting a culture that makes health and safety a priority. To ensure senior management was aware of the inspections MOL would be conducting, hospital CEOs received a letter at the start of the initiative. Meetings were later held with MOL staff and senior executives to discuss the results of the field visits. As well, a survey was sent to senior management of hospitals at the end of the initiative to obtain their feedback.

Initiative focus

During the health care enforcement initiative, inspectors focused on hazards at health care workplaces that contribute to a number of injuries and illnesses. Based on stakeholder input and 2015 Workplace Safety and Insurance Board (WSIB) lost-time injury (LTI) data, the five most serious hazards across the sector were identified as:

  • musculoskeletal disorders (38% of LTIs)
  • exposures (17%)
  • slips, trips and falls (17%)
  • workplace violence (12%)
  • contact with and struck by injuries (10%)

When this three-year initiative began, the MOL was aware that emerging issues might call for flexibility and/or an additional focus for the inspectors’ field visits. This was what happened when the concerns regarding Ebola occurred in 2014/15. MOL inspectors included a component on Ebola preparedness when they were conducting field visits related to this initiative.

Inspection activity summary

  • 2,525 field visits
  • 908 workplaces visited
  • 6,051 orders issued for a number of violations under the Occupational Health and Safety Act and its regulations
  • 62 stop work orders issued
  • 109 requirements issued to provide an inspector with information
  • an average of 6.7 orders and requirements issued per workplace visited
  • an average of 2.4 orders and requirements issued per field visit

The breakdown of field visits and orders by sub-sector are:

  • group homes:
    • 210 field visits
    • 158 workplaces
    • 274 orders
    • 1.73 orders per workplace
  • homes for nursing care:
    • 392 field visits
    • 191 workplaces
    • 912 orders
    • 4.77 orders per workplace
  • homes for residential care:
    • 304 field visits
    • 156 workplaces
    • 675 orders
    • 4.32 orders per workplace
  • hospitals:
    • 1,391 field visits
    • 245 workplaces
    • 3,750 orders
    • 15.3 orders per workplace
  • nursing services:
    • 15 field visits
    • 12 workplaces
    • 18 orders
    • 1.5 orders per workplace
  • professional offices and agencies:
    • 150 field visits
    • 98 workplaces
    • 314 orders
    • 3.2 orders per workplace
  • treatment care and specialized services:
    • 63 field visits
    • 48 workplaces
    • 108 orders
    • 2.25 orders per workplace

Order summary

During the three-year initiative, 2,635 (44%) of the orders and requirements were issued for various contraventions under the OHSA, 2,966 (49%) for contraventions under O. Reg. 67/93: Health Care and Residential Facilities and the remaining 7% were written under 10 other regulations, including Regulation 860: Workplace Hazardous Materials Information System (WHMIS), O. Reg. 297/13: Occupational Health and Safety Awareness and Training and O. Reg. 474/07: Needle Safety.

The orders issued most frequently under the OHSA involved employer duties (s. 25—1,659 orders), workplace violence (s. 32.0.1 and s. 32.0.3—344 orders) and joint health and safety committees (JHSC) (s. 9—170 orders).

The most frequently issued orders under section 25 of OHSA were related to the need to take every precaution reasonable [s. 25(2)(h)]—806 orders; to maintain equipment [s. 25(1)(b)]—446 orders; and to provide information, instruction, and supervision to a worker [s. 25(2)(a)]—189 orders.

Of the s. 25(2)(h) orders, the most common topics were eyewash fountains, electrical/lockout, housekeeping/maintenance, protective personal equipment (PPE) and fall hazards.

Of the 2,966 orders issued under O. Reg. 67/93, the most common ones were 417 under section 103 (material handling), followed by 404 orders under section 9 (measures and procedures), 371 orders under section 33 (work surfaces), 192 orders under section 8 (consult with JHSC) and 191 orders under section 32 (food and drink in contaminated areas).

