Workplace Violence Prevention Program Research Articles

Workplace violence prevention standardization using lean principles across a healthcare network

PurposeThe purpose of this paper is to describe the process used to standardize a Workplace Violence Prevention Program (WVPP) within a five-hospital healthcare system in Veterans Health Administration (VHA).Design/methodology/approachA description of the lean process improvement principles, used to bring the WVPP into compliance with Occupational Safety and Health Administration (OSHA) and other agencies through streamlining/standardizing processes.FindingsThere was significant standardization in both the threat assessment and education arms of the WVPP. Compliance with all major US Department of Labor OSHA requirements, as well as substantial time savings, were realized as part of this process improvement.Originality/valueVHA is leading the way in inter/multidisciplinary assessment and mitigation of workplace violence, however, there are significant competing demands on staff time. This first ever use of lean principles to streamline processes around workplace violence prevention freed up clinician time for care while improving internal and external customer satisfaction, representing a major step forward in workplace violence risk mitigation.

Educational and managerial policy making to reduce workplace violence against nurses: An action research study

Background:The level of occupational violence against nurses increases from 68.8 to 98.6 percent, which is a considerable rate among healthcare settings. To create a safe environment for patient care in the emergency department (ED), a comprehensive program for the prevention of violence is necessary. The aim of this study was to plan a workplace violence prevention program (WVPP) to reduce the level of patients' and their families' violence against nurses.Materials and Methods:The present study is a quantitative part of a participatory action research project conducted in an 18-month period from October 2012 to May 2014 in an ED of Iran. In the diagnosing phase, we used quantitative and qualitative approaches. The second and third phases were assigned to design and implementation of WVPP involving a combination of educational and managerial interventions. In the evaluation phase, frequencies of patients' and their families' violence against nurses and nurses' fear of violence were measured.Results:Mc-Nemar test showed that 85.70% (n = 42) frequencies of verbal violence before implementing WVPP significantly decreased to 57.10% (n = 28) after implementing WVPP (p = 0.007). Statistical-dependent t-test (p < 0.001) indicated a significant difference in the mean (SD) scores of nurses' fear of violence before 46.10 (8.3) and after intervention 34.30 (4.6).Conclusions:Applying educational and managerial interventions was effective in reduction of workplace violence. Thus, it is recommended to include a combined approach in designing WVPP in cultures similar to Iran and pay attention to effective interactions with patients' family.

Preventing and managing workplace violence against healthcare workers in Emergency Departments.

Background and aim: Healthcare workers (HCWs) employed in Emergency Departments (EDs) frequently face with patients becoming violent because of long wait or diseases or under the influence of alcohol or drugs. Globally, workplace violence (WPV) in EDs is a major challenge to safety for HCWs, involving significant consequences to the victims, patients, and healthcare organizations. We reviewed the current literature with the aim to explore the topics focused on and to detect new evidences about approaching the issue of WPV toward HCWs in EDs. Methods: A search for articles regarding WPV toward HCWs employed in EDs and published from January 2007 through December 2017 was performed; using predetermined criteria for inclusion, selected articles were reviewed and qualitatively assessed for the aims of the review. Results: We found 60 papers which matched our inclusion criteria; the topics, discussed in order of frequency from highest to lowest, were: “Risk Assessment”, “Occurrence Rates”, “Risk Management”, and “Physical/non Physical Consequences”. Dementia, schizophrenia, anxiety, acute stress reaction, suicidal ideation, and alcohol and drug intoxication were found as predictors of physical violence perpetrated by patients against HCWs. Conclusion: A strategic way to the effective management of WPV should prioritize training courses focused on: constructing HCW-patient relationship, improving the workers’ communication skills, accurate reporting of each violent incident, and improving the labor context through management commitment and employee involvement in WPV prevention programs. A special effort is required in implementing workplace design effective in minimizing stressful conditions in waiting rooms which turned out to be the most frequent site of assaults.

Promoting Workplace Safety: Teaching Conflict Management and De-Escalation Skills in Graduate Medical Education.

Promoting Workplace Safety: Teaching Conflict Management and De-Escalation Skills in Graduate Medical Education.

Erratum to "Computer-based training (CBT) intervention reduces workplace violence and harassment for homecare workers".

