Abstract
BACKGROUND:
There is very little in the literature on the effectiveness of Joint Health and Safety Committees (JHSCs) in the healthcare sector and a paucity of information on how JHSCs are perceived in the workplace.
OBJECTIVE:
This study was carried out to explore hospital worker, hospital management, and healthcare sector stakeholder views on the effectiveness of JHSCs in the acute healthcare setting.
METHODS:
The study used a qualitative descriptive design with: (1) nineteen focus groups and twenty two individual interviews in three hospitals of different sizes; and (2) eight individual interviews with external stakeholders.
RESULTS:
Study findings showed gaps in awareness and understanding of the role and responsibilities of the Joint Health and Safety Committee. Some participants indicated that JHSCs lacked profile and had low visibility in the organization. Facilitators and barriers to JHSC effectiveness were investigated and measures to assess effectiveness identified. The attributes of a “gold standard” JHSC were outlined by respondents and can be used to develop an evidence-driven assessment tool to evaluate JHSCs.
CONCLUSIONS:
The results of this study indicate both a continuing need for education and training related to JHSCs and the need to develop better tools to assess JHSC functioning and effectiveness.
Introduction
Joint worker-management committees are used in many jurisdictions to improve worker participation in occupational health and safety within a workplace. In spite of the widespread use of such committees, there is relatively limited literature related to their evaluation and effectiveness. Much of the literature from the 1980s and 1990s relates to worker participation in health and safety, often focusing on the objective measures of effectiveness, such as injury rates or compliance inspections. The majority of studies report a positive assessment of the use of Joint Health and Safety Committees (JHSCs), mostly within industrial sector workplaces [1–9]. Only a few reports looked at indirect factors that influence JHSC effectiveness, such as communication and decision-making or strong management commitment and labour relations [3, 7]. The recent literature offers a more critical assessment of JHSC efficacy and relevant factors influencing committee success [10–14]. In the industrial sector, the most commonly identified factors shown to impact JHSC effectiveness include management commitment to health and safety, education and training for committee members and open communication practices. There has been a recent intervention study in a scrap metal recycling business demonstrating small positive effects on safety performance [15].
Recently, Yassi and colleagues conducted a systematic review on the effectiveness of health and safety committees [16]. Key findings included: legislation requiring committees is necessary but not sufficient; perceived effectiveness of JHSCs correlates with safer workplaces; the extent of worker involvement / empowerment is an important determinant of lower injury rates; committee members need more information, education and training; a clear mandate for the JHSC is critical; there is a need for leading and trailing indicators; and the need exists for high quality intervention studies.
There is very little in the literature on JHSC effectiveness in the healthcare sector and a paucity of information on how JHSCs are perceived in the workplace. In Ontario, Canada, Joint Health and Safety Committees are a legislative requirement in workplaces with more than 20 workers as well as those with designated substances [17]. While the healthcare sector has long been one with relatively high workplace injuries and illnesses, it was not until the outbreak of Severe Acute Respiratory Syndrome (SARS) in 2003 that specific attention was given to occupational health and safety in Ontario’s healthcare sector. In a review of the SARS experience in Ontario, it was noted “also missing were two key components of a safe workplace: neither internal responsibility systems nor Joint Health and Safety Committees were, in general, fulfilling their intended roles and responsibilities” [18].
A previous study of JHSC form and function in acute care hospitals in Ontario found that although they appeared to be meeting the legislated requirements there was concern regarding their effectiveness and visibility [19]. The current study was designed to extend the work of the pilot study to explore the awareness and effectiveness of JHSCs within acute care hospitals in Ontario.
Methods
Research design and objectives
A qualitative research design using focus groups and individual interviews was implemented to address the four key research objectives of the study: Describe healthcare workers’ and management’s understanding of the role of the JHSC and its impact in three acute care hospitals; Describe healthcare workers’ and management’s views of how effectiveness of JHSCs should be measured and identify factors that should be incorporated into the assessment process; Describe key stakeholders’ views of the role of the JHSC and its impact; and Describe key stakeholders’ views of how effectiveness of the JHSC should be measured and identify factors that should be incorporated into the assessment process.
