Contra Costa Regional Medical Center,

Health Centers, and Detention Health

Center for Workforce

Safety & Vitality

Draft concept paper for employee review & comment 12/17/10

Center for Workforce Safety and Vitality Draft Concept Page 1

Introduction
Contra Costa Regional Medical Center (CCRMC), Health Centers and Detention
Health Services include a 166-bed full service acute care facility, eight primary
care health centers, and medical care at four detention facilities throughout Contra
Costa offering comprehensive, personalized, family-centered health care.
Our mission is to improve the health of all people in Contra Costa County with
special attention to those most vulnerable. We will realize our mission by
partnering with employees, patients, families and diverse stakeholders to address
the health needs of our community and to provide high quality services with
respect and responsiveness to all.
In November of 2010, Contra Costa Health Services lost one of our employees to
an act of violence at one of our detention health facilities. This tragic event deeply
affected us all and stimulated crucial conversations about employee safety and
vitality. What we heard from employees echoed the results of recent studies– that
the healthcare workplace is inherently hazardous, that ensuring staff safety is of
paramount importance to all other efforts, including patient safety and quality of
care, and that the best way to assure staff safety is to engage employees directly.

“More modern, and much more effective, theories of production seek to

harness the imagination and participation of the workforce in
reinventing the system.” (Don Berwick)i

CCRMC, Health Centers, and Detention Health are proposing the creation of a
dedicated Center for Workforce Safety and Vitality to guide and support
employee safety initiatives. In its preliminary phase, the Center would focus on
supporting staff efforts to design and create the scope of this project. Engaging
employees directly aims to ensure both successful implementation of employee
safety initiatives and to improve overall employee satisfaction.

The purpose of the Center is to ensure a partnership between employees,

management and key stakeholders to define measureable aims and to make sure
that activities link to a coherent strategy to improve the safety and vitality of our
workforce.

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Background
The innovations and improvements realized by our healthcare system are a direct
result of the commitment and hard work of our dedicated staff. However, the
healthcare industry remains rife with potential hazards. Employees face daily
exposure to body fluids, sharp objects and high stress situations which can lead to
violent confrontations.
• More than 600,000 violent victimizations of healthcare workers occurred
between 1992 and 1996.ii
• Nurses are at particularly high risk, with an annual average of 69,500
reported violent victimizations.iii
• More health care workers become ill or injured than in any other industry
sector with at least 100,000 employees. In fact, more than 250,000 health
care workers are injured on the job each year.
• The two occupations with the greatest number of injuries and illnesses
[requiring recuperation away from work] were truck drivers and nursing
aides (including orderlies and attendants). iv
• Levels of staff health, stress, motivation and behavior are inextricably
linked to patient outcomesv

The healthcare industry is currently undergoing enormous changes in regulation

and payment due to health care reform, while simultaneously facing the influx
of aging “Baby Boomers” and their commensurate increase in demand for
healthcare services. This in turn will put a greater demand on our workforce. We
need to take care of the workforce so they can focus on our mission in an
increasingly complex environment.
The costs of not addressing employee safety are staggering. According to the
Bureau of Labor Statistics, the health care industry spends $20 billion annually
in workers’ compensation and related costs due to employee injuries and
illnesses. According to Boston-based Liberty Mutual, the leading private
provider of workers' compensation insurance in the United States, workplace
injuries cost employers nearly $1 billion per week in payments to injured
employees and their medical care providers. vi Elevating employee safety and
health to the same level as patient safety is long overdue.

Goals/Objectives
Our aim is to create a Center to support employees in identifying best practices
for employee safety, engagement and vitality. The employees themselves with
dedicated support will decide the specific aims, actions and measurement
strategies to best improve their work environment.

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Scope of Work
The scope of work for the Center continues to evolve and will be determined in
Phase I. The Center will be designed by and for the employees, with the support
of Administration.
During Year One, employees nominated by their peers will have dedicated work
time to devote to this endeavor, with sufficient technical support so as to not
interrupt patient care. Administration will help ensure that the employee
workgroup and the Center’s scope of work represent all levels, types and
locations of employees.
It is the expectation that the Center will not duplicate existing resources, but
rather partner with subject matter experts to coordinate the success of planned
interventions. The Center would not replace, but work with, Personnel,
Professional Development, The Safety & Performance Improvement
Department and other areas & stakeholders concerned with the work
environment.

Timetable
The first step is to bring in the employees to support them in designing what the
Center should do and how it should look.

Table 1
Description of Work Start and End Dates
Draft proposal for staff comment;
facilitate nomination process for
Pre-work workgroup; perform literature review for December 2010
model programs and organizations;
convene workgroup
Design: Engage frontline staff in
scanning, planning and scoping the work;
Phase One January 1 – March 31, 2011
identify Best Practices; implement plan
for transparency and accountability
Build: Staff to task the Center with
Phase Two primary initiatives, measurement strategy April 1 – December 31, 2011
& communication plan
Evaluate: Spread proven interventions,
ensure sustainability of effort,
Phase Three + January 1, 2012 forward
consistently integrate employee voice in
all areas

Estimated Resource Allocation

Table 2
Description of Work
Phase One .5 FTE (Project Manager ),
.5 FTE (Clerical Support),
Workspace,

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 Equipment & supplies
Develop an RFP for Employee Engagement/Opinion Survey,
Phase Two Identification of fiscally sustainable finances

Development of workforce engagement,

Phase Three Identification of best practices

Evaluation
The impact of the Center and its interventions will be ongoing. During the design
phase, every intervention proposed will have a developed measurement strategy.
We will use the Model for Improvementvii with Plan, Do, Study, Act cycles to
ensure continuous, measurable progress.

Possible measurement areas include:

• number of employee injuries (violent, accidental and repetitive)
• lost work days/number of light/modified duty days
• staff turnover rates (all areas)
• employee opinion/organizational capacity/culture of safety survey
scores
• external recognition (safety awards, Best Place to Work)
• calls for assistance
• direct care time (practitioner time spent at the bedside)
• patient satisfaction scores

Conclusion
Workforce safety is one of our biggest challenges. In order to honor the
commitment of our employees and to create conditions that support their ability to
be fully present in their jobs, the need for a safe environment is paramount. For an
environment to be safe, we must listen to those who have their feet on the floor.
Our aim is not only to be to amplify the voice of employees, but also to engage all
employees in shared decision making to build and sustain a safe and gratifying
workplace and work experience.

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References

Center for Workforce Safety and Vitality Draft Concept Page 6

i
Berwick, DM. “Improvement, trust and the healthcare workforce.” Quality and Safety in Health Care. 2003; 12(Suppl
1):i2-i6.
ii
Public Health Services Branch. “Workplace violence and prevention in New Jersey hospital emergency departments.”
National Institute for Occupational Safety and Health. http://www.nj.gov/health/surv/documents/njhospsec_rpt.pdf
iii
ibid
iv
http://www.forbes.com/work/2004/05/28/cz_cc_0528dangerousjobs.html
v
Michie S and West M (2002) Managing people and performance: an evidence based framework applied to health service
organizations, Int J Management Reviews, 5-6(2):91-111
vi
http://www.forbes.com/work/2004/05/28/cz_cc_0528dangerousjobs.html
vii
Model for Improvement, Institute for Healthcare Improvement (IHI.org)