Nau mai hoki mai-welcome back to your online learning in this module. In this topic we will identify potential risks related to supporting tāngata in the health and wellbeing environment and explore strategies to manage them using workplace policies and procedures.
We start off our learning by defining some terms.
Hazard or Risk
A hazard is the possibility of something causing harm while a risk is the probability of harm occurring. Something, such as an action or exposure needs to happen in order for a hazard to become a risk. Here are some examples:
| Hazard | Risk |
|---|---|
| Wet floor | The wet floor in the hallway becomes a risk when a staff member slips and injures their back. |
| Exposed electrical wires | Exposed electrical wires pose a risk when a patient accidentally touches them, leading to electric shock. |
| Cluttered walkways | A cluttered walkway turns into a risk when a client trips over an obstacle and fractures their ankle. |
Watch and āta whakarongo-listen carefully as this video explains the difference between a hazard and a risk
Video Title: Hazard vs Risk - Same Difference?
Watch Time: 1:30
Post Watch Task: Reflect on what hazards there are in your health and wellbeing workplace and how they can become a risk to people in the environment.
Source: Risk Bites: YouTube
Hazards in the Healthcare Environment
Activity
Click on the arrow button to work through the following slides, describing hazards found in the healthcare environment.
Identifying Hazards in the Workplace
Some hazards are obvious and easily identifiable, but others might not be identified until they manifest as a risk. The following are examples of ways you could proactively identify hazards in your workplace.
- Conduct a thorough safety inspection check.
- Consult with colleagues to see if they have identified anything dangerous.
- Check any organisational policies and procedures.
- Observe the behaviour of those you support and identify any habits or actions that could potentially lead to harm.
- Talk to your client; they may have identified hazards in their home.
Assessing Risk
A risk assessment is an examination of an environment, any items within it and anyone or anything (including the person’s own behaviour) that could cause harm or lead to the abuse of individuals. The purpose of this examination is to assess whether certain precautions are needed in order to manage any identified risks. You will need to think about the environment, identify any hazards and decide if they are actual and/or potential risks.
Risks must be assessed so that you can identify the effect or consequence of the risk. You need to consider what risk is posed, who could be affected by the risk, and what the circumstances of the risk are. The following are risk categories based on the effect (consequence) of the risk.
| HIGH | MODERATE | LOW |
|---|---|---|
| When there is a strong likelihood of harm occurring. It may result in severe or permanent injury or even death. | When there is a reasonable chance that the client or support worker will be injured or harmed. | Where the effect is likely to be short-term, occur infrequently and/or where there is minimal likelihood of harm happening. |
Organisations usually choose to focus attention on moderate and high-risk areas within the organisation.
Organisations may use other ways to describe the effect or impact of risk. This could include a numbering system from 1-10 or a financial scale measured in monetary terms or costs. The organisation you are employed by will have a way of describing the level of risk for each risk it has identified.
Risk assessment matrix
A risk assessment matrix is an example of a tool that can be used to help assess risk in your workplace.
| Likelihood | ||||||
|---|---|---|---|---|---|---|
| Rare | Unlikely | Possible | Likely | Almost certain | ||
| Consequences | Major | Moderate | High | High | Critical | Critical |
| Significant | Moderate | Moderate | High | High | Critical | |
| Moderate | Low | Moderate | Moderate | High | High | |
| Minor | Very low | Low | Moderate | Moderate | Moderate | |
| Insignificant | Very low | Very low | Low | Moderate | Moderate | |
The risk assessment considers both the likelihood of a risk occurring (from rare to very almost certain to happen) and the severity of the consequences if the risk occurs (from insignificant to major). Based on these two pieces of data, a level of risk is calculated, ranging from very low to critical.
The speed with which the risk needs to be addressed is determined by the level of risk. A critical risk must be dealt with immediately. A very low risk does not need to be addressed (but should be monitored in case the risk level changes).