Study participants
Three hospitals were recruited to participate as study sites. Selection criteria for the sample included the following: Number of beds: For the purpose of the study, the aim was to recruit three hospitals as follows: one large (>100 beds, teaching), one medium (>100 beds), and one small (<100 beds). A condition of hospital participation was that the identity of the hospitals would not be revealed; therefore, the participating sites are referred to according to their size (large, medium and small hospital). Geography: All three hospitals were within a two hour drive from the university where the research was conducted. While this proximity factor offered logistical and budgetary benefits, it was also methodologically advantageous given the limited study scope to have homogeneity with respect to geographical region. Injury Experience (frequency rate of lost-time injuries per 100 full-time equivalents): All three hospitals were required to fall outside the top and bottom 10% of the most recently available annual frequency rate for workplace injuries and illnesses for all hospitals in Ontario. Otherwise, the findings could reflect a setting that is not typical or usual in terms of JHSC function. Number of Committees: Hospitals with one JHSC were chosen for the study. Hospitals with more than one JHSC would have added a level of complexity that would have made it difficult to attribute organizational characteristics, resources and activities to effectiveness of a specific JHSC.
The following types of participants were recruited for participation in the focus groups in each of the participating hospitals: 1) program directors; 2) unit administrators/managers (clinical and non-clinical); 3) corporate occupational health personnel; 4) infection control practitioners; 5) JHSC members; 6) front-line nurses; 7) environmental and dietary workers; and 8) allied health professionals (ex. respiratory therapy, social work, nuclear medicine technology). These eight groups were selected because they represented different occupational groups and perspectives (worker and management) in the hospital. However, it became evident during the data collection that the differences in hospital size made it necessary to change the nature of the groupings. For example, in the small hospital, managers and program directors participated in the same focus group as the number in each role was fairly small. In the large hospital, due to scheduling challenges, the program directors focus group was changed to individual interviews. A total of 19 focus groups with 113 participants from the three hospitals were conducted.
Senior hospital executives were recruited for individual interviews. Fifteen in-hospital interviews were conducted with Board members (3), Chief Executive Officers (CEO) (3), Chief Nursing Officers (CNO) (3) and Chairs of the Medical Advisory Council or other medical leadership roles (6) in each hospital.
It is important to understand perceptions of key external stakeholders given the shared professional concerns relating to employee health and safety and their direct or indirect involvement that might ultimately have an impact on JHSC outcomes. Eight individual interviews were conducted with the following external stakeholders: Ministry of Health and Long-Term Care Nursing Secretariat, Ontario Nurses Association, Ontario Public Service Employees Union, Service Employees International Union, Ministry of Labour Healthcare Team, Registered Nurses Association of Ontario, Ontario Hospital Association and Ontario Medical Association.
Recruitment involved a number of methods including personal, telephone and email contact. In each hospital, a champion for the study was identified, most commonly being an individual from the JHSC. Purposive sampling was used to recruit external stakeholders according to the relevance of their professional role to the study objectives.
Procedure
Data collection was completed over a fifteen month period from March 2010 to May 2011. Due to the exploratory nature of the study, some questions were broad or open-ended (for example, “describe a gold standard JHSC”) while others were more specific (awareness of internal responsibility system; awareness of JHSC representative).
Focus groups were approximately one hour in length and in-hospital interviews lasted approximately 45 minutes. The external stakeholder interviews were conducted in-person at their respective work offices with the exception of one telephone interview and were 45 minutes to one hour in duration. All focus groups/interviews were digitally recorded and transcribed, except for two external stakeholders who did not consent to being recorded, in which case the facilitator conducted the interviews while the coordinator took notes. Following these two interviews, the facilitator reviewed the notes for accuracy and the final write-up was included in the analysis. For the majority of focus group discussions, it was not feasible to re-locate the participants to ascertain accuracy of the transcriptions as the recruitment of participants involved asking volunteers to show up at a set time and place. Instead, the research team shared preliminary findings during several knowledge translation activities, thereby employing the dissemination route of obtaining feedback.
