HRET HIIN Culture of Safety Virtual Event · IAHSS, working with the AHA, has focused significant...
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HRET HIIN Culture of Safety Virtual Event Preventing Workplace Violence August 27, 2018
Transcript of HRET HIIN Culture of Safety Virtual Event · IAHSS, working with the AHA, has focused significant...
HRET HIIN Culture of Safety Virtual Event
Preventing Workplace ViolenceAugust 27, 2018
WELCOME AND INTRODUCTIONSKavita Bhat, MD, MPH | Program Manager, HRET
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Today’s Agenda11:00 - 11:05 am Welcome and Introductions
• Introduction to today’s event and agenda overview. Kavita Bhat, MD, MPHProgram Manager, HRET
11:05 - 11:15 am Introduction to Workplace Violence• Introduction to workplace violence and it’s impact at the national level Laura Castellanos, MHA
Associate Director, AHA Hospitals Against Violence (HAV)
11:15 - 11:45 am Strategies to Prepare and Respond to Workplace Violence• Understand the different types of violence and its impact from within or outside the hospital• Learn the importance of collaboration with internal and external stakeholders in planning,
training, and responding to workplace violence• Gain knowledge on the tools and resources available to assist in preparing and responding the
workplace violence
Kevin Tuohey, CHPABoard President, IAHSS
Roy Williams, CHPABoard Member at Large, IAHSS
11:45 – 11:55 am Q&A• Open discussion for participants to ask subject matter experts questions. Kavita Bhat, MD, MPH
Program Manager, HRET
11:55 – 12:00 pm Wrap Up• Conclusion of today’s event with CME instructions and Culture of Safety resources. Kavita Bhat, MD, MPH
Program Manager, HRET
Culture of Safety – Workplace Violence
Laura CastellanosAssociate Director Hospitals Against Violence
Workplace Violence
The Cost of Violence to Hospitals
Source: https://www.aha.org/guidesreports/2018-01-18-cost-community-violence-hospitals-and-health-systems
Hospital settings represent large institutional medical facilities; Residential Treatment settings include institutional facilities such as nursing homes, and other long-term care facilities; Non-residential Treatment/Service settings include small neighborhood clinics and mental health centers; Community Care settings include community-based residential facilities and group homes; and Field work settings include home healthcare workers or social workers who make home visits.
registered nurses, nurses’ aides, therapists, technicians, home healthcare workers, social workers, emergency medical care
personnel, physicians, pharmacists, physicians’ assistants, nurse practitioners, and other support staff
Workplace ViolenceThe National Institute for Occupational Safety and Health (NIOSH) defines workplace violence as
"violent acts, including physical assaults and threats of assault, directed toward persons at work or on duty."
Even if no physical injury takes place, threats, abuse, hostility, harassment, and other forms of verbal violence can cause significant psychological trauma and stress—and potentially escalate to physical violence.
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Workplace ViolenceAlthough OSHA has no specific standard on the prevention of workplace violence, an employer has a general duty to “furnish to each of his employees employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees.”
This requirement comes from Section 5(a)(1) of the Occupational Safety and Health Act of 1970 (OSH Act).
Federal Legislation
H.R. 5223 Health Care Workplace Violence Prevention Act Introduced March 8, 2018 by Rep. Khanna (D-CA) The bill, introduced with the support of 12 other members of
Congress, would mandate that the federal Occupational Safety and Health Administration (OSHA) develop a national standard on workplace violence prevention that would require health care facilities to develop and implement comprehensive facility and unit-specific workplace violence prevention plans.
Strategies to prepare for, respond to, and prevent workplace violence.
Workplace Violence
Presenters
Roy Williams III, CHPABoard Member at Large
Kevin Tuohey, CHPABoard President
Learning Objectives
IAHSS, working with the AHA, has focused significant efforts on developing tools to address workplace violence. Learning objectives are as follows:1. The importance of understanding the different types of violence
and its impact when from within or outside the healthcare facility
2. The importance of collaboration with internal and external stakeholders in planning, training, responding and critiquing.
3. Available resources.
The mission of IAHSS is simple and straight forward:
Leading excellence in healthcare security, safety and emergency management.
What keeps us up at night?
As it should
“Overall, we estimated that proactive and reactive violence response efforts cost U.S. hospitals and health systems approximately $2.7 billion in 2016. This includes $280 million related to preparedness and prevention to address community violence, $852 million in unreimbursed medical care for victims of violence, $1.1 billion in security and training costs to prevent violence within hospitals, and an additional $429 million in medical care, staffing, indemnity, and other costs as a result of violence against hospital employees.”
And this
And we discuss those concerns all the time
As do others…
So…What are we doing?
Providing guidance…
IAHSS Foundation Research
Designing for safe operations
Developing a Data Warehouse
What’s a Data Warehouse?• A large store of data accumulated from a wide range of
sources within a company and used to guide management decisions
Why do we need one?• To establish industry benchmarks – to guide management
decisions• Tie security data to the business of healthcare
Threat Management - continued
The HCF should develop a threat management program that is informed by data and research in this area. Individuals should be designated with responsibility for:
• HCF staff education that promotes reporting and the real time communication of threats including an anonymous/confidential means of doing so
• Assessing formal or informal reports of behaviors of concern
• Implementing timely response plans
• Addressing reported incidents or threats in collaboration with internal and external responders and potentially affected parties.
