Health care safety consultant Randy Charpentier walked into his hospital client’s half-billion-dollar renovation project unannounced one day during lunch hour to find a subcontractor crew working without proper safety equipment and failing to follow basic infection control protocol. They hadn’t even sealed up an exposed overhead from an adjoining space occupied by mothers and newborns. He knew he had no choice but to stop the entire project immediately.
“The foreman told me I didn’t have the authority to shut them down because I was a consultant. I told him that I was not going to have a dead baby on my conscience and not only were they through for the rest of the day, they weren’t getting paid,” Charpentier recalled.

His next stop was the hospital administrative office where he informed the hospital executives of his decision to halt their massive five-year overhaul of the facility’s most crucial — and most infection-sensitive areas — including operating rooms, imaging procedure rooms, intensive care units and an obstetric delivery unit.

“It was a tense conversation,” he says with a laugh. “But I finally persuaded them they had hired me to be responsible for the safety of the patients, employees and contractors on this project. There was either a culture of safety or there wasn’t. And if there wasn’t, I was resigning.” By the time he finished the consulting job, Charpentier says he was able to reduce the hospital’s infection rate related to construction to zero.

Charpentier, who is president of HealthSafe New England and has held management positions in-hospital and workers’ compensation insurance providers, shared his story to highlight the best tool in preventing workplace mishaps: a culture that values injury prevention. While staffers are usually the ones hurt on a job site, patients and customers can also be impacted, which often leads to lawsuits. It seems there is never enough of a budget for safety, but when something bad happens, money cannot be spent fast enough.

A 2012 UC Davis study placed the direct and indirect costs of occupational work injuries and illness at $250 billion a year. This expenditure, according to the report, is higher than annual costs for three other major disorders, including cancer ($220 billion), diabetes ($175 billion) and strokes ($63 billion).

A lack of organizational commitment to preventing on-the-job injuries nearly always manifests itself in obvious ways. “I can walk into a company and within five minutes tell you if that company has a safety-based culture or safety-avoidance culture,” says Charpentier.

Since all states mandate employer obligations to injured workers, a company’s leadership needs to focus on workplace injuries, he adds. “Companies are really good at making rules that don’t work,” says Jim Murphy, who has served in a wide range of human resources and organizational development management positions, including for the City of Boston and Massachusetts Bay Organizational Development Learning Group. He now acts as a consultant through his own firm, Management 3000. He notes that a common mistake he sees is that a company has a safety policy – most often linked to a new employee handbook – and they call it good. But if that’s as far as the effort goes, it’s far from good.

“You have to make sure you are dealing in the real world with your people,” he explains. “Employees learn how to ignore the rules, especially those that don’t seem to apply to them or are not reinforced by their manager. So it’s important to allow employees a voice in the policies designed to keep them safe.”

In hospitals, this fact of human nature can be seen in the stats for nursing injuries. Nurses have access to many types of equipment designed to prevent injury to caregivers when lifting patients. Yet according to a landmark study released in 2013 by the Lucian Leaps Institute titled “Through the Eyes of the Workforce” up to a third of health care workers suffer back or musculoskeletal injuries every year related to lifts, as well as exposure to blood borne pathogens through preventable events like needle sticks or respiratory compromise. Beth Boynton, a nurse and workplace safety advocate who is writing a textbook on the subject, says employers often create adversarial relationships with employees in their response to an injury claim.

“Sure there are some malingerers who work the system, but treating every injured worker like a suspect turns injury management into a self-fulfilling prophecy of conflict. The injury becomes a source of power for the employee because that’s all they have to negotiate with,” she says. “This kind of attitude does not help recovery and it doesn’t help prevent future workplace accidents.”

There’s a lot of shame and guilt when people get hurt on the job – both on the part of the employee and the employer, says Management 3000’s Murphy. “Most organizations hesitate to expose emotions, but people need the ability to speak up.”

Underscoring this point is Boynton’s personal experience as a nurse. “Early in my career I was choked by a patient who was going through heroin withdrawal. Fortunately, I wasn’t seriously injured, but the doctor who was on the floor dismissed the incident like it was just part of the job,” says Boynton. “There was no concern about how I felt [about] being attacked,” she says.

Andy Gebhard, director of communications and social media at SFM Mutual Insurance, which issues workers’ compensation polices in several states, says that his company is having good early results with a new program to foster open communications between injured workers and their client employers.

“In October, we set-up a 24-hour hotline staffed by registered nurses,” says Gebhard. “The manager dials the number and then hands the phone over to the employee. The nurse performs a triage to determine the extent of the injury and if the employee needs to go to the emergency room, to their doctor or self-treat the injury.”

According to Gebhard in the short time the program has been in place, 20 percent of their clients have already self reported accidents through the nurse triage system.

He says that several clients have aggressively adopted the system to help address common mistakes that are made in reporting workplace accidents with injury. This includes: reporting the injury late; indicating if the employee is missing work due to injury; communications breakdowns; not reporting questionable claims, and allowing employees to fill out accident forms.

“Our perspective is from that of the employer,” Gebhard stressed. “But there is nothing to be gained by avoiding taking care of an injured employee,” as all states mandate programs for injured employees that allow salary continuation and coverage of medical expenses related to the injury.

“Back in the days when workplaces were more dangerous than they are now, employees were treated like replaceable equipment. That’s why workers’ comp laws evolved into the system we have today. My company seeks out clients who have a good commitment to keeping their employees safe. We then partner with them to help them reduce their claims losses by improving safety through good practices.” It always comes back to the idea of a commitment to safety and employees.

“There are two kinds of people in charge – those who know and care what is going on and those who don’t,” Murphy states. “You can’t get to be CEO without being conscious of details of the job and employees are the most important detail. Get that wrong and it can be very costly.” Charpentier’s experience echoes Murphy’s views. A workplace with a poor safety culture is the common thread in organizations with substantial workplace safety and injury records.

“You can see safety banners and signs all over a company and no one adhering to the safety policies. Management will tell you that OSHA has never visited them, so they must have a good safety program. That’s when I know this is a company focused on production and the bottom line, and the leaders don’t understand that if nothing else, keeping employees from getting hurt is also a good way to control expenses.” He recalled a case in which he visited a client who nearly lost an entire research facility because one of the employees did not follow safety procedures.

“I spent all night going through the building with the fire chief to figure out what happened and it was an obvious safety policy violation. The next morning I met with the CEO and COO, with whom I had good relationships, to ask how they planned to hold the employee accountable. Their answer was, “We’ll talk to him.” Of course, that’s not going to prevent another fire. Later, I learned the researcher brought in a $50 million-research grant and had been exempt from safety training. So I knew what values were important to that organization – and so did their employees.”

He says part of the problem is that making changes to save $100,000 in an injury claim expense in an organization as big as a hospital, for example, which can have hundreds of millions in revenue, seems like a lot of effort for a little return.

“I understand that senior executives have a lot of competing priorities,” he says. “But if nothing else, a 10 to15 percent increase in workers’ comp insurance a year is going to add up eventually. It’s worth the effort to make a workplace safer.”

The top five common issues related to workplace injuries:

1 No safety policy or an outdated policy
2 Ignoring safety policies (no enforcement)
3 Poor safety training/prevention
4 Poor incident reporting
5 A culture of injury denial (blaming the injured)