Workplace health environmental audit report               Workplace  health environmental audit report
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Workplace health environmental audit report Workplace health environmental audit report


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Workplace health environmentalaudit reportA guide to tools appropriate forprimary care facilitiesSue CavanaghAcknowledgementsThanks to my colleagues in the HDA HAWPC team, Jane Chambers, Sarah Hart, Robert Langford; and to Claira Bannon, HugoCrombie, Lucy Hamer and Dominic Harrison at the HDA; also Lorraine Brayford, NHS Estates; Howard Price, Chartered Instituteof Environmental Health, for their assistance with this project.Written and researched by Sue CavanaghFor further copies of this publication please contact:Health Development AgencyHolborn Gate330 High HolbornLondonWC1V 7BAEmail:© Health Development Agency 2002ISBN 1-84279-068-4ContentsSummary 11. Introduction 31.1 Background 31.2 Legal responsibility 31.3 Audit responsibility 41.4 Audit s tructure 42. Research a pproach a nd methods 52.1 Research m ethods 52.2 Reference a rticles 63. A s election o f a ppropriate tools 73.1 H ealth a nd safety 73.2 A ccess 83.3 Sustainable d evelopment 104. Summary o f r commendations 125. Sources o f information, t ain ing and c onsultancy 14reSummaryPurpose of the mapping exercise Section 5 provides links to key organisations that providesources of information, training and consultancy inThis report outlines the findings of a mapping exercise connection with environmental audit.undertaken by the Health at Work in Primary Care team overa four-month period in 2001. The ...



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Workplace health environmental audit report
A guide to tools appropriate for primary care facilities
Sue Cavanagh
Thanks to my colleagues in the HDA HAWPC team, Jane Chambers, Sarah Hart, Robert Langford; and to Claira Bannon, Hugo Crombie, Lucy Hamer and Dominic Harrison at the HDA; also Lorraine Brayford, NHS Estates; Howard Price, Chartered Institute of Environmental Health, for their assistance with this project.
Written and researched by Sue Cavanagh
For further copies of this publication please contact:
Health Development Agency Holborn Gate 330 High Holborn London WC1V 7BA
Email: Website:
© Health Development Agency 2002
ISBN 1-84279-068-4
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Purpose of the mapping exercise This report outlines the findings of a mapping exercise undertaken by the Health at Work in Primary Care team over a four-month period in 2001. The exercise was conducted in response to indications from previous projects, and feedback from contacts, of a need for accurate, up-to-date information about environmental audit tools appropriate for general practice, aimed at primary care estates managers and practice managers. Aims of the mapping exercise To identify existing environmental audit tools that might be appropriate for self-administration at small primary care/ general practice level. To identify key organisations providing tools, training and consultancy in environmental audits. To identify any major gaps in audit tools that could be usefully provided by primary care trusts, possibly in partnership with other agencies. Structure The report is divided into five sections: Section 1 outlines the purpose of the project, defines environmental audit, and outlines the benefits and mechanisms of environmental audits Section 2 describes the approach and methodology adopted to identify the audit tools Section 3 outlines a selection of tools identified as appropriate for use by general practice Section 4 summarises the findings and makes recommendations for future audit tools that would be useful
Workplace health environmental audit report
Section 5 provides links to key organisations that provide sources of information, training and consultancy in connection with environmental audit. Findings This exercise has identified and assessed a selection of appropriate environmental audit tools in the following fields: Health and safety risk assessment ergonomics/workstations manual handling equipment personal safety and security Access physical access to premises in accordance with Disability Discrimination Act 1995 Sustainable development energy waste and procurement transport Conclusions and recommendations The report concludes that although numerous audit tools are available, only a small proportion are ideally suited for use at general practice level, as they are either geared to larger or more commercial organisations, or are too complicated and detailed to use at this level. The NHS Environmental Assessment Tool (NEAT), which is to be produced in January 2002, is intended for generic use across the whole healthcare field, whether hospitals or small primary care/GP facilities. With the exception of this and the other tools outlined and
recommended in the report, there are gaps that could be usefully filled by primary care trusts and other agencies. This could be either through the development of a first general audit tool, which might provide a one-stop shop for environmental audit in primary care for practice managers; or through the production of several separate tools such as: a signposting document for primary care trusts and GP practices based on information contained in this document
a manual handling guide for general practice produced with external expertise (e.g. practice nurses) targeted audit materials in the areas of risk assessment health and safety in general practice, possibly linked with a training video or a CD-ROM an audit tool/checklist to assess premises for staff safety and security in general practice a guide for auditing the environmental impact of health buildings in the locality which could be undertaken by primary care trusts.
