Workplace violence (WPV) prevention programs are critical to risk management in healthcare. Your initiatives build a culture of trust, reduce threats, and standardize reporting procedures. A proactive approach also ensures compliance with The Joint Commission's (TJC) new and revised standards, effective on January 1, 2022, and emergency management requirements, effective July 1, 2022.
In addition, comprehensive plans help your organization meet guidelines set by OSHA and prepare for potential legislative changes. However, your health and safety program must account for different scenarios based on a thorough risk assessment. Improve your facility's workplace violence prevention program by exploring situations involving violators and victims. Use this guide to evaluate your current workplace violence program and improve your approach.
What To Assess for Patient-to-Staff Violence?
The CDC classifies "client-on-worker" violence as Type II and says it's the most common situation in healthcare environments. According to a 2021 study published in Workplace Health and Safety, patient-to-staff violence was prevalent during the early months of the pandemic. The survey found that 44.4% of nurses experienced physical violence and 67.8% encountered verbal abuse and "nurses who provided care for patients with COVID-19 experienced more physical violence and verbal abuse" than nurses who didn't care for COVID-19 patients.
Start with an environmental assessment of high-risk areas, such as emergency departments. Look at your incidence rates, including possible trends related to time-of-day and seasonal surges. Then, use your data to identify ways to reduce potential threats by adjusting staffing levels, increasing awareness, and monitoring high-risk spaces.
Security professionals should examine patient rights and responsibilities and ensure your healthcare staff can deliver on your promise to clients. Unmet expectations of patients are a critical factor in patient-to-staff violence. Also, it's vital to standardize methods for screening and sharing patients' history.
Your organization should prioritize staff training and build a culture that removes any stigma related to reporting violence. Often, healthcare professionals feel like some violence is merely part of their job and don't want to criminalize the people they're trying to help. Your training and education programs should address these beliefs and highlight the benefits of reporting all incidents. To this end, healthcare leaders should actively instill a culture of trust and encourage staff to feel comfortable speaking out.
Once a violent incident occurs, whether verbal or physical abuse, your healthcare teams should understand their responsibilities. Moreover, your response must support victims, ensure accurate reporting, and communicate with the public while continuing to provide patient care. Consider TJC's requirements when documenting your response to patient-to-staff violence.
The core components of your response plan should include the following:
- Security response: Determine how your hospital's security professionals will respond to an incident, including how their reaction should differ according to the situation.
- Law enforcement: Define the steps for notifying law enforcement and your expectations for staff assisting with a law enforcement investigation.
- Public relations: Any incident within your facility will leak to the public through word-of-mouth or social media. Decide what details to share and reach out to media contacts as soon as possible.
- Victim support: Describe the steps your organization will take to help staff affected by violence, including care for physical and emotional trauma.
- Transfer of patient care: Ensure consistent patient care by outlining the process of transferring a patient to another caregiver or institution after a violent incident.
- Health system facility committee: Explain how incidents are reported to your committee and the expected response time.
What To Evaluate for Visitor-to-Staff Violence?
The CDC also considers visitor and family violence against healthcare workers as Type II, and while less common than patient-to-staff, it's equally detrimental to healthcare environments. Like patient-to-staff violence, heightened emotions often contribute to violence. Therefore, it's essential to establish transparent communication processes with visitors and family members while documenting the steps required for a swift response.
Keeping everyone safe in your hospital is a joint effort. Establish role-based guidelines and communication methods for all employees, from front desk receptionists to the aids who check on families and patients. For example, your ED registrar may notice agitation among family members in the waiting room. As part of your proactive guidelines, registrars may request a patient update from nursing staff and put your on-site public safety professionals on notice.
Your staff's reaction must be immediate to protect themselves and other hospital visitors. Develop protocols that align with hospital policies and provide role-based instruction for your teams. Ensure accountability by completing the same post-incident actions for each event.
