The reporting and consequences of workplace violence in six Ontario hospitals Peter Smith and Basak Yanar IWH Speaker Series May 22 nd 2018
Acknowledgement The Institute for Work & Health operates with the support of the Province of Ontario. The views expressed in this document are those of the authors and do not necessarily reflect those of the Province of Ontario. Special thanks to the various staff members at each hospital who helped with study recruitment and ethics applications Thanks to Amber Bielecky, Maaike de Vries and Michael Beckett for initial work related to this project, through the Indicators, Evaluation and Reporting working group. www.iwh.on.ca 2
www.iwh.on.ca 3
Technical specifications for the mandatory indicator of the number of workplace violence incidents Unit of Measurement: Number of workplace violence incidents reported by hospital workers within a 12 month period Workplace violence: As defined under the Ontario Occupational Health and Safety Act Data Source: In house data collection: The number of reported workplace violence incidents through each organisation s internal reporting mechanisms. www.iwh.on.ca Source: http://www.hqontario.ca/portals/0/documents/qi/qip/guidance-workplace-violence-en.pdf 4
Workplace violence under the Ontario Occupational Health and Safety Act the exercise of physical force by a person against a worker, in a workplace, that causes or could cause physical injury to the worker, an attempt to exercise physical force against a worker, in a workplace, that could cause physical injury to the worker, a statement or behaviour that it is reasonable for a worker to interpret as a threat to exercise physical force against the worker, in a workplace, that could cause physical injury to the worker. Source: Ontario Occupational Health and Safety Act www.iwh.on.ca 5
Hospital reporting systems as an method to monitor workplace violence Arnetz et al (2015) Pompeii et al (2016) Target population Employees in 42 hospital units within seven hospitals in Mid-west United States (approximately 15,000 employees). Two large hospital systems in Texas and North Carolina (approximately 11,000 employees) Num invited to participate 2,010 11,000 Response rate (N) 22% (N=446) 49% (N=5,385) Types of violence examined All Types (violence or aggression) Type II only (patient/visitor) (assaults, attempted assault and threats) Experienced violence 62% 39% www.iwh.on.ca 6
Hospital reporting systems as an method to monitor workplace violence 100% 90% 80% 70% 48% 25% Did not report 60% 50% 40% 66% Reported some other way 30% 20% 40% Reported to the Hospital System 10% 0% 12% 9% Arnetz et al 2015 (N = 275) Pompeii et al 2016 (N = 2,098) www.iwh.on.ca 7
Objective Working together with six Ontario hospitals we sought to: Estimate self-reported rates of different types of workplace violence in the previous 12 months Understand how many of these incidents were reported to the hospital system Examine perceptions of workplace violence prevention activities at each hospital For the most serious incident we also wanted to know More about the incident and the consequences of the incident If it was reported to the hospital system Reasons for not reporting to the hospital system www.iwh.on.ca 8
Study timeline Nov 2016 March 2017: Engagement with each hospital concerning study objectives and survey content March 2017: Ethics application submitted to U of T May June 2017: Additional survey modifications following feedback from hospital representatives June 2017: Ethics applications submitted to each of the six hospitals (approved between August and September) Late October to late Nov 2017: Survey launched at each hospital Jan 2018: Surveys closed
Survey content Part One: Experience of WPV and reporting Part Two: Details on most serious WPV event Part Three: Workplace violence prevention and demographic, occupational information All surveys done online, following a mass email to staff at each hospital
Part One: Sample size per hospital (N = 1,564; 1,323 (85%) with some data) 450 400 350 83 Info No Info 49 300 250 200 150 339 13 39 336 22 35 100 50 105 168 163 152 0 A B C D E F
No differences in respondent demographics and direct care work across hospitals 90% 80% A B C D E F 70% 60% 50% 40% 30% 20% 10% 0% Direct care Female 45+ years 10+ years experience
Proportion of respondents who experienced workplace violence (past 12 months) by type and hospital 60% 50% A B C D E F 40% 30% 20% 10% 0% Physical Assault Attempted Assault Threat Any WPV
Reporting of different WPV types (all hospitals) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 45.5% 51.6% 63.9% 30.8% 34.6% 27.6% 23.7% 13.8% 8.5% Physical Assaults Attempted Assaults Threats All Events Reported Some events reported No Events reported
