Q&A: Joint Commission on Workplace Violence

This member-only article appears in the July issue of Patient Safety and Quality Healthcare.

The Joint Commission is the latest healthcare heavy-hitter to call for better protection of healthcare workers, announcing on Tuesday the creation of Sentinel Event Alert 59, which addresses violence—physical and verbal—against healthcare workers. About 75% of workplace assaults occur in the healthcare and social service sector each year, and violence-related injuries are four times more likely to cause healthcare workers to take time off from work than in other kinds of industries.

Patient Safety Monitor Journal spoke with Victoria Fennel, of Compass Clinical Consulting, about the alert and healthcare’s culture of violence.

Q: In your opinion, how much of the workplace violence (WPV) issues in healthcare is cultural (behaviors around WPV) vs. policy?
Fennel: When you think about violence, most of all let me say that it’s a learned behavior. It comes from modeling or observing behaviors in which there was violence. From a cultural perspective, if violence can be a learned behavior, then I think responding to violent behavior must become a learned response.

You can have all the policies in the world, but if you don’t have some things in place culturally that help leaders and staff understand how to respond to those situations, then it’s not going to be real helpful. It has to be more than just policies and procedures. There has to be some kind of accountability in terms of leadership and how they won’t tolerate certain types of behaviors so that the staff feels comfortable going to authority and expressing things that have occurred where they felt like there was the potential for them to be harmed, be it through verbal abuse or if they experienced physical abuse.

Q: How do you keep these alerts from just becoming white noise in the array of things that accreditation and patient safety people have to worry about?
Fennel: I think that in and of itself is part of the problem. The concept of workplace violence is more than something that only accreditation and patient safety facilitators need to be worried about. You have to have leadership involved.
I think if you have the leadership commitment, and I mean true commitment, that certain behaviors will not be tolerated, then I think it helps the organization. Because you’ll have more satisfied staff, and they’ll feel comfortable coming forward with these certain situations.

At one facility, I heard a chief medical officer say he’d spoken to a physician and said a certain behavior would not be tolerated, and that he could replace the physician faster than the organization could replace a nurse.

Also, the organization will need to provide the training on how to respond. There’s not enough training that goes on.

Q: Would better restraint-and-seclusion training, to include de-escalation training, help hospital staffers dealing with abusive patients? And should that include security personnel?
Fennel: If an organization is looking at de-escalation in only terms of patients who need to be restrained, then they are not looking at a big enough picture.

There are many areas within an organization where employees are potentially exposed to violent behavior that has nothing to do with restraining a patient. Many times when we’re looking at de-escalation training in organizations, we’re looking at different areas of the hospital where this is being provided.

It may be that this training is provided to a limited number of people in the ED or people in the psychiatric department. But what about all the people who have the potential for dealing with this violent behavior all the time (for example, people at the front desk)? And they receive no training, don’t know how to respond, and don’t know what the organization’s stance is in regards to violence. If they are experiencing something, they don’t know if they have the freedom to come forward with what’s going on.

For example, we know there’s been a lot of violence that’s happened in the surgery area over the years, where it gets to the point that someone is throwing a scalpel at a nurse or a chart that barely misses a nurse’s head. Those are behaviors that cannot be tolerated, but at the same time not a lot of information has been provided to the staff on how to respond in those situations.

There’s also the fear of retaliation if someone says something, that someone will come back at them because they brought this information forward. There are a lot of things that are involved, but it’s far beyond the scope of just accreditation and safety people to be concerned.

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