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To Improve Patient Safety, Commit to Worker Safety

Posted By Administration, Tuesday, November 18, 2014
Updated: Monday, November 17, 2014

“Unless caregivers are given the protection, respect, and support they need, they are more likely to make errors, fail to follow safe practices, and not work well in teams.”


By Tejal K. Gandhi, MD, MPH, CPPS


  Tejal K. Gandhi

As the Ebola crisis continues in West Africa, and the US health care system works to address potential risks to workers here, it is worth noting that long before this year’s events, health care was known to be among the most dangerous sectors of the US workforce. According to the Occupational Safety and Health Administration, US hospitals reported 253,700 work-related injuries and illnesses in 2011. That amounts to 6.8 illnesses or injuries per 100 full-time employees (OSHA 2013). And that’s just hospitals; many more injuries occur in other health settings, such as long-term care facilities and ambulatory centers. More work days are lost in health care each year than in such industries as mining, machinery manufacturing, and construction (OSHA 2013).


These numbers represent muscle strains and musculoskeletal injuries, exposure to blood-borne pathogens, trips or falls, and other physical harms. Moreover, the health care sector experiences a significant toll of psychological injury as a result of bullying, stress, and burnout. One survey of health professionals found that 77% reported witnessing disruptive behavior by a physician, and 65% reported witnessing such behavior from a nurse, with the overwhelming majority saying that such behavior resulted in stress, loss of concentration, and reduced communication, and other hazards (Rosenstein and O’Daniel 2008).


NPSF has long supported the precept that health care workforce safety is a precondition to patient safety. In 2013, the NPSF Lucian Leape Institute examined this issue in a report compiled from the proceedings of two expert roundtable meetings and other research. Through the Eyes of the Workforce: Creating Joy, Meaning, and Safer Health Care states that “workplace safety is inextricably linked to patient safety. Unless caregivers are given the protection, respect, and support they need, they are more likely to make errors, fail to follow safe practices, and not work well in teams.”


The report cites root causes for the slow progress in improving workforce safety in health care. For one, many organizations do not have systems in place to support learning and improvement about worker safety. There is little awareness that by keeping workers safe, we help keep patients safe. Unnecessary risk to workers is largely driven by “rigid organizational structures and hierarchical models that are deficient in respect, teamwork, and transparency.”


Progress in workforce safety has been slower than many would like, yet there are health care organizations that are making great improvements. The Institute’s report outlines a number of recommendations to advance worker safety, among them:

  1. Develop and embody shared core values of mutual respect and civility; transparency and truth telling; safety of all workers and patients; and alignment and accountability from the boardroom to the front lines of care.
  2. Adopt the explicit aim to eliminate harm to the workforce and to patients.
  3. Create a learning and improvement system using evidence-based management skills for reliability.
  4. Create and track metrics for physical and psychological harm
  5. Support research to study issues and conditions in health care that are harming the workforce and, by extension, patients.

The National Patient Safety Foundation’s vision is: “Creating a world where patients and those who care for them are free from harm.” While addressing the current Ebola concerns is paramount, we must not lose sight of the long-term transformation required to make the health care sector a much safer place for workers and patients alike.

How does your organization monitor and respond to worker injury? Comment on this post below.



Occupational Safety & Health Administration (OSHA). 2013. Caring for our caregivers: Facts about hospital worker safety. Washington, DC: US Department of Labor. Available at:


Rosenstein AH, O’Daniel M. 2008. A survey of the impact of disruptive behaviors and communication defects on patient safety. Jt Comm J Qual Patient Saf. 34(8):464-471.



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