4 Things You Could Be Doing Right Now to Mitigate the Threat of Workplace Violence- Training, Training, Training (Part 3 of 4)

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This is a part three of a four-piece article written by guest contributor, David Corbin. He is the former Director of Facilities, Engineering and Public Safety & Parking at Newton-Wellesley Hospital. Corbin managed all aspects of Public Safety, Facilities, Engineering and Construction operations for a 3.6 million square foot, 313-bed institution. He created and held the co-chair positions for the hospital’s first multidisciplinary Infant Security Committee and Workplace Violence Subcommittee. Corbin has an extensive background in the security industry and consults on a national level. He is a Certified Protection Professional (CPP) and a Certified Healthcare Protection Administrator (CHPA).  Corbin obtained both a Bachelor’s Degree and Master’s Degree in Criminal Justice from Roger Williams University and Northeastern University respectively. Visit David’s website here.

Hospital Security Central

A nurse, checking in on her patient in the Emergency Department, suddenly finds herself pinned against the wall by the patient who was showing signs of escalation earlier. A transporter is walking to the ICU to pick up a patient when he hears what he thinks are gunshots behind him. The outcomes of both of these situations can be influenced by several factors, but one thing in particular can help both of these employees to prepare for and respond to violence- training. Now picture the same nurse noticing the signs of escalation earlier in her shift because of MOAB training and asking that another nurse or security officer accompany her into the room. The transporter who found himself in a potentially lethal situation now quickly and instinctively reacts by seeking shelter from the gunshots per the active shooter training he received. Both of these employees now have a better chance of staying safe and escaping harm because they were trained.

No matter how resource-rich your hospital is (I know, I don’t know of any either), you can’t have security everywhere all the time. Employees need to be empowered to keep themselves safe on a daily basis through appropriate, timely, and high-quality training. Today’s post focuses on getting the right training to the right people to prevent and intervene in workplace violence.

It’s no secret- every hospital in this country (and abroad) is experiencing workplace violence in some form on an increasingly more frequent and more intense basis nearly every day. If you don’t believe this is happening in your facility, talk to staff at all levels of the organization and you will likely see the undercurrent of violence begin to emerge. I know- this is gloomy stuff, but we are not helpless in the fight against this epidemic in our hospitals. Here are some steps you can take right now to determine if your current workplace violence prevention/intervention training program is appropriate or to form the foundation of a new training program:

Start From the Top

I know that I preach this in many of my posts, but you need buy-in from senior leadership to form a successful training program. Without their support, the training program will lack the support it needs to get off the ground and to keep running.  Sounds like a plan, but how can you get this done? Get your statistics around workplace violence in your facility together by pulling the incidents involving violence together from your security incident reporting system (if you have one) and your hospital’s incident reporting system for the past three years. Don’t forget to pull some example incident reports to illustrate some of the more serious situations that have occurred. Next, check with your Occupational Health Department for statistics around the number of injuries related to violence that they’ve treated over the last three years and the lost workdays (read: dollars and productivity loss) associated with these injuries. To assess the threat posed by your hospital’s surroundings, pull a SecurityGauge® Crime Risk Report. This will show the current, past, and future risk of crime in your area, including violent crime risk. The SecurityGauge® report in particular has a high predictive validity when it comes to future crime risk.

Once you have all of your data together, get it down to an easily digestible format (we’re talking charts and graphs here folks). You’ll also want to analyze the information you’ve gathered. What do I mean by analyze? Basically, you want to look for trends in the data, such departments or shifts that are more prone to violence.  Now, armed with some good data, you can go to your boss and get some support to put this information in front of senior leadership. But, don’t go to senior leadership half-cocked- you’ll need to show them your plan to address the issues you have identified. This is where training and education come into play. But, before you roll out training to the staff, you’ll need to take a few more steps, the next of which is to conduct a needs assessment.

Conduct a Training Needs Assessment

Now that you have looked at the data and analyzed it, it’s time to use that data to figure out who in the hospital needs what training. Typically, you will find that your hotspots for violence are the Emergency Department and Behavioral Health Units.  However, every hospital is different and violence knows no bounds within any institution. What we are really seeking to accomplish here is a risk and job-based approach to deciding what training staff will receive. For example, a nurse working in the Emergency Department is likely going to need de-escalation training and hands-on restraint/self-defense training while the environmental service worker in the same department may just need some violence awareness training. The difference in this example is that the nurse has direct patient contact, and, therefore, is more likely to encounter violence than the cleaner.

