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Good work design for the healthcare and social assistance industry, Suzanne Johnson, Dr Keith Adam and Brooke Dench

This webinar, featuring Suzanne Johnson, Dr Keith Adam and Brooke Dench, examines how key work health and safety risks in the health care and social assistance industry can be addressed through good work design. You might be thinking you’re not a designer, but many people can be designers of work, including managers, business owners, designers of plant, substances and structures, and designers of work processes.

This webinar series is part of Workplace Health and Safety Queensland’s broader Culture of Care Initiative, which recognises and promotes that caring for the health and safety of your workers is just as crucial as caring for your patients. In fact, the two areas are interdependent for a positive outcome for both workers and patients.

Download a copy of this film (ZIP/MP4, 610MB)

Welcome and thank you for joining us. I'm Suzanne Johnson, manager of the Ergonomics Unit Work Health Design branch, Workplace Health and Safety Queensland. I'd like to begin by acknowledging the traditional custodians of the land in which we meet today, and pay my respects to the elders past, present and emerging. I'd like to extend that respect to Aboriginal and Torres Strait Islander peoples watching today. This webinar is first in a series that will illustrate how key work health and safety risks in the healthcare and social assistance industry, can be addressed through good work design. You might be thinking you're not a designer, but many people can be designers of work, including managers, business owners, designers of plant substances and structures, as well as designers of work processes. This webinar series is part of Workplace Health and Safety Queensland's, broader culture of care initiative, which recognizes and promotes the caring for the health and safety of your workers is just as crucial as caring for your patients. In fact, the two areas are interdependent for a positive outcome for both workers and patients. I'm going to commence today by giving you a brief overview of the background theory on good work design. We'll then be hearing from Dr. Keith Adam, a specialist Occupational and Environmental physician and Chief Medical Officer at Sonic HealthPlus. Keith we'll be examining some of the statistics around worker's compensation claims, and the claims rates in the health care and social assistance industry, and data around psychological injuries, and what this might tell us about the future of this industry. He'll consider how workplaces can immediately and continually improve work design, with incremental changes, rather than waiting for a fundamental redesign and explore ways to improve psychological design. Finally, we'll hear from Brooke Dench, a human factors specialist and the chair of The Health Special Interest Group within the Human Factors and Ergonomics Society of Australia. Brooke, will present a case study on how she applied good work design, to improve safety and efficiency in an endoscopy unit. There is much evidence available in both the injury prevention and return to workspaces that supports good work as good for health and safety, but the important element here is good work. The image on the slide shows you Safe Work Australia's publication principles of good work design handbook, you can access the publication on Safe Work Australia's website. It contains some useful guidance as to why, what and how of good work design. Dr. Adams will talk a little more about this later in his in the session. If you're not already familiar with this publication, I encourage you to take a good look. So what does good work look and feel like? If we ask ourselves what good work is I suspect we would come up with many descriptors as there are people in your workplace. The Human Factors and Ergonomics Society of Australia, recently published a paper about good work design, including a definition of what good work is. This definition includes some of the following, work that provides purpose and meaning for workers, Work that engages, promotes and protects worker health, work, where work expectations are transparent and manageable, and work when mental, social and physical activity has been considered. Good work protects workers from harm, improves their health and well being and increases business productivity. Based on self-reporting data analysis, the healthiest workers have been found to be three times more productive as unhealthy workers, and there is also research suggesting, economic returns that indicate decreased absenteeism, and workers compensation costs. There's definitely increasing recognition that you can't just look at a problem or a hazard in isolation, there are many factors within the work system and ensuring worker