Work safety: Freedom from harm, disrespect

‘These are not sentimental notions.’

Seeking joy and meaning in work might seem like a stretch for a workforce that tops other sectors for back strain, workplace violence and stress-related disorders. But creating a workplace that is respectful and engaging also results in improved patient and worker safety, a roundtable of experts in patient and worker safety recently concluded.

“These are not sentimental notions,” says Julianne M. Morath, RN, MS, Chief Quality and Safety Officer at Vanderbilt University Medical Center in Nashville, TN, and a member the Lucian Leape Institute of the National Patient Safety Foundation, which convened the roundtable. “Meaning is the sense of importance of an action. Joy is ... the feeling of success and satisfaction as a result of the meaningful action. Workforce safety is the physical and psychological freedom from harm and disrespect.

“The costs of inaction of addressing the culture and conditions in which people are working in health care are significant,” she says, citing high rates of burnout, turnover and medical errors in health care.

Through the Eyes of the Workforce: Creating Joy, Meaning and Safer Health Care offers seven recommendations for creating more effective organizations. Key strategies: Develop core values of respect, work to eliminate workplace harm, and create a high-reliability organization that constantly seeks improvement. (See box, below.)

“Organizations are either habitually excellent or they’re not,” said Paul O’Neill, former chairman and CEO of Alcoa and former U.S. Secretary of the Treasury, in a webinar on the report. He is also a member of the Lucian Leape Institute.

The institute is known for actively promoting its findings and for getting the attention of hospital leadership on efforts to improve quality, says Sandy Shea, policy director of the Committee of Interns and Residents/SEIU Healthcare, which sponsored the report.

“It’s potentially a game-changer,” says Shea. “They really want to move the needle on reducing medical errors.”

The report details the current risks to health care workers of physical and psychological harm, including high rates of musculoskeletal injuries, needlesticks, and emotional abuse and bullying. Yet it calls worker safety “a quality indicator for the culture of the organization — the culture that provides the critical context for achieving patient safety.”

O’Neill, a powerful public speaker, already has projected his view that health care employers need to make a stronger commitment to preventing injuries.

“The injury rates for people in health and medical care are unbelievably high,” he said. “I think it basically says, unfortunately, leadership in health and medical care organizations don’t really believe the sentiment they espouse about people being our most important asset.

“I believe that workforce safety needs to be a pre-condition, never a priority. The word priority suggests that priorities could change,” he said.

[Editor’s note: The report, Through the Eyes of the Workforce: Creating Joy, Meaning and Safer Health Care, is available at]

The Lucian Leape Institute report is the latest to link quality patient care to worker safety. The Joint Commission recently issued a monograph detailing “high-reliability” organizations and the importance of an overall culture of safety. (See HEH, January 2013, p.1.)

The path to joy and meaning in HC

Through the Eyes of the Workforce, a new report from the Lucian Leape Institute of the National Patient Safety Foundation, offers these recommendations for improving the culture of safety at hospitals:

Strategy 1: Develop and embody shared core values of mutual respect and civility; transparency and truth telling; safety of all workers and patients; and alignment and accountability from the boardroom through the front lines.

Strategy 2: Adopt the explicit aim to eliminate harm to the workforce and to patients.

Strategy 3: Commit to creating a high-reliability organization (HRO) and demonstrate the discipline to achieve highly reliable performance. This will require creating a learning and improvement system and adopting evidence-based management skills for reliability.

Strategy 4: Create a learning and improvement system.

Strategy 5: Establish data capture, database, and performance metrics for accountability and improvement.

Strategy 6: Recognize and celebrate the work and accomplishments of the workforce, regularly and with high visibility.

Strategy 7: Support industry-wide research to design and conduct studies that will explore issues and conditions in health care that are harming our workforce and our patients.