VPP as a First Step in Preventing Workplace Violence

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By Chris Field, MBA

It was a simple matter really. A patient was informed that additional documentation was needed to complete her file. "Why? What do you need that for? I'm not going to do that. Who else does this stuff? Give me a list. I'm done with you," were the rapid-fire responses the unwitting front office specialist received from the angry patient standing in front of her.


After explaining the need for the documentation, the patient was still not satisfied. "I want to go somewhere else," she replied tersely. After again trying to appease the patient, and even asking a supervisor to assist, the staff gave up on the situation, and provided the patient with a list of neighboring providers. The patient then stormed out the door. The staff, though somewhat shaken by the incident, thought that was the end of the matter. They were wrong.


The patient called back after hours and left a hostile message on the office voicemail: "You're an ignorant S.O.B. and I hope you rot in hell. You will. I put a curse on you from my friend in Haiti. Watch you don't get killed in a car accident on the way home. You're ignorant and rude. Goodbye. Good riddance. Rot in hell."


The staff was extremely upset to receive this message. Not only was the wording offensive, there was also an implied threat to their physical well-being. Was anyone in imminent danger? Was there potential for violence? What would your response be?


While there may not be a definitive answer to prevent a unique case like this or any other, this article will provide some best practices and ideas about how you can guard your facility, your staff, and your patients against the potential of violence.


Workplace violence in healthcare settings is a frequent and well-documented occurrence. Between 2011 and 2013, the Bureau of Labor Statistics reported that workplace assaults averaged over 24,500 cases annually with over 70 percent occurring in the healthcare field. While that number is staggering, it is commonly held that not all workplace violence is reported, an assumption that would then place the number of incidents even higher. The nature of the work, the patient's physical condition, and the often astronomical financial obligations combine to create a situation that has the potential to turn violent. Considering this, what steps can your practice take to evaluate and identify potential violence initiators and causes, and what preventive measures can be implemented to minimize the possibility that your business will be affected?


Insufficient staff training in recognizing and managing escalating hostile behaviors, and a lack of facility policies and procedures are major organizational risk factors in appropriately responding to violent or confrontational encounters. The first step to prepare for such situations is to implement a sound violence prevention program (VPP). Many resources exist for developing a VPP program for your business, including the U.S. Occupational Safety and Health Administration website (www.osha.gov/sltc/workplace violence).


Your VPP needs to GUARD your facility through:


Let's take a closer look at each aspect of the program.


Goals and Objectives

What are you trying to achieve with your program? While each business will have its own unique goals for the VPP, they should exist to provide a safe environment for staff, patients, and the public to the extent possible. When you and your staff internalize this objective, it will transform the process from one of completing a task to one of potentially saving someone's life. List your objectives and let them serve as a beacon in guiding your program development.


Unique and Suitable

The best way to tailor a program to your company is to perform a thorough workplace analysis to identify areas of the physical building that may be isolated, poorly lit, or that contain objects that can be used to perpetrate physical violence. Are your facility's exam rooms locked? Can they be locked from the inside? Is cash kept locked away and out of view? Are security cameras and panic buttons in use? Do patients and the public have unrestricted movement and access throughout your facility? What channel is on the TV in the waiting room? Although it may seem insignificant, political or news channels can serve to incite violence and may be better avoided.


These are just some of the questions that need to be considered. The point of the workplace analysis is to gather as much input as possible. Ask employees to perform or participate in the analysis and actively seek their input.


A detailed checklist to evaluate workplace safety titled Workplace Violence Prevention Guidelines has been developed by the California Department of Human Resources. To access this resource, visit www.calhr.ca.gov/Documents/model-workplace-violence-and-bullying-prevention-program.pdf (Appendix E, pg. 47-51).



After completing the workplace analysis, begin educating your staff about workplace violence. Every employee should understand the concept of universal precautions against violence, when violence could be expected, and how it can be avoided or mitigated. The goals of the staff training are to increase awareness, provide the tools to identify potential hazards, and address problems before they arise. In addition to classroom training on safety topics, real-life practice situations, and possibly even self-defense and hostile intruder simulations should also be considered as part of your program.


Reviewable Guidelines

A key aspect of the VPP will be the regular review and evaluation of your company's safety and security measures. Evaluation will include the establishment of a uniform violence reporting system, a review of any safety/security meeting minutes, an analysis of findings, and program effectiveness as measured by reported incidents. It is important to remember that near misses need to be considered and evaluated just as diligently as actual events. If an incident should occur, ensure that the cause is identified and addressed to prevent a reoccurrence.


Deemed of Utmost Importance

The full support of management along with active employee involvement is a critical aspect of a successful VPP. Management support of the program can include acknowledgement of the value of a strong VPP, the allocation of monetary and physical resources, establishing a system of accountability for all levels of employees, supporting the staff recommendations, and demanding strong and thorough analysis and effectiveness reporting. While senior management support is critical, the employees on the front lines are just as important. Through their involvement and active participation, employees are best suited to provide the information necessary to create, install, and evaluate a successful VPP.


While workplace violence may not be prevented in every case, a comprehensive assessment of risk factors and assessment of violence hazards along with the implementation of a VPP can be excellent first steps in the prevention of an incident at your facility.


Chris Field, MBA, has worked for Boas Surgical, based in Bethlehem, Pennsylvania, for over 15 years. He serves as the treasurer of the Pennsylvania Orthotic and Prosthetic Society and was named the CFO of the Year by the  Lehigh Valley Business Journal in 2014. He can be contacted at cfield1185@gmail.com.