2-Enos keynote WPV June 7 2019 FINAL PPT keynote final.pdf7 ØOSHA – General Duty Clause ØORS 654. 412 to 654.423 - Workplace Violence Against Health Care Employees or “Safety

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Presentedby

LyndaEnos,RN,BSN,MS,COHN-S,CPEErgonomist/HumanFactorsSpecialist,HumanFit,LLC.,[email protected]

OIOHSWorkplaceAggressionSymposium2019

Home

Scotland

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ØOSHAdefinesworkplaceviolenceasanyactorthreatofphysicalviolence,harassment,intimidation,orotherthreateningdisruptivebehaviorthatoccursattheworksite.Itrangesfromthreatsandverbalabusetophysicalassaults(e.g.hitting,kicking,biting,shoving,stabbing,sexualassaultetc.)andevenhomicide.

ØActsofworkplaceviolencecanbeperpetratedbystaff,patients,visitors,customers,vendorsorothers.

ØWorkplaceviolencealsoincludesactsofviolencebyindividualswithcognitiveimpairments,mentalillness,orbraininjury.Theperpetrator’sinabilitytoform“intent”isnotareasontonotlabelbehaviorasviolent.

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ØTypeI(CriminalIntent):Resultswhileacriminalactivity(e.g.,robbery)isbeingcommittedandtheperpetratorhasnolegitimaterelationshiptotheworkplace.

ØTypeII(Customer/client):Theperpetratorisacustomerorclientattheworkplace(e.g.,healthcarepatient)andbecomesviolentwhilebeingservedbytheworker.

ØTypeIII(Worker-on-Worker):Employeesorpastemployeesoftheworkplacearetheperpetrators.

ØTypeIV(PersonalRelationship):Theperpetratorusuallyhasapersonalrelationshipwithanemployee(e.g.,domesticviolenceintheworkplace).

(NIOSH,2013)

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ØAllUSindustriesprivateandgovernment

◦ 3131fatalitiesduetohomicide◦ Average/year:447 Range404-500/year

https://www.bls.gov/iif/oshcfoi1.htm

Ø Oregon

◦ 55fatalities- Violenceandotherinjuriesbypersons◦ Average/year:8 Range4-12/year

https://www.bls.gov/iif/oshstate.htm#OR

ØIntentionalinjurybyotherpersonØInjuriesandillnesses involvingdaysawayfromworkratesper10,000workers

◦ HealthCareandEducationServicessteadyincreasesince2011◦ Frequencybyage:20-24years◦ 70%ofassaultedrelatedinjuriesinvolvedfemales

Industry RateHealthcareandsocialassistance 9.1Educationalservices 5.0Realestateandrentalandleasing 2.4Transportationandwarehousing 1.0Administrativeandwasteservices 1.0

Source:NationalSafetyCouncilhttps://injuryfacts.nsc.org/work/safety-topics/assault/data-details/

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Healthcareandsocialassistance

196,70%Administrativeandwasteservices20,7%

Accommodationandfoodservices20,7%

Retailtrade18,7%

Otherservices6,2%

Educationalservices6,2%

Construction5,2%

Manufacturing3,1%

Agriculture,forestry,fishing

2,1%Utilities1,1%

Wholesaletrade1,0%

Arts,entertainment,recreation

1,0%

9999Industryunknown1,0%

PrivateSector– 295ADCsPublicSector– 363ADCs

Ø2017Nonfatalassaultorviolentact=3.1%ofallaccepteddisablingclaims(ADCs)inallindustries

ØHealthCare&SocialServices(70%ofallADCs)- Private◦ 46%- nursingandresidentialcare◦ 29%- privatehospitals◦ 8%- ambulatoryhealthcareservices

ØMajorityclaims- nursesaides,orderlies,attendants,nurses

ØPerpetrator- mostlypatients

ØMostcommonevent:Hitting,kicking,beating,shoving– 84%Source:https://www.oregon.gov/dcbs/reports/Pages/index.aspx


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§ Healthcare&socialassistanceworkersarenearlyfivetimesmorelikelytobeinjured&requiretimeawayfromworkasaresultofWPV(OSHA,2016)

§ HighestratesofWPVusuallyintheED&BehavioralHealth,butalsotheICUandMed-Surg

§ Someprofessionalsmoreatrisk

§ Perpetratormostlythepatient(verbal&physicalabuse)

§ ActiveShootereventsrare- Between2000and2015,241shootingswithinjuryeitherinsideahospitaloronthegrounds

§ LackofdataaboutWPVinhealthcareinnon-hospitalsettings

§ Highlevelofunderreporting


HelpUsHelpYou– ViolenceandaggressionareunacceptableRoyalMelbourneHospital,Australia

