A Study of Leading Indicators for Occupational Health and Safety Management Systems in Healthcare

A Study of Leading Indicators for Occupational Health and Safety Management Systems in Healthcare

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Occupational Health and Safety Management Systems: what are they?

The Institute for Work and Health (IWH) defines OHSMS as “the integrated set of organizational elements involved in a continuous cycle of planning, implementation, evaluation and continual improvement, directed toward the abatement of occupational hazards in the workplace”.  OHSMSs are distinguishable from traditional occupation health and safety (OHS) programs by being more proactive, better integrated internally and incorporating elements of evaluation and continuous improvement. Many organizations put programs in place, but do not develop an overall OHSMSM. When an organization is focused on a program, lagging indicators are often used to measure the outputs of the program.

Lagging indicator is defined as a measure taken after events with a focus on outcomes and occurrences based on retrospective data. Some examples include accident and incident rates, disease statistics, frequency of accident investigations and costs associated with compensation systems. In contrast, leading indicators are workplace characteristics that precede occupational health and safety outcomes and, if changed, are expected to change these outcomes (e.g. rate of absenteeism, workplace injuries, etc.). A leading indicator is often associated with proactive activities and is an important tool to help organizations track, measure and adjust their OHS-related activities to effectively direct the health and safety performance and avoid incidents or harm.  By identifying and using leading indicators, performance outcomes under the current conditions of an organizational system may be anticipated and action taken.

Leading Indicators

Much has been written about leading indicators for OHSMSs, but there is inconsistent terminology, lack of uniformity, and little discussion on how to measure these indicators. Utilizing the eight standards identified by Chrvala and Bulger (1999) and Toellner (2001) to guide the selection of leading indicators (e.g. measurable, understandable, actionable, cost efficient), a review of the literature found that Bennett and Foster (2005) summarized six key leading indicators, and proposed contributory indicators along with measurable objectives. These six indicators were used in this project and include:

1) Senior management commitment: includes health and safety objectives at the senior management level and ingrained in organizations, with progress included in all team-meeting agendas (Bennett & Foster, 2005);

2) Continuous improvement: includes managers setting and reviewing OHS objectives integrated into operational management, a process that implements audits and deals with non-conformities quickly, the completion of a risk assessment and a thorough investigation of incidents to understand how the system failed (Bennett & Foster, 2005);

3) Communication: includes interactive discussions and company-wide messages supportive of occupational health and safety from senior management (Redinger, 2001; Haight & Thomas, 2003);

4) Competence: includes all jobs being analyzed for competence requirements including OHS understanding, workers receiving safety inductions, individuals with confirmed qualifications for the work being undertaken, and annual competence reviews (Bennett & Foster, 2005);

5) Employee involvement: includes each employee taking part in OHS activities, such as workplace inspections, incident investigations, or risk assessments, to stimulate everyone within the organization to take responsibility and understand various aspects of OHS (Bennett & Foster, 2005); and,

6) Occupational health management: includes the management of occupational health risks such as violence, musculoskeletal disorders, and infectious diseases which are monitored and controlled based on the findings of a risk assessment (Bennett & Foster, 2005).


Bennett J, & Foster P. (2005). Predicting progress: The use of leading indicators in occupational safety and health. Policy and Practice in Health and Safety, 3(2), 77-90.

Chrvala CA, & Bulger RJ. (Eds.). (1999). Leading health indicators for healthy people 2010: Final report. Washington (DC): National Academies Press (US).

Haight JM, & Thomas RE. (2003). Intervention effectiveness research: A review of the literature on leading indicators. Chemical & Health Safety, 10(2), 21-5.

Redinger C. (2001). Background report on occupational health and safety management systems: Prepared as a resource document for members of ANSI Z-10 committee. Alexandria, Virginia.

Toellner J. (2001). Improving safety & health performance: Identifying & measuring leading indicators. Professional Safety, 46(9), 42-7.