PREVENTION

Violence in the healthcare industry, like any other threat to the safety of the workplace can be effectively managed by a well supported, proactive safety program. Why the Safety Program? Unfortunately, along with maintaining a hazardous chemical inventory, developing ergonomics/workman's compensation programs, fire safety training, a comprehensive safety program must include a violence prevention/preparedness component. Placing the responsibility of prevention, education and emergency preparedness as they pertain to workplace violence under the direction and authority of the Safety Program & Committee will:

• Insure a multidisciplinary team approach to managing identified problem areas
• Avoid territorial issues
• Communicate the importance of the prevention/preparedness program to all employees.

To begin addressing an issue with such far reaching and potentially disastrous outcomes, requires a total commitment from top management. The lack of top management commitment will result in futile attempts to garner employee support for such a program. Top management must insist on a "Universal Zero Tolerance" policy. Simply stated, "Violence of any type, which can range from intimidation, threats, harassment to assault, rape and even homicide, will not be tolerated. Any and all violators of this policy, no matter what position they occupy on the organizational chart or within the community, will be dealt with in a swift, judicious and definitive manner." The establishment of such an organizational policy will empower the multidisciplinary Safety Committee/Team to move forward with program development. The multidisciplinary team approach is essential to successfully developing a complete workplace violence program. The team approach will focus on problem solving, emphasize corrective action and eliminate the placing of blame.

Team membership should include representatives from all departments of the organization. Chairperson duties should be assumed by the Director of Safety or the facility Safety Manager. It is vitally important to include a union representative, Equal Employment Opportunity representative and the Employee Assistance Program counselors. These individuals will have valuable insight into employee concerns, wants and needs.

Committee membership should be on a rotating basis, involving as many people in the problem solving process as possible. The establishment of the team complete, the next item on the agenda is the development of a system that will clearly communicate, to the entire organization, the mission, vision, goals and objectives of the committee when it comes to addressing workplace violence.

There is no room for secrecy. The more information shared and communicated, the more comfortable the work force will feel, dealing with the changes occurring around them. Remember, a tightening of security, a heightened awareness and openly speaking to the fears of concerned employees, may create an uncomfortable, uneasy atmosphere within the organization. Ironically, people may feel more vulnerable because of the new openness, "Things like violence in the workplace were never talked about before. I can't believe that would happen here." Consequently, it is extremely important to listen to employee concerns, encourage further discussion/openness and provide support through action. You may encounter a group of "nay sayers", which should be expected with any organizational change. Be aware of these individuals and any attempts to hinder or derail the efforts of the organization.

The organizational policy in place, the team membership solidified, the mission, vision, goals and objectives identified, the next item on the agenda is; a facility-wide security/safety assessment aimed at preventing violence in and around the facility.

The facility assessment should be conducted by the entire team in two parts.

Part I

Part I of the facility assessment consists of a floor by floor, office by office inspection of the facility and grounds. The assessment team should make note of the following:

• Hidden doors, closets, hallways, driveways, etc.
• Isolated work areas
• Hours of operation which may create an isolated work area
• Adequate, available lighting
• Unrestricted areas (where unauthorized individuals can gain access)
• Work areas where staff work alone
• Appropriate locks on doors and windows
• Appropriate, accessible alarm systems (fire, duress)
• Adequate, clearly identified escape routes
• Employee concerns in the inspected area
• Overall security of the area

• ID Badges
• Security/surveillance Cameras
• Card (bar coded) access systems
• Metal detectors
• Armed guards
• Guard dogs
• Bullet proof glass/partitions/barricades
• Escort system
• Buddy system

A thorough review of the workplace concentrating and focusing on providing a non-threatening, user friendly environment is the subject of Part II of the facility assessment.

