Human Resources – Workplace Violence/Disruptive Behaviour

Any type of violence in the workplace, including harassment, physical aggression, sexual assault, or any violent, responsive, or disruptive behaviours can result in significant physical and psychological harm to workers. Such behaviours may stem from underlying factors such as agitation, frustration, or stress, or from clinical conditions such as delirium, dementia, substance withdrawal or overdose, mental health disorders, and head injury. The information in this document was provided by HIROC Subscriber healthcare organizations (acute and non-acute) through the Risk Register application to support you in your risk assessment and decision making.

Key Controls/Mitigation Strategies

Physical/Environment

• Planning/Assess Layout
  • Assess workspaces to minimize hazards and ensure escape routes
  • Plan adjacencies (i.e., proximity to the nursing station, security station)
  • Designate a station/place for security worker in the Emergency Department and in high-risk areas
  • Identify additional controls for workers’ safety areas (i.e., plexiglassed stations, secure employee break areas)
  • Ensure proper placement of furniture to prevent entrapment
  • Minimize/avoid storage of equipment and supplies to reduce staff injury risk
  • Dedicate room in the Emergency Department for de-escalation of responsive, aggressive, violent patients
  • Identify safe Client/Resident/Patient room design (e.g. weighted or secured furniture, anti-rooms, pass-windows)
• Communication
  • Consider use of communication devices based on risk and location (e.g., cell phones, intercoms, walkie-talkies)
  • Provide alternative method of communication if unable to make emergency call in rural/remote areas)
  • Ensure emergency communication devices are available, functional, and accessible for all workers (i.e., on-site, community, remote)
  • Document regular testing of safety communication equipment (including batteries testing and testing of alarms)
  • Post public signage to promote a culture of safety and respect
• Monitoring/Technology
  • Implement advanced security system with remote video access
  • Install duress alarm systems in high-risk areas (i.e., silent alarms or panic buttons including mobile personal alarms)
  • Increase visibility within the building and in high-risk areas (i.e., video cameras/surveillance in high-risk areas/monitored building access)
  • Identify belongings search and room search kits in Emergency Department and high-risk areas

Organizational Supports/Resources

• Governance
  • Establish a multidisciplinary workplace violence prevention committee
  • Develop and apply organizational ethics framework to use where indicated
  • Maintain up-to-date risk mitigation plan for high-risk areas
  • Promote regular reporting of workplace violence to all levels of leadership, including senior leadership team and board subcommittees
  • Include workplace violence as a standing agenda item at the Joint Occupational Health and Safety Committee (JHSC)
• Assessment/Monitoring
  • Conduct regular workplace violence risk assessments and security audits to identify high risk areas (consider at least annually or as new information becomes available)
  • Develop formal flagging and information sharing of Client/Resident/Patient at risk for responsive, aggressive, violent behavior
  • Identify safety risks at huddles every shift (i.e., rapid rounds to review patients daily and identify immediate risks)
  • Ensure regular security hospital-wide rounds and high-risk areas rounds
  • Consider electronic/information boards at nursing stations to flag risks
• Documentation and Reporting
  • Maintain a reporting system for workplace violence incidents
  • Establish reporting and support and safety for workers at risk of domestic violence
  • Develop a mechanism for the reporting and investigation of disruptive workers in the workplace
  • Document client status risk assessments based on current standards, as well as all related investigations, mitigations, and conversations
  • Create a standardized process and procedure for approval and issuance of ‘no trespass’ orders when necessary
• Culture and Collaboration
  • Promote a culture of psychological safety for employees
  • Provide staff with access to counseling and debriefing services (i.e. Employee Assistance Program (EAP)
  • Ensure collaboration mechanisms exist with law enforcement and security personnel (i.e., police liaison contact)
  • Include Clients/Residents/Patients and families in discussions and care plans to address aggressive or responsive behaviour
  • Foster positive relationships with unions and have workplace violence prevention as a standing agenda item on the JHSC agenda
• Staff Protocols and Procedures
  • Establish models of care within high-risk areas of practice (i.e., Mental Health and Addictions programs, etc.) to improve safety
  • Develop a mechanism to implement safety plans for high-risk situations and system-wide response
  • Communicate risk information in transfers of care amongst workers and to other care areas
  • Identify care strategies for Clients/Residents/Patients with specific care needs (e.g. dementia, dual diagnosis, withdrawal)
  • Provide staff accompaniment to parking in high-risk situations and for night shift workers as required
  • Ensure de-activation of building and information-system access upon staff departure

