OSHA’s Workplace Violence Prevention Program

1. OSHA’s Workplace Violence Prevention Program

2. What Is Workplace Violence? Any physical assault, threatening behavior, or verbal abuse occurring in the workplace. The workplace may be any location either permanent or temporary where an employee performs any work-related duty.

3. Types of Serious Injuries and Deaths from Workplace Violence • Physical assaults • Beatings/stabbings • Shootings • Rapes • Attempting to cause physical harm, i.e.., striking, pushing, or other aggressive acts against another person

4. Acts of Aggression Which May Indicate Risk • Disorderly conduct, such as shouting, pushing or throwing objects, punching walls, or slamming doors; • Verbal threats to inflict bodily harm including vague or overt threats; • Fascination with guns or other weapons, demonstrated by discussions or bringing weapons to workplace;

5. Acts of Aggression Which May Indicate Risks (Continued) • Obscene phone calls; • Intimidating presence; and • Harassment of any nature.

6. Types of Workplace Violence Incidents • Based upon the relationship between the assailant/worker/workplace, violent incidents can be divided into categories: • Violence by strangers • Violence by customers/clients/patients • Violence by co-workers • Violence by personal relationship

7. Types of Workplace Violence Incidence (Continued) Homicides Leading cause of job-related deaths for women, second leading cause for men. Claimed the lives of 1,071 workers in 1994; approximately 3 workers died each day under violent circumstances. Nonfatal Assaults Between 1987-1992, one million persons were annually assaulted at work.

8. Establishments Affected by Workplace Violence According to the Bureau of Labor Statistics, the highest number of homicides occur in night retail establishments. The highest number of nonfatal assaults occur in the health care and social service sectors.

9. Establishments Affected by Workplace Violence (Continued) • Workers in retail establishments, such as convenience stores, retail groceries and restaurants account for one half of all homicides. • Work-related homicide rate for gas station attendants and sales counter clerks exceeded by 10 times the national average. • Workers at greatest risk are those who work alone, late at night, and are known to handle cash.

10. Establishments Affected By Workplace Violence (Continued) Almost two thirds on nonfatal assaults occurred in service industries, such as nursing homes, hospitals, and establishments providing residential care and other social services (i.e.., halfway homes) with a: - rate of 47 per 10,000 workers workers for residential care. - rate of 38 per 10,000 workers for nursing and personal care facilities. This is compared to 3 cases per 10,000 workers for all of private industry.

11. Health Care Establishments Nonfatal assaults were primarily by patients on nursing staff in health care institutions. According to one study (Goodman et al. 1994), between 1980-1990, 106 violence-related deaths occurred among health care workers.

12. Why Health Care Workers Are At Risk of Work-Related Assaults - Examples • Prevalence of handguns and other weapons among patients, their families, or friends; • Increasing number of acute and chronically mentally ill patients being released from hospitals without follow-up care; • Availability of drugs or money at hospitals, clinics, and pharmacies;

13. Why Health Care Workers Are At Risk of Work-Related Assaults - Examples (Continued) • Low staffing level during times of specific increased activity; • Isolated work with clients during examinations or treatment; and • Poorly lighted parked areas.

14. Economic Impact of Workplace Violence • According to the Department of Justice, assaults at work cost 500,000 employees 1,175,100 lost work days each year. • Annual cost of lost wages totals more than $55 million. • When the cost of productivity, legal expenses, property damage, diminished public image, increased security and other factors are included, the cost is measured in billions of dollars.

15. OSHA’s Commitment to Workplace Violence Published and distributed Guidelines for PreventingWorkplace Violence for Health Care and SocialServices Workers 3/96. Plans to conduct a coordinated effort consisting of research, information, training, cooperative programs, and appropriate enforcement to address issue of workplace violence.

16. Occupational Safety and Health Act The OSH Act of 1970 mandates that, in addition to compliance with hazard-specific standards, all employers have a general duty to provide their employees with a workplace free from recognized hazards likely to cause death or serious physical harm. This includes the prevention and control of the hazard of workplace violence. OSHA will rely on Section 5 (a) (1) of the OSH Act (the “General Duty Clause”) for enforcement authority.

