OSHA, JCAHO join forces to monitor employee health

Joint effort means closer watch on workplace safety

In an effort to shrink rising occupational illness and injury rates among health care workers, the federal government is forming an unprecedented partnership with the private organization that accredits U.S. hospitals and other health care institutions, a move that will result in closer scrutiny of compliance with federal regulations for employee health and safety.

The U.S. Occupational Safety and Health Administration (OSHA) in Washington, DC, and the Joint Commission on Accreditation of Health-care Organizations (JCAHO) in Oakbrook Terrace, IL, recently joined forces to launch a project that will give Joint Commission surveyors the knowledge and ability to ensure that hospitals are complying with government standards for HCW safety during their regularly scheduled inspections.

The partnership between the two standard-setting giants — one a private entity whose primary focus has been patient-related issues, the other a government regulatory agency focusing on worker safety — is "a logical and significant alliance to assure a safe and healthful environment for those who give and for those who receive care," says Joseph A. Dear, the U.S. Department of Labor’s assistant secretary of labor for occupational safety and health. "Underscoring this partnership is the realization that the care environment is also a work environment."

OSHA spokesman Stephen Gaskill says the agency initiated the collaboration because of rising illness and injury rates among HCWs. The U.S. Bureau of Labor Statistics nonfatal occupational injury and illness incidence rates show that in 1994, 11.4 out of every 100 hospital workers and 16.6 out of every 100 nursing and personal care facilities workers became injured or ill, with a total of 12.5 of those requiring restricted work activity in addition to days lost from work. The numbers represent the highest rates among health care organizations nationwide.

"Health care is such a growing industry, and given that the Joint Commission is such a prominent presence in health care, it made sense to work with them," Gaskill says. "We each have our own specific standards, but often they are in sync or very close. Obviously they can’t be exactly the same because the organizations each have separate charges and separate missions. They’re not the government, and we are."

While the JCAHO routinely surveys hospitals and other health care institutions according to a three-year accreditation cycle, OSHA inspections take place only in response to worker complaints. According to Gaskill, given the number of OSHA inspectors, the number of workplaces, and the number of workers they represent, it would take OSHA about 70 years to complete an inspection cycle of all sites. The partnership allows JCAHO surveyors to inspect for compliance with OSHA regulations at the same time they are checking for compliance with JCAHO standards, without the need for an employee complaint.

"This is one way of making it more likely that an organization will be up to OSHA compliance standards," he says. "When the Joint Commission issues its guidelines every year, health care organizations will know that by being in compliance with what is in that guide, they are also likely to be in compliance with OSHA guidelines."

Gaskill cautions, however, that just because a hospital is in compliance with JCAHO guidelines does not necessarily mean it is in compliance with OSHA regulations. "We’re trying to match the two. What the Joint Commission is looking for to accredit [a hospital] might not be all that OSHA is looking for in terms of workplace safety. This just makes it more likely. Essentially, the Joint Commission is now looking more at worker safety and health when it goes in to accredit," he says.

The JCAHO’s new responsibilities do not require surveyors to report any OSHA violations to the government. Instead, the Joint Commission will regard the problem as an "educational opportunity," says Carole Patterson, deputy director of the JCAHO’s department of standards.

Joint Commission surveyors have been undergoing intensive training to learn how to recognize potential OSHA compliance issues related to employee safety and health hazards in health care organizations, Patterson notes. If violations are found, the JCAHO is more likely to provide "education and consultation" than is the government agency.

"We’ve been looking at these areas before but we just didn’t call it employee health. We called it the management of human resources, within which are a lot of issues related to employee health," she says. "OSHA sought us out to enter into this educational partnership to see if the approach would make a difference in health care worker illness and injury rates. They don’t have the manpower or resources to do routine surveys of everybody. Now we have more information available to us than we had before. We are more familiar with the letter of the law, and we are going to be interpreting that in an educational arena to the people we accredit."

In addition to staff cross-training, the partnership will include two other initiatives: cataloging and evaluating potentially duplicative compliance activities, and developing a series of collaborative publications and education programs. Initially, the JCAHO is releasing an information sheet describing its OSHA compliance activities. (See editor’s note at end of article.) The JCAHO 1997 accreditation manual, available at subscribing health care facilities, provides examples of how to meet both JCAHO and OSHA requirements. Check the manual’s index under "OSHA." (One example from the 1997 manual is provided above.)

Despite the new partnership, Patterson says the Joint Commission’s activities will not change radically.

"Are we going to survey for OSHA? The answer is no; we have our own standards. If there’s a problem with worker safety, we have standards we can cite that under right now. We may not have been as sensitive to the OSHA side of it before, so now we can provide education saying that when [a hospital] is not in compliance with our standards, there may be an issue related to OSHA, too," she says.

The OSHA-JCAHO partnership begins Jan. 1, 1997, and will be evaluated after three years to determine its effect on accredited organizations.

[Editor’s note: For a copy of the JCAHO’s information sheet on meeting OSHA standards, contact the JCAHO, 1 Renaissance Blvd., Oakbrook Terrace, IL 60181-4813. Telephone: (708) 916-5635.]