Workplace Violence and Harassment Prevention
Workplace Violence in Continuing Care
In recent years, the health care sector has witnessed an increase in the occurrence of violence and aggressive acts towards staff. In fact, over the last 5 years, “assaults/violent acts/harassment’ remains one of the top 5 types of injuries reported to WCB in both long-term care and senior supportive living industries (See the latest report).
According to WCB data analyzed for the Alberta continuing care sector: from 2019 to 2023, Workplace Violence related Lost time injuries have doubled since 2018 with continuing care home type A reporting at three times the rate of reports in CC Type B, supportive living and senior’s housing. Nevertheless, both continuing care and Supportive Living and Senior’s Lodges show an increasing trend over the years. In fact, over the last 5 years, “assaults/violent acts/harassment’ remains one of the top 5 types of injuries reported to WCB in Continuing Care Homes Type A, B, supportive living accommodations and senior’s lodges.
Though statistical information is often contingent on many variables, evidence suggests that the risk to health care workers experiencing violent, aggressive, or harassing behaviour is nine times greater than in any other industry. In the continuing care sector, anecdotal evidence also suggests as the population ages and the continuing care sector continues to grow, so will the number of incidents.
CCSA Workplace Violence and Harassment Prevention Program
Request for CCSA Guided Support in Building, Reviewing or Evaluating Your Program:
The CCSA aims to reduce the injury rates in continuing care and senior supportive living industries by providing targeted resources to promote the adoption of effective violence prevention initiatives; prevent incidents or injuries caused by violence and acts of aggression, and build a more robust culture of safety. The CCSA also aims to guide our members in building their organization’s Violence and Harassment Prevention Program through focused consultations and collaboration.
After receiving your request, a CCSA Health and Safety Consultant will connect to start collaborating with your organization to assess your site’s needs and guide you through the Five Step Process of developing, reviewing, or evaluating your Workplace Violence and Harassment Prevention Program. This comprehensive approach may also include tailored training options – all designed to foster a robust culture of safety:
“Managing Workplace Violence, Harassment, and Responsive Behaviours”
This 2-hour interactive on-demand course prepares you to handle challenging situations through industry-specific real-life scenarios. Featuring 360-degree videos, branching decisions, and animated scenarios, you’ll test your de-escalation skills. By the end, you’ll be equipped to address violence, harassment, and responsive behaviors professionally, prioritizing safety for yourself and others.
“Managing Workplace Violence, Harassment, and Responsive Behaviours”
An Introduction to CCSA’s Psychological Health and Safety Program along with a CCSA’s Managing Violence Harassment and Responsive Behaviours Virtual Reality application provided on-site at your facility.
Pre-requisites: Complete 360-Video On-Demand Course and participate in the CCSA’s Workplace Violence and Harassment Prevention Program.
3D Virtual Reality scenario application – a brief yet effective training tool lasting only five minutes that has demonstrated its effectiveness:
- replicates a complex organizational environment and teaches participants the skills necessary to intervene when they experience or observe workplace violence or harassment;
- provides learners with an opportunity to apply their knowledge in a safe and controlled environment.
“Managing Workplace Violence and Aggression”
This in-person or virtual instructor-led course addresses the serious topic of violence in the workplace and how to prevent it. As per best practice, we embrace a holistic, team-based philosophy and use group activities that facilitate openness, cooperation, and discussion. By the end of the course, you will have the knowledge and mindset you need to reduce the risk of violence and harassment for yourself and those around you.
This course can be requested by organization or advised by CCSA.
The Five Step Process to building or evaluating your Workplace Violence Prevention Program:
Securing Leadership Commitment
Assessing Your Program Needs
Developing the Program Components
Implementing the Program
Evaluating the Program
Securing Leadership Commitment
Effective leadership and enhanced accountability are critical in any workplace safety program, which includes violence and harassment prevention. Leadership’s commitment to preventing workplace violence provides the necessary resources and clear directions for workers and employers to successfully implement a workplace violence and harassment prevention program and make it a priority to continually improve.