health and safety requires a holistic approach. As a broad overview, good work design considers the work, work environment and the workers capabilities. Sharon Parker of the Center for Transformative Work Design describes good work design as, "the content and organizing of tasks, activities, "relationships, and responsibilities within a job "or a role or set of jobs and roles." When work is not designed Well, a business loses the opportunity to innovate and improve the effectiveness and efficiency of work and the health and safety of its workers. Poor work design, on the other hand, can have personal costs, including sickness, absence, presenteeism, and high staff turnover. Good work design is a human centered approach, it's about thinking how work is going to affect an individual as much as how an individual might interact in a workplace. It's about understanding the work and the tasks and involving people in their own work design. In the case of the healthcare industry, it's also about better managing the risks to the benefit of both the patient and the worker. Picture this, your workflow is smooth and you have the right equipment available for all your workers. There are adjustable workstations to suit the diversity of your workforce. The work demands are manageable, and there's clear communication from management and co-workers. You have clear expectations and work duties with processes applied consistently across work groups. Under the work health and safety legislation, we have duties relating to designers, you might be thinking you're not a designer, but many people can be designers of work, for example, consider do you make decisions about the design or redesign of work? Are you a business owner? Are you a designer of plant substances structures? Do you design work processes and systems for example, HR personnel, software and IT systems designers, organizational psychologists, ergonomists, it's highly likely you can apply some of the principles around good work design to the work you do. Good work design considers all the characteristics of work. Look out for these elements, when you hear from Brooke in her case study a little later. When making decisions about work tasks, activities and responsibilities, there are typically four elements to think about that interact together, these are physical hazards for example, biological and chemical hazards, this is a common issue in the healthcare industry, by mechanical elements are aspects of the work that include for example, hazardous manual tasks that can lead to musculoskeletal disorders, often called sprains and strains. For example, patient resident handling, or services such as maintenance and cleaning. There's cognitive elements, aspects of the work that create demands on the human mental capacity for example, determining medication needs based on the patient's physiology or juggling multiple pieces of information at once. And then there's psychosocial hazards, social, psychological, and organizational aspects of work that place demands on human capacity, for example, shift work and fatigue, remote and isolated work, and bullying and harassment. This image published by The Human Factors and Ergonomics Society, is one way of illustrating a process for achieving good work design. You'll see engaging people is at the very beginning, and should go right through the process. In the discovery stage, it's about analyzing the fit between workers and the task within the context of the workplace. Tasks or processes, are then examined under different conditions, and/or relevant stakeholders need to be involved. Depending on what you're looking at, there are different tools and techniques you can use, while working in the discovery phase. You'll focus on bringing people and teams together, to determine solutions in the design stage. Solutions should be supported by evidence and widely accepted. This stage involves testing and trials of multiple design versions or models and incorporating feedback and data. The next stage is the realization stage, where improvements are implemented, realized and monitored. Good work design may be done on only a small scale such as task specific improvements, or it might be for a whole work area. Getting design right is of course best done in the early planning of a project, but the same process and approach can be applied at any age or stage, even small steps and improvements can be made to improve health, safety and well being outcomes for your workers. So, that's a brief overview of the background theory on good work design. I'd now like to hand over to Dr. Keith Adam, Chief Medical Officer at Sonic HealthPlus. He'll consider claim statistics for the health care and social assistance industry, how workplaces can implement incremental changes to continually improve work design, and ways to improve psychological design.