The analytical approach involved two researchers independently reviewing the transcripts to identify codes. Following initial coding, and alongside the coding process, the data were re-visited to examine concept linkages. Categories were created according to patterns or commonalities that emerged in response to the interview or focus group questions between hospitals. In doing so, the research team met several times to discuss the data, preliminary findings, and organization of the results based on the category/theme groupings.
Results
The four research objectives guided data collection and results are presented based on the following twelve themes identified in both focus group discussions and interviews: understanding of Internal Responsibility System roles and responsibilities of the JHSC process of raising health and safety concerns awareness of the JHSC and its work leadership role of the JHSC in health and safety factors contributing to JHSC effectiveness barriers to effectiveness suggestions for improving JHSCs hospital assets to strengthen JHSCs changes in JHSCs post-SARS evaluation measures of JHSC effectiveness attributes of a gold standard JHSC.
Within each theme, we present worker and managers’ perspectives first, followed by external stakeholders’ points of view; except if a theme was discussed with external stakeholders only.
Understanding of Internal Responsibility System
To initiate the interview and focus group sessions with hospital participants, familiarity with the concept of “Internal Responsibility System” (IRS) and perspectives relating to who is responsible for worker health and safety was explored. For some participants, “IRS” did not seem familiar or meaningful.
This is the formal thing you’re talking about, right? I’m sorry I haven’t heard of it.
Managers, in particular, described the concept of IRS as shared responsibility among all hospital workers to follow safety procedures and identify hazards in the hospital. There was recognition of joint responsibility for health and safety.
I think everyone has the responsibility for health and safety. I mean, the hospital administration needs to make sure that people are aware of their committees, and the managers know what the legislation states, but ultimately everyone who works here is responsible for knowing how to maintain a safe work environment.
Some viewed managers as having the ultimate responsibility because of their decision-making authority, while others emphasized the role of senior leadership in identifying health and safety as a priority for the organization. Also emphasized was the role of departments or parties such as Human Resources while, at the same time, recognizing worker health and safety as the responsibility of every worker in the hospital.
Roles and responsibilities of the JHSC
Hospital participants identified several roles and responsibilities of the JHSC. Conducting inspections, identifying hazards and making recommendations was claimed to be the responsibility that promoted the most visibility of the JHSC.
For me it’s not very clear as an outsider in a sense, right? To me, I think, they just come in to check the environment and I myself don’t feel that they would have the power to change things. They only write up things that they see as a deficiency.
JHSC inspections, monitoring of health and safety data and knowledge of policies and standards serve as a basis for its advisory role and development of recommendations. Several participants alluded to a sense of trust in the committee members and the institution in that safety requirements are being met.
I know nothing about the JHSC here, but I know that this institution takes its responsibility seriously. So, if it’s a governmental policy that has certain requirements relayed to, I can assure you that we are following them very strictly.
JHSC inspections were linked to the opportunity for workers to raise health and safety concerns, and the responsibility of the JHSC to discuss their issues and offer resolutions.
Also when they do come in to do the safety checks, they are always asking us, is there anything that you’ve seen that should be looked into? So, they don’t just come and look –they talk to us too about if we have concerns.
Representing the voice of workers and management and their joint work in health and safety were acknowledged as roles of the JHSC. The committee was also seen as a liaison between managers and workers regarding workplace health and safety.
The staff in the hospital know … the staff representation on the JHSC and so they know if they are uncomfortable in situations or aware of any hazards that they can report to –if they are not getting any action with their manager –they can report to the JHSC and they know that there will be the follow up done.
