When Medxcel, a health-care services provider, launched a violence prevention program for its 141 U.S. health-care facilities, it understood that violence is four times more prevalent in health care than any other industry. But that’s not to say other industries are safe. As this article was being written, an active shooter incident was underway inside YouTube.
After steady declines between 1994 and 2014, workplace homicides are increasing. In 2015—the Bureau of Labor Statistics’ most recent reporting year—9 percent of all fatal workplace incidents were homicides. Burglary was the most common trigger, and retail supervisors were the most frequent victims.
Violence isn’t always life threatening or physical, however. Workplace violence—including incidents that occur during work commutes—more often take the form of bullying, intimidation, and assault. While the perpetrators may be strangers, they often are coworkers, clients, patients, and family members. Now, employers are taking a stand by developing violence prevention plans and training to stop violence before it escalates.
The Cardinal Rule
“The cardinal rule in workplace violence prevention training is that if you see something, say something,” stresses Charlie Morgan, partner in Alston & Bird’s labor and employment group. “Take each threat of violence seriously. Assume the person will carry it out.
“The area where companies are most likely to fall short is in not addressing red-flag behaviors, such as a series of threats,” he continues. “Communication is key. Employees should elevate any concerns about workplace violence, even if they are small concerns.”
When caught early enough, supervisors may be able to solve the problem through employee assistance programs or professional counseling.
Medxcel Draws a Baseline
In the health-care industry, 80 percent of the violence is caused by patients. Recognizing that, “we needed a comprehensive approach to identify the indicators of escalating anxiety and potential violence,” says Scott Cormier, VP, Emergency Management, Environment of Care and Safety at Medxcel. Historically, industry-wide, only physicians and nurses were trained to de-escalate situations. Starting December 2015, Medxcel extended that training to the entire health-care team by also training psychiatric aides, emergency medical services personnel, and nursing assistants.
“Our first step was to identify workplace violence events, including ‘near misses,’ such as when someone throws a punch that doesn’t connect,” Cormier says. “In our first year, we saw a 300 percent increase in reported events (as staff learned about their options). Another year later, we think incidents are still underreported.”
Legally, Morgan observes, “if there were a legal claim, all those incidents would come out in discovery.” It’s better, therefore, to analyze patterns in your facilities, in your industry, and in similar types of locations globally to identify any serious problems before an incident occurs in your organization.
Compliance Issues
If an incident escalates to a legal case, Morgan says attorneys will examine the situation in terms of:
OSHA’s general duty clause: Keeping the workplace free from recognized hazards. That includes workplace violence.
Negligent security: Not securing the workplace against an outside threat. “While the employer isn’t responsible for a criminal act, there could be legal action if that act was reasonably foreseeable,” Morgan says. Prepare by analyzing trends in your region and industry, and act accordingly.
Negligent hiring, retention, or supervision: Overlooking or disregarding tangible evidence, such as threats or criminal convictions. “Legal cases look for such tangible indicators. Employers have a right to check employees’ records to uncover this,” Morgan notes.
OSHA Guidance in a Nutshell
Although OSHA has no regulations governing workplace violence prevention, it does have guidelines. Jodi Taylor, an employment attorney with Baker Donelson, summarizes the OSHA guidance as recommending strong:
1. Management commitment: Enact a zero-tolerance plan with a system of accountability and a safety committee. “Details will vary by demographic and location, but the plan should include an active shooter scenario, track claims and near misses, and monitor trends in the news,” Taylor says.
2. Employee participation: “There should be no retaliation or discrimination for reporting concerns,” Taylor explains. “Active shooter scenarios often include misdiagnosed or assumed mental illness, so beware of a witch hunt that could expose you to Americans with Disabilities Act claims.”
3. Threat assessment: Form a team to conduct worksite analysis and implement prevention and control mechanisms. The team should include managers from throughout the company, and they should develop a good working relationship with law enforcement.
4. Safety and health training: “In my practice, I conduct the training with HR,” Taylor notes. “I give a blanket statement and HR adjusts for local situations.” For active shooter training, she suggests bringing in law enforcement to lend their insights.
Additionally, Taylor says, approximately 20 states allow firearms to be stored in parked cars even though the employers may ban firearms from the premises. She recommends taking these so-called parking lot laws into account when crafting a violence prevention plan.
Form Threat Assessment Teams
Threat Assessment Teams (TATs) are vital to a robust program. At Medxcel, these multidisciplinary teams identify, evaluate, and address threats of violence to ensure warning signs observed by multiple people don’t slip through the cracks. Team members include trained administrators, counselors, employees, medical professionals, and law enforcement personnel.
Once the risk is assessed, “look at controls: policies, physical security, and implementation. Match previous incidents with the controls and identify any gaps,” Morgan advises.
Medxel’s team then performs “a holistic analysis of changing and relevant behaviors (such as any family and work issues) and identifies strategies to manage them, such as counseling or law enforcement intervention. The team also may identify potential victims,” Cormier says. “Of course, for the program to be effective, our employees must recognize the behavior and have a simple process to report it to the TAT.”
Drill to Instill
Once threats are identified and a policy is developed, employees at all levels need to be trained to effectively implement those policies and to respond to violent situations.
“It’s important not only to know what to do, but to practice it,” emphasizes Norman Ford, VP of Compliance Products at Skillsoft. “Studies show that when people are stressed, they throw knowledge out the window and just react.” Therefore, train them until the proper reactions become second nature.
Unfortunately, drills are rare. A 77-company survey conducted by University of Iowa researchers in 2017 found that less than half the companies that have violence prevention policies trained their employees or managers about them. More recently, Taylor says, “of the 300 attendees at my recent active shooter Webinar, only 30 percent had a safety plan that included an active shooter. Of those, only 10 percent had conducted drills. Their concern is that drills bring up emotions and can be frightening. Yet, policy is only as good as implementation,” and good implementation requires practice.
Some of the anxiety can be mitigated by preparing employees beforehand. “When you conduct a drill, especially for an active shooter, be clear this is a drill and there is no active shooter,” Taylor emphasizes. Drills are to help people know what to do, where to go, and how to respond, so if they ever face that situation, they have some training to fall back on.
In this day and age, violence prevention plans and drills are as important as drills for fires and earthquakes. Make them a part of your organization’s emergency and business contingency plans, and practice, practice, practice.
Learn more by listening to this Training Magazine Network Webinar recording, “Workplace Violence: Develop a Culture of Preparedness”: https://www.trainingmagnetwork.com/events/998