People go to the hospital to be cared for and get better. But for health care professionals, going to work can put them in harm’s way.

Nursing homes and hospitals are among the most high-risk occupations for injuries generally , and their rate of injuries from workplace violence are much greater than the average — 5 to 12 times higher, according to a recent Washington Post article .

According to OSHA , “health care accounts for nearly as many serious violent injuries as all other industries combined.”

Defining workplace violence

Workplace violence encompasses more than physical assaults. The National Institute for Occupational Safety and Health’s definition includes threats of assault as well as verbal abuse, hostility and harassment.

This violence can be committed by co-workers, patients or family members of patients. Health care workers interact with a large number of people throughout their day, often in stressful situations.

Quantifying violent incidents in the health care sector

The most recent statistics from OSHA and the Bureau of Labor Statistics paint a picture of shocking risks to workers:

• In 2015, more than 11,000 violent incidents against employees in the health care and social assistance sector occurred
• Assaults made up 10 percent of all lost-time work injuries in health care
• Of the 24 work-related fatalities in hospitals, five were a result of “violence and other injuries by persons or animals”
• The same category of “violence and other injuries by persons or animals” accounted for 11 percent of lost-time injuries in private hospitals and a staggering 45 percent of injuries in state-run hospitals (possibly because these facilities are predominantly psychiatric and substance abuse hospitals)

Within health care, some positions are more exposed to the risk of violence. Employees who work with patients with dementia or psychiatric issues, for example, may be at greater risk. Registered nurses and nursing assistants have higher lost-time injury rates due to violence than private industry on average.

Under-reporting workplace violence

According to OSHA’s “Workplace violence in health care: Understanding the challenge” report , violent incidents in health care often go unreported, with verbal abuse and bullying less likely to be reported than physical altercations.

A 2004 study of Minnesota nurses in the Journal of Occupational and Environmental Medicine “found that only 69 percent of physical assaults and 71 percent of non-physical assaults were reported to a manager.” The same study concluded that workplace violence — or the threat of violence — can hurt workplace morale and productivity and lead to higher burnout and turnover.

Preventing violent injuries in health care

With such a high rate of injuries in health care, OSHA updated its “Guidelines for Preventing Workplace Violence for Healthcare and Social Service workers” in 2015. The voluntary recommendations are designed for health care workers at all levels, from support staff to physicians, and in settings across the continuum of care, from home health care to hospitals.

The guidelines recommend incorporating a workplace violence prevention program into an organization’s broader safety and health program. An effective workplace violence prevention program addresses five components:

1. Management commitment and employee participation
2. Worksite analysis
3. Hazard prevention and control
4. Safety and health training
5. Recordkeeping and program evaluation

OSHA’s resources include a workplace violence program assessment checklist, which covers topics such as staffing, training, facility design, security measures and workplace procedures, as well as considerations for workers who do field work. Training may include de-escalation and self-defense techniques.

With health care workers facing a real threat of workplace violence, organizations should take steps to track incidents accurately, train employees on de-escalation techniques and implement a workplace violence prevention program.

Additional resources

• SFM fact sheet: Occupational injuries in health care
• SFM De-escalation Team Training – health care
• Combative patient behaviors Supervisor Initiated Training
• OSHA: Workplace violence in healthcare: Understanding the challenge
• OSHA: Preventing workplace violence in healthcare
• American Nurses Association bullying and workplace prevention page

By Lee Wendel, CIA, CSP, CSPHA
SFM Director of Loss Prevention

Nationally about 350 fatalities occur each year among workers covered by Occupational Safety and Health Administration’s walking-working surfaces and fall protection standards.

Earlier this year OSHA updated the standards. Minnesota OSHA announced that it would mirror and implement these standards effective September 19, 2017.

The updated rule applies to a wide range of businesses considered general industry. It doesn’t change expectations for those in the construction or agriculture segments.

Three categories covered by this standard are leading sources of severe injuries for SFM policyholders:

1. Walking-working surfaces
2. Ladder safety requirements
3. Fall protection systems

Walking-working surfaces

OSHA defines walking-working surfaces as “any horizontal or vertical surface on or through which an employee walks, works or gains access to a work area or workplace location.”

