Pilot studies show coordination often is lacking
With all the complex issues raised by workplace violence, it may be something as simple as communication that holds the key to success. Not that policies, training, and a safe work environment aren’t important, but poor communication can minimize the effectiveness of the best efforts in these areas.
This is among the key early findings in pilot studies of selected health care facilities being conducted by Corinne Peek-Asa, PhD, an associate professor of occupational health at the University of Iowa’s Injury Prevention Research Center, in Iowa City. Peek-Asa’s work is being funded by a grant from the National Institute of Occupational Safety & Health (NIOSH) under the Workplace Violence Research Initiative — the first-ever federally directed legislative appropriation for workplace violence research, she says.
Peek-Asa is studying the effectiveness of two initiatives in California: Cal/OSHA’s "Guidelines for Security and Safety of Health Care and Community Service Workers," released in 1993, and the California Hospital Security Act of 1993, which required licensed acute care and psychiatric facilities to implement a comprehensive program by July 1995.
Such a two-pronged approach is unique in this country, and one of Peek-Asa’s goals is to ascertain whether it should serve as a national model. In her pilot work, which began about a year ago, she says that many of her findings are applicable not only to health care facilities, but to the majority of workplace environments.
Who’s on first?
Peek-Asa asserts that one of her most striking findings to date is that there seems to be a lack of communication between the different components of security programs. "So even though a facility may have a lot of the requisite pieces in place — training, policies, security guards — the security guards don’t know what the training program is, and the floor staff may not know what the policies are," she observes. "Management might know what’s in the policy, while floor staff may know that one exists, but not what it is."
Sometimes a creative approach to trying to prevent violence can also contribute to communication problems, says Peek-Asa. "For example, we’ve found that some nurses have an innovative way of communicating aggressive behavior; they may tag the patient’s chart in a certain way," she explains. "However, the security guards might not know what the tags on the chart are; in fact, they may not even be part of official policy."
Such communication problems, says Peek-Asa, can actually minimize the potential effectiveness of the California model. "In our research, we have found that hospitals have actually made a great deal of effort [to comply]," she says. "We don’t know how many did it because of the legislation, and how many did it out of concern for reducing violence. But all the facilities we have looked at had implemented training, all had written policies, and all had spent some funds for security in some way — guards or equipment. What I hope to be able to conclude is that with a little more effort in coordinating what’s being done, it will make the efforts that much more effective."
The key elements
In most workplaces, says Peek-Asa, the workplace violence programs should look about the same, "but communication must be there," she insists. So, too, must these key elements:
- An administrative approach: Policies must be written, available, and in place.
- Training: In any workplace, all employees should get some level of training.
- Environmental control: Security equipment, proper lighting, and security guards.
A small workplace may not require security guards, but some level of environmental control should be in place.
Training, says Peek-Asa, is a very important concept and cannot be overlooked. "Even though the [California] legislature requires that everyone on staff get training, some docs are excluded, or in-house floating staff, or contract employees," she notes. "It’s very important that [contract employees] be trained, because they are the ones who are least familiar with the environment."
While some facilities contract out their training, others have it done by their security guards. This is not always a good idea, warns Peek-Asa. "Some guards themselves often don’t have a lot of training in workplace violence prevention," she notes. "What we saw ranged from very good to not so good."
If the key elements are all in place, its essential that they be coordinated. This responsibility should reside with the safety committee, she says. "We found that every hospital had a safety committee," she notes. "The ones that seemed to be most effective combined a broad representation of departments. In a small clinic or workplace, that could mean everybody." What’s important, she stresses, is that at regular meetings of this committee key issues should be addressed and ironed out. "The organization must take this on as a cause," she says, emphasizing again that broad representation is key. "So, for example, when you talk about important training issues, security is there."
Another key issue that arose in her pilot studies was surveillance. "No hospital had a really good surveillance effort, although everyone thought they had one," she says. "For example, there are a number of different ways to report events, but there was no database that included all of the events. What we tended to find was that the only ongoing data was that followed by the risk assessment or security office, while most of the reporting was in response to standard requirements, like when someone misses time from work. Usually [that type of information] ends up in individual files, and not in any database."
Peek-Asa says she expects to publish the findings of her pilot projects in about a year.
[For more information, contact: Corinne Peek-Asa, PhD, associate professor of occupational health, Injury Prevention Research Center, the University of Iowa, Iowa City, IA 52242. Telephone: (319) 335-4895. E-mail: [email protected].]
With all the complex issues raised by workplace violence, it may be something as simple as communication that holds the key to success. Not that policies, training, and a safe work environment arent important, but poor communication can minimize the effectiveness of the best efforts in these areas.
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