Linking Service and Safety

Transcription

1 Likig Service ad Safety Together Creatig Safer Places of Service Strategy for Maagig Work-related Aggressio ad Violece withi the Irish Health Service Summary Health Service Workig Group o Work-related Aggressio ad Violece December 2008

2 Cotets Itroductio 1 Cotextual Uderstadig 2 Itegrated Respose 2 Public Health Approach 3 Partership Workig 3 Extet of Problem 4 Impact ad Respose 5 Quality Safety ad Risk 6 Educatio ad Traiig 7 Physical Itervetios 8 Staff Support 9 Orgaisatioal Security Resposes 10 Orgaisatioal Policy 11 Implemetatio: Structure ad Process 12 Implemetatio: Actios ad Outputs 14 McKea K., 2008 Likig Safety ad Service: Together Creatig Safer Places of Service. Summary Report. ISBN: Published by Health Service Executive Irelad

3 Summary Strategy for Maagig Work-related Aggressio ad Violece withi the Irish Health Service 17 we should feel that challeges associated with the maagemet of work-related aggressio ad violece are beig effectively maaged Of equal value is the fact that this strategy demostrates how partership workig ca give expressio to multiple perspectives so that we move forward i cofidece that the pla of actios will address stakeholder eeds i a adequate ad equitable maer. This level of partership workig should either be uderestimated or udervalued ad ideed the shared learig from this collaborative workig has added value for all parters beyod the scope of this project. The commitmet to collaboratively embracig the challeges idetified, coupled with a commitmet to establishig facts rather tha faults has resulted i this strategy which is both comprehesive i scope ad iovative i approach. This has ot goe uoticed, as evideced by the fact that the work of the group has bee preseted at a EU social dialogue forum, ad as a keyote paper at the first iteratioal cogress o violece withi the healthcare sector, atteded by delegates from 47 coutries coverig all cotiets. I the fial aalysis the complex issue of work-related aggressio ad violece is oe which compromises the care experiece from the perspectives of both recipiet ad provider. Despite the cosiderable challeges idetified i maagig this problem, it is importat that we are either reticet i its recogitio, or doubtful that we ca achieve excellece i implemetig a effective respose. It is clear from the work of this group that there is o simple, sigle or quick fix solutio to this problem. However the careful collaborative cosideratio which has uderpied the productio of this strategy will serve it well as we meet the challege i a iformed, cosidered, balaced ad cohesive way. Refereces 1. McKea, K., Paterso, B. (2006) Locatig traiig withi a strategic orgaisatioal approach to the maagemet of aggressio ad Violece i Richter, D. ad Whittigto, R. eds. Violece i Metal Health Settigs; Causes Cosequeces Maagemet. Spriger, New York. p Advisory Committee o Health Services Sector (2001) Report of the advisory committee o health services sector. Natioal Authority for Occupatioal Safety ad Health, Dubli. 3. Poyer, B., Ware, C. (1988) Prevetig violece to staff. HMSO Publicatios, Lodo. 4. Camero, A. (2001) The art of partership: A practical guide. British Istitute of Learig Disabilities, Kiddermiister. 5. Paterso, B., Leadbetter, D., Miller, G., Crichto, J. (2007) Adoptig a Public Health Model to Reduce Violece ad Restraits i Childre s Residetial Care Facilities i Nuo, M., Day, D. ad Bullard, L.B. For Our Ow Safety: Examiig the Safety of High-risk Itervetios for Childre ad Youg People. Arligto, USA, Child Welfare League of America Ic. p Rogers, K.A., Chappell, D. (2003) Prevetig ad respodig to violece at work. Iteratioal Labour Office, Geeva.

4 Cotets Itroductio 1 Cotextual Uderstadig 2 Itegrated Respose 2 Public Health Approach 3 Partership Workig 3 Extet of Problem 4 Impact ad Respose 5 Quality Safety ad Risk 6 Educatio ad Traiig 7 Physical Itervetios 8 Staff Support 9 Orgaisatioal Security Resposes 10 Orgaisatioal Policy 11 Implemetatio: Structure ad Process 12 Implemetatio: Actios ad Outputs 14 McKea K., 2008 Likig Safety ad Service: Together Creatig Safer Places of Service. Summary Report. ISBN: Published by Health Service Executive Irelad

