Affordable Care Act (ACA)

The comprehensive federal health care reform law enacted in March 2010.

Coinsurance

The percentage of charges a member pays when receiving a covered service. The member’s health plan coverage pays the balance up to the health plan’s allowance. Coinsurance amounts vary depending on the member’s plan and the service provided.

Copayment

The fixed dollar amount a member pays when receiving certain covered services or prescriptions. The member’s health insurance pays the rest. Copayments vary depending on the member’s plan and the service provided.

Cost share

The portion of charges for a service or prescription that the member is responsible for paying, such as a copayment, coinsurance or deductible payment.

Deductible

The fixed amount a member must pay in a calendar or contract year for certain health care services before the member’s health insurance begins to pay.

Dependent

A family member, such as a spouse, child or partner, who is covered under a policyholder or subscriber’s plan.

Federal financial assistance (subsidy)

Financial assistance in the form of reduced premiums and reduced out-of-pocket expenses to provide help for some people to pay for health coverage or care. The government will pay part of the premium and the out-of-pocket expenses directly to the health plan issuer. Usually determined by income level and family size.

Grandfathered plan

A group health plan that was created or an individual health insurance policy that was purchased on or before March 23, 2010. Grandfathered plans are exempted from many changes required under the Affordable Care Act.

Health care reform

A general term for the major health policy changes put in place by the federal Affordable Care Act of March 2010 and any state laws passed to put it in place.

Health Insurance Marketplaces

Government-run online markets, formerly called Health Insurance Exchanges, where individuals and small businesses will be able to compare and enroll in health plans, get answers to questions, and find out if they are eligible for financial assistance or special programs.

The marketplace

A common nickname for the Health Insurance Marketplaces, also called “exchanges.”

Medicaid

A government insurance plan for the poor and disabled; in California, it’s known as Medi-Cal.

Out-of-pocket expenses

These include the copayments, coinsurance and/or deductible payments members make for the health care services they receive, as opposed to the premium they pay each month to their insurers.

Pre-existing conditions

Medical conditions that a person has before he or she applies for a new health insurance policy.

Premium

The amount a member and/or the member’s employer pays, usually each month, for health care coverage.

Bringing joy and meaning to work may sound like a lofty aspiration. But if your workplace is lacking these things, it's more than dreary—it’s also dangerous, according to the Lucian Leape Institute at the National Patient Safety Foundation.

Start with the fact that health care itself is dangerous. The institute’s March 2013 report on workplace injuries in health care, “Through the Eyes of the Workforce: Creating Joy, Meaning and Safer Health Care,” noted that:

• Health care workforce injuries are 30 times higher than other industries
• More work days are lost due to occupational illness and injury in health care than in such industries as mining, machinery, manufacturing and construction
• Seventy-six percent of nurses in a national survey said unsafe working conditions interfere with the delivery of care
• An RN or MD has a five to six times higher risk of being assaulted than a city cab driver
• Emotional abuse, bullying, threats and learning by humiliation often are accepted as “normal” conditions of the health care workplace

These conditions are harmful to patients, caregivers and the organization, according to the report:

“Workplace safety is inextricably linked to patient safety. Unless caregivers are given the protection, respect, and support they need, they are more likely to make errors, fail to follow safe practices, and not work well in teams.”

Role of leaders

The authors conclude, “The basic precondition of a safe workplace is the protection of the physical and psychological safety of the workforce.”

Physical and psychological safety is also a precondition to “reconnecting health care workers to the meaning and joy that drew them to health care originally,” said Lucian Leape Institute President Diane Pinakiewicz, at Kaiser Permanente’s second annual Workplace Safety Summit February 12.

“These preconditions enable employers to pursue excellence and continuous learning,” she said. “The purposeful maintenance of these preconditions is the primary role of leadership and governance.”

Systemic causes of harm

While pointed in their assessments, Pinakiewicz and the report’s authors refrain from finger-pointing. Pinakiewicz outlined systemic organizational stresses that work against workforce and patient safety. These include:

• People feeling overwhelmed (58 percent of workers surveyed by the American Society of Professionals in Patient Safety cited overwork as an issue)
• The volume of non-value adding work
• Workforce safety and patient safety being managed separately and non-systemically
• Operating pressures exacerbating traditional behavioral norms

The report identifies several “exemplar organizations,” including the Mayo Clinic, Virginia Mason Medical Center, Kaiser Permanente and the Coalition of Kaiser Permanente Unions, that are working to “create cultures of safety and respect.” KP’s 2012 National Agreement provisions for workforce total health and interest-based problem solving are cited as contributors to that culture.

Seven strategies for improvement

The Lucian Leape Institute offers seven strategies for improving safety and restoring joy and meaning to the health care workplace:

1. Develop and embody shared core values of mutual respect and civility; transparency and truth telling; safety of all workers and patients; and alignment and accountability from the boardroom through the front lines.
2. Adopt the explicit aim to eliminate harm to the workforce and to patients.
3. Commit to creating a high-reliability organization and demonstrate the discipline to achieve highly reliable performance.
4. Create a learning and improvement system.
5. Establish data capture, database and performance metrics for accountability and improvement.
6. Recognize and celebrate the work and accomplishments of the workforce, regularly and with high visibility.
7. Support industry-wide research to design and conduct studies that will explore issues and conditions in health care that are harming our workforce and our patients.

“Through the Eyes of the Workforce: Creating Joy, Meaning and Safer Health Care” is available online from the Lucian Leape Institute at the National Patient Safety Foundation.