Niveau I Zorgsystemen: wetenschappelijke onderbouwing en ... · onderbouwing en capita selecta...

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Niveau I Zorgsystemen: wetenschappelijke onderbouwing en capita selecta

Prof. Ir. J. Van Peteghem Faculteit Ingenieurswetenschappen, KU Leuven

Lesdoelstellingen

De les geeft een aantal praktische aandachtspunten m.b.t. de implementatie van zorgsystemen: •  aanduiding van enkele verwante beheerssystemen: HACCP,

Responsible Care, thematische zorgsystemen (bv. Onderhoudsmanagement)

•  integratie van zorgsystemen: voor- en nadelen •  hoe interne en externe auditing inplannen? •  wetenschappelijke onderbouwing van de toegevoegde waarde

van zorgsystemen, alsmede van de oorzaken waarom deze kunnen falen.

De cursist moet hierdoor een duidelijk zicht op de mogelijkheden om geformaliseerde zorgsysteem onderling te integreren. Hij is zich bewust van de centrale plaats die interne auditing inneemt in een geformaliseerd zorgsysteem, en kan een dergelijk auditschema opstellen.

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Lesinhoud

1.  Enkele aan OHSAS verwante zorgsystemen 2.  De integratie van verschillende zorgsystemen 3.  Het belang van auditing 4.  Zijn zorgsystemen effectief? 5.  Vraagstelling 6.  Wat hebben we vandaag geleerd? 7.  Meer weten?

1. Enkele aan OHSAS verwante zorgsystemen

Formele zorgsystemen, gekoppeld aan het sturen van organisaties op basis van KPIs, is sinds enkele tientallen jaren het gangbare beleidsconcept. Dit geldt ook voor andere aspecten dan milieu, kwaliteit en veiligheid&gezondheid

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1. HACCP

Quid: a management system on food safety Objective: promoting the commercialization of foodstuff (raw materials, semifinished products and retail trade products, as well as the preparation of meals, in such a way as to guarantee that: •  legal requirements are being respected; •  the risk of food poisoning is limited to the absolute

minimum; •  responsibilities in the case of an incident can be allocated.

This will be achieved via implementing a formal management system and by documenting the production process.

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Food poisoning case: a Belgian home for elderly care (1999)

•  dish: roast beef, rare

•  pathology germ : Salmonella Typhimurium

•  Number of fatalities : 8

convicted in 2005

❑  number of persons present : ✔  47 inhabitants,

✔  8 staff members

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2. Responsible care

“Responsible Care is the chemical industry's global voluntary initiative under which companies, through their national associations, work together to continuously improve their health, safety and environmental performance, and communicate with stakeholders about their products and processes in the manufacture and supply of safe and affordable goods that bring real benefits to society.”

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2. Responsible care (2)

How does Responsible Care work?

•  Responsible Care is a commitment, signed by a chemical company's Chief Executive Officer and carried out by all employees, to continuous improvement in health, safety and environmental performance, and to openness and transparency with stakeholders. It helps companies improves performance by identifying and spreading good management practices (peer pressure!).

•  Responsible Care commits chemical companies to be open and transparent with stakeholders at the local, national and international level. It encourages dialogue and cooperation, and has helped industry work much more closely with local communities, governments, trades unions, international organizations, environmental groups and others to understand and address their concerns.

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Responsible care (3)

Innovaties ten aanzien van OHSAS ü Product stewardship is Responsible Care applied to products, and covers more than just production and use of chemicals: it extends to other parts of the product chain such as transport, storage, use and eventual disposal. To be effective, product stewardship requires the close co-operation of everyone involved in the product's life cycle. Companies are working with their suppliers, customers, distributors and user groups to spread Responsible Care throughout the supply chain.

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Responsible care(4)

Innovaties ten aanzien van OHSAS (2) ü reporting openly on performance, achievements and shortcomings. These data are to be collected on a national basis. These data will be collated and reported publicly at the international level and will be updated at least every two years;

ü sharing of best practices (between others: exchanging incident/accident data);

ü companies adhering to the Responsible Care principles should not limit themselves to self-assessments but should adopt third party verification processes;

ü extending dialogue processes with all external stakeholders.