Activity
Think about the level of risk you would apply to the following:
- The risk of a person entering a residential care facility and physically attacking a resident.
- The risk of a person with an obvious respiratory illness refusing to wear a mask when visiting an elderly relative.
- The risk of your client yelling at you when they become frustrated.
Types of risks
The following are some categories of risks that may be identified during a risk assessment.
General health and safety risks
When hazards are not managed, accidents may occur. This could result in injury to the healthcare worker or their client. A ‘near miss' is an incident that could have caused an accident. Not having an active health and safety programme within an organisation could be seen as a risk.
Legal risks
If an organisation acts in a potentially illegal manner, they may be subject to civil or criminal prosecution. Examples may include being accused of breaking privacy law or providing treatment to a client without informed consent. Dissatisfaction from a client or their whānau may lead to complaints, and the way these complaints are managed and followed up can present a legal risk.
Emergencies
Civil defence emergencies such as fires or earthquakes are risks. A major fire in a residential facility would have the potential to cause injury and death. Even a minor fire, such as in a kitchen, would potentially impact the service that could be delivered to residents.
Governance
A poorly managed or governed organisation presents risks. Poor financial management may result in insufficient funds, leading to a less effective service. Unsafe systems, lack of training or supervision, lack of information, along with poor work culture are all potential risk factors. A poorly governed organisation risks losing contracts to provide services.
Clinical risks
Infection control, for example, outbreaks of infection or the inadequate sterilisation of medical equipment, presents a risk. Errors in the management of medication are a major area of risk in healthcare. Staff working outside their scope of professional practice is also a risk if they attempt to provide medical treatment they are not trained to perform. Abuse or neglect of clients would potentially pose both a clinical and legal risk.
Environmental
Environmental risk includes factors such as the weather, for example, very cold or hot temperatures or storms. The layout and maintenance of buildings may present risks, for example, inadequate lighting, poor ventilation or obstructed or difficult access to emergency exits. Outside terrain, such as steps or hills and other factors, such as a busy road nearby, may also present risks.
Activity
Read the following article: Home care support workers burnt out and unable to take breaks.
Overworking support workers can have several potential risks and negative consequences, both for the workers themselves and for the organisations or individuals who rely on their services. Reflect on what some of these potential risks could be.
Click on the heading to display information on potential risks.
Burnout
Overworked support workers may become exhausted and overwhelmed, leading to physical and emotional exhaustion, reduced job satisfaction, and decreased productivity. Burnout can lead to mental health problems, such as anxiety and depression.
Decreased quality of care
When support workers are overworked, they may have less time and energy to devote to each individual client, leading to decreased quality of care and increased risk of errors, accidents, and incidents.
Increased turnover and recruitment costs
When support workers are overworked, they may be more likely to leave their jobs, leading to increased turnover rates and recruitment costs for organisations. This can also result in a loss of experienced and knowledgeable staff, which can further impact the quality of care.
Legal and regulatory compliance risks
Organisations that overwork their support workers may be at risk of violating legal and regulatory requirements related to working hours, rest periods, and employee health and safety.
Reputational damage
If the public becomes aware that an organisation is overworking its support workers, it could damage the organisation's reputation and make it more difficult to attract clients or staff.
Context of risk
The nature of care and the context of risk can differ from place to place and organisation to organisation.
Residential environment
Residential care situations include facilities designed for the older person, community homes with supervision, residential rehabilitation centres, secured units, and hospital-level care. In some organisations, the work environment may be controlled from within the work setting. For example, the supervisor or manager is on site. In other work environments, workers may work in isolation or on shifts in community homes, and they are supervised from a distance, such as from a central office.
Home-based environment
Workers who provide support to a person in the person’s home face hazards similar to those experienced in other healthcare settings. However, the home-based work environment is likely to be less controllable. It can be isolated as support workers often work alone. Supervision may be from a distance, and there may be delays in response to calls for assistance owing to the distance or degree of isolation. They may be more likely to perform potentially hazardous activities such as lifting people or shifting medical equipment alone.
