Violence In The Workplace Preventing and Responding to Violence in The Medical Practice Workplace Presented by Tom Loughrey Economedix, LLC From The National Institute of Occupational Safety and Health Violence is a substantial contributor to occupational injury and death, and homicide has become the second leading cause of occupational injury death. Each week, an average of 20 workers are murdered and 18,000 are assaulted while at work or on duty. Nonfatal assaults result in millions of lost workdays and cost workers millions of dollars in lost wages. Defining Workplace Violence Workplace violence is: Any physical assault Threatening behavior Verbal abuse Intimidation Threats Frightening or disruptive behavior 1
Defining Workplace Violence The workplace may be: The office The building The parking lot Out of office assignments Traveling to or from work assignments Workplace Violence Includes: Beatings Stabbings Suicides Shootings Rapes Near-suicides Psychological traumas Threats Obscene phone calls or e-mail Intimidation Harassment of any type Stalking Sworn or shouted at Typology of Workplace Violence Criminal Intent (Type I) Customer/Client (Type II) Worker-on-Worker (Type III) Personal Relationship (Type IV) Type of Violence Determines Plans for Prevention 2
Criminal Intent (Type I) The perpetrator has no legitimate relationship to the practice Usually committing a crime in conjunction with the violence Can include robbery, shoplifting and trespassing Most workplace homicides fall In this category Customer/Client (Type II) The perpetrator has a legitimate relationship with the practice (a patient or family member) Violence occurs while doing business with the practice Includes patients, family/friends, vendors Health care workplaces have among the highest rates of Type II violence Worker-on-Worker (Type III) The perpetrator is an employee or past employee May commit violence against current or past employees and physicians in the workplace Tend to be the most sensationalist of all types Tend to get most focus for problem solving 3
Personal Relationship (Type IV) The perpetrator does not usually have a relationship with the practice Usually has a relationship with the intended victim Includes victims of domestic violence assaulted or threatened at work May result in additional violence to others in the workplace Victims of Workplace Violence Rape/Sexual Assault 2.1% Homicide 0.1% Robbery 4.0% Aggravated Assault 18.6% Homicide Rape/Sexual Assault Robbery Aggravated Assault Simple Assault Simple Assault 75.2% Workplace Violence Statistics 645 homicides in the workplace in 1999 Down from 1,080 in 1994 Homicide is second leading cause of fatal workplace injuries for women The National Crime Victimization Study estimates more than 2,000,000 workers are victims of non-fatal injuries in the workplace 4
Workplace Violence Statistics Rate of Violent Victimization per 1,000 workers: Physicians 16.2 Nurses 21.9 Technicians 12.7 Other health care workers 8.5 Police officers 260.8 Taxi cab drivers 128.3 Convenience store clerks 53.9 College/University teaching staff 1.6 Workplace Violence Statistics Average Annual Rates of Aggravated and Simple Assault 1993-1999: Medical Field 878,700 assaults Aggravated 96,200 1.4 per 1,000 Simple 782,500 11.4 per 1,000 Aggravated vs. Simple Assault Aggravated. A completed or attempted attack with a weapon, regardless of whether or not an injury occurred, and an attack without a weapon in which a victim is seriously injured. Simple An attack without a weapon resulting in either no injury, minor injury (bruises, black eyes, cuts, scratches, or swelling) or an undetermined injury requiring less than two days of hospitalization. May include attempted assaults 5
Risk Factors In The Medical Practice Prevalence of handguns Treatment of patients dealing with trauma and stress Availability of drugs (may be perceived) Distraught family Lack of health insurance or adequate coverage Unrestricted public access Isolated work with patients in treatment areas Inadequate signaling systems Personal family situations Drugs and alcohol Occupational Safety & Health Act Not a new standard Advisory in nature and informational in content Intended to be used by employers to provide a safe and healthful workplace through effective workplace violence programs Do you have any liability to workers if you do not do this? OSHA General Duty Clause Section 5(a)(1) of the Act: Each employer shall furnish to each of his employees employment and a place of employment which are free from recognized hazards that are causing or likely to cause death or serious physical harm This includes the prevention and control of the hazard of workplace violence 6
Prevention Environmental Adjusting lighting, entrances and exits, security hardware and other engineering controls Organizational / Administrative Developing programs, policies and work practices aimed at creating and maintaining a safe workplace Behavioral / Interpersonal Training staff to anticipate, recognize and respond to conflict and potential violence Prevention Responses Physical security enhancements Threat management procedures Employee Assistance Programs (EAP) Zero tolerance policies related to threatening or harassing behavior Employee training to promote recognition and appropriate responses Screening to identify employees at high risk Policies designed to promote employee comfort in reporting Hiring of security firms specializing in prevention The Physical Environment Practice walk-through Parking lot lighting, security, signaling, escorts? Elevators and hallways Common restrooms Other businesses and practices Sight control in reception area Front desk security Money handling Samples and access Prescription pads and access Signaling and communications 7