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DirectCosts(LargelyWorkersComp)

IndirectCosts(e.g.,tempandpermanentstaffreplacementcosts)

• Impactofpsychologicalstress,PTSD,burnout,presenteeism,etc.- Increasedsickleave&staff

turnover- Reducedqualityofcare/service- Decreasedefficiency- ‘Human’error&accidents 11

• Increased- Insurancecosts- Propertydamage- Litigation- Securityneeds– personnel;

equipment;modifyingfacilitydesign

- Regulatorynoncompliance

OperationalLosses/Costs

Ø DeathØ Physicalinjury&disabilityØ Psychologicalstresse.g.,PTSD

Ø Bullyingisassociatedwith:§ Poormentalhealth

o Lowself-esteem,hostility,nervousness,hypersensitivity,anxiety,irritability,depressionandsocialisolation

§ Physicalsymptomsincludelossofstrength,chronicfatigue,sleeplessness,andstrokeandevensuicide

§ Decreaseincognitiveabilitiesleadingtoimpairedclinicaljudgement

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ØOSHA– GeneralDutyClause

ØORS654.412to654.423- WorkplaceViolenceAgainstHealthCareEmployeesor“SafetyofHealthCareEmployees”(IntentionalAssault)

Ø 2019SenateBill823amendmenttoORS654.412to654.423

ØORS163.165– FelonyforintentionallyassaultingEMSworkers,highwayworkersandtaxidrivers

ØOARDivision60(OAR259-060:0005-0600)‘PrivatesecurityServicesProvidersRules’

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ØJointCommissionhasmadeWPVapriority• StandardEC.02.01.01Thehospitalmanagessafetyandsecurity

risks.ElementsofPerformanceforEC.02.01.01A• SentinelEvent(Alert59)March2018

Ø DNVGLHealthcareUSA,Inc.

Ø Dec2016- April2017FedOSHARequestforinformation

Ø Feb2019- WorkplaceViolencePreventionforHealthCareandSocialServiceWorkersActHR1309andS.851

https://www.congress.gov/bill/116th-congress/senate-bill/851

Ø NFPA3000™StandardforanActiveShooter/HostileEventResponse(ASHER)Program

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ØClinicalRiskFactorse.g.

◦ Substanceabuse&mentalillness

◦ Alzheimer’sdisease

◦ Historyofviolence/aggression

◦ Neurologicaltrauma– braininjury

◦ Reactiontomedicaltreatment


ØSocialandEconomicRiskFactorse.g.,◦ Financialstress◦ Accesstofirearmsandotherweapons◦ Communitieswithhighcrimerates/gangactivity

◦ Domesticviolence◦ Ethnicconflict

Ø"RevolvingDoor"Syndrome◦ Thereisaviciouscyclethatsometimeslinksworkplaceviolence,psychiatrictreatment,andthe"revolvingdoor":

CDC/NIOSH,2012http://www.cdc.gov/niosh/topics/healthcare/default.html


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ØEnvironmentalRiskFactorse.g.◦ Noise

◦ Crowdedwaitingareas◦ Unrestrictedmovementofthepublic◦ Poorlylitareas

◦ Availabilityoffurniture/itemsthatcanweaponized◦ Inadequatesecurity

◦ Poorworkspacedesigne.g.noeasyegressorshelterinplace


ØOrganizationalRiskFactorse.g.


◦ Jobdemandsandcontrol

◦ Transportingpatientsandclients

◦ Workingalone

◦ Workingwithcashand/ornarcotics

◦ Manualpatienthandling

◦ Longwaittimes

◦ Interpersonalcommunicationwithstaff

◦ Shiftsandhoursworked

◦ Staffingandhighworkerturnover

◦ Skillmix

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ØOrganizationalRiskFactorse.g.◦ Leadershipstyle◦ Organizationalvolatilityandhierarchy◦ Intensefocusofhealthcareorganizationsoncustomerservice

◦ Lackofo Systemsapproachtoservicesprovided(silos)andsafety

o PoliciesforpreventingandmanagingWPV

o Stafftraining


ØBarrierstoReportingWPV◦ Theseverityoftheincident◦ Whethersomeoneelsereportedtheincident◦ Theconditionofthepatient◦ Fearofretaliation◦ Perceptionofwhatis‘violence’byworkers◦ Noclearpolicy◦ Complicatedreportingprocess◦ Poormanagementresponse,stigmabycoworkers,normalizing◦ Responsebylawenforcementandthelegalsystem◦ ExpectationthatWPV/assaultis“partofjob”


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HumanFit, LLC © 2015-2018.HumanFit, LLC © 2015-2018.

