Hospitals are among the most dangerous workplaces in the country, averaging nearly seven work-related injuries and illnesses for every 100 full-time employees. That’s nearly twice the rate for private industry as a whole. Cases of nonfatal occupational injury and illness for healthcare workers are among the highest of any industry sector.

The U.S. Bureau of Labor Statistics (BLS) concludes that, in terms of lost-time case rates, it’s more hazardous to work in a hospital than in construction or mining. The challenge is that health care is the fastest-growing sector of the U.S. economy, employing over 18 million people.

Among the risks these dedicated employees face are needlestick injuries, harmful exposures, back injuries, latex allergies (from gloves), stress, and workplace violence.

The problems are significant, but so are efforts to address them. This Compliance Report introduces you to a physician-turned consultant who has some bold new ideas about why worker safety efforts have lagged behind patient safety. And a risk expert at the nation’s largest nurses’ organization talks about the hazards and solutions facing these front line healthcare professionals.

Healing the sick is a risky business

What makes hospitals such dangerous workplaces? OSHA suggests a few reasons:

• Unique risks. Hospital workers lift, reposition, and transfer patients who have limited mobility. Other unique risks include needlesticks and violence.
• Unique culture. Caregivers feel an ethical duty to do no harm to patients. As a result, some put their own well-being at risk in order to help.
• Hospitals are not assembly lines. Employees must react to unpredictable events with split-second decisions with significant consequences.

OSHA identifies the five chief causes of injury among hospital workers as:

• Overexertion and bodily reaction (48%)
• Slips, trips, and falls (25%)
• Contact with objects (13%)
• Violence (9%)
• Exposure to substances (4%)

Two emerging risks include the aging of the workforce and patient obesity, which poses challenges for safe handling and mobility. OSHA points out that safer caregivers contribute to happier patients. Studies have found higher patient satisfaction levels in hospitals where fewer nurses are dissatisfied or burned out. And patients who are handled with lifting equipment report an improved feeling of dignity.

OSHA’s answer to these risks is no surprise. The agency recommends a safety and health management system (injury and illness prevention program), described as a “proactive, collaborative process to find and fix workplace hazards before employees are injured or become ill.” The elements are familiar to OSH professionals:

• Management commitment
• Employee participation
• Hazard identification and assessment
• Hazard prevention and control
• Education and training
• Program evaluation and improvement

As for the problem of patient handling, OSHA recommends a comprehensive program to promote safe lifting, repositioning, and transfer of patients. Among program elements are:

• Equipment—from ceiling-mounted lifts to simple slide sheets that facilitate transfer
• Minimal-lift policies and patient assessment tools
• Training for caregivers or dedicated lifting teams on the proper use of the equipment

Several states now require hospitals to implement safe-patient handling programs, and many are considering it, OSHA notes.

A new view of hospital worker safety

For many years now, hospitals have been taking aim at patient safety by focusing on issues like medication errors, ensuring that the right limb or body part is treated, and finding ways to reduce hospital-acquired infections. Pediatrician, hospital safety officer, and now Safety Consultant  Tom Peterson, MD, is promoting a big idea. He maintains that the same conditions and attitudes that improve patient safety can be used to protect hospital employees. Integrating the two disciplines can have significant positive results. He calls his idea OneSafety, which is also the name of his recently launched consulting practice. Peterson first came to this thinking when he served as vice president and chief safety officer at SCL Health, a Denver-based healthcare system that operates eight hospitals in Colorado, Kansas, and Montana.

Unlike other industries, Peterson says health care was late to the game when it comes to safety overall. Pressured by an Institutes of Medicine report in 1999 about the prevalence of medical errors and other concerns, hospitals started to look for ways to better protect patients. Regulators, including Medicare, exerted pressure by way of financial penalties for failure to make certain improvements. Musculoskeletal issues were one area of focus, as OSHA had attempted, unsuccessfully, to regulate ergonomics earlier in the decade.