Hospital participants perceived the JHSC as a key player in education and training in occupational health and safety with particular responsibility for new workers. Establishing communication with the workforce was described as being important, particularly if linked to education of the workers.
Hospital participants were invited to comment on the advisory versus enforcer role of the JHSC. Many participants perceived the JHSC as having more of an advisory role, noting that enforcement is the responsibility of management. Front-line workers often described the role of JHSC as enforcer, or a combination of “gentle enforcers” and advisors. It was also noted that personal characteristics of committee members may influence the nature of the JHSC role.
From what I saw at the meeting, it is a combination of both. There are some people that will advise, and others who try to enforce. I think it kind of depends on the person and their personality, right? How they go about it. I think they have the power to do both.
The roles significant for a successful JHSC were identified by both external stakeholders and hospital participants. Stakeholders described the importance of inspections to identify and investigate potential hazards.
The role of the Joint Health and Safety Committee in a hospital is principally one of acting as an internal audit for the health and safety management system within the hospital. They are the eyes and ears of the health and safety system. Through that, they do that job by carrying out the health and safety inspections for the hospital as required by the legislation.
Discussing issues raised by workers was perceived as a responsibility of the JHSC to ensure worker representation and participation in the occupational health and safety system. Recommending and advising was described as being linked to the investigative role of the JHSC via inspections. Representation and joint work was claimed to be necessary in bringing together worker and management voices.
Process of raising health and safety concerns
Hospital participants indicated that workers should follow an established process or procedure for voicing concerns to management before taking concerns to the JHSC.
Basically, people have to be responsible for reporting it to the manager. Like, that is the staff, you know. He is ultimately responsible –but if the staff weren’t reporting to their manager and in turn, it gets reported…How is he ever going to know what the problems are or if there are problems … ?
Others stated they could go to the occupational health department with their concerns and be redirected to the appropriate individual. There were also suggestions to access the JHSC directly through email or personal contact or via the union or the “safety person”. A hierarchy was also noted where concerns were raised first with the manager and, if not satisfied, subsequently with the JHSC. A number of participants did not know how to access the JHSC.
Awareness of the JHSC and its work
The term JHSC was either unfamiliar to some hospital participants or they could only recall the term from the study materials received prior to data collection.
I assume that there’s a committee but I must admit that I’ve not heard the term JHSC until I started reading this material [the study information sheet].
Participants had a general awareness of JHSC composition, specifically the equal representation of workers and management. Some were able to name the most visible person on the committee, but were uncertain about his or her role. While some could not give names of committee members or their own representative, they knew where to find this information. Others did not know the identity of JHSC members or their roles on the committee. This lack of knowledge of the objectives and ongoing work was reaffirmed in discussions with JHSC members themselves.
Dissemination of JHSC meeting minutes is one way to promote awareness of the committee and its work. Some hospital participants knew where these were posted while others did not.
No. I’m not aware how often they meet and not aware of their minutes, because it’s not circulating, right? So, if I don’t receive an email or publication, and will not go out and look for them, myself, right? I have enough work to do, so I don’t go out and look for, like, oh, where are the minutes of the Joint Health and Safety Committee.
Others noted they did not receive the minutes or reported reading them selectively or not at all. In terms of distributing minutes, e-mail was identified as a more preferred method than posting.
If people had a desire, it is just more convenient than standing in front of the board, I guess. So, that might be a better way of doing it. Because I know, for me personally, I wouldn’t wander down the hall and go to the health and safety board and just start reading the minutes, but if it was sent to my email…
Participants suggested that other forms of communication might be more effective. Promoting health and safety awareness was viewed as important but not necessarily through posting of the minutes.
Some external stakeholders rated JHSC visibility and awareness as moderate because they thought workers did not know how to access their JHSC. They suggested that hospital size could play a role and that is more of a challenge in larger hospitals.
