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Dr. Joshua Tepper

Making Freedom from Violence a Quality Indicator

The Safe Patients/Safe Staff program at Sinai Health System provides resources to help staff safely and effectively care for patients who are at risk of aggressive or dangerous behaviour.

At Grand River Hospital Corporation, teams are available to respond to codes for potential workplace violent incidents. In the event of a code called for aggressive behaviour/physical danger, an immediate and mandatory debrief is held to ensure the emotional, psychological and physical wellbeing of all staff and patients.

The North Bay Regional Health Centre and the Centre for Addiction and Mental Health are among nine hospitals in Ontario implementing the Safewards program, an evidence-based series of interventions that promote patient and employee safety by reducing conflict and containment.

These are among the many examples of how health care institutions in Ontario are acting to deal with a serious and pervasive problem – violence in the health care workplace. They come from a report just published by Health Quality Ontario, with information taken from 2017-2018 Quality Improvement Plans (QIPS) showing health care organizations in Ontario are working to address the issue.

There has been a growing awareness in the province of the importance of addressing workplace violence, and Health Quality Ontario believes violence prevention should become part of quality improvement culture. Health Quality Ontario’s Quality Matters framework for quality states that caregiver wellbeing is a precondition for achieving a high quality system. All of those working in health care, as well as patients, need an environment that is safe and free of violence so they can thrive.

Rigorous statistics do not exist on the incidence of workplace violence in Ontario’s hospitals and other health care settings. Statistics from the U.S., however, indicate the problem is pervasive and growing. A 2001 U.S. Bureau of Justice Statistics (BJS) document reported an annual incidence of 16.2 assaults per 1,000 physicians, 21.9 assaults per 1,000 nurses, and 8.5 assaults per 1,000 healthcare workers with varying job titles.

In 2015, the Ministry of Health and Long-term Care and Ministry of Labour announced the creation of a leadership table which engaged over 100 workers, employers, government representatives, associations, unions, patient advocates and researchers to improve workplace safety culture and make health care settings safer for both staff and patients. In May 2017, a progress report was published which contained a series of 23 recommendations, as well as a series of tools and resources that hospitals can use to implement effective workplace violence prevention programs.

One of the recommendations was that workplace violence prevention plans be included in the Quality Improvement Plans (QIPs) submitted annually to Health Quality Ontario by hospitals. In their 2018/2019 QIPSs, hospitals will be required to report on incidents of workplace violence as a mandatory indicator, and all organizations who submit QIPs to Health Quality Ontario will be asked to describe how workplace violence prevention is a strategic priority in their organization. If an organization is building a reporting culture for workplace violence, the QIP target may be to increase the number of reported incidents. If the organization’s reporting culture is already well developed, the QIP target may be to decrease the number of reported incidents.

By including workplace violence in the Quality Improvement Plans, the intent is to have activities viewed through an improvement lens rather than a compliance lens. This means hospitals and other organizations across the system will make changes in order to improve the quality of care, rather than to comply with regulations.

Workplace violence can be addressed through quality improvement by building a culture of psychological safety in which all workers are empowered to report their experiences.

Administrators, front-line workers and patients all need to be engaged in making those settings safe.

There is a real opportunity to give health professional and employee safety the attention it deserves. Many see improving the work life of healthcare providers as necessary to achieve the Triple Aim of improving a patient’s experience of care, improving population health and doing this at a reasonable cost – a concept known as the Quadruple Aim when the wellbeing of health care professionals is included.

We have done a lot of work as a province to foster this culture of quality in health care - now is the time to make workplace safety a part of that effort.

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