The home-based working environment restricts the employer’s ability to control the place of work. It could be in a state of disrepair, conditions may be unhygienic, or there may be hazards such as faulty appliances, electrical wiring, or breakages.
People also have a greater degree of autonomy (personal control) in their own homes, which support workers must respect. Support workers may be more likely to make allowances for people’s behaviour and can gradually come to accept increasingly dangerous behaviours as ‘normal’ or manageable.
Community facilities
Community facilities such as pools and community centres present risks that cannot always be planned for. As a support worker, if you are using community facilities and services, it is important to follow any risk management plans in place for your client. It is also important to think about some of the risks that you may encounter and have strategies in place that will help to keep the person safe.
Excursions
Excursions or trips pose their own unique risks. If you are planning or participating in an excursion, always make sure you visit the place yourself first before you take any person or group there. You need to be able to identify any possible risks and how you will deal with them before actually making the trip.
The Health and Safety at Work Act requires all significant hazards to be identified, eliminated, or controlled by substituting, isolating or minimising them.
The hierarchy of controls
The hierarchy of control is a tool used to help you to work through safety problems and reduce the risk.
Eliminating the risk (level one)
Eliminating the risk is the highest level in the hierarchy. Removing a risk completely is always the preferred option when available as it means there is zero chance of a future incident occurring. While it may not be possible to remove the risk completely in most cases, it should always be the first control measure explored. An example of risk elimination could be providing extending poles operated from the ground to access a high window latch rather than requiring climbing a ladder, which presents a risk of falling.
Substituting the risk (level two)
The next level down in the hierarchy is risk substitution. Risk substitution is the process of removing risk by replacing it with another risk that is either less likely to occur or less severe in its potential damages. Substitution is less preferred to eliminate the risk completely as it still leaves a risk present, albeit in a reduced form. An example of risk substitution could be to replace noisy equipment with a quieter option, or it could be replacing a highly toxic chemical with a less dangerous version. It’s important to conduct a new risk assessment after the substitution has been completed to identify any new risks created by the substitute process.
Isolate the risk (level three)
The third level in the hierarchy is risk isolation. Risk isolation is performed by placing some form of barrier between the employee and the risk factor in order to provide protection. The key difference between this level and risk elimination (level one) is that the risk is still present, with the employee only shielded from it by the barrier. If the barrier were to fail or require bypass, the risk would return to being uncontrolled. Risk isolation could be enacted by placing dangerous machinery in a separate room from the operating and installing remote control systems.
Engineering controls (level four)
Engineering risk control is the process of designing and installing additional safety features to workplace equipment. Safety features could be installing more stringent ventilation systems in noxious environments or installing guardrails on a raised walkway.
Administrative controls (level five)
Level five of the hierarchy is administrative controls. These are measures the management and chain-of-command can implement to reduce the likelihood of a risk occurring. Measures could include providing dedicated training targeted at the risk or arranging work schedules to limit exposure times in hazardous environments.
Personal protective equipment (level six)
The final level in the hierarchy of risk control is the use of personal protective equipment (PPE). It’s likely that this level will be utilised regardless of what other levels are also being used to control risk. However, it remains at the bottom of the hierarchy as it doesn’t remove or reduce the risk itself. Instead, this level is designed around assuming an incident will occur and protecting the employee from harm when it does. Personal protective equipment includes hard hats, noise-reducing ear protection, or cut-resistant gloves.
Case study on applying hierarchy of controls
Liliana’s managers asked her to help them to apply the hierarchy of control to a resident who has become more dependent and at risk of falling during a transfer. Working through each level, they considered the following levels:
- Elimination
- The resident has to be provided with support, so Lilianna and her manager both agree that eliminating the transfer altogether is not an option.
