WONG PEI SHAN

Background information of the Office of Risk Management in Changi General Hospital

The Office of Risk Management (ORM) is Changi General Hospital was formed to manage risk within the hospital. Reducing and mitigating risks protects CGH’s patients and staff from preventable harm, minimising disruption of hospital operations and preserving reputation of hospital and morale of staff. An example of what ORM does is to help manage risks by detailed systematic analysis of incidents to find the root cause in order to prevent a recurrence. Examples of such incidents vary and include a burnt electrical plug or a compliant made in the social media. For the plug example, the investigations reviewed that the plug was placed below a water cooler and condensation resulted in water dripping into the plug. The lesson learnt was the importance of anticipating hazards when positioning plugs close to a water source.

Background information of the projects / tasks which I was involved in

The aim of our project was to sense the level of understanding risk awareness, risk controls and risk escalations that the frontline staff in CGH have. This is so as to let the Office of Risk Management come up with appropriate measures to minimise the risks that frontline staff faced in their workplace. ORM will also be using our survey responses to plan training and development to bridge any gap of understanding that the frontline staff may have.

At the point we joined the project, our mentors were in the process of gathering the list of respondents. Our task was to get the staff to open up to us about their sincere feelings of their workplace culture and mindset, as well as their understanding and confidence regarding risk and risk management. So we conducted 40 sessions of focus survey with Nurses, Allied Health Professionals (AHP) and Patient Service Associates (PSA) using questions that we came up with after learning about Risks and Managing Risks in Healthcare through a 2-day crash course. The survey questions were finalised after much deliberation and many drafts.

Our interviewees are all CGH’s frontline staff, which includes Nurses, Patient Service Associates (PSAs) and Allied Health Professionals (AHPs). Nurses take care of and assist the patients when they are warded or when they are visiting the clinic, AHPs consist of Speech Therapists, Physiotherapists, Radiographers, Pharmacists etc and PSAs handle the admin work for the hospital when patients visit or leave the clinic. All three types of jobs come into direct contact and interact with patients and their families for their day to day work.

These front-line staff are selected as they are the ones who interact the most with the public during their day to day work and have the highest risk of being put into situations caused by misunderstandings, high human traffic etc. affecting CGH's reputation, operations and staff morale.

Elaboration / record of the activities done

Firstly we went through a 2-day crash course/briefing where we spent about 10 hours in total learning about the background of ORM as well as the work they do. Hazards are dangerous objects or situations that may potentially cause harm, when an action is applied to it. This makes it a risk, and when there is a negative outcome of the risk, it will be an incident. For example, an uneven carpet is a hazard, walking on the uneven carpet is the action applied, and if the person falls, it becomes an incident. Furthermore, we learnt about Root Cause Analysis and Just Culture, where the ORM will analyse and incident to find and eliminate the Root Cause of the incident so as to prevent it from happening again. Just Culture is then applied where the act will be categorised into Human Error, At-Risk Behaviour or Reckless Behaviour and appropriate measures will then be taken to ensure improvement in workplace safety. Human error cases usually require changes in process to take into account the possibility of human error. Whereas in the other categories different measures are needed. Most times, coaching on risk awareness and making safe choices, and changing the process to encourage safe choices is what is needed. Reckless behaviours are however not tolerated and punitive actions would be considered. The rationale behind this was to ensure that we knew what we were trying to obtain from the respondents, so as to let ORM have accurate information to use as reference.

After learning, we were told to draft out survey questions, categorise them into the different objectives so as to ensure that all information collected will be useful and not irrelevant. Throughout this process, we went through multiple vetting and learnt a lot on how to phrase questions and avoid sensitive words so as to engage the respondents better and obtain more truthful and sincere feedback. We were also told to collect their information such as the type of ward (subsided or private etc.) they work in as well as the number of years of experience in their job. In addition, we also did field visits to the frontline staff’s workplace such as the A&E, Medical Intensive Care Unit (MICU) and the Surgical Intensive Care Unit (SICU) as well as the different type of wards where the Nurses and PSAs worked in. This was to better understand the responses they give as we are able to understand their background.

We then proceeded to conduct the survey over 6 working days, and transcribed them onto a template that we had prepared beforehand so as to better facilitate our analysis and make it easier to refer and compare to. Finally, we analysed the responses and picked out key ideas and observations of their culture and mindset towards risk management as well as identifying the present trends.