Thank you, Suzanne. Just following on from what you said, I'd like to share with the audience, part of my experience, you talked about the why, the what and the how, but I'd like to talk a little bit about the when, because I think there's an opportunity which crops up reasonably frequently to look at workplace design, and that's following injury. In my experience, often when you're considering how you can get someone back to work after an injury, considering how the workplace might be modified, you're actually looking at workplace design, you may be modifying the workplace, and it's been worthwhile considering whether those changes can be applied more broadly, to help prevent injuries to others. I now like to turn to some statistics, and then talk to you about the psychological aspects of good work design. So if we turn to the health care and social assistance workforce between 2018 and 19, you'll see that the health care and social assistance sector is the largest group in Queensland industry. Ahead of retail ahead of construction, and despite perhaps the publicity way ahead of mining. You'll also see that the health care and social assistance sector is the most rapidly growing sector in the Queensland workforce, with an average growth of 5.2%, greater than most other sectors. If we look at workers compensation claims for serious injuries, you'll also see that the health care and social assistance sector has the highest proportion of those injuries and in fact that proportion is greater than their proportion of the working population. I'm looking at serious injuries because, a large proportion of serious injuries will be psychological injuries, although not all serious injuries are psychological. And if we look at the rate of serious injury claims per thousand workers, you'll see that overall the healthcare and social assistance sector is not quite as bad as some others, but within the sector, there are some very high-levels, particularly in residential aged care services and hospitals, where the incidence of serious injury claims is quite high. If we now turn to psychological injuries, you'll see that compared to all serious injury claims, the mental disorder claims, have a much greater duration of days lost 85 compared to 25, and also a much greater claim payment. Almost a third of accepted mental disorder claims to healthcare and social assistance workers, were associated with exposure to occupational violence, and work pressure also featured heavily in three of the top four industry groups. 63% of all mental disorder claims, arise from four of 19 industry divisions, with healthcare and social assistance at the top, followed by public administration safety, which I expect includes the police, education and training, and then followed by transport postal and warehousing. Again, you'll see that health care and social assistance, is by far and away the greatest contributor to mental health claims. Again, if we look at the rate of claims, you'll see that hospitals, social assistance services, residential care services and medical other health care, all have rates greater than the industry average. If we look at accepted psychological claims, then work related harassment and bullying, and exposed occupational violence, are the two largest contributors in most sectors. There's a significant contribution in the transport and postal sector, perhaps unsurprisingly with vehicle accidents but that apart, it's mainly work related harassment and bullying, which contributes to these claims. I'd now like to turn to the aspect of good design, in the psychological setting. I believe we can apply the principles of good work design to the psychological environment in the workplace, in particular, I've been looking at the prevalence of psychological injuries in in-home care and support, which presents some unique challenges. While some of my talk may be directed more particularly to that group, it can be generalized to many, many workplaces. Dealing with individuals with care needs, means you better deal with the range of attitudes and behaviors found in the population at large. We'd like to believe that all our patients are kind, considerate, cooperative people and they support their families there're totally supportive and don't argue and don't disagree with what you're going to do, but I'm afraid that's not true, we've really got to understand that the workplace involves dealing at times with difficult and sometimes uncooperative people, and that can take a toll on the workers in the industry. This workplace involves a complex interaction between patients, their families, clinicians, the technology they may rely on, and also, workers in this area are often working in isolation both from their peers and from the office. There can be demanding interactions with clients and with their families, there's unpredictability attached to going into new clients homes, and not knowing what to expect, even though some sort of assessment should have been done beforehand, and there can be difficulties in managing unpredictable client behaviors in public settings, where people have got to be taken out. There are a number of specific factors that have been identified in this environment, there's pressure to perform. People may be encouraged, to perform unpaid or unsafe work to satisfy unmet client's needs, we've all seen the publicity, or had direct experience ourselves of how the money in the sector never seems to go far enough, and there are a number of unmet needs, when you having a personal relationship with your client, then there's clearly a pressure to try and do the right thing always, and that may lead people into doing things that are unsafe. It puts a strain on not only people's physical capacities, but also their emotional and mental capacities, on their needs and their experience, and on top of that, it's become a casualized workforce with insufficient and highly variable weekly work hours, and sometimes just-in-time work. And the rostering sometimes leads to financial insecurity. Whilst some of those I believe are societal factors which we aren't gonna change straight away, we need to understand that they're at work, and it emphasizes, I believe, what's even more important to deal with those things that we are able to. There are a number of practices which employers can institute to mitigate the risk of psychological injury. One of the important keys is ensuring that there are sound operational business systems, which provide a supportive environment and a predictable environment for workers in this area. On top of that, there need to be supportive leadership structures, both managers and supervisors, need to understand the problems in the industry and need to provide appropriate support to their workers. Perhaps most critically, we need appropriate and timely responses to incidents. Incidents