FOR A VIOLENCE-FREE WORKPLACE

Transcription

1 FOR A VIOLENCE-FREE WORKPLACE GUIDE FOR A PREVENTIVE APPROACH TO ASSAULTS BY THE CLIENTELE INTRODUCTION Over the years, workplace violence has become a global problem that affects practically all sectors and all categories of workers. However, this violence threatens the health sector and its workers in particular. Almost a quarter of all the acts of workplace violence effectively come from this sector 1. In fact, healthcare professionals run a high risk on any given day of being a victim of an assault at work by the clientele patient(s) or user(s), family members and visitor(s). A national study on the work and health of nursing personnel, carried out in 2002, showed that 34% of healthcare professionals assigned to direct patient care stated that they had been the victims of a physical assault from the clientele during the previous year 2. The same is true for the surveys that the FIQ conducted in 2002 and in 1995 which revealed that more than a quarter of the respondents confirmed that they did not feel safe at work. Now, this fact is not acceptable and must not, under any circumstances, be tolerated or considered as a normal working condition. The negative consequences arising from exposure to workplace violence no longer have to be proven. They are numerous, significant and destructive. Besides the fear, anxiety, suffering, symptoms related to post-traumatic stress, problems sleeping, feeling of isolation, depression and many other symptoms, healthcare professionals who are victims of assault can be profoundly affected in their integrity and self-esteem, on both a personal and professional level. This can result in, among others, a loss of efficiency, motivation and satisfaction at work, by a cropping up of the inevitable professional mistakes, by taking sick days more and more often, even by an irresistible urge to quit their workplace, their job or the profession, no matter the cost Framework Guidelines for addressing workplace violence in the health sector, International Labour Office ILO, International Council of Nurses ICN, World Health Organization WHO, Public Services International PSI, Geneva, 2002, 37-page document available on line at the following web address: 2. Factors related to on-the-job abuse of nurses by patients, Research Work, Margot Shields and Kathryn Wilkins, Statistics Canada, No XPF, Health Reports, Vol. 20, No 2, document available at the following web address: x/ /article/10835-eng.pdf 3. Violence is destructive by nature; it has a profoundly negative impact on observers as well as the victims. [ ] Obviously, violence harms nurses both personally and professionally, altering their lives and the quality of their contributions to health services. Moreover violence against nurses also lessens the profession s ability to recruit and retain qualified nurses. International Council of Nurses ICN, Guidelines on coping with violence in the workplace, 2007, p.10, 30-page document available on line at the following web address: copingwithviolenceintheworkplace.pdf FIQ OHS WEEK 2010

2 Workplace violence, an important source of stress, may also seriously compromise the quality of the care provided to the patients, and by the same token, their safety. A healthcare professional obviously needs a sound workplace with a respectful and serene climate in order to effectively and meticulously perform her duties according to the rules and maintain the required mandatory relationship of confidence with her patient. Consequently, all the stakeholders in the environment employer, administrators, workers and unions have a definite interest in interceding and acting in concert to eliminate violence by the clientele on the personnel. This weighty responsibility cannot rest only on the shoulders of the healthcare professionals, even with support from their union representatives, nor solely on their employer s goodwill. In addition, improvisation has no place in this area and is doomed to failure. Only a strategic approach to prevention of assaults that is well organized and structured, that calls for the involvement of all people in the environment and their commitment throughout the process, can make it possible to reach the objective sought. It is with this viewpoint that the Federation created the Guide for a preventive approach to assaults by the clientele in order to provide that each healthcare professional can at last have a VIOLENCE- FREE WORKPLACE. The violence they suffer at the hands of the clientele is a reality that must MOVE OUT OF THE SHADOW, without further delay. To suffer or be the object of workplace violence is abnormal and unacceptable. [ ] Prevention of violence implies that a set of conditions be present and that practices be introduced within organizations. Prevention of violence hinges on several steps and requires that energy and resources be dedicated to it 4 (our translation) 4. Prévention de la violence au travail Guide de prise en charge, Serge André GIRARD, Denis LALIBERTÉ, Direction régionale de santé publique de la Capitale nationale, Johanne DOMPIERRE, Université Laval, October 2005, 57-page document available on line at the following web address: FIQ OHS WEEK

