Both partners aligned to provide & advocate for work environments free of violence / harassment.

Background

Work related aggression and violence within the health and social services sector can compromise organizational effectiveness and negatively impact the provision and quality of care. Michael Garron Hospital and the Ontario Nurses Association have partnered to further their mission of leadership in quality and value on this exact topic.

In an effort to create a culture of safety and respect both partners have aligned to set the scene in providing and advocating for work environments free from all forms and sources of violence/harassment. Their overall position on violence prevention is that employers must strive to eliminate risks of violence/harassment in all aspects. An ONA member survey revealed that 54% experienced physical violence in the workplace, 85% experienced verbal abuse and 39% report other forms of violence/abuse in the workplace making it apparent that health care is dangerous work. As well being up against the hard reality that there is growing awareness of the prevalence of violence, the MGH CEOs was also questioning the number of weapons confiscated as well as a reluctance to file incident reports. This along with the belief that violence is part of the job is contributing to a sense of urgency and a need for strategic partnerships to develop and implement solutions.

Solution

Together MGH with ONA’s support started a workplace violence prevention committee that would include:

• Staff, management and organized labour
• PSHSA
• Local police engagement
• JHSC
• Joint advocacy at the systems level
• And a shared vision for ZERO tolerance with increased incident reporting

Stakeholder and staff engagement meant that it would feel personal, would demonstrate the value proposition with clear measurement and outcomes. CEO Rob Devitt felt the message should not be softened and should remain graphic to drive home the reality of the risks including injury rates and lost-time. The Stakeholders committee developed a policy and procedures, monitored statistics, conducted risk assessments, reviewed risk audit action plans, monitored incident reports, evaluated the overall program and lastly supported an ongoing culture of safety. The tenets to drive quick and effective results were established as:

• Risk assessment
• Security measures
• Communication devices
• Training and education
• Support
• Incident management
• Patient flagging
• Program Evaluation

Risk Assessment

MGH conducted a pre-risk assessment violence awareness survey along with facility and departmental risk assessments. This would set the stage for first steps and address areas of challenge in getting a solution off the ground. Action plans were then presented to the stakeholder committee along with individual safety plans and checklists for identifying and addressing domestic violence and patient/family violence.

Security Measures

Surveillance cameras increased from 29 in 2002 to 350 as this improved access control measures throughout hospital facilities. External security experts were utilized to conduct assessments and intensive training was implemented for Protection Agents (security staff).

Communication Devices

The need for constant contact with staff and security was identified so over 400 staff members were equipped with communicators that would provide instant two-way communication. This also included communication with all on site Protection Agents. Code White response times reduced by over 50% as a result.

Training and Education

An online ilearn module was produced to provide comprehensive explanations and information around all policies. The committee also ran a practical workshop teaching de-escalation strategies and physical safety techniques. This took on a train-the-trainer model and also included training around patient flagging. Accompanying these efforts were emotional intelligence training to facilitate early recognition of personal triggers.

Support

With new psychological standards in place the committee then implemented on site crisis counsellors, advocated for executive team support, union support and ensured follow up by OHS and the JHSC. Also in place was an organizational psychologist who reviewed any accommodation required to address identified issues.

Incident Management

Electronic reporting implementation meant that staff had the ability to flag violent persons and track incidents. This also provided the ability to identify areas within the facility whose needs were changing and would require further risk assessment. This type of multi-departmental team approach allowed for immediate access to information and a team approach to incident response.

Patient Flagging

Nursing staff uses the tactic of placing a blue hospital armband on the patient and enable a flag in the patient’s electronic chart communicating the acting out behaviours’ exhibited by the patient. As well nursing staff affix a blue Stop Sign to the patient’s door and over his/her bed as a visual cue so that all staff interacting with this patient will inquire about the patient care plan which is tailored to their needs.

Results

Program Evaluation
Results to date indicate that since 2001 – 2014 security use of force incidents has decreased from 113 to 65. Effective actions taken if staff is abused/bullied by patients/public has increased from 69% to 73% in the same timeframe. Effectively addressing verbal abuse incidents from patients/clients/public has increased from 61% to 69%. One can see the results of overall program commitment and efforts to build further capacity will drive further efficiency.

Conclusion

In conclusion partnerships of this nature will enable the same success in other organizations. Key enablers have made it possible through partnerships with Labour and expert organizations, the support of senior leadership through engagement and education as well as integrating efforts with Joint Health and Safety Committees. Using quantitative measurements to frame issues from a value proposition will also ensure policy applies to everyone. Show and tell will further build and enhance a culture of continuous improvement and “just” culture. Action planning and monitoring with rigorous post incident debriefing is also paramount and ultimately violence prevention becomes a patient safety initiative. The call to action is now and this case study demonstrates how Michael Garron Hospital and the Ontario Nurses Association have collaborated for the standardization of all safety measures and are helping to drive accountability at the CEO level. Unions and employers must work together to set minimum standards for training all staff involved. Ultimately improving health and safety for those who work in hospitals is critical to ensure we have the staff to provide quality care—and makes good business sense.