April 17, 2011
The California Division of Occupational Safety and Health (Cal/OSHA) recently fined Children’s Hospital in Oakland, Calif., for allegedly failing to protect workers from violence in the emergency department. Cal/OSHA penalized the hospital for having an ineffective training program, incomplete and inadequate procedures to deal with safety concerns, and an “incomplete and untimely hazard correction for workplace violence exposures in the emergency department.” The citations totaled $10,350.
U.S. education officials are standing by their finding that Virginia Tech officials broke federal law when they waited two hours to notify the campus that a gunman was on the loose at the outset of a 2007 shooting rampage.
Shootings, stabbings, bombings and similar tragedies are some of the most visible forms of workplace violence, yet they are not the most common in hospitals, schools and universities. Threatening body language, invasion of personal space, verbal or written threats, verbal abuse, psychological harassment, intimidation, retaliation and physical attacks occur with striking frequency in these settings.
Eliminating the possibility of violence is unlikely, but specific organizational strategies can decrease the frequency and severity of all types of incidents. Addressing the problem involves a comprehensive and ongoing process of assessment, planning, communication, training and follow up.
1. Address a Wide Variety of Incidents
Workplace violence occurs along a continuum, and this continuum includes behaviors ranging from discourtesy and disrespect to intimidation/bullying, harassment, retaliation, assault and physical aggression. The process needs to begin with policies and procedures that address this continuum of behaviors and any others that could cause physical or emotional injury, damage assets, impede the typical course of work, or make internal or external customers fear for their safety.
Education and healthcare managers have a responsibility to foster an environment that is safe, respectful and service oriented. This responsibility is equally shared by every individual involved in providing or receiving any level of service from the organization. The institution should make every reasonable effort to ensure that no internal or external customer is subjected to any kind behavior on the workplace violence continuum.
2. Include Safety Team Members With Diverse Backgrounds
One or more safety teams should be responsible for workplace violence prevention and response as well as any associated policies, practices, training programs, emergency drills and ongoing follow up. The team should consist of representatives from management, human resources, employee assistance, frontline employees, legal counsel and any other appropriate organization-specific roles.
This team should represent stakeholders at every level of the organization. These may include students, patients, union representatives, media relations specialists, risk management personnel, loss prevention and security.
3. Identify Individuals Who Are at Risk
Safety teams should assess the risk factors in operating sites and related work contexts. Those individuals at highest risk for assault, violence and threats may include anyone having contact with the public; are involved in the exchange of money; deliver passengers, goods, or services; work alone or in small numbers; work late night or early morning hours; or work in high-crime areas.
The assessment should include a comprehensive review of each work area and work context to evaluate vulnerability to any type of violence. The safety team should then oversee planning efforts on any agreed preventive actions. For example, a university may identify the exchange of cash by personnel working late at night as an area of vulnerability. Often, this vulnerability is addressed by requiring that any cash collected is immediately deposited into a locked safe that can’t be opened by on-duty campus staff. This practice is then publicly posted in order to lower the possibility of theft.
4. Review Recordsto ID Vulnerable Locations, Trends
The assessment should include a review of any available records involving past incidents and a site-specific security analysis for each work location and work context. Organizations should adopt policies and procedures addressing identified vulnerabilities and specific organizational expectations.
For example, many campuses enforce specific time frames for the replacement of defective lighting in parking facilities since dark parking facilities are prime targets for crime. Many also require the presence of specially trained security personnel in the financial aid office and in libraries.
5. Develop Clear, Specific Responsibilities
Policies and procedures should define roles and address employee rights and responsibilities. Comprehensive policies and procedures need to extend well beyond what many organizations call “zero-tolerance” or “hands-off” expectations. They need to spell out specific organizational guidelines, requirements and limits.
Some examples would include whether or not there is a strict policy for not touching a physically aggressive individual. Another policy might state whether certain trained personnel are authorized to safely physically intervene. Some campus policies allow only designated personnel to contact external law enforcement, requiring others to instead contact campus police.