The “Shiny Car” effect for organizational safety culture

In a past career I was a safety director for 40 geographically separated work sites. One of the main complaints (or grievances) I usually heard about was that I did not just look at the compliance checklists and move on to the next work site. Instead I would review the paperwork and then put my boots on the ground and visually inspect the areas to ensure that what was on paper actually matched the work practices. Even though this was an unpopular approach by many safety managers, I was able to find the ones that had the flashy written programs or the newest software or gadgets to provide numbers and analytics but lacked a working model for real-world implementation.

Now, anyone that knows me usually gets very frustrated or lost quickly with how much I love analytics and data. I WANT to see numbers, metrics, and shiny new software to be used. However, my philosophy is that a safety program is like purchasing a car. The image above shows an incredibly technological marvel of a car. It has the looks, the speed, the sexiness of an incredible vehicle. If I were to purchase this vehicle based on the outside alone, I may be in for a real-world awakening when I get it home (I am sure an extended warranty on this type of car is more than I make in a lifetime anyways!).

Let’s say I did just look at the outside and take the safety program at face value from what was documented. I could always use the concept that I trust my safety managers, which I did for many of them. The majority of them documented their real world practices and I did not have to “trust but verify” very often. Other than my annual required walk through. However, there were a few that I had to verify at least monthly.  We can use the analogy of a used car salesmen for this. Let’s say he talked me into purchasing the gorgeous vehicle pictured above without me doing my due diligence of checking the service records, kicking the tires, or checking under the hood. I would be in for a rude awakening when I find something like this when I get home (obviously not the same car, but the point is the same).

Obviously, I should not have just trusted the salesmen. Instead I needed to verify that he was being honest, doing this would have saved me a lot of the headaches that I now have to deal with. The same is true for our safety programs.

I have taken over safety programs that looked amazing on paper but the actual work site was a hazard playground. If I had not done my job and trusted but verified, I would have had a lot more headaches and out of control mishaps. Instead my proactive approach to ensuring the documentation showed my managers that safety is more than just a fresh coat of paint. It is a real-world practice that requires documentation AND working programs.

So the real question is how is the safety culture in your organization? Is it the shiny car where no one has looked under the hood? Or does it get cleaned and receive tune ups on a regular basis?

OSHA and the Dental office

All too often I run into a common thought process in many dental practices is that an OSHA inspection is not a very likely issue to worry about. This leads to a reactive compliance program that is not fully prepared for the day an inspector walks in unannounced. Not only will this create a panicked process for the dental team, a lack of proactive compliance will potentially lead to hefty fines. How common are violations and fines in dental practices? Lets explore this a bit.

Before we discuss the types of violations we commonly find and the amount of the fines, we need to clear up some misconceptions. OSHA inspections are not announced and can occur at any time. They can be initiated by a complaint or as a scheduled random inspection. Regardless of why OSHA decides to visit your practice, if the compliance program does not fully cover all regulatory requirements, violations and fines will be issued. Violations are categorized into three different “pay-scales”, ranging from minor violations to serious repeat offenses.

The first grouping is where the most common violations are found. “Serious”, “Other-Than-Serious”, and “Posting Requirements” incur fines to the practice of $12,675 per violation. According to OSHA the most commonly cited violations in dental offices in 2016 were:

  • Bloodborne pathogens requirements.
  • Hazard communication (Remember those new SDS libraries we have you set up?).
  • Inadequate use of Personal Protective Equipment.
  • Medical services and first aid (Yes, you have to have a first-aid kit in your practice! Oh, and the ADA standard of care to have an AED on site? Yes, that can be a violation as well if you don’t have one).
  • Cluttered or inadequate walking/working surfaces.
  • No Ionizing radiation protocols or safeguards.
  • Forms (This means not having the five required OSHA paperwork items for each employee. These are:
    • Proof of Annual OSHA Training
    • Occupational Exposures Form/Occupational Hazards per each Job Title
    • Proof of GHS Training
    • Proof of Hepatitis B Vaccination Form
    • Medical History (on-file) for Each Employee (updated annually)
  • Maintenance, safeguards, and operational features for exit routes (Yes, even a $2 light bulb to replace the burned out one in your exit sign can cost you $12,675…. oh and $2 for the bulb).
  • Sanitation (I don’t need to say much on this, keep your practice clean).

If we think about all of these, which are not an all inclusive list of violations cited, how many could be found in our practice right now? Now add up the $12,675 per violation. Would your practice survive?

This is the worst case scenario for an OSHA violation though. Many times violations are given abatement periods with much smaller fines. Most inspectors understand human nature and will work with the practice to fix the issues. However, this does not develop a proactive approach to regulatory compliance and if that lesson is not learned, the same pattern will be repeated.

The next category of of fines is “Failure to Abate”. Remember how I mentioned that inspectors will give an abatement period? Unfortunately, some practices do not take the citations seriously. This will lead to a fine of $12,675 PER DAY, PER VIOLATION past the abatement date!!!!! Let that sink in for a moment, even one unabated violation can close a practice. This may lead to the question “OSHA doesn’t give us enough time to fix the issue!” Well, let me dispel that right now. Plenty of time is given to abate the violation, true it may take some of the staff away from patient care for a while, but that is the price of fostering a reactive “knee-jerk” culture.

The final, and most egregious, is the “willful” and “repeated” violations. These carry a maximum penalty of $126,749 per violation. However, this is reserved for those practices that refuse to correct previously identified violations and show a willful disregard for staff and patient safety. An excellent example of this is a case study conducted on a dentist a few years ago. OSHA inspected the practice due to a patient complaint that the instruments used still had blood and tissue from a previous patient on them. It was discovered that the dentist and his staff were not wearing any PPE, were not sterilizing instruments correctly, and were not performing biological spore testing on the sterilizers. The abatement period was broken and none of the violations were corrected, then upon a second complaint the same violations were categorized as willful and repeated. After OSHA finished shutting him down, he was turned over to the state dental board.

This is an extreme case, but it does highlight the true disregard some have for the safety of others. The majority of us want to ensure our practices are safe and in compliance with all regulations. The reason most fall short is the sheer amount of requirements that must be in place and constantly worked on. This leads the majority of practices to live in a constant state of reactivity towards regulatory compliance.

Many of my clients become discouraged and half-jokingly say “I just want to be a dentist, not an OSHA expert….” This is a sentiment I can not disagree with! Eight to twelve years of medical school and specialization to all boil down to citations for not knowing every aspect of federal regulations is ludicrous! Fear not though, there is a bright light at the end of the tunnel. That light is created through fostering a culture of proactive compliance and comprehensive programs. Don’t have the time to research and create one from the ground up? Well, you are in luck!

There is an industry leading compliance consulting company that has paved the way in this area. Their consultants range from Registered Dental Hyginests and Expanded Function Dental Assistants to Dental Instructors from the U.S. Air Force and Occuptional Safety Managers with experience in building compliance programs for large medical training groups and hospitals. The company, Dental Enhancements Inc. has clients nationwide with a return customer base of nearly 98%!

Dental Enhancements Inc. has been an industry leader nationwide in comprehensive compliance programs that fulfil all federal mandates for over 15 years with excellent results. However, I am not trying to sell you on the company, I invite you to look into their compliance programs and other comparable ones. Or even look into resources to build your own! The whole goal is to build a culture of proactive and comprehensive regulatory compliance. That way when the OSHA inspector walks in and shows you his badge, you can smile and say “we’ve got this!”.