Organizational Risk Reduction Policies and a Crisis Response Plan Procedures for calling for help Procedures for notifying proper authorities Emergency escape procedures Safe places to escape Procedures to secure the workplace Procedures to account for staff during evacuation Training and education Procedures for regular evaluation of the plan The Written Policy Statement Designed to inform employees that the policy covers intimidation, harassment, and other inappropriate behavior It encourages employees to report incidents It informs employees who to call It demonstrates management s commitment to creating and maintaining a safe work environment The Statement Conveys: That all employees are responsible for a safe work environment That it covers physical and non-physical violence That it covers coworkers and incidents involving patients and visitors That the practice will be responsive to stop inappropriate behavior 8
Recognizing The Warning Signs Direct or veiled threats of harm Intimidating, belligerent, bullying aggressive behavior Numerous conflicts with supervisors and other employees Bringing a weapon to the workplace or making inappropriate references to guns or an unusual fascination with weapons Recognizing The Warning Signs Fascination with workplace violence indicating approval of use of violence Statements indicating desperation Drug and alcohol abuse Extreme behavioral changes Aggressive complaints from patients or family about care, denial of care, bills, etc Topics for Training Explanation of the practice s workplace violence policy Encouragement to report incidents Ways of preventing or diffusing volatile situations and aggressive behavior How to deal with hostile persons Managing anger Conflict resolution skills Stress management Security procedures Personal safety and security precautions Explanation of the Employee Assistance program Patient Relations 9
Training for Supervisors Ways to encourage employees to report incidents Skills in behaving compassionately and supportively towards employees reporting incidents Skills in administering discipline Emergency procedures Pre-employment screening Incident Response Do not respond at a level you are not prepared to deal with call for appropriate help Get all the facts before making any judgments or taking disciplinary action Control the location for possible legal intervention Practice with case studies Coping With Threats and Violence For an angry or hostile co-worker or patient Stay calm. Listen attentively Maintain Eye Contact Be courteous. Be patient Keep the situation in your control Summarize and repeat concerns for clarification Let me make sure I understand Adapted from Federal Protective Service 10
Coping With Threats and Violence For a person shouting, swearing, and threatening: Signal a coworker you need help Do not make any calls yourself Have someone else make a call to security or police if needed Work to prevent escalation be calm and attentive Adapted from Federal Protective Service Coping With Threats and Violence For a person threatening with a weapon or physical harm (fists and feet) Stay calm and signal for help Maintain eye contact Stall for time Keep talking but follow instructions from the person who has the weapon Don t risk harm to yourself or others Do not try to grab the weapon Watch for a safe chance to escape others should have already left if safe Adapted from Federal Protective Service Telephone Threats Keep calm and keep talking. Don t hang up Signal a coworker to get on an extension Ask the caller to repeat the message and write it down Repeat questions if necessary If it is a bomb threat ask where the bomb is and when it will go off Listen for background noises and write down a description Write down whether it is a man or woman; pitch of voice, accent, etc Coworker should contact police immediately Get the manager 11
Fax and E-mail Electronic Threats Maintain a copy of the documents Does Fax maintain list of incoming phone numbers? Get most recent numbers Get supervisor Assess and report to authorities if appropriate Recovering From An Incident Ensure a management presence in the practice Share information with employees Bring in professionals if needed contact your county department of public health Provide informal debriefing Support care-giving among employees Invite family to participate Returning to normal routine is healing Summary Violence in medical practices does occur and every practice needs a plan Violence has degrees and can take many forms. No single response will always be the right response The best medicine is prevention but when that does not work then mitigation is the next best alternative 12
Resources US Department of Justice, Office of Justice Programs, National Crime Victimization Survey, Violence In The Workplace 1993-99. December 2001 US Office of Personnel Management, Dealing With Violence in the Workplace. OWR-09. December 1998. http://www.opm.gov US Office of Personnel Management, Handling Traumatic Events. OWR-15. December 1996. http://www.opm.gov OSHA. Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers. US Dept of Labor. OSHA 3148. http://www.osha.gov/oshpubs/ NIOSH Current Intelligence Bulletin 57. Violence in the Workplace: Risk Factors and Prevention Strategies, 1996. http://www.cdc.gov/niosh/violabst.html Video http://www.cdc.gov/ niosh/docs/video/violence.html Thank You for Participating in This Teleconference Presentation From Economedix! Please direct questions to tloughrey@economedix.com Or (877) 328-5303 13