Health care industry employees are injured on the job more than in any other industry. Providing health programs helps them focus on delivering better care.
By Daniel Barr, MHSA, FACHE; Heather Miller, CSSMBB; AJ Principe, MBA; Jenna Merandi, PharmD, M.S.; Charline Catt, R.N., M.S.
Hazards lurk in almost every corner of a hospital. Slips, trips, sprains, strains and needle pokes are just a few of the things that make hospitals perilous for employees. On average, more employees are injured in the hospital and health care industry than any other.
U.S. hospitals recorded 6.8 work-related injuries and illnesses for every 100 full-time employees in 2011, according to the Occupational Safety and Health Administration (OSHA). This totaled about 60,000 work-related injuries and illnesses that caused employees to miss work, outpacing the construction and manufacturing industries.
In addition, these days away from work include only the more severe injuries and don't account for injuries where an employee continues to work but on modified duty—meaning the problem is even larger than the numbers suggest. The result is that hospitals pay a high cost—into the billions annually in workers' compensation and illness-related costs to the organization.
So what can make hospitals hazardous places to work? Hospital workers face risks not typical of other industries: they frequently lift, reposition and transfer patients who have limited mobility. There's also risk of needle sticks, particularly in children's hospitals where patients may squirm.
Hospital caregivers also feel an ethical duty to do no harm to patients—some will put their own health at risk to help a patient. In addition, hospitals are not assembly lines; employees must react to unpredictable events with split-second decisions and often bear the emotional toll of their work during off-hours.
Placing the same emphasis on employee health and wellness as hospitals currently place on patient safety can change this costly pattern. Quality patient care requires quality employee care. Caregiver fatigue, injury and stress are tied to a higher risk of medication errors and patient infections. Strategies for improving patient care and employee health and wellness can go hand in hand, and the emphasis on each area must be equal.
Build on patient safety success
At Nationwide Children's Hospital in Columbus, Ohio, employees arrive to work every day ready to do their part to contribute to the Zero Hero Program. This initiative led Nationwide Children's to aspire to zero preventable harm and make it a public goal. At Nationwide, the Zero Hero campaign has:
- Prevented more than 500 events of harm, including 63 serious safety events and decreased overall hospital mortality 40 percent
- Helped the hospital achieve a 50 percent reduction in actual harm and an 85 percent reduction in serious safety events
- The hospital has made great strides in improving patient safety, and now it's putting the same effort into keeping employees well.
Common employee incidents
In 2012, Nationwide had 179 OSHA-recordable injuries and 846 days lost due to employee injuries. This resulted in approximately $1.2 million dollars in expense related to workers' compensation. While these statistics are lower than national benchmarks listed in the Department of Labor's Bureau of Labor Statistics (BLS) and OSHA, they are nowhere near zero. In 2012 the organization's top reasons for employee injury were:
- Needle sticks
- Slips, trips and falls
- Back injury
- Blood or bodily fluid exposures
From a volume and frequency perspective, needle sticks are the organization's most reported OSHA-recordable injury. Patient injections and lab draws are available at almost all inpatient and outpatient (onsite and offsite) locations throughout the Nationwide Children's Hospital care network.
The areas experiencing the highest level of needle stick occurrences include: intensive care units, operating rooms, dental offices and the emergency room. Reasons for the needle sticks range from the patient moving or jumping to people just trying to do too many things at one time.
Similar to the organization's approach to patient safety, Nationwide Children's invested the necessary resources to develop focused strategies to reduce and eliminate the top reasons for employee injury in the future, as well as other situations that put employees at risk of injury.
Create a healthier work environment
According to OSHA, almost all successful injury and illness prevention programs include these elements:
- Management leadership: Managers demonstrate their commitment to improved safety and health, communicate this commitment, and document safety and health performance. They make employee wellness and health a top priority, establish goals and objectives, provide adequate resources and support and set good examples.
- Employee participation: Employees, with their distinct knowledge of the workplace, ideally are involved in all aspects of the program. They are encouraged to communicate openly with management and report concerns.
- Hazard identification and assessment: Processes and procedures are in place to continually identify workplace hazards and evaluate risks. There is an initial assessment of hazards and controls and regular reassessments.
- Hazard prevention and control: The organization implements processes, procedures and programs to eliminate or control workplace hazards, and achieve health goals. The organization tracks progress in implementing controls.
- Education and training: All employees receive education on hazard recognition and control and their responsibilities under the program.
With this framework in mind, in early 2012 Nationwide Children's Hospital's executive leadership team convened a multidisciplinary group to develop a strategy to eliminate work-related injuries at the organization. The Employee Safety Team consists of experts with diverse backgrounds such as environmental safety, employee health, industrial engineering, data management, quality management and hospital operations.
After reviewing internal processes, historical incident reporting and gathering feedback from key stakeholders throughout the organization, the Employee Safety Team identified interventions the hospital could implement to further reduce employee-related harm. Each of these strategies complements the others and is necessary to ensure the organization's success.