Your healthcare team's response may include:
- Calling your security team
- Informing law enforcement
- Escorting the individual from the building
- Documenting the incident on the patient's record
- Posting an alert to future caregivers and security professionals
- Informing the patient of the reasons for the family exclusion
- Providing patient updates by phone for excluded people who are decision-makers
What To Consider for Staff-to-Staff Violence/Harassment?
Staff-to-staff violence is less likely to be physical than other WPV types, yet it impacts victims emotionally and physically. It also affects co-workers and your culture. Additionally, verbal abuse and bullying may result in higher absenteeism and turnover.
According to the American Hospital Association (AHA), "America will face a shortage of up to 124,000 physicians by 2033 and will need to hire at least 200,000 nurses per year to meet increased demand and to replace retiring nurses." Consequently, your approach to Type III violence directly impacts your ability to hire and retain staff and indirectly affects patient experiences.
Staff-to-staff harassment and violence require a multi-level approach, beginning with a supportive and inclusive culture. Evaluate your current workplace violence and harassment policies, screening process, reporting methods, and training programs. Ensure the reporting process is convenient and user-friendly. Involve leaders and staff in ongoing training on recognizing and reporting incidents.
A supportive and inclusive workplace culture benefits all employees. Therefore, your healthcare organization should actively promote and recommend your Employee Assistance Program (EAP). Its use can give would-be aggressors tools for coping with stress.
Staff may report incidents in several ways, so it's vital to ensure accountability. For instance, a team member may tell a supervisor (who then enters it into the incident reporting system) or report it through an online hospital program. Define the timeline for your initial response, investigation process, and regulatory reporting requirements. Also, outline how your organization will provide victim support, including methods that account for personal preferences, such as on-site care and self-service options.
What To Assess for Third-Party Professionals-to-Staff Violence/Harassment?
Your healthcare system works with many third-party contractors, from foodservice staff to external physicians. Since they're not directly employed through your organization, you may feel like you have less control. However, your health and safety plan should also outline ways to prevent workplace violence in these cases.
Vet your third-party professionals, staffing agencies, and contractors before signing a contract. This process should include background checks and screenings. Review your agreement to ensure it outlines your workplace violence and harassment terms, including your zero-tolerance policy.
Facility leaders should also interact with contractors to identify potential issues and address them before a problem escalates. Lastly, if the reporting process involving external workers differs from staff-to-staff violence, provide instructions for appropriately reporting the incident.
Provide time-based deadlines for your incident response and investigation process, including regulatory reporting requirements. This plan should also offer guidance for working with staffing agencies to improve communication and data sharing efforts. Moreover, it's vital to support victims and limit their contact with the aggressor.
What To Evaluate for Stranger/Non-Employee to Staff Violence?
Bad actors can target hospitals for any reason or no reason at all. These include would-be child abductors, active shooters, and bomb threat calls. Also, your employees may have personal issues that can spill over into the hospital. Your health and safety plan should identify strategies for reducing violence from strangers and others known to healthcare employees.
Proactive Prevention - Non-Employee
Type IV violence refers to incidents stemming from your employee's personal relationships. It can include domestic violence, stalkers, or threats made over email, social media, or phone. In addition, your team member may have a restraining order or other documented evidence in some cases. Reduce domestic violence in your facility by asking staff to report any private matters that could impact their safety at work. You may use an online portal or encourage private discussions with supervisors to ensure the information is collected readily and confidentially.
Proactive Prevention - Stranger
Type I violence can be anyone without a relationship to your hospital system or healthcare workers, patients, or visitors. Stranger violence, such as an active shooter, child abduction, or bomb threat, may happen suddenly without warning signs. Therefore, your approach should define your campus safety plan for various situations. Also, outline your follow-up plan for victim support and notifying law enforcement.
Position Your Hospital for Success
Instilling trust throughout your culture and providing training is crucial to preventing workplace violence. Situation-based plans should focus on individual roles in the prevention and include proactive, reactive, and follow-up measures.
Furthermore, it should ensure your organization is compliant with the new and revised TJC's workplace violence regulations. Learn more by registering for our workplace violence webinar.
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