Providing such an atmosphere can be accomplished through the following:

• Bright (natural lighting when possible), clean, comfortable, cheerful waiting areas and office space
• Eliminate cramped, confined waiting areas and office space
• Provide visitors, customers (external) with distractions such as music, magazines, video games, TV, aquariums, plants, refreshments, waiting time updates, etc.
• Decorate in soft, natural colors
• Art work
• Comfortable furniture
• Carpeting (reduces background noise)
• Access to public telephones and bathrooms
• Flexibility ( be prepared to address a person's immediate needs)
• A comprehensive internal/external customer (human) relations program
• Access to a customer (human) relations representative

A complete facility assessment without a comprehensive training program to compliment and back up any proposed changes is time wasted. A training program that addresses the problem of violence in the workplace must contain the following components:

• Problem Awareness
• Personal Safety (in and out of the workplace)
• Employee's and employer's responsibilities in maintaining a safe workplace environment
• Warning Signs of potential problems
• Problem Reporting (mechanisms)
• Verbal, Nonverbal De-escalation
• Conflict Resolution
• Domestic Violence
• Crisis Management
• Critical Incident Response
• Negligent Hiring/Retention
• Customer (human) Relations
• Employee Assistance Programs

PREPAREDNESS

The importance of communication cannot be over stated. The key to any successful prevention program is the sharing of information, education and ideas. A violence in the workplace prevention program is no exception to this rule. Like any other prevention program, complete safety and security from danger or accidents cannot be guaranteed. The steps already outlined in this article will provide the reader with the basic tools to create a comprehensive prevention program.

Despite all efforts to prevent a violent incident from occurring, the chances of an unfortunate event taking place in your workplace, are very real. The key question to ask management is, "when" not "if" a situation occurs, will this organization be ready to respond in an organized and coordinated manner?

Make no mistake, a violent incident in the workplace, is a disaster situation and like any other disaster situation, a rapid, coordinated and trained response is essential to preventing further injury, damage and death.

The Occupational Safety and Health Administration requires that employers provide their employees with annual fire and safety training. In addition, many organizations are required to have some type of emergency preparedness response plan in place to deal with a natural or man-made disaster that may require the evacuation of the facility. Unfortunately, the realities of living in the nineties requires an emergency response plan that addresses workplace violence. Oklahoma City will forever be a testimony to the necessity of an organizational response plan ready to deal with the unthinkable.

If the organization for which you work does not have an emergency response plan or does not address the following:

• Harassment
• Robbery
• Threats
• Assaults
• Rapes
• Homicide
• Domestic violence
• Stalking
• Hostage/barricade incidents
• Terrorist attacks

An emergency response/preparedness plan is only as good as the last time the plan was exercised. This means, "practice the plan you have developed on a regular basis." The response plan exercises can take the form of table top discussions or actual hands on scenarios. All aspects of the plan must be practiced, reviewed and refined. At the completion of each exercise a critique should be scheduled within the first 24 hours. The critique functions as a way for all the players to review their participation and suggests improvement in a constructive setting. The critique also functions as a time for the players to debrief each other and share their feelings regarding the disaster scenario, the victims and the response. Once all individual aspects of the plan have been exercised, an exercise that will test the entire plan can be scheduled and executed.

It is in the best interest of your organization to extend an invitation to local law enforcement, fire departments and emergency medical organizations to either observe or participate in the planning and/or actual disaster exercise. These departments will be responding in a real time incident, not only will these individuals be familiar with the plan and the facility, they will be familiar with the organization's personnel. Obviously, having the chance to meet, greet and discuss plans before there is a need for implementation will greatly enhance cooperation and coordination.

CONCLUSION

The day that we baby boomer's began planning for our future careers, the subject of violence in the workplace was not a concern. The potential for violence erupting while on the job was only a reality for those individuals in the field of law enforcement. Americans have been forced to give up many pleasures such as nightly walks, bike rides in the park and visiting your corner store because of the threat to personal safety. Most disturbing of all, our children can no longer have the care free independence that many of us enjoyed as a child. The information presented in this article will not eliminate risk, the information will provide your organization with the building blocks for developing a program to manage the risk.