Most frequently issued orders by sub-sector

Hospitals

  • employer duties (OHSA s. 25)
  • material handling (O. Reg. 67/93 s. 103)
  • measures and procedures (O. Reg. 67/93 s. 9)
  • work surfaces (O. Reg. 67/93 s. 33)
  • machine guarding (O. Reg. 67/93 s. 45)

Homes for nursing care (long-term care homes)

  • employer duties (OHSA s. 25)
  • material handling (O. Reg. 67/93 s. 103)
  • work surfaces (O. Reg. 67/93 s. 33)
  • measures and procedures (O. Reg. 67/93 s. 9)
  • food and drink in contaminated areas (O. Reg. 67/93 s. 32)

Homes for residential care (retirement homes)

  • employer duties (OHSA s. 25)
  • JHSC (OHSA s. 9)
  • Violence and harassment policy (OHSA s. 32.0.1(1))
  • awareness training for workers (O. Reg. 297/13 s. 1)
  • workplace violence risk assessment (OHSA s. 32.0.3)

Group homes

  • employer duties (OHSA s. 25)
  • measures and procedures (O. Reg. 67/93 s. 9)
  • violence and harassment policy (OHSA s. 32.0.1)
  • work surface (O. Reg. 67/93 s. 33)
  • JHSC (OHSA s. 9)

Nursing services

  • JHSC (OHSA s. 9)
  • employer duties (OHSA s. 25)
  • electrical (Reg. 851 s. 44)
  • notice (Reg. 851 s. 3)
  • awareness training for workers (O. Reg. 297/13 s. 1)

Professional offices and agencies

  • employer duties (OHSA s. 25)
  • violence and harassment policy (OHSA s. 32.0.1)
  • workplace violence risk assessment (OHSA s. 32.0.3)
  • health and safety representative (OHSA s. 8)
  • awareness training for workers (O. Reg. 297/13 s. 1)

Treatment care and specialized services

  • employer duties (OHSA s. 25)
  • violence and harassment policy (OHSA s. 32.0.1)
  • workplace violence risk assessment (OHSA s. 32.0.3)
  • JHSC (OHSA s. 9)
  • health and safety representative (OHSA s. 8)

Senior leadership commitment

A commitment to health and safety by the senior leadership of an organization is important for an effective health and safety program. Their commitment to the prevention of workplace injuries and illnesses is reflected in the priority the program is given. It’s also a key indicator in the overall performance of the organization and the quality of patient/resident/client care.

One of the goals of the three-year initiative was to engage with the senior leadership of hospitals. Two stories are outlined below that highlight how chief executive officers (CEOs) can shift the culture in their organizations to make health and safety a priority. The personal commitment of these CEOs reflects the foundation of a solid internal responsibility system.

The Ottawa Hospital

Dr. Jack Kitts, CEO of The Ottawa Hospital, recognized that the culture of safety for patients and staff at the hospital was one and the same. He feels that staff and patient safety are linked: you can’t provide safe patient care without staff working safely to deliver that care.

A few years ago, The Ottawa Hospital adopted a “just culture” philosophy. This is a term commonly used in the aviation industry, whereby reporting of incidents, near misses and hazards is not just encouraged—it is expected.

For Dr. Kitts, “a just culture improves accountability at all levels, it treats staff members fairly and consistently, and addresses risk. It’s a framework that is designed to make it feel safe for all staff members to comfortably discuss safety concerns, issues or mistakes so that we can learn from them and improve the way we work. In a just culture, we respond to choices, not outcomes, in a way that is fair and addresses bias.”

Since its implementation, staff at The Ottawa Hospital are reporting incidents and many of the reports are identified as “good catches,” where there is not an adverse outcome and the report identifies an opportunity for improvement.

Dr. Kitts highlights another key element that has enhanced the culture of safety at The Ottawa Hospital: partnering with unions to recognize and resolve health and safety concerns. A “Workplace Safety Council” was also established to enable the JHSC co-chairs from the different hospital campuses, union and hospital executives to discuss strategic safety initiatives and learn from each other’s experiences.