The challenges we faced was having the respondents misinterpret our questions and answer them without knowing what we are asking, this makes it risky as we have to sense whether or not they understand correctly before taking their responses down as it might not have been an accurate response due to the misunderstanding that had occurred. This happened because some respondents may be afraid to ask or speak up saying that they do not understand.

However, having conducted the interviews face to face, we had the benefit of being able to directly clarify ourselves and check to ensure that both parties are on the same page.

Elaboration / record of results / deliverables / impact of work done

The outcome of this project was to have key observations about the mind set and culture that CGH frontline staff has. One of the more general observations we found was that risks surfaces often due to overlooking hazards in the workplace and due to busy and hectic work.

We found that frontline staff in the healthcare industry actually faced a lot of risk in their day to day work as compared to frontline staff in other industries. This is because the staff deal with unwell and anxious patients and their family which may result in incidents occurring due to their inability handle the emotional needs of patients and their family members at specific times. This can be trying for both family as well as staff. By conducting interviews with the Nurses, AHPs and PSAs, we found out that although they may not take manuals, leaflets and talks on workplace safety so seriously, they are very worried about the safety of their patients and will stay alert and try their best to ensure nobody, colleague or patients or patient’s family members , will be harmed.

[Due to the PDPA policy and agreement we made with the respondents, their responses are to be kept confidential and there is sensitive information being shared. Hence we are unable to provide a detailed report/analysis of what we have found.]

However, it is safe to say that we have learnt a lot from this project.

3 content knowledge / skills learnt

1. I have learnt that it is important to be able to adapt to unexpected situations on the spot as you will never know what is going to happen. We were asked to explain many things that we did not put on script hence we had to phrase our understanding in a way that would be most helpful to them. We also had to find a way to lead the interview towards our goal and to manage the time and engage the respondents on the spot, when we sensed that they have interpreted our question differently from us.

1. I have learnt the difference between Risks, Hazards and Incidents. As well as the need to classify errors into different categories so as to be able to manage and solve the incident more effectively. The mentors have also shared the ways the hospital will operate when a fire happens or when a patient with infectious diseases arrives at the hospital. When a fire happens, critically ill patients will be enclosed in a fireproof room while staff will evacuate patients with movement difficulties with special equipment. For infectious diseases, contact tracing, quarantine areas and Personal Protection Equipment (PPEs) will be used to manage these incidents.

1. I have also learnt that it is important to keep the end point in mind when doing our task. For example, I've changed my way of thinking when creating survey questions as we had to think if the answer obtained whether or not it is useful for us. We also had to think of possible responses and examples so as to help us explain it when the respondents ask. This made our work process more efficient and helped us to collect more accurate information.

2 interesting aspects of your learning

1. People who work in the healthcare industry are really compassionate towards their patients. They feel a strong sense of responsibility to ensure that the people they are tending to receive the best care and that no harm should be caused to their patients. They also face a lot of different types of risks while doing their job (all medical frontline staff face most of these risks) such as needle-stick injury, where people get injured by needles and risk the transmission of blood borne diseases/diseases transmitted by contact of bodily fluids, physical and verbal abuse, chemical spillage etc.

1. Through a story shared by one of my mentors, I have learnt that even though a hazard may seem really unrelated and does not concern you at all, it may cause unexpected harm to the people who are not directly involved with it. This highlighted the importance of speaking up when dangerous objects/situations are spotted to me, so as to ensure that everyone is in a safe environment at all times.

1 takeaway for life

I have learnt to take risks and dangerous choices more seriously as it not only causes harm to myself but also to the people around me. For example, if I am a nurse and I risk behaving recklessly when tending to others, if a complaint is uploaded online, everyone working in my organisation will be placed in the bad light and may be indirectly blamed even if the situation does not seem to concern them at all. Through this attachment, I saw the hard work that people have put in to encourage people to take note of their actions and to be alert and on their toes so that when incidents occur, they will be able to tackle the problem safely. Before this attachment, I would not have taken into serious thought what are the consequences when I take risks. For example, jumping down the last few steps on the staircase. As simple as this risk might be, I have learnt that it is important for me to be responsible for my actions and not take unnecessary risks as the consequence might not only affect myself but others as well.