The Best Way to Prevent an OSHA Inspection

By Debra Gordick, Mediator/Government Liaison, Total Medical Compliance

2022 Alliance sponsor feature article courtesy of Total Medical Compliance

Most OSHA inspections in healthcare practices are brought about by employee complaints. You may think that disgruntled ex-employees are doing the reporting. That does happen frequently, but OSHA is aware of these kinds of retaliatory complaints and weighs that factor into their determination on whether to send you a letter or to show up for an inspection. However, OSHA will always give its attention to a current employee making the complaint. You may be surprised to learn that it is most often your best employee who makes the complaint that leads to an inspection.

Why would your good employees “stab you in the back” like that? Usually, it is because of one of these reasons:

• The employee raised concerns to you but feels ignored and frustrated.
• You have, perhaps unknowingly, created a closed-door atmosphere that discourages employees from raising concerns and offering recommendations.

What can you do to change this dynamic? Have a written policy on employee complaints and recommendations in your employee training manuals. Create an open-door culture in your practice. Let employees know this is important to you. Ensure that the policy aligns with any Human Resource policies you have with your company. Make sure you give everyone a copy including managers. Let them know it is important to you.

Most managers are uncomfortable with handling complaints, and this causes avoidance. Here are some recommendations gathered from consulting human resources professionals including a very good article at https://toughnickel.com/business/How-to-Address-Employee-Complaints.

1. Ask for something in writing.
2. Listen fully to the complaint, even if it seems like a frivolous issue.
3. Show respect. Don’t belittle their complaint, question their veracity, or do anything to make them feel like you don’t take the issue seriously.
4. Ask lots of questions.
   • Who – Who is this situation about? Who was involved? Who witnessed it?
   • What – What happened? What else was happening at the time of the incident? What caused the incident? What proof can be provided?
   • When – When did the incident take place? When else could this have happened?
   • Where – Where did this incident take place? Where else could this have happened? Where exactly were employees at the time of the incident?
   • Why – Why did it happen? Why did the employee come forward with this complaint? Why do they think the incident happened?
   • How – How are they feeling after this incident? How has this incident affected others? How can you help them? How can this problem be rectified?
5. Assure the individual that you will investigate and then take appropriate action as quickly as possible.
6. Take the appropriate action regarding the complaint. The action should as quick as possible so there won’t be any future issues. Consult a professional if you need advice like your human resources contact or your OSHA consultant depending on the issue.
7. Set a timeframe for communicating and notify all involved parties of any delays.
8. Refrain from quick disciplinary action against the complaining employee or any person they’re complaining about. Take the time to find out what happened before you take any action.
9. Inform the complainant about resolution status but avoid details about other employees.
10. If the complaint was unfounded, turn the situation into a training opportunity.
11. Look for patterns of the same complaint from the same person or other employees. You may see another issue that needs to be addressed.
12. Document. Document. Document.

What NOT to Do When an Employee Complains:

• Make jokes.
• Allow distractions. Instead, turn off your phone and close your office door.
• Make the complaint public.
• Punish the complainant in ANY way. There are very stringent laws on protecting whistleblowers.

The very best thing you can do to prevent an OSHA inspection is to show your employees respect and listen to their concerns.

Visit https://totalmedicalcompliance.com/ for more information and a free quote.

Debra Gordick is the mediator/government liaison for Total Medical Compliance. TMC is a private consulting company providing affordable programs and seminars for health care providers, allowing them to achieve and maintain compliance with government regulations such as HIPAA, OSHA and infection control. TMC services include on-site employee training, customized compliance manuals, office inspections, and ongoing client support through monthly newsletters and a fully staffed Client Service Center. For additional information call 888-862-6742 or email service@totalmedicalcompliance.com.

July 29th NCMGMA Webinar: OSHA ETS Q&A

July NCMGMA Webinar
OSHA ETS Q&A Session

Thursday, July 29, 2021 | 1:00 PM EDT | Zoom

Please join us in a conversation with Josh Dobson, North Carolina Commissioner of Labor, to discuss the impact of the OSHA ETS on practices. Please submit questions during registration for Commissioner Dobson and his office.

Webinar Speaker

Josh Dobson
NC Commissioner of Labor
Josh Dobson was sworn in as North Carolina’s 18th labor commissioner on Jan. 2, 2021, after serving eight years in the state House of Representatives. Dobson represented the 85th district covering Avery, McDowell and Mitchell counties located in the western part of the state. Dobson is a native of McDowell County and currently resides in Nebo with his wife, Valerie, and his daughter, Kennedy.