According to the standard, employers must ensure:

• Surface conditions are clean, orderly and sanitary
• Floors are maintained free of sharp or protruding objects, loose boards, corrosion, leaks, spills, snow and ice
• Employers must inspect, maintain and repair walking-working surfaces as often as necessary
• Hazardous conditions on walking-working surfaces must be corrected or repaired. If corrections or repairs cannot be made immediately, the hazard must be guarded to prevent employees from using the surface until repairs are completed

Ladder safety requirements

According to OSHA, falls from ladders account for 20 percent of all fatal and lost-time work injuries in general industry. In recent years, some of the most severe injuries and fatalities from our policyholders could also have been prevented using the standards’ requirements as defined in the update.

Key elements for portable ladders

• Ladders must be inspected before initial use in each work shift to identify defects that could cause injury
• Employers must ensure that steps and rungs are slip-resistant
• Portable ladders are not moved, shifted or extended while under use
• Top steps and caps are not used as steps (ladders are labeled accordingly)
• Fastening multiple ladders together is not allowed
• Ladders cannot be placed on top of other items such as boxes or barrels to gain added height

The update also covers additional requirements and future standards for fixed ladders, mobile stands and platforms.

Fall protection options

OSHA defines fall protection as “any equipment, device, or system that prevents a worker from falling from an elevation or mitigates the effect of such a fall.”

The update requires all employers to protect employees from fall hazards along edges that are at least 4 feet above a lower level. Fall protection is also required in specific situations such as hoist areas, runways, areas above dangerous equipment, wall openings, repair pits, stairways, scaffolds and slaughtering platforms.

Fall protection anchoring and design is a complex topic — if your company doesn’t have a trained “competent person,” engage an expert to help.

Fall protection options under the new rule

• Guardrail System – A barrier erected along an exposed side, edge or another area of a walking-working surface to prevent workers from falling to a lower level
• Safety Net System – A netting system to stop falling workers before they make contact with a lower level or obstruction
• Personal Fall Arrest System – Consists of a body harness, anchor, connector and may include a lanyard, deceleration device, lifeline or a combination meant to stop a fall before the worker contacts a lower level
• Positioning System – Equipment and connectors that when used with a body belt or harness allows a worker to be supported on an elevated vertical surface and work with both hands free
• Travel Restraint System – Combination of anchor, connector, lanyard or other means of connection to eliminate the possibility of a worker going over the unprotected edge or side of a surface
• Ladder Safety System – A system attached to a ladder designed to eliminate or reduce the possibility of a worker falling; Cages and wells are not considered ladder safety systems

Training requirements for these topics were also updated. A qualified person must train workers affected by these risks on how to correctly: Identify and minimize fall hazards; use personal fall protection (if used); and maintain, inspect and store equipment or systems used for fall protection.

More topics covered in the standard can be found on the OSHA website . See the OSHA site for details with general requirements starting at §1910.22.

Additional resources

• OSHA walking-working surface final rule
• NIOSH ladder app
• SFM blog: Ladder safety resources

This is not intended to serve as legal advice for individual fact-specific legal cases or as a legal basis for your employment practices.

Knowing what hazards are associated with a job gives employees the power to avoid them and prevent injuries. Using job hazard recognition is a great way to review a work area in order to identify, eliminate or control work-related risks that could cause injury.

Workplace analysis

Workplace analysis can help identify and control hazards and prevent injuries through assessment of operation, procedures, processes, physical environment and individual workstations. There are four steps in workplace analysis:

1. Review previous injury records

Injury records can reveal trends in types of injury, time of year, specific shift or work area, specific tasks and tools and equipment used or not used.

2. Use a checklist and review it

You can identify hazards more consistently and without overlooking the obvious by following a checklist. Reviewing the checklist can help generate ideas for improvements to be made.

3. Walk through the worksite

Look for hazards: evaluate specific jobs, workstations, equipment, the environment and employee’s behaviors.

4. Determine ways to eliminate or control hazards

If there is risk of injury due to the process of completing a task, consider modifying the process or choosing a different one. Eliminate the hazard through improvements to the workstation, enclosures, machine guards or personal protective equipment or find ways to reduce exposure to the hazard.

Know the hazards

Before beginning a job, take the time to evaluate the potential dangers. Safety issues to watch out for include:

• Slip, trip and fall hazards
• Ergonomic hazards
• Hand tools/power tools
• Lifting, handling, pushing, pulling
• Unguarded/unprotected moving parts
• Eye hazards
• Breathing hazards
• Pinch points
• Electrical hazards

Specific safety procedures, such as lockout tagout, confined space and fall protection procedures, may also be associated with certain jobs. Serious injuries can be prevented by knowing and following all associated safety procedures.

