Prevent violence and aggression in healthcare and social assistance

How to prevent and manage workplace violence and aggression.

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Overview

How this helps your business

Being exposed to aggressive or violent incidents - especially if it happens repeatedly - can have serious, ongoing effects on your staff's physical and mental health.

When you understand the risk factors, you can find ways of working that reduce the risk of violence and aggression.

Developing a violence and aggression prevention policy makes it clear how you expect your staff, clients/patients and visitors to behave. It also helps to develop solutions, and shows you are committed to their health and safety.

Key stats and facts


95%  

Up to 95% of our healthcare workers have experienced verbal or physical assault. 


20%  

Only around 20% of healthcare workers report the verbal and physical assault they experience. 

Step 1

Show leadership commitment

Prevention and management of aggression and violence requires active engagement from all levels of your workplace, and needs to start with the board and senior leadership.

Board members and senior leaders can have a powerful influence when they communicate their commitment to a workplace culture free of aggression and violence and when they champion continuous health and safety improvements. Leadership needs to be active and visible in their commitment to prevention.

Senior leadership can show their commitment to preventing aggression and violence by:

  • setting prevention of aggression and violence objectives
  • identifying who is accountable in the health service, including the role of the board and the senior leadership, for the delivery of prevention
  • ensuring effective health and safety systems of work are in place to identify and control aggression and violence risks
  • allocating resources to prevention and management of aggression and violence
  • developing and promoting prevention of policies and key initiatives
  • consulting with and supporting employees about prevention of aggression and violence
  • monitoring and reporting on prevention of aggression and violence outcomes
  • acting on issues and opportunities so there is continuous improvement

Step 2

Share the campaign

There is a scale of violent and aggressive behaviours that can include:

  • aggressive gestures or expressions such as eye rolling and sneering
  • verbal abuse such as yelling, swearing and name calling
  • intimidating physical behaviour such as standing in someone's personal space or standing over them
  • physical assault such as biting, spitting, scratching, pushing, shoving, tripping and grabbing
  • extreme acts of violence and aggression such as hitting, punching, strangulation, kicking, personal threats, threats with weapons and sexual assault

None of these behaviours are ok, and no one should ever feel that it is 'part of the job'. Everyone has a right to feel safe at work.

In some workplaces, aggression and violence may be symptoms of clients'/patients' conditions, or part of how they express emotions such as frustration or confusion. Carers and clinicians are obliged to uphold the human rights of the people they care for. There is also a requirement for staff to be safe at work. This requires workplaces to use a risk management approach to focus on systems, design and processes to keep employees safe.

The WorkSafe resource includes videos, posters, case studies and brochures from the "It's never OK" campaign that explore aggression and violence in carer settings. Some are aimed at your staff while others are for the community. See page 9 of the SafeWork NSW 'Preventing and responding to work-related violence' resource for a brief example in a community services setting.

Step 3

Review your policy

Ensure your workplace aggression and violence policy is specific to your workplace and clearly sets out how everyone is expected to act. You can compare your policy with the resources below to identify any areas where you could improve.

Your staff must be involved in the development and review of your policy. They must also be clear on where the policy is located and how to action it. Whether your policy is a stand alone document or included in your general occupational health and safety policy, make sure you have a systematic way to share the updated policy with all of your staff. Once reviewed, and the updates shared, set a date for the next policy review.

Step 4

Investigate all incidents

Decreasing the number of aggressive and violent incidents starts with every event being reported and investigated. Watch the 'OVA Interviews Nurses' video to understand why this is so important, and hear from clinical educators how they've used the tool at work. Although the video is based in a hospital setting it is also relevant to other carer roles that work with clients and families.

WorkSafe's incident investigation tool helps you collect information about an incident, document the factors that may have contributed to it, and plan remedies to prevent a similar incident happening again. The tool is designed for a hospital environment, but you can adapt the tool to make it relevant for different settings within your workplace. As you work with the tool, consider the support that managers and supervisors may need to start using the tool themselves. For more information watch this 'OVA Incident Tool Instructional' video, or download the tool.