Additionally, during the 2019-2020 legislative session, Dobson served as a full chair of the House Appropriations Committee and chairman of the House Health Committee.

Employee safety is Commissioner Dobson’s top priority.

Registration

This webinar is free but you must be registered to attend. Space is limited so register early! After you register, you will receive an email confirmation and an email reminder with webinar login instructions.

Click here to register online

Continuing education credit may be granted through your professional organization (MGMA, PAHCOM, AHIMA, etc.). Please self-submit for these organizations.

Questions

For questions, please contact the NCMGMA offices at info@ncmgm.org.

Physician Safety and Protection in the Outpatient Setting

By Asha Patel Shah, MD, FAAD
2020 Alliance sponsor feature article courtesy of MagMutual

Physicians are experiencing a growing incidence of workplace violence in the outpatient office setting. Workplace violence can take on many forms such as emotional, mental, verbal and physical harassment or abuse. This can even extend online in the form of cyber bullying and stalking. According to the Occupational Safety and Health Administration (OSHA), approximately 75 percent of nearly 25,000 annual assaults occurred in the healthcare/social service arena. In addition, workers in healthcare settings were four times more likely to be victims than workers in private industry.

We are generally silent on this issue and underreport violence because we subconsciously accept it as a part of the job. Patients who exhibit violence or abusive nature may have physical injury or mental incapacity that affects their ability to appropriately control their behavior, which can lead us to excuse an outburst because we are empathetic to their vulnerable situation. However, with the dramatic changes in medicine that include longer wait times, less quality time with the patient, higher co-pays and deductibles, shrinking pharmacy formularies and endless bureaucracy, the environment is ripe for increased and sometimes misplaced anger against the healthcare community. Keeping yourself and your office protected from violent situations will allow you to continue to serve patients without feeling burnout. Remember, most patients are very grateful for the care they receive.

Below are a few tips that can help keep everyone safe:

1. Anticipation – One of the best ways to avoid a negative situation is to be aware it could occur. Teaching your staff to identify situations that could lead to a patient breakdown should be a priority. For example, communication between patient care staff and reception staff can keep waiting patients updated. Usually, if the patient’s long waiting time is acknowledged by staff with a polite apology and explanation, anger can be diffused.
2. De-escalation Techniques – Likewise, de-escalation protocols can be used for specific patient encounters. For example, using a combination of verbal and non-verbal techniques to build rapport with an agitated patient can do wonders for all parties involved. Taking the time for active listening, reflective language and creating a calm environment usually do the trick. Also, having a patient support representative or office manager on site can help bridge the situation to an amicable agreement and allow the physician to keep on track with patient care.
3. Environmental Design – Patient care layout is key. First, empower your reception staff as the gatekeepers to the patient care area. There should be a physical distinction between the waiting area and the path towards patient rooms, preferably a locked door that can be operated electronically via office ID tag or remotely via button. Patients or visitors should only be allowed to enter the patient care area under direct supervision of office staff.
4. Video Surveillance Systems – Another idea is to consider an external and internal continuous video surveillance system. Important areas to monitor are reception desks, nurses’ stations, common patient thoroughfares and all entrances/exits to the building. Of course, abide by states laws regarding audio/video surveillance in patient settings, such as no surveillance in sensitive areas where undressing occurs and posting notification signs in public areas notifying visitors that video surveillance is occurring.
5. Emergency Alert Plans – A variety of situational awareness alert systems can be established for both physician and staff. Set up a non-threatening code word or hand signal that only your staff knows that can be used to signal for help in the presence of an unstable situation. For example, asking staff to call for “Dr. Grey” can be a code for “privately call 911.” If financially viable, carrying a wireless panic button or having one installed in each patient care room would also be effective. It is also important to have a medical staff member assist as a patient chaperone and witness, however a code word or panic button can serve as an alternative in an emergency situation.
6. Situational Awareness of Weapons – The reality is weapons can enter the office setting both legally and illegally. Having a weapons policy posted at the patient entrance should be strongly considered and consistent with state law to protect yourself, your staff and your patients. The other reality is the possibility of an armed intruder or active shooter. Every medical setting needs to be prepared and alert. At minimum, an emergency plan and establishing a relationship with the local police department is a must.
7. Practice Drills – With on-site staff, help keep everyone informed and prepared if the worst-case scenario were to unfold. Professional trainers are also available to serve as mentors to combat these unique but increasingly common situations. The recent Workplace Violence Prevention for Health Care and Social Service Workers Act is a step in the right direction but more work is yet to be done for physicians in the outpatient setting.

