Improving Patient and Worker Safety - Joint …

1 Improving Patient and Worker SafetyOpportunities for Synergy, Collaboration and InnovationImproving Patient and Worker SafetyOpportunities for Synergy, Collaboration and InnovationHealth care professionals whose focus is on Patient Safety are very familiar with thesealarming and frequently cited statistics from the Institute of Medicine: medical errorsresult in the death of between 44,000 and 98,000 patients every year. health care profes-sionals whose focus is on occupational health and Safety , however, are likely aware ofadditional statistics that are less well known: health care workers experience some of thehighest rates of nonfatal occupational illness and injury exceeding even constructionand manufacturing do these statistics tell us about Safety for both patients and workers in the healthcare environment? Is there a connection between Worker Safety and Patient Safety ?

2 Arethere synergies between the efforts to improve Patient Safety and efforts to improve work-er Safety ? How can improvement efforts be coordinated for the benefit of all?This monograph is intended to stimulate greater awareness of the potential synergiesbetween Patient and Worker health and Safety activities. Using actual case studies, itdescribes a range of topic areas and settings in which opportunities exist to improvepatient Safety and Worker health and Safety activities. This monograph is designed tobridge Safety -related concepts and topics that are often siloed within the specific disci-plines of Patient Safety /quality improvement and occupational health and monograph includes information about the following: High reliability in health care organizations and benefits to Improving Safety forboth patients and workers Management principles, strategies, and tools that advance Patient and Worker safe-ty and contribute to high reliability Specific case examples of activities and interventions to improve Safety Key themes and action steps to meet challenges and achieve successThis monograph was developed in collaboration with the National Institute forOccupational Safety and health (NIOSH), National Occupational Research Agenda(NORA)

3 Healthcare and Social Assistance Sector Council and supported in part by acontract from this Joint Commission MissionThe mission of The Joint Commission is to continuouslyimprove health care for the public, in collaboration with otherstakeholders, by evaluating health care organizations andinspiring them to excel in providing safe and effective care ofthe highest quality and monograph was developed under a project supported inpart by the National Institute for Occupational Safety andHealth (NIOSH), National Occupational Research Agenda(NORA), Healthcare and Social Assistance Sector Program,under contract no. 212-2010-M-35609. The goal of the proj-ect is to stimulate greater awareness of the potential syner-gies between Patient and Worker health and Safety monograph is designed to introduce concepts and topicsbut is not intended to be a comprehensive source of all rele-vant information relating to Patient and Worker Safety topicsand resources in health care settings.

4 The monograph is notdesigned to provide guidance on compliance with OSHA reg-ulations, state legislative requirements, or Joint Commissionstandards. Readers should refer to the source documentslisting requirements from the respective organizations forguidance on compliance issues. Similarly, recommendationsfor practice described herein should not be construed as pol-icy or practice recommendations from The Joint many suggestions and recommendations arederived from literature and consensus, they should not nec-essarily be considered evidence-based because of the limitedamount of rigorous research in this content and recommendations are solely the responsi-bility of the Joint Commission project staff and others whocontributed material. We have worked to ensure that thismonograph contains useful information, but this monographis not intended to be a comprehensive source of all rele-vant information.

5 In addition, because the information con-tained herein is derived from many sources, The JointCommission cannot guarantee that the information is com-pletely accurate or error-free. The Joint Commission is notresponsible for any claims or losses arising from the useof, or from any errors or omissions in, this monograph. 2012 The Joint CommissionPermission to reproduce this guide for noncommercial, edu-cational purposes with displays of attribution is granted. Forother requests regarding permission to reprint, please callHasina Hafiz at in the USA 5 4 3 2 1 Suggested citationThe Joint Commission. Improving Patient and Worker Safety :Opportunities for Synergy, Collaboration and Innovation. Oakbrook Terrace, IL: The Joint Commission, Nov more information about The Joint Commission, pleasevisit Commission Project StaffBarbara Braun, PhDProject DirectorDepartment of health Services ResearchDivision of Healthcare Quality EvaluationAnnette Riehle, RN, MSNP roject Consultant, WriterDepartment of health Services ResearchDivision of Healthcare Quality EvaluationKris DonofrioProject CoordinatorDivision of Healthcare Quality EvaluationHasina Hafiz, MPHR esearch AssociateDepartment of health Services ResearchDivision of Healthcare Quality EvaluationJerod M.