3 STEP BY STEP CONTENT OF THE GUIDE The guide 5 developed by the FIQ presents the main steps in a preventive approach specifically adapted to the issue of assaults by the clientele on healthcare professionals. Briefly, the suggested preventive approach of assaults unfolds in five steps. It consists of: 1. Prepare the preventive approach; 2. Assess the scope of the problem; 3. Target the priority problems; 4. Select the possible and attainable solutions; 5. Implement the action plan and assess its impacts. Moreover, it is imperative that each institution, even every centre of activities, do its own assessment in order that the solutions applied meet the specific realities of the workplace and lead to the desired results. The solutions put into action in one area may actually turn out to be inappropriate or ineffective in another workplace. Each area wanting to act on the problem of assaults by the clientele on healthcare professionals and healthcare workers in general need to use this preventive approach and seek their own solutions. Prepare the approach Assess the problem (diagnosis) Priority problems Possible and attainable solutions Action plan/follow-up 5. This guide is largely inspired by the Guide pour une démarche stratégique de prévention des problèmes de santé psychologique au travail, by Jean-Pierre BRUN, Caroline BIRON and France St-Hilaire in June 2009, 76-page document available on line at the following address: FIQ OHS WEEK

4 STEP NO.1 PREPARE THE PREVENTIVE APPROACH TO ASSAULTS This first step serves to bring together all the pre-conditions required for a successful preventive approach to assaults on care-giving personnel. Among the conditions deemed essential at the beginning of the approach are the following: Recognition of the phenomenon of violence suffered by healthcare professionals and the importance of taking action 6 Before undertaking a preventive approach, it is necessary that the administration, healthcare professionals and the local union team acknowledge that violence is not a normal or acceptable working condition. They must also recognize that healthcare professionals are victims of assaults by the clientele and that it is important to take action to prevent or eliminate this violence. Besides this acknowledgement, the administration must be ready to commit to this preventive approach and to take the necessary actions so that each healthcare professional can provide care without being assaulted. At this time, it is important that the local union team ask the healthcare professionals about the level of assaults that they may be subject to from the clientele, about their opinion on the subject, of their belief that these assaults have no place in their work and their motivation for being involved in a preventive approach seeking to prevent or eliminate this violence towards them. Discussions on this set of problems must therefore be undertaken, particularly during meetings or union assemblies, in order to ensure that the healthcare professionals see the incidents in the same way and are ready to commit to such an approach. A preventive approach to assaults will not be productive without their full support. Thus, fortified by the participation and unquestionable commitment of its members to a preventive approach to assaults, the local union team will then be in a good position to start talks with the employer and to convince him of the need to act in order to adequately protect the healthcare professionals from the violence they are subjected to by the clientele. Commitment of all stakeholders Closely related to the preceding commitments, it remains important to obtain a real commitment from all the stakeholders the employer, personnel and local union decision-making bodies in achieving each one of the five steps in the approach. This is an essential condition. The success of the approach is in fact conditional on obtaining their support and their participation from start to finish. The discussions undertaken leading up to the approach by the local union team, both with the healthcare professionals and the employer, must moreover continue throughout the implementation of the action plan in order to ensure that these respective commitments and indispensible talks are maintained in order for the approach to be successful. Determination of the values and objectives of the approach In order to be able to defend the validity of the approach, it is essential to set the fundamental values as well as the specific and reachable objectives on which it rests. As it is of primary importance and perfectly normal that healthcare professionals can safely provide quality care without fear of being assaulted by the clientele, specific actions must be taken to eliminate this violence towards them at work or because of their work. 6. See note 4 (Serge André GIRARD, Denis LALIBERTÉ, Prévention de la violence au travail Guide de prise en charge), section 2.2 Pre-Conditions p.17-20: To recognize that the phenomenon of violence exists within his organization constitutes a key condition towards taking charge. According to many contributors, it is even the first condition for any approach seeking to implement measures to prevent violence. (our translation) (p.18) FIQ OHS WEEK

