How One Health System Has Successfully Tackled Workplace Violence

UVA Health offers more than a dozen workplace violence resources on the health system's Situational Awareness Violent Event website.

A workplace violence initiative at UVA Health has increased reporting of workplace violence incidents and decreased care team member injuries related to workplace violence.

A recent survey found that 40% of healthcare workers had experienced workplace violence in the past two years. Workplace violence in healthcare settings has several negative consequences such as care team members suffering physical and psychological trauma, according to the survey report. Acts of violence can also disrupt patient care when care team members fear for their personal safety or are distracted by disruptive patients or family members, the survey report says.

UVA Health launched its Situational Awareness Violent Event (SAVE) initiative in 2016. "We have developed comprehensive resources that are available to all care team members through a desktop icon that can be found on any shared health system computer. That desktop icon brings team members to our SAVE website," says Ava Speciale, nursing governance clinical leader at UVA Health.

The staff members working on the SAVE initiative feature an interdisciplinary team. The team includes direct-care clinicians from inpatient and ambulatory settings, an employee health injury coordinator, the Behavioral Emergency Response Team (BERT) leadership, the behavioral medicine consult service, members of the UVA Health security and university police department, Office of Patient Safety and Risk Management staff, and emergency management leaders.

The SAVE website at UVA Health has a range of online resources:

• A link that goes directly to UVA Health's workplace violence policy
   
• Links to de-escalation training and other educational resources on workplace violence
   
• A resource for complex behavioral challenges, which usually apply to inpatients, and the resource lists the different teams that can be involved in a complex care meeting
   
• A de-escalation tip sheet
   
• Standard work for the use of "stop signs," which are signs that are hung up outside patient rooms as a visual indicator for the potential for workplace violence
   
• A standard operating procedure for setting flags in the electronic health record that can alert care team members to the potential for workplace violence by patients
   
• A template document that goes with the EHR flags for ambulatory settings, so ambulatory setting staff know ahead of time that a patient is coming who has a flag for the potential for workplace violence, and the document walks team members through how to prepare for those patients
   
• A visitor algorithm that gives care teams tools on how to manage challenging visitor behaviors
   
• Standard work for obtaining a security assessment, which is conducted by UVA Health security staff for ongoing threats of violence
   
• Tools on how to obtain a private security resource, with a description of the private security role and how to escalate performance concerns related to security
   
• A link to the UVA Health Red Book, which is the health system's emergency management manual that has a section on workplace violence
   
• A recovery process for team members, so if a workplace violence incident occurs, the process makes sure that leaders are offering team members resources for recovery
   
• A link directly to the health system's quality reporting system, so a care team member can report a workplace violence event that has occurred

The SAVE leadership team meets monthly, Speciale says. "We have a lot of ongoing work, which includes producing resources and keeping resources updated. We assist with education, training, and presentations to care team members. We report up through our Safety and Security Subcommittee. We are always available on an ad hoc basis," she says.

The robust and comprehensive resources offered on the SAVE website allow team members to problem-solve on their own, but they have support, Speciale says. "When they hit barriers, the SAVE team leadership is available to assist."

Involving clinicians in SAVE

Physicians can avail themselves of SAVE resources, and they have played an active role in launching and maintaining the SAVE initiative, Speciale says.

"We collaborate with physicians. We have gone to some of their groups such as their quality conferences and clinical chairs meeting to present SAVE to our physician leaders, so they can make sure their teams are aware of our resources," she says. "One of our neurology physicians was a great partner in the efforts that started SAVE, including securing many of the resources that we have today."

Recently, the SAVE leadership team has had a graduate medical education resident participate in their meetings and workgroup. "She has helped bring back information she learned about SAVE to her colleagues to educate new interns and residents," Speciale says.

Including residents and interns in the SAVE initiative is important, says Lauren Mathes, a UVA Health clinic manager and co-chair of the SAVE committee. "As an academic medical center, especially with the residency program, we are excited to have the participation of residents because our residents are on multiple units. Because they cross several specialties and clinics, having their participation is great for our team," she says.

Workplace violence efforts beyond SAVE

UVA Health offers workplace violence prevention efforts outside of the SAVE initiative, Speciale says.

For example, in certain departments at the health system, care team members are required to take training that teaches them how to respond to a physical attack. This effort is focused on high-risk areas such as the emergency department.

The physical attack training features Crisis Prevention Institute training, which is common across many organizations, Speciale says. "Team members are trained on how to safely defend themselves if they are attacked. They are trained on physical restraint maneuvers if they need to administer a medication or respond to a situation where someone is physically violent."

As another example, BERT staff respond to workplace violence calls if there is an episode with a patient on a unit or at a practice environment that includes a behavioral health element, Mathes says. "In those cases, the whole BERT staff responds, including behavioral health emergency staff, security personnel, nursing supervisors, and local leadership from the unit or practice. They can help problem-solve those events in the moment. We also have a behavioral medicine team that works closely with the BERT," she says.

Generating results

At UVA Health, the SAVE initiative and other workplace violence efforts have generated positive results at a low cost, Speciale says.

"If you talk to anybody about workplace violence data, there is a challenge of under-reporting. Since we started having our data represented on our internal data portal, we have put a lot of effort into encouraging more reporting and reporting has increased. I have seen statistics from across the country that 80% of workplace violence incidents are unreported," she says.

There has also been a decrease in the number of workplace violence events that result in injury to care team members, Speciale says.

These results have been achieved at a modest cost, she says. "We have incorporated this work as part of our daily jobs. We have pulled together teams where the workplace violence work is part of their jobs, and we have extended that to our leaders, with an expectation to put the resources in place to prevent and respond to workplace violence. Because this is incorporated into our daily work, the costs are minimal."