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Prakash Chandran: June is national safety month. This is the time to bring awareness to workplace conditions and focus on providing a safe environment for all employees. We're gonna talk about it today with Tanzi Brock, the environmental safety manager at Ridgecrest Regional Hospital. This is the Ridgecrest Regional Hospital podcast.

My name is Prakash Chandran. So Tanzi, thank you so much for being here today. I really appreciate your time. What exactly does National Safety Month mean to you?

Tanzi Brock: So of course safety is something that must be observed every day. But National Safety Month is very important because it generates safety awareness. We typically generate awareness, safety officers who, things like safety, bulletins, posters, meetings, and training. So this is just another layer of generating awareness. Most workers do know how to prevent workplace injuries, just like we know how to prevent a fall. Watch where you're going pick up your feet. Don't walk distracted, use the handrails. But people do become complacent, hurri, and that's when accidents happen.

Prakash Chandran: Yeah, that makes a lot of sense. I'm curious. What are the most common workplace injuries that

Tanzi Brock: So by far the most common workplace injury, and this is in all industries is musculoskeletal disorders. So this is disorders of ligaments, bones, joints, nerves. So it is a pretty broad category. But it does account for about 33% of all worker injury cases. And that's true for us in healthcare as well. The majority of these types of injuries are caused by patient handling activities in healthcare. So, these are things like transferring a patient from a bed to a chair, adjusting them in bed, dressing wound. And a lot of injuries are also caused by trying to prevent or prevent a patient fall or an assisted fall.

Prakash Chandran: Yeah, that's tough. And I imagine because these are requirements to doing your job well, like handling these patients, how exactly can this type of injury be prevented?

Tanzi Brock: Okay. So in safety there's a hierarchy of hazard control. And the first thing is to eliminate the hazard or substitute it with a less hazardous option. We can't do that in healthcare. We cannot get rid of our patients. So the next thing we do is engineering controls. So that's where mechanical lifts and things like that different types of patient handling equipment is used. The next thing would be administrative controls, such as no lift policies, policies saying that you must use the lift equipment right. To refuse policies saying you have the right to refuse to lift. If you feel that it is a safety hazard without fear of retaliation, or like a two person lifting technique. The final part of the hierarchy is PPE. So that would be something maybe like a back belt to be warned.

Prakash Chandran: Yeah. And expanding on that hierarchy a little bit. Are there rules or guidelines in place? For example, like if a nurse is trying to lift someone that is clearly too heavy for them, are there guidelines that they can follow to actually get someone for that lift assist?

Tanzi Brock: Yes, we always encourage getting. When needed and there are interventions, people that we can call to come help. We have kind of an ad hoc lift teams that we can put in place. If we do have, sometimes we do have patients that are heavier than our average patient, and we need to take extra steps in that case.

Prakash Chandran: Yeah. One thing that I know about health providers and especially a lot of the ones in my in my network and in my family, they kind of have, this can do attitude and just, they just roll up their sleeves and get things done. But I also know that over time, some of the injuries that we're talking about can be sustained, right? And might start as a minor pain and maybe graduate into something differently. So one of the things that I wanted to ask you is if someone is starting to feel pain or have an injury, when exactly should they consider getting help?

Tanzi Brock: Yeah, that's a great question because they are cumulative injuries and this pain can be come and go or it's a slow onset. So it's really difficult to identify also the source of that pain. Is it. something you did at home or is this repetitive injury from work? We always encourage staff to report pain before it results in a serious injury, because there are interventions that we can take to prevent that from becoming a serious injury.

Prakash Chandran: So I'm curious as to what prevents people from reporting their injuries. Like, I can speak for my friends. I feel like they just have this can do, I wanna do it all on my own, but is that something that you see as well? Or is there another reason that prevents people from reporting?

Tanzi Brock: So I usually don't encounter unreported injuries. The problem is that the hazards leading up to the injury go unreported. So we often discover the hazard or discover the problem after the injury occurs. So, obviously wanna prevent serious injury and illness by reporting early, the barriers for reporting. Usually that's fear of retaliation, feeling as if nothing is going to be done about it. So that report is going into no man's plan or simply lack of time and effort.

Prakash Chandran: So another piece of this puzzle in terms of national safety month is also talking and thinking about workplace violence. And that's something that is less known and less addressed, but in your mind, what exactly is workplace violence?

Tanzi Brock: So by definition, and this is from OSHA, occupational safety and health administration, workplace violence is an act or threat of physical violence, harassment, intimidation, or any other threatening, disruptive behavior that occurs at the work site. So, that could be verbal, it could be physical, it could even be aggressive dogs for some of our home health workers.

Prakash Chandran: Yeah. Wow. And who does this violence typically come from?

Tanzi Brock: So there are four categories or four types of workplace violence, type one would be stranger. And that is a person that has no relationship to the business or the employees. And it's usually committing a crime in conjunction with the violence. So they're committing a robbery or something like that. Type two is customer client that's would be our patients. This is the most common type of violence in healthcare patients and visitors. The third type is worker. So this is like worker on worker violence. It's things like bullying. and the fourth type is a personal relationship. So that could be maybe a strange spouse or something like that.

Prakash Chandran: Right. So you're saying, but by far and a way that customer client or the patient is where you're seeing most of that violence in terms of statistics.

Tanzi Brock: Absolutely.