Background The study examines the effectiveness of a workplace violence and harassment prevention and response program with female homecare workers in a consumer driven model of care. Methods Homecare workers were randomized to either; computer based training (CBT only) or computer-based training with homecare worker peer facilitation (CBT + peer). Participants completed measures on confidence, incidents of violence, and harassment, health and work outcomes at baseline, 3, 6 months post-baseline. Results Homecare workers reported improved confidence to prevent and respond to workplace violence and harassment and a reduction in incidents of workplace violence and harassment in both groups at 6-month follow-up. A decrease in negative health and work outcomes associated with violence and harassment were not reported in the groups. Conclusion CBT alone or with trained peer facilitation with homecare workers can increase confidence and reduce incidents of workplace violence and harassment in a consumer-driven model of care.

Computer-based training (CBT) intervention reduces workplace violence and harassment for homecare workers.

The study examines the effectiveness of a workplace violence and harassment prevention and response program with female homecare workers in a consumer driven model of care. Homecare workers were randomized to either; computer based training (CBT only) or computer-based training with homecare worker peer facilitation (CBT + peer). Participants completed measures on confidence, incidents of violence, and harassment, health and work outcomes at baseline, 3, 6 months post-baseline. Homecare workers reported improved confidence to prevent and respond to workplace violence and harassment and a reduction in incidents of workplace violence and harassment in both groups at 6-month follow-up. A decrease in negative health and work outcomes associated with violence and harassment were not reported in the groups. CBT alone or with trained peer facilitation with homecare workers can increase confidence and reduce incidents of workplace violence and harassment in a consumer-driven model of care.

Broken windows effect

Many experts consider that reporting is essential for developing a successful workplace violence prevention program (1,2). Health care workers can learn from the reported violent episodes both to perform early intervention and to protect themselves. However, we doubt that whether the public and patients will be affected by the workplace violence reporting. It is well known that the main channel for people to obtain this information is the media. If the media reported the violent events partially or non-objectively, the potential perpetrators would receive a false signal to imitate the behavior reported in the past. Workplace violence could spread like an infection, which is so-called broken windows effect.

Evaluation of an Education and Training Program to Prevent and Manage Patients' Violence in a Mental Health Setting: A Pretest-Posttest Intervention Study.

Workplace violence can lead to serious consequences for victims, organizations, and society. Most workplace violence prevention programs aim to train staff to better recognize and safely manage at-risk situations. The Omega education and training program was developed in Canada in 1999, and has since been used to teach healthcare and mental health workers the skills needed to effectively intervene in situations of aggression. The present study was designed to assess the impact of Omega on employee psychological distress, confidence in coping, and perceived exposure to violence. This program was offered to 105 employees in a psychiatric hospital in Montreal, Canada. Eighty-nine of them accepted to participate. Questionnaires were completed before the training, after a short period of time (M = 109 days) and at follow-up (M = 441 days). Repeated-measures ANOVAs and Cohen’s d effect sizes were calculated. Results demonstrated statistically significant improvements in short-term and follow-up posttest scores of psychological distress, confidence in coping, and in levels of exposure to violence. This study is one of very few to demonstrate the positive impact of this training program. Further research is needed to understand how to improve the effectiveness of the program, especially among participants resistant to change.

Understanding small business engagement in workplace violence prevention programs.

Worksite wellness, safety, and violence prevention programs have low penetration among small, independent businesses. This study examined barriers and strategies influencing small business participation in workplace violence prevention programs (WVPPs). A semistructured interview guide was used in 32 telephone interviews. The study took place at the University of North Carolina Injury Prevention Research Center. Participating were a purposive sample of 32 representatives of small business-serving organizations (e.g., business membership organizations, regulatory agencies, and economic development organizations) selected for their experience with small businesses. This study was designed to inform improved dissemination of Crime Free Business (CFB), a WVPP for small, independent retail businesses. Thematic qualitative data analysis was used to identify key barriers and strategies for promoting programs and services to small businesses. Three key factors that influence small business engagement emerged from the analysis: (1) small businesses' limited time and resources, (2) low salience of workplace violence, (3) influence of informal networks and source credibility. Identified strategies include designing low-cost and convenient programs, crafting effective messages, partnering with influential organizations and individuals, and conducting outreach through informal networks. Workplace violence prevention and public health practitioners may increase small business participation in programs by reducing time and resource demands, addressing small business concerns, enlisting support from influential individuals and groups, and emphasizing business benefits of participating in the program.

How to engage small retail businesses in workplace violence prevention: Perspectives from small businesses and influential organizations.

