Pop! Pop! Pop! Imagine hearing this unexpected sound in an office building, and then you see a person waving a firearm with active rounds.
Workplace violence is on the rise and in healthcare there is no exception. The first line of defense is preparation. Directives on the response to workplace violence should be developed and integrated fully with all other simulated disaster drills, such as those developed for earthquakes or power outages. Hospitals and some offices include regular education and drills on what to do in the event of violence in the workplace, including active shooter scenarios.
Physician safety, and that of his or her staff, is an issue all need to consider. Offices see patients with mental health imbalances, patients in need of pain management, patients and staff struggling with personal issues, and patients with addictions. Unfortunately, healthcare professionals sometimes become the target of their patients' anger and often unforeseen recipients of their violent outbreaks. What can you do?
Practical measures for the office:
- Be alert as you enter and leave the building.
- Set up exam rooms so the patient is not between you and the door.
- Train staff to de-escalate and defuse tense situations (have protocols in place, practice drills as a team).
- Review OSHA and CDC resources for minimizing workplace violence and managing conflict.
- Involve local law enforcement in your training and drills.
- Review CAP's Risk Management Institute Program (Effective Office Communication, Patient Education).
The Occupational Safety and Health Administration (OSHA) defines workplace violence as any physical assault, threatening behavior, or verbal abuse occurring in the workplace setting. While federal law does not impose a duty on employers to prevent workplace violence against employees, OSHA mandates that employers provide a safe working environment and requires employers to provide a workplace free from recognized hazards that are causing, or are likely to cause, death or serious physical harm to employees. It is important that employers take an active approach to control these risks and associated exposures.
There are four key categories of workplace violence: Personal Relationships, Employee-on-Employee, Customer/Client, and Criminal Intent. Common triggers for workplace violence include: domestic violence/marital or relationship problems, job-related stress or frustration, workforce reduction, alcohol/drug abuse, romantic interest in a coworker, and disgruntled patients and visitors. How you respond to specific situations is critical.
Perform an office risk analysis. Identify strengths and weaknesses of your office violence prevention plan. Integrating safety in a culture of respect and trust creates a positive work environment. Require all staff to undergo training in responding to a patient’s family members who are agitated and potentially violent. Training should focus on prevention, verbal de-escalation skills, and personal safety. Effective training involves role playing, simulations and drills because if you don’t rehearse, it won’t work in a real-life situation. It is also essential to include education on procedures for notifying supervisors and security staff. Encourage employees and other staff to report incidents of violent activity and any perceived threats of violence. Have processes in place for post-incident debriefing and follow up. Have your plan in writing and have it accessible to employees at all times.
When dealing with disruptive behavior, verbal threats, use of profanity, acts of physical threat, and refusal to comply with reasonable requests from an office team member, place the person somewhere away from onlookers with as little environmental stimulation as possible. Listen and acknowledge the person’s concerns. De-escalate the situation as much as possible. Call for assistance.
Everyone in the office has a responsibility to contribute to preventing, identifying, responding to, and recovering from incidents of workplace violence. Important questions to consider are:
1. Do you have a team or personnel to develop, review, and implement policies to deal with violence?
2. What is the office plan for maintaining security?
3. What is the strategy for maintaining a safe and secure environment?
4. Know how to contact law enforcement authorities.
5. What do you do in an active shooter scenario? A consultant on safety issues with the FBI gives the following advice:
RUN - Know which exits to use. Leave your belongings behind. Evacuate regardless of whether others agree to follow. Keep your hands visible.
HIDE - Know where to hide. Hide in an area out of the shooter’s view. Lock or block entry to your hiding place. Remain quiet.
FIGHT - Know what office equipment to use as a weapon. Fight as a last resort and only when your life is in imminent danger. Improvise weapons or throw items at the active shooter. Commit to your actions … your life depends on it.
6. Provide event debriefing and availability of trauma counseling for all employees.
7. Conduct a risk analysis of your practice's emergency plan to identify opportunities for improvement.
The office practice team responsible for the workplace violence management program may also be responsible for developing an active shooter response plan in collaboration with local law enforcement and emergency management responders. The International Association for Healthcare Security & Safety (IAHSS) has developed general guidelines for management of an active shooter in a healthcare facility that reference the “Active Shooter Handbook — How to Respond” and the Department of Homeland Security.
We live in a time of high anxiety, stress, and misinterpreted communications. Taking the time to communicate clearly with each other, be it coworker, patient, or family member, can hopefully alleviate the stress and fears of underlying health issues. Working together and being prepared are pivotal to a safer response in the event of emergent situations. We all deserve to work in a safe environment.
Deborah Kichler is a Senior Risk Management Specialist for CAP. Questions or comments related to this article should be directed to dkichler@CAPphysicians.com.
“Planning and Response to an Active Shooter: An Interagency Security Committee Policy and Best Practices Guide.” November 2015
OSHA Workplace Violence • www.osha.gov
“Workplace Violence Prevention Strategies and Research Needs.” Department of Health and Human Services
“Preventing HealthCare Workplace Violence Toolkit.” April 2017 Washington State Hospital Association
“Physician Office Risk Management Playbook.” American Society for Healthcare Risk Management
e-Evolve: Active Shooter Response • CAPAdvantage • http://www.capphysicians.com/practice-management-services#capadvantage
Federal Bureau of Investigation • https://www.fbi.gov/about/partnerships/office-of-partner-engagement/acti...
CAP website resources: Safety and Security
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