Health Center Emergency Management Education and Training Series

1. Health Center Emergency Management Education and Training Series Webinar # 3: Workplace Violence: Plans, Tools, and Resources February 13, 2013 Presenter: Nora O’Brien, MPA, CEM Connect Consulting Services

2. Together we are better and stronger • Joint education and training • Peer-to-Peer learning • Wisconsin and Michigan have similar risks • We encourage participation as teams • All webinars will be recorded and archived • Schedule • March 13th (virtual table top) • May 8th • June 12th • July 10th • September 11th

4. Facilitators and Presenter: • Primary Care Associations • Michigan: Lynda Meade • lmeade@mpca.net • Wisconsin: AleksandrKladnitsky • akladnitsky@wphca.org • Presenter: • Nora O’Brien, MPA, CEM Connect Consulting Services

5. Workplace Violence: Plans, Tools, and Resources Nora O’Brien, MPA, CEMConnect Consulting Services February 13, 2013

6. Presentation Agenda • Welcome and Intros • Workplace Violence Program Development • Workplace Violence Types • Planning Considerations • Policies and Procedures • Resource Links and Training • Questions and Answers • Member Hot Topics • March Workplace Violence Tabletop Exercise overview MPCA & WPHCA Workplace Violence Training

7. Bio: Nora O’Brien, MPA, CEM • CPCA • Created community health center - specific tools, EOP plan, and ICS trainings • Secured $28 million for CHCs in emergency supplies, planning, and training in HPP funding • Connect Consulting Services • Healthcare emergency management firm that works with healthcare organizations in 12 states • Center for Domestic Preparedness Instructor • Teach the Advanced Public Information Officer Course for Hospital and Healthcare Emergencies • Masters of Public Affairs, Disaster and Emergency Management; Certified Emergency Manager MPCA & WPHCA Workplace Violence Training

8. Training Objectives and Acknowledgements Training Objectives • Recognize common warning signs of violent behavior • Understand the steps you can take to prevent workplace violence, or effectively respond if it occurs. • Policies/Plans needed • Establishing a culture of safety and preparedness Acknowledgements MPCA and the WPHCA appreciates the New Jersey Primary Care Association, the Washington Association of Community and Migrant Health Centers, and NACHC for sharing their workplace violence training resources. MPCA & WPHCA Workplace Violence Training

9. MPCA & WPHCA Workplace Violence Training Workplace Violence Types and Definitions

10. Inflection of Voice Examples—How We Communicate • I didn’t say you were stupid • Ididn‘tsay you were stupid • I didn‘tsay you were stupid • I didn‘tsay you were stupid • I didn‘tsay you were stupid MPCA & WPHCA Workplace Violence Training

11. Workplace Violence is a Growing Concern • Violence in workplace causes significant number of workplace fatalities and injuries. • Annually, 1.7 million American workers are directly affected by assaults and violent acts. • The healthcare sector lead all other industries with 45% of all nonfatal assaults against workers resulting in lost work days in US. • Can strike anywhere, at anytime. MPCA & WPHCA Workplace Violence Training

12. What is Workplace Violence? • Workplace violence is often thought of as a physical attack. But it may also include threats, intimidation, and other disruptive behavior, oral or written statements, and gestures or expressions that communicate a direct or indirect threat of physical harm. • Physical & Psychological • Threats/Harassment • Physical abuse • Cyber harassment • Bullying • Intimidation • Yelling/Cursing MPCA & WPHCA Workplace Violence Training

13. Four Types of Workplace Violence • Type 1: Criminals/Strangers • Type 2: Customers/Patients • Type 3: Employees/Coworkers • Type 4: Related Parties/Personal Relations MPCA & WPHCA Workplace Violence Training

14. Type 1: Violence by Criminals/Strangers • Type 1 violence includes violent acts by criminals who have no other connection with the workplace, but enter to commit robbery or another crime. • Such violence accounts for the vast majority (nearly 80 percent) of workplace homicides. The motive is usually theft. • In many cases, the criminal is carrying a gun or other weapon, increasing the likelihood that the victim will be killed or seriously wounded. MPCA & WPHCA Workplace Violence Training