More resources:

• Job hazard recognition Supervisor Initiated Training
• Hazard analysis of the workplace 5-Minute Solution
• Workplace analysis CompTalk and supervisor checklist

One visit from a loss prevention representative — that’s all it took to measure a significant reduction of risk for a lost-time claim in a newly published study.

The research, published in the September 2017 Journal of Safety Research , shows the value of loss prevention representatives for helping a high-risk industry reduce severe employee injuries.

In the study, small and medium-sized construction firms tracked their lost-time claim frequency and the number and type of loss prevention contacts they’d had. Researchers then quantified the connection between contact and reduced lost-time injuries.

We spoke to the study’s lead author, Katie Schofield, Ph.D., assistant professor at the University of Minnesota-Duluth. Schofield is a former SFM loss prevention representative.

The interview has been edited for clarity and length.

What led you to this research?
I used it for my doctoral dissertation, looking at injury burden and construction contractors, particularly smaller ones. They don’t have a full-time safety person. Oftentimes they weren’t getting safety or health [resources] from anyone else, except loss prevention reps. Because I worked with them myself as a loss prevention rep, I was interested: Is what we’re doing making a difference? Is it doing something positive?

That’s part of my story behind this, too. Insurers are such a valuable resource, because loss prevention reps can get out there and really have the opportunity to help the business, disseminate research, make the business case for safety.

What were the conclusions you were able to draw from looking at the data over a number of years? Did anything surprise you about these results?
It was heartening to see that there was a significant reduction in risk with these on-site visits with policyholders. Compared to groups that had no loss prevention contacts, when employers did have contact with a loss prevention rep, their risk of a lost-time claim was reduced. Employers that had one contact had about a 27 percent reduction in risk. Employers that had two contacts had a 41 percent reduction in risk. And then three or more contacts was a 28 percent reduction in risk.

So the risk reduction doesn’t continue to go up evenly with repeated visits. Do you have an explanation for the fluctuation, how risk was reduced more with two contacts than with three or more?
Somewhere between that second and third visit, you’re still getting a reduction – not as dramatic of results, but still a significant reduction. That was just interesting in trying to consider, OK, why is this happening? How do we look at what we see in these results here and try to find an explanation in real life?

When you’re first establishing this contact and giving policyholders resources or a plan of action, that would be that first contact that would reduce the risk.

Then maybe your second contact, you check back in, you see how things are going, you follow up. Those might be the things that have the biggest impact, and then with each subsequent contact, you’re still making a difference, but it’s not that dramatic as the first ones. So the effect tapers down.

Or, those accounts that are being visited a lot, they may have a higher risk to begin with. Perhaps that’s why the trend doesn’t continue with bigger and bigger reductions of risk. But it still is significant; 28 percent risk reduction at three or more contacts, that still is a nice effect that you’re seeing there.

Read the full study

A Rand Corporation survey released this week sheds light on working conditions in the United States, and results are mixed.

On one hand, significant numbers of respondents reported physically taxing, unpleasant and potentially hazardous conditions. On the other hand, most reported positive feelings toward their bosses and colleagues.

The report is based on a nationally representative sample of participants in the American Working Conditions Survey, fielded in 2015.

The bad news: Workers report physical exertion, safety hazards

According to the report:

• 60 percent of respondents reported engaging in one or more of the following activities: moving heavy loads or people at least 25 percent of the time, maintaining tiring or painful positions at least 25 percent of the time or standing almost all or all of the time
• 75 percent reported using repetitive hand/arm movements at least 25 percent of the time
• 44 percent reported sitting all or almost all of the time
• 55 percent reported exposure to at least one unpleasant and potentially hazardous working condition such as vibrations from hand tools or machinery; loud noise; extreme temperatures; breathing in fumes, smoke, powder or dust; handling chemicals or handling infectious materials
• 20 percent reported experiencing some form of hostility at work such as verbal abuse, threats, humiliation, unwanted sexual attention, bullying, harassment or physical violence
• 66 percent reported working at high speeds, tight deadlines or both at least half the time

Nearly all of these conditions can increase the risk of work injuries. For a big-picture look, read our past blog post: Four signs that you genuinely value workplace safety.

The good news about U.S. working conditions

It wasn’t all bad! Most respondents reported supportive social conditions at work.

According to the report:

• 58 percent of respondents said they have a supportive boss
• 78 percent said they like and respect their colleagues
• 78 percent said they have good cooperation with their colleagues
• 57 percent said conflicts are resolved fairly

This is good news since research shows that workplace friendships generate employee satisfaction, and employee happiness at work contributes to higher productivity.