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3. SOLAS

•  International Convention for the Safety Of Life At Sea •  First version was passed in 1914 (Titanic…) •  Successive versions: 1929, 1948, 1960, 1974, 1988 •  The SOLAS convention has 159 contracting states, which flag about 99% of merchant ships

•  Contains 12 chapters, completed by a large number of Regulations, Protocols and Amendments

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2. Zijn verschillende zorgsystemen integreerbaar?

De gangbare opinie is dat het integreren van verschillende zorgsystemen (milieu, kwaliteit, veiligheid&gezondheid) voordelen biedt. Dit is evenwel niet altijd het geval.

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1. Voordelen

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1. Voordelen (2)

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1. Voordelen (3)

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2. Nadelen

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2. Nadelen (2)

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3. Auditing

Het functioneren van een formeel zorgsysteem (al dan niet gecertificeerd door een externe instantie) staat of valt met het opstellen van een degelijk intern auditschema. Voor wat betreft zorgsystemen m.b.t. veiligheid&gezondheid, is het de interne preventieadviseur die, alvast in de initiële fase, die het best geplaatst is voor deze rol.

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It is only through the eyes of others than one can see himself.

Confucius

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1. Conducting audits

(ISO 9 001, § 8.2.2) “The organization shall conduct internal audits at planned intervals to determine whether the quality management system

a) conforms to the planned arrangements, to the requirements of this standard and to the quality management system requirements established by the organization, and b) is effectively implemented and maintained.

A documented procedure shall be established to define the responsibilities and requirements for planning and conducting audits, establishing records and reporting results.

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1. Conducting audits (2)

An audit programme shall be planned, taking into consideration the status and importance of the processes and areas to be audited, as well as the results of previous audits. The audit criteria, scope, frequency and methods shall be defined. Selection of auditors and conduct of audits shall ensure objectivity and impartiality of the audit process. Auditors shall not audit their own work. Records of the audits and their results shall be maintained The management responsible for the area being audited shall ensure that any necessary corrections and corrective actions are taken without undue delay to eliminate detected nonconformities and their causes. Follow-up activities shall include the verification of the actions taken and the reporting of verification results.”

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Ø “The organization shall take action to eliminate the causes of

nonconformities in order to prevent recurrence. Corrective actions shall be appropriate to the effects of the nonconformities encountered.

Ø A documented procedure shall be established to define requirements for:

a) reviewing nonconformities (including customer complaints), b) determining the causes of nonconformities, c) evaluating the need for action to ensure that nonconformities do not recur, d) determining and implementing action needed, e) records of the results of action taken, and f) reviewing corrective action taken.”

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An audit shall give an answer to three basic questions: 1. DOES THE EXECUTION OF PROCESSES AND ACTIVITIES

CORRESPOND WITH THE OBJECTIVES DEFINED BY THE ORGANIZATION?

2. HAS THE MANAGEMENT SYSTEM BEEN IMPLEMENTED EFFECTIVELY (DOES THE ORGANIZATION MANAGE TO DELIVER PRODUCTS IN CONFORMITY WITH REQUIREMENTS AND EXPECTATIONS?)

3. HAVE ALL ISO REQUIREMENTS BEEN INTEGRATED INTO THE MANAGEMENT SYSTEM?

F and so there are three kinds of nonconformities (zie slide 40)

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Policy & Objectives

Company's Manuals and Procedures

Regulations Operational Requirements Organisation & Responsibilities

Must

Action Corrective Measures

Is Audit

Do Daily Practices

Action

Improvements Satisfying? Functioning?

Can it better ?

Deviation

OK not at this time yes

no

Check

Plan

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2. What is an audit?

If nature provided the human body with two ears and one tongue, it did so that it would twice as much listen than it would speak.

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2. What is an audit? (2)

•  An audit is an evidence gathering process. Audit evidence is used to evaluate how well audit criteria are being met. Audits must be objective, impartial, and independent, and the audit process must be both systematic and documented.

