OSHA to hospitals: Do the right thing by making worker safety a priority
But will a 'bully pulpit' work without bully power?
While there is no national standard requiring safe patient handling, the U.S. Occupational Safety and Health Administration is making an all-out appeal to hospitals to do the right thing — and to recognize the potential cost-savings.
OSHA launched an extensive website (www.osha.gov/hospitals) that focuses primarily on the No. 1 source of injury at the nation's hospitals with self-assessment tools and checklists, sample safe patient handling policies, and training and evaluation documents. OSHA also provides "best practice" case studies of hospitals that have reduced injuries and workers' compensation costs.
"These materials highlight hospitals that embraced a culture of safety that benefit both patients and workers," OSHA administrator David Michaels, MD, MPH, said in a telephone press conference.
OSHA makes the case for a greater emphasis on injury prevention, noting that "hospital work can be surprisingly dangerous." It presents bar graphs and pie charts to show that hospitals consistently report more serious injuries than other private sector employers.
The site also relies heavily on publications from a variety of organizations, such as the well-regarded "Beyond Getting Started" guide on safe patient handling from the Association of Occupational Health Professionals in Healthcare (AOHP) and the Safe Patient Handling and Mobility Interprofessional National Standards of the American Nurses Association (http://nursingworld.org/SPHM-Standards).
In fact, the quantity of information on the site can be a little overwhelming, says Dee Tyler, RN, COHN-S, FAAOHN, AOHP executive president and director of medical management for Coverys Insurance Services in Lansing, MI.
While she lauds OSHA for providing a one-stop spot for safe patient handling resources, she suggests that the site could be even more helpful with a shorter executive summary or even a PowerPoint presentation. She also would like to see one other change: "It doesn't speak to the role of the occupational health professional or occupational health nurse. They're a vital component to an effective intervention," she says.
The assessment tools on the site can help employee health professionals set priorities and make a case to hospital leadership, says Jaime Dawson, MPH, senior policy analyst at the ANA in Silver Spring, MD. "Helping the audiences assess the issue in their workplace is an important first step," she says.
OSHA boosts awareness of hazards
Will it work for OSHA to use a kind of "bully pulpit" to promote safety — without bully power? As OSHA notes on its site, other hazardous industries have made greater improvements in safety over the past two decades and construction and manufacturing are now safer than health care. Yet there are few OSHA regulations directed toward health care.
The agency takes years developing its regulations and often faces swift and stiff opposition from business interests and political opponents. An Injury and Illness Prevention Program (I2P2) standard would require employers to identify and address job hazards, similar to the "safety and health management system" OSHA recommends on the website. Michaels has called an I2P2 standard his "highest priority."
But though the agency said it would release a draft version in January 2012, two years later there is no proposed rule. OSHA's regulatory agenda from the fall of 2013 projects that a notice of proposed rule-making will be issued in September 2014.
Even in the absence of new rules, some worker advocates applaud OSHA for promoting safety in hospitals and raising the awareness about the widespread hazards.
"What they suggest is absolutely the correct way to approach safe patient handling in the workplace," says Keith Wrightson, worker safety and health advocate with Public Citizen in Washington, DC, and co-author of the report, Health Care Workers Unprotected, which details the mismatch between OSHA enforcement action and the hazards in health care. [See HEH, September 2013, p.97.]
While Wrightson says that regulations are ultimately needed to compel employers to address the hazards, he calls OSHA's compendium of facts and tools "a great first step."
It reflects a new emphasis on health care, which has the nation's fastest-growing workforce, he says. "The economy switched from being industrial to service-based and OSHA has not been able to keep pace with that," he says.
OSHA engaged The Joint Commission accrediting body to echo the importance of safe patient handling. The Joint Commission promotes the concept of "high reliability," which means an intense and comprehensive focus on safety within an organization.
"Without an established, organization-wide culture of safety, neither patients nor workers can ever truly be safe," Erin DuPree, MD, chief medical officer and vice president of The Joint Commission's Center for Transforming Healthcare, said at the OSHA press conference.
The Joint Commission has published articles about safe patient handling as part of its alliance with OSHA, but it has no standard that specifically calls for hospitals to have a safe patient handling program.
What about enforcement?
Some worker advocates are most concerned with what OSHA failed to mention in its expansive web-based materials. For example, OSHA didn't cite the role of state legislation. Nine states have regulations or laws requiring health care facilities to have a comprehensive safe patient handling program.
"They don't mention enforcement or successes from enforcement," says Mark Catlin, health and safety director for the Service Employees International Union (SEIU). "It's an unusual missing piece. To tout it as a comprehensive look and to leave that out seems unusual."
OSHA also may be getting some new scrutiny over the role of enforcement in reducing workplace violence hazards. U.S. Rep. George Miller (D-CA) and Rep. Joe Courtney (D-CT) asked the U.S. Government Accountability Office to assess "whether [OSHA] has taken sufficient steps to protect health care workers from exposure to workplace violence in health care settings" and whether a regulatory standard would provide better protection for health care workers.
Jonathan Rosen, CIH, an occupational safety and health consultant with AJ Rosen & Associates, LLC, in Albany, NY, and an advocate for workplace violence prevention, commends OSHA for its 2011 compliance directive, which guides inspectors to use the agency's general duty clause to address workplace violence hazards. The Occupational Safety and Health Act states that employers have a "general duty" to maintain a workplace free of serious recognized hazards.
Yet OSHA still needs a regulatory standard and stronger action against workplace violence, he says.
"Violence and safe patient handling are two of the leading causes of death and injury [in health care]," Rosen says. "It just doesn't make sense. Why wouldn't that be part of OSHA's standards and enforcement?"
Workplace violence is mentioned as a hazard in hospitals in the new OSHA web-based guide, but without specific tools or resources. There is little information about other hazards, such as needlesticks, slips and falls, and exposure to dangerous drugs.
"It would have been better to say this is a look at ergonomic issues in health care," says Catlin.