5 The Charter, entitled, Charter for the safety of healthcare professionals for a violence-free workplace, developed by the FIQ, is included in the Antiviolence Internet Kit and constitutes a starting point for establishing these values and objectives. The respect, dignity and kindness referred to in this Charter are essential values for reaching the objective of caring for patients in a safe environment, free from all forms of violence. Openness, partnerships and co-management are others which, without a doubt, will support, even enrich the process. Appointment of people in charge of the project It is essential to first appoint the people who will be responsible for the implementation and proper progress of the preventive approach to assaults. Since the solution lies above all in the active and parity participation of the work environment, a management person and a union person should be appointed to chair the committee to set it in motion. Furthermore, these people can come from the occupational health and safety parity committee (OHSPC) in the institution, or from a sub-committee specially created to lead the preventive approach to assaults. Ideally, this implementation committee will remain focused on the approach and will devote all its efforts and time to this unique mandate. Availability of resources In order to talk about a true commitment on the part of the employer to a preventive approach to assaults, it is essential that the latter agree to provide the human resources, material and funding necessary to achieve it. This means the employer must grant, among other things, a budget, time and room for discussion, or still, access to internal or external expertise, as the case may be. Development of a communication plan ( ) communication is a tool for action 7. (our translation) The success of the preventive approach relies on the implementation of an effective, bidirectional and open internal communication plan which allows the quick diffusion of the actions carried out and the results obtained, as need be. The usefulness of such a plan is all the more so in that it gives the chance to set up a continuous dialogue between the stakeholders in the institution, to consolidate their commitment to the approach and to facilitate reaching the objectives sought. In fact, the communication plan is more than a simple tool for diffusing information. It is a real management tool that allows for the use of all types of communication useful in reaching the goals set by the preventive approach and to convince all those involved. It prepares, so to speak, the ground where the information will end up during each of the steps in order to inform the personnel about the reason for the process, on the means implemented to carry it out, on its progress and on reaching its objectives. The people in charge of the project must therefore logically develop and set up the communication plan at the beginning of the preventive approach to assaults and then do a periodic follow-up. This plan must be submitted to the implementation committee in order to fine tune and validate it and to the administration of the institution, who should not only confirm it, but also support it to enhance its credibility. Lastly, the communication plan must contain its own objectives, the targeted public to be reached, the information to be transmitted, the modes of communication, the calendar of activities, the people responsible for its implementation and the resources required to carry it out. What is more, the communication plan is not a static tool and needs regular follow-up in order to optimize the modes of communication used. Here is an example: 7. See note 5 (Jean-Pierre BRUN), p.42. FIQ OHS WEEK

6 PREVENTIVE APPROACH TO ASSAULTS BY THE CLIENTELE ON HEALTHCARE PROFESSIONALS THE COMMUNICATION PLAN 8 OBJECTIVES of the communication plan TARGETED PUBLIC to reach INFORMATION or messages to transmit MODES OF COMMUNICATION to promote CALENDAR of activities to achieve the objectives PERSONS IN CHARGE of the implementation of the plan RESOURCES needed to carry out the plan l Sensitize the staff to the steps for preventing assaults l Insure that the questionnaire on assault risks be completed by all staff l Inform the clientele of the administration s expectations l etc. l B. of D., administrators, managers l all staff l clientele l union decisionmaking bodies l OHSPC l etc. l commitment of the administration and its partners in the steps of prevention l objectives of the approach l implementation of the approach s action plan l role and responsibilities of people l usefulness of the tools used l launch campaign l information and awarenessraising meetings l conferences, union meetings l posters, leaflets, surveys, reports l memos, letters, messages attached to pay cheques (dates) l Madam X l Mr. Y MATERIALS l Documents l Conference and meeting rooms l Computer l etc. FINANCIAL l Cost of room rental l Speaker fees l etc. l etc. l articles in the local and union newsletter l etc. Important: The communication plan must be subject to regular follow-up in order to optimize the modes of communication used. 8. This example is from the document entitled L accès à l égalité en emploi Le plan de communication created by the Commission des droits de la personne et des droits de la jeunesse, November 2001, which is available on line at communication.pdf FIQ OHS WEEK