Small retail businesses experience high robbery and violent crime rates leading to injury and death. Workplace violence prevention programs (WVPP) based on Crime Prevention Through Environmental Design reduce this risk, but low small business participation limits their effectiveness. Recent dissemination models of occupational safety and health information recommend collaborating with an intermediary organization to engage small businesses. Qualitative interviews with 70 small business operators and 32 representatives of organizations with small business influence were conducted to identify factors and recommendations for improving dissemination of a WVPP. Both study groups recommended promoting WVPPs through personal contacts but differed on other promotion methods and the type of influential groups to target. Small business operators indicated few connections to formal business networks. Dissemination of WVPPs to small businesses may require models inclusive of influential individuals (e.g., respected business owners) as intermediaries to reach small businesses with few formal connections.

Using database reports to reduce workplace violence: Perceptions of hospital stakeholders.

Documented incidents of violence provide the foundation for any workplace violence prevention program. However, no published research to date has examined stakeholders' preferences for workplace violence data reports in healthcare settings. If relevant data are not readily available and effectively summarized and presented, the likelihood is low that they will be utilized by stakeholders in targeted efforts to reduce violence. To discover and describe hospital system stakeholders' perceptions of database-generated workplace violence data reports. Eight hospital system stakeholders representing Human Resources, Security, Occupational Health Services, Quality and Safety, and Labor in a large, metropolitan hospital system. The hospital system utilizes a central database for reporting adverse workplace events, including incidents of violence. A focus group was conducted to identify stakeholders' preferences and specifications for standardized, computerized reports of workplace violence data to be generated by the central database. The discussion was audio-taped, transcribed verbatim, processed as text, and analyzed using stepwise content analysis. Five distinct themes emerged from participant responses: Concerns, Etiology, Customization, Use, and Outcomes. In general, stakeholders wanted data reports to provide ``the big picture,'' i.e., rates of occurrence; reasons for and details regarding incident occurrence; consequences for the individual employee and/or the workplace; and organizational efforts that were employed to deal with the incident. Exploring stakeholder views regarding workplace violence summary reports provided concrete information on the preferred content, format, and use of workplace violence data. Participants desired both epidemiological and incident-specific data in order to better understand and work to prevent the workplace violence occurring in their hospital system.

Barriers to Effective Implementation of Programs for the Prevention of Workplace Violence in Hospitals

Effective workplace violence (WPV) prevention programs are essential, yet challenging to implement in healthcare. The aim of this study was to identify major barriers to implementation of effective violence prevention programs. After reviewing the related literature, the authors describe their research methods and analysis and report the following seven themes as major barriers to effective implementation of workplace violence programs: a lack of action despite reporting; varying perceptions of violence; bullying; profit-driven management models; lack of management accountability; a focus on customer service; and weak social service and law enforcement approaches to mentally ill patients. The authors discuss their findings in light of previous studies and experiences and offer suggestions for decreasing WPV in healthcare settings. They conclude that although many of these challenges to effective implementation of workplace violence programs are both within the program itself and relate to broader industry and societal issues, creative innovations can address these issues and improve WPV prevention programs.

A workplace violence educational program: A repeated measures study

Violence against healthcare employees is a profound problem in the emergency department worldwide. One strategy to reduce the risk of violence is prevention focused education. The purpose of this paper was to report the learning outcomes of a workplace violence educational prevention program tailored to the needs of emergency department employees. A quasi-experimental design was used to determine the knowledge retention of program content following a hybrid (online and classroom) educational intervention. One hundred twenty emergency department employees that completed the workplace violence prevention program participated in the study. A repeated-measures analysis of variance was conducted to determine if individual test scores increased significantly between baseline, posttest, and six month posttest periods. The results indicated a significant time effect, Wilk's Λ = .390, F (2, 118) = 26.554, p < .001, η2 = .310. Follow-up polynomial contrasts indicated a significant linear effect with means increasing over time, F (1, 119) = 53.454, p < .001, η2 = .310, while individual test scores became significantly higher over time. It was concluded that the use of a hybrid modality increases the probability that significant learning outcomes and retention will be achieved.

