2. Goals / Objectives
The attendees will understand and be able to articulate
the scope and depth of the workplace violence problem
as it relates to healthcare.
The attendees will be provided tools to assess their
organization for security risks.
The attendees will be able to create a comprehensive
plan to address the risks associated with workplace
violence.
Insurance concerns surrounding workplace violence will
be explored and the attendees will be provided with
options to better deal with insulating these exposures.
3. What is Workplace Violence
O “A violent act (or acts) including physical assaults
or threats of assaults directed towards a person at
work or while on duty”
(The National Institute for Occupational Safety and
Health (NIOSH))
4. 4
Four Types of Workplace Violence
The person who came to commit the crime
• Has no relationship to the workplace
• Is the recipient of a service
• Has an employment relationship with a current or former
employee
• Has a personal relationship with a current or former
employee
8. National Crime
Prevention
Council
8
Levels of Violence: Level One
•The employee
• Refuses to cooperate with immediate supervisor
• Spreads rumors and gossip
• Consistently argues with co-workers or management
• Is belligerent toward customers
• Swears at others
• Makes unwanted sexual comments
9. National Crime
Prevention
Council
9
Levels of Violence: Level Two
•The employee
• Refuses to obey company policy
• Sabotages equipment and steals property
• Verbalizes wishes to hurt co-worker(s) or management
• Writes sexually violent notes
• Sees self as victimized by management
11. Difference Other Workplaces Vs Hospitals
O The circumstances of hospital violence differ from the
circumstances of workplace violence in general.
O In other workplaces such as Banks, Malls, General
Stores and Taxi-Rikshaw, violence most often relates
to robbery.
O Violence in hospitals usually results from patients and
from their family members who feel frustrated,
vulnerable, and out of control.
12. It‘s a Violent World
An elderly patient verbally abused a nurse and pulled
her hair when she prevented him from leaving the
hospital to go home in the middle of the night.
An agitated psychotic patient attacked a nurse, broke
her arm, and scratched and bruised her.
A disturbed family member whose father had died at
hospital walked into the emergency department and
fired a small-caliber handgun, killing a nurse and an
emergency medical technician and wounding the
emergency physician.
Physician repeatedly slapped anesthetized patients,
hospital fined
13. Who is at risk?
O In general, anyone who works in a
hospital or health care setting
O Doctors
O Sisters
O Ward-boys & Ayahs
O Reception & Office Staff
O Security Guards
O Any Health care provider
O Pathologist, Radiologists,
14. Where violence may occur?
O Violence may occur anywhere in the hospital, but it
is most frequent in the following areas:
O Emergency rooms
O Billing Counters
O During transportation/shifting
O Waiting rooms
O Psychiatric wards
O Consulting Rooms
O Waiting room
O Reception Counters
O Wards
15. Direct Effects of Violence
O Minor or major physical injuries
O Temporary or permanent physical disability
O Psychological trauma
O Death
16. Indirect Effects of Workplace Violence
O Low worker morale
O Increase in job stress
O Increase in worker turnover
O Reduced trust of management/co-workers
O A hostile work environment
17.
18. Violence Prevention
O Develop a comprehensive prevention program
that includes:
• Zero tolerance policy
• Management commitment/enforcement
• Employee participation
• Hazard identification
• Training
• Hazard prevention
• Accurate and timely reporting
19. O Develop emergency signaling, alarms, and
monitoring systems.
O Install security devices such as metal
detectors to prevent armed persons from
entering the hospital.
O Install other security devices such as
cameras and good lighting in hallways.
O Provide security escorts to the parking lots
at night.
Environmental Designs
20. Environmental Designs
O Design waiting areas to accommodate and assist
visitors and patients who may have a delay in service.
O Design the triage area and other public areas to
minimize the risk of assault:
O Provide staff restrooms and emergency exits.
O Install enclosed nurses' stations.
O Install deep service counters or bullet-resistant and
shatterproof glass enclosures in reception areas.