7 STEP NO.2 ASSESS THE SCOPE OF THE PROBLEM The second step in the preventive approach consists of assessing the scope of the problem of assaults by the clientele on healthcare professionals in the institution or the centre of activities concerned. In other words, it is necessary to develop a specific local diagnosis before carrying out any intervention. The more exact the diagnosis, the easier it is to identify the priority problems and the more appropriate and effective the chosen solutions will be. Different tools and indicators can help in realizing the importance of the problem and determining a diagnosis. As there is currently no scientific tool which in itself produces a reliable diagnosis in matters of workplace violence and assaults 9, it seems preferable to resort to an appropriate combination of tools and indicators adapted to the situation. Here is a non exhaustive list for developing a statement on the subject of violence: Identification grid of assault risk factors For the purpose of this approach, the FIQ developed an Identification Grid of the assault risk factors for healthcare professionals by the clientele, which is an adaption of the one produced by the FIIQ in June, 2003 for the Workplace Safety: Taking Action 10 operation. Resting on the six main principles developed by women s groups concerned with developing a safe urban landscape, this tool seeks to pinpoint the different elements of the work environment that can contribute or, conversely, harm the safety or feeling of safety for healthcare professionals and all personnel in the health sector. This grid, which is part of the Antiviolence Internet Kit, was specially designed by the FIQ in order to help every healthcare professional to identify the assault risk factors in their work environment that need to be eliminated to provide care without being assaulted. The grid is divided into three parts, the safety of the personnel and the work premises, the management practices and interventions in matters of workplace violence, as well as the training, awareness-raising and information for people on workplace violence. Each one of these parts is also subdivided into three sections in order to cover the different realities associated with the positions of healthcare professionals and to deal with the assault risk factors and protection within the institution, in the parking lot and the external environment, as well as during travel and home care visits. Once the pertinent sections of the grid are completed, the assault risk factors identified in the work environment concerned are transferred to the Compilation of the assault risk factors for healthcare professionals by the clientele table. The completion of this exercise contributes, at least in part, to making a diagnosis of the scope of the problem of workplace violence, thus making it possible to move on to the following steps in the preventive approach. 9. See note 3 (ICN, 2007): Research has not yet provided a reliable tool to predict the potential for violence. A certain number of studies have however proven the validity of the theory that healthcare workers are at greatest risk of future assaults with the small percentage of patients who have a history of violent behaviour and who are, in fact, responsible for the majority of assaults. Interestingly, a history of violent behaviour within the past several hours was a strong predictor of assaults in the emergency department. (p.15). 10. Audit Guide Workplace Safety Taking action, FIIQ brochure, June, 2003, 40-page document available on line at the following address: FIQ OHS WEEK

8 Self-evaluation questionnaire on assault risks at work Another tool helpful in determining the diagnosis has been developed by the FIQ, and is also part of the Antiviolence Internet Kit. The Self-Evaluation Questionnaire on the assault risks for healthcare professionals at work by the clientele takes the pulse of the workplace for assaults by the clientele on healthcare professionals. It looks to obtain the perception of the latter on the risk factors likely to be present in their workplace, as well as the experience they have had regarding this problem. Once completed by the healthcare professional, the questionnaire is given to her local union team. Depending on the number of questionnaires received, an assessment of the answers obtained can contribute to making the most exact diagnosis possible. Group maintenance may also be carried out with the help of this questionnaire for consulting the personnel on this occupational health and safety problem. Other indicators The indicators for workplace assaults suffered by healthcare professionals over previous years may also be very useful in determining a diagnosis in matters of violence: n administrative statistics on absences, both for employment injuries and salary insurance; n the employment injuries register 11 kept by the employer by virtue of section 280 of the AIOAD 12 ; n the internal incident and employment injury reports; n the complaints and grievances filed on this subject; n the intervention reports and corrective notices issued by a CSST inspector; n the complaints lodged with the police; n the number and type of assaults committed by the clientele, the circumstances surrounding these assaults, the type of interventions carried out by the workplace, the reactions of the victims and the witnesses to these assaults, the preventive actions put in place, the evolution of the situation over the years; n the human and financial consequences of these assaults; n the assessment of the personnel training on violence by the clientele (Which people were trained? When? What type of training did they receive? Was an updating or a professional improvement course needed?...) n etc. 11. According to section 280 of the AIAOD, the employer shall enter in a register the work accidents that happen in his establishment (including the parking lot and home care visits) that do not make the employee unable to carry on his employment beyond the day his employment injury became apparent. The employer shall put the register at the disposal of the union or send a copy on request. 12. An Act respecting Industrial Accidents and Occupational Diseases. FIQ OHS WEEK