• Alerting HCF staff and others who are at risk to include those who come onto campus as well as notifying other hospitals/health systems in the area as to the threat, as dictated by the situation.
• Creating and monitoring safety plans related to the threat
• After-action debriefing sessions to review, evaluate and revise as needed, the actions taken to mitigate the threat
• Victim advocacy, support and counseling as necessary
• Regularly reviewing trends in threat management events
• Routinely reporting program status and recommended changes to HCF leadership
Threat Management - continued
Risks
Notification / Reporting Systems
Example - Violence Levels - Defined
• Level 1 – Verbal: Individual is belligerent and/or challenges authority.• Level 2 – Verbal Abuse / Threats: Individual is belligerent, challenges authority and
making verbal threats to harm staff or an individual.• Level 3 – Physical Threats: Individual ready to fight and making statements that they will
try to hurt someone. Staff does not have to go hands on with the individual.• Level 4 – Physical Non-Injury: Individual is acting out and staff has to go hands on to
control the individual without anyone receiving injuries.• Level 5 – Physical Injury Occurred: Individual is acting out and staff has to go hands on
to control the individual and someone is injured from having to control the individual. • No Violence: Individual confused, not knowing what is going on.
Example - Violence levels 1 JAN-31 DEC 2015
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4 6
31
7 0
53
1518
40
118
65
3
2426
100
69
19 19
78
913
57
2022
88
22
17
0
10
20
30
40
50
60
70
80
90
100
Level 1 Level 2 Level 3 Level 4 Level 5 No Violence
2011
2012
2013
2014
2015
Example - Violence levels 1 JAN-31 DEC 2015
43
4 6
31
7 0
53
1518
40
118
65
3
2426
100
69
19 19
78
913
57
2022
88
22
17
0
10
20
30
40
50
60
70
80
90
100
Level 1 Level 2 Level 3 Level 4 Level 5 No Violence
2011
2012
2013
2014
2015
144%
Example - Violence levels 2015 - 2016
Threat Management - continued
• The HCF should have training programs that address the prevention, recognition, response and reporting of threats, acts of aggression and other behaviors of concern. Education appropriate for job function and potential risk should be provided to all healthcare workers and support staff and should include:
• Early awareness and identification of persons displaying behaviors of concern
• Reporting protocols
• Activating an emergency response
• Documenting threats and incidents
• Emphasizing that all threats should be taken seriously
• Learnings and sharing key takeaways from historical event
Learning from incidents
Learning from incidents
Trainings
Threat Management - continued
• The HCF should consider establishing a multi-disciplinary Threat Management Team (TMT).
• The TMT may include representatives of the following areas: • Human Resources / Administration
• Legal / Risk Management
• Security
• Mental Health/Behavioral Specialist
• Clinical Services/Nursing
• Leadership from the area impacted by the threat
• Other departments as circumstances require (e.g. Social Services, Public Relations)
• Local/regional law enforcement as needed
The Team
Human ResourcesSecurity &
Internal Responders
External Responders
Mental Health
Risk Management
Clinicians
Leadership
Workplace Violence Assessment & Response Team
II
Threat Management - continued
The TMT should develop procedures on receiving, interpreting, validating, responding to, and managing threats and behaviors of concern. Such procedures should define a pathway to include:
• Identifying threats
• Determining the seriousness and severity of the threat
• Developing intervention plans that protect potential victims and addressing the problem or conflict that precipitated the threat
Threat Management - continued
• Providing training for the TMT and other HCF personnel as necessary regarding violence policies, procedures, industry standards and guidelines. Such training should include regularly scheduled drills to ensure competencies are retained.
• Documenting the threat assessment process allowing for confidentiality and in accordance with privacy requirements
• Conducting and participating in an after-action review / debrief process
Related IAHSS Guidelines
01.09 Violence in Healthcare01.09.01 Targeted Violence01.09.02 Management of Weapons01.09.03 Threat Management01.10 Collaborating with Law Enforcement01.11 Media and External Relations02.02.02. Stopping & Questioning Persons of Interest02.02.03. Incident Response02.02.04. De-Escalation Training02.02.05.Security Officer Use of Physical Force05.02 Security Role in Patient Management05.03 Violent Patient Visitor Management05.04 Searching Patients and Patient Areas for Contraband05.05 Patient Elopement Prevention and Response05.06 Security in the Emergency Care Setting05.07 Behavioral/Mental Health (General)
05.07 Behavioral/Mental Health (General)05.08 Pediatrics Security05.08.01 Infant/Pediatric Abduction Response and Prevention05.09 Intensive Care Units05.10 Prisoner Patient Security06.01.01 General Staff Security Orientation and Education06.02 Home Health Provider (Community Provider Services)06.04 Crime Prevention/Safety Awareness08.09 Active Shooter
Q&A
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WRAP UPKavita Bhat, MD, MPH | Program Manager, HRET
Continuing Education Credits
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2017 Culture of Safety Change Package
Culture of Safety Change Package Link