See ISO 19 011 (2002): Guidelines for Auditing Management System •  The general definition of an audit is an evaluation of a person,

organisation, system, process, enterprise, project or product. The term most commonly refers to audits in accounting, but similar concepts also exist in project management, quality management, and energy conservation.

Definition by Wikipedia

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Subclasses of audits are definied as a function of the person who conducts the audit

•  "First party audit“ (Internal audit) A First-Party Audit is a management system audit carried out by an organization of its

own management system. It is also called a self-assessment or internal audit. These audits may be performed by sub-contractors, but no external certification is given or expected.

•  "Second party audit" A Second-Party Audit is a management system audit carried out by a customer of the

organization.

•  "Third party audit“ (Certification audit) A Third-Party Audit is a management system audit performed by a body that is

independent of both the organization being audited and any customers of the organization.

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Most audits are process audits

Traditional vision on organisations versus process approach ô

Traditional auditing versus process auditing

TRADITIONAL PROCESS ORIENTED

Planning on a division level Planning as a function of a logical succession of activities

Focus on what goes on whithin the division

Focus on interfaces between divisions

ò ò

Fragmented Cross-divisional

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Parties involved:

•  Audit customer = the organisation or person ordering an audit

•  Auditee = the organisation undergoing an audit

•  Auditor = knowledgeable person with a proven experience on the field (e.g. occupational safety), having an in-depth knowledge of the appropriate management standard and disposses of all skills necessary to follow an audit through to a successful conclusion. If several auditors are involved, one of them will be the lead auditor.

•  Audit manager = person that manages the audit programme.

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The organisation of internal audits

ü Is conducted by an external consultant (warning: the consultant shall not interfere in the certification process) or by an in-company knowledgeable person (quality manager, environmental co-ordinator, safety engineer)

ü Mutual auditing by staff members belonging to other divisions/branches is an excellent alternative (on condition that training sessions have been attended and close supervision is guaranteed)

ü An internal audit plan has to be established in detail

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Example of an internal audit plan

PROCESSES DIVISIONS CONCERNED OWNER OF THE PROCESS 1 2 3 4

MA NAGEMENT PROCESSES MANAGING DIRECTOR TOP MANAGEMENT

X

SELLING, DESIGNING, INSTALLING, PUTTING INTO SERVICE AND INVOICING

OF NEW ELEVATORS

MANAGING DIRECTOR PRODUCTION MANAGER

TECHNICIANS AND SUPERVISION ADMINISTRATIVE ASSISTANTS

X

SELLING OF MAINTENANCE CONTRACTS AND TECHNICAL MAINTENANCE OF

EXISTING ELEVATORS

MANAGING DIRECTOR MAINTENANCE MANAGER


X

REPAIR OF EXISTING ELEVATORS (incl. EMERGENCY INTERVENTIONS)

MANAGING DIRECTOR MAINTENANCE MANAGER


X

SELLING AND EXECUTION OF MODERNIZATION PROGRAMMES FOR

EXISTING ELEVATORS

MANAGING DIRECTOR ASSEMBLY MANAGER


X

SUPPORT PROCESSES (PURCHASING, HR MANAGEMENT, …)

MANAGING DIRECTOR ADMINISTRATIVE ASSISTANTS

X

1 – 4 = QUARTERS

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3. The auditor

What is an auditor?

•  An auditor is een catalyst to encourage reactions leading to review and improve practical aspects of the management system and its effectiveness (not: efficiency!)

•  An audit is a matter of human interaction; it is not a police interrogation during which an auditor has to extorque a confession of guilt from a person suspected of misdemeanor.

•  Within this context, there is no room for mistakes.

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4. Steps in auditing

Main mission of the auditor: surveiling the chronology of the

process. The various steps are:

1.  Preparing the audit 2.  The kick-off meeting 3.  The « on site » audit 4.  The final meeting 5.  Reporting and filing registrations

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4. Steps in auditing (2)

The introductory meeting

F Useful/mandatory for (internal first) audits and (external) certification audits

F Extremely important phase: decisive impact on the audit’s succes and the validity of the end result. Presence of top management and interested line managers is essential.

