 Thank you and welcome back. Our next speaker is Associate Professor Sharon Newnham, Director of the Systems Safety Team at the Monash University Accident Research Centre. Sharon has published widely in the area of workplace safety from a systems thinking perspective. She's a prolific author and has published work in a variety of academic and media outlets. She's an Associate Editor of the Leading Safety Journal Safety Science. And Sharon was invited by the Transportation Research Board to be an international member of the truck and bus safety and is Chair of the Subcommittee in Safety Management. Sharon, welcome. Thank you very much for having me here today. Okay, I'm really excited to present the findings of this project. I'll jump straight into the slides. So the Patient Handling Injuries Review of Systems project was funded by WorkSafe in 2018. The goal of the project was the developer tool to help guide manual handling coordinators, conduct systems thinking, review and revision of risk controls following the report of a patient handling injury. So the tool itself was developed in collaboration with Monash University Accident Research Centre, where I'm from, the Centre for Human Factors and Sociotechnical Systems at the University of the Sunshine Coast, WorkSafe Victoria and in particular the Victorian Public Health Service played a critical role in the co-design of this tool. Now the goal of FIERS is to provide health services in Victoria and broader now too with a standardised process for reviewing and revising risk controls following the report of an injury to staff in a hospital setting and we're extending that to aged care. Now the purpose of the FIERS is to improve compliance with Regulation 281c, optimise risk controls used to prevent future patient handling injuries, optimise the allocation of resources to control risks associated with patient handling across Victorian health services and the last one there is to prove collaboration across all levels of the system. The unique aspect of this tool is that it's underpinned by a systems thinking accident analysis method, Resmussen's risk management framework and the AxiMap technique and is also based on WorkSafe Victoria's guidance material on the review and revision of risk controls. So you can see here on the right hand side we derive five principles from Resmussen's risk management framework to improve work systems to reduce the risk of injury to staff and these principles underpin the development of the tool itself. So the first one is there is a need to focus factors at the higher levels of the system rather than just focusing on the behaviour of staff or changes to equipment. There is a need to improve interaction between all components of the system. There is also a need to improve the flow of communication up and down levels of the system. There is a need to make the system more resilient to people performing tasks in their own way and becoming more efficient over time and finally the last one work systems need to have good processes in place for monitoring the implementation of risk controls. So there is five steps, six steps in the development of the FIRE's investigation and I'll go through those steps briefly. So when a report is made by an injured staff member, the first step is to actually summarise the incidents and that involves summarising outcomes of the injury to staff, the current risk controls and any response prior to review. Step two involves relevance stakeholder consultation across all levels of the system. Step three involves identifying the factors contributing to the incident, why the risk controls were ineffective and whether better practice risk controls were available. Step four is where the AxiMap technique comes into it and it creates that visual representation of all the factors contributing to the incident under review that were identified in step three. Step five is about involving the review and revision of risk controls internal to the health service, where step six is about looking at recommendations for external stakeholders to improve risk controls to prevent patient handling injuries. So external stakeholders are particularly referring to regulators and relevant government bodies. So in terms of the implementation of the FIRE's here in Victoria, this actually involved a first of all training in the actual systems thinking and use of the tool. So this involved a two-hour webinar on systems thinking and the model and method used to develop the tool itself. There was a four-hour workshop on systems thinking. We really focused on communication style within the workshop too. That was important in regards to step two in identifying relevant stakeholders and how to communicate effectively to essentially piece together all of those pieces of the puzzle that need to be captured to create a systems thinking review and revision of the risk controls. There was follow-up coaching and consultation following the completion of the first report. So we gave feedback on all of the steps within the FIRE's tool and there was technical support throughout implementation of the FIRE's, particularly in the development of the ACSI maps as well, which we use an online program called Lucent charts for this. So the participants within the implementation trial of the FIRE's were asked to complete a minimum of five reports using the FIRE's and that was undertaken from July to December in 2019. So 16 occupational health and safety officers from 10 health services in Victoria were trained in the FIRE's. So they received the training in the webinar and the workshop and the majority of these were metropolitan based. There was some attrition over time because of the length of the project. This was due to individuals changing job roles. So I'm just going to provide some information regarding the findings of the FIRE's. So this actually presents the risk management framework as I presented earlier. So you can see the FIRE levels of the system here going from equipment and surrounding environments to the overall level here to government regulators and external influencers at the higher levels. And essentially what this figure is representing is all of the factors that were aggregated across those health services participating in the implementation of the FIRE's over that time period. So we were able to aggregate all of those factors, which was step three of the FIRE's tool. So this presents essentially the summation of all the factors contributing to patient handling injuries as identified in the FIRE's review was implemented here within Victoria. So essentially this data shows that the complex system of factors contributing to patient handling injuries. And this is really evidenced by the percentage of factors identified at each of the levels of the system. As you'll see that 11% of factors were identified at equipment and surrounding environments and up to there was 9% of the factors were identified at government regulators and external influencers level. There was evidence from the findings here that the FIRE's guided coordinators in a systems thinking review of incidents. And this is really evidenced by the identification of contributing