Workplace violence prevention must be a clear priority for all. It is recommended that:
- CEOs create and implement a strategic plan that places importance on the creation of a working environment free of violence for workers and patients;
- The strategic plan is shared with everyone in the working environment;
- Targets are set for reducing workplace violence;
- Achievements towards those targets are shared and monitored by the most senior committees and the HSR/HSC; and
- Members of the board of directors maintain oversight of its outcome.
Promoting a culture of safety – one that ensures the best patient care is delivered within a violence-free working environment – begins with members of the Board of Directors and senior leadership.
This is accomplished by:
- Promoting reporting of incidents/events;
- Staff who feel supported, heard, and protected when reporting hazards; and
- Staff and HSR/HSCs members who feel supported and heard by providing input into policy, measures and procedures, and training that could positively impact worker safety. Everyone, from the members of the Board of Directors to patients and families, must understand how they contribute to a violence-free workplace, and become champions to implement change.3
Securing commitment for a successful program also requires leaders to understand their overall responsibility and accountability for workplace safety.
To ensure ongoing program sustainability, organizations should integrate health, safety, and wellness into an organization’s core business through a Health and Safety Program or an organization’s OHSMS.
The Health and Safety Program/OHSMS can be utilized to motivate an organization to achieve employee health, safety, and wellness, provide quality care and embrace public safety. Successfully implemented, an HSMS will lead to a positive culture of health, safety, and wellness. The CSA standard Z1000 (Plan, Do, Check, Act) and the CCSA’s Health and Safety Program Review can identify gaps in the organization’s OHSMS and helps mitigate employee, resident, and public risks. For more information refer to the CCSA Health and Safety Toolkit.
Training to support Step 1:
Assessing Your Program Needs
A strong workplace violence prevention program should include a comprehensive risk assessment and a plan to reduce those risks. Workplace violence is a hazard that all workplaces should continually strive to prevent and control.
The Alberta Occupational Health and Safety Act requires employers help prevent workplace harassment and violence and address incidents when they do occur. A risk assessment is essential to identify the specific risks of exposure to violence in particular work settings. It also helps put in place controls to prevent and minimize workplace violence. To develop a successful violence prevention program, it is essential that workers, employers, the HSC/HSR and unions participate and cooperate to identify and assess risks in the workplace.
You are encouraged to involve workers, supervisors, health and safety and/ or workplace violence prevention committees, health and safety representatives, and/or unions in this process.
Assessing the risks associated with workplace violence should include an assessment of:
- Internal documents such as:
- Employee feedback from company “suggestion boxes”;
- Security logs;
- Reports about emergencies, incidents and accidents;
- The minutes from joint health and safety committee meeting;
- Workplace inspection reports;
- Reports generated through collective agreements;
- High-level Employee Assistance Program usage reports (which do not identify individuals);
- Grievances; or,
- Workplace Compensation Board (WCB) Claims;
- The organization’s physical environment;
- The work setting and clients;
- Community workplace violence issues;
- Point-of-care work practices;
- Staff perceptions.
Developing Program Components
To ensure a comprehensive program, organizations must design a Workplace Violence Prevention Program that consists of a workplace violence prevention policy and a program that includes; reporting, response and investigation procedures; environmental control procedures; work practice and administrative control procedures.2
The Prevention, Protection, and Post-incident Response (the 3 P’s) conceptual model was adapted from risk management practices (Wiskow, 2003) that are widely accepted and used in the occupational health and safety industry.
To adequately address workplace violence aggression, and responsive behaviour, organizations should take a three-pronged, cyclical approach: Prevention, Protection, and Post-incident Response (the 3 P’s). Wherever possible, the emphasis should be on implementing measures to prevent the workplace violent event. Organizational culture may affect the success of each prong.4
Prevention involves strategies undertaken prior to an incident to deter the onset of workplace violence. Four important stages include:
1. Recognizing risks;
2. Assess existing precautions and prioritizing risk;
3. Controlling and communicating risk;
4. Evaluating and refining the action plan, i.e., R.A.C.E. information gathered in Step 2 complete the first 2 stages of Recognition and Assess. This information should be used to develop the measures and procedures to Control the hazards identified.4
Resources for “preventing” injuries may include:
Procedures to control Administrative and Work Practice hazards such as:
- Client assessment and screening
- Flagging alert Program
- Triggers and care planning
- Engaging patients and families in workplace violence prevention
Protection focuses on strategies undertaken during an incident to manage workplace violence and limit the extent of harm.
