# Exploring the impact of high reliability organization implementation on patient handling injury rates: a cross-sectional study

## TL;DR

This study found no link between high-reliability organization programs and patient handling injuries, but highlights staffing and facility factors as important for injury prevention.

## Contribution

The study provides new insights into the limited impact of HRO implementation on patient handling injuries in healthcare settings.

## Key findings

- HRO program duration was associated with higher HRO climate, but not with lower PHI rates.
- Higher staff-to-patient ratios were linked to lower PHI rates.
- Facility type and complexity significantly influenced PHI rates.

## Abstract

Patient handling injuries (PHIs) are among the leading causes of workplace injuries among healthcare workers. High-reliability organization (HRO) programs aim to prevent detrimental errors and improve organizational safety. This study examined the relationship between HRO implementation and direct care staffs’ PHI rates.

This cross-sectional study used data from 124 Veterans Health Administration (VHA) facilities. HRO implementation was measured by program duration and HRO climate. Negative binomial regression models were used to examine the relationship between HRO implementation and PHI rates, progressively adjusting for staff-to-patient ratio, facility type, size, and complexity.

A longer HRO program duration was associated with higher HRO climate (p = .01), but HRO implementation (duration and climate) was not associated with PHI rates. Higher staff-to-patient ratio was associated with lower PHI rates (p < .05). Ambulatory care service facilities had lower PHI rates than acute care facilities (β = -0.824, p = .03). The most clinically complex facilities (level 1a) had higher PHI rates than the level 3 least complex facilities (β = 0.806, p = .04).

While this study did not observe a significant relationship between HRO implementation and PHI rate among direct care staff, the study findings highlight the importance of adequate staffing for injury prevention and the need to consider facility type and complexity in PHI prevention efforts. Future research is needed to explore the impact of HRO on worker safety, using more sophisticated measures to assess HRO programs and climate.