Three nurses lined up in a hospital hallway with their arms crossed, two holding stethoscopes
HealthSeptember 02, 2020

Correlations between staff, provider engagement, and culture of safety

By: Sarah Handzel, BSN, RN
According to Johns Hopkins, it’s estimated that approximately 250,000 patient deaths result from medical errors each year. While factors such as burnout, medication administration errors, and other medical mistakes are to blame, employee engagement may also be a significant variable in preventing patient harm.

Many quality improvement initiatives focus on improving healthcare employee engagement, which is positively associated with lower turnover, lower healthcare costs, and improved patient experience of care and quality. And perceptions of patient safety (POPS), which are monitored by the Joint Commission, may indicate just how strongly employees like nurses are engaged in their work.

While several studies have already demonstrated the correlation between employee engagement and POPS, many were only focused on single clinical service units, such as intensive care units, or they used engagement measures that were not specific to healthcare. Additionally, much of the previous work focused solely on the hospital environment. A new study in the Journal for Healthcare Quality explored the concepts of employee engagement and culture of safety in ambulatory settings, identifying factors that contribute to engagement and suggesting interventions to drive engagement to maximize safety.

Defining a culture of safety

According to the study authors, a culture of safety can be defined as:

  • An encompassing acknowledgement of the high-risk nature of activities and the determination to achieve safe operations
  • Blame-free environments
  • Encouragement of collaboration across ranks and medical disciplines
  • Organizational resource commitment to address safety concerns

Perceptions of patient safety are related to employee engagement in several ways. First, engaged healthcare workers, including physicians, nurses, and ancillary staff, are more likely to report safety concerns and participate in improvement efforts. Also, providing safe care is an important part of each individual’s practice.

Because healthcare depends on team-based care in most settings, there is likely a close relationship between healthcare provider and staff engagement. In many cases, improving engagement in one group correlates to improved engagement in the other.

Factors influencing healthcare employee engagement

As the study found, a range of factors influence engagement and the culture of safety in the workplace, including event reporting, communication, patient safety leadership, staffing, and accreditation. Other, more personal factors, such as teamwork effectiveness, workload, and job satisfaction also influence levels of engagement among staff members.

The data showed that there were weak, yet significant, correlations between staff engagement and culture of safety, provider engagement and culture of safety, and between provider and staff engagement. There were also significant increases in POPS scores when engagement was increased. In both the hospital and ambulatory environments, a one point increased in employee engagement was estimated to increase safety scores by around 5%.

Tips to build engagement in the workplace

Building engagement among healthcare staff members takes effort from leadership. However, it isn’t an impossible task. An article in The Online Journal of Issues in Nursing identifies six themes that help provide a roadmap for engaging healthcare workers who take care of patients every day:

  1. Acknowledge the work – The work performed by nurses and other healthcare professionals is complex, important, and physically and emotionally challenging. Leaders must acknowledge these efforts in ways that demonstrate appreciation for the staff.
  2. Encourage work-life balance – Scheduling, training, and communication with caregivers must be considered in order to foster a positive work-life balance. This is especially important as more Millennials enter the nursing workforce, as this generation places greater value on balancing their careers with their personal lives.
  3. Ensure communication – Communication and transparency in the workplace are fundamental for the demonstration of empathy and trust. Listening, providing opportunities for discussion and improvement, and ensuring clear and direct communication can help align the focus of care to provide optimal outcomes.
  4. Foster empathy and trust – Accountability, integrity, and fidelity at all levels of a healthcare organization are important for building trust. Treating one another with respect while anticipating each other’s needs helps foster empathy among staff.
  5. Provide support from leadership – Leaders help to create the work environment, and they can make it positive or negative based on their leadership style and decision-making abilities and preferences. Leaders must ensure proper staffing, working equipment, and clear and direct communication to help employees feel valued and supported.
  6. Support teamwork – It truly takes a team to provide the best care for each patient. Leaders must coordinate teams around each patient’s unique diagnosis and needs, selecting those personnel who can best provide the level of care needed.

Building staff and provider engagement contributes greatly to a culture of safety, regardless of care unit or setting. Using specific techniques to build engagement, such as acknowledging the work and ensuring communication, helps healthcare staff feel more valued and appreciated in their work. This, in turn, helps ensure better, safer patient outcomes.

Sarah Handzel, BSN, RN
Freelance Health and Medical Content Writer, Wolters Kluwer Health
Sarah has over nine years’ experience in various clinical areas, including surgery, endocrinology, family practice, and pharmaceuticals. She began writing professionally in 2016 as a way to use her medical knowledge beyond the bedside to help educate and inform healthcare consumers and providers.
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