Workplace Safety

Publication ID: 7248369051
Published on: September 2023
Major Revision: June 9, 2024

Overview

Our actionable evidence-based practices were designed by world-renowned patient safety experts to serve as proven step-by-step guidelines on eliminating the top causes of preventable harm. This blueprint has a proven track record of ensuring the best patient care. Please note that our guidelines are continually updated and incorporate the latest safety practices recognized as the gold standard of care.
Frontline staff

This blueprint outlines the steps that frontline staff can follow to ensure workplace safety: 

Best Practice Summary:

  1. Create a safe workplace culture.
  2. Review workplace safety-related data and share findings.
  3. Perform routine workplace safety assessments.

Clinical Workflow:

  1. Contribute to a safe workplace culture.
    1. Recognize one another for the value you bring to the organization. Embody “Commitment to My Coworker” principles.
    2. Hold team members accountable and learn from your and others’ mistakes.
      1. Participate in root cause analysis workshops and debriefing sessions after the event.
      2. Reflect on all opportunities for personal and team improvement to avoid the same error or risk in the future.
    3. Listen to other team members if they are explaining concerns or are approaching you for advice.
    4. Do not leave a team member alone in a potentially hostile environment.
    5. Treat everyone as your equal.
    6. Respond to staff, patients, and family members who report bullying. Have a conversation with the reporting individual and try to understand how you can best help them.
    7. Participate in peer support programs and “buddy systems” for both social support and safety.
    8. Normalize and encourage help-seeking behavior in peers. Seek out help yourself when needed.
    9. Raise concerns about intimidating behavior or exclusion.
    10. Do not feel as though you are alone in resolving someone’s concern. Collaborate with leadership, security, and human resources.
    11. Practice peer support principles, including presence, psychological safety, empathetic listening, nonjudgmental curiosity, problem-solving guidance, coping encouragement and exploration, reframing, resource connection, and appreciation.
  2. Remain vigilant for and report workplace safety risks.
    1. Report conditions that often lead to injury. If you sense a potential future problem, say something and allow the experts to do a risk assessment.
    2. Be as transparent as possible around workflow and policy gaps that could contribute to unsafe environments.
    3. Encourage colleagues to use the reporting system.
    4. Raise concerns regarding unclear or ambiguous guidelines, procedures, or standards.
    5. Elevate concerns regarding increases in workload after the implementation of new processes or technologies.
  3. Expect that leaders respond to concerns.
    1. Follow up with leaders after raising a concern or suggestion.
    2. Participate in debriefing sessions, root cause analyses, and performance improvement initiatives.
Unit Managers

This guide outlines the steps that managers can follow to ensure workplace safety:

The following checklist contains essential elements that should be implemented and sustained to improve workplace safety for everyone across the organization.

Build a shared vision for workplace safety:

  1. Normalize open, ongoing conversations about workplace safety by leading by example. Be vulnerable.
  2. Demonstrate organizational priority on workplace safety by
    1. Remaining an active participant in process change
    2. Allocating appropriate resources
    3. Routinely being open and available for staff
    4. Expecting that multidisciplinary team members discuss an event and lessons learned
    5. Providing staff support in a timely fashion after an event
    6. Including workplace safety on senior leadership discussion agendas
  3. Ensure proper allocation of resources for prevention of workplace injury and illness (e.g., infection prevention resources).

Improve detection of risk and safety concerns:

  1. Conduct a performance improvement initiative to assess risks and priority areas.
  2. Ensure staff have the ability to report concerns on or offsite.
  3. Inquire about incidents or areas of concern during rounding.
  4. Simplify the reporting process as much as possible.
  5. Establish a near-miss reporting system for worker safety, just as there is a near-miss reporting system for patient safety.

Respond to all safety concerns:

  1. Clearly standardize policies and guidelines that will be referenced when responding to concerns.
  2. Establish robust mechanisms for closed-loop communication, which may include:
    1. Clearly articulating what the user can expect for next steps on the “report successfully submitted” confirmation page
    2. Providing an opportunity for the reporter to choose to remain anonymous or disclose identity and contact information for follow-up
    3. Bringing the individuals who have reported into improvement efforts
  3. Ensure all reported events are taken seriously and responded to in some way.
  4. Involve the frontline (e.g., via surveys) in understanding the effectiveness of the intervention. Be sure to evaluate both the objective data and their perception of the intervention.

