High-injury hospitals get warning from OSHA

Prevention program keeps VA off the list

Hospitals with higher-than-average injury rates once again are coming under the spotlight as the U.S. Occupational Safety and Health Administration (OSHA) launches its targeted inspection program. Fifty-six hospitals have received letters advising them that they have rates above eight lost workday injuries or illnesses per 100 full-time workers. Those with rates of 14 or higher will receive unannounced, wall-to-wall inspections.

OSHA reviews the lost workday injury rates of about 1,000 hospitals each year, and keeps on its list those hospitals previously surveyed that had a rate of seven or higher. That means the pool of hospitals in the targeted inspection program will grow somewhat each year, a senior OSHA official says.

One group of hospitals has been notably missing from the list: The Veterans’ Health Administration (VHA) maintains 163 hospitals nationwide, but not one has injury rates high enough to attract an OSHA warning. In fact, in 1999, the VHA had just 2.3 lost time cases per 100 employees, the consequence of a Veterans Affairs (VA) focus on reducing accidents and spreading best practices from its low-injury hospitals. The VA has created "a cultural shift where occupational safety and health becomes the core value, where people think about safety and health as a part of their job rather than a program goal they have to meet," says Arnold Bierenbaum, MS, CCE, director of safety and technical services at the VHA in Washington, DC.

The payoff comes not just in healthier workers, but in lower costs, says Bierenbaum. Despite rising medical costs, the VA’s workers’ compensation dropped from $142 million in 1994 to $138 million in 1999. "We’ve been able to show management we’ve been able to hold the line on costs by making investments in [safety]," he says. Bierenbaum offers these areas as among the most important elements of an effective health and safety program:

• Have an organizational structure that directly connects occupational safety and health with top management. "The CEO of the hospital should have the occupational safety and health function directly accountable to him or her. That would be my recommendation," he says. In a VA reorganization, Bierenbaum began reporting to the assistant deputy undersecretary for health, who is the direct supervisor of the VHA’s 22 network directors. Each network director supervises the CEOs of hospitals and clinics in his or her region.

Previously, Bierenbaum had reported to the director of facilities. "[The network directors] were given specific performance measures in occupational safety and health, and they have to report on the progress they’re making toward those goals quarterly," he says. For example, the network directors have specific targets for lowering accident rates. They also select an occupational safety and health initiative to implement networkwide. Successful projects are shared with other networks.

• Maintain a database to analyze injury trends. The VHA is developing a national database to track accidents and injuries. While some VA hospitals had used databases to collect information on needlesticks, this system will be much more extensive, says Bierenbaum. "This database will be able to tell you where an accident occurred, the time of day, what shift, where the employee was working," he says. "If we have shift problems, we’ll be able to see that. If we have a service or function within a hospital that has a high accident rate, we’ll be able to look at that. We’ll be able to search and sort and analyze these accidents at a number of different levels."

The goal is to find common elements and to use the information to prevent accidents. "Anytime there’s a lost-time accident or an accident with medical costs, once this is implemented, the accident review board will be required to do a cause analysis to find out what the cause of the accident was," says Bierenbaum. (For more information on accident review, see Hospital Employee Health, June 2001, p. 66.)

• Work as a team with other safety professionals. Bierenbaum says the VA is building a "community of practice," made up of the main "stakeholders" in the effort to improve worker safety. They include safety and occupational health professionals, workers’ compensation, unions, and top management. "They all share a common goal of wanting more money for patient care and lowering their costs," he says. "You’ve now formed a common cause for collaboration. That’s been hard to come by, but we’re getting there. If employee health tries to work alone, [it] won’t succeed," he says. "If safety works alone, [it] won’t succeed. If workers’ comp works alone, [it] won’t succeed. But together, they will succeed."

The teams help develop best practices and policies, he says. The VHA also has compiled guidebooks with sample policies that can be used by its hospitals; the CD-ROMs are available for purchase by private sector hospitals, as well. (See editor’s note at the end of this article for more information.)

• Involve the unions in planning and implementing the safety program. "One way we ensure there’s quality control is to train and empower the unions," says Bierenbaum. "In some management quarters, that sounds like heresy. But the truth of the matter is the unions are . . . out there in every workplace. They know what’s going on."

The union participates on the local management teams for safety and health, Bierenbaum says. It is involved not just in accident evaluation and prevention, but in related areas, such as software development, he says. That doesn’t mean the union has the ultimate power. "We don’t seek its approval for everything; we seek its input," says Bierenbaum. "If [it has] good ideas, we use them. If [it doesn’t], we don’t."

Involving the union pays off in better accident prevention. But it also means union negotiations are much smoother. "It takes more time on the front end, but overall you save time," he says. "Plus you get a good program [that involves] the front-end workers."

[Editor’s note: To obtain VA Occupational Safety and Health guidebooks, contact Nancy Adams, Center for Engineering, Occupational Safety & Health. Telephone: (314) 543-6711.]