10 Steps to Workplace Violence Reduction

By Scott Cormier

It can happen anytime, anywhere.  Workplace violence isn’t confined to one person, on room or one act.  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.

According to a 2016 study published in the New England Journal of Medicine, 80% of emergency department workers will personally experience violence in their careers.  In addition, 100% of emergency room nurses reported verbal assault and 82.1% reported physical assault in the past year.

Workplace 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, the time is now to act against this too-common occurrence.

Take preventive measures to protect healthcare organizations’ patients, staff and visitors against workplace violence.  It takes more than a policy, class, or lecture.  Following these 10 steps can help you create and sustain a workplace violence reduction program.

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 includes not only financial support of the program, but visibility through rounds and team meetings, following the program (such as always wearing their identification badge in a visible location on their body.). The Joint Commission (TJC) recently updated an alert that highlighted the top six “contributing casual factors” or failures by healthcare facilities, which contributed to violent incidents in recent years.  At the top of the list, 62 percent of events were partially due to leadership. 

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, 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

A key to success is making sure all staff are aware of the program and how to activate the 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.  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 a violent emergency.

A misconception is that plain language messaging could cause panic.  However, decades of research shows that during an emergency people do not panic from messaging.  Rather, they often will freeze due to a lack of information (what is happening) and guidance (what to do.)

4. Incorporate Workplace Violence Plans into your Emergency Operations Plan

The Emergency Operations Plan contains the base plan for how the 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 violences will not require the establishment of a formal hospital command center, those that do should be able to seamlessly integrate with the incident command team

5. Train Staff

One failure of workplace violence programs is to only train 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 services, and facilities maintenance.  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.  Multiple levels of training from awareness to response should be conducted and become an annual competency.

6. Define Terms

Lockdown, shelter-in-place, and barricade can be confusing terms.  Lockdown, for example can mean nobody allowed into the facility; nobody allowed out of the facility; or nobody allowed in or out of the facility.  Hospital campuses typically include multiple buildings.  In fact, 40 percent of all hospital-based shootings occurred outside of hospital buildings, according to research by Johns Hopkins University of Medicine in Baltimore.

The term active shooter is defined is people or persons with firearms attempting to cause mass casualties.  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 not only de-escalation and restraint techniques, but also barricade and escape/evacuation procedures is 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.

8. Establish Local Collaboration

Help other local healthcare facilities and public safety agencies assist you during a violent event.  Relevant information they’ll need may include incident command phone numbers, points of contact, and campus layout.  When it comes to a workplace violence emergency, it’s all hands on deck.

Having information ready and easily accessible during an emergency can help the appropriate organizations’ teams act quickly when every second counts.

9. Evaluate Efficiency

Data collection, including number and types of workplace violence incidents, types of injuries, and outcomes are important to understand the success (or failure) of your program.  Staff have to have the confidence in the program to report all incidents including near misses, and each incident should be reviewed to discuss the efficiency of the current plan.  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.  This will ensure the plan is always improving and continuing to put safety first.

10. Sustain the Process. 

It’s great to implement a plan, but tougher to maintain it.  Training, incident review, and feedback from staff will help to 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 video, newsletters, and exercises.  The crisis management team should hold monthly meetings to review incidents and make adjustments to the plan as needed.  

Planning and procedures are crucial to diminishing workplace violence.  However, it’s equally important that they are effective and relevant.  Not only will these steps diminish violence against healthcare workers, but 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.

About the Author

Scott Cormier is the Vice President of Emergency Management, Environment of Care (EOC) and Safety at Medxcel, specializing in facilities management, safety, environment of care, and emergency management and provides healthcare service support products and drives in-house capabilities, saving and efficiencies for healthcare organizations that, in turn, improve the overall healing environment for patients and staff. Cormier leads the development and implementation of emergency management, general safety and accident-prevention programs for a national network of hospitals that Medxcel serves.