- Activities may include:
- Early identification of violent, aggressive, or responsive behaviour;
- De-escalation and diffusion techniques;
- Avoiding physical contact where possible;
- Protocols for managing individual behaviours;
- Use of coded requests for help;
- Crisis management training;
- Prompt and appropriate attention by managers;
- Mobilization of resources and security measures; and
- Keeping safety a priority.4
Resources for “protecting” workers may include:
- Policy and procedure development for Reporting of incidents.
- Security and Personal Safety Response System Programs and Tools
- Code White Response procedures
- Procedures to control Administrative and Work Practice hazards such as:
- Preparing for a meeting with a potentially violent client
- Work-related travel
- Working alone or in isolated areas
- Behavioural contracts between client and facility which outline agreed-upon behaviour, treatment and expectations
- Working in the community –CCSA Assessing Violence in the Community: A Handbook for the Workplace
- Dealing with visitors and the public
Post-incident Response strategies are undertaken after an incident has occurred to reduce long-term negative effects on the victim(s), other people involved, and the workplace following the incident.
- Suggested post-incident responses cover the following:
- Assistance and support for victims;
- Information-sharing and team debriefing;
- Reporting procedures, and workplace investigations to prevent recurrence.4
Resources for “post incident response” may include:
- Systematic Approach to Post Incident Follow Up – RCA, incident Debriefing- including steps taken to prevent a recurrence
- Victim assistance and support (Incident and treatment options such as EAP, in house resources, or peer counselling).
References:
2. PSHSA – A guide to the Development of a Workplace Violence Prevention Program: Implementing the Program in your Workplace;
4. Guidelines on Workplace Violence in the Health Sector. Comparison of major known national guidelines and strategies: United Kingdom, Australia, Swede, USA (OSHA and California) Written by Christiane Wiskow (2003) for International Labour Office, International Council of Nurses, World Health Organization, Public Services International.
Implementing the Program
To ensure all staff are aware of your Workplace Violence Prevention Program, develop a detailed plan for implementing the workplace violence prevention program that includes marketing and communication strategies.
Staff must also be trained on measures and procedures to protect themselves. Training should be mandatory and incorporated into the orientation and regular (annual) education programs. The design of the educational and training programs should reflect the specific needs of the staff. Information from the needs assessment phase of the program development strategy should be incorporated into the design of the education and training programs. All education and training programs must be evaluated in terms of employee comprehension, quality of learning, change in practice or behaviours, and organizational performance.
Evaluating the Program
An organization cannot evaluate effectiveness without measuring indicators. Measuring and evaluating your program is vital in guiding program improvement. Evaluation is a critical component of a workplace violence prevention program to determine the program’s effectiveness and highlight opportunities to enhance the program. The set of indicators should be comprehensive, include both leading and lagging indicators from Qualitative and Quantitative sources, and enable performance measurement and reporting at the provincial and the local level.
Goals of program evaluation:
- Create and maintain a safe working environment without the threat of violence
- Review, revise, enhance and improve program components
- Identify and implement corrective measures that may prevent subsequent violent situations
- Modify the program when insufficiencies are identified in policies, procedures, and employee training/education
Quantitative sources of information:
- Violence reporting data
- Environmental assessment data and workplace inspection reports
Qualitative sources of information:
- Data from training evaluations, staff surveys, compliance audits 2
Resources for evaluating your program:
Review Your Existing Workplace Violence Prevention Program:
Continuing Care Tools
Long Term Care and Facility Living
Community and Senior's Housing Tools
Senior's Housing, Independent Living
Additional Resources: Standards and Best Practices
This whitepaper delves into various trends and strategies, evaluating their effectiveness and impact in different operational contexts. It highlights psychosocial risk factors, including burnout, turnover rates, and the impact of regulatory compliance on staffing decisions. By understanding these elements, organizations can develop robust staffing models that not only enhance worker well-being but also minimize risks of violence and harassment and improve overall service quality.