oWrkplace healthe nvironmental audit report
1. Introduction
1.1 Background This report outlines the findings of a mapping exercise undertaken in response to information received by the Health at Work in Primary Care team (HAWPC) at the Health Development Agency during 2000/2001. During this period, reference site contacts, discussion groups and other project work indicated a lack of available guidance about self-assessment audit tools and external support appropriate for use in general practice environments. Particularly, the need was expressed for more guidance on audits that could be used to assess health and safety risk assessment; physical access to premises to comply with the legal requirements for 2004 that were outlined in the Disability Discrimination Act, 1995; and sustainable development directives on the management of waste and procurement, energy and transport. The aim of the mapping exercise was to identify environmental audit tools that might be used by primary care trust estates managers and practice managers to evaluate the physical workplace health conditions in primary care facilities. The exercise also aimed to assess how appropriate selected tools were for this purpose; to identify any major gaps in audit tool provision; and to identify which organisations offered information, training and consultancy concerning environmental audit. This project is also intended to link and support other guidance recently undertaken by the HAWPC team. This includes Workplace Health is Good Practice: Framework for Action  (2001); New Primary Care Premises: Guidance for GPs and their Staff (2001); and the risk assessment CD-ROM training tool being developed by the HDA and the HSE ( The HAWPC publication Workplace Health is Good Practice: A Framework for Action in Primary Care (2001) outlines
Workplace health environmental audit report
reasons for developing a planned strategy to address workplace health issues. A good physical environment is identified as one of the key contributors to workplace health. Some positive impacts of audit in helping to achieve a good working environment are that they can: provide information form a basis for conducting interventions and upgrading the work environment and facilities help to improve standards and environments of care highlight discrepancies between perceived standards of practice and measured standards be intrinsically rewarding by demonstrating improvements aid in bidding for resources promote higher standards of care, effectiveness and efficiency stimulate education. (Breeding, 1999; Phillips, 2000) In Britain, government departments and agencies such as the Department of Health and the Health and Safety Executive recommend using an audit process, such as the one described in 1.4, to cope with regulatory requirements and organisational changes. It is a research tool that does not require much academic or intellectual input and is practical and easy with formal, well documented stages to assist those who are new to it. On the negative side, audits do take time to complete and are likely to indicate a need for some financial investment. 1.2 Legal responsibility As employers, GPs are legally responsible for providing suitable workplaces for all their employees. Legal obligations with regard to workplace health and estates management relating to primary care premises include compliance with:
Health and Safety at Work Act (1974) Management of Health and Safety at Work Regulations, 1993 Display Screen Equipment Regulations, 1993 Manual Handling Operations Regulations, 1993 Personal Protective Equipment at Work Regulations, 1993 Provision and Use of Work Equipment Regulations, 1993 Workplace Health, Safety and Welfare Regulations, 1993 Fire Safety (HSC1999/191) Disability Discrimination Act, 1995 (See Access) Control of Substances Hazardous to Health (COSHH) regulations Environmental Protection Act, 1990.
There are regulatory and statutory requirements which employers must legally comply with. There are also good practice standards or levels of provision that individual practices may wish to voluntarily adopt that exceed these requirements (Blotzer, 1998). For example, most sustainable development initiatives are not yet legal requirements, but they are increasingly recommended as good practice by the Department of Health, and they can save employers money. 1.3 Audit responsibility The audit approach is appropriate to ensure compliance with many of the legal requirements and attainment of good practice. Employers must decide whether there is sufficient expertise internally within the practice to undertake the audit, or if external assistance is required, using criteria determined internally, or externally by authorities such as Health and Safety officers. The literature suggests that each approach is likely to have advantages and disadvantages. Many individuals, groups and organisations will carry out environmental audits on a consultancy basis. In appointing an audit consultant, the main advice is to agree a clear brief. If this brief extends beyond the identification of buildings deficiencies into the area of recommending possible solutions, it will become necessary to establish that the consultant is sufficiently experienced in, or qualified to advise on, health and safety, access or sustainable issues (HFN 20; NHS Estates/CAE, 1997). The disadvantages of using external consultants include: they are unlikely to be familiar with the building; and their contracts are unlikely to allow sufficient time for an in-depth study of the way a building is used, the work practices of its staff or the sometimes complex interrelationships between the various spaces and activities. A self-audit , carried out by people familiar with the building,
often the practice manager along with other staff, enhances the value of an audit (HFN 20; NHS Estates/CAE, 1997). The self-audit is also an educational programme for practice staff, as those involved in the process acquire knowledge and understanding of the changes that result, and are therefore less likely to create barriers or to take actions that reduce the benefit of alterations. A compromise between self-audit and using external consultants is to send staff on audit training courses, or to bring in consultants after an initial audit has been conducted in order to analyse findings and obtain advice on possible solutions and priority-setting.
