A New Jersey health system launches several efforts to prevent and contain workplace violence against healthcare workers.
That's why RWJBarnabas Health is taking a stand against workplace violence at its hospitals and clinics.
Over the past year, West Orange, New Jersey–based RWJBarnabas Health, an academic integrated healthcare system, has launched or enhanced efforts to curb workplace violence.
"Nurses, nursing assistants, and security guards are more likely to encounter violent behavior, but it is not limited to them. You can find violent incidents in all areas of a health system's facilities," says Nancy Holecek, RN, MHA, MAS, senior vice president and CNO of RWJBarnabas Health's Northern New Jersey Region.
Data showing the impact of the health system's violence prevention efforts is not available yet, but RWJBarnabas is currently collecting data to gauge the impact, monitor violence trends, and plan additional prevention measures, Holecek says.
“There are several indicators that we monitor related to our workplace violence efforts, including the number of reported incidences, employee health referrals, and medical claims data,” she says.
Here are five things that RWJBarnabas is doing to thwart workplace violence:
Created facility safety assessments
Facility safety assessments seek to ensure buildings are as safe as possible, Holecek says.
"We have been looking at our technology, looking at our visitor access system, and looking at our security workforce to ensure that we have the most updated technology and that we have our entrances covered and locked down at the appropriate time," she says.
A major facility challenge is aligning safety and service, she says. "We have to always make sure that we balance the security piece with open access for anyone who needs our services."
Instituted quick reporting technology for violent incidents
RWJBarnabas focused on ease of reporting largely because workplace violence incidents are underreported, Holecek says.
"If it's an event that results in a serious injury, then it gets reported. If it's something minor or a threat, unless staff members truly feel they are in danger, they generally treat the incident as part of the symptoms or disease that a patient is presenting," she says.
The health system has adopted reporting technology that allows staff members to click on a computer desktop icon and quickly file reports on workplace violence, she says.
Eased reporting has created a data opportunity, she says. “We have seen an increase in reported events, which was to be expected. The trending of this data related to number, severity, location, and person—patient, visitor or other—will allow us to better track, respond, and strategize our efforts.”
Raised awareness among staff
Raising awareness about workplace violence boosts safety and increases the likelihood of reporting, Holecek says.
"Oftentimes, [violent behavior] is something a patient can't control [because of] dementia or a behavioral health issue. Our staff understand this and make excuses for it. The problem with that is we can't collect data and we can't intervene; so, we are encouraging our staff to report," she says.
RWJBarnabas is improving its Behavioral Emergency Safety Training (BEST) with the help of a consultant.
"The focus is to de-escalate the behavior—not to pin the person against a wall. This has been very successful. It works a large percentage of the time," Holecek says of BEST.
The consultant is adding a new layer to the BEST training—instructing staff about duty to warn, duty to act, and duty to respond.
"The consultant is training trainers who will go out to work with our security workforce, behavioral health workforce, and emergency workforce, and then expand to make sure all of our employees are trained," she says.
Added violent incidents to daily debriefings at each of RWJBarnabas' 11 hospitals
Addressing incidents of workplace violence has become part of a larger high-reliability initiative at RWJBarnabas.
The initiative includes 15-minute leadership huddles in the morning at every RWJBarnabas hospital to review facilitywide issues from the previous 24 hours. Workplace violence incidents are among the topics discussed.
The CEO usually leads the morning huddle, with about 45 participants ranging from the C-suite to the department director ranks.
"This informs the entire senior team and department heads so they know what has transpired. It helps us stay abreast of any incidents of workplace violence that may have occurred," Holecek says.
Another workplace prevention effort
In addition to those initiatives, the health system formed a steering committee to lead workplace violence prevention efforts.
The Workplace Disruption Prevention Steering Committee oversees the office of emergency management, security, and workplace violence.
The steering committee is an interdisciplinary group with representatives from compliance, emergency management, HR, legal, nursing, physicians, IT, and security.
"On the Workplace Violence Committee, we have the same steering committee members, but we also have an emergency department physician and a nurse from behavioral health. We wanted to make sure there were people who experience these kinds of issues day in and day out," she says.
Guidance to prevent workplace violence
Recent guidance issued by The Joint Commission features seven recommendations to prevent workplace violence that could help healthcare organizations prevent violent encounters.
Holecek says she and her colleagues are examining the workplace violence report released by The Joint Commission.
The report could prompt more workplace violence initiatives at RWJBarnabas, she says.
Christopher Cheney is the senior clinical care editor at HealthLeaders.