Writing A Lone Worker Policy

Increasing numbers of people are working on their own, at least some of the time, from shop assistants to warehouse staff to night workers and those who are occasionally based at home.

This shift away from traditional nine to five, office-based working has meant fresh challenges for employers, who need to manage the risks associated with lone working.

The first step if you have solo workers in your organization, is to carry out a proper risk assessment. Decide what needs to be done to ensure the safety of those who work alone – your current policies and procedures may not be sufficient.

You need to be sure that the person working unsupervised has the experience and good health to cope unaided, especially if they are handling potentially dangerous equipment. Has enough training been offered? Is it too stressful for them? Equally, you will need to think about how they will communicate and get help in an emergency. If the worker’s first language is not English, this can be even more important.

For example, what would be done if there were a break-in while only one night security guard was on duty? You may want to consider emergency alarms and the like. Equally, consider whether the person is trained in First Aid – or needs to be.
Regular contact and visits for those working alone can be vital. At the same time, consider how the quality of their work will be evaluated.

Some groups, such as expectant moms, the very young, older workers, those with disabilities, or trainees, may face particular challenges, and, in fact, it may not be safe for them to work without supervision.

Finally, if the lone worker deals with members of the public, there may be special considerations concerning who they see, and what emergency procedures are in place.

You may well need to have in place a lone worker policy, which sets out all these things in stone and makes procedures clear. Communicate this clearly to anyone who works alone, and display the document prominently.

Apart from anything else, lone working can be a lonely business. Make sure the employee knows they are looked after, and that you have given due consideration to their safety and welfare.

GPS Tracking Devices Attached to Toucans Help Scientists Gather Data on Seed Dispersal

In Panama, scientists form the Smithsonian Institute are using GPS tracking devices to gather data on how Toucans disperse seeds.

Toucans love nutmeg seeds. When Toucans eat, they gulp the nutmeg seeds whole. The outer pulp is processed in the bird’s crop, and the hard inner seed is then regurgitated.

There were were two main things scientists had to do to set up the experiment. First, the scientists had to figure out how long and how many seeds the Toucans would eat in a day. So the scientists gathered fresh seeds from a nutmeg tree and fed them to captive toucans at the Rotterdam Zoo.

During the GPS tracking experiment, five zoo toucans fed 100 nutmeg seeds took an average of 25.5 minutes to process and regurgitate the seeds.

Next the scientists captured six wild toucans that were feeding from a large nutmeg tree in the rainforest. The scientists attached lightweight backpacks containing GPS tracking devices to the wild birds. The GPS tracking devices recorded the birds’ exact location every 15 minutes and used accelerometers to measure the Toucans’ daily activity level.

The GPS-enabled backpacks are designed to fall off the Toucans after 10 days.

When matched with the seed-regurgitation time of the zoo toucans, the GPS tracking data indicated the wild toucans were probably dropping nutmeg seeds a distance of 472 feet, on average, from the mother tree. Each seed had a 56 percent probability of being dropped at least 328 feet from its mother tree and an 18 percent chance of being dropped some 656 feet from the tree. In addition, the accelerometer revealed that the toucans’ peak activity and movement was in the morning followed by a lull at midday, a secondary activity peak in the afternoon, and complete inactivity at night. This is a normal pattern of tropical birds.

“Time of feeding had a strong influence on seed dispersal,” the scientists write. “Seeds ingested in morning (breakfast) and afternoon (dinner) were more likely to achieve significant dispersal than seeds ingested mid-day (lunch).” This observation explains why tropical nutmegs are “early morning specialists” with fruits that typically ripen at early and mid-morning so they are quickly removed by birds.

Ideally, the scientists observed, nutmeg trees could increase their seed dispersal distances by producing fruit with gut-processing times of around 60 minutes.

Source: The original article, “The effect of feeding time on dispersal of Virola seeds by toucans determined from GPS tracking and accelerometers,” was recently published in the journal Acta Oecologica (http://www.sciencedirect.com/science/article/pii/S1146609X1100107X).

Patient safety: what's to be learned from road safety?

The idea that healthcare has a lot to learn from industries that are inherently risky but nonetheless manage good safety records – like aviation – has proven enormously persuasive. Aviation provides many examples of how to improve things that are currently not done as well as they could be, including effective teamwork and standardisation of routines.

But there are important differences between healthcare and air travel. Aviation incidents, when they occur, are dramatic, headline-grabbing events. And when a plane crashes, the crew has as much chance of going down as the passengers, so the stakes are as high for them as those they serve. By contrast, when errors occur in healthcare, they tend to harm one patient at a time, and clinicians are not affected by the outcome in the same way as patients.

Further differences lie in the scale and nature of the systems, and the constraints on what can and can’t be done. In aviation, the number of different types of personnel and types of procedure is limited: flights are scheduled and airlines can control exactly how many people are on a flight. Both crew and passengers can be compelled to comply with safety instructions, and those thought likely to pose a security risk or cause trouble can be stopped from boarding.

Hospitals are vastly more complex. Delivering good healthcare may require crossing multiple organisational, professional and institutional boundaries. Healthcare organisations conduct many thousands of different procedures, involving multiple staff, and are subject to problems of uncontrollable surge. But they often lack the ability to turn people away either because of capacity problems or because individuals pose a risk in some way.

Many of the factors that disrupt good care may be outside the control of individuals or teams, and they are dealing with autonomous patients, who may either decline or be unable to cooperate with what others feel would be in the best interests of safety. And hospital facilities, sometimes built in centuries past, are often poorly designed for the tasks they now undertake.

So, though there is much to be learned from aviation, it will never provide the full answer for healthcare, and some of its ‘solutions’ may require more adaptation to make them work in healthcare than is often recognised. In fact, looking at examples where achieving safety has been much more challenging, such as road safety, may in fact provide important lessons for patient safety.

As in healthcare, road safety accidents are only rarely headline-grabbers. Road use has the same deceptive familiarity as healthcare, and everyone has had a prang or two.

Road transportation suffers from many problems endured by healthcare: unsuitable physical infrastructure, poorly coordinated design, complexity introduced by individual autonomy and preferences, unpredictable surges, behaviour that is not always consistent with what is known to be safety-promoting, and a wide range of expertise and experience among road users, among many other things. But though it is not fully there yet, road transportation has succeeded in becoming much safer.

Both casualties and deaths on the road have shown steep declines since the 1960s (see the Office for National Statistics website), even though road traffic has substantially increased. Nearly 8,000 people were killed on the roads in the UK 1966, compared with just over 2,200 in 2009. The key is that improvements have been brought about by a range of strategies, targeting different levels and facets of the problem.

Structural and regulatory changes have gone hand in hand with large scale behavioural and cultural adjustments, and improvements to technology and infrastructure. For example, legal interventions have targeted unsafe behaviours such as speeding and drink driving; car design has massively improved; and standards of driving have improved through more rigorous training and licensing regimes.

Some interventions have removed choice and autonomy (such as removing the right to travel without a seatbelt, or to drive a banger that’s deemed not to be road worthy), but over time the resistance to them has diminished. That many people continue to be killed every year shows how difficult it can be to achieve institutional, cultural and behavioural change across the board, especially once the fabled low-hanging fruit has been picked.

Clearly, I am not trying to argue that road safety is a perfect model for patient safety. But neither is aviation. We need to be smart about how we learn from other areas, recognise that we need to select and combine many different instruments, figure out the optimal balance of ‘hard’ and ‘soft’ interventions, and keep working at the wicked problems.

Mary is Professor of Medical Sociology at the University of Leicester and a member of The Health Foundation's Improvement Science Network.