Leadership role of the JHSC in health and safety
Many hospital participants spoke positively about the JHSC, influenced by the following factors: representation and giving a voice in the workplace; a forum to discuss health and safety concerns; a feeling of security as management is not solely responsible for workplace health and safety; JHSC member dedication to workplace health and safety; legislative compliance with regular audits and inspections; and policy recommendations. In terms of being able to show effective leadership, JHSCs were perceived to be constrained within their own role boundaries. Recommending an intervention was distinguished from implementing the intervention, and the JHSC was seen as a leader in the context of making recommendations and pressuring management to implement them. In addition, commitment to health and safety was perceived as a reason to view JHSC members as leaders in the workplace.
Absolutely, indispensable. If they weren’t providing leadership I don’t think anybody else would have time or the inclination to do so. Oh, I shouldn’t say that –maybe there are some, but it would be kind of ad hoc or hit-and-miss, whereas they have the ongoing mandate to identify issues and promote training and promote a safe workplace and, as I say, they do a good job of it.
Some participants had mixed attitudes toward the committee’s leadership role, primarily due to its lack of visibility and proactive efforts required for an effective leadership role.
I think, from my experience, it tends to be more reactive then proactive. So, its leadership is in reaction to circumstances as opposed to proactive, in my experience.
Factors contributing to JHSC effectiveness
A variety of factors that contributed to JHSC effectiveness were reported. Hospital participants perceived JHSC effectiveness as being related to organizational commitment to health and safety, addressing concerns internally without resorting to reporting them to the Ministry of Labor, following scheduled inspections, being visible through communication, and assisting to implement successful procedural changes.
I was just saying that, I mean, years ago, when I worked here we wore yellow, rubber gloves and you wore them for every room you did, the same pair.I mean, since we had a committee, you know, things have changed. I mean, we change our gloves for everything.
Participants suggested that JHSC effectiveness was facilitated by leadership commitment to a culture of health and safety.
I think it is part of the culture, the culture of the organization. The culture means that from the senior management, from the Board through the senior management to the middle Management to supervisors –it’s an endeavor when all people are acting in the same fashion.
Some participants suggested that open communication between the JHSC and the workforce as well as transparency in the reporting process without fear of reprisal could contribute to effective functioning of the JHSC. One senior executive noted:
I would think transparency. I mean, clearly people have to be comfortable to report incidents. So you have to actually collect them to know that they have happened, which then allow them to be evaluated. So, certainly transparency and willingness to look at things in a non-blame kind of way, so people are not afraid to bring these things forward.
External stakeholders were invited to comment on enablers of JHSC effectiveness. They also stated that commitment of hospital leadership to occupational health and safety contributes to the functioning of the JHSC and the IRS in the workplace.
If the Internal Responsibility System is effective, from the CEO downwards, and when everybody is taking care of the health and safety of workplace –the JHSC is able to function properly and to make recommendations and advise accordingly. There has to be the commitment to take the IRS process seriously.
Education and training of JHSC members was perceived as another factor contributing to JHSC effectiveness. One stakeholder explained that it is necessary for JHSC members to understand their rights and responsibilities under the legislation for the effective functioning of the JHSC.
They need the education and tools and knowledge to be empowered. They have to understand what their rights are and what their powers are and they don’t even understand that.
Participants suggested that JHSC’s dedication to workplace health and safety influenced committee effectiveness. One stakeholder suggested that sharing a common goal and overcoming differences amongst a diverse group of workers could be a key factor. Some stakeholders noted that the presence of a senior manager on the committee as a co-chair may enhance JHSC effectiveness.
Barriers to effectiveness
Hospital participants identified several barriers to JHSC effectiveness including: lack of commitment and motivation of JHSC members; lack of time; lack of reporting of health and safety concerns by workers (often due to fear of reprisal); hospital size (specifically larger organizations); and reliance on management to authorize a remedial action to a safety concern leading to lengthy response times.
Well, I guess, if they don’t know about it they can’t look at it. So, the willingness of individuals to report was always an issue for any of these, anything, whether it is an adverse outcome, an adverse event. So, reporting is crucial, and people’s willingness to report.