Policies/Protocols/Processes

• Policy Development
  • Implement a comprehensive workplace violence prevention policy
  • Develop a domestic violence policy, post where employees can view it, and review annually
  • Establish respectful workplace and harassment policy
  • Develop a “working after hours and alone” policy
  • Consider a zero-tolerance policy for workplace violence
  • Cross reference your policies with accreditation standards
  • Establish clear roles and responsibilities for security and staff
  • Ensure all staff know how policies interrelate, i.e., how domestic violence policies link to security and HR processes
• Staff Procedure/High-Risk Protocol
  • Define procedures for reporting, investigating, and responding to workplace violence related incidents and near misses
  • Standardized risk assessments, identification, incident reporting, information system flags and safety plans
  • Develop mechanisms for managing Clients/Residents/Patients with history of violence or aggressive behaviour
  • Provide protocols for paired rounding in high‑risk areas (e.g., night shift, units with known aggressive clients/residents/patients)
  • Include workplace violence prevention measures in emergency preparedness plans
  • Establish mechanisms for rapid activation of safety plans during system wide, high risk events
  • Document staff completion of review of least restraints/sedation policy at least annually
  • Conduct and document regular drills for code white and crisis team response processes
• Wellness and Support Processes
  • Create a code of conduct/behaviour policy that outlines expectations for staff, clients/residents/patients, and visitors
  • Publicly post and monitor complaints process protocols
  • Discuss respectful and safe behaviours at performance reviews and performance development plans
  • Ensure timely follow-up and support for affected employees

Education/Training

• Core Skills/De-escalation
  • Provide mandatory workplace violence prevention, early recognition and response/de-escalation training
  • Provide non-violent crisis intervention/gentle persuasive approach/prevention and management of aggressive behaviour training
  • Ensure mandatory code white team training
  • Offer scenario-based training and simulations on handling aggressive behavior and code white
  • Educate staff on recognizing early warning signs of violence and include all management, volunteers, learners, and workers (physicians, staff, contractors)
• Adjunct Training
  • Offer mental health first aid
  • Offer crucial conversation training
  • Provide respect training
  • Enhanced training to encourage reporting through appropriate channels
• Program Development
  • Ensure collaboration of behavioural response team with units on care planning
  • Develop and promote worker wellness program
  • Maintain diligent documentation of all related education

Monitoring/Indicators

• Leadership Metrics
  • Review the number of ethical situations addressed by unit and leadership
  • Develop and analyze quality issue reports
  • Track number of employee injury reports and lost time injury rate related to workplace violence including physical violence, verbal violence, psychological safety
• Incident Reporting
  • Track overall number/percentage of reported workplace violence and harassment incidents
  • Record number of identity-based incidents
  • Review types and severity of violent incidents, safety and security reports, reviewed and investigated
  • Report and confirm all code white reports and debriefs
• Preventative/Human Resource Metrics
  • Conduct and track annual occupational health and safety risk assessment reports
  • Monitor sick leave related to workplace violence (STD, LTD, WSIB)
  • Survey worker engagement on a regular basis
  • Track usage of benefit plan Employee and Family Assistance Program services
  • Monitor worker grievances and harassment complaints
  • Conduct worker exit interviews, capture and review all relevant feedback
• Security Measures
  • Review building access practices/breaches (security)
  • Review number of risk audit/report recommendations implemented
  • Identify Clients/Residents/Patients as high risk for violence (rate)
• Training Metrics
  • Establish mandatory education of workplace violence prevention, domestic violence, and related safety training
  • Track education/training status (% completion)