Health Center Emergency Management Education and Training SeriesWebinar # 3:

Workplace Violence: Plans, Tools, and ResourcesFebruary 13, 2013

Presenter:

Nora O’Brien, MPA, CEM

Connect Consulting Services

Together we are better and stronger

Joint education and trainingPeer-to-Peer learningWisconsin and Michigan have similar risksWe encourage participation as teamsAll webinars will be recorded and archivedSchedule

◦March 13th (virtual table top)◦May 8th

◦ June 12th

◦ July 10th

◦September 11th

http://www.mpca.net/

Facilitators and Presenter:Primary Care Associations

◦Michigan: Lynda Meade lmeade@mpca.net

◦Wisconsin: Aleksandr Kladnitsky akladnitsky@wphca.org

Presenter:◦Nora O’Brien, MPA, CEM Connect

Consulting Services

Nora O’Brien, MPA, CEMConnect Consulting Services

February 13, 2013

Workplace Violence:

Plans, Tools, and

Resources

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Presentation Agenda• Welcome and Intros• Workplace Violence Program Development• Workplace Violence Types• Planning Considerations• Policies and Procedures• Resource Links and Training

• Questions and Answers• Member Hot Topics• March Workplace Violence Tabletop Exercise

overview

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Bio: Nora O’Brien, MPA, CEM•CPCA•Created community health center - specific tools, EOP plan, and ICS trainings •Secured $28 million for CHCs in emergency supplies, planning, and training in HPP funding

•Connect Consulting Services • Healthcare emergency management firm that works

with healthcare organizations in 12 states•Center for Domestic Preparedness Instructor• Teach the Advanced Public Information Officer Course

for Hospital and Healthcare Emergencies• Masters of Public Affairs, Disaster and Emergency

Management; Certified Emergency Manager

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Training Objectives and Acknowledgements

Training Objectives• Recognize common warning signs of violent behavior• Understand the steps you can take to prevent workplace

violence, or effectively respond if it occurs. • Policies/Plans needed• Establishing a culture of safety and preparedness

AcknowledgementsMPCA and the WPHCA appreciates the New Jersey Primary Care Association, the Washington Association of Community and Migrant Health Centers, and NACHC for sharing their workplace violence training resources.

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WORKPLACE VIOLENCE TYPES AND DEFINITIONS

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Inflection of Voice Examples—How We Communicate

• I didn’t say you were stupid• I didn‘t say you were stupid• I didn‘t say you were stupid• I didn‘t say you were stupid• I didn‘t say you were stupid

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Workplace Violence is a Growing Concern

• Violence in workplace causes significant number of workplace fatalities and injuries. • Annually, 1.7 million American workers are directly

affected by assaults and violent acts.• The healthcare sector lead all other industries with

45% of all nonfatal assaults against workers resulting in lost work days in US. • Can strike anywhere, at anytime.

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What is Workplace Violence?

• Workplace violence is often thought of as a physical attack. But it may also include threats, intimidation, and other disruptive behavior, oral or written statements, and gestures or expressions that communicate a direct or indirect threat of physical harm.• Physical & Psychological • Threats/Harassment • Physical abuse• Cyber harassment • Bullying • Intimidation • Yelling/Cursing

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Four Types of Workplace Violence

• Type 1: Criminals/Strangers• Type 2: Customers/Patients• Type 3: Employees/Coworkers• Type 4: Related Parties/Personal Relations

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Type 1: Violence by Criminals/Strangers

• Type 1 violence includes violent acts by criminals who have no other connection with the workplace, but enter to commit robbery or another crime.• Such violence accounts for the vast majority

(nearly 80 percent) of workplace homicides. The motive is usually theft.• In many cases, the criminal is carrying a gun or

other weapon, increasing the likelihood that the victim will be killed or seriously wounded.

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Type 2: Violence by Patients/Clients

• Type 2 includes violence directed at employees by customers, clients, patients, students, inmates, or any others for whom an organization provides services.• Such violence can be very unpredictable. • It may be triggered by an argument, anger at the

quality of service, denial of service, delays, or some other precipitating event.

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Type 3: Violence by Employees/Coworkers

• The third type of workplace violence consists of acts committed by a present or former employee. • Such violence may be directed against coworkers,

supervisors, or managers.• Internal/External pressures, long hours, etc., may

increase stress and interfere with an individual’s ability to cope.

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Employee Behavior and Warning Signs

• Regardless of the type of workplace violence, the chances for prevention improve with increased awareness of potential warning signs and rapid response to a potential problem.• No one can predict human behavior, and there is no specific

“profile” of a potentially dangerous individual. However, studies indicate that incidents of violence are usually preceded by patterns of behavior or other activities that may serve as warning signs. • While there are no fail-safe measures to ensure that

violence will never occur, early action and intervention can serve to defuse a potentially dangerous situation and minimize the risk of violence.

