Workplace safety is integral for rural hospitals

Safety champions study Dr. David Hurtado

Blog submitted by: Sam Greenspan, MPH

Patient-assist injuries are a significant and costly occupational health problem for healthcare organizations. Hospital staff such as registered nurses and certified nursing assistants often overexert themselves during patient transfers (Dressner, 2018) leading to much higher rates of injury (48.1 and 180.5 per 10,000 workers) compared to all other occupations (32.2 per 10,000) (Bureau of Labor Statistics, 2016). These injuries cost healthcare organizations $15,860 per workers’ compensation claim (Dressner, 2017) and between $37,700 to $58,400 for each turnover replacement (Nursing Solutions Incorporated, 2019).

When healthcare workers face a safety risk at work, they frequently reach out to co-workers before supervisors (Lawton & Parker, 2002; MacPhee & Scott, 2002) (Pravikoff, Tanner, & Pierce, 2005). For these reason, safety programs typically recommend having champions or front-line-workers who impact safety through peer feedback and role-modeling safety, as well as advocating safety at various levels of an organization (Soo, Berta, & Baker, 2010). Our safety champions study is designed to help organizations to address patient-assist injuries in a cost-effective manner for workers and patients as well as sustain annual improvements by providing professional development opportunities to your most influential staff. So how do we do it?

Our safety champion study identifies the most influential front-line workers through Social Network Analysis (SNA), a statistical technique that detects which workers are perceived by their peers as safety savvy. We invite detected workers to complete leadership and quality improvement training workshops (120-minutes). And perhaps more importantly, our program encourages hospital leaders to meet with champions on a regular basis to collaborate for quality improvement plans and actions.

Our preliminary research indicates that SNA can identify workers who indeed are most likely to use safety equipment during patient transfers and best prepared to teach others (D. Hurtado, Dumet, Greenspan, Rodríguez, & Heinonen, 2018) (D. A. Hurtado, Dumet, Greenspan, & Rodriguez, 2018). Our pilot study (Safety Champions) conducted at a critical access hospital in Oregon more than doubled equipment use and decreased the annual injury rate 75% during a time that hospital patient volume and complexity increased substantially.

We are looking to expand our successful program across Oregon Critical Access Hospitals to include patient outcomes. If your organization is interested in learning more about this opportunity to support and participate in safety champions research, please contact Dr. David Hurtado, Sc.D. ( and download our study recruitment flier.

Nurses in OHSU hospital chatting at their computer work station


  • Hurtado, D., Dumet, L., Greenspan, S. Heinonen, G. (2020). Safety Champions: proof of concept of a worker-led program to improve multiple safety outcome. The Joint Commission Journal on Quality and Patient Safety.
  • Bureau of Labor Statistics. (2016). Nonfatal Occupational Injuries and Illnesses Requiring Days Away from Work, 2015 [Press release]
  • Dressner, M. A. (2017). Hospital workers: an assessment of occupational injuries and illnesses. Retrieved from Bureau of Labor Statistics:
  • Dressner, M. A. (2018). Occupational injuries and illnesses among registered nurses. Retrieved from Bureau of Labor Statistics
  • Hurtado, D., Dumet, L., Greenspan, S., Rodríguez, Y., & Heinonen, G. (2018). Identifying Safety Peer Leaders with Social Network Analysis. Occupational Health Science, 2(4), 437-450. doi:10.1007/s41542-018-0026-4
  • Hurtado, D. A., Dumet, L. M., Greenspan, S. A., & Rodriguez, Y. I. (2018). Social Network Analysis of peer-specific safety support and ergonomic behaviors: An application to safe patient handling. Appl Ergon, 68, 132-137. doi:10.1016/j.apergo.2017.11.009
  • Lawton, R., & Parker, D. (2002). Barriers to incident reporting in a healthcare system. BMJ Quality & Safety, 11(1), 15-18. doi:10.1136/qhc.11.1.15
  • MacPhee, M., & Scott, J. (2002). The role of social support networks for rural hospital nurses: supporting and sustaining the rural nursing work force. J Nurs Adm, 32(5), 264-272. doi:10.1097/00005110-200205000-00006
  • Nursing Solutions Incorporated. (2019). 2019 National Healthcare Retention & RN Staffing Report. Retrieved from
  • Pravikoff, D. S., Tanner, A. B., & Pierce, S. T. (2005). Readiness of US Nurses for Evidence-Based Practice: Many don’t understand or value research and have had little or no training to help them find evidence on which to base their practice. AJN The American Journal of Nursing, 105(9), 40-51.
  • Soo, S. D., Berta, W., & Baker, R. (2010). The role of champions in the implementation of patient safety practice change. doi:10.12927/hcq.2009.20979

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