Health and Safety in Children’s Hospice Association Scotland (CHAS)– Culture, Control, and Change

(Managing health and safety)

FIND A SOLUTION

August 2016

A research project conducted for CHAS

supported by the University of Glasgow Settlement

Submitted by

Roxana Corduneanu and Ingrid Martin

ACKNOWLEDGEMENTS

We would like to take this opportunity to thank Mrs Alison Spurway, for giving us the opportunity to take part in this project, Miss Jenny Crocker and Mr Colin Boxer, for their constant guidance and support throughout the duration of the project, Dr Georgios Kominis, for providing us with the background on which this project is founded, and last but not least, all those who took their time to talk to us, answer our questions and share their perspectives. We are extremely grateful for all your help.

Table of Contents

EXECUTIVE SUMMARY

INTRODUCTION

What is ‘Find a Solution’?

The problem to be solved – Health and Safety culture in CHAS

Health and Safety in CHAS

Definition of H&S and H&S culture

Perspectives on the project, Roxana and Ingrid

Ours hopes for the report

H&S system of CHAS which will be focused on in our report

Our plan for the project

METHODOLOGY

KEY THEMES

Positive aspects of the Health and Safety Culture within CHAS

Challenges and perspectives

Strategic approach to managing Health and Safety

Restrictive processes

Lack of accountability

Resources and training

Underreporting and lack of engagement

RECOMMENDATIONS

HSE - Plan, Do, Check, Act

Centralization of health and safety decision making

Policy

Training

Different measures to deal with different levels of risk

Communication

CONCLUSION

Appendix 1 – Sample of interview questions used in research

Appendix 2 – Participants’ roles within the organisation

EXECUTIVE SUMMARY

  1. The aim of this project was to gain an understanding ofthe health and safety culture in CHAS, assess the level of success of the health and safety policies and procedures in place, identify any issues with ineffective processes, and put forward a number of recommendations in order to address these problems. It was considered that this would provide a basis for creating positive change in the organisation. In order to achieve these objectives, 27 interviews were conducted with different employee groups within CHAS, and the interview data was combined with our own observations on the effectiveness of the relevant policies and procedures.
  1. The analysis revealed both positive and negative aspects of the health and safety culture. In terms of positives, we found evidence that the general intent of the health and safety culture in CHAS is not to be a block to activity, but rather to promote positive behaviours. Moreover, there is a ‘no blame’ culture around health and safety, and the policy is perceived to be quite flexible, allowing employees to adapt it to different types of activities.
  1. Regarding the challenges around health and safety, we discovered that the strategic focus on compliance leads to a number of issues, including lack of accountability on the part of both managerial and non-managerial staff, bureaucratic processes, and lack of appropriate resources and training. All these, in turn, lead to issues such as underreporting of incidents, improper investigation, lack of communication, and lack of engagement.
  1. In order to address these problems, a number of recommendations were proposed. First, it is important that CHAS changes its current compliance approach with a continuous improvement approach, which can be achieved particularly through implementing the Plan, Do, Check, Act best practice model recommended by the Health and Safety Executive. Second, we recommend centralization of decision making around health and safety by introducing a new function in the organisation, that of a Health and Safety Manager who would support the implementation of the Plan, Do, Check, Act approach. Third, we advise that the policy is streamlined, so that it is perceived as less bureaucratic and cumbersome. Another recommendation is thatstaff are provided with more specific training around health and safety and thatdifferent measures for dealing with different risks are better promoted. Finally, we advise that employees are consulted in the design and changes to the policies in place, and that health and safety updates are better communicated throughout the organisation.

INTRODUCTION

  1. Children’s Hospice Association Scotland (CHAS) is the only charity in Scotland which exists to provide hospice services for children and young people who have life-shortening conditions. The charity currently runs two hospices, Robin House in Balloch and Rachel House in Kinross, and also provides a CHAS at home service, which together support over 415 families across Scotland.

What is ‘Find a Solution’?

  1. The Find a Solution Project is run by The University of Glasgow Settlement which every year matches two students with a charity in order to ‘find a solution’ for the charity’sgiven problem.

The problem to be solved – Health and Safety culture in CHAS

  1. The problem that was identified by CHAS to be tackled during our 8 weeks was focusing specifically on the role of managers in safety and equipping them with the skills they need to create a safe working environment. It was quickly realised that this would be too narrow a view for the project and the scope was widened to include the general culture around health and safety in the organisation, and more specifically to the idea of creating a more positive culture which would make the safety processes in place more enabling as opposed to a block to activity. It was hoped that a fresh look at the charity’s current procedures and processes could instigate a change in the organisation’s culture.

