Boston, MA, March 26, 2013--Health care workers are experiencing an epidemic of demoralization, fatigue, and risk of injury that threatens not only their safety, but the safety of the patients under their care. That?s the central premise of Through the Eyes of the Workforce: Creating Joy, Meaning, and Safer Health Care, the latest white paper from the Lucian Leape Institute at NPSF. During a well-attended webcast on March 19, members of the Leape Institute Roundtable that produced the paper discussed the issue and proposed pathways to improvement.
Julianne Morath, RN, MS, an internationally recognized authority on patient safety and a founding member of the Leape Institute, began the program with evidence suggesting widespread dissatisfaction with health care as a workplace. For example, 60% of those responding to a survey of physicians said they are considering leaving practice, while 37% of newly licensed nurses are thinking of leaving their jobs.
Ms. Morath noted the dual problems of physical and psychological harm. In the former category, needlestick injuries, back injuries from lifting patients, and the exposure to chemicals all place health care workers at greater risk of injury. Psychological harm is rampant, with lack of respect, lack of support, and production pressures all adding to an environment short on joy and meaning.
?People working under stress, and in the absence of psychological safety, are found to be less vigilant with regard to safety practices, both for patients and for themselves,? she said.
Workplace safety, Ms. Morath said, is a precondition for joy and meaning in work. ?These are not sentimental notions,? she added. ?The costs of inaction are significant.?
David Michaels, PhD, MPH, assistant secretary of labor for occupational safety and health, US Department of Labor, was among the presenters. He pointed out that many people are surprised to learn that health care workers experience the highest rates of injury and illness in the country. ?The same lessons that we know from manufacturing, from construction, to reduce injury and illness are the ones that can be applied to health care,? he said.
Improving the situation will require leadership commitment, robust systems of reporting and evaluating risk, and the evolution of the health care culture from one of disrespect to one of healthy teamwork.
Also speaking during yesterday?s program were Paul O?Neill, former chairman and CEO of Alcoa and the 72nd Secretary of the US Treasury, who has been involved in health and safety issues for much of his professional life, and Sandy Shea, policy director, Committee of Interns and Residents/SEIU Healthcare.
Questions posed to the panel covered a range of concerns, one being that health care organizations? primary focus is ?generating revenue.? How, then, to get leadership to understand the importance of this issue?
?It doesn?t cost more money to be respectful,? said Mr. O?Neill. ?It doesn?t cost more money to investigate things gone wrong in real time.?
In response to a concern about employees? fears of reporting, Ms. Shea suggested that managers and supervisors, ?need to model good, responsible, conscientious behavior. You have to communicate that it?s a safe environment for reporting.?
Through the Eyes of the Workforce recommends seven broad actions that organizations should pursue if they are serious about improvements in this area.
This topic is one of five transforming concepts identified by the Leape Institute as areas requiring system-level attention and action to improve patient safety. The white paper is the result of two interdisciplinary roundtables and focus groups held on the topic.
To read more or download the white paper or the webcast audio and presentation slides, click here.
If you would like to send your thoughts on this work to the Leape Institute members, visit our online comment form.
Workers who want to contact the Occupational Safety and Health Administration (OSHA) can call a toll-free number: 1-800-321-OSHA (6742); TTY 1-877-889-5627. For additional information on worker rights, people should visit the OSHA website.
Read answers to questions that did not get addressed during the webinar.
Additional questions from attendees
- Many staff members equate safety and joy with staffing levels. With increased demands and decreased reimbursement, efficient, effective staffing is always a focus. How do you balance staffing demands with the reality of health care reimbursement? Answer?
- What do you suggest to create a safe place for health workers to talk to each other about mistakes? Answer?
- For Paul ONeill?how did you bring safety to the department and how did you persuade financial people that it was a priority, worth taking a lot of time and energy? Answer?
- Does this sort of change/transformation start at the top and flow down or from the bottom up? Answer
?
Answers
1. [Paul O?Neill]: There is a big opportunity to free up staff time by streamlining the delivery process. If you want to see a major example of this, investigate the work that has been done at Thedacare in Wisconsin?it is worth the trip?major improvements in outcomes and cost reductions AND employee satisfaction..
2. [David Michaels]: Creating a workplace where discussions about hazards are not only safe, but also encouraged, is challenging. The type of change you are describing in safety culture is typical of an organization that further along in the process of implementing a safety and health management system (also called an injury and illness prevention program). The OSHA website is a good place to begin reading about how to approach this type of organizational transformation. Through our partnership with CMS, OSHA is in the process of developing additional materials targeted to implementing injury and illness prevention programs in hospitals. These materials should be available in late summer. Meanwhile, your organization could also explore the topic of high-reliability organizations as well as the Veterans Affairs CREW (Civility, Respect, and Engagement in the Workplace (CREW)) training program. Both of these programs blend well with overall efforts to address organizational safety culture.
3. [Paul O?Neill]: When I went to the treasury, [with] 120,000 employees, the injury rates (lost work day cases) were at the national average, about 30/1000 per year, while the rate at Alcoa, [with] 143,000 people in 43 countries, was 2/1000. So I said, we need to create an injury-free workplace in the U.S. Treasury. Understand, yes there are many office workers at the Treasury but there are also people at the U.S. Mint, which is basically a factory operation, and in those days the agents in Customs and the ATF (Bureau of Alcohol, Tobacco, and Firearms) [were under Treasury]. By using the same ideas I used at Alcoa we reduced the injury rate for Treasury people by 50% in 23 months. If you want to know more read chapter 4 of the Charles Duhigg book, The Power of Habit.
4. [David Michaels]: The evidence on achieving a meaningful change in organizational safety culture demonstrates that the two most important preconditions for success are management leadership and meaningful employee participation. There are many different pathways to accomplishing these preconditions, no one approach is any more valid than the other. What matters most is that these critical components have been accomplished before moving on to the more routinized aspects of finding and fixing hazards. In the new materials on implementing injury and illness prevention programs in hospitals, OSHA is highlighting the fact that our best-practice hospitals have each taken a different journey to the success they now enjoy. These materials should be available in late summer.
Copyright ??2013?National Patient Safety Foundation. All Rights Reserved.
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