The following links offer additional information on workplace violence in the healthcare setting:

• OSHA Safety and Health Topics: Workplace Violence
• CDC Workplace Safety & Health Topics: Occupational Violence
• WHO Framework Guidelines for Addressing Workplace Violence in the Health Sector

Demystifying OSHA Inspections

2017 Alliance sponsor feature article

By Debra Gordick, Mediator/Government Liaison for Total Medical Compliance

An OSHA inspection can be a scary experience. One reason is that they are always a surprise. You are going about your day as usual and suddenly you have an inspector at the front desk. Another reason is that you don’t know what to expect or what to do. Being informed about the process before it happens can help you focus and minimize the impact of an inspection.

How does your practice get chosen by OSHA to be inspected?

The most usual way for your practice to be inspected is that an employee, ex-employee or patient has reported you to OSHA for violations of OSHA regulations. This is called a “for cause” inspection. If it was a current employee who reported a true regulation offense then you will be inspected. OSHA takes that type of report very seriously. They are aware that sometimes an ex-employee may be angry and lashing out. If, in their judgment, that is the case OSHA may send you a letter asking for details and an explanation instead of inspecting. Receiving a letter does not mean you can dismiss the issue. You have a limited time to answer. If you do not answer the letter or do not answer it to OSHA’s satisfaction, they will show up to inspect. They will not give you advance notice and you cannot stop them from inspecting. A “for cause” inspection is usually limited in scope to the area or areas reported. They can expand the scope if they notice something wrong during their inspection. It is important not to volunteer information to an inspector unless they ask a question. Something as innocuous as “we have an excellent training program” requires them to expand their scope to your training program.

The second kind of inspection is a “random” inspection. Every year OSHA has a schedule. First they inspect reported violations. Then they generate a random sampling from their computers of business types that are closely watched. Types of businesses on this permanent rotation tend to be high risk for employee injury and death like construction, manufacturing, mining and farming. This list is a compilation of a federal list and, if your state has its own OSHA program, a state list. North Carolina has a strong state program. If they finish all inspections on high risk businesses, OSHA will look at the computer generated list of business types that have not been inspected for awhile. Unlike the “for cause” inspections, random inspections are full scope. The inspectors will look at all areas of regulations.

What are the steps of an OSHA Inspection?

1. SELECTION
2. PHYSICAL INSPECTION
3. CLOSING MEETING
4. CITATION LETTER
5. ABATEMENT
6. INFORMAL CONFERENCE
7. SETTLEMENT
8. FORMAL HEARING

What happens during the actual inspection?

When OSHA decides to inspect your practice the inspector(s) will show up at your door without notice. Get a business card. Ask the inspector to have a seat in the lobby while you notify management and the OSHA Officer. We recommend delaying the inspector no longer than twenty minutes. Additionally, you cannot refuse inspection. They will leave just long enough to get a warrant and the police. The only time we’ve seen an inspection delayed was when the office was not actually open for business and just a small staff was present doing paperwork.

Use your time wisely. Walk-through your office to spot and correct any problems that can be handled quickly such as replace a full sharps container or secure gas cylinders the delivery service missed that day. Grab a camera or camera phone. Greet the inspector. The inspector is going to ask for information about your business such as tax ID # and unemployment insurance #. You should be told if this is a random inspection or you were reported. If that information isn’t volunteered, you should ask. They can tell you what you were reported for but not who reported you. An inspection can take from one hour to multiple days with an average of 3-4 hours. A “for cause” inspection should be shorter and focused on the reported violation(s). The inspector is going to do the following:

• Ask to see your documentation. This can, and likely will, include your policy and procedure manual, reports of any injuries or illnesses, Hepatitis B vaccination records and training records.
• Walk through you practice and inspect various areas. (Remember that under HIPAA regulations the inspector cannot enter an occupied treatment room without you getting permission from the patient beforehand.) Never leave an inspector unescorted.
• Take pictures. Ask them what they are photographing and why.
• Ask you or other employees questions on how something is handled. (OSHA inspections are performance-based which means that what you are doing should match what your policies and procedures state.)

