In the current climate of significant demographic and economic change, we need to improve quality of care by focusing on the safety and health of healthcare workers
Director, European Agency for Safety
and Health at Work
Health and social care is one of the largest sectors in Europe and employs approximately 10% of the EU workforce.1 However, most healthcare systems in Europe are undergoing reform as a result of various Europe-wide trends. People are living longer and our ageing population is resulting in a rising demand for healthcare services, but skills shortages are expected because of the ageing workforce and declining birth rates.2 Moreover, home and community care is increasing in importance, as fewer elderly people are living with their children.
As well as rapidly expanding the size of the sector, these trends are giving rise to new safety and health risks to healthcare workers, in addition to the well known hazards that already exist in this sector. At the European Agency for Safety and Health at Work (EU-OSHA), we believe that highlighting the importance of occupational safety and health (OSH) in the healthcare sector has never been more important. Throughout Europe we need to improve our understanding of the link between good OSH and high quality patient care. Although patient care is quite rightly the main priority in this sector, this has sometimes been to the detriment of workers’ safety and health – and this needs to change.
Current safety and health risks
The healthcare sector has traditionally been a high risk workplace. Work-related accidents are reported to be 34% higher in the healthcare sector than the EU average,3 and the results of our 2010 European Survey of Enterprises on New and Emerging Risks (ESENER) showed that it was the sector with the highest rate (58%) of sickness absence.4
However, despite the multitude of risks to healthcare workers, the safety and health of patients has always been the priority. This is emphasised during healthcare professionals’ training and throughout their careers, and healthcare organisations have traditionally invested significantly in systems and equipment for patients, often leaving staff safety and health issues unaddressed. But the link between worker and patient safety cannot be ignored. Only if OSH issues are considered a priority in healthcare can the highest quality of patient care be delivered.6
Trends, developments and the emerging risks
In addition to the well known hazards associated with the healthcare sector, recent developments and trends have resulted in new OSH challenges.
Europe’s population is ageing: the number of people over 65 is projected to double over the next 50 years.7 Demand for healthcare services is likely to intensify, putting greater strain on the sector. On top of this, the ageing workforce, combined with a lack of young recruits to replace retirees, could lead to a drastic reduction in the EU’s healthcare workforce over the next 10 to 20 years.8
This discrepancy between a growing demand for healthcare and a lack of healthcare workers is likely to become increasingly problematic across Europe. It will result in greater workloads for the workers who remain, and the ageing patient population may need new treatments and care models, creating greater job demands. Psychosocial risks are therefore likely to increase.
Social and cultural changes
Family patterns have changed significantly. Elderly people often no longer live with their families and the number of single households is increasing. As a result, informal healthcare provided within the family is less common and there is likely to be increasing demand for formal home and community care.
Changes in lifestyles – including unhealthy diets, smoking, alcohol and drug consumption and lack of physical activity – are likely to cause more chronic diseases (for example, diabetes and coronary heart disease), putting further strain on the healthcare sector and its workers.
Migration of workers and patients
Over recent decades, healthcare worker migration has been rising throughout the world, particularly from lower income countries with fragile healthcare systems.9 This is a fantastic opportunity for migrating workers to increase their occupational and personal qualifications, but difficulties can arise in the provision of healthcare in these low income countries, putting strain on the workers who remain.
Moreover, migration causes many cultural and linguistic differences in the workplace, leading to communication issues both among staff and between staff and patients. This can cause tension, misunderstanding and conflict.
Patients have also become more mobile within the EU. They are now able to seek out treatments that are unavailable or cheaper than in their native countries, thanks to advances in information and communication technology (ICT). This not only puts pressure on the system receiving these patients, but also can increase the spread of infectious diseases (for example, Ebola virus) and antimicrobial resistant pathogens (for example, MRSA).
There have been considerable technological advances and innovations over the last century: we have seen great improvements in the possibilities for treatment and the length and quality of life of patients. Genomics and new biotechnologies, nanotechnologies and robotics are just a few examples.
In some cases, these new technologies have the potential to improve the safety and health of workers; for example, robotics can help to reduce ergonomic risks. However, new technologies can pose new safety issues (for example, noise and physical risks) and often require new skills and/or training. Biotechnologies and nanotechnologies (for example, new chemical agents such as nanoparticles) could also affect the health of exposed workers.
In addition, ICT developments have had a considerable impact on the healthcare sector. Electronic records are helping to significantly improve information access and communication, potentially reducing workload and administrative burden. However, ICT advances have also led to a significant increase in computer work and its related health risks, such as ergonomic risks and eye strain.
Finally, globalisation and the economic crisis have affected us all, with healthcare being no exception. I have witnessed wide-ranging impacts on the sector over recent years. Resource restrictions, including wage cuts and lack of investment, have led to increasing working pressure and job insecurity. Through a lack of investment in equipment, there is the potential for failure of medical equipment, and investment in OSH has suffered. Restructuring, including downsizing and closing hospitals, is causing increases in workloads and pressure on healthcare workers. However, closures are also leading to a reduction in the use of healthcare services by patients, which could increase the prevalence of disease, thereby increasing the biological risk to healthcare workers.
Home and community care
With people living longer and increasingly needing long-term care, and with changes in family patterns resulting in a greater need for formal community-based care, care workers are becoming ever more important in the healthcare sector. Community care can include care at home, respite care (non-residential) and home adaptations, among others.