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The introductory meeting (2) F Content of the meeting:

•  Presentation of the auditor(s) •  Explanation of the proceedings

Ø Confirmation of the "scope" of the audit Ø Explanation of the practical mode of operation Ø Conformation of the audit programme (time tables!) Ø Organizational factors: use of languages, accessibility of confidential data,

safety and security issues, monitoring… •  Agreeing on the final meeting date •  Answering questions – avoiding uncertainty and ambiguity

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The introductory meeting (3) Messages to be conveyed by the auditor: •  Audit = assistance to company management in finding “good” elements

and elements to be improved. •  Auditor is a brother-in-arms, not a opponent: in the first place, the

internal auditor assist work unit managers in their mission to direct their division so that targets are being respected

•  Independency and objectivity are key •  No evaluation of staff members (an audit is not a performance review of

individuals) •  The auditor does not take the place of management (he/she has no

decision power whatsoever on measures to be taken)

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The audit process The essential job of an auditor: reformulating – recapitulating •  “Am I right in saying that...? •  “Are you suggesting that...? •  “Do you experience...? •  “Could it be that...? •  “Are you saying that...? •  “If you want to put it clearly, would you then rather not say

that...?

Even more important is: “show me…”

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The audit process (2): manipulation of the auditor •  Limiting the available audit time by distracting the auditor’s attention

(discussing a new product, presenting a new marketing tool, showing a commercial video, organising a “touristical” tour on the premises…)

•  Submitting pre-prepared or last minute texts/procedures/data •  Being drawn into taking sides or internal conflicts – unless there is evidence

that a given conflict lies at the basis of all problems •  Mistakenly assuming the role of problem solver •  Slipping into an appraisal of (groups of) staff members •  “Auditing is not possible on this specific moment or during this specific

period” (e.g. not during the holiday season, during night shifts, in the case of production dips…)

•  “Wining and dining” during lunch hours

5. The on-site audit (2)


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The audit process (3): bumping into non-conformities What: a non-conformity means that a requirement is not being

respected.

Three kinds of non-conformities: 1. Non-conformity with respect to an external requirement (an ISO standard,

legal requirements); can pertain to documentation/registration as well as to execution

2. Non-conformity between execution and company documentation 3. Unsatisfactory work procedures or infrastructure (endangering conformity

of the end result)

Non-conformities 4. Steps in auditing (6)

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Example of a non-conformity with respect to an external requirement

1.  “Design and development activities are not included in the quality

management system. Nevertheless, it appears that new services are periodically being developed that are being tested on the field before they are commercialized. These tests are not done in a systematic way and the results are not filed.”

2.  “Since 1,5 year, no internal audits have been conducted. According to the internal auditing procedure, every work unit and every major activity should be audited at least once a year.”

3.  “There is no proof that staff members of contractors systematically receive information on safety and health issues before they start executing their tasks within the company. It is unclear who is in charge of this process and how it should be evaluated.”

Non-conformities (2)

Examples of non-accordance between internal standards and their adherence

1.  “No evidence was found that the methods that are used in practice for cleaning ADR containers are in conformity with standard cleaning instructions. Surveillance is lacking.”

2.  “The following controls, prescribed in the quality plan, have not been conducted since dd.mm.yy: temperature registration of meat at the acceptance stage – temperature registration of refrigerators.”

3.  “Since dd.mm.yy no performance reviews are being held by line managers in division X., in accordance with the competence management procedure. Likewise, training requirements are no longer assessed during these reviews in division Y.”


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Examples of inefficient work procedures 1.  “The list of approved contractors is too extensive (several

hundreds) and therefore hardly user-friendly when it has to be consulted by the purchasing departement (mere alphabetical listing, no classification according to activity sector).”

2.  “Internal audits focusing on the use of personal protective equipment are not conducted in a systematic way and the observations are not listed. In the new work unit X no systematic risk assessment has been conducted on the issue of personal protective equipment.”

