Violence Prevention Programs
OSHA Guidelines for Health Care
The Occupational Safety and Health Administration (OSHA) Guidelines for Health Care and Social Service Workers offer an excellent framework for thinking about the challenges of workplace violence prevention.
OSHA's five major elements of an effective workplace violence prevention program are:
- Management commitment and employee involvement;
- Worksite analysis;
- Hazard prevention and control;
- Safety and health training;
- Recordkeeping and program evaluation.
It is important to understand that these guidelines are intended to help organizations implement effective workplace violence prevention programs; they are not enforceable regulations. However, OSHA's regulatory authority derives from the General Duty Clause.
The goal is to eliminate or reduce worker exposure to conditions that lead to death or injury from violence by implementing effective security devices and administrative work practices, among other control measures.
Clear goals and objectives are needed to prevent workplace violence. It should be suitable for the
size and complexity of the workplace operation and adaptable to specific situations in each establishment. Employers
should communicate information about the prevention program and startup date to all employees.
At a minimum, workplace violence prevention programs should:
- Create and disseminate a clear policy of zero tolerance for workplace violence, verbal and nonverbal threats and
related actions. Ensure that managers, supervisors, coworkers, clients, patients and visitors know about this policy.
- Ensure that no employee who reports or experiences workplace violence faces reprisals.
- Encourage employees to promptly report incidents and suggest ways to reduce or eliminate risks. Require records of
incidents to assess risk and measure progress.
- Outline a comprehensive plan for maintaining security in the workplace. This includes establishing a liaison with
law enforcement representatives and others who can help identify ways to prevent and mitigate workplace violence.
- Assign responsibility and authority for the program to individuals or teams with appropriate training and skills.
Ensure that adequate resources are available for this effort and that the team or responsible individuals develop
expertise on workplace violence prevention in health care and social services.
- Affirm management commitment to a worker-supportive environment that places as much importance on employee safety
and health as on serving the patient or client.
- Set up a company briefing as part of the initial effort to address issues such as preserving safety, supporting
affected employees and facilitating recovery.
Management commitment and employee involvement are complementary and essential elements of an effective safety and
health program. To ensure an effective program, management and frontline employees must work together, perhaps through
a team or committee approach. If employers opt for this strategy, they must be careful to comply with the applicable
provisions of the National Labor
Management commitment, including the endorsement and visible involvement of top management,
provides the motivation and resources to deal effectively with workplace violence. This commitment should include:
- demonstrating organizational concern for employee emotional and physical safety and health
- exhibiting equal commitment to the safety and health of workers and patients/clients
- assigning responsibility for the various aspects of the workplace violence prevention program to ensure that
all managers, supervisors and employees understand their obligations
- allocating appropriate authority and resources to all responsible parties
- maintaining a system of accountability for involved managers, supervisors and employees
- establishing a comprehensive program of medical and psychological counseling and debriefing for employees
experiencing or witnessing assaults and other violent incidents
- supporting and implementing appropriate recommendations from safety and health committees
Through involvement and feedback, workers can provide useful information to employers to design, implement and evaluate the program. In addition, workers with different functions and at various organizational levels bring a broad range of experience and skills to program design, implementation, and assessment.
- Mental health specialists have the ability to appropriately characterize disease characteristics but may need training and input from threat assessment professionals.
- Direct care workers, in emergency departments or mental health, may bring very different perspectives to committee work.
The range of viewpoints and needs should be reflected in committee composition. This involvement should include:
- Participation in the development, implementation, evaluation, and modification of the workplace violence prevention program;
- Participation in safety and health committees that receive reports of violent incidents or security problems, making facility inspections and responding to recommendations for corrective strategies;
- Providing input on additions to or redesigns of facilities;
- Identifying the daily activities that employees believe put them most at risk for workplace violence;
- Discussions and assessments to improve policies and procedures, including complaint and suggestion programs designed to improve safety and security;
- Ensuring that there is a way to report and record incidents and near misses, and that issues are addressed appropriately;
- Ensuring that there are procedures to ensure that employees are not retaliated against for voicing concerns or reporting injuries; and
- Employee training and continuing education programs.
Associates at St. Vincent’s Medical Center wear badges with alarms that alerts the security office if they feel threatened.
St. Vincent’s Medical Center: training to minimize the risk of violence
The threat of violence is elevated at St. Vincent’s Medical Center in Bridgeport, Connecticut, because the hospital frequently treats “forensic” patients from nearby
correctional institutions. Some of these patients are known to be violent, but all such patients must be considered a threat because they may view the hospital as an escape opportunity.
St. Vincent’s director of safety and security has implemented a multi-pronged strategy to minimize risk to employees, patients, visitors, and the community.”
- St. Vincent’s has established protocols that must be followed before any forensic patient can be sent to the hospital for treatment. These protocols have been arranged with local correctional institutions
and include an exchange of information about the patient, his/her condition, medications, and precautions to be taken. Where necessary, additional security support is put in place in advance of the patient’s
- Patients enter the unit through a locked vestibule system. All patients are required to disrobe and change into hospital attire while being observed by trained staff through a one-way mirror.
- Staff identification badges in the unit feature an automatic paging alert. A staff member who feels threatened can simply tear off their card to activate the alert. The alert goes directly to the nearby
security office. The security office can also page all unit employees with situational updates or instructions on what to do if an incident occurs.
- Staff on the unit undergo extensive training, including training on managing aggressive behavior, incident de-escalation, and active shooter response. Drills are held frequently to test procedures and
evaluate training effectiveness.
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