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Leading indicators for occupational health and safety management systems in healthcare

Study Lead
Study Lead
Associate Professor
Tracy Kent-Hillis, Director of Patient Care, Lennox and Addington County General Hospital
Mike McDonald, Executive Vice President, Patient Care & Community Partnerships, Kingston Health Sciences Centre
Karanjit Lachhar, School of Nursing, Queen’s University
Vanessa Silva e Silva, School of Nursing, Queen’s University
Peter Strahlendorf, Associate Professor, School of Occupational and Public Health, Ryerson University
Elizabeth VanDenKerkhof, Professor, Sally Smith Chair in Nursing, School of Nursing, Queen’s University
Knowledge Users
Louise Caicco Tett, President, Health & Safety Professionals Inc.
Thomas Hayes, Director Safety, Security, Parking and Staff Health, The Ottawa Hospital
Joanna Noonan, Director, Occupational Health, Safety and Wellness, Kingston Health Sciences Centre
Project Manager
Geneviève Paré, School of Nursing, Queen’s University

What? Ontario’s healthcare sector has more than 800,000 employees. Every day, healthcare workers encounter physical risks; from repetitive lifting and moving, exposure to chemicals and infections, and threats of violence. For the past five years, the healthcare sector has ranked second highest for lost-time injury rates (injuries that result in lost time from work) among the 16 Ontario sectors with $2.5B spent yearly on occupational injuries. Despite an increased focus on improving Ontario’s Occupational Health and Safety Management Systems (OHSMS), the injury statistics are not changing significantly.

One of the potential keys to changing this trend is the development of a culture of healthy and safe workplaces, including the effective utilization of leading indicators within OHSMS. In contrast to lagging indicators, which focus on outcomes retrospectively, leading indicators are associated with proactive activities. Using leading indicators to measure health and safety has been common practice in high-risk industries; however, this shift has not occurred in healthcare. 

Why? The aim of this project was to evaluate the feasibility of implementing interventions guided by six leading indicators (senior management commitment, continuous improvement, communication, competence, employee involvement and occupational health management), and the effectiveness of these interventions on improving employee’s perception of their organization’s health and safety climate.

How? This is a two-phase project that used a quasi-experimental longitudinal design within two acute care hospitals. In Phase I, we identified facilitators and barriers to the current OHSMS, assessed the OHSMS in participating sites using the Leading Indicator Assessment Tool, and identified possible leading indicators to be added or changed. This phase concluded with the development of tailored interventions based on the gaps identified in the assessment. Phase II pilot tested and evaluated the feasibility and effectiveness of the interventions. Data were collected pre- and post-interventions.

Results: The results suggest the utilization of leading indicators to assess an organization’s current OHSMS, identify areas for improvement, and implement tailored interventions is feasible to support a culture of safety in healthcare.  This is a promising new approach to proactively develop a culture of healthy and safe workplaces.

Impact of findings: Interventions were developed to improve three leading indicators: senior management commitment, employee involvement, and communication. Overall, both sites supported using leading indicators to guide proactive interventions. Employees’ perceptions of the health and safety climate improved at one site only.



Funded By
The Ministry of Labour Research for the Workplace
Henrietta Van hulle. Executive Director, Health & Community Services, Public Services Health & Safety Association (PSHSA)
Ryan Adam, Director, Health & Community Services, Healthcare Director, PSHSA
Jeremy Holden, Health & Safety Consultant, PSHSA