Prakash Chandran: And in terms of the worker on worker violence or that categorization, it's a slippery slope. I hear you mention bullying. And I think that a lot of people wouldn't immediately associate bullying with violence, but what you're saying is it certainly falls within that category. Is that correct?

Tanzi Brock: Certainly, harassment, intimidation. It causes emotional injury. So that is also violence. And we do consider that workplace violence. Unfortunately worker on worker is probably one of those types of violence issues that goes underreported for that fear of retaliation.

Prakash Chandran: That's unfortunate. This feels like it's common sense, but I'd love for you to talk about some of the risks that come with work place violence.

Tanzi Brock: Yeah. So for healthcare, there's a lot of risks of workplace violence. Most common I see would be patients with altered mental status. So a lot of the violence or combative patients, it's not necessarily intentional. There's also patients with a history of violence. We do have a lot of police prisoner screenings that happen, and that is a source of a lot of violent incidents mental health disorders, emotional circumstances, medications if we have victims of violence, so somebody who is been involved in a domestic dispute or even gunshot wound victims.

We need to be on high alert. Long wait times. And more recently, which has caused a big spike in disruptive or disruptive patient incidents is COVID with the increase in rules or visitation restrictions. So we have a lot of issues with that.

Prakash Chandran: So, I'm curious as to what someone should do if they are a victim of workplace violence in any of the categories that you mentioned. I know that some of it is under reported, as you say, but if they're experiencing something in those categories, what should they do?

Tanzi Brock: So I always emphasize preventing an adverse event before it happens. so we try and implement interventions calling security. When they see early signs of agitation, things like that. But if violence does occur, they need to call security and, or the police immediately staff are encouraged to press charges and they're often reluctant to do so, especially if there was no major injury. But what we've seen is that a patient will come. And maybe they'll be verbally abusive and nothing happens. And then the next visit they're throwing things. And then the next visit, they're hitting and slapping.

So we see that the bad behavior will escalate with each visit when there are no repercussions. So we do encourage pressing charges against the perpetrators. We also encourage employees to get counseling, if they have been in a incident of workplace violence through our employee assistance programs.

Prakash Chandran: So one of the questions that I had is expanding a little bit more on the prevention piece because the customer client is the most common type of violence. And you were talking earlier about patients with altered mental states. Someone is anticipating like looking at a patient, nothing has happened, but maybe given the history or maybe they have a feeling that they might wanna be on higher alert, what should they do at that point? Are there kind of preventative measures or steps that they can take without agitation that can just set them up for reducing the risk of workplace violence?

Tanzi Brock: Absolutely. One important thing, and especially when this is a combative patient that has an altered mental status is communication. So communicating the hazard to other employees so that they can keep safety in mind or have security come with them or bring another person into that room with them. In some ways we do that is through patient alerts. So we can have alerts on the patient account so that all staff can see that. We also have implemented a new door tag, so it's a black shield and it's notifying other staff members, maybe ancillary staff who aren't gonna look in the patient account electronic account, dietary, environmental services employees like that, so that they also be notified that there is a safety hazard, a security risk.

Prakash Chandran: Yeah, that's helpful. One of the final things that I wanted to talk about is I know that there's an important note here around the importance of getting employees to fill out a QRR. Can you talk about what this is and why it's important?

Tanzi Brock: Yes. QRR is an acronym for quality risk report. So this is the reporting system for our whole organization. Some people ask me what, and when do I report. My answer is report anything that has resulted in or has the potential to result in an undesirable outcome. So that's pretty broad. But that would include things like medical errors, maybe a medication was omitted or delayed, complaints, safety hazards things like that get reported into the system. And what's very important is that employees report near misses. So all adverse events are preceded by near misses.

So we have plenty of opportunities to intervene and correct the hazard before it results in an injury or illness. So the QRR is very important system and oftentimes we'll find out something, there was an adverse event say an employee injury. And the employee will tell us that, okay, the bed was broken. So I had to stoop down, provide patient care and my back was injured, but nobody told anybody that the bed was broken. So, it didn't get fixed. So, it's pretty simple. If we don't know about the issue, we can't fix it. So it is very important to report.

Prakash Chandran: That makes a lot of sense. And one question that I always like to ask is given all of your experience as an environmental safety manager for almost six years, what's one thing that uou know to be true, you see it time and time again, and you just wish more of the employees were aware of.

Tanzi Brock: One of the big issues is under reporting. We cannot identify the issue. We don't know that it's going. Until something terrible happens. So one way that my department, I work in the quality and risk department is that we we promote what's called a just culture. And this is a culture, an organizational culture where employees feel safe, they feel safe reporting, voicing their concerns without fear of retaliation, because the organization addresses errors as more of a systematic issue rather than an individual issue.

So we understand that employees don't come to work willfully, planning on making a mistake. It's usually a breakdown in a process, education maybe, you know, lack of staffing or something like that. So what I wish employees would trust trust that I'm here to work for them that this is not retaliatory. I really just want to fix the hazard and improve things.

Prakash Chandran: Well Tanzi, I think that is the perfect answer and wonderful advice for everyone that's listening. So thank you so much for your time today.

Tanzi Brock: RIght. Thank you. And thank you for taking the time to talk to me.

Prakash Chandran: That was Tanzi Brock the environmental safety manager at Ridgecrest Regional Hospital. Thanks for checking out this episode of the Ridgecrest Regional Hospital Podcast. To learn more, please visit rrh.org. If you found this podcast to be helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. My name's Prakash Chandran, thanks again for listening and we'll talk next time.