15. Type 2: Violence by Patients/Clients • Type 2 includes violence directed at employees by customers, clients, patients, students, inmates, or any others for whom an organization provides services. • Such violence can be very unpredictable. • It may be triggered by an argument, anger at the quality of service, denial of service, delays, or some other precipitating event. MPCA & WPHCA Workplace Violence Training

16. Type 3: Violence by Employees/Coworkers • The third type of workplace violence consists of acts committed by a present or former employee. • Such violence may be directed against coworkers, supervisors, or managers. • Internal/External pressures, long hours, etc., may increase stress and interfere with an individual’s ability to cope. MPCA & WPHCA Workplace Violence Training

17. Employee Behavior and Warning Signs • Regardless of the type of workplace violence, the chances for prevention improve with increased awareness of potential warning signs and rapid response to a potential problem. • No one can predict human behavior, and there is no specific “profile” of a potentially dangerous individual. However, studies indicate that incidents of violence are usually preceded by patterns of behavior or other activities that may serve as warning signs. • While there are no fail-safe measures to ensure that violence will never occur, early action and intervention can serve to defuse a potentially dangerous situation and minimize the risk of violence. MPCA & WPHCA Workplace Violence Training

18. Warning Signs of Employee/Coworker -Increased use of alcohol and/or illegal drugs -Unexplained increase in absenteeism -Noticeable change in appearance or hygiene -Depression/Withdrawal -Resistance & overreaction to changes in policy -Repeated violations of company policies -Severe mood swings -Noticeably unstable, emotional responses -Explosive outburst of anger or rage w/o provocation -Suicidal comments -Behavior which is suspect of paranoia -Increasingly talks of problems at home -Escalation of domestic problems in the workplace -Talk of previous incidents of violence -Empathy with individuals committing violence -Increase in unsolicited comments about firearms, other dangerous weapons and violent crimes MPCA & WPHCA Workplace Violence Training

19. Employee Performance Indicators • Attendance problems, such as excessive sick leave, excessive tardiness, leaving work early, or improbable excuses for absences. • Decreased productivity, including making excessive mistakes, using poor judgment, missing deadlines, or wasting work time or materials. • Inconsistent work patterns, such as alternating periods of high/low productivity or quality of work, exhibiting inappropriate reactions, overreacting to criticism, or mood swings. • Concentration problems, including becoming easily distracted or having difficulty recalling instructions, project details, or deadline requirements. • Adverse effect on supervisor's time when he or she must spend an inordinate amount of time coaching and/or counseling the employee about personal problems, redoing the employee's work, or dealing with coworker concerns. MPCA & WPHCA Workplace Violence Training

20. Employee Behavioral Indicators • Continual excuses and blaming, such as an inability to accept responsibility for even the most inconsequential errors. • Safety issues, including a disregard for personal, equipment, and machinery safety or taking needless risks. • Unshakable depression, as exhibited by low energy, little enthusiasm, and/or despair. • Evidence of serious stress in the employee's personal life, such as crying, excessive personal phone calls, or recent change in family/relationship status. • Unusual or changed behavior, such as: • Inappropriate comments, threats, throwing objects, etc. • Evidence of possible drug or alcohol use/abuse. • Poor health and hygiene (marked changes in personal grooming habits). MPCA & WPHCA Workplace Violence Training

21. Type 4: Violence by Related Parties/Personal Relations • Type 4 includes violence committed in the workplace by someone who doesn’t work there, but has a personal relationship with an employee—for example, an abusive spouse or domestic partner. • In such cases, there is a greater chance that warning signs were observed, but ignored—coworkers or managers may have believed the signs were not important or were “none of their business.” MPCA & WPHCA Workplace Violence Training

22. Domestic Violence at the Workplace • DV is a pattern of coercive tactics which can include physical, psychological, sexual, economic and emotional abuse perpetrated by one person against an adult intimate partner with the goal of establishing and maintaining power and control over the victim. • Some abusive partners may try to stop their partners from working by calling them frequently during the day or coming to their place of work announced. • Research indicates that about 50% of battered people who are employed are harassed at work by their abusive partners. MPCA & WPHCA Workplace Violence Training

23. Confidential Policy for Domestic Violence • Anti-Violence policies work best when there is also a general policy of confidentiality letting the victim know that their confidentiality will be maintained to the extent possible and underscore safety and respect for privacy. • De-Stigmatize domestic violence to increase reporting • Custody dispute, divorce, separation and other incidents MPCA & WPHCA Workplace Violence Training

