Interaction of Health Care Worker Health and Safety and Patient Health and Safety in the US Health Care System

Abstract

Since the publication of the Institute of Medicine's groundbreaking report To Err is Human in 2000,1 patient safety has become a key health care issue, driving decision-making and policy formulation in virtually every sector of the health care system. In 2008, Berwick stated that the US health care system could only be improved if it focused on three aims: (1) improving the experience of patient care; (2) improving the health of populations; and (3) reducing per capita costs of health care.2 More recently, a new topic has begun to emerge: the health and safety of those who deliver health care—from physicians and nurses to administrative and service personnel—and how that can impact the health and safety of patients. It is becoming clear that workers in this high stress, demanding sector are themselves prone to a wide variety of health risks, ranging from musculoskeletal issues to depression and burnout. This burnout and dissatisfaction among health care workers compromises the goals of the triple aim. Therefore, there is a need to expand the triple aim into the quadruple aim, which includes the goal of improving the work life and well-being of health care providers.3 In the midst of these factors, health care leaders have begun to recognize the irony that the very places charged with addressing patient safety—America's hospitals, care clinics, and medical offices—face significant health and safety challenges of their own. For example, the incidence rate of total recordable injuries and illnesses for private hospitals and residential care facilities was 7.7 and 8.8 per 100 full time workers in 2007, respectively, as compared with 4.2 for private industry overall.4 There is growing agreement that the health and safety of patients is inextricably linked to the health and safety of those who care for them.5,6 Without a safe and healthy work environment for the millions of individuals who provide care for and support the needs of patients, the core goal of ensuring patient safety is placed at risk. Healthy and safe health care workers are more likely to provide care that leads to optimized patient health and safety. Striving to address this fundamental obstacle to the provision of true patient safety requires a new way of thinking about, and talking about, the health care workplace. It requires a new vision and a culture shift in which health care employers put a new emphasis on ensuring the health and safety of their own workers as well as addressing issues of patient safety. It requires striving to achieve greater parity of resources, alignment of workplace incentives, commitment from health care organizations and standard-setting bodies, and a new focus on accountability for healthy and safe employee environments, beginning with senior leadership. At the heart of this vision is a new and emerging concept of health care worker safety and wellness—a concept that includes a wide spectrum of components that contribute to an optimally functioning health care worker—physical and psychological safety, enhanced individual health, and the creation of well-designed, supportive working environments. The end goal is to create places where it is just as safe to work as it is to receive care. Healthy and safe workers are the gateway to healthy and safe patients. Thought leaders are beginning to construct models that promote this new vision for health worker safety and wellness. BACKGROUND To explore these ideas, the American College of Occupational and Environmental Medicine (ACOEM) and Underwriters Laboratories Integrated Health & Safety Institute (UL IHSI) hosted a Summit on the Interaction of Health Care Worker Health and Safety on Patient Health and Safety in the US Health Care System in July 2016 at ACOEM Headquarters in Elk Grove, IL. Summit participants were health executives and safety professionals from a variety of health care systems and organizations (see Acknowledgments). The purpose and goals of the Summit were to: explore the evidence linking worker health and safety with patient health and safety; develop a series of recommendations on how best to integrate worker and patient health and safety programs; examine potential means of evaluating the effectiveness of these programs, with results to include quality, satisfaction, and cost metrics for employee/patient health and safety that will improve over time; and promote implementation and dissemination of the best and most effective practices. To help achieve these ends, Summit participants reviewed programs from leading US health institutions that are working to improve the health and safety of their employees in an effort to create environments that are more conducive to patient safety and improved health outcomes. SCOPE OF ISSUES For centuries, health care culture has been patient-centered, while physician and nurse training has historically de-emphasized self-care. “Resources are primarily allocated to meet the needs of patients and medical technology, often leaving the safety of staff and quality of work-life issues unaddressed.”7 However, more recently, ethicists have begun calling out the imperative that health care providers must care for themselves.8 Historically, health care organizations have tended to silo safety activities for workers and patients into separate functional areas, in part because the fields of occupational health and patient safety developed independently at different points in time. While occupational health and safety considerations have a long history dating to Hippocrates, the field of