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Organizational Safety Culture - Linking patient and worker safety

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; and
  • 5) The organization's socialization process for new personnel.
Healthcare Professionals
Toward Injury-Free Healthcare - Injury and Illness Prevention Programs

An injury and illness prevention program is a proactive process to help employers find and fix workplace hazards before workers are hurt. Such programs have been proven to help employers and society reduce the personal, financial and societal costs that injuries, illnesses and fatalities impose. Research demonstrates that such programs are effective, at both the establishment and corporate levels, in transforming workplace culture; leading to reductions in injuries, illnesses and fatalities; lowering workers' compensation and other costs; improving morale and communication; enhancing image and reputation; and improving processes, products and services.

A basic prerequisite for preventing injuries and illnesses is knowledge of the types, location, and underlying reasons for their occurrence in the workplace. A readily available resource to assist in determining this information is the employer’s OSHA 300 log. Through careful review and analysis of the log, the employer can develop a roadmap to prevention and tailor corrective actions specific to the situations found in his or her workplace. Further information, and possible solutions, can be obtained by soliciting input and involvement of frontline workers.

Most successful injury and illness prevention programs include a similar set of commonsense basic elements – management leadership, worker participation, hazard identification and assessment, hazard prevention and control, education and training, and program evaluation and improvement. Each element is important in ensuring the success of the overall program, and the elements are interrelated and interdependent. Since every business is different, the elements must be scaled and adapted to meet the needs of the employer's organization.

Programs with strong management commitment and active worker participation are effective in reducing injury risk, while "paper" programs are, not surprisingly, ineffective. Strong and visible management leadership is perhaps the most critical element of an effective injury and illness prevention program. Worker participation makes an important contribution to an employer's bottom line. When workers are encouraged to offer their ideas and they see their contributions being taken seriously, they tend to be more satisfied and more productive.

Despite the value to employers and workers in terms of injuries prevented and dollars saved, many healthcare institutions have not yet adopted injury and illness prevention programs that unite patient and worker safety. Based on the positive experience of employers with existing programs, OSHA believes that injury and illness prevention programs provide the foundation for breakthrough changes in the way employers identify and control hazards, leading to significantly improved overall workplace health and safety environments; improved patient safety; and fewer worker injuries, illnesses and fatalities.

  • For an expanded version of the above discussion, see the following page.

  • OSHA's Injury and Illness Prevention Programs Safety and Health Topics Page

  • NEW Safety and Health Management Systems in Hospitals.

    One of the most effective ways to reduce workplace hazards and injuries is through a comprehensive, proactive safety and health management system. Learn what these systems are, how they align with what you might already be doing to meet Joint Commission standards, and how leading hospitals have used them to reduce injuries, reduce associated costs, and improve quality of care.

  • OSHA's Voluntary Protection Program (VPP).

    The VPP recognizes employers and workers in private industry and federal agencies who have implemented effective safety and health management systems and maintain injury and illness rates below national Bureau of Labor Statistics averages for their respective industries. In VPP, management, labor, and OSHA work cooperatively and proactively to prevent fatalities, injuries, and illnesses through a system focused on: hazard prevention and control; worksite analysis; training; and management commitment and worker involvement.

  • The IOM Report: To Err is Human: Building A Safer Health System.

    This Institute of Medicine report lays out a comprehensive strategy by which government, health care providers, industry, and consumers can reduce preventable medical errors.

  • The Lucian Leape Institute at National Patient Safety Foundation.

    The Lucian Leape Institute focuses on identifying and framing vital transforming concepts that require system-level attention and action, including the safety of the healthcare workforce.

  • Health Care Without Harm (PDF).

    This paper focuses on research within the health care sector in the U.S. centering on patient, worker and environmental health and safety ("the three safeties").

  • Improving Patient and Worker Safety: Opportunities for Synergy, Collaboration and Innovation.

    This document discusses the importance of safety culture and the synergies that exist between patient safety and worker health and safety. It presents management principles, strategies, and tools, along with illustrative case studies, directed toward making the workplace safer for patients and workers.

  • NIOSH NORA Healthcare and Social Assistance Sector Council.

    The National Occupational Research Agenda (NORA) is a partnership effort to define and conduct high priority research in occupational safety and health. The Healthcare and Social Assistance (HSCA) Sector is comprised of four subsectors: ambulatory health care services, hospitals, nursing and residential care facilities, and social assistance. The HCSA Sector Council developed five strategic goals designed to address top safety and health priorities for the sector: Strategic Goal 1 - safety and health programs; Strategic Goal 2 - musculoskeletal disorders; Strategic Goal 3 – hazardous drugs and other chemicals; Strategic Goal 4 - sharps injuries; and Strategic Goal 5 – infectious diseases.


1IOM (Institute of Medicine). 1999. To Err is Human: Building a Safer Health System. Washington, DC: The National Academies Press.

2Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection Control Practices Advisory Committee, 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings (PDF).


*Accessibility Assistance: Contact OSHA's Directorate of Technical Support and Emergency Management at (202) 693-2300 for assistance accessing PDF materials.

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