WORKPLACE VIOLENCE IN THE HEALTH CARE INDUSTRY CALIFORNIA ADOPTS SENATE BILL Workplace Violence In Healthcare: How to stop the madness...

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1 Workplace Violence In Healthcare: How to stop the madness... WORKPLACE VIOLENCE IN THE HEALTH CARE INDUSTRY CALIFORNIA ADOPTS SENATE BILL 1299 ELEMENTS OF A ROBUST WORKPLACE VIOLENCE PREVENTION PROGRAM 1000 Holcomb Woods Parkway Suite 130 Roswell, GA Fax:

2 1 WORKPLACE VIOLENCE IN THE HEALTH CARE INDUSTRY? CALIFORNIA ADOPTS SENATE BILL 1299 It seems more frequently we are seeing instances of workplace violence in the news, especially those that involve an active shooter that are sensationalized in the headlines. The media and Internet coverage of recent events have amplified the fear level and the expectation that the workplace can respond appropriately to keep employees safe. As the news reporters descend, people seem to emerge from the woodwork with anecdotal observations of clues that seem to show hindsight is 20/20. Could these instances of violence be mitigated or addressed before they result in violence? CALIFORNIA SENATE BILL 1299 The new law provides more comprehensive work place violence plan requirements for health care facilities with an emphasis on reporting, education/awareness, and systems for investigating incidents with coverage beyond just emergency rooms and other high risk areas. These elements are focused on prevention and identifying areas for improvement. People do not just snap. There are warning signs, red flags, cues, signals but often they are not considered to be of a serious nature, so they are not reported. Whether violence or cyber-bullying, warning signs and indicators exist. Missing recognition of behaviors of concern or failing to listen to what is being said empowers escalation to violence. Preventing a gun from entering the workplace and thwarting an act of violence before one occurs is a critical intelligence planning responsibility for every company. The earlier a problem is detected, the less impact it will have. The Critical Incident Response Group of the FBI categorizes workplace violence into four main areas, specifically: Type 1 Violent acts by criminals perpetrators with no apparent connection to the workplace whose intent is to commit robbery or some other crime. Type 2 Violence directed at employees by customers those include clients, patients, students, inmates or any others for whom an organization provides services. Type 3 Violence from current or former employees directed at a coworker, supervisor or manager. Type 4 Violence from a non-employee that has a personal relationship with an employee. Health care workers are especially at risk for Type 2 events, nurses in particular. Healthcare workers and social workers, according to the Bureau of Labor Statistics, are five times more likely to be a victim of workplace violence assaults than any of the other major industries combined. Of those acts, almost 75 percent are from a patient of the facility. The violence has moved beyond the Emergency Room and Psychiatric Units to all areas of the health care facility. The earlier a problem is detected, the less impact it will have on your organization.

