Protection is improvement, improvement is protection: Keeping folks safe from workplace violence

By Steve MacArthur, Hospital Safety Consultant

When it comes to the management of workplace violence considerations, I think we all have experienced the many, many ways in which these risks can manifest themselves in the healthcare environment. And now that the tides of COVID appear to be receding, the sense of gratefulness that existed (at least for a little while) seems to be on the decline as well. Now that ambulatory volumes are picking up and waiting rooms are becoming more congested, tempers grow ever shorter and put your frontline folks back to the more traditional risks associated with managing those interactions. It’s hard to say whether the folks not working in healthcare are sufficiently with familiar with the stresses and stressors endured by folks working in healthcare over the past 15-18 months, but it does seem that the sense of healthcare workers as “heroes” (which they most definitely—as they were before the pandemic and will be when we’ve moved on to the next thing) is not enabling good behaviors on the part of patients and their families as might have the case a year ago. In my own, very informal, data collection, there are an awful lot of sick people that are now comfortable enough to seek treatment for long-standing issues, which likely means that folks are scared (but not COVID-scared) and folks that are scared can have a tendency to lash out. This points to making sure that our workers are as well-prepared to deal with patient (and family) concerns before things escalate to the point of violence.

To that end (kind of), our friends in Chicago are implementing a number of “new” requirements to provide a framework for the survey of workplace violence concerns and how effectively hospitals are managing those risks. You can find the details of the standards (they’ll become effective on January 1, 2022) here. There’s also a resource page related to workplace violence.

In noting the use of quotation marks around the “new” requirements, I don’t know that the programmatic elements they’ll be looking for are anything beyond what is typically administered in a credible safety program. I don’t know that I’ve been to an organization in the last decade or so where workplace violence was not an issue to some degree. But much as we’ve had to work hard to protect workers during COVID and in light of the expansion of protections to whistleblowers, I think we should be approaching this as an opportunity to cover as many bases as possible in ensuring all staff (throughout every level of your organization—organizational leadership is clearly on the hook for supporting this endeavor) are effectively prepared to manage the risks associated with workplace violence, particularly de-escalation education. When you break down the requirements, it’s a fairly straightforward “ask”; beyond establishing a mandated frequency for review of the workplace violence prevention program, I don’t think that there’s anything here folks aren’t already doing to some extent. I suspect the education component may require some “ramping up,” particularly if the existing education programs were aimed at an identified group of “at risk” staffers; at this point, anyone working in healthcare, regardless of the environment in which they work have to be considered at risk and would benefit from de-escalation, etc. education. Also, if you’ve not made a concerted effort to include folks in leadership positions in your organization—they need refreshers, too.

So, what will they be looking for?

  • An annual worksite analysis of the workplace violence program, including mitigation or resolution of risks identified in the analysis, based on an analysis of the work environment, investigation of incidents, analysis of supporting policies and procedures, education programs, etc. As a somewhat related aside, keep an eye on your OSHA 300 logs to make sure any occurrences are being captured and communicated (especially to leadership—more on that in a moment);
  • An workplace violence training/education program (at time of hire, annually, when changes occur) for leadership, staff, and licensed practitioners; there is an allowance for determining the contents and to what extent workers need the education (based on their roles and responsibilities), but I don’t see where you can draw the line such that any group (or individual, for that matter) would rule out of the education. And for those of you with skilled nursing facilities, you could argue that they are working in one of your highest risk environments (second, perhaps, to the behavioral health environment), so you need to make sure that you’re including them in the education mix.
  • From a leadership perspective, there needs to be an individual designated leading the workplace violence prevention program (developed by a multidisciplinary team—can be existing) that includes policies and procedures; a process to report incidents and manage the data associated with trends, etc.; a process for follow up and support to folks affected by workplace violence (victims, witnesses); and reporting incidents to the governing body.

My best consultative advice, particularly if you are in the survey window, is to start working on pulling these elements together if you have them or to work to start looking at these considerations as a function of the requirements. Recognizing that the requirements are surveyable by some regulators beginning in January, there are other regulators who are predisposed to looking at this right now. Unfortunately, workplace violence occurrences are going to happen, but we need to consider every occurrence as an opportunity to improve the process and then act on the analysis. This is not going to be a simple fix, but if we can get everybody on the same page in terms of competencies, etc., in this regard, we should be able to demonstrate improvement over time.

About the Author: Steve MacArthur is a safety consultant with The Greeley Company in Danvers, Mass. He brings more than 30 years of healthcare management and consulting experience to his work with hospitals, physician offices, and ambulatory care facilities across the country. He is the author of HCPro's Hospital Safety Director's Handbook and is contributing editor for Healthcare Safety Leader. Contact Steve at