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Warning Signs of Employee/Coworker

-Increased use of alcohol and/or illegal drugs-Unexplained increase in absenteeism-Noticeable change in appearance or hygiene-Depression/Withdrawal-Resistance & overreaction to changes in policy-Repeated violations of company policies-Severe mood swings-Noticeably unstable, emotional responses-Explosive outburst of anger or rage w/o provocation

-Suicidal comments-Behavior which is suspect of paranoia-Increasingly talks of problems at home-Escalation of domestic problems in the workplace-Talk of previous incidents of violence-Empathy with individuals committing violence-Increase in unsolicited comments about firearms, other dangerous weapons and violent crimes

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Employee Performance Indicators

• Attendance problems, such as excessive sick leave, excessive tardiness, leaving work early, or improbable excuses for absences.

• Decreased productivity, including making excessive mistakes, using poor judgment, missing deadlines, or wasting work time or materials.

• Inconsistent work patterns, such as alternating periods of high/low productivity or quality of work, exhibiting inappropriate reactions, overreacting to criticism, or mood swings.

• Concentration problems, including becoming easily distracted or having difficulty recalling instructions, project details, or deadline requirements.

• Adverse effect on supervisor's time when he or she must spend an inordinate amount of time coaching and/or counseling the employee about personal problems, redoing the employee's work, or dealing with coworker concerns.

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Employee Behavioral Indicators

• Continual excuses and blaming, such as an inability to accept responsibility for even the most inconsequential errors.

• Safety issues, including a disregard for personal, equipment, and machinery safety or taking needless risks.

• Unshakable depression, as exhibited by low energy, little enthusiasm, and/or despair.

• Evidence of serious stress in the employee's personal life, such as crying, excessive personal phone calls, or recent change in family/relationship status.

• Unusual or changed behavior, such as: • Inappropriate comments, threats, throwing objects, etc.• Evidence of possible drug or alcohol use/abuse.• Poor health and hygiene (marked changes in personal grooming

habits).

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Type 4: Violence by Related Parties/Personal Relations

• Type 4 includes violence committed in the workplace by someone who doesn’t work there, but has a personal relationship with an employee—for example, an abusive spouse or domestic partner.• In such cases, there is a greater chance that

warning signs were observed, but ignored—coworkers or managers may have believed the signs were not important or were “none of their business.”

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Domestic Violence at the Workplace

• DV is a pattern of coercive tactics which can include physical, psychological, sexual, economic and emotional abuse perpetrated by one person against an adult intimate partner with the goal of establishing and maintaining power and control over the victim. • Some abusive partners may try to stop their partners from

working by calling them frequently during the day or coming to their place of work announced.• Research indicates that about 50% of battered people who

are employed are harassed at work by their abusive partners.

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Confidential Policy for Domestic Violence

• Anti-Violence policies work best when there is also a general policy of confidentiality letting the victim know that their confidentiality will be maintained to the extent possible and underscore safety and respect for privacy. • De-Stigmatize domestic violence to increase

reporting• Custody dispute, divorce, separation and other

incidents

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Warning Sign Levels

• Warning signs of violent behavior may be classified into three levels. • Not everyone exhibiting warning signs will become

violent. However, no warning sign should be completely ignored. Any one or combination of warning signs, at any level, may indicate a potentially violent situation. • Level 1: Intimidation• Level 2: Escalation• Level 3: Further Escalation

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Level 1—Intimidation

• In Level 1, the person exhibits intimidating behaviors that are:• Discourteous/disrespectful,• Uncooperative, and/or• Verbally abusive

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Employee Responses

• Observe and document the behavior in question. • Report his or her concerns to the supervisor to

seek help in assessing and responding to the situation. • One technique for addressing the situation in a

respectful manner and establishing limits with the offending coworker is the use of “I” statements, such as:• “I don’t like shouting. Please lower your voice.”• “I don’t like it when you point your finger at me.”• “I want to have a good working relationship with

you.”

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Supervisor Responses

• The supervisor should meet with the offending employee to discuss the concerns.• If the offending employee is the reporting

employee's immediate supervisor, the employee should notify the next level of supervision. • If the offending person is not an employee, the

supervisor of the employee reporting the incident is still the appropriate individual to receive the information and provide initial response.

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Level 2—Escalation

• Argue with patients, vendors, coworkers, or management.• Refuse to obey agency policies or procedures.• Sabotage equipment or steal property for revenge.• Verbalize wishes to hurt coworkers or management.• Stalk, harass, or show undue focus on another person.• Make direct or indirect threats to coworkers or

management (in person, in writing, by phone).• View himself or herself as victimized by management (me

against them) and talk about “getting even.”

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Employee Responses

• Call 911, if warranted.• Secure the safety of self and others, if necessary.• Immediately contact the supervisor.• Document the observed behavior in question.

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Supervisor Responses

• The supervisor should consult with officials, such as functional area experts, for help in assessing/responding to the situation.

• Avoid an audience. Remain calm, speaking slowly, softly, and clearly.

• Ask the employee to sit, to see if he or she is able to follow directions.

• Ask questions about the complaint, such as: • What can you do to regain control of yourself?• What can I do to help you regain control?• What do you hope to gain by committing violence?• Why do you believe you need to be violent to achieve that goal?

• Direct aggressive tendencies into other behaviors, so the employee sees that there are choices about how to react.