Health and Safety in CHAS

  1. Health and safety is a very important factor in every organisation, and naturally within CHAS – an organisation which deals with a variety of complex needs of children in their end of life care, health and safety of children and staff needs to be paramount.
  1. Currently the CHAS statement on health and safety is as follows:

“CHAS aims to set high standards of health and safety for all. Our policy is to provide a safe and healthy environment for everyone – employees, volunteers, contractors and visitors - within the organisation. Our objective is to ensure accidents at work and hazards to health and safety are kept to an absolute minimum. The promotion of health and safety measures requires the active involvement and support of all.

Although ultimate responsibility for health and safety within CHAS rests with the Chief Executive, day to day responsibilities are delegated. However, we all have an individual responsibility for our own and our colleagues’ health and safety while at work. By law, all employees and volunteers must follow safety instructions and must co-operate with the Chief Executive and management to maintain high standards of health and safety throughout CHAS.”

  1. Of key importance for us in our report was how this statement was realised and implemented further down the line, into the role of managers, and the perceptions and actions of people working on the front-line in CHAS.

Definition of H&S and H&S culture

  1. During our time at CHAS, it quickly became clear that health and safety was an integral part of the organisation, which is inevitable due to the nature of the charity’s aim to provide the best end of life care for children and young people with life-shortening illnesses. However, it also became clear that health and safety and its culture in CHAS was more than just that which involved the care. For example, health and safety is one of the unifying factors of all employees and volunteers in CHAS, from those directly supporting and caring for the children in hospices, to the admin staff in the head office and the fundraising team out and about in the community. For this reason, we knew this project would require a broad interest in how the health and safety culture may differ across different teams within the organisation. It was decided that our project would aim to pinpoint employees’ – and in particular managers’perceptions of health and safety behaviour, as well as the effectiveness of the controls systems in place. We saw these two aspects as interacting, and byfocusing on just one we would not have been able to begin to tackle the possible challenges facing the health and safety culture in CHAS.

Perspectives on the project, Roxana and Ingrid

  1. Throughout this project we have hoped that our differing academic and personal backgrounds might be able to offer some complimentary insights into what the solution for CHAS might be. For Roxana, interests were from the perspective of management control, so in that case – how might the role of managers and their responsibilities to the employees underneath them be related to the health and safety culture. For Ingrid, with a background in Psychology, the perspective was to look at how people perceived and interacted with the health and safety systems in place, and how this impacted on the culture around them. Together we hope that we can give an outsiders’ perspective on the issues identified, which benefits from our different backgrounds and also the chance we have had to discuss with each other and reflect on our time at CHAS.

Ours hopes for the report

  1. In light of the above, our greatest hope is that everyone in CHAS will be able to (and want to!) read our final report. We also hope that while some of our findings may not be surprising to some readers, others might provoke perspectives that have not yet been considered. Even if our report may not be the ultimate and final solution for CHAS, we hope that we may at least provide a basis upon which CHAS can grow and flourish in a new direction regarding the way health and safety is led, managed and perceived. Finally, we hope that our project may in its own way help CHAS to reach its strategic aims to provide care to more and more children with life-shortening illnesses. And to create a more ‘healthy’ and positive health and safety culture which allows staff to perform at their utmost.

H&S system of CHAS which will be focused on in our report

  1. In order to look at the ‘culture’ surrounding health and safety in CHAS, we found it useful to define a basic system of health and safety in CHAS. This was made up of two interacting components: thepeople and theprocesses. The people included the chief executive, the Health and Safety Steering Group (HSSG), the line managers, and front-line staff themselves. Meanwhile processes included (but were not limited to): the use of thehealth and safety policy andthe standard operating procedures (SOPs);the process of incident reporting and riskassessment;andfinally the training that employees receive, both viaLearnPro, the e-learning platform containing a series of online modules and tests which deliver statutory/mandatory training,and anyothertypes of specific training per role.