24. Warning Sign Levels • Warning signs of violent behavior may be classified into three levels. • Not everyone exhibiting warning signs will become violent. However, no warning sign should be completely ignored. Any one or combination of warning signs, at any level, may indicate a potentially violent situation. • Level 1: Intimidation • Level 2: Escalation • Level 3: Further Escalation MPCA & WPHCA Workplace Violence Training

25. Level 1—Intimidation • In Level 1, the person exhibits intimidating behaviors that are: • Discourteous/disrespectful, • Uncooperative, and/or • Verbally abusive MPCA & WPHCA Workplace Violence Training

26. Employee Responses • Observe and document the behavior in question. • Report his or her concerns to the supervisor to seek help in assessing and responding to the situation. • One technique for addressing the situation in a respectful manner and establishing limits with the offending coworker is the use of “I” statements, such as: • “I don’t like shouting. Please lower your voice.” • “I don’t like it when you point your finger at me.” • “I want to have a good working relationship with you.” MPCA & WPHCA Workplace Violence Training

27. Supervisor Responses • The supervisor should meet with the offending employee to discuss the concerns. • If the offending employee is the reporting employee's immediate supervisor, the employee should notify the next level of supervision. • If the offending person is not an employee, the supervisor of the employee reporting the incident is still the appropriate individual to receive the information and provide initial response. MPCA & WPHCA Workplace Violence Training

28. Level 2—Escalation • Argue with patients, vendors, coworkers, or management. • Refuse to obey agency policies or procedures. • Sabotage equipment or steal property for revenge. • Verbalize wishes to hurt coworkers or management. • Stalk, harass, or show undue focus on another person. • Make direct or indirect threats to coworkers or management (in person, in writing, by phone). • View himself or herself as victimized by management (me against them) and talk about “getting even.” MPCA & WPHCA Workplace Violence Training

29. Employee Responses • Call 911, if warranted. • Secure the safety of self and others, if necessary. • Immediately contact the supervisor. • Document the observed behavior in question. MPCA & WPHCA Workplace Violence Training

30. Supervisor Responses • The supervisor should consult with officials, such as functional area experts, for help in assessing/responding to the situation. • Avoid an audience. Remain calm, speaking slowly, softly, and clearly. • Ask the employee to sit, to see if he or she is able to follow directions. • Ask questions about the complaint, such as: • What can you do to regain control of yourself? • What can I do to help you regain control? • What do you hope to gain by committing violence? • Why do you believe you need to be violent to achieve that goal? • Direct aggressive tendencies into other behaviors, so the employee sees that there are choices about how to react. MPCA & WPHCA Workplace Violence Training

31. Level 3—Further Escalation • Level 3 usually results in some form of emergency response. In such cases, the person displays intense anger resulting in: • Suicidal threats. • Physical fights or assaults of coworker(s) or manager(s). • Damage or destruction of property. • Concealment or use of a weapon to harm others. • Display of extreme rage or physically aggressive acts, throwing or striking objects, shaking fists, verbally cursing at others, pounding on desks, punching walls, or angrily jumping up and down. MPCA & WPHCA Workplace Violence Training

32. MPCA & WPHCA Workplace Violence Training Workplace Violence Policies and Procedures

33. Workplace Violence Prevention Policies • Promote sincere, open, and timely communication among managers, employees, and union representatives. • Offer opportunities for professional development. • Foster a family-friendly work environment. • Maintain mechanisms for complaints and concerns and allow them to be expressed in a nonjudgmental forum that includes timely feedback to the initiator. • Promote “quality of life” issues such as pleasant facilities and job satisfaction. • Maintain impartial and consistent discipline for employees who exhibit improper conduct and poor performance. MPCA & WPHCA Workplace Violence Training

34. Reporting Policies • Report violent acts or threats of violence to your immediate supervisor. • Information regarding a threat of a harmful act, where you reasonably believe that the circumstances may lead to a harmful act, should be reported immediately. • All reports of incidents involving workplace violence will be taken seriously and dealt with appropriately. • Individuals who commit such acts may be removed from the premises and may be subject to disciplinary action, criminal penalties, civil litigation, or all of the above. MPCA & WPHCA Workplace Violence Training