- Substitution
- They then consider options such as transferring with more than one worker at all times, using a hoist machine or using a standing machine.
- Isolation
- They considered the options of using guard rails or barriers when transferring the resident and limiting access to high-risk areas.
- Engineering
- Liliana suggests having a bedrail put onto the resident’s bed to help her to hold on during the transfer, but this is a risk to the resident’s safety while she is in bed because clothing might be caught around the rail. The manager also mentioned that it could be considered a restrictive practice if it prevented her from getting out of bed.
- Administration
- The manager suggested that training for staff by the visiting physiotherapist could help them to transfer the resident safely. Lilianna liked this idea.
- PPE
- This level of control was deemed not relevant to this problem, as it could not help with the safety of the transfer.
Using the hierarchy, Liliana and her manager agreed on the most effective controls:
- Using a standing machine to help the resident to transfer
- Having a training session with the physiotherapist to help staff perform the transfer via the machine more safely.
Risk management is the process of assessing risk and developing strategies to manage those risks.
Managing risk requires a proactive approach, following a series of steps to devise a management plan and continuously communicating about the risks to everyone involved.
Levels of risk management
Risk management can be applied at different levels:
- Strategic or management level: for example, the management team or board would consider organisational risks.
- Operational level: for example, clinical services.
- Project level: for example, when a new project or service is started.
- Specific risk level: for example, where risk has already been recognised for infection control.
The risk management process
The Health and Safety in Work Act states there is an expectation that there will be regular reviews of your work activities to identify, assess and control risks. Everyone is responsible for making sure this happens. A risk management process is the way in which risks are considered and managed.
Plan - identify and assess risks
Do - eliminate or minimise risks
Check - monitor the control measures
Act - review for continuous improvement
Activity
View the following cards to learn about the steps in the risk management process.
A risk management plan sets out how any identified risks can and should be managed. The risk management plan must be regularly reviewed in accordance with organisational and legal requirements. You will need to know the risk management plan well and how to implement the plan of the tangata you support. It may include risks that you have little or no control over. It may be something that you can directly influence, for example, managing an infection or practising good hygiene.
The key steps to a risk management plan
- The situation should be identified.
- The situation should be investigated by:
- those with the skills and knowledge to assess the situation
- a multidisciplinary team who can make a more informed or holistic assessment
- the person with an overview of the project
- All the facts should be gathered so that the risks can be identified. These include the risks for service users, the support worker and others.
- The risk should be categorised, for example, high, medium, or low.
- Actions should be decided on, including:
- what needs to be done to prevent harm from occurring, for example, hazard identification forms
- allocating responsibility and resources such as training
- allocating realistic timeframes
- A strategy for follow-up and review needs to be planned. It should include points such as the following:
- This information needs to be communicated to everybody.
- Checks need to be made to make sure the actions have been taken as planned.
- Review checks need to be made to see whether the actions and plan have been effective.
Evaluating and amending risk management plans
If a person you are supporting has a risk management plan, it is important to evaluate the effectiveness of that plan. Health and wellbeing organisations will have their own way of monitoring risk, reviewing risk, and updating the risk management plans to keep them current and effective.
If, in your daily work, you observe new hazards or risks, it is important that you make a note of them. Your colleagues may also have made observations and discussed these with you. These issues then need to be reported using the organisation's procedures. This may be an informal process, such as emailing your supervisor, or there may be a more formal process, such as submitting a report at a team meeting. Larger organisations may have a risk committee, and senior management will review reports on risk and quality.
Remember to get feedback from the client. They will have their own viewpoint on the effectiveness of the plan and how it has impacted the quality of their life. Customer satisfaction surveys will also provide feedback.
From all of the above, the effectiveness of the plan will be evaluated. Recommendations may be made for change or improvement, or indeed for no change, retaining the status quo. There needs to be a rationale for recommendations for change.
When evaluating a plan, consider:
- Is the plan practical to implement?
