The Health and Safety at Work Act 1974 “brought together a range of legislation covering health and safety since the first act was introduced in 1802” (Moonie et al, 1994:232). Important ethical issues arise with the exercise of the above duties through the Codes of Practice and the Human Rights Act 1998. The Codes of Practice help classify the quality of care clients can expect if they receive care services and they can be used as a source for measuring the quality of care provided.
Issues arise because they involve questions of the restriction of liberty and adjudication by health and social care workers, between the sometimes competing interests and wishes of individuals and their families and communities. The Health and Safety at Work Act, 1974 is comprehensive and recognises that everyone has the right to be protected from health and safety risks arising from work activities. A risk assessment is another fundamental aspect of promoting the health, safety and security of people who use services and the working environment.
Risk assessment A risk assessment as discussed by Nolan et al (2008:89) is required by law and every employer has a duty to assess risks in the workplace. Although most already do this, all employers must now conduct risk assessments in a planned way. A risk assessment “is as much an art as it is a science and contains a strong element of detective work in gathering relevant information” (Kemshall et al, 1997:164). It is conducted by a competent person who takes note of anything that could cause harm such as a slippery floor or harmful chemicals.
Managers and supervisors who are risk averse and are at the blunt end of the organisation etc then review a preliminary report. The blunt end refers to management, regulators who are responsible for policies which are lead by productivity goals and often contain failures which kick in at the sharp end resulting in accidents / incidents. The risk of each hazard is analyzed in terms of its likelihood for causing harm or its potential for serious injury.
A risk rating scale is used to help decide which hazards are a top priority. Methods to reduce risks to insignificant levels are analysed, the assessment is recorded and it becomes part of your employer’s health and safety policy. Action is taken, if necessary and new control measures may be introduced or existing ones improved. Reviews are held regularly. After the assessment the employer will tell the employee, who is risk accustomed and who is hands on with vulnerable people and situations.
Employees are at the sharp end of the organisation, managing resources and balancing priorities are then told about any hazards that have been identified and what action is being taken to control risks and whether any special training is needed. There are several benefits to a risk assessment such as a reduction of incidents/accidents. The creation of a working environment that values health and safety and creates a successful culture that promotes health and safety within the work environment and sets a good example for other organisations.
Heller et al (2001:139) suggests that this involves the organisation ensuring it has a clear policy that specifies its approach to managing risks in relation to its service provision and the person who uses its service provision and the person who uses services. It will also reflect the relevant National Care Standards and legislation applicable to its service provision, including the health and safety legislation. Risk management is about ensuring that all foreseeable risks have been assessed and that suitable control measures have been implemented.
The procedures for risk assessment, and the care team’s responsibilities, provide the basic foundation for a systematic risk management approach. Risk management should be integrated within the assessment of needs of individuals and ongoing Care Plan reviews. In order to prevent errors in health care settings, it may be helpful to understand how those errors occur. One analogy used to explain the error process is called the “Swiss Cheese Model” shown in Appendix A, this model was designed by James Reason in 1990.
The idea behind this is that the swiss cheese is cut into slices and each slice within the healthcare setting acts as a barrier to mistakes. However each slice has holes within it that errors can fall through, however if you have several slices of cheese somewhere along the line that mistake will run into a dead-end. It happens occasionally that the mistake is allowed to pass through each piece of cheese and actually arrive at the patient’s bedside. At this point, a critical mistake can occur, which may or may not result in serious injury to the patient.