So, starting with the departments that are most prone to violence, develop a plan to keep those people safe through initial and ongoing training. Then work your way across the institution and decide how your training will reach staff at all levels. Sounds a bit daunting, right? It can seem a bit overwhelming, but why not take your first step by starting at the top again? Begin your workplace violence training with hospital leadership- executives, directors, managers, and supervisors. It’s important that these folks get the training they need to recognize, intervene in, and report violence.  Line staff will inevitably reach out to their leaders when they are feeling threatened or after an incident has occurred. How these leaders respond to their employees can make a world of difference in the employee’s overall feelings of safety and support when violence strikes. In the process of training them, you can also help your efforts to gain support for the line staff training you’ll soon be presenting.

Once the leaders are trained, then you can start getting their staff trained with staff in the highest risk areas receiving training as a priority. But what should they be trained in? That brings me to my next point- you must decide on the training content and frequency of training.

Decide on Training Methodology & Frequency

We’re now getting to the point where we are ready to decide upon what type of training we are going to roll out to our staff. Going back to the risk-based assessment that we conducted, we can tailor the training to different staff based on their potential exposure to violence. Starting with those at higher risk of violence, you’ll typically want to get them trained in a well-established de-escalation, restraint, and self-defense program. I know there are home-grown programs out there that some hospitals swear by, but liability is the name of the game when it comes to going hands-on with patients. Will your homemade program stand up to the scrutiny of the courts in a civil or criminal case? These are questions you need to ask yourself when looking for a training solution.

Two of the more well-established programs out there for de-escalation/hands-on training are Management of Aggressive Behavior (MOAB®) and Crisis Prevention Institute (CPI®). There are certainly other quality programs out there, but these two seem to be popular across the U.S. for violence training. Also, both of these programs require a re-certification every two years or so to keep employees up-to-date on their skills. These are both modular programs as well, meaning that you can train your high-risk staff on everything up to hands-on techniques and give your registration desk personnel de-escalation skills training only. The flexibility of these programs is key for consistency in training for staff. However, I know that many hospitals are limited by budgetary and time constraints for training, so this will certainly play into who gets what training. I know that MOAB® offers online-based training that can be used in place of classroom training, but this program won’t teach staff physical skills- that can only be done in the classroom.

So now that you’ve tackled (sorry- poor choice of words) the violence training for your high-risk staff, what will everyone else be getting?  I would suggest that all staff in the hospital receive at least a basic violence competency every year that includes education on the contents of your workplace violence policy, basic de-escalation tips, reporting procedures, emergency contacts/codes, and support resources.  This training can easily be put together in a PowerPoint slide deck that can be rolled out to staff through your online learning system or during their pre-scheduled in-service training.  Ultimately, what training everyone receives is going to be determined by leadership support, budgetary and time resources. If you can do more training- that’s great.  If you can only get bare bones awareness training out- it’s better than nothing.  Keep in mind that the training you push out will help to empower hospital staff to take charge of their own safety on a daily basis.  Speaking of taking charge- who’s going to conduct all of this great training? Good question! That’s the next step…

Decide Who Is Conducting Training

Who is best suited to conduct all of this training? Oftentimes, it’s the members of the Security Department. However, it’s important to tap into the expertise you likely already have in your institution to establish a more collaborative approach to educating hospital staff. If you’re going with MOAB®, CPI®, or similar training, most of these programs offer a train-the-trainer course, which is ultimately the more cost-effective way to get this training done. What I typically see in hospitals is that security has a trainer along with a trainer in the emergency department and the behavioral health unit. I would suggest that these trainers hold joint classes so that staff from these departments can get to know one another and learn from each other’s expertise.

You’ll want to select the right people as instructors- engaging, professional, experienced trainers make a world of difference in how the training is conducted and received. As for the training for the rest of the house- think about pulling in the expertise from departments across the hospital (your workplace violence committee, if you have one) to develop this material. You may decide to get this training out in a classroom, online, or a combination of both. Again, your choice of instructors for classroom training is going to ultimately determine the success of the training. So now we’re all set, right? We know who is going to get the training, what training they’re getting and how. Not so fast- there’s one last and very critical step– that’s documentation.

Document Your Training!

Your training might as well not exist if you don’t document it. Every hospital has a means to document training, so it’s important to connect with the key people that keep track of training for the institution. The regulatory and accreditation bodies that govern your hospital will look for this information during inspections and in response to complaints. It’s also possible that this paperwork will be subpoenaed as part of a civil liability case. So, don’t forget this very critical step.

Wrapping It All Up

There it is- an overview of considerations when you’re developing your violence prevention training program. Now it’s time to sell the program to senior leadership to get the support you need and start moving forward. Or, perhaps it’s time to look at your existing program and make some tweaks. Regardless of your next steps, it’s important to keep training at the forefront of your workplace violence prevention program.

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