Examining the relationship between occupational health and safety practices and productivity levels in private health facilities in the central region of Ghana

Abstract

Introduction

Literature has established that offering protection for workers’ health and safety is one method of preserving an organization’s human resources and increase worker productivity. The purpose of this study was to examine occupational health and safety practices among selected private hospitals in the central region of Ghana and how it affects work productivity.

Methods

This study was a descriptive cross-sectional quantitative study and structured questionnaires were used to collect data from 344 healthcare workers at sixteen (16) selected private health facilities in the Central Region of Ghana, through the convenience sampling technique. Data entry and analysis were conducted using Statistical Package for Social Sciences (SPSS).

Results

A greater majority of the respondents exhibited positive perceptions and attitudes towards occupational health and safety protocols. The healthcare facilities of almost 6 out of every 10 sampled respondents had high compliance levels with occupational health and safety measures. Also, Pearson correlation analysis revealed a significant positive relationship between OHS implementation and overall productivity (r(344) = 0.255, p < 0.018). This relationship remained significant after controlling for demographic variables through partial correlation analysis (r(344) = 0.272, p = 0.015), indicating a stable and consistent association. The most mentioned potential areas for improvement to optimize employee well-being and productivity were safety training, safety satisfaction and feedback and management safety commitment while the least mentioned were safety reporting, safety involvement and working environment.

Conclusion

This study has demonstrated that the implementation of OHS measures has a positive and significant relationship with the overall productivity of healthcare workers in private health facilities in the Central Region of Ghana.

Introduction

The healthcare sector’s commitment to patient safety has driven considerable research and policy initiatives worldwide, yet comparatively little attention has been directed toward the occupational health and safety (OHS) risks and dangers faced by healthcare workers [1, 2]. This oversight persists despite the healthcare sector’s inherently high-risk nature, exposing its workforce to a range of occupational hazards, from chemical and biological exposures to physical and psychosocial stressors. In Ghana, private healthcare facilities play a critical role in supporting the public health system, particularly in urban centers where demand for healthcare is rising. However, the growth of these private facilities has raised questions about the adequacy of OHS measures to protect healthcare workers, especially given their essential role in maintaining healthcare productivity and patient outcomes.

Healthcare work involves substantial risks that threaten the safety and health of workers. These include biological hazards from infectious diseases, chemical risks from disinfectants and pharmaceuticals, and physical injuries due to patient handling and prolonged shifts [1, 2]. These risks often lead to musculoskeletal injuries, stress, and burnout, which have severe implications for both healthcare workers and the healthcare system overall [3, 4]. The COVID-19 pandemic, in particular, exposed the high vulnerability of healthcare workers, with significant morbidity and mortality among staff treating infected patients [4].

Globally, inadequate OHS practices in healthcare contribute to high rates of absenteeism, job dissatisfaction, and turnover, further straining healthcare systems and reducing overall productivity [5]. For example, the International Labor Organization estimates over 2.6 million work-related deaths each year within healthcare, illustrating the life-threatening risks healthcare workers face [6]. Despite these alarming figures, the focus remains predominantly on patient safety rather than the safety of healthcare providers, creating an urgent need for research into OHS practices and worker protection in healthcare environments.

In sub-Saharan Africa, healthcare workers often face additional barriers to OHS implementation, including limited resources, inadequate training, and weak enforcement of safety protocols [7]. Studies in South Africa, for example, reveal that healthcare workers report insufficient support and resources, with concerns about the prioritization of OHS practices by employers [8]. Similar issues persist across the region, where healthcare facilities face resource constraints that prevent the implementation of rigorous OHS measures. These gaps in OHS not only jeopardize healthcare worker safety but also contribute to burnout, turnover, and ultimately reduced productivity, further straining already limited healthcare resources.

In Ghana, private hospitals have expanded rapidly to meet rising healthcare needs, yet these institutions often operate with limited budgets, fewer specialized OHS professionals, and resource constraints that hinder their ability to implement comprehensive safety protocols [9]. While some studies have explored OHS practices in Ghana’s public healthcare sector, there is limited research focusing on private facilities and how their specific challenges affect worker productivity and safety. With private hospitals accounting for a significant portion of healthcare delivery in Ghana, understanding OHS practices in this sector is essential to support healthcare workforce sustainability and effectiveness [10].

