Who killed this smart system to monitor health care workplace safety?

Some journalists have dens decorated with the political heads they are responsible for felling. Governors run out of office. Agency directors fired. Boards disbanded.

It’s something we take pride in as investigators. We unearthed something, and that something led to big, visible changes.

But when an agency actually helps you do your work and then suddenly disappears, you start to wonder what the heck is going on. And so, to that end, I am asking you, health journalists of the world, to find out why the Occupational Health Safety Network met such an abrupt demise. 

What was it? 

It was a digital data collection system created in 2012 by the National Institute of Occupational Safety and Health (NIOSH), part of the Centers for Disease Control and Prevention (CDC). In the press release announcing the creation of the network, the agency noted that health care workplace injuries were significantly higher than in other types of workplaces. And it noted that workplaces were having a difficult time figuring out how to improve because of a lack of comparable data.

“Historically it's difficult to find work-related benchmarking data that you can compare yourself to," Chuck Payne, director of environmental health and safety at Thomas Jefferson University Hospitals in Philadelphia, and a participant in the OHSN testing group, said in the release. "It's just not super easy to find that data to compare a community hospital with 170 beds with another community hospital with 170 beds. And it's impossible to find any benchmarks in one job place."

Dr. Ahmed Gomaa, when he was serving as the medical officer in the Division of Surveillance Hazard Evaluation and Health Studies for NIOSH, described it well in the network’s early days: 

The network is a voluntary system that enables near real-time, secure tracking of occupational injuries by type, occupation, location, and risk factors using data already collected by healthcare facilities for OSHA reporting. The system allows healthcare facilities to:

Identify the most common injuries occurring at their facility and how they occurred.

Compare injury rates to other participating healthcare facilities by region or size, ensuring hospital and employee privacy.

Evaluate whether interventions are effective at reducing injuries by monitoring trends over time.

Access innovative intervention tools developed by NIOSH and other OHSN participating facilities.

Generate injury data reports as needed to meet OSHA regulatory and Joint Commission accreditation requirements.

How can you argue with that kind of mission? It started with quite a bit of promise, too. The National Academies of Sciences singled it out for praise in its publication, “A Smarter National Surveillance System for Occupational Safety and Health in the 21st Century.” Fairly quickly, the network started producing timely and useful results. Gomaa and colleagues published findings based on OSHN data in 2015:

In 2013, one in five reported nonfatal occupational injuries occurred among workers in the health care and social assistance industry, the highest number of such injuries reported for all private industries. In 2011, U.S. health care personnel experienced seven times the national rate of musculoskeletal disorders compared with all other private sector workers.

Take another look at that number. When taking into account all the industries in the country, one out of every five nonfatal injuries that were reported happened in health care and social assistance, which is a term used by the government to describe individual and family services for the young, the elderly, people with disabilities, as well as community food programs, housing programs, vocational rehabilitation services and day care. Even if that number is artificially high because of data or methodology problems, that number points to real, systemic problems.

The numbers caught the attention of the health care industry and a few reporters here and there. When Gomaa did that initial paper, there were 112 hospitals signed up for the network. By 2016, there were 120. NIOSH actively pursued bringing more hospitals into the network by, for example, offering workshops at health care industry conferences to familiarize hospital leaders with the network. And it started to lead to some action, too. In 2018, Diane Allen and others wrote on behalf of the American Psychiatric Nurses Association to call for immediate policy changes to prevent workplace violence in health care settings.

And then something must have happened. Because all of a sudden in September 2019, the network was shut down and all references to its data were removed from the CDC’s website. 

I wrote Gomaa to see if I could get some clarity. Here’s what I said:

I have read with interest your writings about and scientific articles citing the work of the Occupational Health Safety Network. I am writing about the sudden disappearance of the network for the University of Southern California and wondered if could let me know what, in your view, happened. Thanks in advance.

He politely wrote back:

As of June 1, 2018, we have stopped enrolling new healthcare facilities in the Occupational Health Safety Network (OHSN). The Office of Management and Budget (OMB), which approves all government data collections, placed restrictions on our ability to use the OHSN data. The OMB review indicated that because the information collected by OHSN will not be representative of healthcare facilities we cannot conduct inter-facility comparisons, a main component of the OHSN model. We have not found a cost-effective approach that will meet the OMB requirements and have decided to stop new enrollments and data processing for new enrollees and inactive users.

But there had to be more to the story, right? So, I wrote some follow up questions.

Thank you for your response. Just to help me understand, was the goal to enroll a certain number of hospitals by a certain time and then have a representative sample of information? Was there ever an attempt to make the enrollment mandatory rather than voluntary? How many hospitals ultimately did enroll? What was the incentive for them to enroll? Is there a list anywhere? And what prompted the OMB review? Thank you.

Gomaa wrote me back and asked me to contact the CDC press office for further inquiries. I did write the press office and received a reply from Nura Sadeghpour providing a few more details but nothing about what prompted the OMB review.

I think all of you should consider asking questions, too. What happened? Did the network fail to secure enough interest among hospitals? Did the reporting from the network tick off the wrong person? Did some other finding from the network’s data create an uncomfortable situation for someone high up in a federal agency or in an important congressional district?

It’s hard to know without a fuller explanation. Let me know what you find out. You can find me on Twitter @wheisel.

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