Workforce Safety Panel: Empowering Caregivers to Speak Up for Safety

Added on Dec 18, 2018

By Andrea Fitzgerald, Staff Writer

teamwork (1)Speaking up for safety—whether by asking a question, challenging a decision or reporting a safety event—dramatically improves the delivery of safe, reliable care. For this reason, hospitals and health care organizations committed to fostering a culture that empowers every caregiver with the motivation and psychological safety to speak up will make substantial progress toward High Reliability.

As discussed in Part I of this seven-part blog series, health care organizations face many obstacles on their journey to becoming High Reliability Organizations (HROs). A lack of training, strategic data and leadership visibility were identified as particularly formidable by Donna Cheek, safety ​expert and former nurse executive; Don Goble, safety ​expert with ​experience in naval and commercial nuclear power; Julie Samuelson, RN, patient experience ​expert with more than 40 years of health care experience; and Rob Douglass, safety ​expert and former commanding officer with experience in the nuclear naval and commercial energy industries. Among the steps for moving forward outlined by these Press Ganey experts during a recent roundtable discussion is making workforce safety a strategic priority, which requires aggressively removing barriers and detractions from reporting or speaking up about unsafe practices resulting in errors and harm.

To help begin this process, we asked the group to identify those barriers and explain how health care organizations can protect the physical and psychological safety of patients, families and caregivers.

Q: What is preventing health care organizations from motivating their workforces to consistently speak up about deviations from safety protocols and standards of behavior?

Donna Cheek: To begin, there is often a lack of recognition of deviations. Identifying and uprooting unsafe practices that have become cultural norms is difficult work, both for health care organizations that have recently turned their focus to workforce safety and for those that have already made significant progress in workforce safety and injury prevention. This is because doing so requires every individual in the organization to consistently evaluate and, if necessary, change their processes. It is not a “one and done” activity. I know from my own nursing experience at the bedside that changing the way you pull a patient up in bed to incorporate safe patient handling interventions is an ongoing challenge that requires mindfulness and self-correction. Another formidable obstacle is the power differential or peer pressure between colleagues that may emerge when one caregiver wants to take the time to incorporate the safe handling practice while a more senior caregiver chooses to forego it to save time. The less-tenured caregiver may not speak up out of fear of retribution.

Don Goble: These issues—fear of retribution, flawed processes and many others—boil down to culture. Speaking up must be a core value in health care organizations, not just a nice-to-do or add-on, so that every caregiver understands it is an obligation owed to their patients and each other. There has been success in some areas of health care with this objective. Take glove use, for example. If we asked caregivers to put their bare hands in a blood product, they would be appalled. But we haven’t made the same progress with standardizing safety behaviors that prevent sharps injuries or splash exposures. To me, this highlights a need for providing caregivers with more safety training. When we talk to caregivers about what they believe constitutes employee harm during our diagnostic assessments, they often cite parking lot safety events or assaults, but these represent only a fraction of the harm that occurs. Furthermore, there is often a perception that safety applies only to the patient, and therefore, caregivers have to sacrifice themselves for the good of the patient when necessary. Organizations must help their workforces understand more comprehensively what employee harm is and how to fix it, and that safety in health care means protecting everyone, not just patients.

Julie Samuelson: Leadership can advance this effort through clear communication with staff. Much like we connect the “why” to actions for our patients—for instance, explaining that we want them to use the call button instead of trying to get up on their own to reduce their risk of falling or another injury—leaders must articulate the why behind what they’re asking their teammates to do. For example, instead of simply directing caregivers to use a lift or slide sheet to reposition a patient in the bed, leaders should explain that doing so protects the caregiver and the patient and is consistent with the goal of providing the safest environment possible. If leaders are having those types of conversations, then their teams are much more likely to feel safe and encouraged to raise concerns when they recognize an unsafe condition or practice.

Rob Douglass: If leaders are successful in establishing this culture of openness and demonstrating that they want to hear from their teams, then they will have to share what they learned and how they are responding to feedback. Let’s suppose leaders discover that caregivers are handling patients on their own, at the risk of back injury, because they want to save time for themselves and their colleagues. They could use this feedback as an opportunity to reeducate and validate staff safety training and assess whether they have enough lifts and other equipment to provide for and protect both patients and caregivers. In short, leadership must foster a culture of speaking up and taking action.

This is Part II in a seven-part series on making the health care workplace a safe and highly reliable environment for patients and caregivers. Part I identified deficiencies in data, education and investments in workforce safety as top obstacles for health care organizations to overcome on their journey to Zero Harm. Part III hones in on information that executives need in order to advance workplace safety and the pursuit of a fair and just culture. Part IV takes a closer look at the CEO’s role in an organization’s High Reliability journey. Part V discusses ways in which measurement and reporting can inform and inspire every member of the workforce to reduce harm. Part VI explores the ways leaders can support and empower occupational nursing staff to sustain the organization’s safety culture. Part VII will conclude the series with reflections and advice from the panelists to those in health care considering the commitment to a highly reliable workforce.