Don Berwick, IHI president emeritus and senior fellow, has characterized our current healthcare system as “repair shops” where we rise to the challenge of fixing and correcting the damage for what’s broken. Often work gets accomplished without deeply understanding and addressing the underlying causes and determinants of the problem.
This “first aid” approach was apparent in our earlier, more reactive attempts at addressing patient safety challenges. While we may have implemented a checklist for a circumscribed problem of central-line bloodstream infections, for example, we learned that successful use of checklists required us to assess and address the more foundational aspects for transformation of safety, including values, commitments and cultures of safety, and continuous learning and improvement. Achieving meaningful and transformative progress in workforce safety requires a similar commitment to a total systems approach to safety, one that unifies both patient and workforce safety in a collective approach to eliminating harm to patients and those who care for them.
Accelerating Coordinated and Comprehensive Action
In September 2020, concurrent with the World Health Organization’s World Patient Safety Day theme of health worker safety, the 27-member National Steering Committee for Patient Safety released Safer Together: A National Action Plan to Advance Patient Safety. The Action Plan provides 17 recommendations for healthcare and safety leaders across four foundational, interrelated areas: culture, leadership, and governance; patient and family engagement; workforce safety; and learning systems. Importantly, the plan recognizes that no one area can successfully and sustainably advance without attention to the other foundational areas. As with patient safety, addressing workforce safety in the absence of an integrated approach to leadership, for example, does little to promote progress.
Although the COVID-19 pandemic has drawn attention to the gaps and opportunities associated with workforce safety and well-being, we were already in dangerous and costly territory before the novel coronavirus emerged. While appropriate attention has been placed on vaccination, it would be all too easy to suggest that our workforce is safe because vaccines are increasingly available. Vaccinations may mitigate the risk and severity of contracting the virus, but they will not address the underlying cultural and leadership challenges that remain. Vaccinations will not protect our workforce from falls, musculoskeletal and sharps injuries, exposures to new and existing infectious diseases, violence and the daily psychological harms that are insidious across healthcare. While vaccinations are cause for hope on many fronts, their availability will not reverse the mental health, well-being and societal tolls incurred by the pandemic, including the expansive challenges of inequities experienced by those who work in healthcare.
While physical health risks for healthcare workers have increased exponentially due to COVID-19, associated mental health, well-being and societal consequences, including inequities that have been increasingly recognized, are creating added complexities and priorities that must be addressed. Health inequities result in disproportionate harm experienced by specific population groups, based on characteristics including race, ethnicity, sexual orientation, gender, age, disability and income. For example, according to a brief issued by KFF, “People of color accounted for a majority of COVID-19 infections, hospitalizations and deaths known among healthcare workers for which race/ethnicity data is available.” Similar to the disproportionate impact seen in the general population, National Nurses United reports that 58% of the 213 registered nurses it had identified as dying due to COVID-19 and related complications were nurses of color, including nearly a third (32%) who were Filipino nurses and 18% who were Black nurses. When designing safety efforts, it is imperative to take such inequities into account.
The silver lining of the pandemic is that it has forced the healthcare system, along with society at large, to recognize our longstanding inequities and other burdens that have fallen on healthcare workers. Let us now make sure that we seize this opportunity to make lasting change to truly prioritize safety and well-being for the healthcare workforce.
Patricia A. McGaffigan, RN, CPPS, is vice president of safety programs for the Institute for Healthcare Improvement in Boston, and an ACHE member.