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Whilst there are potential benefits to be gained from the consultative approach to the management of health and safety at work required by recent legislation, the actual implementation of such consultation is not without its problems. In particular the process of developing effective consultation may actually lead to conflict between participants. The process of implementation calls for careful management if the advantages of consultation are to be achieved.

Without doubt office work is becoming more hazardous. Much health and safety literature deals with risks that are always with us — like falling off ladders, tripping over cables, toppling file cabinets and blocked fire exits. But there is increasing worldwide concern now over the health hazards of toxic materials in the office, viral and bacterial infection from air conditioning systems, radiation hazards from VDUs, and the danger of strain injuries from repetitive use of badly designed equipment.

Self‐regulation of health and safety within a legal framework was recommended by the Robens Committee Report (1972). Every organisation will be affected by various factors, both internal and external, which will determine how self‐regulation of health and safety will evolve, and these factors will also influence the effectiveness of joint self‐regulation by management and representatives of the workforce. The effects of some of these internal factors on joint self‐regulation of health and safety in a Scottish local authority are focused on mainly, while, at the same time, some of the external factors are identified.

The safety representative/committee regulations of the Health and Safety at Work Act 1974, which became law in October 1978, have led to a substantial health and safety training programme being mounted by the TUC. In May 1977 a special TUC Conference on workplace health and safety discussed a variety of matters pertaining to this subject area. Among their most important decisions was one reaffirming that the emphasis of such training should be on TUC approved courses only, with the key functions of such training being to help identify health and safety issues in the workplace, find appropriate means and standards for dealing with health and safety problems and help establish an “infallible union workplace organisation” to ensure that the employers actually implemented safety measures. The TUC's target was that some 160,000 safety representatives would have undergone such training by 1980. In fact the TUC failed to attain this extremely ambitious target figure as is evidenced by the following figures:

Describes schools’ obligations under UK health and safety legislation, and the challenge posed to schools by the Health of the Nation targets on accident prevention. Schools’ relative lack of awareness of these obligations caused the Royal Society for the Prevention of Accidents (RoSPA) to initiate a project aimed at producing a training resource for schools, which would help them address their responsibilities. The project received funding from the Department for Education and Employment, the Department of Health, the then Department of Transport, the Health and Safety Executive and The Scottish Office. The result was the resource, Together Safely: Developing a Whole School Approach to Health and Safety. This aims to encourage schools to develop an ethos that promotes health and safety, and to take advantage of the many opportunities that exist to promote and develop health and safety skills and strategies both through the curriculum and good practice.

A case study is described in which an audit programme was developed as a measure of health and safety performance. The audit programme was implemented as a safety competition in a UK water utility over a period of three years with the results also used for benchmarking the company’s health and safety management system. The audit programme, which was based on the Health and Safety Executive’s guidance for effective health and safety management, was used to assess; how well health and safety management was understood; how well health and safety procedures were implemented; and accident frequency rates within the company. An important aspect of the audit programme was the inclusion of managers, supervisors, operators and examples of all operational activities in the assessment process. Weaknesses in the company’s health and safety management performance, which were identified in the benchmarking exercise, are discussed.

This article demonstrates the Queen’s Medical Centre approach to assessing and addressing risk in terms of Health and Safety within a busy children’s unit. This article focuses on compartmentalising a large clinical area on two floors of a busy teaching hospital which become manageable sized subunits; each has a health, safety and risk management link person who attends the regular meetings to discuss key issues. These link people, with experience and training observe clinical areas within the zone, for hazards and potential hazards (risk inspection) and then calculate the hazard on a risk score. This is then risk assessed and all risk prioritised within the Children’s Services Directorate Team. The author describes how a proactive approach to health, safety and risk management has brought about significant improvements, enhanced quality of care and improved morale and motivation of the nursing team.

This paper reports on a study of companies using homeworkers, carried out to gather information regarding the employment status of homeworkers and the health and safety provision afforded to homeworkers. It considers traditional industrial homeworking and home teleworking. For those having employee status, health and safety provision was not necessarily commensurate with legal requirements. In the case of self‐employed status, the health and safety provision was deemed adequate if the employment status was one of genuine self‐employment. However, as the analysis of the data suggests if the status was one of employment, then the health and safety provision is not adequate.

It is becoming increasingly important for providers of health care to manage the health and safety of their workforce effectively. In the competitive world of health care, organizations seeking accreditation for quality are having to allot greater importance to health and safety than in the past. The manager of occupational health services for West Birmingham Health District, which has recently applied for Trust status, explores some of the reasons for this.

This study demonstrates how becoming a high-reliability institution in health care is a priority, given the high-risk environment in which an error can result in harm. Literature conceptually supports the need for highly reliable health care facilities but does not show a comprehensive approach to operationalizing the concept into the daily workforce to support patients. The Veterans Health Administration closes the gap by documenting a case study that not only demonstrates specific actions and functions that create a high-reliability organization (HRO) for safety and improvement but also created a learning organization by spreading the knowledge to other facilities.

The authors instituted a methodology consisting of assessments, training and educational simulations to measure, establish and operationalize activities that identified and prevented harmful events. Visual communication boards were created to facilitate team huddles and discuss improvement ideas. Improvements were then measured and analyzed for purposeful outcomes and return on investment (ROI).

HRO can be operationalized successfully in health care systems. Measurable outcomes verified that psychological safety was achieved through the identification and participation of 3,184 process improvement projects over a five-year period, which yielded a US$2.8m ROI. Documented processes and activities were used for educational teachings, which were disseminated to other Veteran Affairs Medical Center’s through the Truman HRO Academy.

This case study is limited to one hospital in the Veterans Health Administration (VHA) network. As the VHA continues to deploy the methods outlined to other hospitals, the authors will perform incremental data collection and ongoing analysis for further validation of the HRO methods and operations. Hospitalists can adapt the methods in the case study for practical application in a health care setting outside of VHA. Although the model is rooted in health care, the methods may be adapted for use in other industries.

This case study overcomes the limitations within literature regarding operationalizing HRO by providing actual activities and demonstrations that can be implemented by other health care facilities.