The Health Act 1999, which established primary care trusts, enabled them to acquire and dispose of land and to be responsible for the management of the estate. Primary care trusts have to consider the roles, responsibilities and liabilities they will need to adopt in association with estate ownership and facilities management [DH (1999) Primary Care Trusts: A Guide to Estate and Facilities Matters , copies from NHS Response Line: 08701 555 455]. Trusts are required to appoint a board member to be responsible for health and safety, and to provide adequate expertise to ensure the management of the estate takes account of sustainability and environmental assessment. They will have to demonstrate how they are accountable for complying with all health and safety in the workplace, and develop expertise on GP property matters, including a clear understanding of the arrangements set out in the NHS Statement of Fees and Allowances Payable to General Practitioners in England and Wales , Department of Health, 1990 (Red Book), and of facilities management issues for the GP estate, e.g. collection and disposal of clinical and non-clinical waste, oxygen supply, pathology pickup, etc. 1.4 Audit structure The search revealed that many existing examples of audit incorporate a cycle (not dissimilar to the HDA’s Framework for Action cycle), with a sequence of six steps that usually include variations on the following: observing the practice setting up support structures, objectives and standards gathering information comparing performance with the standard implementing appropriate change monitoring the effects of the change.
Workplace health environmental audit report
2 Research approach and methods
2.1 Research methods A mapping exercise focused on identifying self-assessment tools and support organisations for auditing the physical aspects of primary care environments that have the most impact on staff health. These were selected as: health and safety, access and sustainable development. The research for this project was undertaken between April and September 2001. The findings are far from exhaustive due to the limited time allocated, but the investigation has sought to identify a selection of tools and sources of support in each field. The intention is to add and amend information from time to time via the Internet, particularly as some useful material was identified as being in the process of development. The exercise began with electronic literature searches conducted using the Cumulative Index to Nursing and Allied Health Literature (CINAHL) database, which contains professional literature on nursing, allied health, biomedicine and healthcare; and the Health and Safety Executive (HSELine) database of published documents on health and safety at work for 1990 onwards. The search strategy was compiled using a combination of sub-heading terms around checklists, audits and environmental workplace health components. These searches revealed only 11 articles which proved sufficiently related to the topic areas containing information relevant to small service-sector organisations in the UK. These articles, listed at the end of this section, were retrieved using the British Library’s Document Delivery Service, and illustrate the application of environmental audit for different purposes in small organisations. In order to locate practical tools that could be used by small organisations, additional hand searches were undertaken at the King’s Fund, Centre for Accessible Environments, and the
Workplace health environmental audit report
Building Centre libraries in London. Key individuals were also contacted within the HDA, the Department of Health, NHS Estates, Primary Care, HSE and various academic institutions in order to gather information about tools that had been produced and successfully applied. The tools identified are listed with a brief evaluation in section 3. Different types of audit tools have been produced to assist practices in gathering data. The most common forms found in this investigation were: interactive website audits (e.g. setup.html) paper checklist audits (e.g. Centre for Accessible Environments Access Audit checklist). In the second stage of the investigation, key organisations were contacted and web searches conducted to locate sources offering information, training and consultancy on environmental audit. These are listed, along with brief descriptions, in section 6. The findings so far have identified some appropriate audit tools, outlined below, and also indicate a lack of audit tools appropriate for general practice purposes in some areas. A difficulty encountered during the search was in finding tools that were sufficiently targeted and simple to use at general practice level. Many existing tools were too complicated, and aimed at the acute sector or commercial or larger organisations. Cost was also a factor – some tools and sources of training and consultancy were very comprehensive and of high quality, but expensive, which may put them out of reach for individual practice use but may be appropriate for purchase by primary care trusts for shared use. The research has revealed that audit tools, training, consultation and information are delivered through a range
of different organisations which tend to be based around national sponsored programmes, NGOs at national and local levels, and local health authorities. 2.2 Reference articles Blotzer, M. J. (1998) Safety and Health Program Audits, Occupa-tional Hazards , 60 (5):27–30. Breeding, D.C. (1999) Taking stock, Occupational Health and Safety 68 (5):116, 117, 123. BSI (1999) Occupational Health and Safety Management Systems — Specification (OHSAS 18001) , British Standards Institute, London. BSI (2000) Occupational Health And Safety Management Systems — Guidelines For The Implementation of OHSAS 18002 , British Standards Institute, London.
