By Rachel Jokela, RRT, RCP; Diane Rydrych, MA; Tania Daniels, PT, MBA; and Rahul Koranne, MD, MBA, FACP.
Injury data from the U.S. Bureau of Labor Statistics show that doctors, nurses, and mental health workers are more likely than other workers to be assaulted on the job. Nationally in 2013, one in five healthcare and social assistance workers reported nonfatal occupational injuries, the highest number of such injuries reported for any industry (Gomaa et al., 2015). While similar data is not available by state, in Minnesota in 2013, 16.7 per 10,000 healthcare employees missed work due to injuries caused intentionally by others (U.S. Bureau of Labor Statistics, 2013), nearly six times the overall U.S. rate for all industries. Despite these numbers, many incidents that do not cause missed work may go unreported in healthcare. Healthcare providers may choose not to report incidents out of compassion for residents or patients, or they may mistakenly believe that tolerating threats or physical violence from those they care for is just “part of the job.”
Since 2003, Minnesota hospitals and licensed surgery centers have been required by law to report any physical assault on a patient or staff member that results in serious injury or death. The same state law also requires reporting any events that appear on the National Quality Forum’s Serious Reportable Events list. During the 11 years in which Minnesota’s reporting law has been in effect, 11 incidents of physical assault have been reported to the Minnesota Department of Health (MDH).
In late 2012, MDH conducted a statewide survey to evaluate Minnesota’s adverse health event reporting system. The survey found that patient or visitor violence toward staff—defined as a broad range of behaviors, including physical violence and threats that make employees, visitors, patients, and residents concerned for their personal safety—was an increasing concern among leaders of healthcare organizations. To address those concerns, MDH formed a public-private coalition of Minnesota healthcare organizations to explore strategies for preventing violence toward staff in healthcare settings and to provide resources to hospitals, long-term care facilities, clinics, and other organizations to help identify risks for violence and put effective strategies in place to respond to incidents when they occur.
Gap analysis and best practices
The Prevention of Violence in Health Care Coalition began meeting in early 2013. Members include MDH, Minnesota Hospital Association, Minnesota Medical Association, LeadingAge Minnesota, Care Providers of Minnesota, Minnesota Nurses Association, and a number of individual hospitals and health systems. After identifying the scope of the problem, the group set to work defining a set of best practices that organizations could use to identify gaps in their policies and procedures for violence.
Over the course of a year, the coalition facilitated development of a robust document that focuses on identification and de-escalation of violence, as well as prevention. The gap analysis includes best practices that organizations should put in place in the following areas: coordinating a violence prevention program, data reporting, facility culture and accountability, staff education, risk identification, incident response, learning from events, and interventions designed for specific behaviors. The gap analysis builds on the work of the National Organization for Occupational Safety and Health, the Occupational Safety and Health Administration, and the Minnesota Metropolitan Hospital Compact, as well as successful practices used throughout the state of Minnesota. After the gap analysis was finalized in early 2014, the coalition worked to procure sample policies, procedures, training, and educational resources to populate its accompanying online toolkit. The gap analysis and toolkit were released publicly in mid-2014 and are available at www.health.state.mn.us/patientsafety/preventionofviolence/index.html.