Joint Commission Publishes Patient and Worker Safety Monograph


The Joint Commission today released a free monograph, Improving Patient and Worker Safety: Opportunities for Synergy, Collaboration and Innovation, to draw attention to the need to create a culture that focuses on both the safety of patients and the healthcare workers who care for them.

The monograph contends that high rates of injuries and illnesses among healthcare workers serve as a warning that the healthcare environment as a whole must be transformed in order to improve safety. The monograph highlights examples of healthcare organization practices that address patient and worker safety simultaneously and the benefits and potential cost savings attained through collaboration between employee and patient safety departments. The monograph also identifies functional management systems and processes, strategies and tools that have been used to successfully integrate health and safety activities.

In healthcare, the primary ethical imperative is First, do no harm. Although we have traditionally applied this obligation to our patients, this monograph helps to establish it also as our obligation to those with whom we workand to all within the healthcare setting, writes Paul M. Schyve, MD, senior advisor for healthcare improvement for the Joint Commission, in a foreword to the book.

The monograph explores high reliability in healthcare organizations and the benefits to improving safety for both patients and workers. It describes barriers to recognizing and addressing patient and worker safety issues and suggests strategies to overcome them and make safety a priority. In addition, the monograph recommends action steps that healthcare organizations can take to improve safety for both patients and workers, as well as topics for future research. Work on the monograph, which was supported in part by the National Institute for Occupational Safety and Health (NIOSH), National Occupational Research Agenda (NORA) Healthcare and Social Assistance Sector Council, began with a national call soliciting effective  or innovative safety practices from a wide range of settings that address both patients and workers. These practices were related to topics such as worker and patient safety culture, worker and patient satisfaction, injury prevention, infection prevention, performance improvement and individual engagement in safety activities.

Examples of case studies on patient and worker safety that are included in the monograph are:
Ascension Health, St. Vincents Medical Center: Building a high reliability culture for patients and health care workers.
Atlantic Health: Securing a health system red cell program.
Duke Home Care: Focusing on safety in home care the Director Safety Rounds Program.
Intermountain Health:  An integrated employee and patient safe handling program.
Kaiser Permanente Mid-Atlantic Region: Simple steps improve safety A slip, trip, fall prevention measure.
Lancaster General Hospital: Voluntary Protection Program commitment to bariatric patient safety.
Lemuel Shattuck Hospital:  Reducing assaults in a behavioral health unit
University of Missouri: Caring for our own:  Clinician support following unanticipated clinical events.
U.S. Department of Veterans Affairs (two case studies): Building a culture of civility, respect, and engagement in the workplace. Reducing disruptive patient behavior: The behavioral threat management program.

The breakdowns that put both patients and workers at risk are often the same. In order to truly improve healthcare, organizations must implement a system-wide culture of safety, says Jerod M. Loeb, PhD, executive vice president of the Division of Healthcare Quality Evaluation at the Joint Commission. By identifying the causes of breakdowns and near misses, we can learn how to make a real difference.

Ensuring a strong and healthy workforce is critical to the nations health and the health of patients in health care settings, says John Howard, MD, director of NIOSH. NIOSH believes that a workplace where management is fully engaged in the wellbeing of staff, minimizing hazards to workers, benefits everyone involved: employers, workers, and patients.

Copies of Improving Patient and Worker Safety: Opportunities for Synergy, Collaboration and Innovation can be downloaded (Adobe PDF Reader is required) at:

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