Always a challenging problem, workplace violence in healthcare settings has worsened recently as the many stresses of the pandemic push staff, managers, patients, and family members to the breaking point.
The incidence and severity of workplace violence has increased profoundly in the last two years, says Bette McNee, RN, NHA, clinical risk management consultant at insurance broker Graham Company in Philadelphia.
“I’ve never seen worse workplace violence in healthcare, particularly bullying and hostility with co-workers and with patient families. The stress level is just ridiculous,” McNee laments. “Everything has come together to create this incredible stress for everyone coming to work. We’re getting so many increasing complaints and concerns about workplace hostility and harassment from managers.”
McNee and her colleagues are advising risk managers to review their workplace violence policies to ensure they clearly define workplace violence to include bullying, intimidation, and harassment. Many such policies were written to address only physical violence, usually from patients or family members, and do not cover the incidents brought on by stress and pandemic trauma.
“We’re suggesting that hospitals use examples in their policies, training sessions, and newsletters of interactions that constitute workplace violence and will not be tolerated. Physical violence, of course, is a major concern, but people have to understand that there are other types of interactions that are prohibited by your policy,” McNee says. “The prompt follow-up to complaints and violations is extremely important for managers and supervisors. Since many of these interactions are observed by co-workers, it is important to teach them that they have an obligation to report violations they witness.”
Part of the problem was employers were at a loss for how to help overworked and overstressed staff members cope, simply because they have not seen this type of industry-wide overload before, McNee says. It turns out singing songs, providing free meals, and offering yoga classes did little to help staff cope.
Healthcare organizations must try to determine the root causes of all types of workplace violence and devise ways to address those underlying issues. Managers and supervisors can be trained to identify overstressed staff and intervene in meaningful ways before violence occurs.
“The healthcare industry has so much to deal with now, but helping your employees address stress and improve their ability to cope will help the hospital improve their outcomes with every other priority,” McNee says.
Isolation and other frustrations generated by the pandemic has prompted a surge in clinical aggression and behavioral health issues, says Lisa Terry, CHPA, CPP, vice president for vertical markets — healthcare with Allied Universal Security Services in Santa Ana, CA. Those issues usually manifest first in the emergency department (ED).
“We hoped that after the vaccines were available things would calm down a bit, but it really hasn’t,” Terry says.
An effective workplace violence prevention program should include numerous partnerships among a wide variety of stakeholders, Terry says. The workplace violence prevention (WPV) team or committee should be a cross-functional and diverse group dedicated to a culture of safety.
Internal partnerships include security, patient safety, nursing, compliance, risk management, and human resources, Terry says. External partnerships include regulatory, compliance, and consulting organizations such as The Joint Commission (TJC). TJC released WPV prevention standards that took effect Jan. 1, along with a free webpage that includes a host of tools to assist healthcare organizations strengthen their culture of safety.1 (See the story in this issue for more information on the TJC standards.)
“The Joint Commission wants to see that you have a workplace violence management plan, a program that is overarching and includes all the elements of your workplace violence efforts. What many hospitals are not doing is an actual community vulnerability assessment,” Terry says. “That includes looking at your environment, what kind of access there is, and if it should be improved. The emergency department needs to be accessible but in a way that keeps everyone safe.”
Data management and analysis also can help hospitals act in a proactive way rather than only responding to incidents, Terry says.
While statistics show workplace violence is declining in the workforce overall, it has become an epidemic in the healthcare arena, says Paul Baratta, segment development manager for healthcare with Axis Communications, a Boston-based company that provides security technology to healthcare institutions. Data from the Bureau of Labor Statistics show 73% of all workplace assaults happen in the healthcare space.2
“Some of this is due to acceptance of some levels of both verbal and physical violence by medical staff and empathy toward patients and family members under extreme stress,” Baratta says. “One factor that has become evident is that the level of violence has increased and physical assaults are continuing to increase.”
TJC Standards on Violence
There is less acceptance of this form of workplace violence by hospitals that have been mandated to protect patients, staff, and visitors by TJC and create written workplace violence policies and procedures, he says. These are to include reporting and support to staff that have been assaulted both verbally and physically. What was once “part of the job” has become less acceptable to staff and especially administrators who have seen the cost of these incidents, Baratta says.