ØMeaning:Thesenseofimportanceofanaction

ØJoy:Theemotionofpleasure,feelingofsuccess,andsatisfactionasaresultofmeaningfulaction

ØWorkforceSafety:Physicalandpsychologicalfreedomfromharm,neglect,anddisrespect– apreconditiontoJoyandMeaning

NationalPatientSafetyFoundation2013

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Workersshouldbeabletoanswer‘Yes’askthefollowing:

1. AmItreatedwithdignityandrespectbyeveryone,everyday,ineachencounter,withoutregardtorace,ethnicity,nationality,gender,religiousbelief,sexualorientation,title,paygrade,ornumberofdegrees?

2. DoIhavewhatIneed:education,training,tools,financialsupport,encouragement,soIcanmakeacontributiontothisorganizationthatgivesmeaningtomylife?

3. AmIrecognizedandthankedforwhatIdo?

NationalPatientSafetyFoundation2013

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1. Establishagoalofzeroharm(physicalandpsychological)foryourworkforce.

2. Createalearningsysteminwhicheverymemberofyourworkforcelearns,understands,anddemonstratesrespectandsafebehaviorswithacommitmentto100%compliance

3. Createareal-time,transparent,timelymeasurementsystemtomeasurephysicalandpsychologicalharm.

4. Createamultidisciplinary,reliableprocessforrespondingtophysicalandpsychologicalharminvolvingallrelevantdepartmentsanddisciplines(PatientSafety,RiskManagement,Quality,OccupationalHealth,EmployeeAssistance,HumanResources,ClinicalLeadership,andothers).

IHIFrameworkforImprovingJoyinWork.IHIWhitePaperhttp://www.ihi.org/Topics/Joy-In-Work/Pages/default.aspx

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Shanafelt T,NoseworthyJ,ExecutiveLeadershipandPhysicianWell-being.MayoClinicProceedings,Volume92,Issue1,Pages129-146(January2017)/Balik,IHI2017

JoyinWork

Workload&Job

DemandsMeaningIn

Work

SocialSupport&Community

atWork

Control&Flexibility

Work-LifeIntegration

OrganizationalCulture&Values

Efficiency&Resources

DefiningElementsofTotalWorkerHealth

1. Demonstrateleadershipcommitmenttoworkersafetyandhealthatalllevelsoftheorganization

2. Designworktoeliminateorreducesafetyandhealthhazardsandpromoteworkerwell-being

3. Promoteandsupportworkerengagementthroughoutprogramdesignandimplementation

4. Ensureconfidentialityandprivacyofworkers5. Integraterelevantsystemstoadvanceworkerwell-

being.

NIOSH,2016

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ProgramFoundationandManagementA. ManagementLeadership

EnsuringOwnershipandAccountability- JustCulture/HROs

B.EmployeeParticipationC.WrittenPoliciesD.ProgramManagement◦ ProgramChampion◦ ProgramManager&Committee/Team◦ ProgramPlan

E.Communications/SocialMarketingF.HazardIdentification/Assessment◦ Injury/IncidentData Analysis&Worker/ClientSurveys◦ GapAnalysis◦ AssessmentofthePhysicalWorkEnvironmentandPractices

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Multifacetedprogramsaremoreeffectivethanany

singleintervention


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FacilityCultureandAccountabilityØSeniorLeadership

◦ HasknowledgeaboutWPVandtheirroleandresponsibilitieswithintheWPVprogram

◦ Declaresviolencepreventionapriority.

◦ Communicatesanddemonstratestoemployeesthatworkersafetyandsecurityareasimportantaspatientsafety.

◦ AlignsWPVeffortswithqualityandsafetyplans

◦ Facilityleadersassignresponsibilityandaccountabilityfortheimplementationandmaintenanceoftheprogram.

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FacilityCultureandAccountabilityØAcomprehensiveworkplaceWPVpolicyisdeveloped,communicated,implemented&evaluated

ØOngoingresources(e.g.,time,materials,funding)areprovidedfor:◦ Identifyingandmitigatinghazardsandrisks◦ Afacilitychampion&projectcoordinator◦ WPVcommittee◦ Effectiveworkertraining◦ On-goingevaluationandmaintenanceoftheprogram◦ Proactivefacilitiesdesign

ØFrontlinecaregiversareengagedindevisingthesolutionstoasaferworkplaceandtheireffortsarerecognized

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FacilityLeadersSetClearSafetyGoals&Expectations

Ø Employeesareawarethatviolenceisnotanacceptedpartoftheirjob

Ø Patients/visitorsaremadeawarethatviolencewillnotbeaccepted

Ø RolesandresponsibilitiesofallemployeeswithintheWPVprogramareclearlycommunicate

Sustainable&EffectiveWPVProgramsManagementLeadership


FacilityLeadersSetClearSafetyGoals&Expectations

ØExpectationsforreportingallincidentsofWPVareclearlycommunicatedandauser-friendlyprocessforreportingisprovided