5 Summary Strategy for Maagig Work-related Aggressio ad Violece withi the Irish Health Service Itroductio magitude of problem cosistet with experieces iteratioally this strategy blueprit by which a itegrated best practice orgaisatioal respose ca be achieved will assure all stakeholders that every reasoably practical measure has beig take strategy employs four best practice approaches work-related aggressio ad violece serious problem withi healthcare dimiishes quality of workig life for staff compromises orgaisatioal effectiveess impacts egatively o the provisio of services There is uiversal recogitio that work-related aggressio ad violece is a serious problem withi healthcare which dimiishes the quality of workig life for staff, compromises orgaisatioal effectiveess ad ultimately impacts egatively o the provisio of services [1]. Withi the Irish cotext the problem is both persistet ad pervasive, affectig multiple disciplies ad settigs. While the magitude of the problem withi the Irish cotext is cosistet with experieces iteratioally, it is oetheless a matter of cocer with malicious ijury the third leadig cause of occupatioal ijury reported to the Health ad Safety Authority, accoutig for 14.9% of all reported occurreces ad for 19% of all isurace carrier otificatios betwee [2]. It is importat to ackowledge that very cosiderable efforts have bee made by may idividuals ad agecies to address this issue withi the Irish cotext. While may of these iitiatives have accomplished improvemets, their potetial impact could be much more effectively exploited if embedded withi a systematic approach which is strategic, cohesive ad uified. The formatio of the Workig Group o Work-related Aggressio ad Violece ad their productio of this strategy presets the blueprit by which a itegrated, best practice, orgaisatioal respose ca be achieved which will assure stakeholders that all reasoably practical measures are beig take to mitigate agaist the very serious potetial cosequeces for the orgaisatio, its persoel ad those it serves. The strategy employs four best practice approaches from orgaisatioal ad health disciplies icludig: a cotextual uderstadig of aggressio ad violece withi healthcare, a itegrated balaced orgaisatioal respose, a public health prevetive approach, ad a partership ethos of workig.

6 2 Likig Service ad Safety Together Creatig Safer Places of Service Cotextual Uderstadig A cotextual uderstadig of aggressio ad violece withi the healthcare cotext advaces the traditioal framig of the problem as either oe of service user behaviour or staff iability to effectively maage such occurreces. Occurreces cosidered from a cotextual perspective are uderstood as beig a fuctio of a complex iterplay betwee: The service user, The service provider, The iteractio takig place, ad The eviromet i which the iteractio occurs This cotextual perspective cosiders all cotributory factors ad iflueces which ca the iform orgaisatioal efforts to address the problem [3]. Itegrated Respose A itegrated respose ackowledges that effective orgaisatioal efforts to maage work-related aggressio ad violece must achieve a balace betwee the obligatios to: Provide safe effective services Comply with health ad safety legislatio Meet corporate risk maagemet madates Adhere to prevailig professioal ad statutory legislatio Adoptig such a itegrated approach locates the orgaisatioal respose withi a broader goverace framework ad avoids the limitatios of sigular departmetal resposes [4].

7 Summary Strategy for Maagig Work-related Aggressio ad Violece withi the Irish Health Service 3 Public Health Approach Adoptig a public health approach establishes prevetio as the core value iformig a structured framework of tiered resposes. This approach categorises prevetio alog a three-tiered framework of primary, secodary ad tertiary prevetio. Primary prevetio ivolves strategies which prevet occurreces i the first istace. Secodary prevetio ivolves itervetios which recogise potetial occurreces at a early stage ad employ appropriate itervetio to prevet further escalatio. Tertiary prevetio aims to miimise potetial harm to all cocered while occurreces are beig maaged. While adoptig a prevetative approach esures compliace with professioal ad regulatory obligatios, the real value of this approach is its potetial for simple, ofte low cost itervetios, to result i very sigificat reductio i occurreces ad associated risks [5]. Partership Workig The utilisatio of a partership approach ackowledges that work-related aggressio ad violece poses a sigificat problem for the orgaisatio, its persoel, ad those it serves. The developmet of this strategy was greatly eriched by egagig a broadly represetative workig group which gave expressio to the perspectives of multiple stakeholders ad esured that their cocers were adequately ad equitably addressed. The group, which icluded employer ad employee represetatives, regulatory agecies ad professioal bodies, agreed from a early stage that the greatest potetial for sustaiable success could best be achieved i partership through which a stadardised orgaisatioal respose could be developed. This strategy is testimoy to the stregth of this partership approach.