The Occupational Safety and Health Administration (OSHA) has also joined TJC in mandating safety and the reduction of workplace violence, with the possibility of OSHA findings, TJC Sentinel Events, and fines, Baratta notes.
“The OSHA guidelines and mandatory procedures have gone one step further to include long-term care and skilled nursing residential facilities, as well as clinics. OSHA found that 20% of all workplace violence injuries happen in healthcare and over 50% of healthcare workers suffer all assaults,” he says. “There are many factors that lead to this: working with violent people; extended wait times in emergency departments; poor environmental design and lack of access control; poorly lit corridors; and prevalence of firearms, knives, weapons, and legal and illegal narcotics. These are just some examples of what causes an increase in violence.”
The hospital emergency room is the “great unknown.” Often, patients present with a history of violence or are under the influence of narcotics or suffer from mental behavior issues and staff are mandated to help them, Baratta says. This often leads to physical and verbal assaults against staff.
Staffing has become an issue in healthcare, with a lack of people wanting to handle patient watches and security departments having a difficult time hiring officers, Baratta says. Turnover is also an epidemic in healthcare security, at the same time medical staff are overtaxed with the pandemic and care of patients, he says.
A lack of facilities for behavioral patients also has led to increase in violence and does not seem to be improving, Baratta notes.
Train in MOAB
One major issue is a lack of proper training in management of assaultive behavior (MOAB) at all levels of staff, Baratta says. At a minimum, ED staff should all be trained in MOAB techniques, he says.
“OSHA now mandates this training, along with management commitment to worker safety; a full review of all hazards; and security technology to include video, access control, and audio. OSHA has also mandated reporting and other mandatory training, so all hospital administrators should be up to date on their recommendations and mandatory policies and guidelines,” Baratta says. “About 85% of hospitals have instituted a program to reduce workplace violence. The U.S. Department of Labor has also issued guidelines and has recognized workplace violence in healthcare.”
Some acoustic analytics can be deployed to monitor for aggressive behavior, glass breaks, gunshot detection, and alarm notification, Baratta notes. Many hospitals are exploring the use of sound analytics and artificial intelligence to help stop an assault before it escalates into a serious incident where staff are injured.
“Being proactive by using video, audio, and analytics can help reduce workplace violence with better response by both staff and security officers,” Baratta says. “Although not perfect and difficult to determine if someone or their family will become violent, proactive measures with video and audio have been shown to reduce workplace violence.”
A special messaging system can alert hospital staff to violent incidents quickly, says Terri Mock, chief strategy and marketing officer at Rave Mobile Safety in Framingham, MA. Systems are available that can notify staff using multiple communication channels so they are immediately aware and know how to respond.
Hospitals must create emergency preparedness plans, use communication tools so staff can act quickly, and provide a channel to report violent incidents and anonymous tips.
“By deploying a personal safety app that can easily be downloaded onto phones, healthcare organizations can put emergency plans, contacts, and safety tools right into the hands of their staff,” Mock says. “Adopting these more agile communication technologies give employees multiple ways to report violence, and help hospital administrators improve conditions for those on the frontline. Likewise, ensuring hospitals work with police, fire, emergency managers, and others in the community will be crucial to ensuring a swift and collaborative response.”
REFERENCES
- The Joint Commission. Workplace violence prevention resources.
- Bureau of Labor Statistics. Fact sheet: Workplace violence in healthcare, 2018. April 8, 2020.
SOURCES
- Paul Baratta, Segment Development Manager for Healthcare, Axis Communications, Boston. Email: [email protected].
- Bette McNee, RN, NHA, Clinical Risk Management Consultant, Graham Company, Philadelphia. Email: [email protected].
- Terri Mock, Chief Strategy and Marketing Officer, Rave Mobile Safety, Framingham, MA. Phone: (508) 848-2484.
- Lisa Terry, CHPA, CPP, Vice President, Vertical Markets — Healthcare, Allied Universal Security Services, Santa Ana, CA. Phone: (919) 796-8821. Email: [email protected].
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