In 2014, a 68-year-old patient pulled a bar from the side of his hospital bed and attacked a team of nurses at a Minnesota hospital. In 2018, a hospital shooting in Chicago — which left two innocent healthcare workers and a law enforcement officer dead — made national headlines and heightened healthcare leaders’ concerns about violence in the healing environment.

Workplace-Violence-Reduction-Photo.jpgWorkplace violence entails “any act or threat of physical violence, harassment, intimidation or other threatening disruptive behavior that occurs at the work site,” according to OSHA. With nearly 2 million American workers reporting that they have been victims of workplace violence each year, it is time to act against this too-common occurrence.
Your facility can create and sustain a successful workplace violence reduction program by following these 10 steps.

1.  Executive Leadership
The foundation of a workplace violence program must begin with executive leadership. When the program becomes visibly important to the leadership team, the staff will follow. Executive leadership means not just financial support of the program, but visibility during rounds and team meetings and following the program (such as always wearing their ID badge in a visible location on their body).

2.  Establish a Crisis Management Team
Prepare healthcare facilities for any type of workplace violence by establishing a management team that can provide guidance and leadership in a time of crisis. This should be a multi-disciplinary team that includes administrators, clinicians, behavioral health specialists, human resources team members, staff representatives and local law enforcement. The team should receive formal training to understand, assess and provide guidance for near misses, bullying, assault, active shooter events and more.

3.  Implement a Notification Plan
Don’t delay in letting people know what is happening and what they should do during a violent incident — particularly when they may only have seconds to protect themselves. Whether through targeted text messages or a department-wide alarm system, use simple, plain language and, when appropriate, multi-lingual messaging. This will ensure all those present in the facility are aware and understand what to do in the case of violencd.

4.  Incorporate Workplace Violence Plans into your Emergency Operations Plan
The Emergency Operations Plan contains the base plan for how a facility will manage all hazards. This includes communications, resources and assets, safety and security, staff responsibilities, patient and clinical support activities and utilities. While most workplace violence incidents won’t trigger the need for a formal hospital command center, those that do should be able to seamlessly integrate workplace violence plans into the incident command team’s training.

5.  Train Staff
One failure of workplace violence programs is only training a handful of staff to recognize and react to events. Our patients and visitors interact with a variety of personnel, including greeters, registration clerks, food service workers and facilities maintenance teams. With each encounter, those staff have the ability to not only recognize and report a potential workplace violence incident, but also ensure they are not the cause of the escalation. Conducting multiple levels of training, from awareness to response, should be conducted amongst all levels of healthcare staff to ensure consistency and competency.

6.  Define Terms
“Lockdown,” “shelter-in-place” and “barricade” can be confusing terms. For example, a lockdown can mean nobody allowed into the facility, nobody allowed out of the facility, or nobody allowed in or out of the facility. The term “active shooter” is defined as people or persons with firearms attempting to cause mass casualties, but it is not a “suspicious person,” someone with other types of weapons, or someone with a suspicious object. Proper terminology will provide a proper reaction and response.

7.  Practice Techniques
Regular practice with de-escalation and restraint techniques, as well as barricade and escape/evacuation procedures, are crucial. In the most severe workplace violence incidents, such as an active shooter event, staff in the “hot zone” will need to evacuate immediately and head to a safe area or gathering point. Practicing these routes can help save lives in the long run.

8.  Establish Local Collaboration
Help other local healthcare facilities and public safety agencies help you during a violent event. Relevant information they may need include incident command phone numbers, points of contact and campus layout. Having information ready and easily accessible during an emergency can help the appropriate organizations’ teams act quickly when every second counts.

9.  Evaluate Efficiency
Staff require confidence in the program to report all incidents, including near misses, and all incidents should be reviewed afterward. Was the issue mitigated successfully? Were there any unforeseen barriers? Are workplace violence incidents and injuries decreasing? The crisis management team should evaluate the plan and make updates or corrections as necessary, ensuring the plan is always improving and continuing to put safety first.

10.  Sustain the Process.
It’s great to implement a plan, yet it’s tougher to maintain it. Training, incident review and feedback from staff will help keep the program successful. Training shouldn’t be limited to one approach, however. Ensure all relevant audiences know their role and what’s expected of them through periodic orientations, training videos, newsletters and drills. The crisis management team should hold monthly meetings to review incidents and make adjustments to the plan as needed.
Not only will these steps diminish violence in the healthcare setting, they will also help to ensure any crisis situation is handled properly. Protecting patients, staff and visitors against violence can be a taxing job — don’t feel you have to go it alone.