In the season of annual reviews and employee engagement surveys, one question that should absolutely be on your list is "Does your employer make efforts to ensure your physical and psychological safety at work?"
Employee safety is a precise pulse point to check for the health of an organization's culture, no matter the industry. Whether or not employees feel safe at their workplace has a direct impact on the quality of their work. In healthcare specifically, employees work in high-stress, high-stakes environments where physical and psychological harm can occur from the patients in their care, as well as the coworkers who surround them.
Most hospital and healthcare executives do not make employee psychological and physical safety a top priority, according to a recent report from the National Patient Safety Foundation.
"Workforce injuries are often not visible to, or a top priority of, CEOs and other hospital leaders. At the same time, leaders are often unaware of or ill equipped to manage disruptive behavior," reads the report.
The cost of not correcting employee safety is increasing by 1% annually according to a 2012 Aon Global Risk Consulting Health Care Workers' Compensation Barometer report. In 2013, Aon projects that healthcare systems across the nation will experience an annual loss rate of $.79 per $100 of payroll, which will continue to increase 1% annually.
The NPSF's report on healthcare workforce safety cites a survey conducted by the NPSF's American Society of Professionals in Patient Safety, which found that only 16.5% of those surveyed reported that workforce safety was a focus in their organization's quality and safety initiatives. Meanwhile, when asked if there is a link between workforce safety and patient safety, 99% agreed.
The report was the result of a similarly titled NPSF roundtable discussion of hospital and health system executives last year. Gary S. Kaplan, MD, FACP, FACMPE, FACPE, the chairman and CEO of the Virginia Mason Health System in Seattle, WA, was a part of that discussion and building the report.
The health system was highlighted specifically in the NPSF report for its culture, which emphasizes workplace and employee safety through mutual respect.
In a phone conversation with Kaplan, we discussed how Virginia Mason's adoption and implementation of Toyota's Lean Process improvement model in 2002, which the health system tailored for healthcare, known as the Virginia Mason Production System, has shifted the culture from physician-centered to patient-centered.
Kaplan says this shift to a culture of mutual respect is imperative for transforming not only patient safety, but employee safety as well.
"In many healthcare organizations, staff are not treated with respect—or, worse yet, they are routinely treated with disrespect," reads the NPSF report. "Emotional abuse, bullying, and even threats of physical assault and learning by humiliation are all often accepted as 'normal' conditions of the health care workplace, creating a culture of fear and intimidation that saps joy and meaning from work."
The journey to patient-centered care and building a culture of mutual respect at Virginia Mason began in the early 2000s. "We had many elements of the traditional, hierarchical culture that exists and is so prevalent, even today, in medicine—with doctors at the very top of the hierarchy. I used to be very proud to say that we were a physician-driven organization," says Kaplan.
"But we were really coming to understand the importance of change, and I realized that unless we really examined kind of the old deal, and really sat down and made a compact of new expectations together, we would not be able to move forward."
The Institute of Medicine's 1999 report, To Err is Human: Building a Safer Health Care System, had just come out, which established patient safety as a national priority and broke down that a safer healthcare workplace translates to improved patient safety.
"It was apparent to us that we needed to really examine some of the deeply rooted assumptions that had been imbedded particularly with physicians over the decade, and how they needed to change if we were to really become a safer, and stronger organization," says Kaplan.
Shortly after Kaplan became CEO in 2000, he appointed a committee of front-line physicians to work on putting together a "physician compact"—a mutual understanding between the physicians and the organization about expectations and obligations.
These physician compacts specifically addressed an emphasis on collaboration and teamwork as a direct line to patient-centered, quality care. Its elements are still being used actively 12 years later. The compact idea expanded to executive and even board member levels. Each group has its own compact with the organization, all highlighting similar themes of collaboration, mutual respect, and making explicit the expectations of mutual obligations.
"I think that one of the reasons that there's not a lot of joy and meaning at work in places is that expectations are not aligned," says Kaplan. "People come into organizations and into their careers with certain expectations and they may, particularly in healthcare say, 'Gee this is what I signed up for?'"
Virginia Mason pursued Toyota's Lean Process improvement and then eventually created its own specialized model, dubbed the Virginia Mason Production System. Kaplan says this model, which is based on transparency, wouldn't work in a hierarchical culture.
"The Virginia Mason Production System is predicated on process improvement and a deep respect for our people," says Kaplan. "It's all about people closest to the work having the most valid approach, and therefore being in the best position to redesign the work, and so it really empowers front-line staff… it's very much about creating a new kind of environment and leveling the hierarchy."
"Structuring to people's personality or catering to these super humans that are immune from any criticism or feedback. That is the antithesis of what Toyota practices," says Kaplan.
"The costs of burnout, litigation, lost work hours, employee turnover, and the inability to attract newcomers to caring professions are wasteful and add to the burden of illness. Disrespectful treatment of workers increases the risk of patient injury," reads the NPSF report.
If a patient was harmed it would be swept under the rug in a physician-centered culture because it was not an open culture that embraced apology or disclosure. Kaplan says they've moved that significantly, and it's allowed Virginia Mason to make some major breakthroughs in quality, safety, and in cost. In the past five years, quality improvements have led to a 52% reduction in professional liability insurance.
"Organizations have all kinds of initiatives, like flavors-of-the-month sort of approaches to improve quality, safety, or efficiency, but they do these without addressing the fundamental, prevailing culture, and without focusing on what that means to the people on the front lines of delivering care," says Kaplan.
"I would encourage others take a look at one's culture and what is it that we need to do more of to be safer and improve the environment so our staff can do their very best work. You have to get back to why we went into healthcare in the first place, and that's to deliver the very best care for our patients."
Chelsea Rice is an associate editor for HealthLeaders Media.
