Cleveland Clinic has an extensive safety program to inform and protect our caregivers. Our safety teams are responsible for providing training and resources to prevent safety events, responding when events occur, and reviewing safety performance for continuous improvement. Our Environmental Health and Safety (EHS) team monitors and implements safety practices at our main campus and family health centers. Each Cleveland Clinic hospital maintains safety plans specific to their unique environment of care.
The enterprise safety leadership team revises safety policies, equipment, procedures and training as appropriate based on regulatory changes and ongoing reviews of our performance. Occupational Health promotes the health and safety of our caregivers through new hire pre-placement assessments, urine drug screenings, annual compliance, Tuberculosis testing, audiograms and mandatory immunizations and flu vaccinations.
In order to safeguard the health of our caregivers in 2021, we provided personal protective equipment, implemented safety policies and adopted universal pandemic precautions. Our Occupational Health team created a system that included a 24/7 Caregiver COVID-19 Hotline, exposure education, safe return to work practices and vaccine education and access. In 2020 and 2021, we expanded our annual caregiver flu vaccination program to also provide vaccines for caregiver household members. Learn more about how we cared for our caregivers in 2021.
Our Protective Services Department is responsible for the safety and protection of patients, visitors, caregivers and property throughout the Cleveland Clinic Health System. The department is comprised of teams focused on personal safety, confidentiality, security, transportation and parking services and emergency readiness. This includes our Cleveland Clinic Police Department, which is comprised of more than 170 sworn police, security, communications and traffic control officers, and is nationally accredited by Commission on Accreditation for Law Enforcement Agencies (CALEA). One of the many services they provide is the Safety Escort program, which is a free service available to all caregivers, patients and visitors who need safe transportation to locations on main campus.
Safety is one of our core values, and as such, all caregivers contribute to maintaining a safe work environment for patients, visitors and one another. For example, we encourage every caregiver to report all events, exposures and near-misses through our safety reporting system. Caregivers receive information on how and when to report during orientation, and through annual compliance training thereafter. Following a caregiver safety report, we conduct thorough follow-up procedures to address the needs of our caregivers and identify opportunities for improvement to prevent subsequent events. Our EHS, Occupational Health and Protective Services departments maintain intranet pages to keep caregivers informed on safety efforts and provide easily accessible information on programs, services and resources.
Environmental Health and Safety (EHS) Data
Cleveland Clinic records and reports accident statistics in accordance with Occupational Safety and Health Administration (OSHA) and Bureau of Labor Statistics (BLS) requirements. An injury or illness is work-related if an event or exposure in the work environment either caused or contributed to the resulting condition, or significantly aggravated a pre-existing condition.
In 2021, all of our Ohio hospitals had lower total recordable injury rates than the 2020 hospital industry average of 7.6 injuries per 100 full time equivalent (FTE) employees. While in 2019 our overall occupational disease rate was 0.00, in 2020 it was 5.29 and in 2021 was back down to 0.50. We believe this was due to the aggressive implementation of COVID-19 control measures, high percentage of caregiver vaccination rates prior to the vaccine mandate and widespread continuity of care practices across all hospitals. There were no work-related fatalities in 2021.
Note: 2020 is the most current year for comparison data provided by BLS.
In 2021, caregivers in our ambulatory health and surgery centers experienced higher total recordable injury rates and occupational illness rates than the 2020 ambulatory healthcare industry average, again, due to the COVID-19 pandemic. Specialty centers and business locations reported fewer injuries than the industry average, likely due to postponing elective medical care and more caregivers transitioning to work from home and hybrid (working 2-3 at the office and the remainder at home) models.
Cleveland Clinic has a comprehensive Bloodborne Pathogen Exposure (BBPE) program and a BBPE Operations Committee, which is comprised of multiple BBPE Committees representing hospitals across the Enterprise. The committee meets regularly to share metrics, best practices and ideas for improving our program and performance. To reduce BBPE in the workplace, Cleveland Clinic:
- Requires all new hires to complete BBPE training during onboarding.
- Maintains a 24/7 BBPE hotline for caregivers to report events.
- Has dedicated Occupational Health caregivers to document exposures, schedule lab work and follow up with exposed caregivers following a report.
- Provides all caregivers access to BBPE procedures and our BBPE Toolkit via our intranet, which includes training materials, educational graphics and videos, best practices and other assets to help prevent and reduce BBPE.
The 2021 data below reflects Ohio locations with the exception of Union and Mercy Hospitals:
In 2021, Cleveland Clinic developed an online training module for BBP Exposure Prevention Champion Training. We developed an online training due to COVID-19 restrictions on gathering larger groups of caregivers, as well as for ease in reaching more champion candidates. BBP Exposure Prevention Champions ensure all caregivers in their area have completed BBP training at least once per year, identify potential BBP risks in their area, provide instruction on exposure prevention, assist with investigations and interventions and support caregivers post exposure.
OSHA Healthcare Emphasis Programs
Healthcare can be a hazardous place to work. OSHA has a special emphasis program that focuses on the top injury types in a healthcare setting: Bloodborne Pathogen Exposures, Workplace Violence, Patient Handling (ergonomics) and Slips, Trips and Falls. Information on Bloodborne Pathogen and Workplace Violence prevention activities can be found in the Environmental Health and Safety (EHS) Data and Workplace Violence Prevention sections of this report, respectively.