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Level 3—Further Escalation

• Level 3 usually results in some form of emergency response. In such cases, the person displays intense anger resulting in:• Suicidal threats.• Physical fights or assaults of coworker(s) or

manager(s).• Damage or destruction of property.• Concealment or use of a weapon to harm others.• Display of extreme rage or physically aggressive acts,

throwing or striking objects, shaking fists, verbally cursing at others, pounding on desks, punching walls, or angrily jumping up and down.

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WORKPLACE VIOLENCE POLICIES AND PROCEDURES

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Workplace Violence Prevention Policies

• Promote sincere, open, and timely communication among managers, employees, and union representatives.• Offer opportunities for professional development.• Foster a family-friendly work environment.• Maintain mechanisms for complaints and concerns and

allow them to be expressed in a nonjudgmental forum that includes timely feedback to the initiator.• Promote “quality of life” issues such as pleasant facilities

and job satisfaction.• Maintain impartial and consistent discipline for

employees who exhibit improper conduct and poor performance.

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Reporting Policies • Report violent acts or threats of violence to your

immediate supervisor.• Information regarding a threat of a harmful act,

where you reasonably believe that the circumstances may lead to a harmful act, should be reported immediately. • All reports of incidents involving workplace violence

will be taken seriously and dealt with appropriately. • Individuals who commit such acts may be removed

from the premises and may be subject to disciplinary action, criminal penalties, civil litigation, or all of the above.

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Confidentiality Policies

• Managers and supervisors should preserve the confidentiality of employee complaints. • Share information only with those who have a

need to know in order to carry out official business. • Protect incident reports, related information, and

the privacy of persons involved, just as in other sensitive and confidential personnel matters. • However, there is an exception when there is

evidence of a direct threat or potential harm to self or others.

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Security Policies • Maintaining a secure and physically safe workplace is part of

any good strategy for preventing workplace violence. • Employee photo identification badges.• Onsite guard services.• Guard force assistance in registering and directing visitors in

larger facilities.• Other appropriate security measures (e.g., metal

detectors).• Employees should notify the appropriate security office or

designated police about suspicious or unauthorized individuals on agency property.

• Additional law enforcement assistance is available through local police departments for emergency situations.

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Human Resources Policies • Employees and managers can always receive assistance

from the Human Resources/Human Capital Division regarding inappropriate behavior in the workplace. • Inappropriate behavior includes fighting as well as

threatening, intimidating, harassing, disruptive, or other harmful behavior.

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WORKPLACE VIOLENCE PLANNING CONSIDERATIONS

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Response

• Call 911 or other appropriate emergency contacts for the facility.• Secure your personal safety first—leave the area if safety is

at risk.• Remain calm and contact the supervisor.• Contact other people who may be in danger. Keep

emergency numbers for employees up to date and accessible.• Cooperate with law enforcement personnel when they

have responded to the situation. Be prepared to provide a description of the violent or threatening individual, details of what was observed, and the exact location of the incident.

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Defusing Strategies • Adrenal cocktail—do not escalate • Calm, confident• Speak slowly, clearly, gently• Lower your voice• Listen• Create some space• Adopt a non-threatening body posture (open)• Reduce eye contact and keep both hands visible • Avoid audiences when possible

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If Violence Occurs

• Sometimes, despite everyone's best efforts to defuse a situation, actual violence occurs. • If this happens, remain calm and do not put yourself or any

staff member in a position to be injured.• You should call the appropriate officials for assistance.• Once the danger has passed, take appropriate disciplinary

action.

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Recovering from Violence Incidents

• Short and long term psychological trauma• Fear of returning to work• Changes in relationships with coworkers and family• Feelings of incompetence, guilt or powerlessness• Fear of criticism by leaders or supervisors

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Debriefing & After Action Reports• If violence in the workplace occurs, provide the necessary

psychological support for staff, patients, etc.• Provide a debriefing session• Write up incident using a corrective action format so the

organization can learn lessons from the event.• Strengthens• Areas of Improvements

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Helpful Resources and Links• FEMA Workplace Violence Awareness Trainings• IS-106.11 - Workplace Violence Awareness Training

2011• IS-906 - Workplace Security Awareness • IS-907 - Active Shooter: What You Can Do• FEMA Active Shooter Preparedness Training Resources• California Hospital Association Active Shooter Training

Video• MPCA Emergency Management Resources• WPHCA Emergency Management Resources

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MEMBER HOT TOPICS DISCUSSION

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TABLETOP EXERCISE REVIEW

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Questions? Comments?Lynda Meade, MPA Aleksandr Kladnitsky Program Director HPSA & Data SpecialistMichigan PCA WPHCA7215 Westshire Drive 5202 Eastpark Blvd., Suite 109Lansing MI 48917 Madison, WI 53718(517)381- 8000 ext231 608-443-2941 lmeade@mpca.net akladnitsky@wphca.org

Nora J. O'Brien, MPA, CEMPrincipal ConsultantConnect Consulting Services1104 Corporate WaySacramento, CA 95831(916) 806-7361 NoraOBrien@me.com

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