- Is the outcome of the plan what was intended? If not, why not?
- Does the plan have the desired effect? If not, why not?
- What would be an improvement that could be made? How would this improve the plan?
Try it out
Read the following scenario, then complete the activity that follows.
Aspen Care Centre is a residential care centre set in beautiful grounds by the river on the edge of town. Residents love to make use of the grounds, including a lovely area of native bush. They also visit the nearby town centre and are free to come and go as long as they notify the staff of their intentions.
Reg has been attending Aspen Care for the past two months but has still not really settled in. Previously a long-haul truck driver who lived on a small block of land, Reg now needs support because of dementia associated with long-term alcoholism. He’s very fit and likes to go for a walk every day, rain or shine. Lately, the staff have noticed that Reg is returning from his walks much later than his stated return time, and he has also been seen near the bridge where the main road crosses the river a couple of times.
The staff don’t want to spoil Reg’s progression but recognise that these excursions are presenting some risks. One day, Reg returns home two hours late from his walk and appears to be distressed. Staff report their concerns, and Aspen Care’s manager decides that a plan needs to be put into place to help keep Reg safe.
Remember: A risk management plan can never be perfect, but evaluating the plan and constantly refining it will improve the process of risk management. As all potential risks are analysed or checked, the outcome or impact is considered for each risk.
Control measures
The type of control measure implemented will depend on the hazard type. Some examples include:
- Placing warning signs for a slip hazard.
- Training staff on the safe use of new equipment.
- Locking doors and windows to maintain security
- Ensuring there are enough suitably qualified or experienced staff on every shift.
- Ensuring sufficient personal protective equipment is made available.
The context will determine the type of control measures that can be taken. For example, a trip-hazard sign may work in a residential care location but be totally inappropriate in the home-based environment.
Hazard signs and symbols
Safety signs are used to alert people to potential hazards, show the location of emergency and safety equipment or give instructions for dealing with emergency situations. Symbols and graphics save time in emergency situations. They can easily be identified and interpreted by people who are unable to read or understand a written language.
Here is a chart of safety signs and symbols that are commonly used in most settings:
Poison
Emergency exit
Fire equipment
First Aid equipment
PPE must be worn
Cytotoxic drugs
Biological hazard
Sharps disposal
Radiation
An organisation’s needs will determine whether its control measures limit or restrict the risk from occurring or prevent it from becoming worse. If the controls implemented are insufficient to make the risk level acceptable, then the organisation needs to determine what else is required and plan to implement new controls.
It is impossible to list every possible risk and control measure for every possible situation. Common sense tells you what might go wrong, and common sense also tells you what to do to protect yourself and others. If in doubt, ask your supervisor.
Risk management plans will never be perfect. They need to be updated to make sure that the current methods are still working and are relevant. It is only worth spending time and money in managing risks that are considered likely to occur.
Reflection
Read the case study below and reflect on the questions that follow.
Several clients in a residential disability home have become unwell with a vomiting and diarrhoea illness over the past few days. In addition, three support workers have been on sick leave and reported similar symptoms.
The organisation decides to investigate what has caused the outbreak. As part of the investigation, they review policies and procedures about how to manage an outbreak. They discover that the policies were last reviewed more than three years ago and that there is not enough detail in the procedures to guide staff in the event of another outbreak.
They update the policies and procedures by consulting with an infection control nurse and also provide a training session to staff.
- What is the hazard and the risk in this scenario?
- How often should a policy of this kind be updated?
- What sort of thing should be included in the training session?
Consolidation activity
In the following activity, you have been presented with two risky scenarios for an in-home care setting. For each, you will analyse the risk and suggest potential solutions, drawing on your knowledge of the risk assessment matrix and the implementation of controls.
Risk management strategies are used to minimise all risks. When supporting the implementation of a person’s risk management plan you are minimising the identified risk situations and supporting the person to be safe.
