Commentary: Tackling healthcare’s growing safety challenges starts with our workforce


In mid-May, four of the nation’s leading voices in healthcare called for urgent, national action to reform our healthcare system. The Institute for Healthcare Improvement, the Centers for Medicare and Medicaid Services, the Centers for Disease Control and Prevention, and the Agency for Healthcare Research and Quality urged immediate action on patient and workforce safety, imploring leaders to address safety from a total systems approach. The call for action is timely. A survey published in March found 1 in 3 nurses working in hospitals reported they experience violence while on the job. We are in a crisis.

Hospital workplace violence, whether due to a patient experiencing a psychiatric episode, a verbally abusive visitor, or any number of other types of incidents, puts healthcare workers’ and patients’ well-being at risk.

As CEO of Inova Health System, the Washington, D.C., region’s leading nonprofit healthcare provider with 20,000-plus team members across five hospitals, I am keenly aware of the importance of coordinated action to address this growing crisis. But effective solutions cannot be found alone, nor do any of us have a monopoly on good ideas. There are four core lessons I’ve learned from my work and team at Inova to address this issue, and I call on other healthcare leaders to share their own.

We must start with physical security

In 2021, 648 physical workplace violence incidents occurred across the Inova network. On one occasion, an adult patient became violent in a pediatric surgery unit. The situation briefly became so intense that some of our staff could not care for admitted infants out of fear for their own lives. One Inova staff member said they felt like they were being held hostage and patient parents were barricading themselves in their rooms. Situations like these, which are all too common across the country, deny our team members the right to feel psychologically and physically safe while doing their jobs.

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To address this, we created the Inova SAFE (Safety Always for Everyone) Team, a group of experts led by a former law enforcement officer that includes expertise from the nursing, security, behavioral health and communications staff. This team is designed to quickly deploy to mitigate safety incidents and empowered to revise procedures to prevent future issues. Less than a year after its launch, the SAFE program has resulted in fewer incidents and a staff much more confident in their workplace safety.

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We must be willing to experiment

But violence certainly isn’t the only hospital safety concern. Last year, amid burnout, workforce shortages and other ongoing effects of the COVID-19 pandemic, an Inova operating room set a goal to become the “safest OR in the country.” This was in response to staff sharing that despite encouragement to slow down and follow policies and procedures, they felt continued pressure to move quickly, resulting in process breakdowns and human errors.

To achieve this goal, we turned our full attention toward education and accountability to do the right thing for our patients and reinforce safety as our top guiding principle. We stepped up efforts to take the necessary time to encourage teams to speak up, listen to one another and learn. When metrics were reviewed the next month, we found that the team had zero safety events. Not even a minor issue or “near miss.” That means more than 1,500 cases without any sharps injuries, medication errors, lost specimens, pressure injuries or other issues. This author was the beneficiary of one of those surgical cases, and was comforted by the focus.

We must create cultures of psychological safety, accountability and support

We believe in creating an environment where everyone has an equal voice and has the support they need. We celebrate team members calling out potential mistakes before they happen. We have added more social workers and nonclinical staff to ensure holistic support for our workers. While culture will look different at every organization, it is essential that every leader acknowledges the humanity of their people and incorporate daily, always-on practices that encourage accountability, prioritize support and focus on world-class care. By acknowledging mistakes, we improve systems and celebrate the transparency that drives growth.

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While it is critical that we implement immediate solutions for hospital workplace violence, it is equally as important to think about long-term, upstream solutions that create a better, safer workplace for our healthcare heroes. Beyond what this commitment can do for our workforce, our patients deserve safe and excellent healthcare. We can avoid errors and put patient outcomes first by striving to be the safest healthcare organizations we can be.

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Support from our national leaders is critical

Just this month, Reps. Madeleine Dean (D-Pa.) and Dr. Larry Bucshon (R-Ind.) introduced the Safety from Violence for Healthcare Employees (SAVE) Act of 2022. This bipartisan legislation would enhance federal workplace violence protections for healthcare workers to mirror those that already exist for the airline industry.

While the bill is a positive step forward, the message it sends is even more impactful. Having our national leaders stand shoulder to shoulder with our healthcare heroes, rejecting violence and unruly behavior against them, is critical to our progress.

Looking ahead, health systems must share best practices that support the safety, growth and excellence of our teams. Hospital and health system leaders owe it to their team members and their patients to put business aside and work together on this shared challenge.



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