PSHSA Violence, Aggression & Responsive Behaviour (VARB) Project
calendar icon March 16th, 2017
PSHSA Violence, Aggression & Responsive Behaviour (VARB) Project

PSHSA is leading a multi-stakeholder collaboration to address the pervasive and impactful issue of workplace violence in healthcare. The initiative engages partners from various levels and subsectors of the healthcare industry. The goal of the project is to deliver a model and toolkit that provides workplaces with a consistent, scalable, and consensus-based approach for achieving sustainable outcomes and thereby reducing incidents and the impact of aggression, violence, and responsive behaviours.


The Project


This is a 3-phase project.


Phase 1 of the project, Discovery, has been completed. This phase included a literature review, jurisdictional scan of 5 provincial jurisdictions, and focus groups at 5 organizations with frontline staff, managers/supervisors and senior management.


Phase 2Design/Development, has been completed. This phase included determination of a priority list of workplace violence program components; implementation of a communications plan, and; a pilot test of the toolkits. After several iterations, the project steering committee decided on five priority areas that focus on hazard identification, risk assessment and controls and solutions. The five priority areas are:


1. Workplace Violence Risk Assessment

2. Individual Client Risk Assessment

3. Risk Communication/Flagging

4. Security

5. Personal Safety Response System.


Phase 3 – Delivery, involved toolkit pilot implementation; research and evaluation; knowledge mobilization, and; development and implementation of an education session. Researchers from the Institute for Work & Health lead the research and evaluation component at 7 sites across Ontario: 4 acute care sites, 2 long-term care sites, and 1 community care site. The toolkits are being revised and designed based on the feedback received in Phase 3 and will be available FREE to all Ontario Healthcare Workplaces.


Toolkit Descriptions


Workplace Violence Risk Assessment


The Occupational Health and Safety Act (OHSA) states that employers must assess and control risks of workplace violence. This needs to be done as often as necessary to ensure that organizational policies and programs continue to protect workers.


For these reasons, a Workplace Violence Risk Assessment (WPVRA) should be completed at least annually, though each organization should have its own processes for determining how often to complete an assessment, and when to evaluate the effectiveness of the process. Generally speaking, revisions are needed when there is a change in the nature of the workplace, type of work, or conditions of work. Changes could include:


  • layout or design
  • increased or decreased staffing levels
  • increased resident acuity
  • increased resident population


The toolkit includes:


  • Overview on the Four Steps of Workplace Violence Risk Assessment
  • Risk Assessment scale and matrix
  • An overview of 3 Enabling and Reinforcing Factors: JHSC Functioning, Safety Culture and Psychological Health and Safety
  • Hazards, Controls and Solutions for Acute Care and long Term Care Facilities in # categories:
    • Hazard Category 1 – Physical environment risk assessment (completed for the organization as a whole including common areas)
    • Hazard Category 2 – Department / unit-specific work settings / practices (completed for each unit/department)
    • Hazard Category 3 – Direct care of potentially aggressive / responsive residents (completed in units/departments where client care is provided)


Access the Workplace Violence Risk Assessment tools here.


Individual Client Risk Assessment


The Violence Assessment Tool provides a snapshot of a client’s immediate risk of violence by identifying behaviours associated with increased risk. With this insight, healthcare teams can efficiently assess the risk, apply control interventions if needed, and improve worker safety while helping to increase quality of care.


Following extensive stakeholder consultation, the VAT was adapted from the BrØset Violence Checklist and the Dynamic Appraisal of Situational Aggression instrument for use in multiple care settings.


The VAT contains two sections:


1. Behaviours observed and history of violence and a Risk Rating Scale to determine whether the client’s risk level is low, moderate, high or imminently high

2. Action items/Interventions


The VAT is for use in acute care, long-term care, community care, and emergency services (EMS).


The VAT should be completed at first contact with the client, and according to your organization’s policies and procedures — e.g. in acute care this might be once every shift; in long-term care, it might be between prescribed Ministry documentation such as RAI-MDS or RAI-HC. Depending on the client’s individual circumstances, further assessment may be required.


Access the Individual Client Risk Assessment tools here.




Legislative changes in Ontario surrounding workplace violence have created new responsibilities and obligations for employers, and have given new rights to workers to refuse unsafe work. The changes have also broadened our awareness of the issue. Most importantly, they have strengthened our understanding that workplace violence is not acceptable. Under the Occupational Health and Safety Act (1990), employers and supervisors are required by law to take every precaution reasonable in the circumstances for the protection of a worker, including disclosure of information about a violent or potentially violent patient, to keep employees safe.


