Transforming Employee Safety into a Sustainable Culture of Excellence “CARE-MODEL”

Healthcare workers operate in a high-risk environment characterized by long working hours, increasing patient loads, occupational hazards, workplace violence, psychological stress, and burnout. At Symbiosis University Hospital & Research Centre (SUHRC), a tertiary care teaching hospital, employee safety initiatives were focused on occupational health activities such as health check-ups and mandatory trainings. However, there was no integrated framework linking employee safety, workforce planning, fatigue management, psychological well-being, human factors engineering, incident learning, and organizational culture.

A baseline assessment conducted in April 2025 identified concerns affecting employee safety and workplace culture. Employee participation in wellness activities was only 45%, indicating limited engagement with well-being initiatives. The employee satisfaction score stood at 74%, reflecting concerns related to workload, communication, recognition, and work-life balance. Safety culture assessment revealed under-reporting of incidents, with only 85 incidents and 18 near-miss events reported annually, suggesting fear of blame and inadequate reporting mechanisms.

Occupational safety indicators highlighted risks. The hospital recorded 16 needle-stick injuries, 14 staff falls, 23 slip-and-trip incidents, 10 workplace violence incidents, and 8 lost-time injuries during the baseline period. Compliance with critical safety practices was suboptimal, with PPE compliance at 88%, hand hygiene compliance at 82%, and training compliance at 78%. Staffing allocation was norm-based rather than workload-driven, creating potential for fatigue, uneven workload distribution, and burnout in high-acuity clinical areas. These findings demonstrated the need for a comprehensive intervention to strengthen employee safety, promote a just culture, improve workforce well-being, and establish employee safety as a component of patient safety and organizational excellence.

The CARE (Comprehensive Approach to Resilience, Engagement and Employee Safety) Model was implemented from April 2025 to March 2026 to strengthen employee safety, well-being, and organizational resilience at Symbiosis University Hospital & Research Centre. The initiative covered all employees, including doctors, nurses, residents, technicians, administrative staff, and support personnel. The programme focused on improving employee engagement, occupational safety, reporting culture, and compliance with safety practices.

Key objectives included increasing wellness participation from 45% to over 70%, improving employee satisfaction from 74% to above 85%, increasing incident reporting from 85 to over 150 cases, and near-miss reporting from 18 to more than 50 annually. Occupational safety targets included reducing needle-stick injuries by 25%, workplace violence incidents by 20%, and staff injuries related to falls and slips. Compliance targets exceeded 95% for PPE use, training completion, and health check-ups, while hand hygiene compliance was targeted above 90%.

Key workflow changes included scientific manpower planning, roster optimization, anonymous incident reporting, monthly safety rounds, departmental safety champions, and “Coffee with Leadership” forums to promote communication and psychological safety. A structured annual Safety and Wellness Calendar linked employee engagement activities with safety objectives. Progress was monitored through key performance indicators, departmental dashboards, and leadership reviews, ensuring sustainability, accountability, and measurable improvements in employee safety and culture of safety.

The effectiveness of the CARE (Comprehensive Approach to Resilience, Engagement and Employee Safety) Model was evaluated over a 12-month period (April 2025–March 2026) using predefined employee safety, culture, and compliance indicators. Compared with baseline performance, staff participation in wellness activities increased from 45% to 82% (+82%), while employee satisfaction improved from 74% to 90% (+16 percentage points). Incident reporting increased from 85 to 182 reports (+114%), and near-miss reporting increased from 18 to 74 reports (+311%), demonstrating a stronger culture of transparency and learning. Significant improvements were observed in occupational safety indicators. Needle-stick injuries reduced from 16 to 9 (-44%), staff falls from 14 to 7 (-50%), slip-and-trip incidents from 23 to 11 (-52%), workplace violence incidents from 10 to 5 (-50%), and lost-time injuries from 8 to 3 (-62%). Compliance indicators also improved substantially, with PPE compliance increasing from 88% to 97%, hand hygiene compliance from 82% to 95%, and training compliance from 78% to 96%. Beyond safety outcomes, the initiative enhanced workforce engagement, teamwork, communication, and psychological safety. Improved staffing optimization, reduced fatigue, and stronger reporting culture contributed to a safer patient care environment, better operational efficiency, improved retention, and strengthened NABH compliance.

Implementation of the CARE Model presented several challenges, primarily related to cultural transformation rather than technical execution. Initial resistance to incident and near-miss reporting was observed due to fear of blame, disciplinary action, and long-standing hierarchical practices. Engaging staff in wellness activities and safety initiatives was difficult because of heavy clinical workloads, shift duties, and competing operational priorities. Workforce optimization through WISN-based staffing assessments also required extensive data collection, stakeholder engagement, and alignment across departments.

Several institutional factors were critical to the programme’s success. Strong leadership commitment and visible participation by senior management created trust and reinforced the message that employee safety was an organizational priority. A multidisciplinary approach involving clinical departments, nursing services, human resources, occupational health, and the quality team ensured shared ownership and accountability. The establishment of a non-punitive reporting culture, regular “Coffee with Leadership” forums, departmental safety champions, and continuous communication helped overcome resistance and improve engagement. Data-driven monitoring through key performance indicators, monthly reviews, and feedback mechanisms enabled timely corrective actions. Integration of employee safety

The assessment demonstrated that employee safety is a critical enabler of patient safety, quality outcomes, and accreditation readiness. A key learning was that isolated occupational health activities deliver limited results unless integrated with workforce planning, fatigue management, reporting culture, leadership engagement, and employee well-being. The findings highlighted strengths such as leadership commitment, multidisciplinary collaboration, and measurable safety outcomes. The assessment also revealed that under-reporting of incidents and near misses can conceal system vulnerabilities and limit organizational learning. Establishing a just culture and psychological safety improved transparency, accountability, reporting behavior, and continuous improvement. Workforce analysis emphasized the importance of scientific staffing and fatigue management in reducing operational risks and supporting safer care delivery. From an accreditation perspective, the initiative strengthened compliance with NABH requirements related to employee safety, risk management, communication, training, and quality indicators. The experience reinforced that sustainable accreditation readiness depends on robust systems and a mature safety culture.