Patient Safety

Bringing joy and meaning to work may sound like a lofty aspiration. But if your workplace is lacking these things, it's more than dreary—it’s also dangerous, according to the Lucian Leape Institute at the National Patient Safety Foundation.

Start with the fact that health care itself is dangerous. The institute’s March 2013 report on workplace injuries in health care, “Through the Eyes of the Workforce: Creating Joy, Meaning and Safer Health Care,” noted that:

• Health care workforce injuries are 30 times higher than other industries
• More work days are lost due to occupational illness and injury in health care than in such industries as mining, machinery, manufacturing and construction
• Seventy-six percent of nurses in a national survey said unsafe working conditions interfere with the delivery of care
• An RN or MD has a five to six times higher risk of being assaulted than a city cab driver
• Emotional abuse, bullying, threats and learning by humiliation often are accepted as “normal” conditions of the health care workplace

These conditions are harmful to patients, caregivers and the organization, according to the report:

“Workplace safety is inextricably linked to patient safety. Unless caregivers are given the protection, respect, and support they need, they are more likely to make errors, fail to follow safe practices, and not work well in teams.”

Role of leaders

The authors conclude, “The basic precondition of a safe workplace is the protection of the physical and psychological safety of the workforce.”

Physical and psychological safety is also a precondition to “reconnecting health care workers to the meaning and joy that drew them to health care originally,” said Lucian Leape Institute President Diane Pinakiewicz, at Kaiser Permanente’s second annual Workplace Safety Summit February 12.

“These preconditions enable employers to pursue excellence and continuous learning,” she said. “The purposeful maintenance of these preconditions is the primary role of leadership and governance.”

Systemic causes of harm

While pointed in their assessments, Pinakiewicz and the report’s authors refrain from finger-pointing. Pinakiewicz outlined systemic organizational stresses that work against workforce and patient safety. These include:

• People feeling overwhelmed (58 percent of workers surveyed by the American Society of Professionals in Patient Safety cited overwork as an issue)
• The volume of non-value adding work
• Workforce safety and patient safety being managed separately and non-systemically
• Operating pressures exacerbating traditional behavioral norms

The report identifies several “exemplar organizations,” including the Mayo Clinic, Virginia Mason Medical Center, Kaiser Permanente and the Coalition of Kaiser Permanente Unions, that are working to “create cultures of safety and respect.” KP’s 2012 National Agreement provisions for workforce total health and interest-based problem solving are cited as contributors to that culture.

Seven strategies for improvement

The Lucian Leape Institute offers seven strategies for improving safety and restoring joy and meaning to the health care workplace:

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.
2. Adopt the explicit aim to eliminate harm to the workforce and to patients.
3. Commit to creating a high-reliability organization and demonstrate the discipline to achieve highly reliable performance.
4. Create a learning and improvement system.
5. Establish data capture, database and performance metrics for accountability and improvement.
6. Recognize and celebrate the work and accomplishments of the workforce, regularly and with high visibility.
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.

“Through the Eyes of the Workforce: Creating Joy, Meaning and Safer Health Care” is available online from the Lucian Leape Institute at the National Patient Safety Foundation.

Cutting waste and saving money for Kaiser Permanente members and patients is good. But 350 Environmental Service workers in Southern California are taking that mission a step further by tending to Mother Earth as well.

Kaiser Permanente and two Labor Management Partnership-funded workforce development trusts are among the health care partners nationwide that are training frontline workers and managers in improved recycling, waste disposal, energy conservation and other green practices. The U.S. Department of Labor and the Healthcare Career Advancement Program, a national partnership of unions and hospitals, are leading the effort.

“‘Carbon footprint’ is a phrase that’s thrown around a lot,” says Milford “Leroy” Alaman, EVS operations manager at the Los Angeles Medical Center. “Now our staff is able to understand that when you are talking about conserving energy, water and electricity, you are talking about looking at the resources we have in our facility and holding on to just what we need instead of creating more waste for us and the planet.”

Leading change at work

Along the way, these “green teams” also are reducing operating costs, enhancing employee skills and morale, and improving patient and workplace safety. 

For example, the EVS department is now using environmentally friendly microfiber mops to clean a single patient room. This has the benefit of not spreading infections between rooms and preventing lifting and straining injuries caused by wringing traditional mops and hauling buckets of water.

The department also has started a project that is reducing the cost and trouble of replacing the 500 D-cell batteries used in the hospital restrooms’ automatic towel dispensers. The traditional batteries wore out in a matter of weeks—costing about $3,000 a year to replace and adding some 6,000 batteries a year to local waste or reprocessing streams. Starting in February 2012, workers installed new rechargeable batteries. Overall, EVS' green projects, including the use of rechargeable batteries, are saving an estimated $12,000 a year.

Enhancing skills, raising sights

“I feel better having conversations with anyone…doctors, nurses, I can tell them how to be green,” says EVS attendant Jose Velasco, an SEIU UHW member and a recent graduate of a green certification course offered at West Los Angeles Community College.

The program also was piloted at KP Riverside Medical Center, where the EVS unit-based team is reaching out to others with its newfound expertise. Now an EVS member is embedded with the Operating Room UBT—with others to follow—to help tackle waste and hygiene problems there.

The SEIU UHW-West & Joint Employer Education Fund and the Ben Hudnall Memorial Trust have helped underwrite the cost of the training for Kaiser Permanente’s LMP-represented workers. Eventually, frontline workers may be able to use their certifications for higher pay and promotions as medical center “green leads,” a program that would be negotiated between KP and the unions.

But the training already is making a difference to workers as well as to KP and the community. “They have more tools, more knowledge, so they are able to catch things,” says Angel Pacheco, management co-lead of the EVS UBT at Riverside. “We talked about saving the environment for future generations.”