will undoubtedly occur in this sort of environment, it's not so much whether they occur or not that's the problem, it's how you respond once they've occurred, I've seen situations where people have been left sitting in a room with someone behaving aggressively outside and banging on the door for two hours before someone came to relieve them. Unsurprisingly, I was then seeing in the context of a complex psychological claim and I often find myself saying if only people had been able to respond more quickly or respond more appropriately at the time, then the psychological injury surely could have been mitigated. Peer support from colleagues is also important, and it's important to recognize the autonomy and professional practice involved in home care. So what can be done to ensure sound business systems? It's important that employers recognize the value and the difficulties of the work done by home care workers. Scheduling shifts, and hours of work is most important, if possible, accommodate shift preferences, try to provide sufficient hours so that people don't have to work at multiple sites, and careful matching of clients with home care workers is important. The opportunity to move around from time to time or to mix your shifts helps prevent burnout. It's important to assist workers in limiting travel time and maximize their weekly hours. Workforce planning, provide sufficient and healthy hours of work where possible, and I think it's also important when recruiting that you recruit the right people to start off with, one large employer in this sector, explained that we recruit for attitude, and then we train them, because you can't buy attitude, you can't train it, but you can train and everything else, and I think it's important to have some consideration right at the start about whether or not in some cases we have the right people in the right jobs. Communication, is most important changes in care plans, changes in the circumstances at home, changes in treatment, all need to be communicated, and if they're not clearly communicated in timely fashion, that can lead to a great deal of stress and difficulty. What I find is that there are work health and safety systems, but oftentimes, the risk assessment and hazard reduction are directed towards a fairly static environment, and don't necessarily take into account the fact that stress can accumulate over time and lead to burnout. In addition, I find that formal risk assessments, often don't anticipate risks, unpredictable risks, such as changes in client presentation and/or family behavior. You model the processes and the risk management on how things are now without considering what else might happen, or having a process to change the plan when circumstances change. And not only that, I found risk assessments were often not necessarily adhered to, when home care workers felt under pressure to meet client demands that fell outside the care plan, and consequently, the risk assessments. So there's often pressure for people to, go outside the scope of what they're expected to do, and when they do that, the risk assessment often isn't done, and that's often where you see people getting into trouble. Supportive leadership is most important, it's important to have a day-to-day people-centered supervisory practice. Supervisors need to be good people managers, and they need to care for their workers. Communication skills are vital, with regular, meaningful and empathetic contact. It's also important that supervisors accept a normalized discussions about stress, so that workers feel free to discuss it if and when problems are developing. It's also useful to watch for signs of stress in your workers. Excessive time taken off, change in mood, other changes in work practices may all been indication that stress is gradually accumulating. The other advice that I think is most important, particularly for managers and supervisors, is that you shouldn't project your coping skills and resilience on others. We've all had different paths through life, it's left us with different life scars and different vulnerabilities as a result of that experience. So that what you can cope with now, someone else may be more vulnerable to and may not be able to cope with, and our ability to cope changes from time to time. Just imagine, that one of your workers arrived home last night, to find the house empty, the wife and kids gone, one chair, one bed, a TV and the dog left, they get up in the morning, backing up the driveway and they run over the dog, then they come to work, how much resilience do you think that person is going to have on that day? It's not gonna take much to tip them over the edge, so you need to be aware that people's abilities to cope varies with their life experience and with time. It's vital in my view to have appropriate and timely responses to incidents. Certainly on the people who I have seen with long-term and severe psychological claims, it's often not what's happened to them, that's really caused the distress, It's the feeling that after it's happened, no one has cared and the response hasn't been appropriate. You need to accept that things will happen, they will go wrong, and there needs to be a process and a mechanism for responding promptly. The other thing to remember is that, you can talk to your workers, they'll tell you they're okay on the day, but oftentimes, the adverse responses may be delayed and there needs to be a provision for ongoing follow up. In a different context, I was asked on one occasion to examine a train driver who had been involved in several serious incidents where he'd gone through signals and done other safe working breaches, when I spoke to him, the guy was absolutely anxious, and a terrible mess, six months previously, he'd been involved in a fatality, at the time, he told everybody he was all right, but over the ensuing six months, he'd decompensated quite severely, but no one had checked again, and it only became apparent when he was actually starting to make errors at work. It's also important to facilitate the autonomy and professional practice of people doing this work. It's important to ensure that people have the skill and the capability to do the work that's being asked of them, so there's often a need for ongoing training, training in new developments, and involving home care workers in some of the decision making and some of the training. Budding coaching and mentoring can help and autonomy and collaboration over changes and rosters can also be important in relieving stress. So that's a brief overview of the factors that I consider that are important to incorporate in good workplace psychological design. They aren't expensive, they require thought, but they're things that I believe that we can start to implement straightaway, and I trust you find them helpful in your workplace in the future.