patient safety is still relatively young.9 Researchers and experts are now coming to understand that many of the same characteristics of the environment of care and active errors that contribute to unsafe worker conditions and practices also contribute to adverse events for patients. For example, researchers have shown that the same underlying organizational factors that contribute to worker injuries, such as high job demands, workloads, and understaffing, combined with low social support and teamwork and a weak safety culture, also contribute to patient falls.10 Yet the traditional silo approach to patient and worker safety continues, leading to duplication of effort, confusion, missed opportunities, and unintended consequences, despite evidence that integrating patient and worker safety activities could help health care organizations to sustain and improve safety practice and outcomes.11 In the meantime, the extent of issues occurring within the silos that separate patient health and safety and health care worker health and safety is significant. Patient Safety It is difficult to obtain reliable estimates of patient safety-related adverse events and error rates because of the variation in definitions, sources, and methodologies for measurement.12,13 Early estimates for the annual number of premature deaths due to medical error include the oft-cited numbers of 44,000 to 98,000.1 A recent estimate suggests errors contribute to over 400,000 deaths per year.14 A 2016 analysis suggests medical error should be considered the third leading cause of death in the United States,15 although experts have concluded that there is still no agreed upon national rate.16 Since most errors do not result in death, the number of errors is surely many times the number of deaths. This number is subject to the same limitations as estimating death rates due to variation in definitions and methodologies. Commonly reported national estimates of hospital-acquired conditions from 2013 include 1,320,000 adverse drug events, 290,000 catheter-associated urinary tract infections, 9200 central line-associated blood stream infections, 240,000 falls, 77,000 obstetric adverse events, 1,060,000 pressure ulcers, 79,000 surgical site infections, 37,000 ventilator-associated pneumonias, 23,000 postoperative venous thromboembolisms, and 822,000 other hospital-acquired conditions.17 Interestingly, one of the most prominent conceptual models for measuring errors in the patient safety literature is the systems engineering initiative for patient safety (SEIPS) model of work system and patient safety.18 This sociotechnical system approach integrates macro-ergonomic and human factors engineering domains to evaluate the impact of health care work systems and processes on quality and patient safety. It has been suggested that improvements in patient safety have been slowed by inadequate integration of human factors and ergonomics principles into improvement initiatives.19 Health Care Worker Health and Safety According to the US Bureau of Labor Statistics, health care occupations and industries are expected to have the fastest employment growth and will add the most jobs between 2014 and 2024.20 Health care workers deal with occupational health and safety hazards, putting them at risk for musculoskeletal disorders, infectious diseases, and mental Health care is now the most work in the United with to The and rate in hospitals the rate for private industry as a and it is also the rates in and In the US Occupational Safety and Health has health care work in a emphasis that focused on of that with patient safety, and Patient issues other industries have emerging infectious have to high death rates for health care workers for patients with of these such as and In health care workers experience depression the of depression for physicians is at the of among care nurses is to and A recent that of physicians and of physicians for with health among health care workers include work pressure at of in social of and staff and long and between work and of these factors impact the psychological well-being of workers while patient among physicians has also from a rate of in to in is with medical and It also results in physicians leaving the Health care professionals at risk in and do not to provide quality The American nurses in to understand their health and safety in their work environments, to hazards, and in conditions the in The health and safety by nurses the same of and and musculoskeletal an have from to a reported compared with OF The issues in the health and safety of patients and the health and safety of health care workers are and to for is it to create workplace programs that address them in This was a core at the with participants that a key potential is points of between the safety of patients in health care facilities and the workers who staff those Summit participants a wide of factors in health care that can impact the safety of patients and health care workers the Safety of and recent have been that were at these and other points of between patient and health care worker safety. not to be a literature the address components of this of the between health care worker psychological and patient safety that more of the reviewed the concept that well-being and burnout are with patient safety in the expected A of into the of occupational well-being on the quality of patient care reported of occupational well-being with patient satisfaction, patient to and of patient reported for occupational well-being in to of patient care. no between occupational well-being and patient health outcomes. 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