8 Likig Service ad Safety Together Creatig Safer Places of Service Extet of Problem stadardised defiitio robust replicable baselie measure stadardised reportig system patters to iform resposes Work-related aggressio ad violece is a problem for may staff to a extet similar to that reported withi comparable health services iteratioally. Work-related aggressio ad violece ecoutered by staff icludes physical ad o-physical maifestatios. These maifestatios vary by occupatioal fuctio with some occupatioal groups at particularly higher risk of particular maifestatios of aggressio ad violece. Efforts to accurately quatify the extet of the problem of work-related aggressio ad violece are hidered by the absece of a stadardised defiitio. Work-related aggressio ad violece is grossly uder-reported ad verbal aggressio is especially so. There is a bias i reportig behaviour with a tedecy to report more serious occurreces. Orgaisatioal estimates, which rely upo such reports, may subsequetly uderestimate the magitude of the problem ad be biased toward serious occurreces. Recommedatios similar to health services iteratioally physical ad o-physical maifestatios absece of a stadardised defiitio grossly uder-reported The EU defiitio of work-related aggressio ad violece be adopted as the operatioal defiitio throughout the health service. A robust replicable baselie measure of all maifestatios of work-related aggressio ad violece ecoutered by staff throughout the health service be established. A stadardised reportig system for work-related aggressio ad violece be implemeted with a clearly delegated resposibility at local ad atioal levels. Awareess be raised amog staff of the crucial role of occurrece reportig i iformig the implemetatio of strategic orgaisatioal resposes. Occupatioal specific patters of work-related aggressio ad violece be used to iform orgaisatioal resposes.

9 Summary Strategy for Maagig Work-related Aggressio ad Violece withi the Irish Health Service Impact ad Respose mior ijuries commo major ijuries rare cosequeces ca be devastatig potetial emotioal distress serious fiacial burde o rigorous actuarial measure raise awareess of potetial impact establish actuarial measure of costs May staff sustai mior ijuries from physical assaults while major ijuries are rare. For some staff however the cosequeces of beig assaulted ca be devastatig. Staff may experiece emotioal distress subsequet to occurreces of work-related aggressio ad violece which is ot limited to occurreces of physical violece. The exact extet of staff abseces due to work-related aggressio ad violece remais ukow. Estimates of staff replacemet costs aloe due to occurreces of work-related aggressio ad violece suggest a serious fiacial burde o the healthcare services. There has to date bee o methodically rigorous actuarial measure of the cost of work-related aggressio ad violece withi Irish healthcare. Occurreces of work-related aggressio ad violece are a fuctio of a iterchage betwee the service user, service provider, iteractio takig place ad evirometal factors. Withi this cotextual uderstadig, the iheret potetial for coflict is apparet. Effectively respodig to the problem ivolves adequately ad equitably addressig the cocers of all ivolved. Achievig a effective respose is most likely to succeed if udertake i partership. Recommedatios Awareess of the potetial emotioal impact of all maifestatios of work-related violece be raised at all level of the orgaisatio. A rigorous actuarial measure of the costs associated with work-related aggressio ad violece be established. Methods by which retur o ivestmet measures might be employed to evaluate the cost-effectiveess of orgaisatioal iitiatives to address the problem be established. A cotextual uderstadig of work-related aggressio ad violece be adopted. Resposes reflect the potetial for coflict withi the provisio of services. Resposes adequately ad equitably address the cocers of all ivolved. A partership approach uderpi the developmet of resposes.

10 Likig Service ad Safety Together Creatig Safer Places of Service Quality Safety ad Risk safety health ad welfare statutory obligatio risk maagemet corporate obligatio all locatios to have curret safety statemet raise awareess of risk Employers have a statutory obligatio to esure so far as is reasoably practicable the safety health ad welfare of employees, ad others. Recogitio of work-related aggressio ad violece as a occupatioal specific hazard imposes a madate to systematically evaluate the related risks to all ivolved, ad to implemet cotrol measures which mitigate agaist, or elimiate idetified risks. Such assessmets are required by sectio 19 of the Safety, Health ad Welfare at Work Act 2005 which requires that these are explicit i safety statemets. The extet to which required health ad safety risk assessmets are completed withi health services geerally, ad specifically addressig work-related aggressio ad violece, is uclear. The orgaisatio has a corporate obligatio to maage ad miimise foreseeable risk. Evaluatig the risks associated with aggressio ad violece is difficult withi the health service due to the scale of the orgaisatio ad the complex rage of activities. There are sigificat variatios of hazard ad risk betwee ad withi services. There are some well evideced risk reductio measures which could achieve sigificat improvemet i the very short-term. There are a umber of high priority risk reductio measures which eed to be implemeted at the earliest opportuity utilisig the best evidece available. Recommedatios All locatios to have i place a curret safety statemet based o a methodical risk assessmet process. Where work-related aggressio ad/or violece is idetified as a foreseeable hazard the safety statemet to explicitly outlie the cotrol measures required ad those resposible for the implemetatio ad ogoig audit/review of such measures. Risk maagemet efforts raise awareess of the ucertai ad dyamic ature of risk ad develop staffs capacity to udertake cotiuous risk appraisal specific to their service settig ad occupatioal fuctio. Awareess of the very sigificat potetial risks, both physical ad psychological to patiets ad staff associated with the maagemet of aggressio ad violece be raised at all levels of the orgaisatio. A close liaiso betwee those charged with the corporate quality ad risk fuctio ad the maagemet of aggressio ad violece be established ad maitaied.

