Frontline Hospital Workers and the Worker Safety/Patient Safety Nexus

Abstract

Previous work on the relationship between worker safety and patient safety has focused on nurses and physicians.1 Safety climate and nurses’ working conditions predict both patient injuries and nurse injuries, supporting the premise that these outcomes may be linked.2 Less attention has been paid to other members of the health care team, including nursing assistants, orderlies, aides, food service workers, janitors and other environmental service workers, ward clerks, and others. (We use the term health care workers [HCWs] to include frontline hospital workers rather than “support personnel” or other terms that may unintentionally exclude them.) Engaging frontline HCWs in developing, implementing, and evaluating interventions to improve safety may improve patient as well as worker outcomes. A recent monograph issued by The Joint Commission has recommended that health care organizations consider making patient and worker safety a core organizational value and develop a business case for integrating patient and worker safety activities across departments and programs.3 The potential benefits of expanding research to explore the relationship between underlying safety culture and patient and frontline worker outcomes include savings in workers’ compensation costs, lower staff turnover, improved staff morale, increased patient satisfaction, and fewer patient adverse events. A day-long workshop was held in Washington, D.C., on October 25, 2012, to explore whether and how hospital-based frontline HCWs affect patient safety and how they experience safety in their work settings.* The four panels and small-group discussions addressed the following questions: ■ What recommendations do frontline HCWs have to improve patient safety as well as worker safety? ■ What is the current state of the evidence for a relationship between worker safety and patient safety? ■ Are effective, data-driven interventions available that improve both worker and patient safety? ■ What are the data gaps? ■ How could they be filled? ■ What are institutional and policy barriers to implementing interventions that improve safety? Representatives from academe, the federal government, hospitals, unions, and patient organizations participated in the event, which was sponsored by Georgetown University and cosponsored by the Johns Hopkins Bloomberg School of Public Health, the University of Illinois at Chicago School of Public Health, the Service Employees International Union (SEIU), the Occupational Safety and Health Administration (OSHA), the National Institute for Occupational Safety and Health (NIOSH), the Agency for Healthcare Research and Quality (AHRQ), in collaboration with the Veterans Health Administration (VHA) Office of Public Health and The Joint Commission. Workshop sessions focused on the intersection of worker safety and patient safety and on specific steps that health care institutions have used to implement a culture of safety in the workplace. The 85 workshop attendees broke out into small groups to identify barriers and opportunities for specific topics. The Honorable David Michaels (OSHA†) welcomed the attendees and charged them to integrate the occupational safety and health needs of hospital workers when addressing safety culture in health care. HCWs sustain higher rates of nonfatal occupational injuries and illnesses than workers in other sectors, including construction and mining. OSHA is targeting this problem through outreach efforts, with special sections on safe patient handling, infectious diseases transmission, and workplace violence4—and through the OSHA and The Joint Commission and Joint Commission Resources Alliance,5 which includes approaches to recognizing and reducing work-related illness and injury by reviewing and acting on the OSHA-required record-keeping.6 Frontline workers are central to these efforts.