4 Small Changes to Improve Workplace Safety

Publish Date: November 13, 2019

Perioperative workplace safety is not a “one and done,” stress Ross Simon, BA, senior quality engineer and Elena Canacari, BSN, RN, CNOR, associate chief nurse for perioperative services at Beth Israel Deaconess Medical Center in Boston.

Six years ago Simon and Canacari began the work of zeroing in on workplace safety issues that were putting staff at risk by using the Job Safety Behavioral Observation (JBSO) process, which was modified from Simon’s experience with safety in his previous career in manufacturing.

Through continual focus on safety, occupational injuries have been reduced in the OR by 72%.

To implement the JBSO in the perioperative setting, Simon and Canacari shaped a task force that still meets monthly by the area directors to address workplace safety issues, such as sharps safety, moving equipment or transferring patients. Members of this task force include Simon, Canacari, staff nurses and physicians, as well as occupational safety experts working outside of the perioperative setting.

“Sometimes it takes those from beyond the OR to see the dangers we overlook or accept,” Canacari notes.

Watching and Learning

The JBSO process is characterized by structured observation in which regular observations (3–4) are completed within a one-week period using an audit tool.

All recognized hazards are documented and recommended actions taken by the team are then listed on a spreadsheet that clearly outlines the issue addressed, next activity, individual responsible, target completion date and hazard rating on a scale of 1–15 based on severity and likelihood to occur to aid in prioritizing action. Data and analysis from previously reported injuries, as well as staff survey input on potential risks are also reviewed.

With key hazards identified, the task force then develops an action plan that is documented and communicated with OR team members. For example, musculoskeletal injuries were occurring due to lifting heavy linen and trash bags.

“We had to get very specific about details including what was being put in these bags and how staff would work together to reduce the risk for injury,” Simon explains. They discovered that unused saline bags were being dumped into linen or trash bags, increasing the weight so education was completed to prevent this action. They also changed the rule to require two people to move designated heavy equipment.

Addressing Small Safety Risks to Make a Big Difference

Canacari and Simon agree that structured observation and collaboration with frontline staff can identify small changes that make a significant improvement in workplace safety.


Here are four small changes they have made to initiate changes for a safer perioperative setting:

  1. Remove Unnecessary Risks

    “Simple fixes can make a big difference,” Canacari shares. The team observed employees sometimes hitting their head on the bottom edge of monitors when losing situational awareness while bending down to perform a task. The team added rubber bumpers around all monitors to mitigate this risk.

  2. Apply Formal Fixes

    Be on the lookout for quick fixes staff apply that may cause more danger. For example, staff were placing blankets on the OR floor to cover cords that were creating a tripping hazard, Simon explains. However, the blankets created an additional risk. The task force implemented a process to apply cord covers designed and fitted for this purpose to reduce the tripping hazard.

    Another formal approach to occupational OR safety is applying a safe zone for passing sharps. The need for this improvement is something Canacari and Simon initiated after observed and voiced concerns around sharps safety were addressed.

    The task force also is working to trial lateral transfer pads that could be standardized for safe patient transfer. With this change they initiated formal, evidence-based rules for staffing and weight limits to accommodate safe patient transfer.

  3. Look at Your Data and Make a Clear Plan

    “Don’t presume you understand what is causing a pattern of injury without observing practice to connect the dots between actions and reported injuries,” Canacari recommends. She says combining injury report data with audit data can be valuable in building an action plan to mitigate the risk.

    With a burning platform to reduce staff injury, the team renews their project charter yearly, specifying goals including a percent injury reduction target. Doing so, they bring together the correct people to plan and implement a risk mitigation strategy, Simon adds.

  4. Rewrite Safety Rules Using a 3-Column Chart

    Simon and Canacari help teams establish clear work instructions to specify exactly how work must be done to ensure staff safety and quality of work. For example, lifting injuries were addressed in central sterile through established rules for loading and lifting trays. These rules were clearly outlined in a 3-column chart for easy review with the first column outlining the action, the second column describing the potential risk for injury, and the third column describing actions for mitigating the risk.

“Workplace safety is really an extension of patient safety for many reasons,” Canacari says. “We see our focus on workplace safety serving as a draw for recruitment and retention and of course, protecting our staff from injury allows them to be their best to care for their patients.”


Additional Resource

Lucian Leape links workplace safety to patient safety, particularly as the unhealthy work environment leads to dysfunctional team behaviors. Learn more.


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