11 Summary Strategy for Maagig Work-related Aggressio ad Violece withi the Irish Health Service Educatio ad Traiig majority of staff cosider traiig ecessary limitatios i systems ad oe size fits all approaches emphasis o maagemet rather tha prevetio review methodologies ad structures i providig traiig eeds assessed, service specific compliat with the prevailig legislatio ad professioal codes comprehesive guidace be developed The recogitio of work-related aggressio ad violece as a service specific occupatioal hazard places professioal, legislative ad moral obligatios upo the orgaisatio to provide traiig i its prevetio, recogitio, ad safe maagemet. The majority of staff cosider traiig i the maagemet of work-related aggressio ad violece as ecessary for their occupatioal fuctio. There is a gap betwee the umber of staff who eed traiig ad that provided. There are ackowledged limitatios iheret i the practice of providig geeric systems ad oe size fits all approaches to traiig. There has bee a traiig emphasis o maagemet rather tha prevetio. Traiig eeds to reflect the challeges ecoutered by staff withi their service settigs, ad the prevailig legal, professioal ad policy parameters withi which services are provided. The goverace ad cohesiveess of procurig ad providig traiig is uclear. The physical itervetio compoets of some traiig approaches are a cause of cocer. Recommedatios Educatio ad traiig i the maagemet of work-related aggressio ad violece be provided to all healthcare persoel. The cotet ad methodology of educatio ad traiig to correspod to participats professioal ad orgaisatioal resposibilities. A review of the methodologies ad structures for providig staff with educatio ad traiig be udertake as a priority. Educatio ad traiig be eeds assessed, service specific, ad i compliace with the prevailig legislatio ad policies applicable to the service settig. Comprehesive guidace be developed to assist those charged with commissioig traiig. This guidace to icorporate a cohesive structure of practice stadards. The safety of physical itervetio techiques be established as a priority. A structure of verifiably recordig educatio ad traiig i the maagemet of aggressio ad violece completed by idividual employees be established. Educatio ad traiig to iclude loe workig, coflict resolutio ad maagemet of verbal aggressio.

12 Likig Service ad Safety Together Creatig Safer Places of Service Physical Itervetios use of physical itervetios a complex issue miimisatio of seclusio or restrait sigificat prevetative iitiative eed for appraisal of physical itervetio techiques eed for stadards developmet of stadards a priority The use of physical itervetios is a complex issue which poses legal, professioal ad moral dilemmas for idividual staff, uits of service, ad for the orgaisatio. The use of physical itervetios is a iheretly hazardous procedure which poses potetial risks of both physical ad psychological trauma for both patiets ad staff. The most sigificat prevetative iitiative is the developmet of services i which the use of seclusio or restrait is miimised. I additio to the potetial of dimiishig risks to all cocered, miimisig seclusio ad restrait cotributes sigificatly to a broader quality improvemet ageda. There may be circumstaces i which physical itervetios may be deemed ecessary as the oly or most appropriate optio. It is critical that i such situatios staff are traied ad competet i the employmet of safe effective techiques i order to preserve the safety of all cocered. The provisio of traiig i physical itervetios is curretly uregulated, without agreed stadards as to how the origi, safety, or effectiveess of techiques is determied. There is a eed for a structured appraisal of physical itervetio techiques curretly i use. Curret practices which are of cocer require priority attetio from both professioal practice ad risk maagemet perspectives. There is a eed for stadards to gover the provisio of traiig i physical itervetios ad the use of these itervetios i practice. Recommedatios The HSE proactively aspire to the provide services which are seclusio ad restrait miimised at philosophical, orgaisatioal ad operatioal levels. Priority be give to establishig the safety ad fitess for purpose of physical itervetio techiques curretly i use. Future provisio of physical itervetio traiig be subject to such review prior to commecemet. The use of physical itervetios be subject to stadards at least comparable to those applyig to other patiet focussed itervetios. Stadards goverig the provisio of traiig i physical itervetios, ad the use of these itervetios i practice be developed as a matter of priority. Guidelies be developed to guide ad stadardise decisio makig i relatio to the provisio of traiig ad use of physical itervetios.