3.  “The working method to be used when stowing heavy loads on lorries has not been defined. Drivers are not instructed, and training lacks.”


Cave: in safety&health issues, major non-conformities can be given when the auditor “feels” that basic assumptions are not fulfilled.

Specific example (major Belgian company):

Ø  NCR1: (chapter 4.4.6): “operational control on site by line of

command is mixed and sometimes inadequate” Ø  NCR2: (chapter 4.4.6): “operational control on site by executive

staff is mixed and sometimes inadequate”

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Non-conformities are being registred

Per important non-conformity: a NCR (non-conformity report) bearing a sequence number.

•  No ambiguity on the status of the non-conformity (major or minor) •  Objective and truthful reproduction of the facts. Clarity on:

•  What is the requirement? •  What are shortcomings (referring to procedure/part of the standard/legal

requirement)? •  Where or for which activity the non-conformity was observed? •  If possible, referencing to pieces of evidence

•  Always a negative phrasing

5. The on-site audit (4)

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Final Meeting The auditor formally informs top management about the main findings

of the audit and highlights conclusions Important: ü  Create a feeling of involvement when listing the audit conclusions ü  Presence of top management and important senior managers is

essencial ü  Well prepared presentation (ppt) ü  Positive elements should explicitly be adressed.

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Elaboration of the audit report The following elements have to be included in the audit report: •  Objectives of the audit (mostly a standard text) •  Scope of the audit (work units, local branches and/or processes

that have been looked at) •  Identification of all auditees •  Identification of the audit team •  Audit criteria •  Audit findings (non-conformities) •  Audit conclusions •  Factors/items that could not be investigated

+ date + place + signatures

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Elaboration of the audit report (2) Non-conformities are an important chapter in the audit report. The are

listed, one by one. •  Distinction between major non-conformities, minor non-conformities,

points of attention and suggestions •  NCRs are enclosed •  Formal audit conclusions shall be highlighted:

•  “The management system that was audited is found to be in conformity with the ISO XXXX requirements, with the exeption of a few minor non-conformities. The auditor advises the granting of the ISO certificate”.

•  “The strenghts of the organization that was audited lie in technical management of building sites. However, the underlying management processes are less developed”.

•  “In the course of this audit, no indications could be found that the requirements of the Royal Decree … were not being respected”.

•  “The audit made clear that there exists a strong conformity with all items out of the HACCP codex, with the exception of …. in situation X.”.

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5. Aanstelling interne auditors

•  NBN EN ISO 19011 : Ontwikkeld voor audit van kwaliteits –en/of milieumanagement systemen maar ook toepasbaar op veiligheids-managementsystemen zoals OHSAS 18001 •  6 principes voor het uitvoeren van een audit :

–  1) Integriteit : de basis van professionaliteit –  2) Eerlijke verslaggeving : de plicht

waarheidsgetrouw te rapporteren –  3) Gepaste beroepsmatige zorgvuldigheid –  4) Vertrouwelijkheid –  5) Onafhankelijkheid –  6) Aanpak op grond van bewijs

5. Aanstelling interne auditors (2)

•  NBN EN ISO 19011 artikel 5.4.4 : •  “bij het uitkiezen van een auditteam behoort

rekening gehouden te worden met de competenties die nodig zijn om de doelstellingen van de audit te halen”

•  “om de algehele competentie van het auditteam te borgen, behoren volgende stappen te worden genomen : •  1) Het identificeren welke kennis en vaardigheden nodig zijn om de doelstellingen van de audit te halen.

•  2) Het zo uitkiezen van de leden van het auditteam dat alle benodigde kennis en vaardigheden in het auditteam aanwezig zijn.

