Patient and Medical Staff Safety and Healthy Work Environment in the 21st Century – Are we ready?

Adriano Friganovic^1,2*Sandra Bošković²Sabina Krupa Nurcek³Irena Kovačević⁴Justyna Kosydar-Bochenek³Biljana Filipovic^2,4

• ¹University of Applied Health Sciences, Zagreb, Croatia
• ²Sveuciliste u Rijeci Fakultet zdravstvenih studija, Rijeka, Croatia
• ³Uniwersytet Rzeszowski, Rzeszow, Poland
• ⁴Zdravstveno veleuciliste, Zagreb, Croatia

As the 21st century unfolds with its rapid technological advances and shifting societal expectations, the healthcare sector faces many challenges and opportunities (1). At the forefront of this transformation lies a dual imperative and obligations: ensuring patient safety while simultaneously safeguarding the well-being of medical staff (2). Huge medical staff shortage increase risk for patient safety and create enormous obligation to policy makers and hospital management to work extensively on creation of healthy work environment (3). Emotional exhaustion among nurses is a critical factor that significantly impacts patient safety and the overall quality of care in healthcare settings (4). A healthy, supported, and protected healthcare workforce is the foundation upon which safe, effective, and compassionate patient care is provided (5). Understanding Safety in a Complex Healthcare Ecosystem Patient safety has evolved significantly since the publication of the seminal report To Err Is Human (Institute of Medicine, 1999), which brought global attention to the alarming rates of preventable medical errors. Since then, various safety protocols, guidelines, and regulatory frameworks have been introduced (6). However, the complexity of modern healthcare systems means that risks to safety are constantly changing. High patient acuity, staffing shortages, increasing administrative burdens, and rising healthcare demands contribute to a work environment where both patients and staff are vulnerable (7). Increasingly, staff safety has become a critical concern. According to the World Health Organization, healthcare workers experience some of the highest rates of occupational injury, burnout, and workplace violence (1). The COVID-19 pandemic further underscored these vulnerabilities, revealing significant gaps in emergency preparedness, access to mental health support, and systemic resilience. Whether it's ensuring patient well-being during medical procedures or safeguarding healthcare workers from occupational hazards, a secure environment is essential for quality care. Table 1 present key elements of patient and medical staff safety. Table 1. Key elements of patient and medical staff safety Patient Safety Measures Medical Staff Safety Considerations Patients place their trust in medical professionals, expecting care free from preventable harm. Some key aspects include: - Infection Control: Hospitals enforce strict hygiene protocols to prevent the spread of diseases; - Accurate Diagnoses & Treatments: Medical errors can be life-threatening, making precise assessments and treatments critical; - Medication Safety: Ensuring proper prescriptions, dosages, and patient education minimizes risks; - Technology & Monitoring: Advanced systems track patient health in real time, flagging potential complications early. Healthcare workers operate in high-pressure environments and encounter various risks. Their safety is just as crucial: - Personal Protective Equipment (PPE): Shields staff from infections, especially in contagious disease outbreaks; - Workplace Violence Prevention: Training and security measures help mitigate risks of aggression; - Ergonomic Workplace Design: Reducing physical strain prevents long-term health issues; - Mental Health Support: Stress and burnout are prevalent; support programs ensure staff well-being. The Psychological Dimension: Burnout and Moral Injury Burnout is no longer an isolated issue—it is a widespread occupational syndrome affecting every level of the healthcare workforce (8). Characterized by emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment, burnout compromises clinical decision-making, reduces empathy, and increases the risk of medical errors (9). Compounded by the increasing administrative load and misalignment between organizational goals and personal values, many healthcare professionals also report symptoms of moral injury—the psychological distress that arises when they are unable to provide the quality of care they know is needed due to systemic constraints (10). This erosion of the workforce's emotional and psychological health has a direct impact on patient outcomes. Studies have consistently shown that clinician well-being is a strong predictor of patient safety, quality of care, and patient satisfaction. Building a Culture of Safety A global perspective illustrates how different regions address patient and staff safety. In Europe, the EU-OSHA Healthy Workplaces Campaign 2023–2025 emphasizes the importance of managing psychosocial risks and promoting digital safety in healthcare environments (11). In North America, the Occupational Safety and Health Administration (OSHA) has developed specific guidelines on workplace violence in healthcare, highlighting its impact on staff protection and patient outcomes (12). In Asia, research from Singapore documented high levels of burnout among healthcare workers during the COVID-19 pandemic and identified associated risk factors (13). Complementing this, the WHO Western Pacific Regional Office report underlined the need for sustained investment in workforce protection and capacity-building in the post-pandemic era (14). These examples strengthen the global scope of the discussion and