The journey of quality improvement in health care has been phenomenal. We used to believe we couldn’t avoid certain kinds of patient harm. We’ve now seen that we can virtually eliminate things like central line infections and ventilator-associated pneumonias that we used to think were inevitable outcomes of hospital stays.
Today, it’s unthinkable that we wouldn’t do all we can to identify the root causes of harm so we can prevent it. We understand this is as an obligation of what we consider high-quality health care.
Shouldn’t we apply that same rigor and science to the safety of the people providing the health care?
Workforce Safety Myths
Workers in health care face a range of hazards on the job, including back injuries, falling on wet or uneven floors, violence, needlesticks, and stress. It pains me to know that we can control hazards in health care and yet we’re not reliably applying the evidence to do so. I believe one reason we’re not doing more to prevent workforce injuries is the many misunderstandings surrounding this topic.
One of the most persistent myths is the idea that workforce harm is inevitable. Many people think it’s an inescapable cost of doing business. This simply isn’t true. Just as we had to dispel the myth that certain kinds of patient harm are unavoidable, we need to set the record straight about workforce harm in health care.
Every injury to a health care worker is preventable. Every one of them.
The myth about the inevitability of workforce harm in health care is damaging. It risks making us think there’s nothing we can do about it and this idea perpetuates opportunities for harm.
Another false assumption is that workplace injuries are the fault of the person who gets hurt. We’ve all heard these kinds of comments:
They didn’t follow the protocol. They didn’t use the right equipment. They were in too much of a hurry. They didn’t get proper training.
While factors like these may have contributed to the injury, we need to dig deeper. What are the systems issues that led to these circumstances?
Was the protocol confusing? Is it impractical for day-to-day use?
Was the proper equipment broken? Was it stored on another unit?
Was the staff member in a hurry because there was a demand to turn over the bed right away? Have there been budget cuts or recent turnover that have left the unit understaffed?
Why didn’t the staff member get proper training? Were they floating on the unit? Is it more difficult for weekend staff to get access to training?
When I hear someone say or imply that an injury was the fault of the employee, that tells me that something is broken in the system. I liken blaming employees for their workplace injuries to when people talk about patients not adhering to their medication regimen. Instead of criticizing patients for their “non-compliance,” we’re learning to explore the reasons why they might not be able to adhere to their medication schedule. Maybe they can’t afford it. Maybe they don’t understand the instructions on the label.
If we apply that same pivot in our thinking to a health care worker, we can offer empathy, consider root causes, and think about systems solutions that protect both employees and patients.
How to Promote Workforce Safety
The wide range of risks to workforce safety means there are no easy fixes, but there are some keys to improvement:
Use a systems approach. Using a systems approach is essential to make health care safer for the people providing care. Much like we do in the rest of quality improvement, it takes a system to make safety reliable and effective. What are the decision-making channels? Accountability and responsibility need to be clear. You also need the right tools and technology in place.
Make workforce safety a leadership priority. This means answering important questions: How many members of your board of directors look at data about the safety of the workforce? How many leaders understand their specific accountability? For example, if you’re a nurse leader, you should be the expert on safe patient handling. If you are the head of Nutritional Services, you should be the expert on safe food preparation.
Create psychological safety. People must feel safe pointing out or asking questions about hazards, errors, or concerns. If you’re a caregiver in an environment in which you don’t feel safe speaking up, how can issues be escalated for attention and remediation?
Appreciate the business case for workforce safety. If a nurse can’t work after injuring her back while assisting a patient out of bed, there are many costs associated with that injury, including the cost of medical care and worker’s compensation. In California, where my organization is based, the average injury that involves lost time costs about $75,000 per injury. Wouldn’t it be far more cost effective to prevent the injury in the first place?
Demonstrate respect. At Kaiser Permanente, we conduct a workplace safety index survey and it showed us something surprising. The most predictive factor of the degree of safety of the work environment is if individuals report that they get respect, recognition, and adequate resources to do their work. It’s not having the best ergonomic assessment. It’s not having the best lift equipment. Those things are important, but they’re not enough.
Understand that you can’t buy your way to safety. It’s easy to assume that everything will be fine if you order the safest needle or get the latest high-tech piece of equipment, but buying new equipment alone will change nothing. If, for example, you ask a nurse why they’re not using the patient lift equipment, they may say things like, “It’s too far away. It’s in a locked room. Our unit doesn’t have the right sling. The sling is dirty. I don’t know how to use the new lift.” None of these issues will be solved with a new product.
Remember the human costs of workforce injury. I know someone who works on protecting health care worker safety because her mother had been a nurse. Her mother suffered an occupational injury from which she never recovered. She never worked as a nurse again. It affected the entire family’s life emotionally and financially. This daughter is passionate about safety because she believes no worker and no family should go through what her family went through.
We do not accept preventable harm to patients. We should not accept preventable harm to employees. Until we apply the same rigor and thoughtfulness to pursuing zero harm to the people providing the care as the people receiving the care, we will not have fully safe environments for anybody in health care.
Kathy Gerwig, MBA, is Vice President, Employee Safety, Health & Wellness at Kaiser Permanente. She is also a member of the National Steering Committee for Patient Safety.
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You may also be interested in:
WIHI podcast — No Let Up on Safety
White paper — A Framework for Safe, Reliable, and Effective Care
IHI's Patient Safety Congress