Values-Based Safety in the Clinical Setting

Direct service provider (DSP) positions encompass a wide range of occupations that involve providing hands-on care, assistance, or support directly to individuals in various settings. These positions are prevalent in industries such as healthcare, social services, and education. Some common DSP roles include healthcare aides, personal care attendants, behavior technicians, and educational assistants. Such positions require both physical and emotional demands that can put employees at a higher risk for workplace injury. In fact, the U.S. Department of Labor’s Bureau of Labor Statistics reports that the healthcare and social assistance industry has the second highest total recordable cases (4.5 total recordable cases) across all major private industries with only the transportation and warehousing industry reporting higher rates (4.8 total recordable cases). In addition, it was reported that practitioners and technical occupations make up 78.6% of all reported days away from work, job restriction, or transfer (DART) cases due to workplace injury (Bureau of Labor Statistics, 2023). 

Several factors contribute to why DSP positions often have higher workplace injury rates compared to the average:

Physical Demands: Many DSP positions involve physically demanding tasks such as lifting, transferring, and assisting individuals with mobility limitations. For example, healthcare aides may need to lift patients, while personal care attendants may assist with activities of daily living like bathing and dressing. These tasks can lead to musculoskeletal injuries if proper lifting techniques and equipment are not used.

Exposure to Hazards: DSPs often work in environments where they may be exposed to various hazards, including infectious agents, hazardous chemicals, aggressive behaviors, and environmental dangers. For instance, healthcare workers may be at risk of needlestick injuries or exposure to infectious diseases, while behavior technicians may encounter aggressive behaviors from clients.

Emotional and Psychological Stress: Many DSP roles involve providing care and support to individuals who may be experiencing physical, mental, or emotional challenges. This can lead to high levels of stress, burnout, and compassion fatigue among workers, which may increase the risk of workplace injuries due to reduced concentration and fatigue.

Workplace Violence: DSPs, particularly those working in healthcare, social services, and education, may be at higher risk of workplace violence due to interactions with clients, patients, students, or their family members. This includes verbal abuse, physical assaults, and threats, which can result in both physical and psychological injuries.

Training and Resources: In some cases, DSPs may not receive adequate training, resources, or support to perform their duties safely. Insufficient training on proper lifting techniques, infection control practices, or de-escalation strategies can increase the risk of workplace injuries and accidents.

Workplace Culture and Organizational Factors: The workplace culture and organizational factors within industries that employ DSPs can also influence safety outcomes. Factors such as understaffing, inadequate safety protocols, and lack of leadership support for safety initiatives can contribute to higher injury rates.

Overall, addressing these factors requires a multifaceted approach that includes implementing comprehensive safety training programs, providing appropriate equipment and resources, fostering supportive workplace cultures, and prioritizing the physical and mental well-being of DSPs.

Unfortunately, while most healthcare and social assistance providers place client and patient safety at the top of the priority list, it may be at the expense of their employees’ well-being. It is not uncommon to see protecting employee safety and well-being missing from their list of core values, which often results in the lack of an effective and positive safety culture. 

Fortunately, a behavioral approach to safety can help organizations address many of the factors that can contribute to high injury rates in the healthcare and social assistance industry. Implementing a behavioral approach to safety is particularly suitable for addressing workplace injuries among DSPs for several reasons: 

1. Focuses on Human Behavior: With the science of behavior as the underlying philosophy, a behavioral approach to safety recognizes that most workplace injuries are caused by unsafe behaviors. By focusing on critical safety behaviors that have resulted in injury in the past, the behavioral approach to safety allows organizations to improve such behaviors rather than focusing on uncontrollable factors.
2. Proactive Approach: A behavioral approach to safety encourages proactive identification of safe and unsafe behaviors BEFORE incidents occur. This is especially relevant for DSPs who may face hazards and risks in their work environment. By promoting continuous observation, feedback, and reinforcement of safe behaviors, this approach helps prevent incidents before they happen.
3. Emphasizes Positive Reinforcement: A behavioral approach to safety employs and emphasizes the use of positive reinforcement techniques to encourage safe behaviors among employees. This can be particularly effective in the healthcare and social assistance industry where employees may be experiencing high levels of stress and burnout. Recognizing and rewarding individuals and teams for engaging in safe practices not only reinforces those safe behaviors, but also promotes and fosters a positive safety-conscious culture.
4. Data-Driven Decision-Making: A behavioral approach relies on the collection and analysis of data to identify trends, patterns, and areas for improvement. By using data analytic tools to track leading indicators of safety such as close calls, safety leaders can make objective, data-based decisions regarding the effects of targeted interventions to prevent injuries.
5. Continuous Learning and Adaptation: A behavioral approach to safety encourages a culture of continuous learning and adaptation to address ever-evolving safety challenges. DSPs constantly encounter new risks and hazards as they navigate ever-changing work environments and client populations. By fostering open communication, feedback loops, and ongoing training, such an approach to safety enables organizations to stay proactive and responsive to emerging safety needs.

In summary, it is not enough to view employee safety as a priority, it must be viewed as a core value. By taking a values-based approach to safety, organizations in the healthcare and social assistance industry can make remarkable improvements to their safety culture and employee safety and well-being. For more details on incorporating a values-based approach to safety, please see The New Values-Based Safety: Using Behavioral Science to Improve Your Safety Culture (McSween & Hockman, 2024). 

References: 

Bureau of Labor Statistics. (2023, November 9). Employer-reported workplace injuries and illnesses – 2021-2022 [News release]. U.S. Department of Labor. https://www.bls.gov/news.release/pdf/osh.pdf

McSween, T. E., & Hockman, A. S. (2024). The New Values-Based Safety: Using Behavioral Science to Improve Your Safety Culture. KeyPress Publishing.