So, it takes a lot for them to get back to us and it might be something that people have brought forward to us and they keep asking about it, but it’s “in the works”, but it sometimes takes a while to a get response back or get action back, regarding a new policy or new recommendation.
According to external stakeholders, an important barrier to JHSC effectiveness was the absence of leadership commitment to occupational health and safety.
A critical barrier is an employer who is not committed, who doesn’t –either doesn’t understand the purpose or doesn’t want to see the committee function or for whatever reason is not co-operative and is not committed. That has got to be the single most, the largest barrier, I would say …
JHSC members’ lack of education and training, especially when coupled with poor understanding of rights and responsibilities, was identified as another barrier to committee effectiveness.
External stakeholders commented on the representation of workplace parties. The presence of an influential and knowledgeable member on the committee (ex. senior management) could be challenging for the committee’s work because such a presence, while contributing to overall JHSC effectiveness, could sometimes result in by-passing the IRS. Others pointed out that lack of reporting due to fear of reprisals could act as a barrier to JHSC effectiveness.
Suggestions for improving JHSCs
External stakeholders were invited to discuss their view on improvements needed for JHSCs in Ontario’s acute healthcare sector. They emphasized that supportive management and knowledge of JHSC roles and responsibilities was needed for improved committee effectiveness. Increased clarity of JHSC’s roles and responsibilities in legislation would promote increased understanding and acceptance of the JHSC role. Other important suggestions were related to education, including certification training for all JHSC members and their re-certification and ongoing training to broaden general health and safety knowledge and to ensure they stay current with changes in thefield.
Some suggestions for change were related to representation, specifically how JHSC members are chosen. It was suggested that a JHSC member might participate more actively on the committee if the position was voluntary, which was not always the case.
A variety of people are needed, for example, representatives of disciplines and units and departments. Often times, the people are not volunteering –instead they are “volun-told”, and that is not a good membership. From my experience, you usually have 25 people on the committee but only about four actually participating. Many just don’t have dedicated time to be active on the committee.
Some external stakeholders reported that they would like to see legislative changes with respect to the functioning of the JHSC, such as mandatory increase in the frequency of meetings.
Hospital assets to strengthen JHSCs
External stakeholders were asked about assets of the acute care sector that could be drawn upon to strengthen JHSCs. Two main assets were identified: health and safety resources and government support. Some participants emphasized that the acute care sector has numerous health and safety resources in terms of individual expertise and funding that could be drawn upon. The resources could include formal links to research funding and institutions, links to academia and a pool of well-educated people with a range of skills and knowledge such as industrial hygienists, fire safety officers, ergonomists and infection prevention and control specialists. It was the opinion that government support of the acute care sector could be the most significant asset for hospital JHSCs. Sector specific organizations such as the Ontario Hospital Association provide educational opportunities for senior hospital leadership which could have a positive influence on workplace health and safety management practices.
Changes in JHSCs post-SARS
Given the enhanced focus on hospital health and safety and JHSC functioning since the 2003 SARS outbreak, external stakeholder perspectives of changes over this 8 year period (2003–2011) were explored. While they suggested changes and improvements in overall health and safety programs and systems, this did not necessarily extend to improvements in JHSC visibility or functioning. One participant indicated that the most visible changes were in specific areas of occupational health and safety such as respiratory protection programs and fit testing.
According to the external stakeholders, improved government support for occupational health and safety in the acute care sector was a visible change, specifically the creation of the Healthcare Team within the Ministry of Labour and healthcare specific training for inspectors. Some described increased presence and activity of unions in hospitals post-SARS. However, the impact of these changes on JHSC functioning and visibility was not clear. While some felt there was a new and positive connection between worker safety and patient safety raising the overall profile of occupational health and safety, others felt it was not extended to the JHSC and the committee lacked involvement in important health and safety matters. The overall impression was that JHSCs had not attained the required status to be fully successful.