Ergonomic principles support our caregivers in working as safely, comfortably, efficiently and effectively as possible. Ergonomic injuries in healthcare most commonly occur when caregivers are interacting with patients (ambulation, repositioning, wound care, bathing, etc.). Our Mobility with Safe Patient Handling (MSPH) Committee works with our in-patient and out-patient locations to evaluate risks and implement measures to reduce the potential for injury to both the caregiver and the patient. These include overhead and portable lifts, friction-reducing devices, mobility assist devices and most importantly, thorough patient screening and assessment. In addition, Cleveland Clinic hired its first MSPH Program Manager in 2021 dedicated to managing these programs.
Strains, sprains and overuse injuries also occur when individuals move objects and use equipment. Through our intranet, we provide caregivers with guidance and recommended products to help them correctly set up workstations, perform daily tasks and request help to accommodate a disability. Resources include:
- A list of ergonomically approved office products and workstations compiled by Environmental Health & Safety.
- Step-by-step instructions for adjusting chairs, computers and workstations.
- Laboratory set-ups and practices.
- Disability accommodation examples and request forms.
- Guidance documents on safely moving patients and lifting, pushing and pulling items.
- Work area design recommendations.
- Best practices documents on clinical ergonomics, office workstations and work at home computer set ups.
To ensure the safety of our patients, visitors and caregivers, our Environmental Health & Safety team provides resources to help prevent slips, trips and falls. Materials available to caregivers on our intranet include:
- Guides for identifying and preventing common slip, trip and fall hazards.
- Safety and Environmental Health & Safety hotlines to report slip, trip and fall hazards.
- Severe weather alerts.
- Winter walking tips.
Additionally, we conduct ongoing evaluations of walking and working surfaces to proactively eliminate slip, trip and fall risks.
Workplace Violence Prevention
Workplace Violence is an important safety and health issue in today's healthcare workplace. Our organizational leaders are actively engaged in communicating with our caregivers about workplace violence prevention. We have pledged to speak out against workplace violence and foster a culture that supports caregivers who report workplace violence incidents.
To promote workplace safety, Cleveland Clinic has a Workplace Violence Committee, policy and procedure. Cleveland Clinic leadership created a central Workplace Violence Committee to provide guidance, direction and priorities for the planning and execution of workplace violence prevention measures. The committee is comprised of a cross-functional team of caregivers, with several local teams — including one at each of our regional hospitals — providing additional caregiver support.
We are committed to equipping our caregivers with the knowledge and skills to recognize, prevent and react to workplace violence. Some of our workplace violence prevention measures include:
- Providing ongoing education — including customized programs from the Workplace Violence Committee by request — and conducting drills.
- Requiring Welle training for all emergency department caregivers, which provides them with techniques to foster healthy behaviors, recognize signs of agitation and de-escalate threatening situations.
- Expanding police officer presence and visibility, including a commitment to 24/7 coverage at our emergency departments.
- Using metal detectors/magnetometers to prevent weapons from entering our facilities.
- An internal website dedicated to workplace violence prevention with a downloadable toolkit.
- An online incident reporting system and initiatives to encourage reporting.
- Support resources for caregivers affected by workplace violence.
In January 2021, Cleveland Clinic held its second SHIELD healthcare safety conference to educate caregivers on current and relevant safety topics. Cleveland Clinic’s Chief Caregiver Officer led three sessions covering topics such as workplace violence, trauma-informed care, emergency management and general security. Speakers included leaders from Cleveland Clinic’s Nursing, Protective Services, Ombudsman and Caregiver Offices.
RUN. HIDE. FIGHT.
Hospitals represent a vulnerable environment. By definition, they contain a population unable to counter or evacuate due to illness and injury. Additionally, visiting loved ones may not be prepared to leave the bedside of a friend or family member. It is crucial for caregivers to possess the knowledge necessary to respond readily during an active threat situation because patients and visitors are more likely to follow caregivers.
To help caregivers protect themselves, other caregivers, patients and visitors, Cleveland Clinic uses RUN. HIDE. FIGHT. for active threat response. RUN. HIDE. FIGHT. is a quick and easy way to remember what to do in an active threat. During an active threat situation, it is recommended that caregivers escape (RUN) if they can, hide if they cannot escape and, only as a last resort, fight to protect themselves and others around them.
Caregivers receive training on RUN. HIDE. FIGHT. through a module within our annual mandatory online Emergency Management training. Additionally, caregiver teams can request virtual or in-person training with the Cleveland Clinic Police Department and Emergency Management team.
Victim Advocate Program
The Cleveland Clinic Police Department offers a Victim Assistance Program to all patients, visitors and caregivers. Through the program, we provide victims affiliated with Cleveland Clinic individualized, efficient and effective support, and resources to cope with the aftermath of a criminal offense, such as domestic violence, sexual assault, workplace violence, harassment, homicide survivors, assault, child or elder abuse, human trafficking and/or robbery. Advocates offer victims information about the different options available to them and support their decision-making related to medical, legal or emotional interventions. Services advocates offer include:
- Providing information regarding victimization and the criminal and/or civil justice system.
- Informing individuals of their rights as a victim of crime according to the Ohio Revised Code.
- Providing local resources and referrals, such as counseling, shelter, transportation, etc.
- Assisting with safety planning and protection orders.
- Helping apply for Ohio Crime Victim’s Compensation and/or registering for victim notification programs.
- Accompanying individuals to file a police report, meet with detectives and/or prosecutors and participate in court proceedings.
Advocacy services are free of charge and are available at Cleveland Clinic main campus, regional hospitals, family health centers and administrative offices.