Past, Present and Future
Healthcare providers across the nation continue to grapple with increasing incidents of violence and how to select productive mitigation strategies that promote a safe environment while protecting patient care. This is despite the Joint Commission Sentinel Alert issued in 2010 which attempted to address escalating violence. Much debate has ensued since about how best to curb violence. As a result, many programs were introduced to protect clinicians including training on the early indicators of potential violence, de-escalation techniques, timeliness when requesting assistance from law enforcement, mental health intervention, drills, personal alarm devices and self-defense. Greater demands have been placed on security officers to be proactive and present when a patient has the potential to become aggressive. Despite this multi-disciplinary approach, violence in healthcare continues to escalate and remains an issue. The Joint Commission and individual states forge ahead in an attempt to create a safer patient care environment. California’s Senate Bill 1299 attempts to chart new territory through an interactive, transparent, and collaborative process designed, hopefully, to mitigate violence.
California SB 1299 – A Review
California, in its latest effort to protect clinicians, recently enacted SB 1299 requiring numerous standards to be met and is designed to hopefully reduce incidents of violence. In summary, this legislation mandates covered healthcare providers focus their efforts on specified areas including:
Workplace Violence Prevention Plan – Healthcare providers are required to adopt a workplace violence protection plan as part of the hospital’s injury and illness prevention plan. The plan must always be in effect and applies to all patent care areas including in and outpatient facilities and clinics.
Reporting – To meet mandated reporting requirements of violent incidents and to post such incidents on their website; included in this definition is physical force against a hospital employee by a patient or a person who is a companion of a patient, that results in, or has a high likelihood of resulting in, injury, psychological trauma, and stress regardless if injury was sustained; the use of a firearm or other dangerous weapon must be included as well; violent incidents against employees must be documented and records maintained for at least five years; healthcare provider must report violent incidents resulting in injury or if a firearm was used or other dangerous weapon against a hospital employee regardless if an injury occurred; or, incident resulted in an eminent threat; the hospital shall report the incident to the division within 24 hours. All other incidents shall be reported within 72 hours.
Training – To provide education and training for all staff, including temporary or contingent staff, who give direct patient care; training must be delivered at least annually with interactive questions and answers between staff and the trainers; topics are to include how to recognize the potential for violence, when to seek assistance to prevent or respond to violence; and, how to report to law enforcement.
Infrastructure – Must be in place to ensure sustainability and include resources to cope with the aftermath of violence; a system for responding to violence and subsequent investigation needs to be included.
Partnerships – Must allow unions/bargaining units to be viewed as a collaborative partner, Staffing models designed to prevent violence must be established; there needs to be the presence of “sufficient security measures” including alarms, staffing, security personnel, response protocols and crime prevention through environmental design (CPTED).
Assessment/Monitoring – Provide an assessment of specific units and their potential inclination towards a violent event; assess program impact and needs at least annually and adjust where and when necessary.
Definition of Workplace Violence
SB 1299 mandates including in the workplace violence prevention plan a working definition of workplace violence. In California, it is recommended that CAL OSHA’S definition be followed. CAL OSHA defines workplace violence as:
1. “Workplace violence” means any act of violence or threat of violence that occurs at the work site. The term workplace violence shall not include lawful acts of self-defense or defense of others. Workplace violence includes the following:
2. The threat or use of physical force against an employee that results in, or has a high likelihood of resulting in, injury, psychological trauma, or stress, regardless of whether the employee sustains an injury;
3. An incident involving the threat or use of a firearm or other dangerous weapon, including the use of common objects as weapons, regardless of whether the employee sustains an injury;
“Types of workplace violence” are defined in four categories:
a. “Type 1 violence” means workplace violence committed by a person who has no legitimate business at the work site, and includes violent acts by anyone who enters the workplace with the intent to commit a crime.
b. “Type 2 violence” means workplace violence directed at employees by customers, clients, patients, students, inmates, or visitors or other individuals accompanying a patient.
c. “Type 3 violence” means workplace violence against an employee by a present or former employee, supervisor, or manager.
d. “Type 4 violence” means workplace violence committed in the workplace by someone who does not work there, but has or is known to have had a personal relationship with an employee.
Healthcare in the United States prides itself on best practices and continually accepts the challenge of developing new ways to enhance patient care and safety. As such, healthcare has a well-earned positive reputation for sharing information and observing developments beyond state boundaries. While most states have minimum standards for workplace violence prevention and security officer training, it is clear that healthcare providers regardless of location must continue to evaluate their own efforts and watch for breaking developments elsewhere. It is predictable that governing bodies will watch how SB 1299 plays out and the impact it has on curbing violence.
Premier Risk Solutions believes there is an opportunity for healthcare providers across the nation to examine ways to enhance existing safety and security standards. Should transition continue towards the kind of model SB 1299 proposes, then positive changes can be made now ahead of this emerging trend. From our perspective, the unprecedented transparency SB 1299 mandates can adversely impact the brand image and public perception of safety and patient care for California healthcare providers. Should other states adopt similar legislation, the opportunity to have systems in place before being mandated will enhance safety, reputation, and patient care. Therefore, we recommend organizations regardless of location focus on what they have direct control over: High-level execution of the mandated portions of this legislation.
Sufficiently meeting the requirements of SB 1299 or any program designed to enhance safety will be a very time consuming and arduous process involving significant staffing hours to develop, monitor and adjust to meet ever evolving standards. Premier Risk Solutions can help navigate the complexities of SB 1299 or any enhancement of security and safety measures under consideration. We have as part of our team, staff who provided state legislative committee testimony as a subject matter expert during the review process of SB 1299. We can invest the time for you. Our services encompass:
Assessment of your current security posture and future needs.
Preparation of a strategic-plan that fulfills all requirements.
Training for all staff that meets and exceeds requirements.
Follow-up to ensure your program remains on point and producing tangible, positive results.
Enhanced Safety for patients, visitors, and staff.
Contact the PRS team for further information.