Ensuring a safe working environment in private hospitals is critical for sustaining a productive healthcare workforce, especially given the operational differences between private and public healthcare facilities. Private hospitals often have distinct financial and operational constraints, making it more challenging to implement comprehensive OHS policies [11]. However, effective OHS protocols—such as the use of face masks, hand hygiene practices, and periodic training on OHS—can substantially reduce workplace injuries and prevent the spread of infections, improving both worker safety and productivity.

Studies indicate that inadequate OHS standards correlate with increased healthcare worker absenteeism and high turnover rates, which compromise the continuity and quality of patient care [12]. Furthermore, the absence of OHS policies can lead to emotional exhaustion and burnout, known contributors to compassion fatigue and decreased job satisfaction among healthcare workers [13]. As these outcomes negatively affect workforce stability and productivity, prioritizing OHS in private hospitals becomes an imperative step in optimizing healthcare delivery in Ghana.

Hence this study assessses the current OHS practices, thus the policies, procedures, and activities implemented in a workplace to ensure the safety, health, and well-being of employees and patients in selected private hospitals in Ghana’s Central Region, focusing on how these practices impact healthcare worker productivity. This research contributes valuable insights to the discourse on OHS within Ghana’s healthcare sector and similar settings. It also provides actionable recommendations to improve healthcare worker safety and productivity.

Methods

Study setting

The study was conducted in selected private hospitals in some municipal, districts and metropolis (i.e. Cape Coast, Effutu, Awutu-Senya, Mfantseman, Ajumako-Enyan-Essian, Asikuma-Odoben-Brakwa, Agona West and Assin North) in the Central Region of Ghana. The region has a literacy rate of 83.1% which is higher than the national average of 78.2% [14]. High literacy rate, along with proximity, formed the basis for choosing the region for the study. The authors’ inspiration was that the high literacy rate may translate into awareness of OHS Policies and guidelines and high work output.

In total, sixteen (16) private health facilities with two each from the selected municipality, districts and metropolis were chosen for the study. The facilities were chosen because of their high patronage and more professional staff.

Study design, population and sample

A descriptive cross-sectional survey design was adopted as the study design. The cross-sectional design can measure the prevalence of all factors under investigation irrespective of the limited time allocated for the study to be accomplished. In this regard, a descriptive cross-sectional survey enabled the researcher to collect data from a large sample of health workers from selected private health facilities in the central region of Ghana to examine their occupational health and safety practices and productivity level at a point in time.

The targeted population for the study included all health workers who work in the sixteen (16) selected private healthcare facilities in the central region of Ghana.

Slovin’s formula [15] was used to compute the final sample size for the study. Slovin’s formula is $\:n=\frac{N}{1+N\left({e}^{2}\right)}$, where n is the sample size, N is the estimated population and e is the margin of error. The level of precision used was 0.05 (confidence interval of 95%). The estimated population (N) of health workers in private healthcare facilities in the central region of Ghana is 3000 [16]. Thus

$$\:n=\frac{3000}{1+3000({0.05)}^{2}}$$

$$n = 353$$

After computation, the sample size derived is 353.

The study utilised the convenience sampling technique to select the respondents for data collection. This sampling technique was adopted to recruit the study’s total respondents about the fact that there is a limited time frame for the accomplishment of the study in addition to the busy work schedule for health workers in healthcare facilities.

Data collection instruments

Data was collected using the questionnaire method. The questionnaire was developed by the researcher through information from an extensive literature review as well as information and measurement items from similar prior studies on occupational health and safety practices and productivity levels among health workers [17,18,19,20,21]. The questionnaire was developed based on the objectives of the study and structured into four sections. The first section interrogated the respondents on their demographic information. The second section solicited information from the respondents on their perceptions and attitudes towards health and safety protocols. The third section elicited information from the respondents concerning their compliance with the implementation of health and safety measures. The final section interrogated the respondents on the potential areas for improvement to optimize employee well-being and their productivity. The questionnaire was designed specifically for this study. (see supplementaty materials)

Validity of instrument

The researchers presented the instrument to occupational health and safety and health promotion specialists, who carefully examined the items to assess their face and content validity in order to increase their validity. Pre-testing with twelve respondents from a public health facility in the Central Region was conducted to guarantee the instrument’s validity and reliability. Using Cronbach’s alpha, the measures’ internal consistency reliability was evaluated. The alpha coefficient exceeded the bottom limit of 0.69 overall.

