The burden and cost of poor patient safety, a leading cause of death in the United States, has been well-documented and is now a major focus for most healthcare institutions. Less well-known is the elevated incidence of work-related injury and illness among healthcare workers (HCWs) that occurs in the work setting, and the impacts these injuries and illnesses have on the workers, their families, healthcare institutions, and ultimately on patient safety. It is not surprising that patient and worker safety often go hand-in-hand and share organizational safety culture as their foundation.
With the publication of the Institute of Medicine (IOM) seminal public health report in 1999, To Err is Human: Building a Safer Health Care System1, patient safety, or “quality of care” became a national priority. The IOM committee stated its belief that a safer environment for patients would also be a safer environment for workers and vice versa, because both are tied to many of the same underlying cultural and systemic issues. Hazards to HCWs because of lapses in infection control, fatigue, or faulty equipment may result in injury or illness not only to workers but also to patients and others in the institution. Workers who are concerned for their safety or physical or psychological health in a work environment in which their safety and health is not perceived as a priority, will not be able to provide error-free care to patients. The report emphasized the pivotal role of system failures and the benefits of a strong safety culture in the prevention of such errors. Therefore, efforts to reduce the rate of medical error must be linked with efforts to prevent work-related injury and illness if they are to be successful.
Several studies have found organizational factors to be the most significant predictor of safe work behaviors. Studies have shown compliance with standard precautions was increased when workers felt that their institution had a strong commitment to safety and when institutions targeted interventions at improving organizational support for employee health and safety. Also, safety culture has an important influence on implementation of training skills and knowledge.
The lack of a safety culture as a contributing factor to HCW noncompliance with recommended infection control guidance is not a newly recognized problem. The Centers for Disease Control and Prevention’s Healthcare Infection Control Practices Advisory Committee has noted that “several hospital-based studies have linked measures of safety culture with both employee adherence to safe practices and reduced exposures to blood and body fluids.”2 They noted that organizational characteristics, including safety culture, influence healthcare personnel adherence to recommended infection control practices and, therefore, are important factors in preventing transmission of infectious agents. The 1999 IOM report noted that a safety culture is created through:
1) The actions management takes to improve both patient and worker safety;
2) Worker participation in safety planning;
3) The availability of appropriate protective equipment;
4) The influence of group norms regarding acceptable safety practices
5) The organization’s socialization process for new personnel.