The Best Ways to Keep Hospital Patients Safe

If you're a hospital leader, the safety of your patients and of your employees might be keeping you up at night. That's because senior management is accountable for creating and maintaining a safe environment for hospital staff and patients.

And you're right to be concerned. Research has shown that the demands and complexity of work in a healthcare setting have a significant impact on workplace safety, and the risks that patients face are strongly related to safety events that employees suffer. What's also true is that employee engagement -- the extent to which a workplace meets employees' needs in 12 critical areas -- plays a significant role in mitigating employee accidents on the job.

Gallup -- in partnership with Loma Linda University Medical Center (LLUMC) -- has discovered key evidence that shows how employee safety and employee engagement work together to enhance a safe environment for healthcare consumers. This interdependent relationship points to a powerful new way to address patient safety. It gives healthcare leaders a fresh approach to measuring and managing the drivers of a culture of care that is the foundation of patient safety.

Defining a patient safety culture

In 2004, the Agency for Healthcare Research and Quality (AHRQ) released the Hospital Survey on Patient Safety Culture (HSOPSC). This questionnaire was designed to be administered to patient-facing hospital staff to measure attitudes about key factors that can affect patient safety. Taken together, responses to these metrics define the hospital's patient safety culture, and they have been shown to be closely related to patient safety events.

Gallup partnered with LLUMC to study the relationship between employee engagement and patient safety. Gallup administered the HSOPSC questions to the same workgroups over several years, along with Gallup's Q¹² employee engagement survey. This survey measures 12 workplace factors that link to crucial business outcomes, including productivity, customer engagement, quality, retention, safety, and profit.

Gallup used workers' compensation claims for these workgroups as a surrogate for employee safety. Gallup combined the employee engagement scores for these workgroups with the number of workers' compensation claims to produce an overall safety index score for each unit.

Previous Gallup research has shown that engaged employees are less likely than disengaged employees to experience accidents on the job. But researchers were surprised to discover that after accounting for the effects that employee engagement already has on employee safety, these two factors also work together to enhance patient safety.

Employee engagement and employee safety demonstrated a clear additive effect on patient safety culture that substantially exceeded the effect either form of intervention achieved on its own. Workgroups with high employee engagement and no safety claims had a 15% increase in patient safety culture compared with workgroups with low employee engagement and safety claims.

What leaders can do to enhance patient safety

With this connection in mind, healthcare system leaders can take steps to improve patient safety right away. First, they can focus on the HSOPSC metrics themselves, which lead to many sensible practices that can be implemented in the workplace:

• Ensure that there is enough staff at all times to handle workload -- and that staff members don't work longer hours than is best for patient care.
• Limit use of temporary staff.
• Maintain a culture of transparency that encourages staff members to ask questions without fear of reprisal.
• Build a cooperative culture in which groups help each other when they get busy and supervisors don't pressure staff members to work faster at the possible expense of patient care.
• Continuously audit the transfer of knowledge about patients between shifts to ensure that crucial information is not lost or overlooked.
• Encourage staff to provide feedback to leadership on how to improve patient safety, including questioning decisions made in its name.
• Demonstrate that hospital leadership places a priority on patient safety and give feedback to staff on their suggestions for improvement regardless of whether those suggestions are implemented.
• Make sure that staff members are informed of errors that take place in their workgroup regardless of whether patients were harmed, but keep the focus on teaching and improving, not punishing. Discuss how to prevent the error from happening again.

Taking further action

Safety interventions shouldn't stop here. Staff members will execute these tactics more efficiently and productively when their engagement level is high than when it is low.

Engagement shows itself most clearly at the workgroup level, and action planning is a proven means of enhancing it. In this process, employees discuss and focus on the elements of engagement that are most relevant to their own team, free of strict guidelines from leadership. This flexibility allows for a more efficient and effective intervention at the local level than more prescriptive means might mandate.

Employees who participate in action planning must see their workgroup take tangible actions and make visible progress based on their plan. It is only when all three of these elements -- action planning, tangible actions, and the resulting progress -- are in play that the action-planning process maximizes its promise of driving up engagement and patient safety culture while reducing employee accidents.

When engagement is high, its positive influence on employee safety creates a compounding effect on patient safety culture. That's something that will help healthcare leaders sleep much better at night.

Special thanks to our partners at Loma Linda University Medical Center: James Pappas, M.D.; Jonathon Thorp, M.D., M.B.A.; Waheed Baqai; Virginia Mullen, RHIA; and Jisoo Oh for helping make this research possible. To review the full results of this research, see "Workplace Engagement and Workers' Compensation Claims as Predictors for Patient Safety Culture," Journal of Patient Safety, Volume 8, Number 4, December 2012.