and healthcare workers to recognize the inseparable integration of worker safety and patient safety. This includes recognizing and reporting high-risk exposures and activities, developing and implementing prevention and control standards, policies, and strategies with worker input to mitigate and eliminate hazards, and providing sustained resources to address safety concerns. Management and healthcare workers must work together to achieve this continuous effort which contributes to a culture of safety. Focusing efforts on a sound and sustained safety culture will lead to and support better outcomes in patient healthcare and safer working conditions for healthcare workers.”
As we know, better patient outcomes are derived from decreased adverse events such as patient falls, medication errors, and hospital readmissions. A culture of safety can ensure improved quality of care and increased patient satisfaction, as well as better healthcare worker and organizational outcomes. Common features of a positive healthcare worker safety culture, according to NIOSH, include:
● Recognition of differences in practice environments and dynamic systems
● Trust, reporting errors, peer intervention, improved learning, and engagement in work
● Foundational value to lessen harm to patients and providers using basic safety science principles, hazard controls, and best practices
● Actions to build and foster resiliency, continuous support, and feedback
● Opportunities to improve safety culture and climate( e. g., safe introduction of new processes and technologies; organizational vigilance for needed resources)
● Standards for prevention of workplace injuries and good working environments
● Situational awareness and mindfulness; in other words, know what you don’ t know
The impact of COVID-19 on institutions’ safety culture and the stress it inflicted on the healthcare workforce was unprecedented, Byron says, and may have caused many facilities to re-examine their organizational culture.
“ I don’ t think anyone in this country went untouched,” Byron says.“ They either had COVID, had a family member, co-workers or friends get very ill with COVID. I think it’ s very similar to the HIV epidemic of the 1980s. For example, we may have gotten a little bit lax about wearing gloves, but now we wear gloves practically for everything. HIV scared the workforce into taking precautions, and COVID did the same thing. It was a wake-up call to healthcare staff that to stay healthy, you must do everything you possibly can; however, the
That some healthcare institutions struggle with implementing and maintaining a safety culture is troubling but understandable, given the competing priorities, challenges and barriers many facilities face. Some struggles are related to institutional culture, while others are caused by lack of accountability on the part of individuals.”
organization must provide the PPE. They must go to the extra expense of additional training and retraining. Sometimes there’ s only so much a healthcare institution can do. There can be cross-contamination, but facilities have in place the right training so that healthcare personnel are using the right PPE, discarding it properly, and washing their hands afterward.”
That safety culture and infection prevention are inextricably linked is common sense. Additionally, Braun, et al.( 2021) note that if facilities maintain strong relationships between safety culture, IP & C processes and HAI prevention,“ one can focus interventions on improving safety culture. In theory, an intervention that improves safety culture could also improve non-IPC-related outcomes(‘ lift all boats’).”
That some healthcare institutions struggle with implementing and maintaining a safety culture is troubling but understandable, given the competing priorities, challenges and barriers many facilities face. Some struggles are related to institutional culture, while others are caused by lack of accountability on the part of individuals. How healthcare systems address this challenge can be described as the classic carrot-or-the-stick approach to compliance, or in other words, rewards versus punitive measures.
“ Punishment isn’ t the way to go, because it hasn’ t worked, and I’ ve worked in healthcare for decades as a nurse, as a healthcare administrator, and as a consultant performing audits and investigations,” Byron says.“ It’ s also very important to examine the root cause. Many times, it isn’ t necessarily a neglectful staff member, as most of the time people are trying to do the best they can with the circumstances that they’ ve been given and the training that they’ ve received. If a punitive approach is taken, people will be afraid to come forward to say that they see something that needs to be corrected, or they’ ve done something wrong. For example, if there has been an incident in the past that has been covered up, because we know staff members cover for each other because they’ re so frightened that they’ re going to be written up or terminated and won’ t be able to get another job.”
There are numerous theories rooted in behavioral science that address aspects of healthcare personnel compliance, but
Byron advises facilities make safety training personally relatable.
“ When I’ m conducting training, sometimes I’ ll relate to them some personal experiences I have had,” Byron says.“ For instance, when discussing HIPAA violations, I’ ll explain that I had a daughter years ago who died of brain cancer. She was in the ICU and I was sitting in the ICU waiting room. People in the waiting room were asking me questions about her cerebral shunt and about other details relating to her care and I said,‘ How do you know that?’ and they said,‘ Well, the nurses were talking about it and everybody feels so bad because she’ s only 5 years old.’ I got up and I tore down the hall and I went to go look for the director of nursing. I was in tears. The people whom I was training were all volunteers, and I said to them,‘ Do you know how it feels when you are going through one of the worst things you can go through as a parent and yet people are talking to you about things that you don’ t want to discuss with strangers?’ When you relay those kinds of personal experiences, then healthcare professionals start to get it, and then I’ ll say,‘ What kind of things have happened to you or to a loved one that could be an example of a HIPAA violation?’ so that I can try to make it a teachable moment where they can put themselves in a situation that helps them better understand the point we are trying to make in our training session.”
Byron continues,“ When I conduct a webinar, a training camp or onsite corporate compliance training, I try to engage in story-telling, whether it’ s my story or it’ s a borrowed story that I love to tell. I think story-telling is a good way to illustrate examples of why a principle or a practice is important. There are some people who simply clock in and clock out, and if they have to do any more than that, they resist, and maybe those kind of people shouldn’ t be employed at that organization. Maybe we find them a job that’ s better suited for them, where their personality fits the duties and responsibilities, or we retrain them and move them to a different part of the organization. I think prevention has a lot to do with creating very precise types of training programs that inspire people. You have to keep people’ s spark alive, as we usually don’ t live to work, but we work to live. And to repeat what I said before, make it personal. Try to touch on how what you
16 • www. healthcarehygienemagazine. com • mar-apr 2025