Paul D. Kim, M.D. and John N. Sabourin together have over 30 years of experience in emergency preparedness, crisis management, occupational health/safety and law enforcement. They are co-founders of SK CONSULTING, INC., a Pittsfield, Massachusetts based company that addresses occupational health and safety issues. The much sought after SK CONSULTING, INC. Violence in the Workplace training seminars and assessments have assisted a wide range of organizations in successfully managing this growing problem. If you would like further information please call (413) 443-3396 or (401) 331-2911

PAUL D. KIM, M.D.

Dr. Kim graduated from Fordham University in May of 1980 with a BS in Psychology. In 1985, Dr. Kim graduated from the University of Juarez, Mexico with a Doctor of Medicine Degree. Dr. Kim completed his third and forth year of clinical rotations at Berkshire Medical Center in Pittsfield, Massachusetts.

Dr. Kim was employed by Four Winds Hospital in Saratoga, New York from 1986-1989, where he was actively involved in crisis management.

Dr. Kim's desire to enter the field of health care administration and management brought him to the Stratton Department of Veterans Affairs Medical Center located in Albany, New York in January of 1989, where he joined the administrative staff.

In response to the involvement of the United States in Operation Desert Shield/Storm, Dr. Kim was appointed as the Emergency Preparedness Coordinator for the medical center.

Unfortunately, preparing a medical center for a disaster situation that requires a massive medical response is not limited to hurricanes, tornadoes, earthquakes, fires and military conflicts. Preparedness in the nineties includes recognizing and responding to workplace violence.

During the last three years Dr. Kim has researched the growing problem of violence in the workplace and has lectured extensively on recognizing problems before they escalate, responding appropriately to threats and has trained personnel on how to insure safety in the workplace. The programs developed by Dr. Kim have drastically reduced violent problems and staff injury by teaching the employers and employees that a commitment to "stop the violence before it begins," must exist at all levels of the organization.

Dr. Kim promotes a "ZERO TOLERANCE" policy that can easily be adapted to any current work environment.

JOHN N. SABOURIN

Mr. Sabourin is currently the Safety and Occupational Health Manager for the Providence VA Medical Center.

Mr. Sabourin holds an AS degree in Law Enforcement and a BS degree in Fire Science. Prior to receiving his degrees Mr. Sabourin served in the United States Navy for four years and completed a tour of duty in Vietnam. Mr. Sabourin was also a police officer and a firefighter Lieutenant for the city of Providence, Rhode Island. Recently he was nominated for Federal Employee of the Year in the Administrative Category.

Mr. Sabourin's energy and expertise in the field of safety has had a profound impact on the quality of safety, not only at the Providence VA Medical Center, but also at other local, state and federal agencies.

He has been instrumental in designing a model Accident Reduction Program which, when implemented, resulted in one of the lowest lost-time incident rates in the VA health care system. During the past several years Mr. Sabourin's program has deferred several hundred thousand dollars in lost productivity and compensation costs. As a result, Mr. Sabourin has received national recognition for this program.

Mr. Sabourin has been recognized by the Assistant Secretary of Labor, OSHA (Occupational Safety & Health Administration) as the Chairperson for the Southeastern New England Federal Safety and Health Council for his management of the best of 88 national councils, during 1994. Mr. Sabourin recently received notification that through his leadership the Southeastern New England Federal Safety and Health Council will again be recognized as the #1 of 88 councils for 1995.

As a key member of the Secretary of Labor, OSHA Task Force, Mr. Sabourin has been responsible for addressing violence in the workplace and developing programs that have been implemented within his organization to deal with this growing problem.

The extensive background in occupation safety and involvement in workplace violence programs has provided Mr. Sabourin with a wealth of information that he shares through his extensive and busy lecture circuit on the local, state and federal level.