Acute care is experiencing both unprecedented demand and unprecedented risk.
Hospitals and health systems face rising patient acuity, staffing shortages, and relentless throughput pressures.
Clinical staff — including nurses, patient care technicians, and nursing assistants — face injury rates significantly above the national average. Their safety remains disconnected from conversations about patient safety. We believe worker safety and patient safety are not competing priorities but unified imperatives. Organizations that treat them as such gain a competitive advantage in quality, retention, and financial performance.
Lockton's Risk Control Solutions team helps healthcare organizations bridge this gap through integrated Safe patient handling and mobility (SPHM) programs, mobility assessments, and evidence-based risk management frameworks based on the American Nurses Association Safe Patient Handling Guidelines (2013).
Why this moment matters
The growth imperative
An aging population, chronic disease, and the higher burden of complex, multi-morbid patients have led to increasing hospital admissions and inpatient volumes. Clinical workloads are compressed due to sicker patients requiring more intensive care and being discharged faster under shorter length-of-stay pressures. This expansion of demand has outpaced safety infrastructure in many health systems.
The injury crisis
Nurses and bedside caregivers rank among the top occupations for overexertion injuries — the leading cause of musculoskeletal disorders in healthcare. Unlike many other industries, acute care workers face these risks in high-acuity, fast-paced environments with demanding staffing ratios, equipment-dense spaces, and limited time for safe technique. The result: preventable injuries that destabilize the workforce and compromise the quality of care.
The patient acuity shift
Acute care settings admit patients with increasingly complex care needs. Obesity prevalence has risen dramatically. According to the CDC’s Adult Obesity Prevalence (opens a new window) report, in 2024 every U.S. state and territory had an obesity prevalence of 25% or higher, meaning one in four adults was obese. Patients with higher acuity, greater dependence, and increased body weight require more intensive handling. Yet, clinicians who tend to them are under-resourced and operate under productivity pressures that leave little margin for safe patient-handling practices.
This is not a workforce problem. This is a system design problem. And it demands a unified response.
How worker safety and patient safety converge
Healthcare leaders often treat worker safety and patient safety as separate domains. This is a critical error.
The biomechanical reality
Research shows that even a two-person manual transfer of a cooperative 110-pound patient with upper body strength exceeds safe spinal loading limits for the human spine. All one-person manual transfers of dependent patients are now classified as high-risk tasks. When these transfers result in injuries to clinical staff, patients face a parallel risk of falls, drops, and loss of dignity.
The cascade effect
Caregivers with back injuries move differently, lift less safely, and make split-second decisions under pain.
Patient falls increase. Infection control lapses. The worker's injury becomes the patient's injury.
Healthcare organizations face risks when workers and patients suffer injuries. Patient injuries can result in liability claims. When workers are injured on the job, organizations face workers’ compensation claims. Productivity falls, and absenteeism increases.
The U.S. Bureau of Labor Statistics (opens a new window) reports that in 2021 to 2022, registered nurses experienced rates of nonfatal injuries and illnesses requiring at least one day away from work well above the national average for all occupations. Those injuries and illnesses could include exposure to harmful substances or violence-related injuries.
Among overexertion and bodily reactions, registered nurses took at least a day away from work at a rate of 44.4 per 10,000 full-time workers, compared to 26.2 for all occupations.
Organizations that invest in safe patient handling equipment and training see worker injuries decline and patient outcomes improve. Falls decrease. Pressure injuries decline. Patient satisfaction increases. These are not trade-offs; they are aligned outcomes.
The retention connection
Acute care suffers from significant workforce turnover. Nursing turnover rates typically range from 15–30% annually, with estimated replacement costs of $40,000–$60,000 per nurse. Retention, continuity of care, and team cohesion all improve when organizations prioritize safe handling practices. The experienced nurse who knows a patient's history, preferences, and subtle changes in condition provides a level of care that a rotating roster of agency staff cannot replicate.
The three strike zones: Where risk concentrates
Acute care risk is not evenly distributed. It concentrates in three critical areas.
Strike zone one: The patient
Patients in acute care settings often present with multiple comorbidities, higher acuity, greater dependence, and increased body weight. An 85-year-old admitted with congestive heart failure, diabetes, and obesity presents fundamentally different handling challenges than a post-surgical patient with temporary mobility limitations. Yet care plans often fail to account for these differences in a systematic, individualized way.