Reporting of physical assaults by hospital 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% 48.3% 51.7% 37.5% 62.5% 64.3% 35.7% 35.3% 64.7% 43.6% 56.4% A B C D E F Some or All Events Reported No Events reported 72.7% 27.3%
Part Two: Sample size per hospital for most serious WPV incident (N = 511; 419 (82%) with some data) 180 160 140 120 34 Info No Info 27 100 80 60 40 20 0 129 13 10 111 6 14 61 42 29 35 A B C D E F
Types of most serious WPV incidents reported (N = 419) 80% 70% 75% 60% 50% 40% 30% 45% 37% 33% 27% 40% 20% 10% 19% 11% 11% 4% 0% Assault Attempt Assault Threat Patient Visitor Staff Other Intended to harm Did not intend to harm Don't know
Consequences of workplace violence 60% 50% 51% 40% 37% 30% 26% 20% 17% 10% 8% 4% 0% Felt frightened or worried Psychologically traumatized Physically injured Needed medical care Time off work Modified duties
Short Screening Scale for PTSD Because of this event, did any of the following situations occur? 1. You avoided being reminded of the experience by staying away from certain places, people or activities 2. You lost interest in activities that were once important and enjoyable 3. You began to feel more isolated or distant from other people 4. You found if hard to have love or affection for other people 5. You began to feel that there was no point in planning for the future 6. You had more trouble than usual falling asleep or staying asleep 7. You became jumpy or easily startled by ordinary noises or movements? (Bohnert and Breslau, Int J Methods Psychiatr Res, 2011)
Short Screening Scale for PTSD Score by violence type 40.0% 35.0% Score 1+ Score 4+ 35.6% 30.0% 25.0% 20.0% 31.0% 29.1% 25.0% 15.0% 10.0% 5.0% 8.0% 6.7% 10.5% 8.3% 0.0% Overall Assault Att Assault Threat
How did you report this event? 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% 36.2% 35.4% 28.5% * * 25.0% 32.1% 43.2% 18.2% 42.9% 38.6% 38.2% 32.7% 29.1% 45.9% 42.9% 35.1% 19.0% A B C D E F Did not report Hospital System Some other way 22.9% 34.3%
Proportion reporting to the hospital system by WPV subgroups 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 32% 44% 29% 18% 48% 42% 55% 53% 44% 79% 89%
Main reason for not reporting (to hospital system). Multiple responses allowed. 45% 40% 35% 30% 40% 32% 30% All Red = 62% All Black = 54% All Purple = 25% 25% 20% 24% 23% 22% 20% 20% 20% 15% 12% 12% 10% 5% 8% 8% 5% 4% 0%
What corrective action was taken as a result (N = 374)? Multiple responses allowed 60% 50% 40% Reported to hosptial (N = 128) Did not report (N = 246) 47% 54% 30% 20% 23% 23% 10% 0% 12% Adequate protections 6% Root cause analysis 10% 4% Process improvement 17% 9% 11% 4% Dev Safety plan Blamed Not aware of any action
Perceptions of WPV prevention (N = 1,111) Please indicate the extent to which you agree with the following statements. 1. Violence Prevention is a safety priority 2. My organisation takes effective action to prevent abuse 3. My organisation takes effective action to prevent violence 4. Senior managers are committed to providing a safe and healthy workplace 5. The people I work with treat me with respect 6. I know that I can report issues related to WPV to my manager and action to protect me and others will be taken 7. My hospital takes effective action after violence occurs
Proportion agree with each question by hospital (N = 1,111) 90% 80% A B C D E F 70% 60% 50% 40% 30% 20% 10% 0% Safety prority Prevent abuse Prevent violence Senior mgmt commit
Proportion agree with each question by hospital (N = 1,111) 100% 90% A B C D E F 80% 70% 60% 50% 40% 30% 20% 10% 0% Respect Report issues Effective action
Different measures of workplace violence prevention performance across hospitals (higher scores = worse performance) 60.0 50.0 A B C D E F 40.0 30.0 20.0 10.0 0.0 Physical Assult (%) Any WPV (%) Hospital Report (per 100 FTEs) Self Reports * WPV Prev Score (0 to 100)
Strengths and limitations Strengths First study to examine WPV reporting in hospitals in Ontario Breath of information collected Confirms results from other studies in the US (both in rates or reporting and reasons for not reporting) Weaknesses Low response rate Unable to assess potentially important differences between hospitals (low sample size in some hospitals)
Key Messages Underreporting of workplace violence is substantial and differs across six hospitals that are similar in other respects (e.g. size, reporting systems) Key reasons for non-reporting include not being hurt/seriousness, being desensitised, and feeling nothing happens as a result Relationship between self-report WPV, hospital recorded WPV and perceptions of WPV prevention activities are complex More research will larger samples (number of participants and number of hospitals) is required Recommend caution and care in the use of hospital reports of WPV as a KPI for WPV prevention in the short term
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