illustrate the universal relevance of integrating patient safety with staff well-being. Creating a safe and healthy healthcare environment requires a fundamental shift from individual accountability to systems-based thinking. Healthcare workers must be supported by organizational structures that prioritize safety, transparency, and continuous improvement (15). This includes: • Leadership commitment to safety as a core organizational value, not just a compliance metric. • Empowered reporting systems that encourage staff to report near-misses and errors without fear of retribution. • Workplace design improvements, such as ergonomic facilities, adequate rest areas, and reduced noise pollution, all of which enhance focus and reduce stress. • Adequate staffing levels and skill mix to avoid overwork and ensure proper patient-to-provider ratios. • Flexible scheduling and leave policies that promote work-life balance and prevent fatigue. Safety culture must be more than an abstract goal—it must be implemented in daily practice, communication, and organizational policy. It also requires the involvement of all stakeholders, including patients, whose voices can help identify blind spots and improve system responsiveness (15). Technology in Healthcare Technology is playing an increasingly prominent role in shaping the healthcare work environment. From electronic health records (EHRs) to AI-enabled decision support systems, digital tools have the potential to reduce errors, enhance diagnosis, and streamline care delivery (16). Healthcare institutions must adopt a human-cantered approach to technology implementation. This involves engaging clinicians in the design and testing of digital tools, ensuring proper training, and continuously monitoring the impact of technology on both staff workload and patient outcomes. As healthcare systems increasingly rely on interconnected digital platforms, cybersecurity and data privacy must be integral components of safety strategies. Ensuring the confidentiality, integrity, and availability of patient information protects both patients and staff from emerging digital threats (17). Alongside these benefits, research also points to risks associated with digitalization. Work-related technologies can contribute to technostress, blurred boundaries between work and private life, and increased psychosocial strain on staff, as highlighted in a recent scoping review of the public sector (18). At the same time, other evidence confirms that the adoption of digital health technologies can significantly improve staff performance while reducing workload, particularly in resource-constrained hospital environments (19). Occupational Health: From Reactive to Preventive Models Occupational health in healthcare settings has often been reactive, focused on injury management and infection control. A 21st-century approach must be preventive and holistic. Insights from other sectors also demonstrate the value of digital technologies—systematic reviews highlight how wearables, sensors, and AI can transform occupational health by enabling real-time monitoring and prevention strategies (20). This includes: • Regular mental health screenings and support services. • Promotion of healthy lifestyle behaviours through institutional wellness programs. • Measures to prevent workplace violence, including training in de-escalation and physical security. • Access to vaccinations and personal protective equipment as standard protocol. In addition, the introduction of digital technologies into daily workflows has been associated with psychosocial challenges such as technostress and work–life imbalance, as highlighted by Håkansta et al. (18). These findings emphasize that occupational health strategies must address not only physical but also digital and psychosocial risks. Emerging Industry 4.0 innovations—such as drones, collaborative robots, wearable sensors, and VR/AR-based training—are increasingly being applied to strengthen occupational safety and health systems (21). These technologies provide new opportunities for proactive monitoring, prevention, and staff training. Health systems must also acknowledge the long-term effects of traumatic experiences, especially among emergency and critical care workers (22). Providing access to trauma-informed care and peer support programs is essential to maintaining a resilient workforce. Incorporating digital health technologies has also been shown to ease workload pressures and enhance efficiency among healthcare staff, thereby contributing to preventive occupational health strategies (19). Equity and Inclusion as Safety Imperatives The safety and health of healthcare environments are also deeply linked to equity and inclusion. Marginalized staff often experience higher levels of discrimination, abuse, microaggressions, and psychological distress (23, 24, 25, 26). By embedding equity into safety strategies—through bias training, inclusive hiring practices, and patient-centred communication—healthcare organizations can address both overt and subtle risks to well-being. Conclusion: The Path Forward Patient safety and staff well-being must be addressed as one system-level priority. Safe healthcare environments require collaboration across professions and sustained investment in education, innovation, and human resources. The COVID-19 pandemic demonstrated globally—from Europe to North America and Asia—that unprepared systems face higher burnout, errors, and loss of trust. The cost of neglect extends beyond preventable harm to diminished public confidence. Aligning staff well-being with patient safety is essential to ensure effective, compassionate, and resilient healthcare.