Build a better culture to reduce workplace violence
Healthcare organizations are charged with providing and maintaining a safe environment for patients, visitors and staff. However, according to the Journal of Protection Management, this can be challenging due to a variety of clinical, environmental and organizational risk factors that contribute to workplace violence in healthcare settings:
- Clinical risk factors: Those associated with patients under the influence of impairing substances, experiencing significant pain, experiencing various mental/behavioral health issues and/or in law enforcement/corrections custody.
- Environmental risk factors: Those associated with a lack of access control to a sensitive area, insufficient duress/panic alarms and/or lack of safe areas for patients and staff to use in an emergency.
- Organizational risk factors: Those associated with inadequate policies/procedures for reporting/responding to workplace violence incidents, inadequate staffing, inadequate/insufficient training for responding to workplace violence incidents and/or inadequate security programs.
An important component to providing a safe environment — prevention — is often overlooked. Trauma-informed care involves understanding trauma and its potential effects on people's lives and focuses on providing support that is personalized to meet the specific needs of individuals. Simply put, healthcare organizations would not have to de-escalate concerning behavior if they could find a way to prevent escalating behavior before it begins.
Non-escalation as a tool
Non-escalation is the philosophy and practice of mitigating challenging behaviors before they become violent by interacting with people who may have lost their ability to make safe decisions and control their behavior due to cognitive differences, or physical and behavioral impairments.
Non-escalation begins by building a culture and environment that is incompatible with violence. Strategies for creating a safer organizational culture include:
- Treat each person you encounter with dignity and respect. This can be accomplished through empathy, listening and anticipating the individual’s needs.
- Initiate a universal greeting upon your approach. Introduce yourself and your affiliation and give the reason for contact.
- Thoughtfully respond rather than impulsively reacting. Physical intervention should only be taken when necessary.
- Align all elements of your communication with the situation at hand.
- Use proxemics to the fullest for each given situation. Keep in mind the distance between yourself and the person with whom you are interacting. Be non-threatening and remember to stay back if you feel unsafe.
- In the presence of conflict, active listening isn’t enough. Go beyond that by clarifying and acknowledging their emotions, asking open-ended questions, focusing on collaborative solutions, reflecting, advocating and deploying other techniques that allow for better empathy.
While a hospital cannot predetermine the types of illnesses, injuries or even patients that will present to the emergency department and require treatment, healthcare leaders can develop and educate patients, visitors and staff members on acceptable behavior in the healthcare environment.
Building the culture
Gaining buy-in for a culture change project is difficult at best. It’s crucial that change leaders and stakeholders communicate with staff based on each individual’s specific circumstances, roles and challenges within the organization. Effective communication should be personalized to address those unique factors, rather than attempting to use a one-size-fits-all approach.
Four approaches that may be used include in the healthcare environment:
- Align the change to the mission of the organization: Clearly articulate how the cultural change supports the mission, whether that be through improved patient outcomes, compassionate care, staff and patient safety, teamwork, etc.
- Recruit influencers: Bring well-respected individuals such as physicians, clinical leaders and frontline clinical and non-clinical staff who have credibility among their peers into early planning discussions.
- Develop pilots for the change: Select a pilot department or group who is open to change and has leadership support to test change initiatives on a smaller scale before full implementation. Set clear goals and metrics to monitor and gather feedback throughout the pilot.
- Demonstrate value of the change: Data should be used to measure the quality and effectiveness of the current workplace violence program and determine how a change in culture could impact the outcomes.
Whether you’re in the emergency department or in any other health system unit, it’s important to understand trauma-informed care and be trauma responsive to everyone you come in contact with — not just patients. Creating a culture of dignity and respect within the healthcare environment is pivotal to preventing violence.