3 2 In October of 2014, California Senator Alex Padilla introduced SB 1299 that was sponsored by California Nurses Association/National Nurses United and was signed into law by Governor Jerry Brown. Currently, final standards are being developed and due out October Previously, safety training was only required for emergency department staff, while violence prevention programs were only required for emergency departments and other high-risk areas. The new law provides more comprehensive requirements with an emphasis on reporting, education/awareness and systems for investigating incidents with coverage beyond just emergency rooms and other high risk areas. These elements are focused on prevention and identifying areas for improvement. The aim of every health care facility should be to create a culture where safety from violence is a common goal of both employees and leadership. To achieve such a culture, warning signs must be recognized and understood; everyone must know how to report behaviors of concern; there must be procedures in place to investigate when there are concerns; and trained employees must know when to conduct a behavioral risk assessment and possess the necessary resources. These are key elements that CA SB 1299 seeks to put in place. ELEMENTS OF A ROBUST WORKPLACE VIOLENCE PREVENTION PROGRAM For an overall program to be effective and act as a solution, the following components need to work together as an integrated and comprehensive solution: Awareness - First and foremost, creating overall awareness within the organization is essential. Training employees and supervisors to recognize behaviors of concern will assist in identifying issues and key indicators before they become an issue that manifests itself in a violent act. Equally important will be to not only identify behaviors that result in violent or aggressive behavior, but to identify those behaviors that are indicators of emotional and suicidal issues. CA SB1299 specifically calls for education and training policies to recognize potential for violence. Intelligence Network Through awareness, it is important for staff members to recognize behaviors of concern and also feel there is a culture of see something, say something. Establishing an Intelligence Network will provide a source for identifying and documenting behaviors of concern. The intelligence network can be developed from many sources, including internal incident reports, anonymous reporting, social media monitoring and other key indicator data (absenteeism, work performance), etc. Standard internal reporting forms can be used by an employee or their supervisor to report an incident where anonymity is not required. These help provide a standard methodology for obtaining information and a checklist to ensure all critical information is captured. Standard internal reporting forms can include incident reporting forms to document what occurred, as well as interview forms for the victim and those that may have witnessed the incident. Standard forms assist in making sure all aspects are addressed and no detail is overlooked. Anonymous reporting capabilities can be an essential method to obtain information from individuals who would otherwise not want to be involved, but feel the need to report information. Without anonymous reporting capabilities, vital intelligence will not be seen or reported, limiting the ability to identify behaviors of concern or trends. One of the provisions in CA SB 1299 specifically addresses prohibiting hospitals from disallowing an employee from, or taking punitive or retaliatory action against and employee for seeking outside assistance

4 3 from law enforcement. An anonymous reporting system would reduce any reluctance that an employee has to report an issue that this language is trying to address. Another source of important information is Monitoring Actionable Intelligence on social media. Statistics support that more than three-quarters of perpetrators of school shootings tell at least one person before committing the act usually a friend, schoolmate or sibling. In nearly two-thirds, more than one person knew of the intentions. While the use of social media is more prevalent with students, similar social media postings have been identified in corporate environments a perpetrator shared their intentions. Social media is a prevalent communication tool in today s society. People who are aware of premeditated acts represent a force that can change the outcome of events. Repository of Information A critical weakness in many programs is the inability to assess multiple reports to identify patterns of behaviors of concern or see early indicators of future events. Reports are often handled singularly and a determination made based on a single incident. Reporting systems may also be disparate information reported into a security system resides in a different data base than those input to HR systems, making it difficult to view in overall incidents in their entirety. No one is specifically tasked with looking at overall information and identifying overall behaviors of concern. Perhaps one of the most critical elements of a robust workplace violence program is a central repository where all incidents can be viewed and categorized. Incidents reviewed singularly may not be an indicator of the bigger picture. A person witnessing an incident might think someone is having a bad day. However, a series of events as observed by different people may paint a picture of a larger issue and of possible repercussions to come. A security guard observing something may be seen as a non-issue, an incident seen by a coworker may not be taken seriously and an outburst in front of a supervisor may be overlooked. However, when viewed as a whole and by the correct team of people with the proper training, the real picture can start to emerge. While the key driver for a Repository of Information is the ability to view and analyze incidents to identify behaviors of concern, CA SB 1299 specifically calls for annual reporting accessible to everyone. Much like the Cleary Act of colleges and universities, this reporting helps with overall site awareness for employees. Additionally, reporting can identify trends by site, as well as collectively for an industry. This will allow for focus on key areas and the ability to implement continuous improvement. Investigation and Threat Assessment Left to an individual supervisor and without the proper training of assessing threats, a situation may not be handled correctly or recognized in terms of severity. By having a Threat Assessment Team (TAT) in place, with specific areas of expertise, a proper threat assessment can be made and resulting actions can be taken based on team decisions and the full spectrum of considerations. Additionally, by possessing a consistent methodology, misdiagnosis based on lack of expertise and preconceived notions as to a specific threat ( oh, that type of guy would never do that ) can be avoided.