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•  NBN EN ISO 19011 hoofdstuk 7 : competenties van de auditors •  Persoonlijke kenmerken •  Algemene kennis en vaardigheden •  Specifieke kennis en vaardigheden van het

werkgebied en de sector •  Persoonlijke kenmerken :

Ethisch verantwoord (onpartijdig, eerlijk, oprecht, discreet), ruimdenkend, diplomatiek, over een goed waarnemingsvermogen beschikken, opmerkzaam, flexibel, vasthoudend, besluitvaardig, zelfstandig…


•  NBN EN ISO 19011 hoofdstuk 7 : competenties van de auditors •  Algemene kennis en vaardigheden :

•  Kennis van auditprincipes, -procedures en –methoden

•  Kennis van documenten van het veiligheidsmanagementsysteem

•  Kennis van de organisatorische context •  Kennis van de toepassing zijnde wettelijke –en contractuele eisen

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•  NBN EN ISO 19011 hoofdstuk 7 : competenties van de auditors •  Specifieke kennis en vaardigheden van het

werkgebied en de sector : •  Specifieke kennis over het dynamisch risicobeheersingssysteem: (risicoanalyses & identificatie van gevaren, globaal preventieplan en jaaractieplan, preventiehiërarchie, welzijnsdomeinen, noodplannen, grenswaarden beroepsmatige blootstelling…


•  OHSAS 18001:2007 artikel 4.5.5 à “De keuze van de auditoren en de uitvoering van audits moet de objectiviteit en de onpartijdigheid van het auditproces waarborgen”

–  Toekomstige interne audits binnen ISS

worden dus bij voorkeur niet door de betrokken afdeling zelf uitgevoerd

–  bedrijfseenheden binnen ISS dienen uitgevoerd te worden door medewerkers van andere technische bedrijfseenheden binnen de preventiedienst van ISS, rekening houdende met alle vooropgestelde competenties .

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6. Middelen voor interne auditing

•  NBN EN 19011 : Artikel 5 geeft adviezen voor het ter beschikking stellen van voldoende middelen voor het auditteam.

•  Er dienst rekening gehouden te worden met : •  De benodigde financiële middelen voor het

ontwikkelen, implementeren, managen en verbeteren van de auditactiviteit

•  De beschikbaarheid van auditors en eventueel technisch deskundigen met de gepaste competenties die past bij de doelstellingen vah te auditprogramma

•  De reistijden, reiskosten, verblijven en andere benodigdheden voor de uitvoering van de audit

•  De beschikbaarheid van informatie en communicatietechnologieën

4. Zijn zorgsystemen effectief?

Er bestaat nogal wat wetenschappelijk onderzoek over de toegevoegde waarde van zorgsystemen en de voorwaarden waaronder deze effectief zijn.

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1. The efficiency of management systems

Practical experiences (in the past!?) ü (U.K., ca. 1985) A number of enterprises, although in possession of a certificate of compliance with BS 7750, did not turn out to be able to control their essential environmental problems.

ü Supplier performances with respect to the quality of delivered goods or services often show to be independent of the acquisition of an ISO 9 000 certificate of conformity

There is a difference between the validity of a certificate and the efficacy of a management system … Things have improved over time. Although …?

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1. The efficiency of management systems (2)

Most management systems proceed top-down instead of bottom-up

ü Often very bureaucratic systems (excess of procedures)

ü Long implementation period (is the establishment of a management system the longest way for reacting to problem definitions originating at the shop floor level?)

ü Provides only an indirect answer to the question: “what information is needed at the shop floor level in order to achieve sound performances with respect to QESH”?

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A management system is no substitute for sloppy management or a lack of competence …

ü Mind the fetish value of output parameters!

ü Beware of a maximisation/minimisation of targets! ü Added value of external certification?

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Justification of performance

“Organisations follow systematic, formal and consistent procedures, not so much to achieve greater results, but to legitimise their actions to critical publics. Organisations, by this argument, attempt to make their actions logical and defensible so as to satisfy societal demands for rational or competent behaviour”.* ___________________ *Staw B.M., MckKechnie P.I. & Puffer S.M. (1983): The justification of organizational performance”, Administrative Science Quarterly, 28, 4, pp. 582-600

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2. The efficiency of safety management systems

1. Safety Management Systems are often one-dimensional

Most (safety and health) management systems focus exclusively on occupational and process safety. Occupational hygiene, musculoskeletal disorders and psychosocial risks are underdeveloped.