Employers, supervisors, staff — they all have a role to play in eliminating violence at work. Employers however have ultimate responsibility. They must also provide all workers at risk with information (including personal information) about a person with a history of violence. Workplaces, in turn, must adopt effective prevention strategies. One such strategy is a flagging-alert program to communicate violence-related risks to healthcare teams. By taking this kind of proactive approach to managing violent, aggressive and responsive behaviours, we can reduce the risk of harm to workers while providing patients with the best possible care.


This FLAGGING handbook provides practical tools and information that will help organizations develop a sustainable flagging-alert program.


The handbook includes:


A Flagging overview on the purpose, benefits and types of flagging, and related legal and ethical responsibilities The five key steps to developing a Flagging Program Two appendices:


  • Appendix A — Workplace Violence and Health Information Privacy Fast Fact
  • Appendix B — Sample Flagging Policy


The Communicating the Risk of Violence: A Flagging Program Handbook can be accessed here.




This toolkit is designed to help community and healthcare organizations, with or without designated security personnel, establish an effective security program. It aims to increase awareness and understanding of security program functions, program elements, and training requirements, many of which are based on best practices and industry-accepted standards. The toolkit provides sample tools to identify security program gaps and to develop a comprehensive and customized action plan.


The toolkit includes eight (8) tools that can help you develop and implement an effective security program. These tools can be found in the following appendices:


  • Security Program Self-assessment Checklist with Gap Analysis and Action Plan — Appendix 1
  • Sample Corporate Security Policy Template — Appendix 2
  • Sample List of Security-Related Policies and Procedures — Appendix 3
  • Workplace Security Fast Fact Awareness Tool — Appendix 4
  • Sample Security Topics for Workers and Managers — Appendix 5
  • Sample Security Guard Training Duration & Provider Considerations — Appendix 6
  • Sample Security Guard Training Program Components — Appendix 7
  • Sample Security Guard Training Checklist for Healthcare Institutions — Appendix 8


Each appendix includes instructions on “how to use this tool”.


(The toolkit is not intended to address the security of digital or personal health information or make recommendations regarding staffing levels.)


The Security Toolkit can be accessed here.


Personal Safety Response System


The Public Services Health and Safety Association`s Personal Safety Response System (PSRS) toolkit is designed to help community and healthcare organizations establish an effective PSRS that can effectively summon immediate assistance for impending workplace violence situations or an incident in progress. It aims to describe the PSRS; explain how the PSRS is a component of existing programs, processes and frameworks within an organization; and the need to consider PSRS as a system and not merely devices. The tool kit provides practical information regarding legislative requirements; key PSRS definitions; PSRS devices, procedures, training and implementation considerations.


The toolkit contains resources that will assist organizations to:


  • Check legislative compliance
  • Assess PSRS gaps and develop an action plan for implementation using Plan-Do-Check-Act
  • Assess and determine PSRS device needs
  • Evaluate selected PSRS devices
  • Develop and implement PSRS policy, procedures and training
  • Create awareness


The Personal Safety Response System Toolkit can be accessed here.




A Project Steering Committee of 22 members representing key stakeholders from the Ministry of Health and Long-Term Care, Ministry of Labour, labour unions, organizations and associations was established with clearly articulated Terms of Reference. The stakeholders represent the following:


  • Addictions & Mental Health Ontario
  • AdvantAge Ontario
  • Canadian Union of Public Employees
  • Home Care Ontario
  • Institute for Work and Health
  • London Police Service
  • Ministry of Health and Long-term Care
  • Ministry of Labour
  • Ontario Association of Community Care Access Centres
  • Ontario Association of Paramedics
  • Ontario Hospital Association
  • Ontario Long-Term Care Association
  • Ontario Nurses Association
  • Ontario Personal Support Workers Association
  • Ontario Public Service Employees Union
  • Personal Support Network of Ontario
  • Registered Nurses’ Association of Ontario
  • Registered Practical Nurses’ Association of Ontario
  • Service Employees International Union
  • Unifor


Working Groups are comprised of 8 to 15 members, representing over 45 organizations, associations, ministries and unions.


For more information about Workplace Violence in Healthcare, contact: Henrietta Van hulle, Vice President, Client Outreach or Tina Dunlop, Project Coordinator 519-890-9012


Visit to access the PSHSA workplace violence prevention tools. You will also find a 5 step approach to building your workplace violence program.