6 Loeb, PhDExecutive Vice PresidentDivision of Healthcare Quality EvaluationJoint Commission ResourcesEditorial and Production SupportKristine M. Miller, MFAE xecutive EditorDepartment of Publications and Education ResourcesChristine Wyllie, MASenior Project Manager, ProductionDepartment of Publications and Education ResourcesiiiContentsFront matter (Disclaimer, Acknowledgements, List of Expert Advisors, and Project Team)..ii, M. Schyve, MD, Senior Advisor, Healthcare Improvement, The Joint CommissionIntroduction ..1 Monograph parameters ..2 Target audience ..2 Roundtable project overview ..2 References ..3 Chapter 1: High Reliability in health Care Organizations and Benefits to Improving Safety for Both patients and Workers .. What is a high reliability organization? .. High reliability in health care .. The importance of a Safety culture .. Why high reliability requires attention to both Patient and Worker Safety .

7 Potential benefits to Improving Safety for patients , staff, and organizations and return on investment (ROI) considerations ..11 Case Study 1-1: Building a high reliability culture for patients and health care workers: St. Vincent s Medical Center, Bridgeport, ..18 Resources 1-1: Examples of Safety culture surveys ..19 Resources 1-2: Resources related to models for demonstrating value ..22 Chapter 2:Management Principles, Strategies, and Tools That Advance Patient and Worker Safety and Contribute to High Reliability .. Safety management systems: common elements for workers and Civility in the Study 2-1: US Department of Veterans Affairs: Building a culture of civility in the workplace civility, respect, and engagement in the Hierarchy of controls: example of a framework for interventions to prevent harm .. Human factors and safer design.

8 Human Ergonomics .. Safer design of work processes .. Preventing harm through safer design of the built environment .. Improving performance through incident reporting and feedback systems ..40 Improving Patient and Worker Safety : Opportunities for Synergy, Collaboration and InnovationResources 2-1: Human factors and safer Sources for outcome data on Worker and Patient Safety .. Incident surveillance, reporting, analysis, and Examples of injury and illness tracking systems for workers and Selected strategies and tools for Improving Safety .. Leadership strategies .. Tell real stories .. Conduct leadership rounds ..48 Case Study 2-2: Duke Home Care: Focusing on Safety in home care the Director Safety Rounds Management strategies to support staff engagement in Improving Patient and Worker Safety .. Provide training, time and resources.

9 Recognize or reward all efforts .. Utilize frontline Safety coaches, champions, and unit peer leaders .. Analyze feedback and findings from Patient and Worker satisfaction surveys to identify opportunities for improvement .. Tools to enhance communication .. Daily Phrase to signal concern and demand attention .. Teach back or repeat back .. Situation-Background-Assessment-Recommen dation (SBAR) communication and Tools for risk or hazard identification and adverse event or incident analysis .. Failure modes and effects analysis (FMEA) .. Fault tree Tracer methodology for Safety Root cause analysis (RCA)..53 References ..54 Resources 2-2: General resources on leadership and work environment ..59 Chapter 3: Specific Examples of Activities and Interventions to Improve Musculoskeletal injuries and accidents .. Safe Patient Impact on patients and workers.

10 Examples of 3-1: Safe Patient Study 3-1: Lancaster: Voluntary Protection Program: Commitment to bariatric Patient Safety ..68 Case Study 3-2: Intermountain Healthcare: An integrated employee and Patient safe handling program .. Slip, Trip, and Fall .. Impact on workers and patients .. Examples of 3-2: Slips, trips, and Study 3-3: Kaiser Permanente: Simple steps improve Safety a slip, trip, fall (STF) prevention measure .. Sharps injuries and infection transmission .. Sharps injuries and bloodborne pathogen Impact on patients and workers .. Examples of Safe injection practices: The CDC s One and Only Preventing transmission of infectious diseases ..80 Resources 3-3: Sharps Impact on patients and workers .. Examples of Exposure to hazardous substances .. Hazardous drugs, chemicals, and other substances ..84 Resources 3-4: Prevent infection Impact on patients and workers.