5 4 CASE MANAGEMENT ACTION PLAN AND MONITORING The Threat Assessment Team should be responsible for gathering the necessary information to develop and implement interventions that will address behaviors of concern. Strategies selected will have the highest potential for long-term prevention. In cases where the subject is an employee, plans should be regularly reviewed until the subject s Behavioral Risk Level is deemed to no longer pose danger to self or others. In situations where the behavior or incident was from a patient or an individual not associated with the facility, the focus of the plan should focus on methods to eliminate or mitigate similar risks and incidents in the future by a root cause analysis. The monitoring then takes on the task of determining if solutions were effective against future similar incidents, or if further improvements need to be made. OTHER KEY PROGRAM ELEMENTS While the above prevention program is a consistent system and methodology to identify behaviors of concern before they become an incident, additional important elements exist to include assisting in mitigating and responding to events. HR Policy & Procedures In the HR area, there are several key elements. First, policy must explicitly state what specific behaviors and actions are not acceptable or tolerated. Secondly, policies, as well as the overall workplace violence program, must be an aspect of new employee orientation as well as for temporary employees and contractors. This is also a specific requirement of CA SB Lastly, it is important to have robust screening and background checks in the hiring process and also performed at some frequency over the employee s tenure with the company. Site Security Assessment - A thorough review of the site s physical security and procedures is an important aspect to control access of non-approved individuals on site and to monitor employee s safety entering and exiting the facility. In reviewing the physical security and policies, it is also very important to verify against the reality of what occurs. People may tailgate through badge protected entrances or doors (that are to remain locked) get propped open for various reasons. Emergency Response Plan - The best and robust program cannot eliminate all possibilities for workplace violence. Employees and emergency response teams must know how to respond to various events. Plans need to be specific to a threat. For example, evacuation protocols for a fire or earthquake are very different than for an active shooter. An active shooter requires either flee, lockdown or lockout, where a standard evacuation could create a target-rich environment. As with any emergency response plan, training and drills are essential in orienting staff on how to act during a crisis and to identify areas of improvement from post-event, after-action reviews.

6 5 SUMMARY DISCUSSION Workplace violence in the health care industry is a serious issue. The legislation that the California Senate Bill 1299 sets forth is an effort to focus on prevention through effective training, awareness and systems at a broader level than has been done in the past. No longer are fragmented approaches implemented that are limited to just the higher-risk areas such as emergency rooms or psychiatric areas the issues moved beyond those select areas. A total comprehensive, consistent and holistic solution is needed. When implementing programs to comply with the standards arising from the senate bill, it will be important not to just check off the individual elements that the requirements call for, but to look at an overall program. Programs will ensure all elements are aligned and can address the intent of what the senate bill addresses in a fully integrated approach. Jeff Hamilton President & COO, Nexis Preparedness Systems / Firestorm Jeff has more than thirty-three years of experience in technical management and executive level positions in a variety of industries. For the past 6 years he served as Chief Operating Officer and Vice-President of Nexis Preparedness Systems (NPS) and is now President of the company. He is one of the key architects of NPS s unique effective response & recovery approach. In the course of working with customers, first responders, and industry professionals Jeff has developed several tools and integrated approaches to supply cache design and response that have become best practices; providing companies with effective solutions to meet their emergency response objectives. As a principal with Firestorm, Jeff will be able to align these solutions to Firestorm PREDICT.PLAN.PERFORM. methodology.

7 6 About Firestorm Firestorm is America s Crisis Coach. Since 2005, Firestorm has assisted clients in transforming crisis into value. The Firestorm PREDICT.PLAN.PERFORM. methodology combines best-practice consulting with proven crisis management expertise, empowering clients to manage risk and crisis. Firestorm assesses, audits, develops, trains and tests strategies and programs encompassing emergency response, business continuity, crisis management, and crisis communications/pr. Firestorm demonstrates thought leadership in workplace violence prevention, cyber-breach response, communicable illness/pandemic planning, predictive intelligence, and every preparedness initiative. Firestorm has worked with schools and businesses to keep tens of thousands of students and employees safer. Firestorm provided crisis management and crisis communications services to Virginia Tech after the shootings, and more recently to Littleton, CO, Roswell, NM and Jefferson County School District in Colorado (location of Columbine) among others. We are the Crisis Coach. Our experience and programs can provide fully integrated solutions to address the requirements called out in California Senate Bill 1299.