O Arrange furniture and other objects to minimize their
use as weapons
21. Administrative Controls
• Comprehensive, written procedures for
reporting and for responding to occurrences
• Enforce zero-tolerance policy
• Update program as necessary (continuous
improvement
• Design staffing patterns to prevent personnel from
working alone and to minimize patient waiting
time.
• Restrict the movement of the public in hospitals by
card-controlled access.
• Develop a system for alerting security personnel
when violence is threatened.
22. Prevention Strategies
O Changing Behavior
• Create “buddy system”
• Provide security escorts to parking lots
• Prevent personnel from working alone
• Restrict movement of public using controlled-
access cards
• Training in hazard awareness, resolving conflicts,
• Recognizing potential signs
• Make counseling available to reduce workers’ fear
• Have open communication with workers
23. Dealing With the Consequences of Violence
O Violence may occur in the workplace in spite of
preventive measures.
O Employers should be prepared to deal with the
consequences of this violence by providing an
environment that promotes open communication
and by developing written procedures for reporting
and responding to violence.
O Employers should offer and encourage counseling
whenever a worker is threatened or assaulted
24. Safety Tips for Hospital Workers
O Watch for signals that may be
associated with impending violence:
O Verbally expressed anger and
frustration
O Body language such as threatening
gestures
O Signs of drug or alcohol use
O Presence of a weapon
25. Maintain behavior that helps diffuse anger:
O Present a calm, caring attitude.
O Don't match the threats.
O Don't give orders.
O Acknowledge the person's feelings (for example,
"I know you are under stress").
O Avoid any behavior that may be interpreted as
aggressive (for example, moving rapidly, getting
too close, touching, or speaking loudly
26. Steps to take, if you can't defuse
the situation quickly:
O Remove yourself from the situation.
O Call security for help.
O Report any violent incidents to your
management.
O Call for Police help with the
permission of Management
27. Response Recommendations
Remember the “Three R’s”:
Red Flags
Resources
Recovery
Once we identify the problem (red flag) and consult with the
right people (resources), it’s time to “fix it and make it better”
(recovery).
RRR
28. To Prevent WPV --- Go LOCO
Go LOCO
Listen to employees
Observe employees
Compare notes with colleagues
Obtain help
29. Summary
O No universal strategy exists to prevent
violence
O Risk factors vary from facility to facility
O Healthcare facilities should form
multidisciplinary committees to identify risk
factors
O All workers should be alert and
cautious
O Workers should actively
participate in safety training
programs
Bullet 1: The person causing the violence has no legitimate relationship to the workplace and has come to commit a crime.
Bullet 2: The person causing the violence is either the recipient or object of a service provided by the workplace, such as a current or former client, a passenger, or a customer. This person could be unhappy with the service provided or could have some type of conflict with the agency that needs to be resolved.
Bullet 3: The person causing the violence could be a former employee. This could also be a person who was previously fired or laid off and feels this was done unjustly. This person could also be angry with a current employee.
Bullet 4: The person causing the violence is someone who has a personal relationship with a current or former employee, such as an abusive spouse or domestic partner.
Discuss that the highest number of reported incidents of workplace violence come from convenience stores and taxi cabs. Also, emphasize that a significant portion of workplace violence is employment related and these incidents continue to rise.
There are three basic levels of violence. Each will be discussed.
Bullet 2: In many cases, employers will assume that equipment sabotage and theft was committed by outsiders and will investigate the crimes under that assumption. A disgruntled employee could vent his or her frustrations with the employer in this way.
Recommended Facilitator Notes: (read the following text out-loud to participants while showing this slide)
All healthcare employers should develop a comprehensive violence prevention program.
No universal strategy exists to prevent violence.
The risk factors vary from facility to facility and from setting to setting.
Facilities should form multidisciplinary committees that include direct-care staff as well as union representatives (if available) to identify risk factors in specific work scenarios and to develop strategies for reducing them.
All healthcare workers should be alert and cautious when interacting with patients and visitors.
They should actively participate in safety training programs and be familiar with their employers' policies, procedures, and materials on violence prevention.
