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EMS Insights From VFIS: Organizational Climate and Patient Safety

organizational climate impacts patient safety

Content sponsored by VFIS, the largest provider of insurance, education and consulting services to emergency service organizations such as fire departments, ambulance and rescue squads.

Organizational climate can affect both provider and patient safety. Job satisfaction, teamwork and employee retention may all relate directly to patient outcomes and the well-being of providers. Every prehospital provider has a duty to provide the best treatment possible to those in their care.

According to the National Institutes of Health, a growing number of studies in healthcare show that members of organizations are more satisfied when they work in climates that have more supportive and empowering leadership and organizational arrangements, along with more helpful and collaborative group environments.1 A satisfied provider is often one who has more compassion for their patients and contributes to an overall climate of safety. This is the outcome you should strive for. Conversely, a provider who is not satisfied with their job can do significant damage. Here are two examples:

Occupational injury—A leading cause of occupational injury for prehospital providers involves patient movement. Shoulder, back and neck injuries are common in our field. Proper lifting, patient transfer and attention to the task at hand are all forgotten when a provider becomes complacent and the job becomes routine; this increases your risk of occupational injury.

Medical malpractice—Some of the leading causes of prehospital emergency medical malpractice relate to patient handling. Simply stated, we are dropping our patients. Have you had patients who reached for something to brace themselves as you began to move them on a long backboard or raise a stretcher? Did you tell them, “We’ve got you—you’re OK,” or maybe use one of my personal favorites, “I’ve been doing this for many years and never dropped anyone!”?

Too often the basics of patient handling are taken for granted. Whether it be distractions, complacency, arrogance, disregard or just plain laziness, having a preventable injury happen to those to whom you’ve sworn to do no harm is a tragedy. It’s a risk not only to your organization, but to you personally. With an estimated 42,000 patient drops annually, this is a leading cause of claims of negligence. Drops are attributed to a few general areas:2

  • Improper selection and use of equipment;
  • Improper balance/strength of crew;
  • Improper evaluation of scene hazards;
  • Improper maintenance of equipment;
  • Equipment failure/malfunction.

As most of these areas involve human behavior, a climate of safety would certainly help minimize risk.

Strategies for Climate Change

Prehospital providers are often very competitive. If you know your attitude can affect your performance, the competitor in you will want to improve your attitude toward the job. If that improvement is not encouraged or is extinguished by poor leadership and unconstructive feedback, it can add fuel to the fire and contribute to a negative climate. This may result in compounding dissatisfaction and a dangerous situation for both providers and patients.

Employee satisfaction is a critical element not only of providing quality care, but in having lower levels of occupational stress and higher levels of occupational safety. Investing in our people and caring for our patients will improve safety for everyone.

Here are some strategies that may help your organization:

  • Create a safe and supportive climate;
  • Work for continuous improvement of communication practices;
  • Provide frequent safety feedback to providers;
  • Ensure access to and use of quality personal protective equipment;
  • Create an environment of minimal conflict;
  • Ensure the cleanliness of the worksite;
  • Educate providers on proper lifting, knowing their abilities, selection of proper lifting devices, scene hazards, limitations and proper use of stretchers.

You could be my next patient. You would want me to give you my best, so make sure you give yours every time. Establish a climate that positively affects patient safety.


1. Stone PW, Hughes R, Daily M. Chapter 21: Creating a Safe and High-Quality Health Care Environment. From: Hughes RG, ed., Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville, MD: Agency for Healthcare Research and Quality, 2008;

2. VFIS. Patient Handling Risk Communique. Glatfelter Insurance Group, York, PA, 2011.

Ryan Pietzsch is the director of education and training for VFIS, a subsidiary of the Glatfelter Insurance Group. His responsibilities include national coordination and delivery of education and training programs, curriculum development, information analysis, and consulting. He is an active member of many fire-service organizations, including the IAFC, VCOS, NVFC, ISFSI, CFSI National Advisory Committee, and NFPA 1400 series, 1500 series and 1000 technical committees.

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