Staffing Systems and the new Joint Commission’s SAFER Matrix

The Joint Commission began using the “SAFER Matrix” to better communicate to health care organizations their survey results. The Survey Analysis for Evaluating Risk or “SAFER” is designed to convey the level of potential harm to patients, visitors or staff graded from low to high with the findings of the concern, graded from limited, patterned or widespread. The higher the risk and the more widespread, the closer the issue becomes to causing serious harm and threat to life.

The Joint Commission is hoping to use the SAFER Matrix communication model (see below graph) to help health care organizations achieve a “NO HARM” status.

Many who have been in health care for more than ten years are familiar with the Joint Commission survey “rush to prepare”. This includes many labor hours of deep and detailed cleaning, polishing of the floors, and staff reviews of life safety, emergency preparedness and EOC procedures to ensure that everyone could answer the surveyor’s questions. The Joint Commission’s change to unannounced surveys and the increased focus on “NO HARM” is expected to drive better health and patient safety outcomes for US health care organizations.

So, what does this have to do with staffing levels in support service departments?

Nursing and Allied Health departments are significantly impacted when support service staffing levels are below safe staffing levels because typically support services work is not deferrable without consequences. For instance, if an EVS worker is sick and they are not replaced, often a co-worker attempts to cover for their absent team member and cleans double the square footage they are assigned for their shift. That EVS worker feels pressured to “short cut” the cleaning procedures that day, perhaps no high dusting in surgical suites, a “trash and dash” approach in their occupied patient rooms or reduced frequency of sharps collection that day.

In Engineering, it could mean the preventive maintenance cycle won’t get completed and in Food Service it may mean the expired foods are not removed from the nourishment refrigerators in the nursing floors. All of these concerns could easily result in a patient harm situation and could be considered “widespread” if there is no plan for these situations in advance. Given the number of PTO days, intermittent FMLA cases and sick calls in most support service departments the opportunity and problem of inconsistent or lack of “one for one”, meaning one person for every job every day, can be a challenge.

Can Contingency Staffing Plans Help?

Some health care systems are large enough to have several hospitals or clinics in one metropolitan area so may be able to develop an in-house registry system for their contingent support service staff needs. When one clinic needs a food service worker or transporter, they can call on someone in the registry and the need could be quickly filled. Most health care systems are not so fortunate as their locations are far enough apart that support service staff may work near one location but may not have transportation or enough time to travel to another location. This is particularly true in larger metropolitan areas where traffic is a major concern. One efficient and cost-effective plan that has been proven to work well in the San Diego and Seattle metropolitan areas is the use of HireCare.

  • The Joint Commission is now more than ever committed to the “NO HARM” initiative using their SAFER Matrix.
  • The health care leader needs to be committed to having a plan for staffing shortages that keeps all patients safe and comfortable.
  • For more information about the SAFER Matrix, visit
  • For more information on the HireCare support services contingent staffing model visit
    or call 858-974-9944.

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