Involve everyone in continuous improvement efforts:

  1. Hold staff accountable for workplace safety using the “Just Culture” approach. Encourage people to provide essential safety-related information and use the Just Culture algorithm to determine response.
  2. Clearly define what “accountability” for workplace safety means (e.g., “I always speak up when I see a workplace safety risk”).

Create a safe working environment:

  1. Establish a curriculum for ongoing education around
    1. Identification and early recognition of unsafe environments
    2. Reporting
    3. Conflict resolution
    4. Trauma-informed care
    5. De-escalation strategies
  2. Establish mechanisms for workers to report patients at risk for violence in the medical record for future procedures. Standardize which patients should be “flagged” based on evidence-supported risk assessments. Establish an emergency support system to address violence (e.g., “Code White” to call security).
  3. Improve team relationships by:
    1. Cultivating an environment of psychological safety so that team members speak up when faced with challenges
    2. Being transparent and vulnerable
    3. Prioritizing team building
    4. Building common values and a shared vision for the team
    5. Highlighting various strengths in team members
    6. Identifying and dealing with causes of poor morale
    7. Providing rewards

Workplace Safety Metrics to Consider Assessing:

  1. Turnover rate
  2. Employee retention
  3. Job satisfaction rates
  4. Workers’ compensation injury claims
  5. Number of workplace violence incidents, with critical focus on severity and location
  6. Patient acuity over time
  7. Number of patients secluded
  8. Hours of seclusion/1,000 hours
  9. Number of patients restrained
  10. Hours of restraint use/1,000 hours
  11. Unscheduled staff time off (e.g., sick day use/absenteeism)
  12. Staff debriefing meetings after an incident
  13. Reports of bullying
  14. Burnout rates
  15. Employee needlestick injury rate
  16. Employee hospital-acquired infection rate
  17. Number of insurance claims by employees due to occupational hazard
  18. Employee radiation safety rate
  19. Number of employee sentinel events
  20. Number of second victims counseled

The Ideal Workplace

Organizations of high reliability prioritize the safety and wellbeing of those within, regardless of role or status. The following are examples of features of a safe, healthy workplace:

  1. Early recognition of unsafe behaviors
  2. Comfort and empowerment of everyone in reporting
  3. Confidence that reports will be taken seriously
  4. Comfort in asking questions
  5. Support from leaders when confronted with a workplace safety risk
  6. Clear guidelines to reference in situations of workplace safety risk
  7. Supportive environment for pitching ideas for improvement
  8. Clear, universally understood definitions of behaviors that compromise safe environments
  9. Comfort in asking for support
  10. Expectation of being listened to without unnecessary interruptions
  11. Active listening in all conversations
  12. Timely provision of materials needed to ensure safety (e.g., PPE)
  13. Proactive and routine evaluation of workplace culture, safety, and environment
  14. Open door policy by leaders for their frontline staff
  15. Freedom of expression without fear of retaliation
  16. Staff continued education around tools for improving communication and conflict management
  17. Continued feedback to staff around how their feedback contributes to improvement
  18. Rewarding achievement
Hospital Executives

This protocol outlines the steps that executives can follow to increase workplace safety: 

Workplace safety requires an organization-wide, multilevel, cultural paradigm shift toward open and honest communication, conflict resolution, psychological and personal safety, and mutual respect to anticipate and prevent workplace violence, hazards, and injuries and to promote wellbeing, joy at work, communication, and collaboration. 

The Problem:

Violence, unsafe ergonomic conditions, poor patient handling, excessive workload, exposure to hazardous materials, and vulnerability to transmissible infections are among the most common and preventable risks for workplace safety. Seventy-five percent of yearly workplace assaults occur in healthcare, but only 30% of nurses and 26% of emergency department physicians report incidences. Better work environments and decreased patient-to-nurse ratios on medical-surgical units are associated with higher odds of patient survival after an in-hospital cardiac arrest (IHCA). These results add to a large body of literature suggesting that outcomes are better when nurses have a more reasonable workload and work in good hospital work environments. Improving nurse working conditions holds promise for improving survival following an IHCA.

The Cost:

Prioritizing a safe work environment lowers the cost of occupational harm, which is associated with 2% of healthcare spending, and reduces patient harm, which is associated with 12% of healthcare spending. It has been estimated that, per nurse, the cost of turnover, a key indicator of workplace safety, is $16,600 in Australia, $10,100 in Canada, and $33,000 in the US. Other direct costs include litigation, time off, lawsuits, and various indirect costs due to impacts on patient safety, team effectiveness, and morale. In the US alone, workers’ compensation results in a loss of $2 billion for hospitals annually. A Health Affairs survey showed that hospitals in which the workplace environment improved also improved by 15% on the percentage of nurses reporting excellent quality of care, by 16% on reported job satisfaction, and by 12% on burnout.

