Take steps to reduce risk of work violence

Give employees a way to anonymously report

A 70-year-old man waves a gun in the emergency department. A gunman shoots his estranged wife and her mother in an intensive care unit. An environmental services worker at a hospital shoots his ex-wife, also an employee, in the hospital garage.

Headlines tell the stories of violent events at hospitals, many of them from patients but some from visitors or co-workers. The U.S. Occupational Safety and Health Administration put nursing homes on notice that it will look at workplace violence in its inspections as part of the National Emphasis Program. The focus also has heightened at other health care facilities, including hospitals, safety experts say.

Workplace violence is an issue that requires collaboration between employee health and safety, human resources, security and risk managers, says Cara Wzorek, MA, a risk management analyst at ECRI Institute, a research organization and evidence-based practice center based in Plymouth Meeting, PA.

While it isn't possible to eliminate the risk of violence, hospitals can take steps to address it, including training, security audits, reporting systems and counseling for employees who are victims of violence, Wzorek says.

"There are things you can do that show you assessed your risk and that you took steps to show you addressed any risks you identified," she says. "Make sure you document your efforts."

While patients are the source of most violent events in hospitals, violence prevention needs to include the risk from co-workers or outsiders, she says. Possible actions may range from bullying or harassment to acts against patients. Employees also could be victims of domestic violence, which could potentially spill into the workplace.

"Make sure you give employees an opportunity to anonymously report. Employees may be hesitant to report against another employee, especially if it's someone superior to them or someone they fear might retaliate against them," she says.

Hospitals also have an obligation to be thorough in their hiring process, Wzorek says. "One of the biggest predictors of violent behavior is past violent behavior," she says. "You want to make sure you conduct a criminal background check. Look at every state the employee worked in."

ECRI recommends these action steps related to workplace violence:

• Work with the security department to audit the facility's risk of violence. Evaluate environmental and administrative controls throughout the campus, review records and statistical crime rates for the area surrounding the facility, and survey employees on their perceptions of risk.

• Use a self-assessment to identify strengths and weaknesses and improve the organization's violence prevention program.

• Thoroughly prescreen all job applicants, and ensure that procedures for background checks of prospective employees and staff are in place.

• Encourage employees and other staff to report incidents of violent activity or any perceived threats of violence.

• Ensure compliance with OSHA's requirements for reporting workplace injuries.

• If the facility is in an area with a high rate of crime or gang activity, consider taking extra security precautions in the ED (such as installing metal detectors, using police dogs).

• Collaborate with the human resources department to ensure that procedures for disciplining and firing employees minimize the chance of provoking a violent reaction.

• Ensure that counseling programs for employees who become victims of workplace crime or violence are in place.

• Require appropriate staff members to undergo training in responding to patient family members who are agitated and potentially violent. Include education on procedures for notifying supervisors and security staff.

• Ensure that procedures for responding to incidents of workplace violence (such as notifying managers or security, activating codes) are in place and that employees receive instruction on these procedures.

• Inform supervisors that all reports of suspicious behavior or threats by another employee must be treated seriously and thoroughly investigated. Train supervisors to recognize when an employee may be experiencing domestic violence.

• Work with the media relations department to determine procedures for release of information regarding violent events that occur at the facility.

[Editor's note: The ECRI publication, "Healthcare Risk Control: Violence in Healthcare Facilities," is available at http://bit.ly/L0uqHm ]