Measures of JHSC effectiveness
Participants offered a wide variety of measures that could be employed to evaluate JHSC effectiveness. Responses differed between hospital participants and external stakeholders. Their responses are presented in Table 1.
Gold standard JHSC
All participants were asked to describe their view of the key attributes of a “gold standard” JHSC. Participants reported twelve attributes with general agreement between hospital participants and external stakeholders.
1. Visible and approachable –workplace parties should be aware of the committee’s existence, its members, the role and how to access the committee.
They need to be well seen … I think just having them out there, being able to speak with all the workers, everybody knows who they are, can take their issues, they are looked after promptly.
2. Communicates with workforce –Good quality communication between the JHSC and workplace parties that results in information sharing that, especially if in person, could improve the workplace parties’ awareness of and value of the JHSC.
I wouldn’t mind at least once a year to have them come to one of our meetings and just give us a little update, pep-talk type thing of what the latest and greatest is happening out there, you know, what’s going on.
3. Representative of the workforce –the JHSC should be representative of the workplace parties, departments and professions; in large hospitals there would need to be balance between representation and size.
I guess a perfect committee –the representation of all of the areas, like, a true representation, not just a person that works in your area, I mean, it has to represent the area; so, the true representation of all of the affected areas …
4. Well-supported and resourced –supportive management was viewed as a necessary pre-condition for a well-functioning committee. Management support should include adequate resources, including time and people, so the JHSC can perform its work to the best of its abilities.
So, you know, it’s this high-level functioning committee and it’s supported by the senior management fully. The communication is gone out to talk about the value of the committee and they are changing the culture from the top down.
5. Educated and trained members –some suggested that all members should have certification training with ongoing training to remain current.
6. Legislative compliance –including meeting legal requirements for committee structure, functioning, roles and responsibilities.
7. Makes recommendations –a gold standard committee should make recommendations in an appropriate and timely manner.
8. Committed JHSC members –members who are committed and passionate about occupational health and safety.
9. A voice for worker concerns –some participants suggested that a clear and simple procedure for reporting workplace health and safety issues would facilitate workers effectively voicing their concerns to the committee.
Even if there was a form or something you can fill out, on the clipboard on the floor, that that person knows that they go to the Health and Safety Board about personal concerns on the floor. Then when they come to look at it, they can sign it or rip off a copy to follow through and then we can see how it’s been followed through. That would be nice. So that would be the gold standard, just to know that you’ve been heard.
10. Clear mandate and objectives –participants envisioned a gold standard JHSC as having a clear mandate and attainable annual objectives.
11. Increased leadership role –for some, to be a true leader in occupational health and safety, the JHSC needs to be proactive, not just reactive regarding issues raised by workers and managers.
12. Involvement of dedicated health and safety personnel –support and involvement of at least one staff focused full-time on health and safety providing dedicated attention on workplace health and safety issues.
Discussion
Study findings showed important gaps in awareness and knowledge of the Internal Responsibility System and the roles and responsibilities of JHSCs. Particular areas of knowledge deficit included the process of raising a health and safety concern; how to make a recommendation to the employer; and how to access the JHSC. These findings are consistent with the Report on the Expert Advisory Panel on Occupational Health and Safety (Dec. 2010) which recommended the developing of a formal definition for the IRS to assist with raising awareness and knowledge [20]. The Report also recommended enhancements to the legislation guiding JHSC functioning by allowing for a single JHSC co-chair to make a recommendation to management regarding a health and safety concern.
Study findings showed that JHSCs were perceived to have low profile and low visibility which is consistent with findings from our initial work [19]. In practice, those dedicated to occupational health and safety could work with JHSC members to implement initiatives across their organization in raising their visibility and profile. Future intervention-testing studies could assist to identify the most effective ways to do this. In addition, our initial study showed that JHSC co-chairs reported their committees to be compliant with legislation. Participants from this study reported that basic legislative compliance was adequate but could be based on trust rather than reality. It was noted that some participants could not assess the legislative compliance of their JHSCs due to their own limited knowledge of the legislation.