factors at operations management level, which is 24%, the governance and administration level at 17% and 9% at government regulators and external influencers. So why this finding is so unique is the traditional investigation tools tend to prompt the investigation of contributing factors at the lower levels of the system, the equipment and surrounding environments, frontline staff and some at the operations management level. Yet there's very, very little guidance out there in terms of identifying factors at these higher levels of the system. So this is how we came to the conclusion that provided a systems thinking approach and evidence of that to an investigation of incidents. So this next slide is incredibly complex and messy and I don't expect anyone to be able to read all of the different boxes. But essentially why I present this particular graph is to show how complex the system is. As I just mentioned before, traditional investigations typically focus at these two lower levels of the system, which essentially means that actions generated from these reviews then again also focus on these levels of the system, which result in training to staff or changes to equipment. This shows how complex it is and why we need to understand the factors contributing to patient handling injuries at these higher levels of the system. So you can see the number of the factors that are represented within the boxes that have been identified through the reviews, but you'll also see the relationship between factors. And as I mentioned previously in regards to the principles underlying the FIAS tool is that the flow of information and the relationship between factors in the system is incredibly important in being able to identify actions that are going to create systemic change. And this illustrates why we need to identify actions capable of creating systemic change and as represented through the arrows within the system. So this figure provides an aggregate axiomap from one of the health services that undertook 13 reviews using the FIAS tool. So it's an aggregate here. So it's essentially what I want to present is or the message I want to get across is how complex the system of factors contributing to patient handling injuries and the multiple interacting factors within and across different levels of the system. Now in step five and step six of the toolkit, it's about generating actions and these actions are based on review of the axiomap itself. So again, we looked at aggregating those actions across these five levels of the system again. So this figure presents the summation of the key themes that emerging from the actions generated in the FIAS reviews. So as you'll see here, the highest proportions of actions identified the review and revision of controls at the operations management level. And this was three strategies such as safety culture, review of rusted hours and staff breaks. There was also a large number of actions generated at the governance and administration level as you see by 27% here and included strategies like creating a safety culture and introducing a KPI for staff safety. So the majority of these actions also targeted stakeholders internal to the health services such as managers, directors, nurse unit managers. So the actions weren't only focused on occupational health and safety officers or the Department of Occupational Health and Safety within the health service. And that is exactly what we wanted to do in terms of presenting a systems thinking approach within this is to extend or share the responsibility of safety across the system. So again, the actions generated suggest that the FIAS help facilitate a shift away from frontline worker and towards high managerial levels when developing risk controls. It was also great to see that a smaller percentage of actions involved the review and revision of equipment and those just focused on the frontline level. So that was more evidence that it helped provide that systems thinking approach. In this project, we also undertook an evaluation of the FIAS in terms of understanding the user experience. So effectiveness in the implementation of FIAS was evaluated and we found that coordinators strongly agree there was value in using the FIAS. They support using the FIAS in their future work. They believe that it could be easily integrated within their existing work practices and that the feedback could be used to improve FIAS in the future, which is exactly what we aim to do and have done since analysing the results from this implementation trial. We also got some qualitative feedback collected at the completion of the FIAS and as you'll see from these comments here, the participants overall, they believe that the FIAS provided a more comprehensive approach to investigating patient handling injuries. So in conclusion, we found from the implementation of the FIAS that help coordinators to think in systems. And this was really evidenced by identification of contributing factors at the operations management level and above and actions targeting systemic change in healthcare. And that was illustrated through the aggregation of actions, the key things in those actions. There was also positive support for the effectiveness of the FIAS and this was identified through the evaluation itself. The coordinators believe there was a highly valuable tool for investigating patient handling injuries. They said that with the first review took them about one and a half to two hours to complete the review because it's prompting investigation of factors at those higher levels of the system. So factors that you wouldn't have previously considered using more traditional approach to investigation. So it did take an additional amount of time to complete the investigations. However, they found that after they became more expert by the end of the implementation trial that they were completing the reviews in less than one hour. So it was definitely an experience thing that contributed to the longer length of time to start with. But then when, and the other bit of feedback in terms of timing was the development of the ACSI map itself, which brings me on to the next steps and where this has gone to from here. So from the evaluation and the feedback from the FIAS, this stage essentially said that there was extremely positive and insight from the data. And it's also being used this data to inform activities within WorkSafe such as inspector training and guidance material. So at the beginning in the middle of last year, WorkSafe has announced to extend funding to support the development of a software tool to support implementation of the FIAS. Where it's not FIAS anymore, we've now referred to this app-based version as STIR systems thinking in review. So it's going beyond patient handling injuries and looking to investigate or workplace injuries within healthcare and aged care. So there's also going to be within this tool, the capability that will automatically generate that ACSI map, which is coming back to the feedback. That was one factor that contributed to the time taken to complete the review because the development of the ACSI map in the Lucid Chart program is quite time intensive. Very