Towards a more equilibrated management system (wellbeing at work)? Cfr. ESENER*: structure of a universal OSHMS

___________ *European survey of enterprises on new and emerging risks

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Beware of a too unilateral focus on safety

Belgian situation

•  Psychosocial risks and stress are the main professional risks. About 20% of long-term sick leave is due to psychosocial factors, but absence due to musculoskeletal diseases is estimated at 33 % (and in general: absenteism figures have constantly been rising over the last 10 years!)

•  European surveys demonstrate that prevalence of musculoskeletal affections are on the rise since beginning of this century (general tendency throughout the EU);

•  Work-related stress is stable over the last years, but at a rather high level.

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2. The efficiency of safety management systems (2)

2. How effective are safety management systems?

Barriers are*:

a.  System design faults - failure to customise systems to organisational needs

-  imposition without employee consultation -  weak management commitment/resourcing -  lack of integration with existing management

systems -  restricting OHS to technical experts -  failure to train and involve employees

__________________________________ * Cl. Gallagher et al.:” Occupational Health and Safety Management Systems:

a review of their effectiveness in securing healthy and safe workplaces”, April 2001, National Occupational Health and Safety Commission, Sydney

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2. How effective are safety management systems (2)?

Barriers are (2): (…)

b. The inappropriate use of audit tools c. Application in hostile contexts

International research suggest that Occupational Safety and Health Management Systems (OHSMS) can indeed deliver healthier and safer workplaces under the right circumstances.

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Factors contributing to effective OHSMS

A. Type of system -  Customised to organisation’s needs -  Developed with support and involvement of all organisation

stakeholders -  Safe place/innovative system (see slides 20 and following)

B. Internal organisational factors B.1. Management commitment

-  Strong senior management involvement -  OHSMS introduce to improve OHS in the first place -  Provision of adequate resources -  OHS integral to management performance appraisals -  Leading by example

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Factors contributing to effective OHSMS (2)

B.2. Integration into management systems -  All organisational functions incorporate OHS

B.3. Employee involvement -  All employees encouraged and capable of participation -  Independent representation of employees encouraged and

supported

B.4. Workforce characteristics -  Stable workforce C. Nature of organisation -  Large organisation familiar with systems and with adequate

resources -  Stable workplace

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Factors contributing to effective OHSMS (3)

D. Contractor relations -  Principal contractor works with subcontractors to develop

compatible OHSMS E. Audits and audit tools -  Appropriately used audits can verify and validate OHSMS

and facilitate continuous improvement -  Adequate audit tools are tailored to organisational needs

and reflect key OHSMS success factors -  Audit processes are robust and auditors are technically

competent -  Audits are integrated within a comprehensive approach to

measurement

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3. Results of enquiries/statistical studies Number of companies that have implemented OHSAS

and show reduced accident frequencies __________________________________ * Source: T. Sparey (2010): “Does BS OHSAS work?, BSI, White Paper

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3. Results of enquiries/statistical studies (2)

Enquiry amongst 788 companies showed that the most important results of certification according to OHSAS were:

1.  Improvement in safety culture and behaviour (81,3%) 2.  Improvement in performance monitoring (75,5%) 3.  Improvement in communication (61,2%) 4.  Improving in reporting frequency of incidents (56,1%) 5.  Improvement in safety&health training and education

(55,4%) ____________________________ * Source: T. Sparey (2010): “Does BS OHSAS work?, BSI, White Paper

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5. Vraagstelling

Laat maar komen…

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6. Wat hebben we vandaag geleerd?

1.  Er bestaat een diversiteit aan zorgsystemen 2.  Een zorgsysteem heeft pas toegevoegde waarde onder

bepaalde omstandigheden en mits een daadkrachtige aansturing

3.  Interne audits zijn een essentieel onderdeel van een zorgsysteem

4.  Quid toegevoegde waarde van externe certificatie?

7. Referenties

Er bestaat nauwelijks literatuur over zorgsystemen, en degene die er is blijft erg op de vlakte…

Niveau I Zorgsystemen: wetenschappelijke onderbouwing en ... · onderbouwing en capita selecta...

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