De-escalation: Mitigating Violence in Healthcare

This member only article appears in the January issue of Patient Safety Monitor Journal.

The International Association for Healthcare Security & Safety Foundation (IAHSS) in August 2017 released a report to address strategies to prevent workplace violence in healthcare. Those familiar with the healthcare industry won’t be surprised by its conclusion: Healthcare facilities need to take steps now to mitigate violent incidents.
“Violence in the workplace continues to be a major problem in medical facilities, despite a decline in overall assault rates nationally in recent years,” the report’s authors wrote. “Why are people in these environments so vulnerable? And what can hospitals, emergency care units and mental health facilities do to better protect staff, patients and visitors?”
The IAHSS touts itself as the only organization solely dedicated to professionals involved in managing and directing healthcare security and safety programs. Its membership includes more than 2,000 healthcare security, law enforcement, safety, and emergency management leaders. The report, titled Mitigating the Risk of Workplace Violence in Health Care Settings, breaks down stressors and risk factors that can trigger disruptive and sometimes violent behavior.

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Ironically, despite the latest warning, IAHSS released a study in 2016 that found violent crime in hospitals had dropped by 68% between 2012 and 2015. Still, the report found that assaults in general were on the rise in U.S. hospitals.
Available data suggest that healthcare and social assistance workers are far more likely to be injured in an incident of workplace violence than their counterparts in other sectors. In 2014, there were 8.2 injuries related to workplace violence per 10,000 full-time healthcare and social assistance workers—that’s more than quadruple the rate experienced by the private sector overall (which saw 1.7 injuries per 10,000 workers), according to an OSHA analysis of data from the U.S. Bureau of Labor Statistics. Violence rates were highest in psychiatric and substance abuse hospitals, where OSHA found 109.5 intentional injuries per 10,000 full-time workers.
Officials have long been aware of a need to proactively identify and mitigate threats, which is why OSHA published the first version of its Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers more than two decades ago. (The latest version, which was updated in 2015, is available online for free.) These voluntary guidelines, known in the industry collectively as OSHA 3148, include recommended policies and procedures to combat workplace violence in a variety of settings.
While OSHA (and The Joint Commission and CMS) don’t collectively have standards that lay out specific steps for preventing violence, the consensus seems to be that the healthcare industry will eventually be regulated by standards that will protect workers and patients.

Since December 2016, OSHA has been “considering whether a standard is needed to protect healthcare and social assistance employees from workplace violence” and has requested public comments on the subject. The public comment period closed on April 6, 2017.
Federal OSHA is likely to follow in the footsteps of at least nine other states with laws that require employers in the healthcare sector to implement workplace violence prevention policies. In 2014, California passed a law requiring healthcare facilities to, among other things, “adopt a workplace violence prevention plan as a part of its injury and illness prevention plan to protect health care workers and other facility personnel from aggressive and violent behavior.”
The workplace violence policy must be in place by April 1, 2018, but some of the law’s mandates became effective on April 1, 2017, including a requirement that California healthcare facilities keep a record of all violent incidents.

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