Now like to welcome Brooke Dench, Chair of the Health Special Interest Group within the Human Factors and Ergonomics Society of Australia. Brooke is going to present a case study on how she applied good work design to improve safety and efficiency in an endoscopy unit.

Thanks Suzanne, as Suzanne mentioned, today, I will be presenting a case study on how I assisted a team of clinicians to adopt good work design principles to design for safety and efficiency in an endoscopy suite. Firstly, as you may know, healthcare is a complex and dynamic environment, there are complex interactions between patients, families, clinicians and evolving technologies. Health care is offered across a vast range of environments from the GP's office, the radiology department, the pharmacy, hospitals and increasingly patients homes just to name a few. Emerging and evolving technologies and continuous advancements in best practice require continued focus on designing and redesigning health care environments and processes. For this reason, healthcare is heavily regulated, and to achieve ongoing accreditation, healthcare providers must have a compliance and audit program and invest into ongoing continuous improvement. I was initially approached as part of the compliance and audit program to help establish audit criteria within the endoscopy suite. This transformed into a multidisciplinary improvement where good work design principles were adopted to redesign for both safety and efficiency. Before we dive into the details of the improvement, it is important to note that when designing in a health care environment, there are numerous considerations and limitations that must be considered. The aim of any health care improvement is to optimize staff safety and well being as well as balancing the need to ensure positive patient health outcomes. Health care is delivered by multiple professionals with different experiences and backgrounds coming together to achieve the same goal, this is to care for the patient. Consideration for each professional group is essential as the tasks they complete to achieve the goal, vary based on their roles and responsibilities. As different professionals are responsible for different tasks, this may expose them to different risks which need to be considered when designing the end process. We also need to consider how we optimize positive patient health outcomes. Expectations from patients are changing, Therefore, consideration must be given to how we deliver a consistent low variability service, tailored to the specific needs and preferences of each individual patient, whilst minimizing the potential for error and patient harm. There's also emerging evidence that there is a link between patient outcomes and staff well-being and morale. A happy and cohesive workplace can create positive and safe environments, not just for the staff, but also for the patients. The last consideration, is that the demand for health care is increasing, we have finite resources, so design must consider how we optimize system efficiencies, eliminate waste and deliver cost benefits. Furthermore, there are also limitations which make improvement and redesign efforts extremely challenging. Accessing clinicians to be involved in redesign efforts is an ongoing challenge, clinicians are busy providing direct patient care at the bedside. To get a multidisciplinary improvement team together, requires a commitment from leadership to provide adequate staffing and resourcing to allow clinicians time away to undertake improvement. Additionally, it can be difficult to work with the same improvement team, across multiple occasions, due to shift work and rotating rosters. Mechanisms such as visual displays of data and daily huddles help promote transparency to the whole clinical team, so at different clinicians who may not have been previously involved can take part if other team members are unavailable. Lastly, there may be limited budgets to invest in optimal redesign strategies, you may not be able to undertake a complete environmental renovation, or invest in the latest software with all the bells and whistles. Focus should be on what you can do today to change something for tomorrow. In this case example, these were the challenges and considerations that we were faced with. So with this in mind, let's have a closer look at what we did and why. I was invited by an endoscopy department to assist with the establishment of audit criteria, specific to the collection and handling of their specimens collected during an endoscopy or colonoscopy procedure. This is where a camera is inserted into your digestive track to diagnose certain conditions. Specimens are routinely collected during the procedures to test for intolerances or when a lesion or growth are found to identify cancers. Staff were concerned that there was some efficiencies and improvements that could have been made to the process to minimize the chance of error for the patient and promote a more enjoyable