Data collection procedures

Data collection was carried out over one month i.e. from July 2014 to August 2024. After permission to collect data was granted by the various management of the healthcare facilities, the researcher sought assistance from a health worker in each of the healthcare facilities to facilitate the location of health workers for data collection. The questionnaires were personally administered to the respondents by the researcher for answers at their convenience after their consent was sought. During data collection, all difficulties or challenges in answering the questionnaires were addressed by the researcher through deliberations with the respondents as well as guidance. The collected data after data collection had ended was treated with confidentiality to protect the views and identities of the sampled respondents.

Data processing and analysis techniques

To ensure that any inaccuracies brought on by incomplete or wrongly filled out questionnaires are eliminated or significantly minimized, the data gathered from the exercise was subjected to close examination. To prevent missing values, the data was carefully coded and corrected. IBM SPSS Statistics version 21 was used to process the data collected to generate the findings of the study. Statistical tools for both descriptive and inferential analysis were used to examine the produced study findings. Findings were presented in frequencies, percentages and means. Inferential analysis was conducted using Pearson correlation to examine the correlation between the implementation of health and safety practices (independent variable) and the overall productivity levels of the health workers (dependent variable).

Ethical considerations

Per the Declaration of Helsinki, and the sensitive nature of our study, ethical clearance was sought and obtained from the Ghana Health Service Ethics Review Committee (GHS-ERC-052/04/21). Specifically, verbal and written consent were sought before engaging participants in the study. All participants of the study signed consent forms to take part in the study. In addition, all ethical principles such as consent, confidentiality, privacy, autonomy, and safety were ensured and complied with. All methods were performed per the relevant guidelines and regulations.

Results

Socio-demographic characteristics of the respondents

Table 1 presents the socio-demographic characteristics of the respondents. Out of the 86 sampled respondents (health workers), most of them (51.2%) were predominately within the age category of 20 to 30 years and very few were 41 to 50 years (1.2%). More than half of the respondents (53.5%) were females. Most of the respondents (45.3%) had 6–10 years of work experience while few (5.8%) had theirs to be 11–15 years. Furthermore, more than one-third of the respondents (33.7%) were first-degree holders while a handful (12.8%) had post-graduate qualifications. Nearly one-third of the respondents (32.6%) were nurses/midwives and very few of them (12.8%) were management officers. A greater majority of the respondents (86%) were working with the shift-work arrangement in their health facilities. Finally, most of the respondents (44.2%) worked for 21–40 h per week while a minute portion of them (2%) worked for 60 h and over per week.

Table 1 Socio-Demographic characteristics of the respondents

Perceptions and attitudes of health workers towards OHS protocols within private health facilities in the central region of Ghana

Analysis conducted showed that a greater majority of the respondents (81.6%) exhibited positive perceptions and attitudes towards occupational health and safety protocols (OHS). Detailed analysis revealed that the majority of the respondents (81.4%, 86.1% and 82.6%) respectively agreed that safety communication including openness in communication promotes OHS, employees’ compliance with safety protocols promotes effective OHS and adequate knowledge and skills about risks in the job promotes effective OHS.

Also, the majority of the respondents (82.6%, 70.2% and 81.4%) respectively agreed that reporting incidents and hazards in the facility ensures effective OHS, the supervisor’s role in ensuring safety in the workplace ensures effective OHS and leadership style in ensuring safety in the workplace ensures effective OHS. Furthermore, the majority of the respondents (86.1%, 81.4% and 75.6%) respectively were in agreement that management commitment to safety issues in the workplace promotes OHS, we are notified of health and safety hazards at the workplace and we are trained to protect ourselves from hazards in the working environment. In addition, the majority of the respondents (75.6%, 80.2% and 84.9%) respectively were in agreement that health and safety compliance is an essential element for our performance appraisal, employees are encouraged to report workplace hazards to management and employees are involved in health and safety matters. Finally, less than a quarter of the respondents (13.5%) agreed that they are trained to identify and correct health and safety hazards. Table 2 displays the detailed results.