13 Summary Strategy for Maagig Work-related Aggressio ad Violece withi the Irish Health Service Staff Support flexible repertoire of measures be available staff expect to be supported value simple supportive measures value support from colleagues ad lie maagers eed clarity ad uderstadig of key terms Staff expect to be supported followig occurreces of all forms of work-related aggressio ad violece. There is a legislative requiremet o employers to provide appropriate supports. Staff value simple supportive measures which equire after their wellbeig ad validate their utoward experiece. While most staff require miimal post-occurrece support, some may require a wider rage of support measures over a more prologed period. Cosequetly differet support measures are required ad o sigular or uiform approach is appropriate to all idividuals or situatios. Staff highly value support from colleagues ad lie maagers. Staff perceive the role of the lie maager as critical i the provisio of support. The extet to which lie maagers are prepared for, or feel empowered to perform this role remais uclear. For a variety of reasos there have bee sesitivities surroudig the issue of staff support at various levels of the orgaisatio. There is a eed to clarify both the uderstadig, ad iterrelatioship betwee key terms icludig psychological distress psychological ijury compesatio ad support. Recommedatios Awareess of the support eeds of staff be raised at all level of the orgaisatio. A flexible repertoire of best practice support measures be available to staff with readily available iformatio as how these ca be accessed. The rage of available measures form a itegrated multi-layered suite of supports. Maagers be both iformed ad empowered to uderstad ad udertake the role expected of them i providig support. Maagers role be udertake free from ay axiety that their providig support is implicated i later determiatios related to the occurrece cocered. Some exemplars of best practice curretly i use regioally be cosidered for widespread distributio ad systematic evaluatio.

14 10 Likig Service ad Safety Together Creatig Safer Places of Service Orgaisatioal Security Resposes formalised liaiso with agecies clarity ad agreemet of eforcemet optios structure of legal advice framework to guide decisio makig There is a eed to balace the duty to provide services with the obligatio to protect the safety ad welfare of staff ad others ad the property of the orgaisatio. Respodig to perpetrators of acts of aggressio ad violece withi healthcare is complex i that occurreces take place withi a professioal service relatioship. Orgaisatios may utilise either egagemet approaches which rely upo ratioal or emotive appeals, or tariff approaches which rely upo the assumptio that pre-uderstood sactios will modify behaviour. I some istaces the orgaisatio may be obligated to istitute either service specific or idividual specific coditios i order to esure the safety of all cocered. Such measures must be reasoable, justifiable, proportioate, time specific ad be equitably ad cosistetly applied. balace the duty to provide services with obligatio to protect staff ad others reasoable, justifiable, proportioate, time specific equitably ad cosistetly applied The legal remedies which ca be pursued or sactios imposed remais largely uexplored with may services usure of the exact legal parameters goverig such actios. There is a eed for iformed legal opiio to guide the policy i this regard. Recommedatios Public support for measures which dimiish aggressio ad violece withi healthcare settigs be egaged through a campaig which highlights the positive efforts of staff, ad the detrimetal impact of such behaviours o the service eviromet. A formalised liaiso betwee the health service agecies, the Garda Síocháa, ad the Director of Public Prosecutios be established with the purpose of establishig clarity ad agreemet i relatio to the eforcemet optios available to services. A forum icludig employer ad employee represetatives, service users, regulatory bodies, justice, eforcemet ad professioal agecies, be established to determie the potetial value to a itegrated strategy of tariff based approaches. The forum to brig forward a proposed framework which should guide decisio makig. A formalised structure of legal advice be available to guide decisio makig, ad the maagemet of complex situatios. A agreed structure of access to this service be developed.

15 Summary Strategy for Maagig Work-related Aggressio ad Violece withi the Irish Health Service 11 Orgaisatioal Policy provide clarity to guide decisio makig advocated by professioal ad regulatory bodies prevets ucertaity of authorisatio ad expectatios cogruet with prevailig legal, professioal, ad ethical codes Staff require policies to provide them with the ecessary clarity to guide their decisio makig i maagig workrelated aggressio ad violece. The eed for such policies has bee cosistetly advocated by professioal ad regulatory bodies. I the absece of clear policies staff rely o practice as their primary guide. While some practices may be excellet, their lack of critical appraisal ad formal authorisatio may create ambiguity, ad place staff i situatios of ucertaity as to the orgaisatioal expectatios ad authorisatio whe maagig occurreces of aggressio ad violece. It is critical that the policy is cogruet with the prevailig legal, professioal, ad ethical codes which apply to the service settig withi which it is to be eacted. Some orgaisatioal resposes require guidace to support the implemetatio of policy. iterim policy be implemeted capable of service specific adaptatio review completed withi 24 moths Requiremets for guidace iclude, educatio ad traiig, staff support, physical itervetios, ad the deploymet of security persoel. The preset state of multiple coexistig policies developed i previous health service structures eeds to be replaced with a stadardised HSE policy. I the immediate short-term a iterim policy should be implemeted, with a explicit ackowledgemet of iterim status. This policy should be reviewed withi a specified timeframe but i ay evet o later tha twety-four moths from its iceptio. Recommedatios A iterim policy be implemeted to avoid ucertaity ad provide staff with guidace as to orgaisatioal authorisatio ad expectatios of them whe maagig occurreces of work-related aggressio ad violece. Guidace provided be capable of service specific adaptatio. Theme specific guidace support policy i areas related to educatio ad traiig, staff support, physical itervetios, ad use of security persoel. The iterim status of the policy be made explicit with a defied timeframe for review. The review be completed withi twety-four moths order to reflect the emergig work of the structures proposed i this strategy.