9 STEP NO.3 TARGET PRIORITY PROBLEMS Once the diagnosis is determined, a portrait of the concrete problems needing to be resolved in the institution or the centre of activities concerned must be drawn up in order to rid the workplace of situations of assault that could be at the hands of the clientele. It consists of organizing an internal discussion group (focus group) and to submit to them the results obtained in step No. 2. The role of this group of people will be to: n carefully examine these results in order to validate them, if applicable. These results should serve as material for reflection and give the people in the group the opportunity to share their vision of the risk factors present and to verify if they are complete and representative of the reality in the area concerned; n make a list of the concrete problems coming out of these results; n select, from this list, three or four priority problems needing to be resolved first, taking into account certain criteria, such as: l the importance of the problem (frequency, seriousness or risk for recurrence of the assaults); l the consensus on the problem actually being present; l the number of people having experienced or living with the problem; l the impact of the problem on the health and safety of the personnel; l the presence of possible, accessible and effective solutions in a more or less a short time period. n identify the solutions regarding the three or four priority problems targeted by the focus group. This item will be dealt with in step No. 4 of this preventive approach. In fact, it is essential to target a few problems at a time rather than to intervene on all the identified problems at the same time, as the list could be very long. It s better to use the little steps and small successes theory than to fail and find oneself back at square one in the preventive approach. This is why the proposed approach is called strategic. Also, obtaining small successes will help the personnel believe in the pertinence of the approach more and to consolidate their commitment and their involvement. As the expectations for this approach may be understandably important, it will be necessary, when the results are presented to the personnel, to specify that the problems not retained now will be kept and dealt with at a time deemed appropriate by those in charge of the project. FIQ OHS WEEK

10 STEP NO.4 SELECT POSSIBLE AND ATTAINABLE SOLUTIONS The idea for the strategic approach is to maintain a relationship between the following components: risk factors concrete problems solutions. This causality chain is a guarantee that the solutions deployed will seek out the right problems and the right risk factors 13. (our translation) In this step, one must first proceed to an inventory of the existing management solutions or practices aimed at countering the phenomenon of assaults on personnel by the clientele. Indeed, these practices already present in the institution, may have a positive or negative impact on preventing these assaults, but must be truly applied and diffused to all the personnel. If this is the case, it must be verified if they need to be improved, updated or simply disposed of. Secondly, the previously mentioned focus group must determine the array of possible, realistic and attainable solutions and to then choose those which will seek to eliminate each of the priority problems retained in an effective and lasting manner. For an equivalent result, it is preferable to provide for solutions that are easy to implement and that can be quickly agreed to by the stakeholders and the personnel in the institution. It is important to specify that, most of the time, prevention or elimination of workplace assaults and violence requires the implementation of several complementary and diversified actions, which must all be consistent with each other and coordinated with all the management and intervention practices in effect in the institution. To do this, the best way to act with consistency and effectiveness is for the employer to adopt a policy to counter violence. A well-written policy clearly reflects the determination of administration, even the organization, to prevent and eliminate violence by anyone, including the clientele. Such a policy also expresses the values and principles advocated by the stakeholders employer, personnel and healthcare professionals, unions as well as the different means that the organization intends to take to counter the violence likely to be carried out by the clientele. Similarly, the stakeholders must be involved and feel concerned with the development, implementation and application of the policy and the various actions seeking to eliminate workplace violence. The following tool is useful in developing solutions for each targeted priority problem. The Preparation grid of solutions effectively questions each of the stakeholders to determine what might be done to improve the situation and resolve the problem. 13. See note 5 (Jean-Pierre BRUN), p.44. FIQ OHS WEEK

11 PREPARATION GRID OF SOLUTIONS 14 To attain a violence-free workplace Description of the priority problem: What the EMPLOYER can do to improve the situation What the HEALTHCARE PROFESSIONAL can do to improve the situation What the WORK TEAM can do to improve the situation What the UNION can do to improve the situation 14. See note 5 (Jean-Pierre BRUN), p.47. FIQ OHS WEEK

12 STEP NO.5 IMPLEMENT THE ACTION PLAN In a nutshell, the action plan is the interface between the principles and commitments expressed in the violence policy and the measures or activities that the administration intends to implement. [ ] The action plan on violence hinges on three targets: the design of the workplace, the administrative practices and the competencies and interpersonal skills of employees and managers. [ ] It is not a matter of questioning the professional capacity of individuals to perform their work but to truly develop specific competencies as regards violence 15. (our translation) After having clearly identified the assault risk factors by the clientele, accurately targeted the priority problems and chosen the possible and attainable solutions for improving the situation, the action plan must then be developed. For better effectiveness, it is preferable that this exercise be performed by a limited number of people (3 or 4), rather than in a large discussion group. While the solutions are the measures used for acting on the targeted problems, the action plan is the method in which the measures will be introduced. The same importance must be given to both. Indeed, the best of solutions risks having less success if the strategy used to introduce it has certain weaknesses associated with the time chosen to implement it, in particular. The following action plan indicates the strategic elements that it must contain to facilitate the implementation of the chosen solutions and the success of the preventive approach. For each of the targeted priority problems, the plan assigns a priority code 16, the solutions aimed at improving the situation, the timeline (dates) for execution, the human, material and financial resources needed as well as the follow-up which will be done. 15. See note 4 (Serge André GIRARD, Denis LALIBERTÉ, Prévention de la violence au travail Guide de prise en charge), p.28 and Code 1 means that this is a priority situation, presenting objectivable and immediate risks of assault and violence, necessitating action as soon as possible; Code 2 means that this is a major situation, presenting objectivable risks of assault and violence, necessitating action within a reasonable time and Code 3 means that this is a situation with a potential risk of assault and violence, where action would be desirable within a deadline to be evaluated: see note 10 (FIIQ, Audit Guide Workplace Safety Taking Action), p.6. FIQ OHS WEEK

