Joint Commission: Three tips on preventing workplace violence

In late April, Ann Scott Blouin, RN, PhD, FACHE, executive vice president of The Joint Commission, wrote a blog post detailing the need for a practical approach to healthcare’s endemic workplace violence (WPV) problem. In her post, Blouin explains three methods of violence prevention in hospitals.

In 2013, more than 70% of the 23,000 significant injuries resulting from assault at the workplace occurred in healthcare and social service settings. In 2014, a survey found that 76% of nurses have experienced verbal or physical abuse from patients and visitors. In 2015, data published by the International Association for Healthcare Security and Safety Foundation discovered a 4% rise in hospital assaults, from 7.8 assaults per 100 beds in 2014 to 8.1 the following year. 

“Incidents of workplace violence are increasing in many healthcare settings, but hospital workers are especially vulnerable to aggressive behaviors,” wrote Blouin. “It stands to reason. After all, especially for nurses or physicians, we’re the ones sometimes delivering upsetting news to patients and families.
For nurses like myself, it’s a sad fact that violence has unfortunately become more common. In fact, many of The Joint Commission’s Office of Quality and Patient Safety staff are registered nurses and are all too familiar with the reality of a patient or family encounter gone awry. This often occurs in the emergency department or behavioral health, but violence is occurring in long term care, outpatient care, and home care.”

1.    De-escalation Training
Knowing how to defuse a hostile situation has been shown to be more effective than having armed guards in a hospital. Formal training in how to de-escalate a tense situation or encounter can have a major impact on the safety of doctors, nurses, guards, or other staff members. Facilities should make this training a requirement for all employees. 

2.    Create a WPV prevention plan
Acknowledging that there’s an abnormally high risk of violence breaking out in hospitals and clinics, the next step needs to be planning for them. The Joint Commission provides several violence prevention tools at its Workplace Violence Resource Center.

The step that many hospitals skip (but shouldn’t) is conducting a risk assessment, wrote Blouin. This allows you to determine essential details such as points of access, surveillance policies, the security team’s response plan, and your relationship with local law enforcement.

3.    Enforce zero tolerance policy
Do not allow violence in your facility. Period. Staff should know implicitly that they don’t have to work in an unsafe environment, and should feel empowered to report violence to leadership. That includes violence between coworkers as well. Just having a rule on the books saying “no bullying, no violence” isn’t enough to stop such incidents.

“You should really let staff know, from the highest level of the organization, that you care about their safety as well as the safety of all the patients and all the visitors,” says Lisa Pryse Terry, CHPA, CPP, senior healthcare advisor for ODS Security Solutions and author of HCPro’s Active Shooter Response Toolkit for Healthcare Workers.

"At times, staff may feel that they’re supposed to endure spitting, pinching, and hitting from patients. They may feel that it is a part of their job. But it’s not. It is important to open that door for them to report the violence and subsequently have an interdisciplinary group to drill down and look at each incident. Recommended follow-up actions from the committee can assist in implementing actions/programs to mitigate and appropriately respond to the events … to essentially put a stop to it.”

Blouin’s recommendation for this is creating an easy, nonpunitive way of reporting incidents of violence.

“Increased incident reporting goes hand-in-hand with more effective prevention and better understanding of risk areas,” she wrote. “Workplace Violence Prevention Month may be coming to a close; however, our work continues to keep patients and staff safe from workplace violence.”

Additional workplace violence prevention resources
Here are some other free resources and training on WPV prevention:
1.    OSHA’s Guidelines for Preventing Workplace Violence in Healthcare and Social Services (www.osha.gov/Publications/osha3148.pdf )  
2.    OSHA’s Preventing Workplace Violence: A Road Map for Healthcare Facilities (www.osha.gov/Publications/OSHA3827.pdf )
3.    The Center for Health Design’s “Safety Risk Assessment Toolkit”
       (www.goo.gl/eH9IbG)
4.    The CDC’s “Workplace Violence Prevention for Nurses” (www.cdc.gov/niosh/topics/violence/training_nurses.html )
5.    The Emergency Nurses Association’s “Workplace Violence Toolkit”
(www.goo.gl/0GXblW  )
6.    ASIS International’s “Managing Disruptive Behavior and Workplace Violence in Healthcare”
(www.goo.gl/Whcywh)