16 12 Likig Service ad Safety Together Creatig Safer Places of Service Implemetatio: Structure ad Process three iterdepedet compoets goverace fuctio project joit goverace group executive/operatioal fuctio cetral project office cosultatio fuctio multi-agecy advisory forum dedicated resource be established to drive ad coordiate implemetatio It is clear from the precedig sectios that a sigificat challege exists for which a atioal, stadardised, coordiated respose is required. The ecessary programme of cosidered actios ad sustaied improvemets to be achieved will require a clear pla of implemetatio. I formulatig the implemetatio pla there was cosesus that three key elemets of the pla iclude: That the respose should be joitly owed by a employer/employee partership i associatio with other regulatory ad professioal stakeholders. That a dedicated uit resposible for drivig ad achievig the key actios outlied i the strategy should be established. That the iitial ad substatial efforts should focus i the more immediate term of the first 12 moths with a deliberate targetig of high retur measures. While recogisig that the primary resposibility for addressig the problem rests with the maagemet of the health service agecies as corporate etities, it is recommeded that a dedicated resource be established to drive ad coordiate the implemetatios i the shorter term. The structure recommeded cosists of three iterdepedet compoets icludig a goverace fuctio i the Project Joit Goverace Group, a executive/operatioal fuctio i the Cetral Project Office, ad a cosultatio fuctio i the Multi-agecy Advisory Forum. The establishmet of these uits should coicide with the acceptace of this report. Implemetatio Structure Project Joit Goverace Committee (PJGC) Cetral Project Office (CPO) Multi-agecy Advisory Forum (MAAF)

17 Summary Strategy for Maagig Work-related Aggressio ad Violece withi the Irish Health Service 13 very sigificat employer employee partership respose of high value respose to a logstadig ad very sigificat problem partership approach ifers collective owership of the challege to fid ad sposor solutios sustaiable ito the future The roles ad fuctios of these uits are outlied below: The Project Joit Goverace Committee (PJGC): will take resposibility for overseeig the implemetatio of a programme of strategic actios i lie with the agreed recommedatios of this strategy ad direct the Cetral Project Office i the implemetatio of this work. While health service agecies will assig lead resposibility at a corporate level, those charged with resposibility will rely o the PJGC to guide ad oversee the respose to this theme. The Cetral Project Office (CPO): will implemet a effective orgaisatioal respose to the maagemet of work-related aggressio ad violece i lie with this strategy uder the directio of the Project Joit Goverace Committee. The missio of this office will be to reassure stakeholders icludig health service employers, uios ad regulatory bodies, that all is well ad i lie with explicit expectatios. The CPO will i the first istace be established for a period of 3-4 years at which time the arragemet will be reviewed. The Multi-agecy Advisory Forum (MAAF): will provide a vital stakeholder cosultatio fuctio. Forum membership will be coordiated by the Cetral Project Office, subject to ratificatio by the Project Joit Goverace Committee, ad will be broadly represetative of professioal, regulatory, educatioal agecies icludig service user represetatio. The forum will provide a platform to actively cosult ad collaborate i implemetig key actios of the strategy through the exploitable stregths of cosultatio forum, expert resource, ad implemetatio aget. This arragemet is a very sigificat joit employer/employee partership respose, of high leverage value, i respose to a logstadig ad very sigificat problem. The partership approach ifers collective owership of the challege to fid ad sposor solutios sustaiable ito the future. This is cosistet with recommedatios that social parters actively egage i dialogue at atioal ad orgaisatioal level o the protectio of workplace health ad safety as a meas toward improvig services ad that social parters collaboratively moitor ad evaluate such iitiatives [6]. The successful fuctioig of the workig group to date, through its commitmet to collaborative workig i a ethos of partership, also fits comfortably with the prevailig aspiratios toward employee partership ad effective iteragecy workig. This collaborative approach to maagig work-related aggressio ad violece has the potetial to simultaeously improve the service experiece of recipiets, the quality of the workig life for staff, ad the overall effectiveess of the orgaisatio. While priciple resposibility for the service rests at the corporate level of health service agecies, this proposal recogises that active iclusio of all stakeholders i a partership respose is a crucial igrediet for success.

