Linking Patient Safety to Employee Safety: Getting Started

The ERGOLAB practice is a part of Pisano & Associates LLC, an Environmental Health & Safety consulting firm headquartered in Pawtucket RI.  A growing part of our Health & Safety consulting work is in support of healthcare providers; hospitals, nursing homes and medical practices.  Hospitals in particular, are under pressure to drive costs down (do more with less), while ensuring 100% quality at the point of patient care.  An often overlooked aspect in this equation, is the role EMPLOYEE SAFETY plays in supporting or enabling patient safety. Healthy employees are more productive, better focused and less prone to mistakes or mental errors. A healthy hospital employee CONTRIBUTES directly to a safe patient experience.

Our mission at Pisano & Associates / ERGOLAB, is to work with clients to assess the current state of employee safety, identify and eliminate risk factors through Health, Safety and Ergonomics programs. Following is a case study of some recent work; our Safety and Ergonomics teams partnered in the ‘deep dive’ analysis of historical OSHA recordable data across a large hospital ownership group.  The objective?  Identify the all risks factors and build a plan to build a “best-in-class’ safety culture. This initiative was the first step on that journey.

Challenge:

As the largest industry in 2009, health care provided over 16 million jobs. Combining medical technology and the human touch, the health care industry administers care around the clock, responding to the needs of millions of people—from newborns to the critically ill.

 In 2006 (most current data available), the incidence of occupational injury and illness in hospitals was 8.1 cases per 100 full-time workers, compared with an average of 4.4 for industry overall. Nursing care facilities had a higher rate of 9.8. Health care workers involved in direct patient care are at great risk back strain(s) and other MSDs from lifting patients and equipment; potential to exposures to radiation and caustic chemicals; and to exposures to infectious diseases, such as AIDS, tuberculosis, and hepatitis.  

In order to drive holistic safety improvements for both employee and patient across the entire hospital ecosystem a shift in philosophy will be essential to successfully keep up with the demands of this industry.  The symbiotic relationship between patient safety and employee safety cannot be dismissed. As first noted by E. Scott Geller, Ph.D., Professor of Psychology at Virginia Tech, “What impacts one group, impacts the whole”.  Positive changes in hospital safety environments can only come by focusing time, energy and investment on employee programs to compliment already robust patient safety programs.

Our client is large healthcare network operating over 75 Health Care Facilities across the United States and employing over 100,000 associates and their foremost concerns are to maintain a safe environment and reduce both direct and indirect Workers Compensation Costs.  

Solution:

As part their continual improvement efforts Pisano & Associates team was brought in to conduct a 3^rd party OSHA Recordable Trends Analysis for (4) hospitals within the client’s network, using the OSHA 300 Log data over a 3 year period.    The P&A team developed a database tool that provided a deep dive assessment of the data and reviewed over 10,000 OSHA recordable looking for key drivers of workplace accidents and injuries.  From there some very basic questions needed to be answered:

• Which employees’ are at the greatest risk for injury and illness? 
• Are there common denominators between the high risk group(s)?  Type of Injury? Behavior? Location? Activity?  Job Title?
• Does the existing Incident Investigation Database System capture the necessary data for an accurate and valuable data analysis? For example, if a patient is also injured during an employee incident does the system make it possible to make a “connection” between employee injury and patient injury?
• Based on the findings, what existing or new safety and health programs need to be enhanced, or developed and implemented that will drive the greatest reduction in employee injury and result in a safer patient environment?
• What approach should be taken to efficiently and successfully implement these programs?

 Result:                                                                    

This extensive analysis of 10,000 OSHA Recordable Incidents showed that 80% of the total incidents, restricted/transfer days, and days away from work involved one of the following:

• Patient Handling
• Materials Handling
• Needlesticks/sharps
• Slips/Trips/Falls

The following programs were recommended:

• ERGONOMICS: Focus – Patient Handling & Material Handling
• EXPOSURES: Focus – Needlestick/Sharps
• SLIPS/TRIPS/FALLS

In addition, RN’s accounted for approximately 30% of the total incidents, the restricted/transfer days, and the total away from work. As a result a Safety & Ergonomics effort both focusing on and involving RN’s was also recommended as part of a total safety culture effort.

Finally the results showed that 40% of all incidents occurred in the Patients room, they accounted for 35% of all restricted/transfer days and 30% of all days away from work.  It was also recommended that they integrate employee and patient incident tracking and reporting in the existing database. This will allow for a much more accurate estimate of potential cost savings and liability cost avoidance when developing and implementing the recommended programs.

As a result of the project our client is doing the following:

• Moving aggressively towards adopting and embracing the ‘Total Safety Culture’ philosophy.
• Addressing the limitations of their OSHA reporting system that were identified during the project and investigating how to capture and integrate both employee and patient incidents and how they relate to each other.
• Targeting an 80% reduction in employee injuries and related workers compensation costs both direct and indirect base based on recommendations
• The safety and well-being of the nursing staff is at the center of hospital group’s strategy – nurses’ are active in all phases of program development and rollout.
• Employees and management participate in specific safety task forces to promote both employee and patient safety and to develop programs, policies and procedures. Some of these task forces include: the Needle Stick Prevention Task Force, Safe Patient & Material Handing, Medication Safety, and Emergency Management. Hazard surveillance and environmental rounds are done on a regular basis. This activity provides inspection and review of all work areas. Recommendations for improvements are reviewed by the Environment of Care Committee and evaluated and implemented by management.
• Working collaboratively with OSHA and other regulatory organizations to ensure a high level of employee safety.

If you’d like to know more about this project – feel free to contact me via email or phone – cdavis@ergonomicedge.com or 401 527 7047