35. Confidentiality Policies • Managers and supervisors should preserve the confidentiality of employee complaints. • Share information only with those who have a need to know in order to carry out official business. • Protect incident reports, related information, and the privacy of persons involved, just as in other sensitive and confidential personnel matters. • However, there is an exception when there is evidence of a direct threat or potential harm to self or others. MPCA & WPHCA Workplace Violence Training

36. Security Policies • Maintaining a secure and physically safe workplace is part of any good strategy for preventing workplace violence. • Employee photo identification badges. • Onsite guard services. • Guard force assistance in registering and directing visitors in larger facilities. • Other appropriate security measures (e.g., metal detectors). • Employees should notify the appropriate security office or designated police about suspicious or unauthorized individuals on agency property. • Additional law enforcement assistance is available through local police departments for emergency situations. MPCA & WPHCA Workplace Violence Training

37. Human Resources Policies • Employees and managers can always receive assistance from the Human Resources/Human Capital Division regarding inappropriate behavior in the workplace. • Inappropriate behavior includes fighting as well as threatening, intimidating, harassing, disruptive, or other harmful behavior. MPCA & WPHCA Workplace Violence Training

38. MPCA & WPHCA Workplace Violence Training Workplace Violence Planning Considerations

39. Response • Call 911 or other appropriate emergency contacts for the facility. • Secure your personal safety first—leave the area if safety is at risk. • Remain calm and contact the supervisor. • Contact other people who may be in danger. Keep emergency numbers for employees up to date and accessible. • Cooperate with law enforcement personnel when they have responded to the situation. Be prepared to provide a description of the violent or threatening individual, details of what was observed, and the exact location of the incident. MPCA & WPHCA Workplace Violence Training

40. Defusing Strategies • Adrenal cocktail—do not escalate • Calm, confident • Speak slowly, clearly, gently • Lower your voice • Listen • Create some space • Adopt a non-threatening body posture (open) • Reduce eye contact and keep both hands visible • Avoid audiences when possible MPCA & WPHCA Workplace Violence Training

41. If Violence Occurs • Sometimes, despite everyone's best efforts to defuse a situation, actual violence occurs. • If this happens, remain calm and do not put yourself or any staff member in a position to be injured. • You should call the appropriate officials for assistance. • Once the danger has passed, take appropriate disciplinary action. MPCA & WPHCA Workplace Violence Training

42. Recovering from Violence Incidents • Short and long term psychological trauma • Fear of returning to work • Changes in relationships with coworkers and family • Feelings of incompetence, guilt or powerlessness • Fear of criticism by leaders or supervisors MPCA & WPHCA Workplace Violence Training

43. Debriefing & After Action Reports • If violence in the workplace occurs, provide the necessary psychological support for staff, patients, etc. • Provide a debriefing session • Write up incident using a corrective action format so the organization can learn lessons from the event. • Strengthens • Areas of Improvements MPCA & WPHCA Workplace Violence Training

44. Helpful Resources and Links • FEMA Workplace Violence Awareness Trainings • IS-106.11 - Workplace Violence Awareness Training 2011 • IS-906 - Workplace Security Awareness • IS-907 - Active Shooter: What You Can Do • FEMA Active Shooter Preparedness Training Resources • California Hospital Association Active Shooter Training Video • MPCA Emergency Management Resources • WPHCA Emergency Management Resources MPCA & WPHCA Workplace Violence Training

45. MPCA & WPHCA Workplace Violence Training Member Hot Topics Discussion

46. MPCA & WPHCA Workplace Violence Training Tabletop Exercise Review

47. Questions? Comments? Lynda Meade, MPA Aleksandr Kladnitsky Program Director HPSA & Data Specialist Michigan PCA WPHCA 7215 Westshire Drive 5202 Eastpark Blvd., Suite 109 Lansing MI 48917 Madison, WI 53718 (517)381- 8000 ext231 608-443-2941 lmeade@mpca.net akladnitsky@wphca.org Nora J. O'Brien, MPA, CEM Principal Consultant Connect Consulting Services 1104 Corporate Way Sacramento, CA 95831 (916) 806-7361 NoraOBrien@me.com MPCA & WPHCA Workplace Violence Training