Mobility assessments — a systematic evaluation of the patient's ability to move, transfer, and ambulate — are rarely integrated adequately into initial care planning. The absence of this assessment leaves clinical staff to improvise. They estimate what the patient can do, attempt unsafe manual transfers, and skip mobility interventions that could preserve function and reduce length of stay.
Strike zone two: Handling the patient and materials safely
Even well-resourced health systems often lack adequate equipment. Many acute care units lack sufficient safe-patient handling equipment or underutilize it due to inadequate training, workflow barriers, or cultural resistance. A clinical staff member who has never been trained on a ceiling lift will default to manual handling: the familiar, the fast, the dangerous.
Some health systems provide comprehensive Safe Patient Handling and Mobility (SPHM) programs; others provide minimal orientation-level instruction. Even when training exists, it is often one-time, classroom-based, and disconnected from the actual unit environment. A nurse trained in a simulation lab may not know how to adapt techniques to a cramped intensive care unit (ICU) bay, a shared patient room, or a patient with behavioral health complexity.
Strike zone three: The environment
Acute care environments present their distinct hazards. High-acuity units such as the ICU, emergency department, and operating room introduce complexity that standard protocols may not fully address. Shared patient rooms, narrow corridors, and aging facility infrastructure further constrain safe handling options.
Acute care operates within a robust and demanding regulatory landscape that creates external accountability. Yet regulatory compliance alone does not guarantee a culture of safe handling. Organizations must move beyond minimum compliance to build systems that make safe handling the norm — not the exception.
Elements of safe patient handling and mobility integration
Effective risk management in acute care requires integrated SPHM programs that address all three strike zones simultaneously.
Mobility assessment as a foundation
Every patient should receive a formal mobility assessment upon admission. The assessment identifies specific handling requirements, equipment needs, and mobility interventions that can preserve or restore function and support early mobilization goals. This assessment serves as the foundation for the care plan and for clinical staff training and assignment.
Equipment access and training
Organizations must provide access to appropriate equipment and comprehensive training in its use. This includes ceiling lifts, portable mechanical lifts, slide sheets, friction-reducing devices, gait belts, and other assistive equipment. Training must be hands-on, unit-specific, and reinforced regularly. No clinical staff member should attempt a transfer without the equipment and knowledge to do it safely.
Standardized handling protocols
Organizations should establish clear, evidence-based protocols for common handling tasks, such as bed-to-chair transfers, repositioning, toileting assistance, ambulation, and transport. These protocols should specify when equipment is required, when two-person assistance is necessary, and when to attempt mobility interventions. Protocols should be documented, taught, and audited.
Falls prevention integration
Safe patient handling and falls prevention complement each other. Falls prevention programs should include environmental assessment, footwear evaluation, medication review, and mobility interventions — all coordinated with safe handling practices and integrated into the unit's daily workflow.
Common gaps and failure points
Organizations often stumble at predictable points.
Inconsistent equipment use
Equipment is underutilized.
Clinical staff revert to manual handling because it is faster or because of inadequate training.
Mobility assessment absent from care plans
Patients are admitted without a formal mobility assessment.
Care plans are generic, not individualized.
Clinical staff lack clear guidance on what the patient can and cannot do safely.
Workflow and staffing ratio pressures
Safe handling practices can feel economically penalized in environments with stretched staffing ratios and constant productivity pressures.
Organizations must redesign workflows and staffing models to support safe practices as the standard of care, not an optional add-on.
Limited training and competency verification
Training is often minimal and one-time.
No mechanism to verify that clinical staff can actually perform safe handling techniques in real patient care situations.
Competency assessment is rare and rarely tied to performance management.
Regulatory compliance without safety culture
Regulations, accreditation, and licensing create external accountability — but compliance-driven programs often address documentation rather than practice.
Organizations must build internal accountability through real-time audits, direct observation, and performance metrics that reflect actual safe handling behavior.
Resource Constraints and Competing Priorities.
Many health systems operate under significant financial pressure.
Equipment investment, training programs, and assessment protocols require upfront capital and ongoing resources.
Leaders struggle to justify these investments without clear visibility into the return on investment, even as the costs of preventable injuries and turnover accumulate.
Actionable Strategies: Building the Unified Safety System
Organizations ready to align worker and patient safety should implement these evidence-based strategies.
Pre-employment screening
Establish clear physical requirements for clinical positions.
