Focused Efforts Advance Workforce Safety at Sharp HealthCare

Added on Apr 20, 2018

Focused Efforts Advance Workforce Safety at Sharp HealthCare
By Audrey Doyle

At Sharp HealthCare, the guiding principle of “first, do no harm” applies not only to its patients, but also to its workforce.

As a testament to this, the health care delivery system has staff and resources geared specifically toward workforce safety. For example, a multidisciplinary Employee Safety action team conducts cause analyses of injuries incurred by Sharp’s staff of more than 18,000 employees, and then develops ways to prevent future occurrences. In addition, two injury specialists and an analyst are on staff to provide the action team and leadership with deep insights into why, where and how often the injuries occurred, among other valuable metrics.

These efforts, implemented as part of Sharp’s High Reliability Organization initiative, have contributed to a 16% decrease in the number of OSHA-recordable claims systemwide from 2014 through 2017. Based on the number of claims submitted in the first quarter of this year, Sharp predicts an additional 6% decrease by the end of 2018.

“One of our safety goals is to attain zero harm to employees and physicians,” said Anne Davis, vice president of Workforce Support Services at Sharp. “By giving workforce safety as strong a focus as patient safety, we’re putting that goal within reach.”

Injury Trends Lead to Targeted Improvements

Based in San Diego, Sharp HealthCare is a nonprofit, integrated, regional health care delivery system comprising four acute care hospitals, three specialty hospitals, two affiliated medical groups and a health plan subsidiary. In 2001, the system launched a performance improvement initiative known as The Sharp Experience to advance the overall experience for its employees, physicians, patients and families and become the best place to work, practice medicine and receive care. Over the years, Sharp’s commitment to purposeful experience design, leadership development and process improvement has delivered several positive outcomes, including an increase in net revenue and substantial improvements in patients’ satisfaction with Sharp’s delivery of health care.

In 2016, Sharp began working with Press Ganey’s HPI safety consultants to establish and maintain a culture of safety and High Reliability that would make Sharp the safest place to work, practice medicine and receive care. As part of that effort, Sharp started work toward becoming a High Reliability Organization, formed a High Reliability steering committee to lead its safety strategy, and began putting together systemwide action teams to define and develop actions to address perceived gaps in safety.

The Employee Safety action team is among the more recent offshoots of those efforts. The action team is led by a core group of leaders and managers, including Davis, and consists of five subcommittees, each one focused on what HPI determined to be one of Sharp’s top five categories of workforce injury: safe patient mobilization, workplace violence, slips and falls, blood and body fluid exposure, and repetitive motion injury. The subcommittees meet once a month, review the injuries that occurred in their category and determine where to focus improvement efforts.

According to Davis, the action team works with the analyst to provide the subcommittees with detailed data on injury trends so that the subcommittees can develop highly targeted improvement strategies. For example, based on blood and body fluid exposure data indicating the type of injury occurring most often, the skill set incurring the injury, and the hospital where the injuries were taking place, the blood and body fluids subcommittee developed training programs to reeducate nurses at one of Sharp’s hospitals on consistently deploying safety locks on syringes and needles to eliminate needlestick injuries. This subcommittee also ensured that face shields are readily available at all points of care so that the staff consistently protect their face, mouth, nose and eyes from exposure to potentially infectious materials.

Taking the value of injury trends even further, the action team classifies workforce injuries incurred during patient mobilization tasks with specific codes that identify what the workers were doing when their injury occurred. As Davis explained, the California Division of Occupational Safety and Health (Cal/OSHA) requires every hospital in the state to establish a plan to protect health care workers from back and musculoskeletal injuries while also protecting patients. The plan must include a safe patient handling policy requiring use of a powered patient transfer device, lifting device, or lift team, as appropriate.

According to Davis, Sharp has had a safe patient handling policy in place systemwide for years. “But there are some things that powered patient lifting and transferring equipment doesn’t help with, like positioning patients in bed, which is an entirely manual effort,” she said.

“The curse of the nurse is a back injury,” she added. “We’re preventing our staff from being harmed by focusing more intently on exactly what’s causing these back injuries.”