informative and educational and best understanding the all of the factors and relationship between factors. But at the same time, very time intensive. We know occupational health and safety officers within healthcare don't have the luxury of a lot of time to be taken to software tools like this. So this STIR app is going to be fantastic and being able to minimize that time. There's going to be online coaching and coaching through videos that are integrated within the tool as well. And we hope that that component of this app will help broader dissemination of the app. So it's not only going to be able to be used from occupational health and safety practitioners that have a background in undertaking investigations. But it'll be easy enough to understand how to undertake each step for line managers and supervisors, nurse unit managers, for example. As part of this project with WorkSafe Victoria, we're also going to be evaluating the financial, social and cultural benefits of applications. Of the application of the or use of the STIR app as well. So very, very happy to answer any questions and about the STIR app, the fires implementation and in particular the next steps. It's a really exciting project. It sure is. And thank you so much Sharon. And so on point, you know, to our theme of looking at that bigger picture through systems thinking several questions have come in. And I'll go to the first one from Shannon. She says, in using this approach, once you've identified the many factors, how does the hierarchy of control fit with this model? We don't integrate the hierarchy of control within the framework itself. The actual steps of the tool, but it is. We do ask that the occupational health and safety officers or those under in charge of the investigation consider that in the development of their action plans. So, for example, within the STIR video, which is the coaching video to be integrated within the app, there's reference to hierarchy of controls when developing the action plan itself. We're very happy to be able to share those videos and WorkSafe Victoria is currently putting them on their website to tell you the truth. I don't think the last step has been uploaded yet on to the WorkSafe Victoria site, but I do know that steps one to four have. And that provides some guidance in terms of using hierarchy of controls in the development of the action plan. Thank you for that resource as well from Annette. Is there consideration of extending the use of fires toolkit in the home care sector where work is performed in the home environment and within consumer directed care model? Absolutely. And what we've come out with at the end of this project is essentially an understanding that the five, the six steps of the fires tool are applicable to any setting. It's important being able to develop a classification scheme. What I mean by classification is step three, where you're identifying the contributing factors, that step is underpinned by an evidence base. And so understanding the context, regardless if it's patient handling, workplace violence, we're even developing a tool now for undertaking system seeking investigations in work related driving crashes as well. As long as that classification scheme accurately represents the context, it can be used in any setting. Thank you. A great question next from Kerry. We're contributing factors were outside the organization's control. Have you any examples where information from fires were shared? Government regulators external influences and and whether any change resulted or perhaps be tabled for review? We as part of the implementation of the fires itself, we weren't able to track monitor those actions that came out of the implementation trial itself. So that's what are the main considerations in the development of the stir app and the evaluation side is to monitor that over time. What we did find from the results that were generated from the buyers investigation works. They Victoria used that information to in their guidance material to develop new guidance material and to incorporate that within inspector training as well. So we did see the uptake from that more the local level. But in terms of the health services itself, follow up regard follow up, which was around three months after the implementation. They said that the actions was was still being actioned at that point in time. There was discussions. So there's definitely progress being made, but from that and that local level, we needed a longer amount of time, which was the purpose of the stir implementation. Thank you. Similar questions from both Zoe and Louise about whether the toolkit will be available for other employers or other industries. Yes, absolutely. We there essentially no copyright on this work. So Victoria has put the fires tool on their website now and the videos are accompanying that to provide that that's training in in use of the fires. There is this more comprehensive training model for those occupational health and safety offices. But we needed to be able to provide training that was more feasible and practical as well. So it's on the work safe Victoria website now and you're able to access feedback on the videos and how effective the training is most welcome as well. Thank you from Alison. Do you have any suggestions of how you could make the approach part of ongoing core business of an organization? Oh, I would love that. And that's essentially the goal that we have for this entire project. I think embedding that systems thinking within workplace culture is the first step. So we need to have these discussions with the regulators and relevant government bodies to ensure that the understanding of systems thinking is first and foremost in people's thoughts. Because as I was saying the traditional approach to investigation focuses on these lower levels of the system. Most a lot of employers are looking for that silver bullet solution to to prevent injuries in the workplace and that systems thinking goes against that. It's not an easy process. We need to understand map out all the factors and the relationship between factors across the system to be able to create more of that systemic change. So I think how we actually go about doing that is doing systems thinking training in the first instance. And that's what we've been rolling out across New South Wales and more broadly here and here in Victoria as well is doing regular workshops on systems thinking and applying that using this tool. Thank you. As you know, our symposium theme is safety by design building workplace capability. Those words safety by design. What do they mean to you? I think to me safety by design I what resonates with me in that is the translation of research into practice. And what is so unique about this tool is that is underpinned by systems thinking model and method. Resmusin's risk management framework and the axiomap technique and it's underpinned by those five principles. And I think that really resonates and provides an effective foundation to be able to best understand incidents in an investigation process. Sharon such an informative presentation and answering so many of questions. Thank you. No, thank you.