Evaluation of a Comprehensive ED Violence Prevention Program

Health care clinicians are at high risk for workplace violence (WPV) from patients and visitors, 1 Gacki-Smith J Juarez AM Boyett L Hoymeyer C Robinson L MacLean SL Violence against nurses working in US emergency departments. J Nurs Adm. 2009; 39: 340-349 Crossref PubMed Scopus (237) Google Scholar , 2 Gates DM Ross CS McQueen L Violence against emergency department workers. J Emerg Med. 2006; 31: 331-337 Abstract Full Text Full Text PDF PubMed Scopus (189) Google Scholar , 3 Kowalenko T Walters BL Khare RK Compton S Workplace violence: a survey of emergency physicians in the state of Michigan. Ann Emerg Med. 2005; 46: 142-147 Abstract Full Text Full Text PDF PubMed Scopus (202) Google Scholar with 25.5% reporting at least 1 recent incident of victimization. 4 Jenkins EL Fisher BS Hartley D Safe and secure at work? Findings from the 2002 Workplace Risk Supplement. Work. 2012; 42: 57-66 PubMed Google Scholar Researchers found that WPV has negative effects on providers’ stress, ability to provide safe and competent care, job satisfaction, and turnover. 2 Gates DM Ross CS McQueen L Violence against emergency department workers. J Emerg Med. 2006; 31: 331-337 Abstract Full Text Full Text PDF PubMed Scopus (189) Google Scholar , 5 Gates DM Gillespie G Succop P Violence against nurses and its impact on stress and productivity. Nurs Econ. 2011; 29: 59-67 PubMed Google Scholar , 6 Gillespie GL Gates DM Miller M Howard PK Violence against healthcare workers in a pediatric emergency department. Adv Emerg Nurs J. 2010; 32: 68-82 Google Scholar In response, several states enacted legislation making assaults against health care workers a felony or requiring employers to implement WPV prevention programs. 7 California Division of Occupational Safety and Health Guidelines for security and safety of health care and community service workers. http://www.dir.ca.gov/DOSH/dosh_publications/hcworker.html Google Scholar , 8 HCA 50 State survey: criminal laws protecting health professionals. http://www.ena.org/IENR/Documents/State%20Survey%20-%20Criminal%20Laws%20-%20Misdemeanor%20and%20Felony.pdf Google Scholar Professional organizations voiced their concerns about the safety of health care workers. The Emergency Nurses Association's 2010 position statement Violence in the Emergency Care Setting states, “Health care organizations have a responsibility to provide a safe and secure environment for their employees and the public.” 9 Emergency Nurse Association Position statement: violence in the emergency care setting. http://www.ena.org/SiteCollectionDocuments/Position%20Statements/Violence_in_the_Emergency_Care_Setting_-_ENA_PS.pdf Google Scholar Gordon L. Gillespie, Member, Greater Cincinnati Chapter and Treasurer, Ohio Emergency Nurses Association, is Assistant Professor and Robert Wood Johnson Foundation Nurse Faculty Scholar, College of Nursing, University of Cincinnati, Cincinnati, OH. Donna M. Gates is Adjunct Professor, College of Nursing, University of Cincinnati, Cincinnati, OH. Tammy Mentzel is Project Director, College of Nursing, University of Cincinnati, Cincinnati, OH. Ahlam Al-Natour is Assistant Professor, College of Nursing, Jordan University of Science and Technology, Irbid, Jordan. Terry Kowalenko is Professor of Emergency Medicine and Medical Education, Medical School, University of Michigan, Ann Arbor, MI.

Workplace Violence Prevention Policies in Home Health and Hospice Care Agencies

Workplace violence in the home health industry is a growing concern, but little is known about the content of existing workplace violence prevention programs. The authors present the methods for this study that examined workplace violence prevention programs in a sample of 40 California home health and hospice agencies. Data was collected through surveys that were completed by the branch managers of participating facilities. Programs were scored in six different areas, including general workplace violence prevention components; management commitment and employee involvement; worksite analysis; hazard prevention and control; safety and health training; and recordkeeping and program evaluation. The results and discussion sections consider these six areas and the important gaps that were found in existing programs. For example, although most agencies offered workplace violence training, not every worker performing patient care was required to receive the training. Similarly, not all programs were written or reviewed and updated regularly. Few program differences were observed between agency characteristics, but nonetheless several striking gaps were found.

A Framework for Translating Workplace Violence Intervention Research into Evidence-Based Programs

Workplace violence, a dangerous and complex occupational hazard in the modern health care work environment, presents challenges for nurses, other health care employees, management, labor unions, and regulators. Violence from patients, visitors, and coworkers is often tolerated and explained as part of the job in the fast-paced, stressful health care delivery workplace. Addressing violence in health care requires very purposeful organizational processes conducted by very specific organizational structures. The strength of the scientific evidence for workplace violence prevention strategies is well past the “emerging” evidence stage but has not achieved the “unequivocal” stage. It is unlikely that workplace violence interventions will be tested using randomized controlled experimental conditions. Consequently, educated and aware nurses often provide key leadership for organizations undertaking the development of workplace violence prevention programs, but must do so using local evidence generated at the facility level. In some cases, tools such as state regulations and federal workplace safety policies provide important impetus and support for nurses and hospitals undertaking these transformational programs. This article provides background information about workplace violence and offers a framework for developing comprehensive workplace violence prevention programs built on the existing scientific evidence, regulatory guidance, and locally generated practice evidence

Clinical Office Safety: Strategies to Enhance the Safety of Staff and Clients

Mental health practitioners' exposure to threats and acts of nonfatal violence are among the highest of all professions. Implementing a comprehensive workplace violence prevention program specific to the clinical setting is paramount to decreasing these risks. However, generic security recommendations at times come in conflict with the professional, legal, ethical, and budgetary constraints unique to the clinical environment. This article discusses how the various types of security surveys, policy considerations and practical training applications can be implemented with sensitivity to those challenges and still enhance the safety of staff and clients alike.