To do this, the action team assigned a code to each patient mobilization task. If a nurse or other employee sustains a back injury while pulling a patient toward the head of the bed, for example, the event gets one code; if the injury occurred during a side-to-side patient turn, it gets another code. Because the action team ascribed a different code to each cause, they can give the safe patient mobilization subcommittee data that more accurately identify the actual cause of the injury.

Consequently, the subcommittee can identify and recommend remediation, such as retraining on proper maneuvering techniques, to prevent that specific injury from recurring. “For example,” said Davis, “we recently determined that, at one particular site, 60% of back injuries occurred during side-to-side bed turns, so the subcommittee is drilling into that—observing how nurses there are doing it now, and making recommendations for repositioning techniques that will prevent these injuries in the future.”

According to Davis, one type of back injury where the safe patient mobilization subcommittee has achieved notable success is back strain, which decreased approximately 13% from 2016 to 2017. Based on the number of OSHA-recordable claims submitted in the first quarter of this year, Sharp predicts a 22% decrease in back strain injuries from 2017 to the end of 2018.

Davis noted that one reason back strain injuries have dropped systemwide is because the action team and analyst track claims by employee discipline (RNs; technicians and specialists; aides and orderlies; licensed vocational nurses), causal factor (pushing/pulling; lifting; twisting; reaching; prolonged activity such as holding/pushing), and hospital or entity, which ensures that the improvement recommendations are highly targeted.

“Another reason is that we stay on top of the findings,” she stressed. “If the employee was hurt because of employee drift, for example, we make sure the employee is retrained on back strain prevention techniques.”

Making department leaders aware of injuries incurred among their staff members is also integral to Sharp’s workforce safety efforts. Toward that end, Sharp’s injury specialists have been providing the action team and department leaders with valuable metrics, such as the number of days without a workforce injury and the total case incidence rate (TCIR) for each department.

The first department the injury specialists worked with was Corporate Services, where a lot of computer work is performed and a lot of repetitive motion injuries were occurring. “Although we’d conducted a number of ergonomic evaluations and made recommendations, we learned that employees were drifting away from them instead of following them consistently,” Davis said. “So we trained the department leaders to work with their staff to adhere to the recommendations.” According to Davis, repetitive motion injuries decreased 62% from 2014 to the first quarter of 2018, and based on Q1 figures, they’re predicted to decrease 27% from Q2 2018 to the end of the year.

At press time, the injury specialists were completing a pilot program at one of Sharp’s hospitals. “The injury specialists are giving the hospital’s COO injury trend data on the claims they’re investigating, and we’re sending reports to the department leaders with recommendations,” Davis said. The reports include analyses comparing Sharp’s TCIR to the TCIR of other hospitals in the state, as well as additional metrics such as the average cost per claim. The recommendations will be made to the affected employees, and the hospital’s safety officers will follow up to ensure that action items are addressed. The pilot is scheduled to end in June, after which the program will be expanded to the other facilities in the system.

The Challenge of Addressing Workplace Violence

Of Sharp’s top five categories of workforce injury, workplace violence has been the most challenging to address, primarily because it’s often unexpected and unpredictable. The key, Davis said, has been to ensure that employees and physicians know the proper techniques for de-escalating an aggressive patient or family member, such as maintaining eye contact with them, speaking in a clear and calm voice, being attentive, and exhibiting a nonthreatening, relaxed, open posture. In addition, the action team investigates each injury to identify environmental risk factors that contributed to the event, such as lamps and IV poles that were used as weapons or lack of a sitter or security guard.

Sharp’s efforts in this area are relatively new. “Cal/OSHA only began requiring that hospitals in California report workplace violence incidents in July 2017, so we haven’t made huge changes in the environment yet,” Davis said. “But we have made sure our emergency departments and behavioral health units—the areas where we see most of our workplace violence—do’t have movable objects, and we’re quicker to put a sitter or security guard with a combative or aggressive person than we’ve been in the past.”

According to Davis, reducing workforce injury has provided Sharp with important benefits. “The obvious one is that it’s kept our employees and physicians safe, which we consider to be our duty as a health care organization,” she said.

“But the other part of that duty is to keep our patients safe,” she added. “By reducing the need to replace an injured employee with a temporary worker who doesn’t know our organization or its policies and procedures, we’ve reduced associated safety risks for our patients.”

This, she concluded, advances The Sharp Experience by making Sharp the best and safest place to work, practice medicine and receive care.