The inspector may want to talk to employees without management present. This is allowed.

Things you can do during the inspection to minimize citations and lower fines:

1. Always be polite and courteous. The inspector is just doing their job. Also, you get a 15% reduction in fines for being “cooperative and courteous.”
2. Take a picture of anything the inspector does for your records.
3. If asked for something you don’t know the answer to, ask for clarification. It is easier to stop a citation from being written than to get it removed later.
4. Always answer truthfully but do not volunteer information. By law they must inspect any area you bring up.
5. At no point should an inspector ask for money. Report this to OSHA immediately. This person is most likely a scam artist.

After the inspection is over, the inspector will have a Closing Meeting to cover the preliminary findings. This meeting can happen immediately after the inspection or can be scheduled for a future date. At the Closing Meeting the inspector will meet with the OSHA Officer (and management if you request it) to go over all issues noted during the inspection. This list of issues is not the official citation list as it may include issues that are noted but so minor that they will not end up on the official list. Feel free to ask questions and to volunteer information that could prove you have addressed the issue. Start fixing the problems identified immediately.

What happens after the inspection?

After the Closing Meeting the inspector will return to their office and write up their results. They may call you to get follow up information. Once the report is written it is submitted to their manager. The manager will review the report and create an official citation letter listing each issue, the regulation that was involved and the amount of the fine for each citation. This letter will include information on your rights to contest the OSHA citations and your responsibilities to post the results for your employees and the dates by which you are required to fix the problems identified. This letter will be sent to you usually within two weeks of the Closing Meeting.

OSHA divides citations into “Serious” and “Non-Serious” categories. Non-Serious violations usually are not fined but can be minimally fined. OSHA increased their fines in August 2016 and again on 1/13/17. Each Serious violation starts at $12,675. There is a series of fine reductions which are available.

• 60% for small businesses
• 15% off if you were “courteous and cooperative
• 10% if you have an OSHA program in place.

However, if OSHA notes that this is a repeated violation from a previous inspection or if they determine that it is a “willful” violation the fine starts at $126,749.

You will then have to submit a form (included in your citation letter) back to OSHA to prove that you have fixed the problems listed within the timeframe allotted. This is called Abatement. Abatement should include a short explanation, supporting documents or even pictures if necessary. You can request an extension if necessary. Failure to abate the citations by the stated date can result in a fine of $12,675.

You also have the right to contest the citations. The first step of this process is to request an Informal Conference with the manager/supervisor who sent you the citation letter. This meeting must be asked for within the timeframe listed (usually 15 days of receipt of the citation letter). It can usually be conducted by phone. It is your chance to state your reasons for removing or reducing citations and/or fines. You ask for this even if you don’t have any explanation but “we’re sorry and we fixed it”. OSHA cannot increase the citations or fines and you do not get on a black list. You can usually get some reduction in fines just by asking.

After the Informal Conference, OSHA will send a Settlement Letter to you. This will list what changes they are willing to make. You then have a limited time to decide whether to accept the settlement, sign it, return it and pay any remaining fines or you can choose to move to the next and final phase, the Formal Hearing.

If you do not accept the Settlement you have only one last recourse. You can request a Formal Hearing. This meeting will be in person before an administrative judge in Raleigh. This step should only be taken if you believe OSHA has violated regulations or if you have a legal reason that you did not violate a regulation. You are allowed to bring a lawyer and your consultant. OSHA will have their lawyers there. Results are final.

On a final note, your best protection from OSHA citations is a strong and continuing OSHA program. You need to understand what is expected from your business. Your program should include policies, procedures, strong documentation, good records, current SDS, annual review of safety devices for sharps, and thorough training.

Debra Gordick is the Mediator/Government Liaison for Total Medical Compliance. TMC is a private consulting company providing affordable turnkey programs and seminars for health care providers allowing them to achieve and maintain compliance with government safety and privacy regulations such as HIPAA, OSHA and Infection Control. A TMC consultant works in partnership with the safety and privacy officers at your location to ensure all aspects of the regulations are addressed. TMC services include on-site employee training, customized compliance manuals, office inspections, and ongoing client support through bi-monthly newsletters and a fully staffed Call Center. Information on seminar schedules and products can be found on the TMC web site, http://www.TotalMedicalCompliance.com.

For additional information call 888-862-6742 or email Service@totalmedicalcompliance.com