Workplace Homicides Among U.S. Women: The Role of Intimate Partner Violence

Intimate partner violence (IPV) is an important public health issue with serious consequences for the workplace. Workplace homicides occurring to U.S. women over a 6-year period, including those perpetrated by an intimate partner, are described. Workplace homicides among U.S. women from 2003 to 2008 were categorized into type I (criminal intent), type II (customer/client), type III (co-worker), or type IV (personal relations) events using the Census of Fatal Occupational Injuries. Fatality rates were calculated and compared among workplace violence (WPV) types, occupations, and characteristics including location of homicide, type of workplace, time of day, and weapon used. Between 2003 and 2008, 648 women were feloniously killed on the job. The leading cause of workplace homicide for U.S. women was criminal intent, such as robbing a store (n = 212; 39%), followed by homicides perpetrated by a personal relation (n = 181; 33%). The majority of these personal relations were intimate partners (n = 142; 78%). Over half of workplace homicides perpetrated by intimate partners occurred in parking lots and public buildings (n = 91; 51%). A large percentage of homicides occurring to women at work are perpetrated by intimate partners. WPV prevention programs should incorporate strategies to prevent and respond to IPV.

Drivers' and conductors' views on the causes and ways of preventing workplace violence in the road passenger transport sector in Maputo City, Mozambique

BackgroundWorkplace violence (WPV) is an occupational health hazard in both low and high income countries. To design WPV prevention programs, prior knowledge and understanding of conditions in the targeted population are essential. This study explores and describes the views of drivers and conductors on the causes of WPV and ways of preventing it in the road passenger transport sector in Maputo City, Mozambique.MethodsThe design was qualitative. Participants were purposefully selected from among transport workers identified as victims of WPV in an earlier quantitative study, and with six or more years of experience in the transport sector. Data were collected in semi-structured interviews. Seven open questions covered individual views on causes of WPV and its prevention, based on the interviewees' experiences of violence while on duty. Thirty-two transport professionals were interviewed. The data were analyzed by means of qualitative content analysis.ResultsThe triggers and causes of violence included fare evasion, disputes over revenue owing to owners, alcohol abuse, overcrowded vehicles, and unfair competition for passengers. Failures to meet passenger expectations, e.g. by-passing parts of a bus route or missing stops, were also important. There was disrespect on the part of transport workers, e.g. being rude to passengers and jumping of queues at taxi ranks, and there were also robberies. Proposals for prevention included: training for workers on conflict resolution, and for employers on passenger-transport administration; and, promoting learning among passengers and workers on how to behave when traveling collectively. Regarding control and supervision, there were expressed needs for the recording of mileage, and for the sanctioning of workers who transgress queuing rules at taxi ranks. The police or supervisors should prevent drunken passengers from getting into vehicles, and drivers should refuse to go to dangerous, secluded neighborhoods. Finally, there is a need for an institution to judge alleged cases of employees not handing over demanded revenues to their employer.ConclusionsThe causes of WPV lie in problems regarding money, behavior, environment, organization and crime. Suggestions for prevention include education, control to avoid critical situations, and a judicial system to assess malpractices. Further research in the road passenger transport sector in Maputo City, Mozambique and similar settings is warranted.

Assault Rates and Implementation of a Workplace Violence Prevention Program in the Veterans Health Care Administration

This study examined the relationship between changes in assault rates over time and the implementation of a workplace violence prevention (WVP) program in 138 Department of Veterans Affairs health care facilities. Data on WVP implementation were assessed for each facility by a three-person team. We computed three WVP dimension scores: training, workplace practices, and environmental control and security. We obtained 6 years of assault rate data from the national injury system. Using a linear mixed model, we analyzed whether the WVP implementation was associated with lower assault rates controlling for time and organizational characteristics. Training implementation was negatively associated with assault rates. Facilities with smaller bed sizes and without academic affiliates had lower assault rates. Particular attention should be given to these dimensions because they may be associated with lower facility-level assault rates.