Quan Nguyen, DO, learned in seventh grade how devastating a workplace injury can be. His father, a carpenter, severed part of his thumb when he lost control of the power saw he was using. The accident put him out of work for a time and forced the family to stretch its skintight budget even further.

Years later, the memory inspired him to join Orange County’s Workplace Safety Steering Committee, says Dr. Nguyen.

“I’ve witnessed, firsthand, how things at work can lead to pain and suffering for the person and his family,” says Dr. Nguyen, a physical medicine and rehabilitation physician at the Chapman Medical Offices in Orange, California. “We’re like a big family at work and I don’t want to see people hurt.”

Team visits worksites to improve safety

As the sole physician on the 12-member committee, Dr. Nguyen uses his singular perspective to engage physicians and others to build a culture of workplace health and safety.

“He’s very unique,” says Jim Ovieda, assistant medical group administrator and the committee’s management tri-chair. “He brings another voice of authority to the conversation.”

Four years ago, Dr. Nguyen helped form the Tiger Team, a task force of union members and managers who visit units with high injury rates and offer expert advice on how to reduce risks. They developed a simple process to identify and address workplace hazards at the local level (see “Five Tips for Workplace Safety Site Visits”).

“It’s not a punishment. We’re there to help departments succeed and to help our staff and physicians to be safe,” says Dr. Nguyen, who named the Tiger Team in honor of “Tigger,” the fictional tiger character who bounces around and helps others.

Collaborating with frontline union members is vital to keeping everyone safe, says Dr. Nguyen.

“There seems to be two cultures inside the hospital – the physician and non-physician. We’re trying to bridge those two cultures by bringing together a diversity of voices to improve the culture of health and safety for everyone,” says Dr. Nguyen. 

Host teams say the visits and ensuing discussions help create an environment where everyone feels comfortable speaking up—essential to building safety into daily work.

Partnership approach gets results

The team aims for six site visits a year and had conducted 31 visits as of November 2015. Most of those departments reported significantly fewer injuries in the months after the visit; many reduced injuries by 50 percent or more. The approach has gained attention region-wide and other medical centers in Southern California are adopting the practice. The team also presented its partnership approach at the 2016 National Workplace Safety Summit.

“It’s a way of taking the pulse of the department,” Ronald Jackson, a medical assistant, SEIU-UHW member and the steering committee’s labor tri-chair, says of the team's site visits.

“We bring a fresh set of eyes to the department,” says Albert Alota, workplace safety coordinator for Orange County.

Three practical solutions

Recently, the committee’s labor and management members sat side by side reviewing workplace safety records for the Irvine Medical Center’s recovery room. The department had accrued nine injuries in as many months, three of them involving employees and gurneys. The team identified several hazards related to work space and storage and recommended ways to fix them. For example:

• To address heavy traffic down narrow hallways and around blind corners: Provide standardized traffic flow for gurneys, mirrors at key intersections and a recognized verbal cue to alert bystanders to passing gurneys and equipment
• To unclog crowded patient bays that forced staff to work at laptops in busy hallways: Install wall-mounted computers and exam stools to replace the office chairs in the room
• To reduce injuries caused by incorrect use of new gurneys: Ask vendors to help train staff how to safely operate new equipment

Employees appreciate the attention. “It’s good to have the team come in,” says Sol Estrella, RN, a staff nurse and UNAC/UHCP member. “It shows that management and higher-ups are responding to our staff needs.”

It’s not hard to figure out why people are hesitant to speak up at work. Offering a suggestion for improvement or pointing out when you think something isn’t right exposes a person to any number of possible responses—many of them unpleasant.

There’s the sarcastic retort. There’s the deafening silence. There’s the reply, pointing out exactly why you’re wrong, delivered in the nicest of tones but carrying an unmistakable edge of one-upsmanship. Who needs it? Who wants to create waves and risk a good job?

But when we don’t speak up, we put health and happiness at risk. As Doug Bonacum, Kaiser Permanente’s vice president of quality, safety and resource management, says in this issue’s cover story, speaking up “is mission critical for worker and patient safety.”