ØLeadershipsupportsthereportingofallactsofviolenceorthreatsofviolence

ØEmployeesareinformedofwhatactionsarebeingtakenaftereventstopreventfutureviolence

32Sustainable&EffectiveWPVProgramsManagementLeadership


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OngoingWorkerEngagementorReengagement

Participationin:1. The safety/violencepreventionplanning process2. Identifyingsafety/violencerelatedhazards3. Reportinganinjury,hazard,orconcern,including

nearmisses4. Identifyingsafetysolutions,WPVsafetyequipment

andprocesses5. WPV/safetyaudits&walkthroughs6. Educationandtraining

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OngoingWorkerEngagementorReengagementParticipationin:

7. Safetychampion/coachingprograms8. ‘Safety’huddlesfortraining,feedbackandkudos9. Executive/managementrounding10.Security/physicalsafetyconsiderationsinnew

buildingorremodelingprojects11.Evaluatingandupdatingtheprogram12.ParticipatingintheWPVcommittee

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Elimination

Substitution

EngineeringControlsAdministrative/WorkPractice

Controls

Training

PPELeastEffective

MostEffective

AdaptedfromNIOSH,2018

Physicallyremovethehazard

Replacethehazard

Isolatepeoplefromthehazard/Redesignthework

Changethewaypeoplework

ProtecttheworkerwithPersonalProtectiveEquipment

Providingknowledge&skillstobeabletocomplywithAdmincontrols

G.HazardAbatement(Notallinclusive)I. EngineeringControlse.g.,• Controlledaccess tobuildings• Security/silencedalarmsystems• Exit routesincludingsaferoomsforemergencies• Monitoring systemsandnaturalsurveillance• Improvelightingindoorsandoutdoors• Noisebarriers• Metaldetectorsystems• Barrier protectiontoworkareas• Designofpatientareasforde-escalation;comforttoreducestress• Furniture,materialsandmaintenance

• Travelvehicles areproperlymaintained;barriersarepresent

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II.AdministrativeandWorkPracticeControls

• Hiringpractices• IncidentReporting• IdentifyingandTrackingPatients/VisitorsatHighRiskforViolence

• IncidentResponse&PostIncidentProcedures• IncidentInvestigation• EmployeesWorkingAloneorinSecureAreas• EntryProcedures• TransportationProcedures• SecurityPersonnel&Rounding

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H.Education&Training◦ Tailoredtostaffgroups/disciplines&stratifiedrisklevels

relatedtoworkroleswithintheorganization◦ Haveclearlydefinedgoalswithmeasurableoutcomes◦ Measureeffectivenessoftraining(cananddostaffuse

skillstaught)

I. OngoingProgramEvaluation&ProactiveHazardPrevention

J. Processestoimprovethepatientorclientexperience

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DO

CheckAct

Plan

https://www.oahhs.org/safety

ØHaveaplan,setmeasurablegoalsandevaluatethemoften

ØUseeconomicmodelingtoshowprogramreturnoninvestment

ØStartsmall,testpilotanddemonstratesuccesses

ØChooseevidence-basedinterventionsanduseexistingresources.....don’treinventthewheel

ØDon’tforgettoinvolveallstakeholdersincludingpatients&families

ØPlanforprogramsustainability&tousingproactivemeasures

ØMaintainmanagementsupportandemployeeengagement

ØMarket&communicatetheprogramandyoursuccesses

ØTreatpatientandemployeesafetywithequalemphasis

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WorkplaceViolencePreventionToolkitforHealthCarehttps://www.oahhs.org/safety

StateofOregon- DASRiskConsultingUnitandStateAgencyInterestGrouphttps://www.oregon.gov/das/Risk/Documents/WPVToolkit.pdf

Violenceintheworkplace:OSHA/OROSHA/NIOSHhttps://www.osha.gov/SLTC/workplaceviolence/https://osha.oregon.gov/Pages/topics/violence-in-the-workplace.aspxhttps://www.cdc.gov/niosh/topics/violence/default.html

CPWR(construction)– SafetyClimateAssessmentTool– S-CATwww.safetyclimateassessment.org

InstituteforHealthcareImprovementIHI/NPSF:LeadingaCultureofSafety:ABlueprintforSuccesshttp://www.ihi.org/resources/Pages/Publications/Leading-a-Culture-of-Safety-A-Blueprint-for-Success.aspx

WorkplaceViolencePreventionResourcesforHealthCarehttps://www.jointcommission.org/workplace_violence.aspx

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