Our plan for the project

  • Defining the problem and getting familiar with the culture in CHAS
  • Data collection (interviews)
  • Data analysis
  • Reflection
  • Recommendations

METHODOLOGY

  1. In order to gain a better understanding of the perspectives of both managerial and non-managerial staff on the health and safety culture in CHAS, employees were invited to take part in semi-structured interviews. The interview questions covered topics such as respondents’ understanding of CHAS’s health and safety policy, their perspectives on the health and safety culture in the organisation, and their contribution to the design and subsequent changes of policies and procedures. In addition, we prompted for examples of their experience with risk assessments, incident reporting and investigations, and the ways in which health and safety policy either restricted or enabled them in their daily activities. A sample of the interview questions used in this research can be found in Appendix 1, although their use varied from case to case.
  1. In our interviews, we aimed to gather the perspectives of both managerial and non-managerial staff, and also of clinical and non-clinical workers, so as to determine if there are any differences in the way health and safety is perceived by different employee groups. Over the course of the project, 27 interviews were completed and the functions of the employees consulted in this research are presented in Appendix 2.
  1. In terms of data analysis, interviews were transcribed verbatim and analysed through thematic analysis. In addition, the researchers also kept field notes and the qualitative interview data was triangulated with our own observations of relevant health and safety documents and the minutes of the Health and Safety Steering Group meetings. The key themes that emerged from the analysis are presented below.

KEY THEMES

  1. The following sections address the key themes which arose from our data analysis. We have grouped these themes into positive aspects, as well as challenges, in order to provide a balanced overview of the health and safety culture in CHAS.

Positive aspects of the Health and Safety Culture within CHAS

  1. An important question which we sought to address in our time at CHAS was to look at whether the current processes for health and safety were either enabling or restrictiveto activity.This was complimentary to a management control perspective which posits that controls aim to either restrict undesirable behaviours or reinforcedesirable behaviours.The general consensus of our findings was that the general intent of the health and safety policy in CHAS was to promote positive behaviours rather than restrict employees in their daily work. This was evident particularly from examples of activities that had been carried out within the hospices which sought to bring the best possible care to children, both clinically and non-clinically. This made it clear to us that the culture in CHAS generally does allow for things to happen even when an objective view may deem it impossible, thus proving a very valuable asset to CHAS. We also found strong evidence that the underlying focus of the health and safety systems in place is not to allow health and safety to limit the experiences that CHAS can provide for children in their end of life care, but instead to use risk assessments as a tool to control for and minimize risks and achieve what previously might have been viewed as impossible.
  1. Another aspect of the current health and safety culture which can be argued as being strongly positive is the question of the flexibility of the policies and how they could be altered to suit the different circumstances which employees may find themselves in. The overall perceptions found in our interviews were strongly in support of the flexibility of the policies across the different areas of CHAS, which we consider to be another strong asset to the charity. In addition, it was clearly identified that health and safety was seen as important, although the amount of time and effort devoted to health and safety by each team varied to some extent.
  1. Finally, another very important positive attribute that was identified was that the health and safety culture in just was not one of ‘blame’, where employee are generally reluctant to report incidents out of fear. There was good consensus that the culture in CHAS was to ‘absolutely let us know’ and there was a general awareness of the importance of reporting incidents and near-misses. However, some challenges were also identified, as evidenced below.

Challenges and perspectives

  1. In discussing challenges, we constructed a three-level model, which aims to illustrate the different issues that impact on the effective use ofprocesses and procedures in place. We identified that the strategic focus of compliance leads to problems with processes, accountability and the provision of adequate resources. In turn, these issues affect staff’s level of engagement with the processes, and result inlower levels of reporting, improper investigations and lack of feedback and communication across different levels in the organisation. In this section, we shall consider each of these aspects in turn.

Figure 1. Causes and symptoms of an ineffective health and safety system in CHAS

Strategic approach to managing Health and Safety

  1. In order to meet its legal obligations as an employer, CHAS has a written health and safety policy, an incident reporting system, documented risk assessments, and three designated health and safety advisors. However, the organisation does not follow the recommended Plan-Do-Check-Act approach to managing health and safety, and generally has a reactive rather than proactive focus in its use of policies and procedures. For example, action tends to be taken in response to workplace accidents and legislation, rather than proactively. Even in the HSSG meetings, the main topics discussed are changes in legal requirements, completion rates for LearnPro, statistics on incident reporting and outcomes of site inspections, rather than the need for/ implementation of new quality management systems. The pressure in everyday work is towards being efficient rather than thorough, which reduces the possibilities for continuous improvement.
  1. A reactive/compliance approach, however, leads to restrictive safety processes that employees perceived as ‘tick-box exercises’ that are too formal and bureaucratic. In addition, there are less resources invested in training, and because the organisation is only required to record incidents, but not necessarily the actions taken, there is also a general lack of accountability within the organisation.For instance, we found evidence that managers sometimes fail to carry out the appropriate investigations, and, most importantly, they fail to provide feedback to employees on the outcomes of their inquiries. This tends to create a vicious cycle where communication is hindered and employees become more reluctant to reporting any more incidents, especially when they are not perceived as related to their jobs.

Restrictive processes