The OHS Act and Code requires employers in Alberta to assess the risks of workplace violence, and to put in place a policy and a prevention program.
Workplace Violence Prevention is a Required Organizational Practice (ROP). A strategy to prevent workplace violence should be in compliance with applicable provincial or territorial legislation and is an important step to respond to the growing concern about violence in healthcare workplaces.
Accreditation Canada Required Organizational Practices (2020) – Workplace Violence Prevention
A documented and coordinated approach to prevent workplace violence is implemented.
Accreditation Canada has adopted the modified International Labour Organization definition of workplace violence, as follows: “Incidents in which a person is threatened, abused or assaulted in circumstances related to their work, including all forms of harassment, bullying, intimidation, physical threats, or assaults, robbery or other intrusive behaviours. These behaviours could originate from customers or co-workers, at any level of the organization.”
The Registered Nurses Association of Ontario describes four classifications of workplace violence:
- Type I (Criminal Intent): Perpetrator has no relationship to the workplace.
- Type II (Client or Customer): Perpetrator is a client, visitor, or family member of a client at the workplace who becomes violent toward a worker or another client.
- Type III (Worker-to-worker): Perpetrator is an employee or past employee of the workplace.
- Type IV (Personal Relationship): Perpetrator has a relationship with an employee (e.g., domestic violence in the workplace).
A strategy to prevent workplace violence should comply with applicable provincial or territorial legislation and is an important step to respond to the growing concern about violence in healthcare workplaces.
Test for Compliance:
Major:
- There is a written workplace violence prevention policy.
- The policy is developed in consultation with team members and volunteers as appropriate.
- The policy names the individual(s) or position responsible for implementing and monitoring adherence to the policy.
- Risk assessments are conducted to ascertain the risk of workplace violence.
- There are procedures to investigate and respond to incidents of workplace violence.
Minor:
- There are procedures for team members to confidentially report incidents of workplace violence.
- The organization’s leaders review quarterly reports of incidents of workplace violence and use this information to improve safety, reduce incidents of violence, and improve the workplace violence prevention policy.
- Information and training is provided to team members on the prevention of workplace violence.
Resources: Required Organizational Practices 2020 Handbook. Qmentum. For on-site surveys starting January 2021
CSA Z1002-12: Occupational Health & Safety Hazard Identification, Elimination, and Risk Assessment & Control sets the foundation for adequate risk assessment process.
Assessing the risk of violence in different settings and targeting interventions based on the identified risks results in positive change and lower worker injury rates, regardless of the intervention.
Ontario's PSHSA Violence and Aggression Resources Terms of Use
PSHSA Violence, Aggression, and Responsive Behavior (VARB) Tools
Accessing the PSHSA violence prevention materials for use in the Province of Alberta is with the agreement that the terms and conditions will be met under the license agreement between PSHSA and the CCSA.
The resources in the CCSA Violent and Harassment Prevention Program are aligned with the content from PSHSA violence prevention materials. These documents and resources may have references to the Ontario context and legislative requirements specific to the Province of Ontario. Though the CCSA has adapted these for use in Alberta, users of these resources are still advised to reference the Alberta OHS legislation.
- Workplace Violence Risk Assessment
- Individual Risk Assessment
- Risk Communication/ Flagging
- Security Gap Analysis
- Personal Safety Response System
- Emergency Response (Code White)
- Work Refusuals
- Transitions
On May 15, 2017 the Ontario Ministry of Labour released “The Workplace Violence Prevention in Healthcare Leadership Table Report”. This report provided recommendations from healthcare stakeholders, and will allow Ontario to lead the way with producing resources to prevent violence in the Healthcare Sector. It recommended the use of Public Services Health and Safety Association (PSHSA)’s tools to provide workplaces with a consistent, scalable and consensus-based approach. CCSA has adapted these violence and aggression prevention tools and resources and we acknowledge the hard work the PSHSA has done in the development and sharing of these valuable resources for our members in the Alberta Continuing Care Industry.