A Comprehensive Plan to Prevent Workplace Violence

Good morning!

There was a time during my parents’ generation when a trip to the hospital to visit a sick friend or family member was somewhat of a formal occasion.  They wore their nicer, “dressier” clothes and took on a more serious manner.  Children, if we were allowed to go at all, were kept on a short leash and meant to be seen and not heard.  Hospitals were generally quiet places where sick people were convalescing to recover from an illness, injury or surgical procedure.  Visiting hours were strictly enforced by stern-looking nurses in starched white uniforms. 

My word, how times have changed.  The patients are still here, but they are often more acutely ill.  The visitors come and go at all hours of the day, and the dress is much more casual.  T-shirts, shorts and jeans are standard attire.  The behavioral norm is much less formal as well – louder, at times more boisterous and expressive.  The language some people use can be coarse and laced with expletives. 

Of course, this trend that we see in hospitals is mirrored in society at large.  The social norms that prevailed in the 1950s and ‘60s have long since given way to a much more freewheeling, “anything goes” mentality.  In addition, people are much more likely to publicly vent their emotions, air their grievances and express their anger than in past decades, sometimes to the point of being physically threatening or violent. 

And that’s when it’s time to say, “enough is enough.”

A group of 25 UMMC faculty, staff and administrators has been studying this trend in workplace behavior for most of this year and is now poised to begin the rollout of a workplace violence prevention initiative.  This program is meant to communicate to our patients, visitors and employees that we have a zero tolerance policy for violence – and the behaviors that are often the precursors of violence – in the work setting.  It also establishes a system to report, monitor and respond to incidents of inappropriate behavior.

It all starts with a definition of workplace violence, as follows:

“Incidents where persons at work or on duty are abused, threatened or assaulted in the workplace.  These incidents may involve either intentional or unintentional risk of harm occurring, and may include instances of high risk that have the potential to result in harm, as well as overt acts of violence.”

Some of the behaviors that can tend to “create anxiety, fear or distrust in the workplace” include verbal abuse, emotional abuse, intimidation, threats, bullying, stalking, and sexual and other forms of harassment, all the way up to physical or sexual assault and battery and homicide.

We began more systematic tracking of these types of incidents more than a year ago in our Jackson hospitals and logged a total of 304 events in the 12 months ending in September.  About three-quarters of them were patient-employee encounters, 12 percent were between patients and 10 percent involved a visitor and an employee.

It’s important to note that these inappropriate behaviors extend to the way we treat each other as employees.  During that same time period, 55 employee-to-employee incidents were reported, including five that involved some sort of physical interaction.   

Additional accomplishments of the work group involved the establishment of an incident reporting mechanism through the iCare system; the creation of a three-tier classification system (yellow, orange, red) that describes a hierarchy of concerning behaviors and the measures staff can take in response; and participation in a national benchmarking study that is tracking workplace violence initiatives in 144 hospitals. 

The group’s next steps are to develop and roll out staff training in reporting workplace violence events, in how to use the classification system, and in managing/de-escalating aggressive behaviors.  In time, we will expand the focus to the ambulatory setting and the non-clinical parts of the organization.  The hospitals have been initial targets of these efforts because, frankly, that’s where the vast majority of concerning behavior occurs.

One of the most visible aspects of this initiative should appear soon:  Signs that inform patients and visitors of the aggressive/disruptive behaviors that will not be tolerated.  

I want to thank the members of the work group, led by Dr. Josh Mann, director of the Office of Well-being and chair of preventive medicine, for all the time and effort that have clearly gone into this comprehensive, thoughtful response to a growing problem. Space does not permit listing all the members of the work group, but special recognition goes to Elizabeth Toony (Risk Management), Skye Stoker (Office of Patient Experience), Kristin Dowdy (Batson Nursing Administration), and Sondra Redmont (Office of Well-being) for leading aspects of the work.

I want to be clear that the vast majority of our patients and visitors do not present any concerns at all with respect to workplace violence.  We appreciate them and are glad they have chosen UMMC for their care.  But for those few who push the envelope with provocative and threatening conduct (and that includes members of our own staff), we will not allow our employees and students to be subject to such behavior.

You will hear more about this topic in the future – I hope in the context that we have “turned the corner” on this issue – on our journey toward A Healthier Mississippi.