In addition to the moral imperative of protecting people from injury, there’s a strong economic incentive for speaking up. Improvement doesn’t typically come from a single person’s great idea—it comes from people sharing ideas. And we at KP have to keep improving, finding ways to deliver care as good as or better than we deliver now with fewer dollars per member. Our future depends on it.  

Since we get good at what we practice, we each have to practice speaking up. Practice means starting with lots of baby steps—don’t tackle the high-stakes stuff first! And let’s practice being good listeners, too, providing the space that lets others speak up safely.

The Labor Management Partnership and unit-based teams provide the framework for transforming what Bonacum calls a “culture of fear” around speaking up. But with that framework in place, it’s still up to each and every one of us to find the courage to address the immediate, particular obstacles that keep us silent.

When employees speak up, teams score high on patient safety, quality, service and workplace safety. But it can be hard to speak up when you don’t feel safe or comfortable. Gain the confidence to use your voice with these tips from two frontline workers with the Ambulatory Care Pharmacy team in West Los Angeles. 

Chakana Mayo, pharmacy technician, UFCW Local 770, Workplace safety champion

Practicing speaking up when you feel safe. “When we first began peer rounding, people were comfortable speaking to one another versus speaking with management. Once people were comfortable speaking with one another, then they felt like they could be comfortable speaking with management.”

Your voice can make a difference. “It’s important to speak up early because you can prevent long-term injuries from occurring. If you’re confident enough to speak up to your manager and just let them know what’s going on, they’ll appreciate it more.”

Employees who feel free to share their ideas and concerns help keep our patients safe and make Kaiser Permanente a better place to work. Managers can help team members feel comfortable speaking up by creating a “psychologically safe” work environment—one where no one is afraid they will be embarrassed, rejected or punished for speaking up. Here are four tips from supervisor Nee Tang, Pharm.D., Ambulatory Care Pharmacy, West Los Angeles, on how to help workers make their voices heard.

Follow up and take action. “When an employee brings up something, look for the solution and be accountable. Make sure things are done. Having that accountability is really crucial to employees.”

Be authentic. “Having a manager who is open-minded and who truly, genuinely wants to create a safe environment for everybody, that’s the key.”

Be patient and persistent. “In the beginning, people may not be as comfortable speaking out. But once they see we’re coming every month no matter what [to do peer safety rounding], they’re speaking out. We’re really getting the equipment that is needed and reminding everyone about the proper ergonomic positions. People know we’re serious about making an environment that is safe for everyone.”

Find people who want to share their passion with others. “Another key is to have people who are passionate. Angie Chandler, our labor co-lead, is really passionate about ergonomics. I’m passionate about eating healthy. We have another employee who is passionate about exercise. Everybody wants everyone to be safe and healthy and to work well together. We’re passionate about what we do and want to spread that to everybody.”

Angela Chandler and Nee Tang, Pharm.D., didn’t like what they were seeing.

The team co-leads for the West Los Angeles Ambulatory Care Pharmacy crouched beside Camille Wong, scrutinizing her posture as the pharmacist and UNAC/UHCP member sat typing at her computer.

After a quick huddle, the pair worked together to adjust Wong’s chair until she was sitting in the ideal position to protect her from pain—and a potential injury.

“I didn’t know I could adjust my chair this way. It feels good,” Wong said appreciatively, her feet resting flat on the floor and her legs bent at the appropriate 90-degree angle.

Shift in culture

Such peer safety rounds are one of the hallmarks of a dramatic shift in culture for the team, a shift that has built engagement and created a workplace where frontline workers feel confident speaking up. The department went 3½ years without injuries and earned a national workplace safety award earlier this year.

“We’re all in it together, and we’re all here for each other,” says Chakana Mayo, a pharmacy technician and UFCW Local 770 member who is the team’s workplace safety champion.  

But the situation was not always so bright.

In 2011 and 2012, the department experienced a spate of workplace injuries. Employees, who spend most of their time on phones and computers, were sometimes reluctant to report pain—including one who suffered a repetitive motion injury so severe that it required two surgeries and time off from work.

“It was really a wake-up call,” says Tang, a pharmacy supervisor and the team’s management co-lead. “We needed to make sure that everyone feels comfortable enough to speak up when they have a problem.”