Some strategies you may be involved in are:
- Using your common sense and being practical in the support you offer
- Ensuring the support you give is practical and fair
- Reacting early enough to prevent a risky situation
- Ensuring that you provide opportunities for the person to explore and experience their environment safely.
A support worker may be involved in identifying early warning signs, and these should be documented in the individual risk management plan and reported, recorded and acted upon.
A support worker may also contribute to managing risk through being involved in a multidisciplinary team. For example, attending meetings and providing feedback or reports on individual people.
Consider some of the strategies used to manage risk below.
| Type of Risk | Risk Situation | Early warning signs | Strategy to implement | Steps to take |
|---|---|---|---|---|
| Behavioural | John stands too close to people, placing him at risk of verbal or physical abuse. |
He stares at people. He behaves in a confrontational manner. Others become restless and scared of him. |
Encourage John to imagine a ‘comfort circle’ for other people at arm’s length away. He must stand outside that circle. |
Remind John of the circle. Remind John to take a step back. |
| Health | Amiria places herself at risk when she forgets to take her diabetes medication. |
She is drowsy. Has slurred speech. |
Reminder notes on the bedside Verbal reminder by support worker. |
Make up the cards. Inform other support |
Overall, having a strategy when managing risks is crucial for organisations to achieve their objectives, protect their assets, and maintain confidence in those involved. A well-planned and implemented risk management strategy can help organisations to thrive in a complex and uncertain environment.
Reflection
For each of the following situations, identify the risk and a strategy or strategies for managing the risk.
- Taking a service user to a dental appointment.
- Observing a service user pushing his father roughly.
- Coming into contact with the blood of a service user who has hepatitis.
- Seeing a senior staff member bullying a new support worker.
Workplace policies and procedures to address risk
Workplace policies and procedures to address risk are guidelines and protocols established by organisations to identify, assess, and manage potential risks in the workplace. These policies and procedures are designed to protect employees, clients, visitors, and the organisation itself from harm or damage and to ensure compliance with legal and regulatory requirements.
Overall, workplace policies and procedures to address risk are essential for maintaining a safe, healthy, and productive workplace and for minimising the potential negative impact of risk on employees, clients, and the organisation itself.
There are four common models of policies and procedures that workplaces use to address risk.
Health and safety policies
These policies outline the organisation's commitment to providing a safe and healthy work environment and describe the procedures for identifying and addressing potential hazards, such as providing personal protective equipment (PPE), conducting risk assessments, and reporting incidents and accidents.
Emergency response procedures
These procedures provide guidance on how to respond to emergency situations, such as fires, natural disasters, or medical emergencies. They outline the roles and responsibilities of employees, provide evacuation routes and emergency contacts, and describe how to communicate with emergency services and stakeholders.
Information security policies
These policies outline the procedures for safeguarding sensitive information, such as personal or medical data. They describe how to identify and manage information security risks, establish access controls and passwords, and ensure compliance with privacy laws and regulations.
Quality assurance policies
These policies outline the procedures for ensuring the quality and consistency of products or services. They describe how to identify and address potential quality issues, establish quality control measures, and maintain records and documentation.
Reading
This letter from Auckland DHB highlights the importance of having policies and procedures in place.
As indicated in this letter, every potential incident is recorded following specific procedures or policies established by the District Health Board (DHB). The number of policy sections would depend on the organisation's size and operations. These particular policies and procedures are designed to align with the organisation's needs, outlining precise steps for staff to adhere to. The organisation's unique policies and procedures are tailored to its services and activities.
End of Topic
Ka rawe! Excellent! That’s the end of our topic on Risk and Risk Management. You should now have an awareness of the potential risks in relation to the role of the support worker. You will now also have knowledge of some strategies to address these risks to contribute to a safer environment in the health and wellbeing setting.
In our next topic we explore professional and ethical practice- what it means for support workers and the tools to support your own professional and ethical practice.
Keep up the great work!