18 Likig Service ad Safety Together Creatig Safer Places of Service Implemetatio: Actios ad Outputs The recommedatios ad associated actios outlied eed to be implemeted adoptig a strategic, itegrated, cohesive ad balaced approach. The CPO, to be established with the lauch of the strategy, will deliver a itesive programme of work over the first three years at which time there will be a substatial review. The expectatio is that withi this timeframe a very sigificat impact will have bee made o all priority themes. I three years there should be a real sese that the challeges associated with the maagemet of work-related aggressio ad violece are beig effectively maaged withi the service. Recommedatios rage from awareess raisig ad system wide educatio, to very specific deliverables o issues icludig baselie measuremet, costig, ad establishig the safety of physical itervetios. Deliverig success is cotiget upo two critical factors, resourcig ad adequately matchig authority with resposibilities. Resource requiremets, icludig CPO budget, are relatively modest, pricipally as a fuctio of the 74 Likig Service ad Safety Together Creatig Safer Places of Service potetial to utilise ad redeploy huma ad fiacial resources Implemetatio: Short-term Targets Stadardisatio of Defiitio Measures will be implemeted to stadardise defiitio icludig: Adoptig of EU defiitio of work-related aggressio ad violece Developig operatioal categorisatio of work-related aggressio ad violece Itegratig defiitio i guidace ad policy statemets Target: A system wide defiitio adopted withi six moths Completio of Safety Statemets Measures will be implemeted to esure that safety statemets with specific referece to work-related aggressio ad violece are completed i all places of work icludig: Developig structure for risk assessmet of work-related aggressio ad violece. Esurig full compliace with completio of risk assessmets ad safety statemets which icorporate work-related aggressio ad violece. Esurig that safety statemets icorporate explicit cotrol measures. Target: Complete compliace with safety statemets withi six moths Baselie Measure The plaig ad structure of the baselie measure will be iitiated with a umber of key actios Agreeig parameters of study ivestigatio Fialisig structure ad methodology of the baselie measure Target: Parameters of study agreed ad commissioed withi twelve moths

19 Summary Strategy for Maagig Work-related Aggressio ad Violece withi the Irish Health Service Cosiderig that the recommedatios are i large part iterdepedet ad complemetary, the successful implemetatio of the strategy requires a cohesive ad coordiated sequecig of actios. While some actios will cosume cosiderable efforts by CPO persoel, others will require exteral ad expert egagemet with the time demads of CPO persoel limited to a commissioig ad steerig role. There are a umber of actios which should ot be delayed, ad should be completed to implemetatio stage as far as possible withi the first twelve to fiftee moths. These priority actios have bee collaboratively agreed withi the workig group based o the criteria of potetial impact, relevace, cost/retur o ivestmet, ad orgaisatioal readiess. It is importat to stress that efforts toward priority Strategy for Maagig Work-related Aggressio ad Violece withi the Irish Health Service 75 actios i the first istace should ot preclude simultaeous workig toward advacemet Safety of Loe Workers o all themes. Measures will be implemeted to esure the safety of loe workers icludig: Systematically categorisig risk associated with loe workig Developig ad implemetig of loe worker traiig Explorig ad pilotig of safety techologies, e.g. alarm devices Target: Loe worker assessmet ad traiig be available to 10,000 withi twelve moths Safety of Physical Itervetios Measures will be implemeted to esure the safety of physical itervetio techiques curretly i use withi services icludig: Cataloguig physical itervetios curretly i use atioally Establishig a framework of by which safety of techiques ca be measured Commissioig the expertise to udertake evaluatios Establishig a repertoire of safest practices Target: All high risk physical itervetios evaluated withi six moths Developmet of Guidace Measures will be implemeted to provide guidace to assist decisio makig icludig: Developig stadardised guidace o the provisio of educatio ad traiig Developig stadardised guidace o the use of physical itervetios Developig stadardised guidace o the provisio of staff support Target: Guidace o educatio ad traiig issued withi four moths Guidace use of physical itervetios issued withi eight moths Guidace o staff support issued withi twelve moths

