Violence against healthcare professionals is prevalent in Australia, with 87 percent of workers reporting at least one physical assault over a six month period.
With the rise of methamphetamine usage and the number of patients presenting to emergency wards with acute mental health problems, the issue is growing. Between 2016 and 2019 physical assaults in healthcare settings more than doubled throughout Australia.
As clinicians become increasingly aware of their right to a safe workplace, in line with other sectors, there has been mounting pressure to address the problem.
Steve Bills is Director of Security and Emergency Management for Australia’s largest public healthcare network, Monash Health. He says that while protocols for de-escalating violence exist, they often fail, leaving workers, equipment and patients vulnerable.
To help minimise the impact of workplace violence, he lists three simple strategies, ahead of the Safe & Secure Hospital & Healthcare Worker Conference hosted by Informa Connect.
#1 – Team building
Team building has far-reaching benefits in the context of security management, ensuring protocols are properly executed and team members held accountable.
“Often, and quite understandably, clinicians don’t want to be in charge of code greys*, meaning security staff are sometimes left to ‘hold the baby’ when a threatening situation arises,” said Steve.
“That’s a problem because security staff always need direction from clinicians before applying restraint techniques. For legal reasons, we cannot exercise discretion in that respect, and violence can quickly escalate as a result.
“Creating a team culture where everyone has clear roles in conflict resolution, based on their skill-set, and takes pride in their position, can make bad outcomes a lot less frequent.”
To foster teamwork, Steve believes making staff feel safe and valued is a good place to start.
“Showing workers you care about their safety by going the extra mile with security protocol and technology is really important. Staff that feel valued in this way are more likely to go the extra mile themselves when dealing with violence and aggression.”
#2 – Digital incident logging
Creating detailed accounts about instances of workplace violence is critical for working out what went wrong (and right), and mitigating repeat events. To this end, replacing handwritten reports with electronic logging has been a useful approach for Steve’s team.
“The electronic log we recently implemented is a fairly simple tool. We were initially sold on its ability to send out notifications to management when a code black has occurred. But an added benefit has been the speed of filling out reports, meaning staff often go into more detail about what happened.
“Since implementing digital logging, all conflict situations have been properly reported. This gives us more opportunity to review and assess responses and maintain an ongoing focus on continuous improvement.”
#3 – Understand risk factors and underlying conditions
Certain psychological conditions, including autism, can pre-dispose patients to physical outbursts. When de-escalating violence among this cohort, simple interventions can sometimes work.
“On one occasion, we found that providing a noise distraction helped diffuse a situation where a girl living with autism had begun physically lashing out at hospital staff. We simply shook a tin of mints and it really helped to calm her down,” said Steve.
Simple techniques can also work when de-escalating violence among children.
“Often diffusing conflict is about striking an instant rapport with the aggressor,” said Steve. “When the aggressor is a child, simple tricks like distraction can be very effective.”
#4 – Focus on positional awareness
Preventing bad outcomes in violent situations is not just about de-escalation or restraint. Often, simple strategies around positional awareness are key to preventing injury.
“Recognising where you are standing, what is around you, and which tools may be used as weapons is really important. Even seemingly harmless tools such as laptops and trolleys can be dangerous when in the wrong hands,” said Steve.
“The more teams plan and train around things like this, the less chance there is of people getting hurt.”
Steve Bills is the Director of Security and Emergency Management at Australia’s largest health network Monash Health. Steve, who oversees in excess of 1300 code greys every month, will give more expert advice at the Safe & Secure Hospital & Healthcare Worker Conference.
This year’s event will be held 23-24 November at the Swissotel Sydney.
*In NSW a ‘code grey’ is a universal alert code for a combative or violent patient.