>>Joint Commission: 7 Ways to Prevent Workplace Violence in Healthcare Without Adding Security

The Joint Commission urged hospitals to look beyond simply adding security to address workplace violence in healthcare as part of a Sentinel Event Alert issued April 17.

Instead the commission suggested several policies and initiatives hospitals can adopt to improve the safety of their work environments.

That’s not to say the commission doesn’t acknowledge that adding security systems and officers can help the problem. In fact, in places like emergency settings and inpatient psychiatric settings, where studies show employees are victimized the most, the commission cited inadequate security presence as a major factor.

Still, there are areas where hospital officials can strengthen their ability to detect, prepare for and respond to workplace violence that have nothing to do with investing in more security systems or officers, and we all know that’s not an option for some facilities anyways.

To understand the reasoning behind the policy recommendations it’s important to review what the Joint Commission cites as some of the underlying causes of workplace violence in healthcare.

Reasons For Workplace Violence in Healthcare

The CDC defines workplace violence as “violent acts (including physical assaults and threats of assaults) directed toward persons at work or on duty.” The Department of Labor explicitly includes actions such as physical aggression, controlling behavior and written threats in its definition.

“Workplace violence is not merely the heinous, violent events that make the news; it is also the everyday occurrences, such as verbal abuse, that are often overlooked,” the Joint Commission’s guidance states.

The most common characteristic of perpetrators of workplace violence is an altered mental status associated with dementia, delirium, substance intoxication or a decompensated mental illness.

Studies have also found that hospitals are increasingly providing care for potentially violent individuals, such as prison inmates or other patients in police custody.

The Sentinel Alert also included the following factors associated with workplace violence in healthcare settings:

• Stressful conditions, including long wait times or crowding in the clinical environment, or being given “bad news” related to a diagnosis or prognosis
• Lack of organizational policies and training for security and staff to recognize and deescalate hostile and assaultive behaviors from patients, clients, visitors, or staff
• Gang activity
• Domestic disputes among patients or visitors
• The presence of firearms or other weapons
• Inadequate security and mental health personnel on site
• Understaffing, especially during mealtimes and visiting hours
• Staff who are working in isolation or in situations in which they can be trapped without an escape route
• Poor lighting or other factors restricting vision in corridors, rooms, parking lots and other areas
• No access to emergency communication, such as a cell phone or call bell
• Unrestricted public access to hospital rooms and clinics
• Lack of community mental health care

How Hospitals Can Respond to Workplace Violence

There are number of steps the commission suggests hospitals take to further address the problem of workplace violence in healthcare.

The Sentinel Alert gives seven tips that generally complement existing security initiatives on site.

1. Clearly define workplace violence and put systems in place across the organization that enable staff to report workplace violence instances, including verbal abuse

The healthcare organization is responsible for identifying, addressing and reducing workplace violence, not the victims.

Encourage conversations about workplace violence during daily unit huddles. Emphasize the importance of reporting every type of incident— staff members must recognize verbal assault as a form of workplace violence because it is a risk factor for battery. Also ensure staff members are familiar with reporting requirements by the hospital and organizations like OSHA, police and state authorities.

For example, Western Connecticut Health Network developed a protocol after incident of workplace violence against employees. A sample of that protocol is shown below:

Hospitals should also create tools to help staff identify the potential for violence, such as checklist or questionnaires asking if patients are irritable, confused or threatening, and systems to help them report incidents.

2. Capture, track and trend all reports of workplace violence in healthcare including verbal abuse and attempted assaults

Hospitals must recognize that information on these incidents comes from several sources, such as hospital databases, human resources, employee surveys and more.

Once the reports are compiled, regularly distribute them throughout the organization, and aggregate the incidents for larger, external organizations to help identify new trends, hazards and mitigation strategies (such as the CDC’s Occupational Health Safety Network).

3. Provide appropriate follow up and support to witnesses and others affected by workplace violence

Support may include psychological counseling and trauma-informed care, if necessary.

4. Review each case of workplace violence and analyze workplace violence data to determine contributing factors and opportunities for intervention

Analyze where, when, why and how violence has occurred and to whom. Of course there is also threat assessment guidance and requirements to take into account (linked to below).

Demonstrate the value of reporting to staff by following up on reports with threat assessment findings and any interventions taken.

5. Develop quality improvement initiatives to reduce incidents of workplace violence in healthcare

Invest in cost-effective, evidence-based solutions and initiatives as they are discovered to prevent and respond to workplace violence, considering:

• Changes to the physical environment, like better exit routes, panic alarms, regular security patrols and environmental changes to facilitate deescalation and reduce hazards.
• Changes to practices or administrative procedures, such as assigning sufficient staff to units to reduce wait times and providing adequate mental health personnel on-site. Other examples include developing workplace violence response teams, changing work procedures to decrease worker isolation and reviewing entry and identification procedures at your facility.

6. Train all staff members in de-escalation, self-defense and response to emergency codes

When visitors use threatening language and become agitated, staff members must use de-escalation techniques quickly.

Self-defense training may include topics such as violence risk factors, de-escalation techniques, alarms, security support, safe rooms, escape plans, and emergency communication procedures.

7. Evaluate workplace violence prevention and reduction initiatives

Hospital officials can do this by reviewing leadership’s responses to reported incidents, surveying workers and analyzing trends in incidents, injuries and fatalities.

Other methods include hospitals partnering with local law enforcement, having a security consultant review the worksite and leadership staying abreast of the newest strategies.

In Conclusion

Hospital officials will have heard of many of these strategies before.

Additionally, there are already many Joint Commission standards that deal with the issue of workplace violence in healthcare. These include Leadership (LD) and Rights and Responsibilities of the Individual (RI) standards; Provision of Care, Treatment, and Services (PC) standards; Environment of Care (EC) standards; and Emergency Management (EM) standards. You can view all of those standards here.

OSHA also offers the following:

• Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers
• Preventing Workplace Violence in Healthcare

You can read the full Sentinel Alert that this article was based on here.