In addition, Dr. Kitts recognized “champions” are essential to establish and advance a culture of safety. He ensured there are champions within the organization that have expertise in health and safety; that champions on the medical staff support the need and value of staff health and safety; and senior management champions to ensure there is effective direction, support and communication with respect to staff safety.

St. Mary’s General Hospital

Everyone at St. Mary’s General Hospital in Kitchener, from the president and board of trustees to front-line staff, has played a key role in enhancing safety for patients and staff. This commitment to people’s safety is driven by the hospital’s vision to be the safest hospital in Canada.

The board-endorsed vision, which until his retirement on June 30, 2018 was led by St. Mary’s President Don Shilton, guides the focused hospital-wide goals for safety improvements each year. Management and front-line staff, including unions and the members of the joint occupational health and safety committee, are actively involved in setting goals and measuring success through a performance improvement system called lean.

Progress on goals is closely monitored through a variety of regular touch-points between manager and staff, manager and director, director and vice president, vice president and president and on, up to board trustees. Quick 15-minute check-ins called ‘status exchanges’ feature a standard set of questions that allow staff to share with managers what they are working on, identify challenges, problem-solve and proactively plan. Department ‘huddles’ held one or more times a week bring staff and managers together at a unit level to identify and track improvements.

Addressing workplace violence has been a priority for St. Mary’s. A sub-committee was established in 2008 and continually examines and addresses gaps using the Workplace Violence Prevention in Health Care Leadership Table report as a benchmark. A recent staff engagement survey revealed that 79% of St. Mary’s staff feel safe at work. This is credited to staff training, daily patient risk assessments, visual reminders of the hospital’s zero tolerance for violence, effective communication regarding patients with a history of violence and the availability of security personnel who respond to escalating situations.

MOL Hospital CEO Survey

The Ministry of Labour distributed a survey to senior leaders of hospitals at the end of the three- year initiative to obtain their impressions of the health care initiative. The survey allowed for anonymous responses. Twenty surveys were completed.

Eight were from small hospitals (fewer than 100 beds), seven were from mid-sized hospitals (100-350 beds) and five were from large hospitals (more than 350 beds). The results indicated the following:

CEOs indicated the important steps they are taking to advance health and safety include:

  • getting buy-in from senior leadership
  • developing a workplace violence prevention committee
  • embedding it in the strategic plan
  • implementing a new flagging system and new panic alarms
  • formalizing/increasing training
  • putting safety first, before caring for others
  • conducting joint investigations of all incidents

Observations

Workplaces within all seven of the health care sub-sectors were inspected during the three-year initiative. Every hospital, including multiple worksites for many of the hospitals, were visited. Hospitals received in-depth inspections that resulted in an average of 15.3 orders per workplace. More than 90% of orders, to all the sub-sectors, were issued under either O. Reg. 67/93: Health Care and Residential Facilities or the Occupational Health and Safety Act. Orders were written under other regulations, including Regulation 860: Workplace Hazardous Materials Information System (WHMIS), O. Reg. 297/13: Occupational Health and Safety Awareness and Training and O. Reg. 474/07: Needle Safety. Most orders were associated with employer duties.

Conclusion and next steps

The results indicate that inspectors continue to find contraventions related to the internal responsibility system. The Ministry of Labour is committed to raising awareness of the importance of a strong internal responsibility system. A strong IRS means that everyone takes their duties seriously and hazards in the workplace are controlled. All workplace parties—employers, supervisors, workers, members of the joint health and safety committees and the health and safety representatives—must continue to work together to identify and control hazards in the workplace.

In addition, workplace violence prevention in health care continues to be a priority for the Ministry of Labour. The work of the Workplace Violence Prevention in Health Care Leadership Table has resulted in an increased awareness about this issue, a number of recommendations to address workplace violence and tools for workplaces to help them meet their obligations under the OHSA.

Help for employers

Contact the Public Services Health & Safety Association (PSHSA) for resources and training on identifying, preventing and controlling workplace hazards in health and community workplaces.

Visit Workplace-violence.ca for resources and tools to prevent workplace violence.