Jeynes, J. (2000a) Safety on tap, Fire Prevention No. 337, October: 24–25. Jeynes, J. (2000b) Practical Health and Safety Management for Small Businesses , Butterworth Heinemann, Oxford. Manning, B. and Palmer, K. (1999) One world, one safety system, Quality World , November: 12–14. McDaniel, J. L. (2000) Auditing OSHAs: proposed self auditing policy, Occupational Health and Safety USA 69 (3): 80–81. Phillips, A. (2000) Manage risk by audit (parts 1 and 2), Practice Manager , October:16–17, November: 37–41. Smith, D. and Hunt, G. (2000) Managing Safety the Systems Way: BS 8800 to OHSAS 18001 – Implementing a Cost Effective Management System for Occupational Health and Safety , British Standards Institute, London. Williams, N. (1992) Auditing for COSHH, Occupational Health: A Journal for Occupational Health Nurses , 44 (10):306309.
Workplace health environmental audit report
3. A selection of appropriate tools
3.1 Health and s afety failing to fix it. In this environment employers may be hesitant to conduct self-audits, and it is therefore imperative A fundamental objective for health and safety auditing in that employers have strategies to follow up identified risks general practice is to prevent or control foreseeable and are prepared to take immediate and decisive action if a workplace hazards through a systematic identification and serious risk to staff or patients’ health is identified. evaluation process. If there are no legal standard requirements, national or locally agreed standards can be Details of employers’ legal duties under the 1993 regulations adopted, or they can be internally set as agreed good are summarised in Unison’s Health and Safety ‘Six Pack’ , and practice. There have been moves towards adoption of are explained comprehensively in Croner’s General Practice international health and safety standards. An example of this Risks Management and Practice . Particularly relevant to is OHSAS 1801, published by the British Standards Institute in environmental audit, the Workplace Health, Safety and April 1999, a risk-based methodology that specifies Welfare Regulations 1993 lay down minimum standards for monitoring by inspection and internal auditing (Manning and workplaces, and state that workplaces must be suitable for all Palmer, 1999; Smith and Hunt, 2000). employees including staff with any kind of disability. This regulation outlines duties of employers and controllers of Surveys undertaken in the 1980s in the USA by the premises for: Occupational Safety and Health Administration (OSHA) found ‘a distinct correlation between the application of sound maintenance management principles in the operation of health and safety ventilation programmes and a low incidence of occupational injuries and temperature illness’. The OSHA defined effective management as actively lighting analysing the work and worksite to anticipate and prevent cleanliness harmful occurrences, which is in effect a self-audit process space (McDaniel, 2000). Although the OSHA assessed voluntary workstations self-audits as an effective tool for employers to identify floors deficiencies and resolve them before real problems occur, it falls also conceded that there could be problems in interpretation windows between the employer and the health and safety inspectorate traffic (McDaniel, 2000). doors escalators In primary care premises in England, an example of this might toilets occur if a practice identifies a risk during a self-audit, but washing then there is a time lag between the problem’s discovery and water its resolution. If a serious or fatal occurrence took place in the clothing intermediate period, the employer could be seen as having rest rooms. knowledge of the problem, documenting the problem via the (Unison, 2000, pp. 50–51) self-audit report and/or maintenance request, and then
Workplace health environmental audit report
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