working environment. I approach this as a co-design opportunity, with co-design, I as the human factors specialists, work closely with the clinical team to help them identify and implement improvements. I collected a range of different data and then presented this to the team, the team then use this data to understand where improvements could be made, and they came up with the ideas that could be used to address any of the issues or concerns which we found in the data. Co-design is really important for adoption of changes and creating a feeling of ownership for the team. It's not me coming in and telling them where they can change, it's them coming up with their own ideas and owning the solutions. So how is the data collected? I attended and observed as the procedures were occurring, I varied the days and times and the teams in which I observed, to capture if there was any variation between certain factors. I documented the process step by step and noted who was completing which step. In addition to mapping the process, I considered the three human factors, categories or domains, specifically looking for improvements related to physical factors, cognitive factors, and organizational factors. When assessing physical factors, we consider the height, size shape of individuals, and how this impacts the interaction within the environment and the completion of their tasks. We also observe how repetitive a task might be, is the person performing the same thing over and over? Is there potential for physical injury or strain? Is there a physically strenuous activity? Or is the work just dull and repetitive? Is there any physical risks associated with task completion that we're not aware of? These are the types of physical factors that I was looking for during my observations. The second category includes cognitive factors, such as does the individual have to remember lots of information, or do they have to make complex decisions? Other considerations may include fatigue or dividing attention between multiple tasks. And finally, organizational factors, looking at factors such as culture, or how they work together as a team, or if there are policies in place to support what they are doing. Addressing any issues identified within these three categories can bring improvements. I'm going to take you through each of the three categories to present some of the findings observed in the endoscopy suite. Firstly, the physical findings, the workbenches in which the specimen collection pot or jar set on top of, were of a fixed non-adjustable height at 120 centimeters. When a specimen is collected, it requires placing the tip of a specimen collection tool, which is like a long wire into the specimen jar and gently tapping the collection tool to release the specimen that was collected. Due to the fixed height of the benches, some clinicians struggle to see into the specimen pot to ensure that the specimen had actually been released, If the specimen had not been released, this would resulted in a loss specimen if this was not recognized in time, this would mean that the specimen could not be tested to establish a diagnosis for the patient. Also, due to the closeness of the pot, to the clinicians face, this posed a splash injury risk from the contents of the specimen jar, which includes a fluid to preserve the specimen. Additionally, due to the height of the bench and the nature of the task, the specimen pots could on occasion fall over, resulting in the spillage of the specimen pot and the contents. If there was a specimen in that pot, this could mean a misdiagnosis for the patient if the sample was unable to be retrieved. What did we find from a cognitive perspective? Some patients require many specimens to be taken, this can range from one specimen up to 50 or 60 specimens, documentation of the location of the specimens so exactly where it was taken in the digestive track, such as the small intestine, or large intestine, occurred throughout the procedure, this was documented in a computer program on the nursing notes page, this covered just the location that the specimen was taken, and not the number of specimens collected. The documentation on the number of specimens that were taken during a procedure was done at the end of the procedure. This relied on clinicians remembering exactly how many were taken at each location. Adding to this, was the fact that when the doctors were writing their notes into the computer system at the end of the procedure, they were in a separate room to the location of the nursing notes, and did not have visibility of those notes in their computer program. They were reliant upon their memory for both the location that the specimen was taken, and the number of specimens collected. There were occasionally discrepancies between what the nurses had documented and what the doctors had documented, which could cause confusion, particularly if identified at a later time. Finally, from an organizational perspective, we found