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5 Steps RWJBarnabas Took to Combat Workplace Violence


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By Christopher Cheney

This article first appeared on HealthLeaders Media on January 25, 2019.

Workplace violence is a widespread problem within the healthcare setting that must be prevented for the safety of clinicians and patients.

That's why RWJBarnabas Health in New Jersey is taking a stand against workplace violence at its hospitals and clinics. The academic integrated healthcare system has launched or enhanced efforts to curb workplace violence in several key ways.

"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 chief nursing officer of RWJBarnabas Health's Northern New Jersey Region.
Here are five things that RWJBarnabas is doing to thwart workplace violence:

1. 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."

2. 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.”

3. 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.

4. Enhanced training

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.

5. Added violent incidents to daily debriefings
 
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 each of RWJBarnabas's 11 hospitals 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.

In addition to those initiatives, the health system formed a steering committee—an interdisciplinary group with representatives from compliance, emergency management, HR, legal, nursing, physicians, IT, and security—to lead workplace violence prevention efforts.