Photo by Erica Nilsson | Unsplash
It’s taken a pandemic for the conversations about job-acquired illness and injury in health care workers to be more broadly seen as a critical priority. Yet the reality is that health care workers have long experienced high rates of illnesses and injuries on the job — and for too long this has been accepted as simply a cost of doing business.
My first experience of workplace harm occurred before I was even licensed as a registered nurse. For weeks during nursing school, I experienced fatigue and nonspecific symptoms, but multiple tests for strep and mono came back negative. Finally, the telltale glow of jaundice emanated from my skin, and I would go on to become the second student in my cohort to be diagnosed with hepatitis. My course was complicated by a relapse, hospitalization, liver biopsy, and years of follow-up. It was happenstance that, on a visit to my former faculty member, I’d learn that several nurses on the same medical-surgical unit where we’d done our clinical rotation had also tested positive for hepatitis during the same period of time.
Decades later, during a Lucian Leape Institute expert panel on workforce safety, I’d come to more deeply understand that for the health care workforce, physical and psychological harms exceeded those in many other industries, and remained largely unnoticed and unaddressed. The subsequent report and recommendations of this panel helped spark momentum for leaders to commit to eliminating physical and psychological harm to the workforce. In recent, pre-pandemic years, and despite the clear business case for prioritizing workforce safety and the availability of evidence-based programs and practices for eliminating harm, progress has remained sluggish and piecemeal.
Are We “Fixing” or Are We Solving?
Don Berwick, IHI President Emeritus and Senior Fellow, has characterized our current health care system as “repair shops” where we rise to the challenge of fixing and correcting the damage for what’s broken. Often work gets accomplished without deeply understanding and addressing the underlying causes and determinants of the problem.
This “first aid” approach was apparent in our earlier, more reactive attempts at addressing patient safety challenges. While we may have implemented a checklist for a circumscribed problem of central-line bloodstream infections, for example, we learned that successful use of checklists required us to assess and address the more foundational aspects for transformation of safety, including values, commitments and cultures of safety and continuous learning and improvement. Achieving meaningful and transformative progress in workforce safety requires a similar commitment to a total systems approach to safety, one that unifies both patient and workforce safety in a collective approach to eliminating harm to patients and those who care for them.
Accelerating Coordinated and Comprehensive Action
In September 2020, concurrent with the World Health Organization’s World Patient Safety Day theme of Health Worker Safety, the 27-member National Steering Committee for Patient Safety released Safer Together: A National Action Plan to Advance Patient Safety. The Action Plan provides 17 recommendations for health care and safety leaders across four foundational, interrelated areas: culture, leadership, and governance; patient and family engagement; workforce safety; and learning systems. Importantly, the plan recognizes that no one area can successfully and sustainably advance without attention to the other foundational areas. As with patient safety, addressing workforce safety in the absence of an integrated approach to leadership, for example, does little to promote progress.
Although the COVID-19 pandemic has drawn attention to the gaps and opportunities associated with workforce safety and well-being, we were already in dangerous and costly territory before the novel coronavirus emerged. While appropriate attention has been placed on vaccination, it would be all too easy to suggest that our workforce is safe because vaccines are increasingly available. Vaccinations may mitigate the risk and severity of contracting the virus, but they will not address the underlying cultural and leadership challenges that remain. Vaccinations will not protect our workforce from falls, musculoskeletal and sharps injuries, exposures to new and existing infectious diseases, violence, and the daily psychological harms that are insidious across health care. While vaccinations are cause for hope on many fronts, their availability will not reverse the mental health, well-being and societal tolls incurred by the pandemic, including the expansive challenges of inequities experienced by those who work in health care.
While physical health risks for health care workers have increased exponentially due to COVID-19, associated mental health, well-being, and societal consequences, including inequities that have been increasingly recognized, are creating added complexities and priorities that must be addressed. Health inequities result in disproportionate harm experienced by specific population groups, based on characteristics including race, ethnicity, sexual orientation, gender, age, disability, and income. For example, according to a brief issued by KFF, “People of color accounted for a majority of COVID-19 infections, hospitalizations, and deaths known among health care workers for which race/ethnicity data is available.” Similar to the disproportionate impact seen in the general population, National Nurses United report that 58 percent of the 213 registered nurses it had identified as dying due to COVID-19 and related complications were nurses of color, including nearly a third (32 percent) who were Filipino nurses and 18 percent who were Black nurses. When designing safety efforts, it is imperative to take such inequities into account.
The silver lining of the pandemic is that it has forced the health care system, along with society at large, to recognize our longstanding inequities and other burdens that have fallen on health care workers. Let us now make sure that we seize this opportunity to make lasting change to truly prioritize safety and well-being for the health care workforce.
Patricia A. McGaffigan, RN, MS, CPPS, is an IHI Vice President.
You may also be interested in:
Free IHI Virtual Learning Hour on Workplace Violence: Protecting Health Care Workers (Tuesday, March 16 from 1:00 – 2:00 PM ET) during Patient Safety Awareness Week (March 14 through March 20, 2021)
“Every Injury to a Health Care Worker Is Preventable”