Yet despite some progress, Peterson said occupational safety continued to lag behind patient protection in hospitals. There were two primary reasons. The first is that as a relatively small federal agency, OSHA lacks the regulatory muscle of a huge government organization like Medicare. The second reason is a lack of awareness. Peterson says there was no comparable document like the eye-opening 1999 Institutes of Medicine report on the topic of employee injury.

For these and other reasons, hospitals were slow to acknowledge the depth and cost of occupational injuries and illnesses. Today, even with more attention to the problem, the needle still hasn’t budged much. Peterson points to recent research suggesting that as health care emerges as the largest employer in this country, injury rates are up as well. And patient and employee safety remain largely on parallel tracks.

While some hospitals have patient safety officers, they are usually part of the risk management department, and employee safety typically falls under human resources. The initiatives are managed separately with little overlap.

Peterson’s aha moment

In 2013 Peterson was at SCL, which had recruited him to oversee both patient and employee safety and to build a program like one he had created at a health system in Michigan. One of his colleagues was a senior vice president of human resources who was passionate about employee safety and helped open Peterson’s eyes to the problem. At the time, Peterson, like most doctors and nurses, knew little about workplace safety. “I didn’t know what an OSHA recordable rate or DART rate was,” he admits.

Peterson began thinking that perhaps the answer was to converge the safety efforts and apply similar strategies on both the patient and the employee side. At the time, SCL was rebuilding a hospital in Denver. Peterson heard that the contractor, Mortenson Construction, had a strong safety program, and he wanted to learn more about it. “I found out that their injury rate was 80 percent less than that of the hospital they were rebuilding. It blew me away!” He met with the contractor’s safety leader and learned that many of the techniques were the same ones being used on the patient side—daily safety huddles, culture-building, and encouraging reporting of risks.

Hospitals had borrowed many of these patient-protection strategies from airlines and nuclear power plants. Often referred to as high reliability organizations (HROs), they are known for avoiding catastrophes in high-risk environments. By way of example, Peterson points out that the six major airlines operate some 34,000 flights a day and have not experienced a fatality in 14 years. While hospitals were using this model, they hadn’t applied the same thinking to employee protection.

Intrigued, Peterson learned more about Mortenson’s approach, which included such tactics as preshift calisthenics and stretches. “I went to the hospital and said, ‘Your number one cause of workers’ compensation claims, and your number two cause of injury is ergonomics. Is anybody in the ICU or nursing stations doing any stretches?’”

One approach, one culture

Peterson began to align the two safety efforts. “It became clear to me that if you apply these same things from the patient side to the employee side, you’ll get the same results. You can’t have two different cultures—you have to do this all together.” The focus was on injury prevention, wellness, addressing injuries when they occur, and improving engagement. He admits that it was hard at first to blend the previously separate functions and managers who came from different backgrounds. Efforts included:

• Establishing a single department to oversee both patient and employee safety.
• Providing the hospital CEO with monthly reports of employee injuries, as well as patient injuries.
• Using the same reporting tools and cause analysis (incident investigation) for both.
• Training employees to use familiar patient safety techniques to better protect themselves and coworkers. For example, healthcare personnel commonly advise patients to get up slowly from a bed or chair, make sure their feet are solidly on the ground and their hands are free before getting up. The same approach—stop, assess risk, then proceed—can help employees prevent slips and falls as they get out of their cars, especially on icy surfaces.
• Communicating the way high-performance organizations do. For example, instead of saying “fifteen,” train employees to say “one five” to reduce the chance for error.
• Developing safety coaches cross-trained in both patient and employee safety.
• Celebrating success, like safety improvements and individuals who go the extra mile.

The good news, says Peterson, is that employee safety is less complicated because it involves fewer elements. “Patient safety is so hard to do—there are medications, surgery, and risks like operating on the wrong limb. But when it comes to hospital employees, 85 percent of injuries come from four sources—sharps; patient handling; slips, trips, and falls; and workplace violence/combative patients.” At SCL, focusing on these risks and using the one safety concept resulted in a dramatic decline in employee injuries.

