The Essential Elements of a Staff Safety Program

Occupational safety products and policies that protect workers’ physical and psychological well-being can achieve “total system safety.”

Are employees kept free from harm because they work in a place that has a culture that places a high value on safety, or because a facility buys products with all the latest bells and whistles?

The answer, of course, is both, and organizations are increasingly improving the tools they provide their teams as well as making the atmosphere less prone to physical and psychological harm and more respectful overall. Put together, such facilities are well-positioned to achieve what is known as “total system safety,” according to Shannon Davila, MSN, RN, CPPS, CPHQ, CIC, FAPIC, who is — not coincidentally — director of total systems safety at ECRI, an independent nonprofit in Plymouth Meeting, Pa., whose mission is to improve safety, quality and cost-effectiveness in all healthcare settings.

“The term ‘culture of safety’ has been used a lot in the last 25 years, and while it’s a good term, it’s not one thing that is a silver bullet that’s going to bring great success,” says Ms. Davila.

“It’s really more of an outcome that includes leaders investing in the right technology and creating an environment that is physically and psychologically safe for your team members and your patients.

“The results of that will be a culture of safety that will include improved efficiencies and better outcomes for your patients.”

To get to their total-systems-safety destination, facilities must install an enterprise safety model that includes the following components.

Have a safety event reporting system in place. Staff need an anonymous, voluntary way to share information with leaders when they recognize something took place in a way it shouldn’t have, or witnessed a near miss that was prevented when someone stepped in to address it. In addition to implementing a way to collect this kind of information from staff, the process also inherently makes staff feel they are part of the solution by allowing them to share their safety concerns.

Importantly, staff should know that speaking up isn’t just for patient safety issues. Managers and other leaders should encourage staff members to alert them when they see things that aren’t safe for staff, too.

“If you’ve noticed an electrical cord that is a trip hazard, speak up! Tell somebody if you notice a piece of equipment that is starting to fray or crack,” says Ms. Davila. “We want team members to know they have the ability to do this.”

SPEAK UP! Don’t fall into the trap of thinking that reporting of safety issues is only for a patient’s benefit. The concept applies to staff safety as well.

Have a feedback process in place. When a staff member says the names of two medications are so similar that they almost administered the wrong one to a patient, or if they told a manager about an overly worn piece of equipment, they need to be told what was done about it.

“After taking the information and learning the root cause of the problem, leaders should thank the team member for coming forward and explain what changes were made to prevent a recurrence,” says Ms. Davila. “Closing the loop in this fashion really makes staff feel they are part of the solution.” Failing to do so will likely result in future reports about problems from staff. If a team member tells a manager three times about a tripping hazard or a piece of equipment that doesn’t get taken out of service, that employee will become frustrated and will perceive the inaction as indifference. “It’s all about the follow through, and things that could put healthcare workers at risk are as important as patient safety issues,” she says.

Engage patients and families as part of the solution. Rather than focusing exclusively on measuring the patient’s experience, follow-ups should also include an attempt to understand if they felt their care was delivered in a safe manner.

“Bringing the patients and families into the conversation is really important, in addition to engaging the team members,” says Ms. Davila. “When leaders show they’re listening to everyone and they’re acting on what they’re hearing, a culture of safety really begins to develop.”

The same principles apply when purchasing technology and equipment. Buying the right devices and supplies should always be done with patient outcomes in mind, of course. But those outcomes are achieved by the end users of the products — your team members — so their wants and needs should be your primary pre-purchase considerations.

“Make sure you provide your team members with equipment that is going to work for them,” says Ms. Davila. “Because if it doesn’t work for the clinicians, I’ll guarantee you they’ll make it work for them by creating workarounds, which are generally not safe. Trust me, nurses are like little engineers and will figure out a way to make something work in ways that work for them.”

For example, focusing on value should not be the top priority when choosing which kinds of gowns, gloves, masks, booties and other personal protective equipment to procure. “This equipment should be bought with meeting the needs of the end user in mind, not the price,” says Ms. Davila. “If a facility is buying gowns that tear easily, I promise you the team members will figure out a way to either double-gown, which means you’ll be wasting money in the long run, or they’re just not going to use the product, which puts their own physical safety at risk.”

When it comes to sharps safety issues such as needlesticks and other injuries, there should be more to a safety program than simply buying disposal receptacles.

“Really assess the environment,” says Ms. Davila. “Ensure that you are providing easy access to people so they can get to those containers. If the environment is messy, or if the lighting is poor, healthcare providers are put at a much greater risk of getting injured.” These injuries can create numerous inefficiencies, such as case delays, that create risks for the organization.

From an ergonomic standpoint, organizations should invest in equipment that allows patients to be transferred from the OR to the PACU in a safe manner. These devices should be designed to prevent injuries to both staff and patients.

“If team members see that leadership is investing a lot of money in marketing but skimping with technology that really doesn’t work for them, that is going to create a team of frustrated members who don’t trust the decisions that are being made,” says Ms. Davila.

Help is available. There are professionals who specialize in human factors engineering and systems design who can help with these kinds of purchases. “We’re seeing more and more health systems investing in people who are trained to design work systems in ways that reduce harm to staff and patients,” says Ms. Davila. “Thinking really systematically about the environment keeps team members safe. Not doing so creates safety risks, which can impact your bottom line because you can’t care for patients optimally and generate revenue.”

Strike the right balance. The equipment component keeps staff safe from an occupational safety perspective. A speak-up culture makes workplaces psychologically safe. Facilities also must protect their teams from physical violence, potentially from an upset patient. They also need to monitor coworkers’ behavior for things such as bullying, verbal abuse, discrimination and microaggressions. “If leadership does not find the balance between creating that physically and psychologically safe environment, that can be toxic, as can the perception that the bottom line is more of a priority than safety,” says Ms. Davila. “I think there is a balance in which you can design the workflow so it is still efficient and you’re able to maximize time, get patients through, have really good outcomes for your patients, but also engage your team members so they know they are really part of that process and part of a safety-management system.”

SELF CARE Getting a good night’s sleep and staying hydrated can be the difference between choosing a safe patient-transport method or a risky one.

Employees should focus on their own wellness. Studies have shown that perioperative nurses often engage in at-risk behaviors such as overreaching, working in awkward positions and lifting while bending and twisting. Even though there are often remedies available to minimize these behaviors, fatigued workers often don’t make the best decisions.

“I started my career as a critical-care nurse, and while I know this can be easier said than done, getting eight hours of sleep each night and staying hydrated during shifts is the best preventative medicine,” says Ms. Davila. “I was definitely more tired during those 12-hour shifts on days that I didn’t get a lot of sleep the night before and ran my tail off without drinking enough water.”

Fatigue can be one of the biggest enemies in a perioperative environment because people can become overwhelmed when they’re tired. “We can make decisions that perhaps we wouldn’t have made if we had felt better,” says Ms. Davila. “If I’m tired, I may decide to move a patient myself instead of waiting for a transport person to come to help me.”

Safety culture’s first cousin. A “just culture” goes hand-in-hand with a culture of safety. But what exactly is it? As Ms. Davila explains, it’s not a blame-free culture. Rather, it’s creating an environment in which all people are treated with respect.

Staff members who make mistakes should be treated in fair and accountable ways. Their decisions should be reviewed to determine whether it was human error or something closer to making a poor choice that led to risky behavior.

“And team members who report these things should never fear that they’ll be punished for speaking up and sharing their concerns,” she says. OSM