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Lessons learned from an OSHA violation

One of the most feared things in healthcare safety circles is the dreaded surprise OSHA inspection, but it can also be a learning experience.

That was the case for Melrose–Wakefield Hospital, a suburban Boston hospital that was penalized $28,000 (eventually reduced to $22,000) in April 2014 for several violations of the agency’s bloodborne pathogens standard and safe sharps violations.

William Doherty, MD, Chief Operating Officer of Hallmark Health System, and the parent system of the hospital, shared some of the lessons he learned from the experience in a story I wrote recently for Briefings on Hospital Safety. Perhaps you can use some of them in your own facility.

Make sure you know what OSHA wants. This isn’t always as easy as it sounds. The Joint Commission has earned a reputation for being what many call the “top cop” of survey expectations, mainly because hospitals pay thousands of dollars for surveyors to come in and scrutinize their processes and procedures. So it came as a bit of a surprise to Doherty that OSHA fined his hospital $6,000 for not having locking containers designed to contain spills while transporting medical waste and used surgical instruments.

“You need to understand exactly what OSHA is looking for. Just because the Joint Commission it’s okay doesn’t mean OSHA thinks it’s okay,” Doherty says.

OSHA inspectors are people too. An inspection by OSHA doesn’t happen often, mainly because the agency doesn’t have enough inspectors to routinely inspect all of the workplaces in America—there are millions of them and only about 2,000 inspectors. For that reason, there is an unspoken belief among the safety crowd that inspectors are grouchy robots bent on catching your every mistake, and fining you for it.

That’s simply not true, and anyone who has been through an inspection will tell you that, yes, while an inspector’s job is to ensure the safety of the workplace, most of them are nice people willing to make the inspection into a learning opportunity.

“They are reasonable people,” says Doherty. “There is a willingness on the part of OSHA to have a dialogue.”

He added that after the inspections, the hospital was served with what’s called an “Invoice Debt Collection Notice,” which is essentially a bill for the fines owed. Because of the hospital’s cooperation, and willingness to fix mistakes made and show a written abatement plan, he said inspectors lowered fines from $28,000 to $22,000 during the settlement conference.

If you can, fix your mistakes immediately. You are only human: sometimes you make mistakes and didn’t know it. Own up to your mistakes and don’t do it again. The same goes for an OSHA violation. In the case of Melrose-Wakefield, fixing their mistakes immediately lowered their fines. When an OSHA inspector pointed out that storage containers needed to have a locked lid on them, the problem was fixed the very next day and made a permanent procedure at the hospital. New sharps will never be instituted at the facility without staff input from all departments—even the pharmacy and other departments not normally associated with sharps. A new sharps committee will review all sharps needs and purchases. Lastly, a staff checklist was produced to help ensure all sharps are safe and accounted for when transferring to central sterile processing staff.

Be willing to change your ways. Even when mistakes are fixed, unless the overall culture of a facility is changed the same mistakes can be made over again. If you’re serious about fixing a broken system, actions speak louder than words.

In addition to instituting new checklists and ways of keeping staff members involved in helping make decisions about sharps, the hospital had to deal with problems inspectors found with the training program, specifically that there were no managers on site during the third shift that could answer safety questions the staff had. Now, the hospital has a policy that even at 2 a.m., there will be a nurse manager or administrator on call that can be reached 24 hours a day, 7 days a week. This simple change in culture helped reduce a fine by $2,000 and has helped raise employee morale at the hospital, Doherty said.