At the end of the day, Peterson believes that uninjured, healthy employees are essential for patient well-being. “You need engaged employees who come to work safe every day with critical thinking at its peak—employees who are alert, not fatigued, and know you care about them. They will take better care of patients.”

Zeroing in on risks for nurses

They comfort patients, administer medicines, change dressings, interpret doctors’ orders, educate patients, monitor conditions, and communicate with family members. Nurses are on the front lines of health care, and the risks they face are daunting, from chemical exposures to lifting, shift work, fatigue, and stress.

For insight on nurse safety and health, we turned to Jaime Murphy Dawson, program director, department of nursing practice and work environment, for the American Nurses Association (ANA). The organization represents some 3.6 million registered nurses.

In its most recent survey of members, the ANA analyzed 13,000 responses to questions about work and nonwork safety and health risks. Notes Dawson, “Stress is far and away the highest rated workplace environmental concern, with 82 percent of nurses reporting that they experience workplace stress.” Next is concern about lifting and repositioning heavy loads (including patients and equipment), followed by prolonged standing, needlesticks, and workplace violence.

Other findings from the ANA survey are:

• Student nurses and older nurses were more likely to use safe-patient handling and mobility equipment.
• More than half reported experiencing musculoskeletal pain at work.
• Up to half had been bullied in some way in the workplace.
• Almost a quarter had been physically assaulted at work.
• About 10 percent were concerned for their physical safety at work.
• About 70 percent reported access to wellness/health promotion programs.

Dawson points out that, while more than 70 percent of nurses reported that their employer has a safe-patient handling and mobility program, more than half said they experience musculoskeletal pain while working. This suggests that access to the technology may be the problem. Even if the hospital has purchased a lifting device, it may be in a closet or down the hall. And a caring nurse might use her time to get a patient safely to the toilet rather than go searching for a device that could prevent her from becoming injured.

ANA believes the answer is not just purchasing equipment, but in promoting safety culture, i.e., implementing a safe lifting program that includes policies that ensure equipment will be easy to access and that nurses are part of the equipment selection process. “If safety isn’t identified as a top priority, efforts are going to fall flat,” she adds.

The search for answers

As for solutions, ANA was behind publication in 2014 of a set of best practice standards for patient handling. According to Dawson, the recommendations have been widely adopted. The standards describe the need to conduct a comprehensive needs assessment that addresses the specific population, injury particulars, and appropriate equipment to match the needs.

Dawson also emphasizes the importance of training at the point of care. “It’s not just training to achieve competency. You can’t throw equipment into a facility and think people are going to figure out how to use it.” Rather, training must take place in the context in which it will be used. The standards, which include an implementation guide, can be viewed at http://www.anasphm.org.

Another focus for the association is violence against nurses. “For a long time,” explains Dawson, “violence was accepted as part of the job—something that happens. I think awareness has definitely increased and we’re hoping to achieve less acceptance.”

In 2014, ANA published a book titled Not Part of the Job that incorporates OSHA guidelines, policy guidance, and other elements of a violence-prevention program. ANA’s position statement on violence reads in part, “… the nursing profession will no longer tolerate violence of any kind from any source. All registered nurses and employers in all settings, including practice, academia, and research must collaborate to create a culture of respect, free of incivility, bullying, and workplace violence. Best practice strategies based on evidence must be implemented to prevent and mitigate incivility, bullying, and workplace violence; to promote the health, safety, and wellness of registered nurses; and to ensure optimal outcomes across the health care continuum.”

ANA is extending its reach into improving nursing health. In 2017, the organization will launch a major initiative to address physical activity, nutrition, quality of life, and safety. One impetus is to make nurses a role model for patients. She adds, “If you have a healthy nursing population, nurses are more likely to educate and advocate for patients, and you’re going to have a healthier nation.”