A new report by some of the nation’s leading patient safety advocates shows strong support for the healthcare workforce, saying protecting patients must begin with protecting their caregivers.

“The tactics recommended in the report would support developing strong employee health and occupational health programs within hospitals and, in fact, in all healthcare settings,” says Sanjay Saint, MD, MPH, a member of the report committee and chief of medicine at the VA Ann Arbor (MI) Healthcare System.

The National Patient Safety Foundation (NPSF) convened an expert panel to create the recently released report,“Free from Harm: Accelerating Patient Safety Improvement Fifteen Years after To Err Is Human.”1

The report emphasizes that “workforce safety, morale, and wellness are absolutely necessary to providing safe care. … Such support should include attention to both physical harm (e.g., physical injury, violence in the workplace, stress-related illness) and emotional harm (e.g., disrespectful behavior, intimidation, and verbal abuse).”

The report specifically recommends that the healthcare setting adopt initiatives to improve working conditions by establishing the following:

  • an environment of respect;
  • programs to support staff and improve resiliency;
  • fatigue management systems;
  • communications, apology, and resolution programs.

“As background, the panel members reviewed much of the literature, including a report from the NPSF Lucian Leape Institute, which focused on workforce safety and emphasized that we cannot achieve patient safety without providing a safe environment for healthcare workers,” Saint says. “Workforce safety encompasses physical, psychological, and emotional safety. One example of how directly this can be tied to patient safety is by providing necessary resources to counter burnout, which contributes to safety lapses.”

Noting that workforce safety is a precondition to patient safety, the report recommends healthcare settings “expand or develop resources that support the workforce.” That would seem to certainly suggest support for employee health and occupational health programs in hospitals. However, somewhat surprisingly in the wake of Ebola, the infectious disease threat to healthcare workers is not underscored in the report.

“The report focuses broadly on workforce safety,” Saint says. “Although outlining specific clinical guidelines is beyond the scope of the report, I would say the threat of infectious and communicable disease falls within the report’s recommendations for strong training and resources, be that personal protective equipment and the training to use it effectively, or other resources. The panel also suggests involving the workforce in identifying areas for measurement and focus.”

Again, this goes beyond hospitals, as a recent study2 shows nurses in ambulatory settings largely falling short of following all standard precautions to protect themselves from bloodborne pathogens, he says.

“We need to know why it is that any particular nurse would not do this — is it because of a time crunch, lack of resources, lack of education, or another reason?” Saint says. “The answer may not be the same for every institution, or every unit within the same institution.”

In grim statistics that will be all too familiar to employee health professionals, the report noted that healthcare workers suffer almost twice the rate of injury and illnesses as private industry as a whole. Other observations in the report include the following:

  • In terms of days lost from work due to injury, hospitals are among the most hazardous job sites in the U.S.
  • Healthcare workers are at risk for physical injuries on the job, sometimes inflicted by violent patients or families.
  • Bullying behavior among healthcare professionals has direct effects on workforce safety and patient safety. Many organizations do not address disrespectful behavior decisively; too often, individuals in roles of power or influence are not corrected or reprimanded when they intimidate others.
  • Healthcare workers who are bullied may be intimidated from speaking out when they observe safety violations or failures to complete safety-related tasks. Healthcare organizations should take steps to eliminate bullying behavior and address the security of the workforce.
  • Professional burnout is common. About half of physicians in primary care and some specialties report symptoms of burnout.

“Pockets of awareness” about workforce support are emerging, as research increases and the importance of finding “joy” at work is recognized.

“The important role of joy and meaning in work for patient care outcomes was not widely recognized 15 years ago; its acknowledgement as a valid topic for research, and its discussion represents progress,” the report states.

To find joy and meaning in their daily work, each employee should be able to affirmatively answer the following three questions each day, according to the report:

  • Am I treated with dignity and respect by everyone?
  • Do I have what I need so I can make a contribution that gives meaning to my life?
  • Am I recognized and thanked for what I do?

Organizations must adopt modern quality improvement tools and methods and train all professionals in safety culture and implementation science throughout their career trajectory. Providing the knowledge and skills to improve safety may improve job satisfaction, engagement, resilience, and patient safety, the panel concluded. Overall, the report calls for the establishment of a total systems approach and a culture of safety, and calls for action by government, regulators, health professionals, and others to place higher priority on patient safety science and implementation.

In addition to supporting the workforce the report makes the following seven recommendations:

  • ensure that leaders establish and sustain a safety culture,
  • create centralized and coordinated oversight of patient safety,
  • create a common set of safety metrics that reflect meaningful outcomes,
  • increase funding for research in patient safety and implementation science,
  • address safety across the entire care continuum,
  • partner with patients and families for the safest care, and
  • ensure that technology is safe and optimized to improve patient safety.


  1. National Patient Safety Foundation. Free from Harm: Accelerating Patient Safety Improvement Fifteen Years after To Err Is Human. National Patient Safety Foundation, Boston, MA; 2015.
  2. Powers D, Armellino D, Dolansky M, et al. Factors influencing nurse compliance with standard precautions. AJIC 2016;44:(1)4–7.