17. Overview of the Guidelines The guidelines are: • Not a new standard or regulation • Advisory in nature and informational in content • Intended for use by employers who are seeking to provide a safe and healthful workplace through effective workplace violence prevention programs

18. Overview of Guidelines (Continued) The guidelines are based on the 1989 generic Safety and Health Program Management Guidelines. Although not exhaustive, the new workplace violence guidelines include policy recommendations and practical corrective methods to help prevent and mitigate the effects of workplace violence.

19. Workers Covered by Guidelines The guidelines cover a broad spectrum of workers including, but not limited to the following: • Physicians • Registered Nurses • Pharmacists • Home Health Nurses • Social/Welfare Workers • Emergency Medical Care Personnel

20. Four Components of Guidelines • Management Commitment and Employee Involvement • Worksite Analysis • Hazard Prevention and Control • Training and Education

21. Management Commitment and Employee Involvement • Management commitment and employee involvement are complementary elements of an effective safety and health program. • Management commitment provides the motivating forces to deal effectively with workplace violence. • Employee involvement and feedback enable workers to develop and express their commitment to safety and health.

22. Management Commitment Demonstrated by: • Organizational concern for employee physical and emotional safety and health; • Equal commitment to worker safety and health and patient/client safety; and • A system of accountability for involved managers and employees.

23. Employee Involvement Should include the following: • Understanding and complying with the workplace violence program and other safety and security measures; • Participating in an employee complaint or suggestion procedure covering safety and security concerns; and • Prompt and accurate reporting of violent incidents.

24. Written Program A written program for job safety and security: • Should be incorporated into the larger organization’s overall safety and health program; • Must provide clear goals and objectives to prevent workplace violence; and • Must be adaptable to specific situations in each establishment.

25. Written Program (Continued) • The workplace violence prevention program should do the following: • Create and disseminate a clear policy of zero-tolerance for workplace violence, verbal and nonverbal threats and related actions; • Ensure that no reprisals are taken against an employee who reports or experiences workplace violence;

26. Written Program (Continued) • Encourage employees to promptly report incidents and to suggest ways to reduce or eliminate risks: • Outline a comprehensive plan for maintaining security in the workplace; • Assign responsibilities and authority for the program to individuals or teams with appropriate training and skills;

27. Written Program (Continued) • Affirm management commitment to a worker-supportive environment that places as much importance on employee safety and health as on serving the patient or client; and • Set up a company briefing as part of the initial effort to address such issues as preserving safety, supporting affected employees, and facilitating recovery.

28. Worksite Analysis Worksite analysis involves a step-by-step common sense look at the workplace to find existing or potential hazards for workplace violence. This entails reviewing specific procedures or operations that contribute to hazards and specific locales where hazards may develop.

29. Worksite Analysis (Continued) A “Threat Assessment Team,” Patient Assault Team,” similar task force, or coordinator may assess the vulnerability to workplace violence and determine appropriate actions. The team should include representatives from senior management, operations, employee assistance, security, occupational safety and health, legal, and human resources staff.

30. Worksite Analysis (Continued) • The recommended program for worksite analysis includes, but is not limited to: • Analyzing and tracking records; • Monitoring trends and analyzing incidents; • Screening surveys; and • Analyzing workplace security.

31. Worksite Analysis (Continued) Record analysis should include: • Reviewing medical, safety, and workers’ compensation and insurance records to pinpoint incidents of workplace violence; • Scanning unit logs and employee and police reports of incidents or near-incidents of assaultive behavior; and • Tabulating the data to target frequency and severity of incidents to establish a baseline for measuring improvement.

32. Worksite Analysis (Continued) Monitoring trends and analyzing incidentsinclude: • Contacting similar local businesses, trade associations, and community and civic groups to learn about their experiences with workplace violence; and • Tracing trends of injuries and incidents of actual or potential workplace violence.

33. Worksite Analysis (Continued) Screening surveys include: • Giving employees questionnaires to get their ideas on the potential for violent incidents and to help identify or confirm the need for improved security measures; • Pinpointing tasks that put employees at risk; • Identifying new or previously unnoticed risk factors and deficiencies or failures in work practices, procedures, or controls; and • Assessing the effects of changes in the work processes.

34. Worksite Analysis (Continued) Workplace security analysis includes: • Analyzing incidents, including the characteristics of assailants and victim and relevant details of the situations; • Identifying jobs, locations, processes, and procedures with the greatest risk of violence; • Noting high-risk factors such as the types of clients or patients and physical risk factors of the building; and • Evaluating the effectiveness of existing security measures, including engineering control measures.