If a work injury does occur, good working relationships between managers and employees are especially important.

For more details on the survey, visit the Rand Corporation website .

Cleanliness is next to godliness, the saying goes. In construction, cleanliness reduces risk of injury.

Proper housekeeping is an important part of keeping your construction site safe and avoiding OSHA penalties. Accidents such as trips and falls, being struck by falling objects and cutting or puncturing the skin can often be avoided by keeping a jobsite neat and organized.

Here are some guidelines to create a safer workplace:

• Clean up debris
  Keep all walking and working surfaces clean and clear of debris. Clean as you go to prevent build-up of debris and to minimize the amount of time needed to clean a larger mess at the end of the day. Watch for debris in stairwells.
• Pay attention to proper storage
  Identify designated areas for storing tools and materials. Out-of-place objects such as leaning lumber, plywood and other materials can cause trips and falls. Stack materials orderly and secure them so they won’t fall.
• Eliminate hazards
  Clear away protruding pipes, lumber, rebar or other materials that could cause injury. Bend over or remove nails that are sticking out of lumber. Provide adequate lighting.
• Keep extension cords clear of walkways
  Extension cords and airlines should be elevated, if possible, out of walkways, or covered with lumber or plywood. When not in use, coil up and neatly store.

More resources:

• General housekeeping for construction SIT
• General housekeeping for construction 5-minute solution – English
• General housekeeping for construction 5-minute solution – Spanish

Injuries from “distracted walking” have more than doubled since 2004, and surveys have shown that 60 percent of pedestrians are distracted by other activities while walking as well, according to a 2015 report by the American Academy of Orthopedic Surgeons .

The study also shows that distracted walking is resulting in people falling down stairs, tripping over curbs, and stepping into traffic, causing cuts, bruises, sprains, and fractures. Walking while distracted can also cause you to miss potential hazards like ice, snow or a change in the walking surface, putting you at risk for a fall.

To avoid distracted walking accidents at your workplace, encourage employees:

• NOT to use cell phones, tablets or other devices while walking
• NOT to read documents while walking
• NOT to carry more than they can handle safely
• To take it slow when they see snow
• To stay focused on their path and their end goal
• To wear proper footwear

Encourage your employees to watch each other’s backs. When employees see coworkers being distracted by cell phones, stress or other factors, encourage them to help each other get back on track and focused. Showing you care is often a very effective safety measure.

There are many things supervisors can do to promote safety in the workplace and awareness among employees. Start by being a good example and practicing what you preach. Avoiding distractions yourself will go a long way. Hang SFM’s Don’t be distracted posters as reminders, and check out SFM’s other free downloadable safety resources.

Don’t miss your moment

We also have a series of short videos demonstrating what people can miss going on around them when distracted.

This post was originally published on January 24, 2014, and updated on June 30, 2017.

It’s easy to say “safety first.” It’s tougher to truly carry it out.

Here are a few signs that you and your organization practice what you preach when it comes to employee safety:

• Your workflow expectations match your safety doctrine.
  Your production quotas aren’t so high, nor deadlines so tight that workers have to cut corners on safety to meet them. You’ve tested and verified that it is possible to meet expectations while following all of the proper safety procedures. One way to test this: if you catch a frontline employee violating your safety rules, ask why. You might learn that the employee feels the need to carry too much at once or skip putting on safety equipment in order to meet production goals.
• All leaders consistently communicate the company’s safety expectations to staff.
  Safety procedures are part of new-hire training, and then reiterated and expanded upon regularly by supervisors. Safety is mentioned often — a regular topic in staff meetings. Employees know if they break safety rules, their supervisors won’t look the other way. The communication isn’t limited to words. Employees see that their supervisors follow the safety rules, too.
• You analyze your safety programs to make sure they’re working.
  Just like you’d analyze any other process change or company initiative to make sure it’s giving you the desired results, you evaluate your safety efforts periodically to see if they’re working. You make changes as necessary to improve your results. Safety initiatives aren’t rolled out and then forgotten. You remind your staff about ongoing safety programs regularly to keep them top of mind.
• Your workplace is an environment of mutual respect.
  Since employees often know best the safety risks and challenges of their jobs, your company fosters an atmosphere in which employees feel comfortable informing leadership when there’s an issue or opportunity for improvement. Similarly, employees respect their leaders enough to follow company safety rules.

Management sets the tone for employee safety. Employees can tell the difference between a management team that just says “safety first” and one that really means it, and their behavior will follow suit.