Screen candidates for baseline strength, mobility, and health status.
Provide pre-employment education on the role’s physical demands and the organization's commitment to safe handling practices.
This sets expectations early and identifies candidates who may need additional support.
Create a safety and risk management team
Establish a cross-functional team including clinical leadership, nursing operations, frontline caregivers, and safety specialists.
This team should meet regularly to review incidents, identify trends, and implement improvements.
Frontline clinical staff should have a voice in this process as they understand the real-world barriers to safe practices.
Develop key performance indicators for safety
Track metrics that matter: injury rates, near-miss reports, equipment utilization rates, training completion, mobility assessment completion, patient falls, and pressure injury rates.
Share these metrics with leadership and frontline staff. Data should drive continuous improvement and connect safety performance to organizational quality scorecards.
Establish best practice care standards
Document evidence-based standards for safe patient handling, mobility assessment, falls prevention, and equipment use.
Make these standards explicit, teachable, and auditable. Align staffing models and scheduling with the time required to meet these standards safely.
Implement customized safe patient handling programs
Partner with experts to design SPHM programs tailored to an organization’s patient population, unit environments, and workforce.
Generic programs fail. Customized programs that address specific risks — ICU complexity, ED throughput, surgical unit demands — succeed.
Integrate mobility assessments into care plans
Require a formal mobility assessment for every patient upon admission. Document assessment findings in the care plan.
Use assessment data to guide equipment selection, training focus, and clinical staff assignment.
Ensure equipment access and competency
Provide the equipment clinical staff need and train them to use it competently.
Audit equipment availability and utilization by unit.
Remove barriers to equipment use.
Make safe handling the path of least resistance — not the exception that requires extra effort.
How Lockton's Risk Control Solutions Team Helps
Lockton's Risk Control Solutions team partners with hospitals, health systems, and inpatient care organizations. Together, we identify, eliminate, mitigate, and control risks across the full spectrum of acute care operations.
Our approach is consultative, not prescriptive. We begin by understanding an organization’s specific patient populations, clinical workforces, unit environments, and operational constraints. We conduct comprehensive risk assessments that identify gaps in mobility assessment, equipment access, training, and protocols. We review incident data and Occupational Safety and Health Administration (OSHA) 300 logs to identify patterns and root causes. We observe actual caregiving practices on the unit floor to understand real-world barriers to safe handling.
From this foundation, we develop customized recommendations and implementation roadmaps. We help organizations design SPHM programs, establish mobility assessment protocols, select and deploy equipment, and build training curricula aligned with Joint Commission and Centers for Medicare and Medicaid Services (CMS) expectations. We support implementation through staff education, competency verification, and ongoing coaching. We establish metrics and audit processes to ensure sustained compliance and continuous improvement.
We are not here to blame or shame, but rather help build systems that protect clinical workforces, improve patient outcomes, and strengthen financial and operational performance.
Why this matters beyond ethics
Aligning worker and patient safety is the right thing to do. It is also the smartest thing to do.
Organizations with strong safety cultures and working conditions reduce turnover, improve engagement, and enjoy stronger team cohesion. Improved retention improves continuity of care and reduces recruitment and training costs.
Handling patients safely reduces injuries to both staff and patients and improves patient outcomes. These combine to reduce workers’ compensation claims, litigation risk, insurance costs, and regulatory exposure.
Safe organizations enjoy stronger financial resiliency, improved market position, attract and retain better talent, and perform better under value-based reimbursement models.
Safety is not a cost center; it is a profit center.
The question is not whether to invest in safe patient handling and mobility programs. The question is how quickly you can implement them.
Lockton's Risk Control Solutions team is ready to partner with you on this journey. Together, we can build acute care systems that protect clinical workers, improve patient outcomes, and create organizations that are safer, stronger, and more sustainable.
The time to act is now.
About the Author
Lori Severson is Vice President, National Director Risk Control Solutions-Healthcare at Lockton. She brings 20+ years of healthcare risk management expertise to help organizations identify, eliminate, mitigate, and control risks across clinical, operational, and safety domains. Lori partners with healthcare executives, risk managers, and safety leaders to build integrated risk management systems that protect people, improve outcomes, and strengthen organizational performance.
Contact
For more information on Safe Patient Handling and Mobility programs, risk assessments, and customized solutions for your organization, contact Lockton's Healthcare Risk Control Services team at HCRiskControl@lockton.com. (opens a new window)