Interrelatedness of Patient & Staff Safety: Part I-Environment of Care Survey Process

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Author: Randall B. Charpentier, HEM, President/Principal Consultant – HealthSafe New England

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 System, 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. The U.S. Dept of Labor speaks to these points in Organizational Safety Culture: Linking Patient and Worker Safety. 

How are these recommendations unfolding in the real world?

This is what I’ve experience with The Joint Commission (TJC), Environment of Care review for the Hospital Accreditation Process. TJC will typically review your Safety, Security, Hazardous Materials & Waste, Emergency (Preparedness), Fire & Life Safety, Medical Equipment and Utilities Management Programs.  They may also sit in on a Safety Committee meeting to review content, involvement, and achievements of the group.  During the survey, the Life Safety surveyor will typically examine your document binders to determine your level of compliance with the Elements of Performance in the standards and tour your facility to determine compliance with your eSOC and Life Safety Code compliance.

hospital roomThe Majority of deficiencies are identified in the documentation review and facility tour.  Although these are all critical elements in determining compliance, are they truly indicative of an effective Environment of Care/Safety Management Program?  Are healthcare facilities really focused on a performance based program where adverse trends regarding patient and staff safety are addressed in a collaborative, team based fashion with tangible results that can be quantified and improved upon?  I haven’t personally witnessed many.  In my formative years as a safety and risk management consultant for healthcare facilities, I’ve experienced something entirely different as outlined below focusing on Safety Management.

Over the next few weeks, I will break this down in a series of follow up posts covering each key component of a performance based Safety Management program.  Those components are as follows:

  • Risk Assessment
  • Environmental Tours
  • Staff/Patient/Visitor Injuries
  • Staff Training
  • Safety Committee Performance Improvement
  • ICES/Communication

CMS is measuring safety and quality in healthcare facilities basing reimbursement on your outcomes.  Do you measure up?  If not, you should conduct a risk assessment.  Are YOU compliance or results driven? You may contact HSNE/Randall for additional information:,, or linkedin profile

Randy CharpentierRandall is a 20 year experienced, safety and risk management consultant specializing in healthcare compliance.   Project experience ranges from leading teams on the construction of the west coast space shuttle project, working internationally & domestically for leading environmental engineering firms conducting real estate assessments involving occupational and environmental risks, assessing business operational risks concerning commercial insurance policies, and reducing/eliminating exposures/hazards, to leading world renowned, top ten/one hundred community based & BioMedical Research/Teaching hospitals, with development and management of environmental health and safety management programs.  HSNE’s/Randall’s passion is keeping patients, staff and visitors safe in a healthcare setting.

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