Joint Commission: You can’t have patient safety without HCW safety

Encourage reporting of ‘near-miss’ incidents

The silos that separate patient safety and worker safety are coming down. Preventing medical errors and protecting health care workers are part of the same continuum, The Joint Commission accrediting body asserts in a new monograph.

For employee health professionals, growing recognition of the link between worker safety and patient safety may mean greater collaboration, more support from hospital leadership, and enhanced resources.

“To be a truly safe environment, you have to be safe for patients, workers and everyone who enters the facility,” says Barbara Braun, PhD, project director of the Department of Health Services Research at The Joint Commission, which is based in Oakbrook Terrace, IL.

Raising awareness of the link between patient and worker safety also is a top strategic goal of the National Occupational Research Agenda (NORA) council for Healthcare and Social Assistance. NORA brings stakeholders together to create a research framework for industry sectors for the National Institute for Occupational Safety and Health (NIOSH).

“We decided the best way to [improve occupational health in health care] was to address explicitly the interface between patient safety and worker safety,” says Eileen Storey, MD, MPH, co-chair of the Healthcare and Social Assistance NORA council and branch chief for surveillance in the NIOSH Division of Respiratory Disease Studies in Morgantown, WV.

The Joint Commission focus on worker as well as patient safety does not involve any new standards and it doesn’t change the way surveys are conducted, says Braun. But it does reflect a broadening of the approach to safety.

There are other signs of The Joint Commission’s focus. A sentinel event alert on fatigue in 2011 raised concerns about the impact of extended work hours on patient and worker safety, and in 2010 a sentinel event alert highlighted violence in hospitals. In October 2012, the EC News, an environment of care newsletter published by Joint Commission Resources Inc., wrote about using the OSHA 300 log to reduce work-related injuries and illnesses.

The nation’s hospitals should get this message, says Melissa A. McDiarmid, MD, MPH, DABT, director of the Occupational Health Program at the University of Maryland School of Medicine in Baltimore, who served as an advisor on the monograph. “The ideas of silos of safety have to now give way to systems of safety,” she says.

Be ‘deeply concerned with safety’

Health care is a high-hazard industry. And to be successful, hospitals need to be high-reliability organizations, the monograph says.

The Joint Commission explains that high-reliability organizations “are deeply concerned with safety,” integrate patient and worker safety and encourage reporting of near-miss incidents.

“High-reliability organizations are always mindful of safety issues, and from a logical standpoint it would apply to workers as well as patients,” says Braun, noting that the concept of high reliability comes from high-risk industries such as nuclear power.

In fact, high-reliability organizations are “preoccupied with failure,” the monograph says. In other words, leaders and workers are aware that adverse events can occur and they seek to learn from close calls.

The monograph highlights case studies that illustrate the benefits of an integrated safety program that includes techniques such as daily huddles to discuss incidents or hazards, safety coaches and root cause analysis of safety events or near-misses.

“There’s an increasing amount of research that shows that worker safety perception of safety culture and the work environment also has an impact on patient safety. The two are basically inseparable,” says Braun. “You cannot have patient safety without having safe workers who feel they’re operating in a culture that supports them and supports the patients simultaneously.”

Since the 1990s, when The Joint Commission began a partnership with the U.S. Occupational Safety and Health Administration, the accrediting agency has acknowledged that the “environment of care” is also an environment of work, says McDiarmid. The monograph includes a crosswalk matching Joint Commission standards with OSHA regulations, which was first developed in the 1990s.

This monograph provides a new forum for an integrated safety culture, she says. “It enlarges the audience who will appreciate the contribution that employee health can make to the wider organization,” she says.

SPH prevents falls and injuries

Safe patient handling is an example of a safety initiative that has an impact on patients and employees. In manual lifting, patients are at risk of being dropped or getting skin tears or bruises, the monograph notes.

Improved patient handling means higher quality of care, The Joint Commission says. For example, using ceiling lifts to support unsteady patients can help them ambulate while preventing patient falls. Repositioning slings also make it easier and safer to adjust patients in bed, which also can mean fewer pressure ulcers.

Seek common ground on patient,worker safety

The Joint Commission’s recent monograph on patient and worker safety offers these suggestions for integrating safety activities:

  • Build and raise awareness of linkages and cross-cutting topic areas.
  • Recognize shared health and safety risks between health care staff and patients.
  • Align patient and worker safety improvement initiatives having common goals. Consider integrating with organizational quality improvement priorities.
  • Convene multidisciplinary safety committees that include representation from patient safety, employee health, occupational/environmental safety and health, infection prevention, risk management, human resources, and other areas.
  • Examine policies for their impact (positive or negative) and unintended consequences on worker and patient safety.
  • Remove structural and functional organizational systems and processes that maintain traditional “silos” for patient and worker health and safety.
  • Develop a business case for integrating patient and worker safety initiatives; calculate a cost-benefit analysis or return on investment for specific initiatives.

The payback of safe patient handling is better patient outcomes and fewer worker injuries, says Guy Fragala, PhD, PE, CSP, CSPHP, senior adviser for ergonomics at the Patient Safety Center of Inquiry at the James A. Haley Veterans Hospital in Tampa, FL.

“This whole area of patient safety and worker safety offers us some great opportunities for cost savings without compromising quality of care,” says Fragala, who was not involved in drafting the monograph.

Yet changing practice – and changing the hospital culture – isn’t easy. “Oftentimes, safety is an after-the-fact science,” says Fragala. “Once something has gone wrong, we make great investments in change. It’s been difficult to get people to be more proactive and understand that we need to do some investment in prevention.”

The monograph outlines other hazards that affect both workers and patients, including slips and falls, sharps injuries, infectious diseases, radiation and hazardous substances.

The integration of patient and worker safety becomes even more important with the increasing health care needs of an aging population – and the greater vulnerability of an aging workforce. “NIOSH does feel this [monograph] is an extremely important development and will have an impact on a large segment of the American workforce,” says Storey.

[Editor’s note: The Joint Commission monograph, “Improving Patient and Worker Safety: Opportunities for Synergy, Collaboration and Innovation,” is available at]