Editor’s note: Our Safety Leadership column is written by experts Michael Greene, Blair Bigham and Daniel Patterson. Following is part five of a 12-part series.
Dave Richter is obsessed with checklists. One could say he’s a control freak, and obsessive-compulsive about safety.
Common in the English lexicon, the phrase obsessive-compulsive is defined as “often used in an informal or caricatured manner to describe someone who is meticulous, perfectionistic, absorbed in a cause, or otherwise fixated on something or someone.” Yes, that’s Dave. After 20-plus years of working and flying with him on air medical missions, I’m OK with his obsessive-compulsive disorder (OCD).
Dave knows his pre-flight checklist is the outcome of decades of risk management in aviation. And I knew that because it was on his checklist, my helicopter wasn’t lifting off until I gave Dave an affirmative response that the cabin, seat belts and doors were secure. I trusted Dave with my life because I saw this OCD behavior during preflight walk-around, safety checks, maintenance run-ups, all phases of flight—heck, even in his written documentation. So in honor of Dave, I’d like to weave some of his character traits into the definition of risk management.
Risk management, from an OCD perspective, is the deliberate and meticulous early recognition and management of potential problems. Risk management is a formal system of hazard identification and management, fundamental in controlling an acceptable level of risk. Fixated on safety, a risk management system describes operational processes across departmental and organizational boundaries; identifies key hazards and measures them; methodically assesses risk; and implements controls to mitigate those risks. More than a system, risk management is a cause to be pursued and perfected.
While EMS is not free of risk, the risk that does exist can be mitigated, managed, lessened and in some cases avoided altogether. In this pillar of a safety management system, we will explore strategies, steps and tools for your safety toolbox.
A look at risk management strategies
At a 50,000-foot view, there are three basic risk management strategies: reactive, proactive and predictive (see illustration above). The reactive strategy—responding to events that have already occurred—is probably the most common approach to safety issues. Reacting to a safety issue is a necessary response, but not one that prevented the incident in the first place.
Being proactive is, by definition, actively identifying hazards, yet how much of a leader’s time—your time—is spent looking around your organization? Management by walking around (MBWA) definitely has its benefits in your safety program. Popularized by business guru Tom Peters, MBWA is an essential element of risk management, as it allows you to see, hear and feel the safety issues facing the organization. MBWA gives you a view of the 96 percent of the iceberg below the surface.
Predictive risk management takes the proactive approach a step further by analyzing processes and the environment and forecasting future risks. Let me use change as an example of predictive risk management. Have you ever gotten a great deal on a disposable supply for your organization, say IV catheters, which was just too good to pass up? As a leader I might say, “This is just a small change. IV caths can’t be that much different, and it saves big bucks.” But as a frontline caregiver, I may see the newest and greatest—albeit cheapest—brand of IV cath as a challenge because of the idiosyncrasies of that device when time, efficiency, effort—and, yes, lives—mattered. (Is this reminding you of the change over to needle safety devices?) A predictive risk management approach would employ management of change principles—identification, request, need, education and implementation—through which the change is fully processed.
The steps and tools of risk management
At the ground level, risk management involves the following steps and tools:
Step 1: Identify the hazards
A hazard is anything that can cause harm, such as sharp objects, chemicals and uncontrolled accident scenes. OSHA categorizes workplace hazards into five types: materials, equipment, environment, people and system (MEEPS). The first three categories contribute to only 3 percent of all workplace accidents, according to a major workers’ compensation insurer, leaving 97 percent attributable to people (employee behaviors) and systems. The take-home message, when assessing hazards in your workplace: Look at system weaknesses and human factors for the biggest return on a safer workplace.
Step 2: Evaluate the risks
Risk is the chance, high or low, that someone could be harmed by a hazard, including an indication of the degree of seriousness of harm. The best way to describe and assess risk is through the use of a risk matrix (see table below). In utilizing the risk matrix, probability is your estimation of the likelihood of an event; severity is your approximation of the result. The tool gives the organization an opportunity to qualify risks as extreme, high, moderate or low.
Step 3: Decide on precautions or controls
The goal of a precaution or control is to reduce the probability or severity of the risk. The best example of a precaution in EMS is the use of personal protective equipment and universal precautions during patient care. Others include needleless systems, driver alert systems or break-away shore power lines. Checklists are also excellent process controls. In fact, the World Health Organization’s surgical checklist has been credited with a reduction in patient morbidity and mortality on a global scale!
Step 4: Implement controls and document your findings
Implementation of controls can be one of the most challenging steps because it affects the workforce, who may be resistant. Implementation of precautions and controls goes to the heart of good change management, especially education on the previous three steps. Don’t neglect documentation, either, to demonstrate if controls and precautions are being successful and cost beneficial, and ultimately making the workplace safer.
Step 5: Supervise, review and update if necessary
Few organizations stay the same. EMS is no exception—new procedures, new equipment and new staff all call for supervision, review and updates to risk assessment and management.
Michael Greene, R.N., MBA, MSHA, is a senior associate at Fitch & Associates. He has served in numerous front-line and leadership positions throughout his career, working in volunteer and paid search and rescue and as a paramedic, county EMS director and air medical/critical care transport director. He is the author of numerous articles and chapters on EMS and air medical transport topics. He can be reached via e-mail at mgreene@fitchassoc.com or by phone at 816-431-2600.