Table 2 Perceptions of health workers towards OHS protocols within health facilities

Levels of compliance of OHS measures in private health facilities employees’ perception of OHS culture in private health facilities

Analysis carried out revealed that in all, the healthcare facilities of almost 6 out of every 10 sampled respondents (59%) had high compliance levels of occupational health and safety measures. Detailed analysis showed that most of the respondents (57% and 64%) respectively agreed that their facility has provided adequate orientation on OHS legislation and protocols and their facility has made available copies of health and safety policy to employees. Also, the majority of the respondents (67.5% and 65.1%) were in agreement that adequate health and safety training is provided to employees of our facility and their facility supplies at no cost to employees with adequate personal protective equipment. Furthermore, most of the respondents (46.6% and 58.2%) respectively agreed their management and leaders supervise the use of personal protective equipment and that their management has provided a safe workplace system without health risks. Finally, more than half of the respondents (52.3%) agreed that compensation benefit is paid to employees who sustain injuries at the workplace. Table 3 displays the detailed results.

Table 3 Levels of employees’ perception of OHS culture in private health facilities compliance of OHS measures in private health facilities

Productivity levels of workers of private health facilities

The results revealed that half of the respondents (n = 172, 50%), had high productivity levels, followed by respondents with moderate productivity levels (n = 152, 44%) and few of them (n = 20, 6%) had low productivity levels (see Table 4 for more details).

Table 4 Productivity levels of workers of private health facilities

Correlation between compliance of OHS and overall productivity levels of health workers in private health facilities

The analysis of zero-order (Pearson) correlations, without controlling for other variables, reveals several key relationships. A positive and significant relationship between the implementation of occupational health and safety practices and the overall productivity of the respondents (r(344) = 0.255,p < 0.018). Conversely, age and OHS showed a negative correlation (r(344)=-0.248, p = 0.021), indicating that older individuals tend to have lower OHS. Additionally, age and education were positively correlated (r(344) = 0.399, p < 0.001), meaning that older individuals are more likely to have higher education levels. There was also a negative correlation between gender and age (r(344)=-0.223, p = 0.039), implying potential age differences between genders. Lastly, a weak negative correlation was observed between plevel and marriage (r(344) = 0.217, p = 0.045), suggesting that lower plevel might be associated with being married.

The partial correlation analysis, controlling for age, gender, experience, education, marriage, and position, confirms a significant positive correlation between plevel and OHS (r(344) = 0.272, p = 0.015), reinforcing the stability of this relationship. Table 5 display these results.

Table 5 Correlation between the implementation of OHS practices and the overall productivity of the respondents

Potential areas for improvement to optimize employee well-being and productivity in the central region of Ghana

Analysis carried out showed that the most mentioned potential areas for improvement to optimize employee well-being and productivity were safety training (60%), safety satisfaction and feedback (57%) and management safety commitment (54%) while the least mentioned were safety reporting (47%), safety involvement (45%) and working environment (38%). Table 6 displays this result.

Table 6 The potential areas for improvement to optimize employee well-being and productivity in the central region of Ghana

Discussion

Results confirmed that a greater majority of the respondents (81.6%) exhibited positive perceptions and attitudes towards occupational health and safety protocols (OHS). It has been noted in the literature that occupational health and safety is a comprehensive field of health care that aims to enable people to carry out their jobs in a way that minimizes risks to their health [22]. Therefore, positive perceptions and attitudes towards occupational health and safety protocols among health workers can serve as strong predictors for the compliance of practices in healthcare facilities. These remarkable perceptions and attitudes can play a significant role in the demand for health workers to ensure that their working environment and logistics are in a state that aligns with safety.

It was encouraging to note that the majority of the respondents (82.6%, 70.2% and 81.4%) respectively agreed that reporting incidents and hazards in the facility ensures effective OHS. This represent remarkable views and opinions on the tenets of occupational health and safety that guarantee the welfare of healthcare workers and that of their patients or clients. These findings concur with research which has established that efforts to safeguard employees and visitors to the workplace from the risks of accidents are covered under occupational health and safety [23]. Not differently, OHS exists to avoid, mitigate, or even eliminate the risk of occupational illnesses and accidents and to enhance worker health to boost productivity at work [23]. Findings however differ from a prior study where most of the respondents had negative perceptions towards the OHS variables explored in the study [24].

Another notable finding was that the majority of the respondents (75.6%, 80.2% and 84.9%) respectively were in agreement that health and safety compliance is an essential element for performance appraisal. The impressive attitudes towards OHS are related to literature which has stated that positive attitudes can yield increased commitment, motivation and proactive OHS behaviours and practices while negative attitudes and perceptions towards OHS often result in disengagement, mistrust and increased risk-taking in the working environment of employees [20].