35. Hazard Prevention and Control After the hazards of violence are identified through systematic worksite analysis, the next step is to design measures through engineering or administrative and work practices to prevent or control these hazards. If violence does occur, post-incidence response can be an important tool in preventing future incidents.

36. Hazard Prevention and Control (Continued) Engineering controls remove the hazards from the workplace or create a barrier between the worker and the hazards. Examples include: Alarm systems and other security devices; Metal detectors - closed circuit video recording for high-risk areas; and Safe rooms for employees use during emergencies.

37. Hazard Prevention and Control (Continued) Administrative and work practice controls affect the way jobs or tasks are performed. Examples include: Stating clearly to patients, clients, and employees that violence is not tolerated or permitted; Establishing liaison with local police and state prosecutors; Requiring employees to report all assaults or threats to a supervisor or manager; and Setting up trained response teams to respond to emergencies.

38. Hazard Prevention and Control (Continued) Post-incident response and evaluation are essential to an effective violence prevention program. All workplace violence programs should provide comprehensive treatment for victimized employees and employees who may be traumatized by witnessing a workplace violence incident.

39. Hazard Prevention and Control (Continued) • Several types of assistance can be incorporated into the post-incident response including: • Trauma-crisis counseling; • Critical incident stress debriefing; or • Employee assistance programs to assist victims.

40. Training and Education Training and education ensure that all staff are aware of potential security hazards and how to protect themselves and their co-workers through established policies and procedures.

41. Training and Education (Continued) Employee Training Every employee should understand the concept of “Universal Precautions for Violence,” i.e.., that violence should be expected but can be avoided or mitigated through preparation. Staff should be instructed to limit physical interventions in workplace altercations whenever possible, unless there are adequate number of staff or emergency response teams and security personnel available.

42. Training and Education(Continued) Employee Training The training program should involve all employee including supervisors and managers. New and reassigned employees should receive an initial orientation prior to being assigned their job duties. Qualified trainers should instruct at the comprehension level appropriate for all staff. The training should involve role playing, simulations, and drills and should be provided to employees annually.

43. Training and Education(Continued) Training should cover topics such as: • The workplace violence prevention policy; • Risk factors that cause or contribute to assaults; • Early recognition of escalating behavior or recognition of warning signs and situations that may lead to assaults; and • Ways of preventing or diffusing volatile situations or aggressive behavior, managing anger, and appropriating using medications as chemical restraints.

44. Training and Education (Continued) Supervisors, Managers, and Security Personnel Supervisors and managers should ensure that employees are not placed in assignments that comprise safety and should encourage employees to report incidents. In addition, they should learn how to reduce security hazards and ensure that employees receive appropriate training. Security personnel need specific training from the hospital or clinic, i.e.., ways to handle aggression and defuse hostile situations.

45. Training and Education(Continued) The training program should also include an evaluation. The content, methods, and frequency of training should be reviewed and evaluated annually by the team or coordinator responsible for implementation.

46. Recordkeeping and Evaluation of the Program Recordkeeping and evaluation of the violence prevention program are necessary to determine the overall effectiveness and identify any deficiencies or changes that should be made. Program evaluation may involve supervisor and/or employee interviews, testing, and observing, and/or reviewing reports of behavior of individuals in threatening situations.

47. Recordkeeping • Recordkeeping is essential to the success of a workplace violence prevention program. The following records are important: • OSHA Log of Injury and Illnesses (OSHA 200); • Medical reports of work injury and supervisors’ reports of each recorded assault; • Incidents of abuse, verbal attacks or aggressive behavior;

48. Recordkeeping (Continued) • Information on patients with a history of past violence, drug abuse, or criminal activity; • Minutes of safety meetings, records of hazard analyses, and corrective actions; and • Records of all training programs.

49. Evaluation • As part of their overall program, employers should evaluate their safety and security measures. An evaluation program should involve the following: • Establishing a uniform violence reporting system and regular review of reports; • Reviewing reports of minutes from staff meetings on safety issues;

50. Evaluation (Continued) • Analyzing trends and rates in illness/injury or fatalities caused by violence relative to initial or “baseline” rates; and • Measuring the effectiveness of improvements based upon lowering the frequency and severity of workplace violence.