NOTE: These recommendations and referenced resources specifically address the healthcare field but are also useful to organizations in other industries.
Healthcare workers are at a higher risk for violence in the workplace compared to other fields, experiencing violence in the workplace often resulting from violent behavior by their patients, clients and/or residents. Healthcare employees are four times more likely to be victimized than workers in other industries, according to OSHA. What can healthcare organizations do to improve safety and minimize the risk of workplace violence?
To help healthcare organizations better prevent and address violence in the workplace, The Joint Commission is advising healthcare facilities on how to address violence—physical and verbal—against staffers. The Joint Commission, the nation’s oldest and largest standards-setting and accrediting body in healthcare, released a Sentinel Event Alert outlining the seven steps healthcare organizations should take to prevent workplace violence.
but there are steps that health organizations can take to better protect employees.
The Joint Commission issued a report this week in conjunction with Workplace Violence Awareness Month offering seven prevention steps providers can follow. The steps seek to help hospitals in assisting their workforce in avoiding incidents and offer more comprehensive support when they do.
1. Clearly define workplace violence and put systems into place across the organization that enables staff to report workplace violence incidents, 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.
2. Recognizing that data comes from several sources, capture, track and trend all reports of workplace violence – including verbal abuse and attempted assaults when no harm occurred.
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 victims, 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 to determine contributing factors. Analyze data related to workplace violence and worksite conditions to determine priority situations 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, including changes to the physical work environment and changes to work practices and administrative procedures.
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 de-escalation 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, including security, 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 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 addition to these seven steps, the Sentinel Event Alert also outlines The Joint Commission’s related standards, references and resources, including those from the Occupational Safety and Health Administration (“OSHA”). Under the General Duty Clause of the Occupational Safety and Health Act of 1970, employers are required to provide their employees with a place of employment that is “free from recognized hazards that are causing or are likely to cause death or serious harm.”
According to OSHA, courts have interpreted the General Duty Clause “to mean that an employer has a legal obligation to provide a workplace free of conditions or activities that either the employer or industry recognizes as hazardous and that cause, or are likely to cause, death or serious physical harm to employees when there is a feasible method to abate the hazard.”
In addition, OSHA has published Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers providing specific recommendations to prevent violence in healthcare workplaces. OSHA also offers this resource: Preventing Workplace Violence in Healthcare
Accordingly, healthcare organizations that fail to have appropriate measures in place to prevent and respond to workplace violence could jeopardize their accreditation and/or risk receiving an OSHA citation.
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