The Solution:

Hospital Executives can establish workplace safety initiatives and allocate necessary resources so that the management team can ensure the following:

  1. Ensure those on the frontline have a copy and have read an organizational “Healthcare Worker Rights and Responsibilities” and “Ethical Code of Conduct” that outline minimum standards for worker respect and safety. Outline what the “ideal workplace” looks like, describe the expected behaviors of all members of staff to uphold the organizational values, and align workplace safety goals with patient safety goals.
  2. Limit entrances to the hospital at night.
  3. Require ID check for visitors to the hospital.
  4. Consider metal detectors.
  5. Consider armed hospital security guards throughout the hospital system.
  6. Establish a clear code of conduct for all employees and stakeholders and for those who report concerns (“whistleblowers”).
Patient & Families

These are steps that patients and family members can take to help healthcare facilities address workplace safety concerns: 

Workplace safety and violence prevention are the responsibility of everyone in the healthcare setting. Healthcare workers have been trained and educated on workplace safety protocols and violence prevention mechanisms.

Patient and Family members can help maintain a safe environment by;

  1. Not leaving tripping hazards in
  2. Asking for help from healthcare professionals when needed.
  3. Using devices to prevent falls and
  4. Expecting mutual
  5. Engaging in active listening and two-way
  6. Engaging in open discussion to ensure expectations for treatment and pain control are
  7. Discussing patient rights and responsibilities with the care team
Resources

Andersen J, et al. Systematic literature review on the effects of occupational safety and health (OSH) interventions at the workplace. (2019)
https://www.jstor.org/stable/26677613?seq=1

Appelbaum P. Regulating Workplace Safety in Psychiatric Facilities. (2023)
https://ps.psychiatryonline.org/doi/10.1176/appi.ps.20230036

Brossoit R, et al. The effects of sleep on workplace cognitive failure and safety. (2019)
https://psycnet.apa.org/fulltext/2018-60899-001.html

CDC. (2019). Healthcare Workers.
https://www.cdc.gov/niosh/topics/healthcare/default.html

Government of Canada, C. C. for O. H. and S. (2020). CCOHS: Health and Safety Report – Past Issues.
https://www.ccohs.ca/newsletters/hsreport/ issues/2015/09/ezine.html

Hammer L, et al. Exploration of the impact of organisational context on a workplace safety and health intervention. (2019)
https://www.tandfonline.com/doi/abs/10.1080/02678373.2018.1496159

Hazard Prevention and Control | Occupational Safety and Health Administration. (2019). Osha.Gov.
https://www.osha.gov/shpguidelines/hazard-prevention.html 

IAEA (2020). A Harmonized Safety Culture Model. International Atomic Energy Agency working document.
https://www.iaea.org/sites/default/files/20/05/harmonization_05_05_2020-final_002.pdf

Joint Commission (2018). Developing a reporting culture: learning from close calls and hazardous conditions. Sentinel Event Alert Issue 60, December 2018.
https://www.jointcommission.org/-/media/tjc/documents/resources/patient-safety-topics/sentinel-event/sea_60_reporting_culture_final.pdf?db=web&hash=5AB072026CAAF4711FCDC343701B0159&hash=5AB072026CAAF4711FCDC343701B0159

Li L, et al. Recreational Marijuana Legalization and Workplace Injuries Among Younger Workers. (2024)
https://jamanetwork.com/journals/jama-health-forum/fullarticle/2815242

McGhan G, et al. Variations in Workplace Safety Climate Perceptions and Outcomes Across Healthcare Provider Positions. (2020)
https://journals.lww.com/jhmonline/fulltext/2020/06000/variations_in_workplace_safety_climate_perceptions.9.aspx

Raveel, A., et al. Interventions to prevent aggression against doctors: a systematic review. BMJ Open, 9(9), e028465. (2019)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6756459/

Woodward, S. Implementing Patient Safety: Addressing culture, conditions, and values to help people work safely. (2020).
https://www.routledge.com/Implementing-Patient-Safety-Addressing-Culture-Conditions-and-Values-to-Help-People-Work-Safely/Woodward/p/book/9780815376859