13 PREVENTIVE APPROACH TO ASSAULTS BY THE CLIENTELE ON HEALTHCARE PROFESSIONALS ACTION PLAN TARGETED PRIORITY PROBLEM N O Description of the problem Priority Code 1 SOLUTIONS RETAINED To improve the situation (person in charge) IMPLEMEN- TATION SCHEDULE (dates) RESOURCES (human, material and financial) FOLLOW-UP (Evaluation of the actions) * Code 1: high priority (quick action) Code 2: important (reasonable time period) Code 3: a good idea (time frame to be discussed) Once the action plan is developed, it must be presented for validation with the members of the implementation committee and the administration of the institution. All personnel should also be met as soon as possible to ensure the participation of all the workplace stakeholders in the implementation of this action plan 17. The use of a participative approach throughout the process is a fundamental condition for the success of a preventive approach. Lastly, it is important to put the chosen solutions in place as soon as possible in accordance with the action plan, and to assess the impacts. 17. See note 4 (Serge André GIRARD, Denis LALIBERTÉ, Prévention de la violence au travail Guide de prise en charge): The failure to consider the opinion of the staff may have effects contrary to those hoped for. (p.26) (our translation) FIQ OHS WEEK

14 ASSESS THE IMPACTS FROM THE ACTION PLAN: FOLLOW-UP A permanent follow-up of the preventive approach to workplace assaults is essential for reaching the objective of the healthcare professional being able to provide care without being assaulted. In fact, it is crucial to perform regular audits of the action plan to determine in which way the chosen solutions help to prevent or eliminate violence and assaults by the clientele. A follow-up serves to assess the impacts of the action plan, even the effectiveness, pertinence and sufficiency of the solutions implemented and to rectify them if applicable. In addition, a follow-up following the struggle against assaults must be constant and not limited in time and must continue beyond the time that the sought results are obtained. It is important to never let one s guard down. A method to assess the effectiveness of each of the chosen solutions and the complete process must therefore be provided from the start of the approach. This means that the implementation committee, in collaboration with the administration, managers, healthcare professionals, all the personnel and the local union decisionmaking bodies need to, in particular: n determine the assessment criteria which will serve to verify, as needed, the effectiveness of each of the actions and measures taken in order to adjust the action plan and the communication plan for the preventive approach to assaults; n register and document 18 the different activities set up to prevent or eliminate assaults throughout the approach; n regularly monitor and diffuse the results obtained from the implemented solutions; n ensure that all necessary information is quickly obtained; n organize periodic meetings between administration, healthcare professionals, staff in general and the union decision-making bodies in order to discuss the effectiveness of the solutions put in place and the improvements that could be made; n follow-up with the staff, as need be, through a questionnaire or a house survey; n implement a permanent risk management cycle in order to ensure the longevity of the struggle against violence and assaults by the clientele on healthcare professionals and healthcare workers in general Summary of the meetings, comments, results of staff consultation, questionnaires, surveys or enquiries and analysis, compilation of statistical data, incident register, etc. 19. See note 1 (International Labour Organization, ILO, ICN, WHO and PSI, Framework Guidelines for addressing workplace violence in the health sector, Geneva, 2002), p.30; also see Code of practice on workplace violence in services sectors and measures to combat this phenomenon Meeting of Experts to Develop a Code of Practice on Violence and Stress at Work in Services: A Threat to Productivity and Decent Work, International Labour Organization International Labour Office, Geneva, October 8-15, 2003, p.20, 27-page document available on line at the following address: FIQ OHS WEEK