Changing behavior to make safety a priority

HCWs need to know safety is priority

Lift equipment sits unused in a closet. Safety needles are deposited in a sharps container without being activated. An employee fails to put on goggles when there's a risk of a body fluid splash.

As these common problems reveal, safety devices alone can't create safety. Rather, employees must "buy-in" to the safety program and believe that safety is a priority — for their managers, CEO, and themselves.

Both research and practice have demonstrated the benefits of a focus on the safety environment as a way to improve employee compliance.

An as-yet-unpublished study of 2,000 nurses in 13 health care facilities found a link between nurse-physician collaboration and nursing management and blood and body fluid exposures, musculoskeletal disorders, and lost workday injuries. Another study of 837 nurses in 39 intensive care units at 23 hospitals around the country had similar findings.

"Across the board, it's the systems approach that is most important," says co-author Pat Stone, PhD, MPH, RN, assistant professor of nursing at Columbia University in New York City.

"When you have employees who are committed to an organization and a work environment that is healthy for the employee, then a lot of other [positive] things happen," she says. "If people aren't feeling it's a supportive environment ... they're more likely to take shortcuts."

At Mercy Medical Center-North Iowa in Mason City, lift equipment once sat idle while nurses injured themselves in patient transfers. But then the hospital decided to focus on safety, with highly visible support from the CEO, an imperative to managers, additional equipment and hiring of an ergonomist, and a marketing campaign aimed at employees.

"We decided we needed to change the climate of the hospital," says employee health nurse Jenean Wolterman, RN, BSN, MA. "You can buy all the equipment you want and people don't use it. We decided to start focusing on safety."

In 2004, the hospital had 35 injuries related to patient transfers. In 2005, there were just 17. The severity dropped as well. In 2001, the hospital had 126 lost workdays due to patient transfer injuries; in 2005, there were just 13.

"We're trying to make a difference. It's really beginning to show," says Wolterman. "People are working safer; they're beginning to understand the importance of working in a safe environment."

Prevention means fighting human nature

Why is it so hard to get employees to use the safety equipment? After all, it's their health that you're trying to safeguard.

It's partly a matter of human nature, says Robyn Gershon, MS, DrPH, an occupational health researcher who has studied the safety climate. It took time for drivers to begin wearing seat belts even after being told they would prevent injury and death, she notes. Now, seat belt use is commonplace (though not 100%). Likewise, it took time for nurses, physicians, and dentists to get used to wearing gloves.

In that context, it's more understandable that nurses don't always activate sharps safety devices or use a lift. "There are many barriers to compliance," says Gershon, who is an associate professor at the Mailman School of Public Health at Columbia University. "One of them is time constraints. One is a cost-to-benefit ratio in the health care worker's mind that somehow is putting it in the negative column."

The best solution to compliance is "to engineer [the problem] out," Gershon suggests. A ceiling lift always is in the room. A needleless system won't cause a needlestick. Or, at least, make compliance as convenient as possible. One example: Providing pocket-sized hand hygiene gels.

In some cases, the injuries reveal a problem with a product. At Tampa (FL) General Hospital, needlesticks dropped but then hit a plateau after the hospital introduced safer devices. Employee health discovered problems with stocking; they provided a manual with the Pyxis numbers next to pictures of the devices, says JoAnn Shea, MSN, ARNP, director of employee health and wellness.

They also learned that nurses were being stuck by safety butterfly devices when they tried to attach the wrong Vacutainer. The hospital purchased butterfly devices with an attached Vacutainer, Shea says.

CEO puts weight behind safety

At Mercy Medical Center-North Iowa, president and CEO James FitzPatrick made it clear that safety was a key goal for the hospital. He wanted to create a climate with safety as a job expectation. No one was to lift more than 50 pounds without the use of lift equipment.

He put some heat behind that imperative. Managers' annual incentive pay is tied to improvements in patient handling injuries. A new safe lifting policy includes possible disciplinary action for employees who repeatedly fail to use lift equipment.

But the primary focus is on support, education, and encouragement of health care workers. "[Discipline] is in the policy in case we need it, but our goal right now is to show our employees that we care about them and we're trying to work in their behalf," says Wolterman.

Using a rebate from their workers' compensation premiums, the hospital purchased new lift equipment and patient transfer devices. "We interviewed all the managers and their charge nurses and asked them to tell us what type of equipment they thought they would utilize," she says.

Nurses had an opportunity to provide feedback on equipment during a safety fair. The hospital also hired a full-time ergonomics specialist, who reviewed jobs and job tasks to determine the physical demand.

"We made a decision tree to help people determine which equipment should be used [in different circumstances]," she says. "We also made a map of where all the equipment is kept in the hospital." For example, the hospital has bariatric lifts, but they aren't available in every unit.

The hospital has implemented other measures, such as functional ability assessments at pre-placement exams and an office prototype with sample devices that enable computer-based employees to select the best chair and keyboard.

Feedback is an important component. In the monthly employee newsletter, Wolterman provides information about the type and number of injuries that have occurred. FitzPatrick also speaks about the hospital's safety record during employee forums.

Meanwhile, a "Simon Says" marketing campaign, using either a cartoon "Simon" or photos of a boy with his teddy bear, reminds employees that they need to use the safety devices.

"We're constantly putting safety issues in front of people," says Wolterman. "We're trying to maintain a focus on that."

Engaged employees are safer

Beyond safety initiatives, Mercy Medical Center has invested in wellness programs as a way to create more "engaged" employees. Engagement is "not just being satisfied with your job; it's being 100% committed to your job," says Kelly Putnam, MA, health promotion coordinator.

One nursing unit designated a room as a quiet, soothing space for stressed-out nurses. They decorated it with "healing" colors and comfortable furniture, and provided aromatherapy and soft music.

The billing department, with more than 120 employees at risk of repetitive injuries from their data entry jobs, takes a break twice a day and joins in group stretching. "They're anecdotally reporting that they have less numbness, less pain, and they love doing it," says Putnam.

The hospital measures the level of engagement among employees with a survey by Princeton, NJ-based Gallup Consulting. It asks about issues such as their relationship with their supervisor and whether they feel they have the tools they need to do their job. If employees are considering a job change, they are encouraged to look for another position within the hospital, says Putnam. "At the root of the compliance issue is engagement," she says. "If you've got an engaged work force, they're going to be compliant [with safety]."