Home and community care can present specific safety challenges. Injuries resulting from travelling in the community, overexertion and repetitive movements when assisting patients, and slips, trips and falls are the main causes of lost working time among care workers.7
Moreover, as a working environment, the home care setting can be particularly challenging. Risks associated with working in patients’ homes include small work spaces and a lack of adequate equipment (for example, adjustable beds and adaptable showers), which can result in ergonomic risks; cluttered and/or poorly lit work spaces, leading to slips or falls; lifting without assistance, which can lead to musculoskeletal disorders (in 2007, home care workers took more frequent sick leave as a result of work-related musculoskeletal disorders7); household-related hazards (for example, poor indoor air quality and toxic substances); and minimal or no supervision and lone working, which can involve psychosocial risks.
In addition, many of the same hazards that exist in institutional settings (for example, spread of infection, development of resistant organisms and medication errors) also exist in home and community care settings, but the necessary healthcare workplace protections may not be in place. Moreover, stress as a result of dealing with patients and family members who are stressed or difficult to work with and who may even become violent can be exacerbated when working alone in unfamiliar and uncontrolled situations.
Future research and practice
Various recommendations for future research and possible directions for future practice were outlined in our 2014 European Risk Observatory report.7 This report was based on a state-of-the-art literature review and a questionnaire that was distributed to OSH professionals throughout Europe. We were therefore able to combine literature findings with those from the ‘front line’.
One of the recommendations for future research outlined in the report was to collect more detailed data that are comparable across Europe on working conditions, exposures and safety and health outcomes for healthcare workers. It was also highlighted that more evidence is needed on how OSH affects quality of care. Although much research has been done on individual risks, more research is also needed on the interaction between risks (for example, between ergonomic and psychosocial risks).
Various possible directions for future practice in the healthcare sector have also been suggested. One was that more practical initiatives be implemented to improve the working conditions of home and community care workers. In addition, more interventions that address OSH could help to tackle the healthcare worker shortage resulting from the ageing workforce. An increased focus on tackling the language and cultural barriers that arise from healthcare worker migration could help to lessen conflict in the workplace.
Moreover, with the introduction of new technologies, there needs to be a focus on continual training of workers, and new risks need to be included in risk assessments. The possibility of new technologies as a source for improving working conditions (for example, in the home care setting) also needs to be explored further.
Finally, in the current economic climate and with the current healthcare funding issues, the benefits of OSH and its business case need to be continually highlighted to policy-makers, researchers and OSH professionals. If the healthcare sector is to meet the challenges it faces and provide high quality patient care, I believe workplace safety and health needs to be high on the healthcare sector’s agenda.
- European Observatory on Health Systems and Policies (2010). Section 4.1 How to create an attractive and supportive working environment for health professionals’ in Investing in Europe’s Health Workforce of Tomorrow: Scope for Innovation and Collaboration. Available at: http://www.healthworkforce4europe.eu/downloads/Report_PD_Leuven_FINAL.pdf. Last accessed April 2016.
- Eurostat (2010). Demography Report 2010: Older, More Numerous and Diverse Europeans. Available at: http://ec.europa.eu/social/BlobServlet?docId=6824&langId=en. Last accessed April 2016.
- EU-OSHA (2003). Facts 29: Safety and health good practice online for the healthcare sector. Available at: https://osha.europa.eu/en/publications/factsheets/29. Last accessed April 2016.
- EU-OSHA (2010). European Survey of Enterprises on New and Emerging Risks (ESENER): Managing Safety and Health at Work. Luxembourg, Publications Office of the European Union. Available at: https://osha.europa.eu/en/publications/reports/esener1_osh_management. Last accessed April 2016.
- EU-OSHA (2015). First findings from the Second European Survey of Enterprises on New and Emerging Risks (ESENER-2). Luxembourg, Publications Office of the European Union. Available at: https://osha.europa.eu/en/tools-and-publications/publications/reports/es…. Last accessed April 2016.
- Sikorski J (2009). Connecting worker safety to patient safety: a new imperative for health-care leaders. Ivey Business Journal, Leadership, January–February. Available at: http://iveybusinessjournal.com/publication/connecting-worker-safety-to-p…. Last accessed April 2016.
- EU-OSHA (2014). Current and emerging occupational safety and health (OSH) issues in the healthcare sector, including home and community care. Luxembourg, Publications Office of the European Union. Available at: https://osha.europa.eu/en/tools-and-publications/publications/reports/cu…. Last accessed April 2016.
- European Commission (2012). Commission staff working document on an action plan for the EU Health Workforce, accompanying the document Communication from the Commission to the European Parliament, the Council, the European Economic and Social Committee and the Committee of the Regions: Towards a job-rich recovery. SWD (2012) 93 final. Available at: http://ec.europa.eu/dgs/health_consumer/docs/swd_ap_eu_healthcare_workfo…. Last accessed April 2016.
- Siyam A, Dal Poz MR (2014). Migration of Health Workers. WHO Code of Practice and the Global Economic Crisis. World Health Organization, Geneva, Switzerland. Available at: http://www.who.int/hrh/migration/14075_MigrationofHealth_Workers.pdf. Last accessed April 2016.