The Life Cycle of a Code White: A Framework for Managing Workplace Violence

Abstract

A global challenge affecting health care organizations in the Covid-19 pandemic recovery era has been an increase in the incident frequency as well as qualitative severity and complexity of workplace violence (WPV) incidents. In Ontario, Canada, WPV in health care settings is often managed using an emergency response procedure known as a Code White (CW). The Toronto-based University Health Network (UHN) — a research and teaching hospital network with four centers of care and about 18,000 employees (including about 1,200 physicians and 3,900 registered nurses), a learning institute serving about 17,500 learners, and a research team with about 1,150 principal investigators — has engaged in a comprehensive quality improvement (QI) framework with the view to fully understand the complexity of CWs and effectively implement and evaluate complex interventions required to address the multidimensional problem of WPV. As part of this effort, UHN has developed the Life Cycle of a Code White (LCCW) by leveraging principles of System Engineering Initiative for Patient Safety 101, including the application of a journey map to outline the steps and involvement of specific functional units in CW incidents. This task necessitated extensive engagement with diverse stakeholders across the organization. The authors provide an example of how the LCCW initiative can be applied to enable the organization to operationalize the complexity of CW QI, catalyzing the formation of a formal CW governance structure, 12 distinct QI initiatives, and 17 quality indicators to inform data-driven change management.