One barrier to preventing workplace violence is an organization’s failure to close the loop with healthcare workers by giving those employees information about what happened once they reported an incident, according to Coleen Smith, MBA, MSN, RN, with The Joint Commission Center for Transforming Healthcare. This is surprisingly difficult to address.

“Most reporting systems, whether electronic or paper, do not make it easy to close the loop by informing both the person who reported the issue and other staff affected by any improvement actions,” Smith explains. “It’s not so much a matter of mechanics, but rather one of process. Some issues take longer to address, while others might involve staff behaviors. The outcomes cannot be shared specifically.”

In cases that involve a broken piece of equipment, it might be easier to let staff know the issue has been addressed. However, this assumes the organization offers a venue for communication to occur, Smith notes. “It is usually most effective for organizations to have multiple methods by which to share this information: in person, in writing, and electronically,” she says. “In healthcare, it is pretty hard to overcommunicate given the issues related to 12-hour shifts and rotating shifts.”

Collecting data on workplace violence should be a policy and expectation. “Sites should be collecting data continuously, starting with developing a reporting system,” says Judy Arnetz, PhD, MPH, PT, with Michigan State University.

Incident reports might include questions such as: What occurred? Who was involved? Where did it occur? Was there a resulting injury? What happened afterward?

“There is a basic problem of healthcare staff underreporting,” Arnetz laments. “One of the big reasons for not reporting is they say, ‘I didn’t get hurt. There was no injury, so I didn’t bother to report it.’”

A workplace violence prevention program includes an understanding of what workplace employees experience. Without records, there is no way to understand the magnitude of the organization’s problems. To keep records of workplace violence incidents, an ASC would need management commitment and employee participation.

“Management has to encourage employees to report immediately what occurs so they can develop interventions,” Arnetz offers. “Employees need to understand what to report, and this all is part of building a prevention culture.”

Managers and staff need to know what types of events occur, regardless of whether such episodes result in injury, because this information is crucial to developing prevention programs, Arnetz explains.

“Even if an employee didn’t get hurt one time, the next time something happens, an employee could be hurt,” she says. “We need to keep employees, patients, and innocent bystanders safe.”

Threats, bullying, and assaults should be reported. “If someone raises his voice, causes a disruption, but no one gets hurt, then it should not be reported,” Arnetz says. “It could be noted in the patient’s chart, and it should not go unnoticed.”

If a patient or former patient says to a healthcare provider, “I know where you live. I know where your children go to school,” then that is a threat that must be reported, Arnetz says. Likewise, bullying (defined as negative or deliberately harmful behavior) often that continued over a long period should be reported.

“If someone comes to work and has a bad day and snubs you, that’s a one-time incident and not bullying,” Arnetz explains. “They usually apologize the next day. But what we’re talking about with bullying is repeated negative behavior in which a person is singled out and is the object of negative behavior from one other person or a group.”

In operating rooms, there are reported incidents of surgeons throwing instruments or head butting someone to get the person out of the way, Arnetz notes. “Surgery is a high-stress environment,” Arnetz notes. “Emotions can flow in these high-stress environments, but that doesn’t give you the right to throw a scalpel.”