Under Health & Safety legislation, employers are required to ensure, as far as reasonably practicable, the health, safety and welfare of their employees and anyone else who may have access to their premises (e.g. other workers, visitors, contractors, patients, out of hours staff).
The Health & Safety Executive's definition of violence is:
'Any incident in which a person is abused, threatened or assaulted in circumstances relating to their work'
Examples of violent and aggressive behaviour include:
- A carer bitten by a person with learning disabilities in the course of the normal care of that person
- An irate visitor who considers that his relative has not been properly treated verbally abuses a ward manager.
- A nurse verbally abused and threatened by a patient who is unwilling to take prescribed medication.
- A catering assistant providing refreshments is hit by a confused elderly patient.
Regrettably, violence and abuse by patients towards doctors and practice staff is increasing. Verbal abuse and threats are more common than physical violence.
What steps should practices take with regard to protecting staff from violence?
The Health & Safety Executive recommends a four stage process, which is described in their guidance leaflet - 'Violence at Work: A guide for employers'. The key points are summarised below:
Stage 1 - finding out if you have a problem
As with all health and safety matters, this starts with a risk assessment. Ask your staff to find out whether they ever feel threatened. Include the doctors in this process. Put in place a system for recording incidents, including verbal abuse and threats, capturing the following:
- an account of what happened
- details of the victim(s), the assailant(s) and any witnesses
- the outcome, including working time lost to both the individual(s) affected and to the practice
- date, time and location of the incident
Classify all incidents - use headings such as place, time, type of incident, potential severity, who was involved and possible causes. Check for patterns, and look for common causes, areas or times. Use this information to try to predict what might happen in the future, so that preventative steps can be planned. It is usually a combination of factors that give rise to violence.
Stage 2 - deciding what action to take
Continue the risk assessment by taking the following steps to help to decide what action needs to be taken.
- identify which employees are at risk - those who have face-to-face contact with the public are normally the most vulnerable
- doctors and nurses are usually alone with patients so they clearly face risks
- where appropriate, identify potentially violent people in advance so that the risks from them can be minimised
- check existing arrangements, are the precautions already in place adequate or should more be done?
Consider the following:
- providing staff with training to spot early signs of aggression and how to deal with it
- providing staff with information about patients who have a history of violence
- it is often the environment which triggers violence, look at waiting room layout and comfort, eliminate cramped conditions
- installation of security equipment - cameras, alarm systems, panic buttons in consulting and treatment rooms
- installation of wider counters at reception to give staff more protection
- development of procedures to follow if a panic alarm is triggered, or if a patient becomes violent in the waiting room. Make sure everyone is fully aware of the procedures
- arrange for staff or doctors to be accompanied if they have to meet a suspected aggressor at their home
- consider the safety of staff who work alone or work late
Keep a written record of the risk assessment
- the record should provide a working document for both managers and employees
- periodically review and revise the risk assessment. Be prepared to add further measures or
- change existing measures where these are not working
- if a violent incident occurs, examine the risk assessment and make any necessary changes
Stage 3 - take action
Develop and publish a policy for dealing with violence, and ensure that all staff and doctors are aware of it. Implement all the actions identified in the risk assessment. Note also that the Equality Act 2010 requires employers to take action where staff are being harassed by third parties.
Stage 4 - check what has been done
Check on a regular basis how well the arrangements are working. Consider setting up a management and staff liaison committee to do this. Keep records of incidents and examine them regularly. If the measures are working well, keep them up. If violence is still a problem, go back to Stages 1 and 2 and identify other preventive measures.
What about the victims of violence?
If there is a violent incident involving a member of staff, respond quickly to minimise distress. It is essential to plan how to provide support before any incidents. Consider the following:
- debriefing: victims will need to talk through their experience as soon as possible after the event
- verbal abuse can be just as upsetting as a physical attack
- time off work: individuals will react differently and may need differing amounts of time to recover. In some circumstances they might need specialist counselling
- legal help: in serious cases legal help may be appropriate
- other employees: may need guidance and / or training to help them to react appropriately