Step 5

Assess the risks

In some workplaces, there may not be a history of aggressive or violent incidents being reported, but this does not mean hazards do not exist. Completing a risk assessment of the hazards you have identified helps you and your staff to identify the most appropriate controls.

Hazards can be identified through:

  • Talking with your staff, or even through a staff survey (see example below)
  • Talking with your union representatives
  • Completing an organisational self-assessment (see example below)
  • Reviewing your incident reports and injury data (Step 4 in particular helps to make this data stronger)
  • Doing a walk-through at your workplace and look for possible design issues
  • Reviewing client/patient data for incidences of aggression or violence

The WorkSafe Victoria document below includes tools and templates to assist you to complete a risk assessment, and address systems, processes and design to keep your staff, clients and patients safe.

Organisational tools:

  • Organisational self-assessment
  • Staff survey

Design tools:

  • Design and aggression
  • Violence and the design process

Prevention tools:

  • Violence prevention policy
  • High-risk screening
  • Violence hazard identification and risk assessment
  • Behaviour assessment
  • Client alert
  • Warning notice
  • Conditions and agreement

Step 6

Assess all clients/patients

The most reliable predictor of aggression or violence is if the person has previously been aggressive or violent. Clients/patients with a history of aggression or violence should be identified and their aggression risk assessed. This information should then be effectively communicated to employees and other service providers as required, including when a person is being transferring to another service or facility.

There are a range of tools available – some directed at hospital and primary health settings, and others that relate more to residential care, mental health or disability settings.

A risk assessment should be conducted if conditions change or if there are any other indicators the behaviour might be a problem. An example of a high-risk screening tool for presentation (triage) and a tool for combined violence risk identification and assessment can be found in the WorkSafe Victoria 'Prevention and management of violence and aggression' guidance.

Risk factors and control measures for a particular client should be noted and highlighted in a care management or treatment plan, after completing a behaviour assessment worksheet.

For disability services who provide care to clients with behaviours of concern, a clinical risk assessment is an essential process. See the Department of Families, Fairness and Housing (DFFH resource for more information.

Step 7

Focus on safe design

Good workplace and work system design can reduce the risk of aggression and violence, enhance quality of care, and optimise workflow and communication. The design process should follow a risk assessment, involve consultation with your staff, and include aggression and violence prevention.

Use the 'Design and Aggression Audit Tool' in the 'Prevention and management of violence and aggression in health services' document to identify aggression risks that may relate to the design of an existing or planned workplace. There is also a chapter on workplace design that covers changes that can be made in the physical work environment.

The case studies below give an insight into some approaches workplaces in healthcare and aged care settings have used including:

  • behaviour management education for all staff and family members of clients
  • taking a regional approach to violence and aggression training
  • reducing aggression in the Emergency Department through a streaming model
  • focusing on violence and aggression in sub acute settings
  • reducing resident aggression through a new model of care
  • peer support following a critical incident
  • caring for patients with behaviours of concern

For staff caring for people living with dementia, the Dementia Behaviour Management Advisory Service can support staff in all care settings with advice around assessment, care planning, training options, evidence-based guidelines and more. See the Dementia Support Australia resource for details.

You can also visit the DHHS website to share information and resources to support continual improvement in managing occupational aggression and violence.

DHHS has a toolkit to assist health care and disability services staff complete quality behaviour support plans for people in care who have behaviours of concern. See the 'Other resources' tab at the top of this page to access their 4 stage behaviour support planning toolkit.

Step 8

Provide training

A comprehensive training needs analysis should be completed before any training programs are introduced. A needs analysis can be conducted using questionnaires, staff surveys or focus groups in specific work areas.

Training needs can also be identified through incident analysis, OHS systems reviews and the use of risk calculator matrixes. Use the tools in the WorkSafe Victoria document to complete your training needs analysis. DHHS also has a number of OVA training resources on the website below.

More resources

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