Changes post-SARS were examined in this study. While specific changes and enhancements, particularly within government and labour, were identified, participants reported that they did not necessarily extend to improvements in JHSC visibility or functioning, and JHSCs still lacked involvement in important health and safety matters, not attaining the status needed to be fully successful. More needs to be done to address findings from the formal review of the SARS experience in Ontario about sidelined JHSCs during SARS.
Although there is limited literature examining JHSC efficacy and the relevant factors influencing committee success in the healthcare sector [10–12], findings from this study were in agreement that management commitment to health and safety, education and training for committee members and open communication practices enhances the functioning and effectiveness of JHSCs. Findings were also consistent with the recent literature review by Yassi and colleagues [16] that identified education and training for committee members and a clear mandate for the committee to be important. The focus on education and training is consistent with the current priority of the Ministry of Labour Prevention Division to refresh and revise certification training and to introduce mandatory training for workers, supervisors and health and safety representatives. Future research could inform the formative training and continuing education strategies required for a JHSC to operate effectively.
In addition to management commitment to health and safety, education and training for committee members, open communication practices and a clear committee mandate, our study showed additional factors to consider. These factors could be used to evaluate JHSC effectiveness and the attributes of a gold standard JHSC. In their review of the literature, Yassi and colleagues recommended an evidence-driven assessment tool that could facilitate JHSC effectiveness [16]. Several tools are currently available that assess knowledge and understanding of JHSCs. Examples include the IRS audit tool developed for the Ontario mining sector, as well as the tools developed by health and safety associations accompanying sector specific product offerings and training programs [21]. While all of these are excellent resources for employers, these tools do not address outcome measures of JHSC impact and effectiveness. An important follow up project to this study could be the development and testing of a tool to assess JHSC effectiveness that incorporates the suggested attributes of a gold standard JHSC. Current evaluation tools could be used as the foundation for the newly developed tool.
Strengths and limitations of any study are largely dependent on the type of research design. The main advantage of the qualitative approach applied in this study was the level of detail present in the findings. The recruitment of participants was conducted purposefully in order to identify cases that would provide a full understanding of the phenomenon being investigated, rather than being concerned that the findings be statistically generalized to a larger population [22]. However, an important strength of the current findings is their relevance to JHSCs in healthcare organizations, particularly in the acute care sector.
One of the limitations in the current study, which is inherent to qualitative research, is the impact of researcher presence during data collection. It is conceivable in this study that some of the interviewees were guessing to some degree in their responses to certain questions, based on what they thought the researcher wanted to hear, such as in their assumptions about the vital role of JHSCs. On the other hand, some participants appeared increasingly capable of elaborating on their responses as the interview progressed, perhaps as a result of feeling more at ease as time went on. A related possibility is that interviewees acquired or realized certain details as a result of interaction with the interviewer. Such interaction is argued to be a beneficial feature in focus groups as well, enabling participants to ask questions of each other, as well as to re-evaluate and reconsider their own understandings of their specific experiences [23, 24].
Conclusion
The current study explored in-hospital and external stakeholder views about JHSCs in acute care settings. Findings suggest there is continuing low visibility of JHSCs despite the overall increased awareness of workplace health and safety post-SARS. Effective leadership and a committed JHSC membership are needed to improve JHSC functioning, requiring management support, clarity regarding the JHSC roles and responsibilities, and improved training and education. Such strategies along with regular evaluation of committee effectiveness will promote sustainability of a “gold standard” committee that is well supported and resourced, visible, approachable, representative of the workforce, demonstrating leadership and clarity in mandate and objectives to better protect Ontarioworkers.
Footnotes
Acknowledgments
This work was funded by an operating grant from the Ontario Workplace Safety and Insurance Board.