20 16 Likig Service ad Safety Together Creatig Safer Places of Service Coclusio cosistet with ILO recommedatio that social parters actively egage i dialogue at atioal ad orgaisatioal level focuses o the protectio of workplace health ad safety as a meas toward improvig services This report sheds light o a largely uspoke reality with which healthcare orgaisatios ad their employees struggle o a daily basis. The magitude of the problem is surprisig, cosiderig that the raiso d être of the service is the provisio of care. These services are frequetly provided uder highly emotive ad stressful circumstaces durig which those ivolved may respod i ways which are ot typical of their usual behaviour. Ideed may maifestatios of work-related aggressio ad violece are primarily a fuctio of illess or disability, ad are uiteded by the assailat. I as much however as they are uiteded, they are equally udeserved by employees ad i such istaces all ivolved are adversely affected. Uderstadig this cotradictio of service recipiet as assailat ad service provider as victim, is complex. This complexity is reflected i the very diverse maifestatios of the problem ecoutered withi differet services, which are ofte more reflective of the iteractio takig place tha they are of the idividuals ivolved. While much is kow about the problem, this report has highlighted that may vital areas of iformatio remai icomplete. Oe critical poit cosistetly highlighted is the extet to which the Irish experiece of the problem, ad the difficulties i achievig a effective respose, mirrors iteratioal experieces. This is i effect a healthcare pheomeo, ad ot oe which is uique to the Irish cotext. While we are ot uique i this challege, either however are we immue, ad the recogitio imposes a imperative to implemet a orgaisatioal respose which ca assure those cocered that all reasoably practical measures are beig take to miimise the associated risks. This report ackowledges the very cosiderable efforts to date withi the Irish healthcare system to meet this obligatio. Notwithstadig these efforts, the deliberatios of the workig group have highlighted a umber of issues which eed to be addressed as a matter of priority. a umber of actios should ot be delayed be completed as far as possible withi the first twelve to fiftee moths There is a risk whe cosiderig the work ahead, to ot fully appreciate the extet ad value of the work accomplished to date. While may healthcare orgaisatios cotiue to struggle i their efforts to address this problem, with various degrees of success, a fully satisfactory respose has remaied elusive. The careful cosideratio reflected i the recommedatios of this strategy sets forward a structured pla of actios which should result i a orgaisatioal respose which at the very least equals that of comparable healthcare systems iteratioally.

21 Summary Strategy for Maagig Work-related Aggressio ad Violece withi the Irish Health Service 17 we should feel that challeges associated with the maagemet of work-related aggressio ad violece are beig effectively maaged Of equal value is the fact that this strategy demostrates how partership workig ca give expressio to multiple perspectives so that we move forward i cofidece that the pla of actios will address stakeholder eeds i a adequate ad equitable maer. This level of partership workig should either be uderestimated or udervalued ad ideed the shared learig from this collaborative workig has added value for all parters beyod the scope of this project. The commitmet to collaboratively embracig the challeges idetified, coupled with a commitmet to establishig facts rather tha faults has resulted i this strategy which is both comprehesive i scope ad iovative i approach. This has ot goe uoticed, as evideced by the fact that the work of the group has bee preseted at a EU social dialogue forum, ad as a keyote paper at the first iteratioal cogress o violece withi the healthcare sector, atteded by delegates from 47 coutries coverig all cotiets. I the fial aalysis the complex issue of work-related aggressio ad violece is oe which compromises the care experiece from the perspectives of both recipiet ad provider. Despite the cosiderable challeges idetified i maagig this problem, it is importat that we are either reticet i its recogitio, or doubtful that we ca achieve excellece i implemetig a effective respose. It is clear from the work of this group that there is o simple, sigle or quick fix solutio to this problem. However the careful collaborative cosideratio which has uderpied the productio of this strategy will serve it well as we meet the challege i a iformed, cosidered, balaced ad cohesive way. Refereces 1. McKea, K., Paterso, B. (2006) Locatig traiig withi a strategic orgaisatioal approach to the maagemet of aggressio ad Violece i Richter, D. ad Whittigto, R. eds. Violece i Metal Health Settigs; Causes Cosequeces Maagemet. Spriger, New York. p Advisory Committee o Health Services Sector (2001) Report of the advisory committee o health services sector. Natioal Authority for Occupatioal Safety ad Health, Dubli. 3. Poyer, B., Ware, C. (1988) Prevetig violece to staff. HMSO Publicatios, Lodo. 4. Camero, A. (2001) The art of partership: A practical guide. British Istitute of Learig Disabilities, Kiddermiister. 5. Paterso, B., Leadbetter, D., Miller, G., Crichto, J. (2007) Adoptig a Public Health Model to Reduce Violece ad Restraits i Childre s Residetial Care Facilities i Nuo, M., Day, D. ad Bullard, L.B. For Our Ow Safety: Examiig the Safety of High-risk Itervetios for Childre ad Youg People. Arligto, USA, Child Welfare League of America Ic. p Rogers, K.A., Chappell, D. (2003) Prevetig ad respodig to violece at work. Iteratioal Labour Office, Geeva.

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