Considering distinct risks that exist in hospitals that have an impact on staff members’ health across all departments [25, 26], it has been suggested that these risks lead to a rise in workplace accidents, negatively impact patient and healthcare worker security, and lower productivity and performance [27, 28]. In this regard, positive attitudes towards OHS exhibited among the respondents can play a critical role in the reduction of myriad health risks that jeopardize the health and safety of health workers as well as their patients. In all, protecting healthcare professionals from workplace dangers is essential through compliance with OHS policies and practices in the healthcare setting. This can be achieved when healthcare professionals develop positive perceptions and attitudes of occupational health and safety protocol as observed among private healthcare workers sampled for this study.

Pearson correlation results showed a positive and significant relationship between the implementation of occupational health and safety measures and the overall productivity of the respondents (r(344) = 0.255,p < 0.018). In addition, partial correlation analysis, controlling for age, gender, experience, education, marriage, and position, confirms a significant positive correlation between plevel and OHS (r(344) = 0.272, p = 0.015), reinforcing the stability of the relationship. The consistent correlation between OHS and plevel across both zero-order and partial correlations indicates a meaningful link, potentially warranting further investigation into causality. Additionally, age plays a complex role, as it negatively correlates with OHS but positively with education, highlighting its nuanced influence. Variables like gender and experience do not show significant correlations with most other factors, suggesting their limited impact in this context. This connection is expected as compliance with occupational health and safety measures in healthcare facilities promotes the right working environments and conditions that promote the effective discharge of the clinical duties of health workers commensurate with productivity. This finding is consistent with research which has opined that by fostering a healthy work environment, occupational health programs can help to tangentially preserve or even boost employee productivity [29]. Not differently, enhanced productivity within an organization can be achieved with a high degree of occupational safety, which reduces the likelihood of accidents leading to disease, disability, or death [30, 31]. The findings therefore portray that OHS programs enhance the productivity of employees which in turn impacts positively on the overall performance of organisations.

In addition, the results showed that the most mentioned potential areas for improvement to optimize employee well-being and productivity were safety training, safety satisfaction and feedback and management safety commitment while the least mentioned were safety reporting, safety involvement and working environment. It is instructive to note that OHS is a multidisciplinary field that focuses on four main issues: enhancing workers’ physical, mental, and social well-being; protecting and promoting workers’ health through the prevention and control of occupational diseases and accidents; developing and promoting safe and healthy work environments and work organizations; and, lastly, enabling workers to lead socially and economically productive lives [32,33,34,35].

Nonetheless, several areas in the OHS fraternity could need improvement to ensure that the safety of the workplace is guaranteed consistently. For instance, improvement in safety training, safety satisfaction and feedback as well as management safety commitment in healthcare facilities are all critical tenets of OHS. Hence, the consistent improvement of OHS tenets is vital for worker wellbeing and productivity. Such improvement could be in their planning, implementation and evaluation phases. Synchronizing these areas with modern technology can also heavily contribute to its effectiveness in the work environment.

Limitations

The cross-sectional design prevents any causal inference regarding the relationship between occupational health and safety (OHS) measures and productivity. Additionally, reliance on self-reported data may introduce social desirability bias, and participants’ subjective interpretations of survey questions could influence the findings. This study was conducted exclusively in private health facilities in the Central Region of Ghana, limiting the generalizability of the results to other regions or public healthcare institutions. Furthermore, this study did not control for potential confounding factors such as workload, salary levels, and institutional policies, which may also impact productivity. Future research should consider a longitudinal design, objective productivity measures, and a more diverse sample to enhance the robustness of findings.

Conclusion

This study suggests a significant positive association between the implementation of OHS measures and healthcare worker productivity in private health facilities in the Central Region of Ghana. However, due to the study’s cross-sectional design, causation cannot be established. While employee perceptions of OHS practices were generally positive, the most mentioned potential areas for improvement to optimize employee well-being and productivity were safety training, safety satisfaction and feedback and management safety commitment. Healthcare facilities must prioritize and strengthen occupational health and safety programs to safeguard the health of their workforce, boost their productivity and enhance the overall performance of the healthcare system.