that on occasion they were scheduled pressures, if there was a delay in a patient arriving, or there was a complex case that took longer than scheduled, this could impact the bookings for the remainder of the day. This resulted in staff feeling like they had to rush or that they couldn't slow down. Sometimes, there were delays in getting to meal breaks or leaving on time, which negatively impacted staff morale. Another organizational finding was teamwork. The teams worked really well together, but there were still some efficiencies that could be created around the teamwork and communication. In healthcare, teams will often vary, they can be made up of different members from day-to-day depending on who is rostered. As a result, there is occasional variation across the teams in which roles perform certain tasks, one team may do it a certain way, whereas the next team may do it slightly differently. This resulted in an increase in clarifying expectations around who was doing what, the task was always performed, but occasionally, it could take a little bit longer, due to the need to clarify those roles. My findings and collated staff feedback were presented to the team, the impacts and possible design solutions were discussed amongst the group. Representatives from each profession were purposely included in the discussion to ensure that there was a voice and a sense of ownership. A common solution to any problem is often to provide training, and it is often the default, particularly within health as redesign is really hard for various reasons. If training was raised as a potential solution, I aimed at coaching the group to challenge the need for training if an appropriate redesign could be adopted. The group came up with the following ideas, Introducing a Lazy Susan with custom cut holes, the size of the specimen jar to avoid spillage. They investigated if benches could be height adjusted, they implemented a tally board to keep track of the number of specimens collected, so they weren't reliant on their memory. They redesigned the computer program, so doctors had visibility of nursing notes, even when they're in the other room. They introduced standardized terminology and roles across teams, so it didn't matter who you were working with, you knew whose role was what and what the expectations were. They reviewed the schedules and the number of bookings made including patient histories to ensure that more complex cases could be scheduled with additional time. And they challenged the culture of rushing and looked at implementing a reward system for asking to slow down. You can see now, how introducing some really simple redesign strategies, can have a positive impact on how work is undertaken within a health care environment. To implement good work design in your healthcare environment, consider the following. Firstly, don't make assumptions, it is really important to sit back and observe, work as done not as imagined. Don't make assumptions as to what is happening, go and observe it directly. More often than not, little subtleties are identified during direct observations. Staff can often just accept things as being normal, this is the way we've always done it, and they won't raise them as issues. Observations allow you to directly observe these normalized problems or issues and the impact they are having. Secondly, undertake co-design where all professional groups involved in that health care process can have their say. It is important that all members of the team are represented and have opportunities to safely raise issues and help shape the design solution. Thirdly, patient safety and workplace health and safety need to work together, both patient safety and employee safety and well-being are closely linked to positive outcomes for both groups. It can no longer be us and them, both parties need to come together to reach the common goal. Finally challenged the need for training, only train if there is an identified gap in knowledge, a design solution should always be considered over training if you're trying to implement a sustained improvement to processes in environments. Through simple observation and co-design, it is possible to create environments where individuals and teams can perform at their best to reach their goals. I challenge you and your team to adopt good work design principles, to see the differences it can make, thank you.

Thanks for tuning in to our webinar today. As I mentioned earlier, this webinar is the first in a series that will illustrate how key work health and safety risks in the healthcare and social assistance industry, can be addressed through good work design. Keep an eye out for further webinars in this series coming soon. The next webinar, A Systematic Approach To People Handling will follow later this year. You can also find further resources on the health and community care industry landing page on, and I recommend taking a look at the health care and social assistance strategy 2019 to 2022.