September 23, 2010

Report on 2009 JCCHS Workplace Violence Survey Of Acute Care Hospital Joint Health and Safety Committees
 

Introduction and methods

In September, 2009, in anticipation of upcoming amendments to the Occupational Health and Safety Act (OHSA), the Joint Central Committee on Health and Safety (JCCHS) surveyed acute care hospitals in the province about the status of policies, procedures and measures concerning workplace violence. The Committee emailed hospital Chief Human Resources Officers, CEOs and Co-Chairs of Joint Health & Safety Committees (JHSC) and requested the JHSC in each hospital to complete the survey. The survey questions reflected a number of the key changes contained in the proposed amendments to OHSA which come into force on June 15, 2010.

Completed surveys were received from 76 acute care hospitals. Respondents were not required to identify themselves or their workplace; consequently in some cases the survey results may represent a summary from a number of sites of a multi-site hospital while in others, JHSCs from individual sites may each have completed a survey. In some hospitals, the whole JHSC collaborated on completing the survey and in others, the JHSC co-chairs completed it without the committee. Respondents had the option of completing the survey on-line, faxing it or emailing it to OPSEU where the results were tabulated. Staff at OPSEU entered the data from the emailed and faxed surveys onto the on-line survey tool where the results could be more easily reviewed.

Findings

Overwhelmingly, respondents reported that their hospitals recognized the hazard of workplace violence and considered bullying and harassment to be forms of workplace violence. Of the 76 respondents, only two had no policy to address workplace violence, while 55 reported that they had a policy and another 19 said that their policy was under development.

Respondents also were also asked to provide the definition of workplace violence contained in their policies. While all of the definitions included physical violence, a majority of them also referred to forms of psychological violence which could result in emotional/psychological harm. More than half of those with a workplace violence policy did not address the hazard of domestic violence entering the workplace either in the definition or through written measures and procedures. Domestic violence in the workplace must now be addressed by employers under the OHSA amendments. About 15% of the responding JHSCs reported that they had no definition of workplace violence in their policy.

Despite the fact that the survey was done prior to the OHSA amendments, it appears that the Ministry of Labour (MOL) had been fairly active in the hospital sector around workplace violence issues. Approximately 20% of the hospitals reported that they had received MOL orders regarding workplace violence in the previous two years.

A critical aspect of the new legislation is the employer obligation to perform risk assessments in the workplace to identify risks of violence associated with workplace conditions and the nature and type of work being done. This is the first time that OHSA has formally required employers to perform risk assessments, although MOL inspectors from time-to-time have ordered employers to perform a risk assessment for violence or other hazards. Given that this requirement was not yet the law when the survey was being completed, it was encouraging to see that more than half of the respondents had done some risk assessments and another quarter were working on risk assessments. Approximately 25% of respondents had done no risk assessments for workplace violence.

Of those hospitals which had developed various measures and procedures to address workplace violence, the majority (over 80%), had procedures to report and investigate incidents as well as emergency response procedures. And the majority (over 80%) reported that JHSC had been involved in developing those measures and procedures.

The two major gaps revealed in the responses were written procedures to address the dangers of working alone and communications strategies to alert staff of risks associated with specific patients. Only 49% of hospitals reported that staff had procedures to follow when they were working alone although an additional 22% reported that procedures were under development. Only 39% of respondents indicated that they had some way, such as flagging charts, to communicate to staff the risks associated with patients who are known to have been disruptive or aggressive in the past. The new legislation requires employers to develop methods to communicate the risks of violence associated with a person with a history of violent behaviour.

The survey asked a number of questions about staff training on workplace violence policies, procedures and measures. It appears from the responses that some of these questions may have had too many variables to elicit useful information. However, it is clear from the responses that the majority of workplaces (74%) are offering some form of training on workplace violence measures and procedures. An additional 12% indicated that they have training scheduled. It also appears that in the majority of workplaces (85%), all staff are receiving training. The employer is obliged under the new legislation to provide appropriate information and instruction on the contents of the workplace violence policy and program.

Conclusions

The JCCHS does not know whether the 76 hospital JHSCs which responded are representative of all hospitals in the province. If the survey results can be generalized to all acute care hospitals in the province, it appears that hospitals were already well on their way to complying with the OHSA amendments at the time of the survey and before the amendments became law. However, it is also possible that only hospitals that were already working on workplace violence policies, procedures and measures chose to respond to the survey and so provided us with a falsely positive picture. It is impossible to tell.

Even if the responses are not truly representative of all of the hospitals in the province, the results do point to a number of gaps that will have to be filled to comply with the new legislation. Notably, approximately 20% of respondents did not include their JHSCs in the development of written measures and procedures to address workplace violence. The Regulation for Health Care and Residential Facilities is clear that JHSCs (and health and safety representatives) must be consulted by the employer as health and safety measures and procedures are developed, established and put into effect. Another area which must be addressed is the creation of measures and procedures to protect workers who work alone or in isolated areas of a workplace. Fewer than half of respondents indicated that they had procedures for staff to follow when working alone.

Another requirement which must be addressed quickly is the employer obligation to perform risk assessments for workplace violence considering the nature of the workplace, the type of work or the conditions of work. It was unclear from the responses how many hospitals had completed all of the now-required risk assessments; however, 24% of the respondents indicated that no risk assessments had been done. As of June 15, 2010, the Act required that risk assessments are to be done throughout all workplaces.

The hazard of domestic violence in the workplace is another key area that the majority of respondents had not addressed in their policies or measures and procedures at the time of the survey. Ontario has become a leader in this area by including the hazard of domestic violence in its occupational health and safety legislation – in part, as a response to the workplace murder of nurse Lori Dupont in a Windsor, Ontario hospital in 2005.

This gap will have to be addressed because OHSA now requires employers to protect workers from domestic violence in the workplace if the employer is aware of the hazard.

The other gap revealed by the responses is the requirement of the employer to provide workers with information, including personal information, about persons with a history of violence. The survey asked specifically about flagging patient charts or other methods to alert staff about patients with a history of violence. Only about 40% of respondents indicated that they had a method of alerting staff, while another 26% indicate they were working on a strategy. Developing such a strategy and putting it into action will require careful assessments and consideration of workers’ rights to work in safety and patients’ rights to privacy. Hospitals may want to seek out the expertise of other facilities which have developed assessment and communication strategies that satisfy both sets of rights.

Additionally, the new legislation extends the employers’ obligations beyond alerting staff about patients with a history of violence. Employers will now have to provide information to workers about ‘persons’ with a history of violent behaviour if the worker can be expected to encounter that person in the course of their work and the risk is likely to expose the worker to physical injury. The survey did not anticipate this obligation and did not ask questions about ‘persons’ other than patients. For many employers, not only hospital employers, this new obligation will require a great deal of skill and expertise – to make the assessments and to determine how much information must be transmitted to whom.

The JCCHS thanks all those JHSCs and JHSC co-chairs who took the time to complete this lengthy survey. We believe the results give hospitals a useful snapshot of the state of workplace violence policies, procedures and measures in the lead-up to the implementation of the Bill 168 amendments to OHSA. It is clear that much work has been done, but there is still more to do to ensure that effective measures, procedures and training are in place to protect all workers in the acute care hospital sector from the hazard of workplace violence.