Industry Voices—You can’t protect your patients without protecting your workers

David Michaels
David Michaels

Who is at greatest risk of injury on the job: a coal miner, a construction worker or an inpatient nurse?

If you said the nurse, you’re right. The risk of harm to hospital workers surpasses that of those employed in mining, construction or manufacturing, according to recent Bureau of Labor Statistics data (PDF). One of the biggest risks for nurses and nursing assistants is when they lift and move patients. Indeed, half of all serious hospital worker injuries are caused by overexertion; these back injuries and other musculoskeletal conditions can be expensive to treat and may even end a nurse’s career, according to data (PDF) from the Occupational Safety and Health Administration.

It doesn’t have to be that way. But in the healthcare industry’s drive to improve patient safety, leaders may not be paying enough attention to the safety of their workforce.

Strive for operational excellence

Worker injuries are important to prevent for the sake of your workers and their families, of course, but injuries also reflect problems that lead to higher costs and greater material waste, essentially making for a workplace that isn’t as productive as it could be.

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Safety pioneers like James Reason long ago made the case for a systems approach to safety in healthcare. Yet the healthcare industry still lags behind other sectors of the economy in recognizing the importance of managing staff safety. For example, while most healthcare organizations have processes in place to investigate the root causes of preventable harm to patients, we rarely see similar efforts made when workers are harmed.

Worker safety directly influences patient care. Staff and clinician actions and decisions are shaped by their environment. If they are at risk of assault, being bullied or are hesitant to lift a patient because they’re fearful of being injured, workers may well end up taking actions that unintentionally result in a patient being harmed.

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All people make mistakes (we are human, after all), and we need to set up systems that take that into account by minimizing those mistakes. We need to build in safeguards so that when errors do happen, no one is hurt.

Look to other industries for guidance

In recent years, many healthcare organizations have sought to emulate the aviation or nuclear power industries as high-reliability organizations, but healthcare can also learn from other sectors. While some in healthcare may not see easy comparisons between their challenges and those of other industries, I would argue that different areas within healthcare settings can apply lessons from different industries. Healthcare is really a set of heterogeneous operations that need to interface and interact quickly and accurately.

Patient handling is a good example. The transportation and warehouse industries have made tremendous progress in improving lifting and materials handling so workers aren’t injured. Organizations can apply many of those lessons to lifting patients. Although there have been some improvement in this area, with organizations installing lift assist devices, these injuries continue to take a toll both in their impact on injured staff members and their families, and on hospital workers’ compensation and operating costs. Put simply, we need to stop thinking of healthcare as unique and look instead for commonalities that can help improve operations and make healthcare organizations function better and more safety.

There has been a lot of talk lately about burnout in the health professions. Burnout comes from both physical and mental challenges. In healthcare, overwork, the stressful work of caregiving and even the threat of workplace violence all lead to burnout. Poor safety conditions just add to these burdens.

In a 2013 report, the IHI/NPSF Lucian Leape Institute noted that to make hospitals better for patients, it’s imperative to improve work and working conditions of staff. You can’t protect your patients without protecting your workers. Said a different way, if you are privileged to be the leader of a hospital or healthcare system, it is your job to ensure that your patients are safe in your care and your workers go home at the end of their shift at least as healthy as when they arrived.

Demonstrate your commitment to staff safety through your hiring and personnel decisions, in your financial incentive systems and within your budgets. By recognizing that healthcare worker safety is a basic, integral part of your operation, as many employers in other industries now do, you will increase safety for your patients and your workers.

David Michaels, Ph.D., is a professor at the Milken Institute School of Public Health, George Washington University. From 2009 to January 2017, he was assistant secretary of labor for the Occupational Safety and Health Administration, the longest serving in OSHA's history. Dr. Michaels is a member of the IHI/NPSF Lucian Leape Institute and will be among the speakers discussing workforce safety in healthcare at the upcoming IHI/NPSF Patient Safety Congress, May 23–25, in Boston.