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For many leaders, concern for workforce safety has focused on physical safety — a health care environment with no lift injuries, slips, trips or falls, and sound infection control with appropriate personal protective equipment (PPE). Yet, the COVID-19 pandemic has highlighted the need for a more holistic notion of workforce safety — one that builds on physical safety as a foundation, but also encompasses psychological and emotional safety, including an equitable work environment free of bias or discrimination.
This concept of workforce safety is consistent with the National Action Plan to Advance Patient Safety, and other national efforts to prioritize the safety of the health care workforce. Of note is the vision offered by the CEO Coalition, a group led by Vocera Communications with support from the Institute for Healthcare Improvement (IHI) that includes leaders from prominent health systems, including Intermountain Healthcare, Providence, and others. The CEO Coalition offers six key principles that fall under three domains to address workforce safety holistically: safeguard psychological and emotional safety, promote health justice, and ensure physical safety. The following domains and principles can form the foundation for a workforce safety agenda for health systems:
Domain 1: Safeguard Psychological and Emotional Safety
This domain and its accompanying principles acknowledge the emotional, mental, and cognitive health needs of health care workers:
Principle 1: Invest in processes and technologies that reduce emotional and cognitive burdens on team members and restore human connection to the health care experience.
Principle 2: Create practices and policies that advance open communication between team members and leaders so people feel safe to speak up and bring their full selves to work.
Principle 3: Provide resources to assess and support team members’ emotional, social, and spiritual health, and alleviate the stigma and deterrents to seeking support.
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During the height of the COVID-19 pandemic, many health systems provided increased mental health services to their staff, acknowledging that health systems have a role in alleviating the psychological toll experienced by their workers. In addition to robust mental health services, some hospitals are also working to reduce the burden of the electronic health record (EHR) by limiting notifications. The time saved has allowed health care workers to spend more time with patients and helped them to feel greater work
Domain 2: Promote Health Justice
Principle 4: Declare equity and anti-racism core components of safety, and require explicit organizational and health equity-focused policies and practices to advance diversity, inclusion, and belonging.
The health inequities exposed by the COVID-19 pandemic and increased attention to racism in our societies have highlighted the need for health systems to take a firm stand on racial justice and health equity. Health systems must look at their own internal practices to ensure they are creating an anti-racist and equitable environment for both patients and staff. An example of this includes incorporating equity into existing practices, such as root cause analyses conducted after workplace injury or harm. Some health systems have begun to include questions specific to equity, such as whether the incident suggests any possibility of biased behavior on any individual’s part, or whether the incident suggests system-level barriers to an equitable workplace, such as impediments to transportation, childcare, or other supports.
Domain 3: Ensure Physical Safety
Principle 5: Implement a zero-harm program for care team members to eliminate workplace violence, both physical and verbal, whether from team members, patients, families, or community members.
Principle 6: Ensure that all health care organizations can procure and provide evidence-based PPE, technology, tools, and processes that health care team members need to do their jobs safely and care for patients.
While important progress has been made to protect the physical safety of workers, recent events have shown the need to scale up efforts related to workplace violence and injury prevention. This includes implementing the US Occupational Safety and Health Administration (OSHA) Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers, forming a behavioral response team to de-escalate workplace violence events, and implementing safe patient handling protocols.
The CEO Coalition now includes a learning community where system leaders can understand evidence-based practices in areas such as workplace violence prevention and reducing the mental burden for health care providers.
Other Efforts to Expand the Scope of Workforce Safety
Multiple national initiatives are converging to broaden the understanding of workforce safety:
- Safer Together: A National Action Plan to Advance Patient Safety makes several recommendations for health systems that go beyond physical safety, including:
- Assume accountability for physical and psychological safety and a healthy work environment that fosters the joy of the health care workforce and
- Develop, resource, and execute on priority programs that equitably foster workforce safety.
The National Action Plan authors also developed an organizational assessment tool and implementation resources.
- IHI’s Joy in Work Results-Oriented Learning Network (ROLN) has highlighted interventions that go beyond typical notions of employee satisfaction. These changes encompass physical safety, improved communication, and reducing unnecessary work and workarounds. In the coming year, the Joy in Work ROLN will also benefit from IHI’s efforts to more explicitly incorporate equity into the joy in work change package.
- In the coming year, IHI’s Leadership Alliance — a dynamic collaboration of health care executives — will assemble a workforce well-being workgroup after convening a year-long workgroup in 2021 focused on physical safety.
- IHI’s overall efforts to advance equity increasingly focuses not only on patients, but also on health care staff. Examples of changes introduced by leading health systems include workforce diversity targets, implicit bias training for all staff, and executive coaching to ensure C-suite leaders have personal goals to promote equity for their system.
How to Take Action Now
Health systems can address workforce safety more holistically in a number of ways:
- Create robust measurement and reporting systems that prioritize workforce safety but go beyond physical safety.
- Regularly report incidents of physical injury, workplace violence, and verbal aggression experienced by the workforce to the C-suite and board level (e.g., as part of an executive dashboard).
- Make workforce safety one of a small number of strategic system priorities, and adopt an investment mentality. This means allocating the time, equipment, and staffing necessary to promote workforce safety. These investments pay off in lower turnover and other avoidable costs.
- Stratify workforce safety data by race, ethnicity, gender, age, and specialty, and also survey the workforce on whether they perceive leadership as prioritizing equity across initiatives.
- Focus on creating a safety culture. As the Joint Commission and others have recognized, the foundations for workforce safety — such as psychological safety, transparent and regular reporting, a focus on identifying root causes and structural factors, as well as working to build a just culture — are much the same as the foundations for patient safety. Leaders must commit to these foundations to make workforce safety sustainable.
- Commit to listening to frontline workers to understand their needs, what matters to them, and what would make them feel safe when thinking about physical safety, psychological safety, and an equitable work environment.
The safety of the health care workforce is essential for safe, high-quality patient care. Yet, harm to the workforce remains a challenge across all settings. The solution, according to an increasing number of organizations, is to take a wider view of workforce safety to include the physical and psychological safety and well-being of workers, including equitable work environments free of discrimination and bias.
Keziah Imbeah, MSc, is an IHI research associate. Jeffrey Rakover, MPP, is an IHI senior research associate. Join them at the IHI Forum 2021 session called “What's New from IHI Innovation?” on Monday, December 6, from 3:00 - 4:00 PM Eastern Time.
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