Employee incident reporting system
With more than 10,000 employees and 62 sites of service throughout Ohio, it was key to implement one standardized employee incident reporting system throughout the Nationwide Children's Hospital care network. After careful deliberation between buying and implementing a new incident reporting system specifically for employee incidents or just to expand upon the current incident reporting system that the organization was using for patient safety, the Employee Safety Team decided to build upon the existing reporting system.
The team worked with a vendor to customize the data entry screens and reporting functionality on the front and back ends. The benefits of having one central place for all employee injury-related matters helps the Employee Safety Team proactively identify trends and develop educational programs, proper methods of using equipment and lastly, complete ergonomic assessments in order to prevent employees from being injured on the job. Additional benefits to this approach include:
- Standardized taxonomy of all incidents to identify and rank incident severity levels
- A 75 percent increase in the reporting of employee incidents over three years
- Use of thorough root-cause analysis for more severe incidents related to employee injury
- Focused strategies for high-risk situations
With the implementation of a uniform incident reporting system, the organization now captures accurate data on the front end, which allows the Employee Safety Team to review and abstract accurate data on the back end. With accurate data, the team proactively engages the appropriate leaders and staff members to identify high-risk situations where injuries are occurring.
The team has also worked with the at-risk staff members to develop new ways of completing their jobs in a safer manner. With the development of a centralized reporting system, the Employee Safety Team will assess trends and implement solutions to prevent injuries.
Today, the organization is continuing to fill the gaps in employee-related incidents. For example, when an employee is stuck with a needle, the hospital works to identify all of the underlying factors that caused the injury to occur, such as patient position, needle type and safety features, staffing, and the last time training occurred. Gathering and reviewing detailed process data helps the organization implement process improvements and new policies and procedures to reduce the rate of occurrence.
Additionally, once the reporting process was implemented, the Employee Safety Team developed a taxonomy to stratify the level of harm that occurred with an employee incident. Similar to a patient safety program, Nationwide Children's developed a serious safety event scale and used it to define a serious safety event to be any incident that resulted in one day or more of work time lost.
Once the organization implemented this system of stratifying risk, the safety team begin using other tools from patient safety to investigate employee serious safety events (eSSEs), such as root cause analysis and huddles to uncover when and if employee injuries were a result of individual or system failures.
Through these efforts, the organization's detection and reporting of employee injuries has increased significantly. To ensure teams were moving in the right direction and making an impact on the organization, the hospital developed several key reporting systems that compared performance internally. The first is the employee serious safety event rate (eSSER), which illustrates the 12 month rolling average for the eSSEs adjusted for 100 full-time equivalents (FTEs).
The second metric is the employee preventable harm index (ePHI), which illustrates key domains of harm and how often these incidents occur each month. For each of the domains of harm, the organization developed a “focused effort team.” Each team, led by a vice president-level champion, develops and executes interventions that will result in zero harm. Though Nationwide has only engaged in this strategy for three years, the organization is seeing an overall reduction in some key domains of harm in the ePHI.
Leadership and employee accountability
Success with these initiatives depends on managers and employees assuming equal responsibility. To ensure managers and employees understand what employee injuries are, how to report them and how to avoid them, the Employee Safety Team trained more than 9,000 employees on the Zero Hero Employee Safety Program. Employees learned about key tools and behaviors to consider when one is in a high-risk situation.
Fortunately, when the Zero Hero Patient Safety Program was implemented in 2009, the organization invested a considerable amount of resources to ensure all employees underwent several hours of training on Zero Hero behaviors and tools. The information is transferable and became the foundation for the employee health program.
The organization continues to hear “good catch” patient safety stories. These are stories where staff members stopped and resolved a potential safety situation that prevented harm from reaching the patient. This same behavior can be applied to employee incidents.
To ensure staff members use these methods consistently, the organization continues to strengthen the message around the motto of 200 percent accountability. This means each employee is 100 percent accountable for themselves and 100 percent accountable for their co-workers.
Similar to the development of the Zero Hero Patient Safety Program, the hospital has engaged national leaders, both from the consulting fields as well as other top health systems in the country, to gain insight on best practices and lessons learned. This information has been invaluable in the creation of Nationwide Children's Hospital employee health program. The organization has developed organizational learning and development strategies to ensure all employees understand how they can have a safe day, every day while working at Nationwide Children's.
Daniel Barr is vice president, Operations, service line administrator, Hem/Onc/BMT, and co-director of Zero Hero Employee Safety; Heather Miller is director of Business Process Improvement and co-director of Zero Hero Employee Safety; AJ Principe is project manager for Employee Safety; Jenna Merandi is medication safety coordinator and program director of YOU Matter Program; Charline Catt is vice president of Patient Care Services and executive sponsor of YOU Matter Program; all from Nationwide Children's Hospital in Columbus, Ohio. This content was presented at the 2015 Quality and Safety in Children's Health Conference. Send questions or comments to firstname.lastname@example.org.