In summary, the term safety culture is a relatively recent idea, and appears to have arisen out of the 1986 Chernobyl disaster investigations and report, where violations of the operating procedures were thought to have contributed to the accident. A culture of safety is the way in which high-reliability industries such as aviation, nuclear power, oil and gas, and health care are moving forward to meet goals and objectives. The reason for this realignment with safety goals is that previously structured safety programs that relied on management to monitor safety simply do not work. A culture of safety relies on employee involvement, along with the practice of developing managers who support safety initiatives that include every member of the team.

SPHM is a driver of safety on many levels. Originally introduced as a method to manage worker’s compensation costs, SPHM has become a strategy to manage risk across units, disciplines, and practice settings. As described in the SPHM Standards, features of a culture of safety include acknowledgment of the risk, a commitment to provide resources to consistently achieve safe operations, a blame-free environment where individuals are able to report errors or incidents without fear, and an emphasis on collaboration across sectors and settings.

Healthcare quality and safety have received intense scrutiny since the 1999 IOM report, To Err Is Human: Building a Safer Health System (Kohn, Corrigan, & Donaldson, 1999). Healthcare organizations have responded to this challenge, and many healthcare facilities are using NDNQI® to identify the structures and processes that improve safety and outcomes of care. A SPHM program may affect a variety of NDNQI measures. For instance, Sturman-Floyd reports that she found a relationship between ceiling lift systems and the reduction of pressure ulcer incidence. She noted that fewer staff members were needed to move healthcare recipients and that by using the technology, family members could turn and reposition the healthcare recipients at home between professional care visits.

Furthermore, as healthcare organizations respond to changes in reimbursement practices that focus on outcomes and cost, direct and indirect mobility-related outcomes become increasingly important. SPHM is addressing fiscal initiatives, which not only reduce injury of healthcare workers, but
also improve safety of healthcare recipients. For example, consider Mercy Health in Missouri: Karin Garrett explains that length of stay among high-risk patients (patients of size) and fall-related injuries both have decreased there as awareness of the SPHM program increased (Garrett, 2013). Julie Lavezzo and Ryan Rodriguez (2013) experienced a similar data outcome with introduction of the mobility coach role to the SPHM program at Marin General Hospital (MGH). Further, at MGH, a qualitative study suggested profound satisfaction, expressed not only by healthcare workers, but by healthcare recipients as well. Darla Watanabe at Stanford Hospitals and Clinics explained that, like Sturman-Floyd, a reduction in the frequency and severity of hospital-acquired pressure ulcers has emerged alongside the maturing of the SPHM programs (Watanabe, 2013). The interprofessional nature of the SPHM Standards is emphasized throughout this document because the value of the Standards is dependent on recognizing how different units, disciplines, and settings interface. To achieve the highest level of success, it is important to understand the underlying causes behind immobility-related consequences of care—the adverse outcomes that are considered nonreimbursable events due to CMS payment restructuring. These underlying causes are often the failure of the healthcare worker to successfully lift, turn, and reposition dependent or immobile healthcare recipients. For the first time, healthcare workers, managers, and leaders have tools to address these underlying causes. The tools serve to assist the healthcare worker in providing early, progressive mobility while managing the risks of MSD and other injury. SPHM tools enhance the culture of safety by involving frontline healthcare workers and providing defined safety opportunities for manager and leader support over time. It is more important than ever to understand the value of a culture of safety as both healthcare recipients and workers are becoming older and larger, creating a “perfect storm” for costly catastrophic injuries in healthcare settings across the United States.

Although the prevalence of obesity in America fluctuates based on the location of data collection, study design, age of participants, and other factors, most researchers agree that nearly 40% of adult Americans living in the United States are obese, 67% are overweight or obese, and nearly 7% are considered morbidly obese. This increase in the prevalence of obesity is occurring at the same time the general population and healthcare worker population are both aging. For example, the proportion of Americans 65 years of age and older is expected to increase from 12% in 2005 to approximately 20% by 2030. In 2013, the age of the average nurse is 53. These parallel increases affect the ability of healthcare workers to manually lift, and concurrently the acuity
of patients is also increasing. Sicker, more dependent healthcare recipients are presenting to larger, older healthcare workers. Again, meaningful SPHM strategies are at the heart of risk management associated with this emerging storm. To integrate the SPHM Standards into a meaningful culture of safety, the SPHM program must address safety issues irrespective of the etiology. A safe work environment and corresponding attitudes will succeed only if these qualities are pervasive across all units, disciplines, and practice settings.