The Joint Commission has issued Sentinel Event Alert (SEA) 59: Physical and verbal violence against healthcare workers. This alert focuses on serious incidents (such as those we hear about on the news) but is also intended to ensure that everyday instances of workplace violence are not overlooked.

The alert was issued to help healthcare organizations “recognize and acknowledge workplace violence directed against healthcare workers from patients and visitors, better prepare staff to handle violence, and more effectively address the aftermath.”

Workplace Violence Defined

While it will be up to individual organizations to “specifically define acceptable and unacceptable behavior and the severity of harm that will trigger an investigation,” the SEA cites definitions of workplace violence provided by the CDC National Institute for Occupational Safety and Health, as well as the U.S. Department of Labor:

  • According to NIOSH, workplace violence is defined as “violent acts (including physical assaults and threats of assaults) directed toward persons at work or on duty.”
  • The U.S. Department of Labor defines workplace violence as an action (verbal, written, or physical aggression) which is intended to control or cause, or is capable of causing, death or serious bodily injury to oneself or others, or damage to property.

Physical and Verbal Violence in Healthcare

According to the Occupational Health and Safety Administration, more than 70% of workplace assaults that occurred between 2011 and 2013 took place in healthcare and social service settings. Furthermore, TJC’s Sentinel Event Alert data show “68 incidents of homicide, rape, or assault of hospital staff members over an eight-year period.”

And in fact, the numbers are likely even higher, given that incidents of workplace violence in the healthcare setting are often underreported. In short, healthcare workers are suffering from workplace violence at an alarming rate, and this violence is occurring across settings.

Areas such as the emergency department and inpatient psychiatric settings are areas of high risk, but other settings, such as home care, also present their own challenges. While nurses are usually victimized at the highest rate, the SEA notes that physicians, particularly emergency medicine physicians, and inpatient psychiatric workers are also frequently victims of workplace violence, whether physical or verbal.

SEA 59 is designed to help organizations better recognize and report these incidents, as well as reduce risks for staff:

“Each episode of violence or credible threat to healthcare workers warrants notification to leadership, to internal security and, as needed, to law enforcement, as well as the creation of an incident report, which can be used to analyze what happened and to inform actions that need to be taken to minimize risk in the future.”

What This Means for Hospitals

Sentinel Event Alert 59 recommends the following actions for healthcare organizations to address workplace violence:

  1. Clearly define workplace violence and put systems into place across the organization that enable staff to report workplace violence instances, including verbal abuse.
  2. Recognizing that data come from several sources, capture, track and trend all reports of workplace violence – including verbal abuse and attempted assaults when no harm occurred.
  3. Provide appropriate follow-up and support to victims, witnesses and others affected by workplace violence, including psychological counseling and trauma-informed care if necessary
  4. Review each case of workplace violence to determine contributing factors. Analyze data related to workplace violence, and worksite conditions, to determine priority situations for intervention.
  5. Develop quality improvement initiatives to reduce incidents of workplace violence.
  6. Train all staff, including security, in de-escalation, self-defense and response to emergency codes.
  7. Evaluate workplace violence reduction initiatives

The alert includes links to numerous related resources from OSHA and the CDC, as well as additional resources from TJC and the Centers for Medicare and Medicaid Services.

Survey Implications for Healthcare Leaders

Workplace violence is a complex issue for healthcare organizations, but an easy one for surveyors to scrutinize. Especially in HR interviews, surveyors will be asking what workplace violence the organization has experienced and what their policies are to prevent and respond to these incidents, as well as any training that has been provided to the hospital and medical staff.

Information shared during the HR interview may lead to further inquiries with the employee health department or environment of care committee regarding the OSHA workplace injuries and illnesses. Additionally, information gleaned from the emergency management/preparedness sessions may yield information about the organization’s response to active shooters, community unrest, or terrorist attacks and any lessons learned.

Surveyors may then carry over workplace violence discussions into the Leadership session as they evaluate the organization’s awareness of workplace violence, analysis of investigative reports (if any), training provided to staff, the organization’s response to actual incidents or practice drills, and any plans to mitigate future incidents.

Contact Us

If you have concerns about workplace violence in your organization or want to ensure that you’re prepared for this increased scrutiny, contact our office via phone at (513) 241.0142 or by email for a confidential conversation.

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