Planning for Workplace Violence in the Physician Office Practice

OSHA reports that, in each year from 2011 to 2013, healthcare workers in the U.S. suffered 15,000 to 20,000 serious workplace violence-related injuries. Issues can arise for numerous reasons, but commonly involve disgruntled employees or domestic violence that spills over to the workplace from an employee or a patient/family member who is unhappy.

Risk Assessment and Development of a Written Plan

  • Conduct an HVA to determine the types of workplace violence events that your organization is most likely to encounter. Workplace violence can involve numerous scenarios such as employee to employee, patient/family member to employee, domestic violence involving a staff member that spills over into the work environment and active shooter. Utilize the findings to develop your plans.
  • Create written plans to address each type of event that is most likely to impact your organization.
  • Consider the culture of safety and employee willingness to divulge information regarding dangerous personal situations they are involved in or concerning behaviors they have observed with visitors, patients or other employees. A culture of safety assessment can be conducted to better understand employee perceptions of safety at your organization.
  • Emergency assistance contacts also need to be included in the plan.
  • Take into account the physical location and the geographic location of the office practice to consider types of environmental and engineering controls that can be implemented to reduce crime. For example, improved lighting, application of locks to prevent unauthorized access, etc.
  • Involve local law enforcement when developing plans to ensure an integrated response if something occurs. Be aware of law enforcement response time to your location as this may impact your organizational response.

Development of Policies and Procedures

  • Develop a written code of conduct for employees to follow.
  • Incorporate an emergency code into the organization plan that alerts staff of violence.
  • Establish a process for handling complaints internally and externally.
  • Establish procedures for staying safe, including criteria for evacuation versus sheltering in place based on the situation.
  • Require and provide awareness, identification of aggressive behavior and de-escalation training for all staff.

Communication Plan

  • Develop a way to contact law enforcement, preferably include a method that may be implemented secretively by employees in the event of an aggressive patient/visitor.
  • Develop an emergency word or code that can be used to quickly communicate the threat internally and externally.

Testing and Training

  • Test emergency contact sources, such as panic buttons to ensure functionality.
  • Train staff to disclose potentially dangerous domestic situations to the practice manager. Once the specific situation is identified, work with the employee to modify working conditions to facilitate a safe environment.
  • Train staff in the identification and de-escalation of violence at least annually.
  • Establish a process for retraining staff periodically throughout the year to keep techniques of violence de-escalation on their minds. Discuss possible scenarios during staff meetings and allow staff to discuss them together in a non-threatening environment.
  • Train staff on behaviors of concern that may indicate possible danger.
  • Test law enforcement response to notification of an event and include law enforcement when doing drills. Including law enforcement will help develop a relationship with your organization, allow them to become familiar with the layout of the building and help them become familiar with your plan.
  • Install surveillance cameras in strategic areas to provide visualization and continuous monitoring.
  • Train staff on your organization’s code of conduct and hold them accountable.