Work Related Violence: Learning the Lessons

Standards and guidance concerning violence risks have leapt forward over the past twelve years and 'violence reduction' is now a respected discipline with a degree for practitioners.

Violence is a complex area of risk and human behaviour that requires a multi element strategy. Informed practitioners realise that early responses which focused on personal safety training and ‘screech alarms’ rarely delivered tangible and sustained results. So what works and what doesn’t?

Consigned to ‘Room 101’

Ten years ago ‘Zero Tolerance’ was in vogue and on a positive note the campaign raised awareness of this workplace hazard and helped educate staff that being assaulted was not ‘just part of the job’. The campaign was however flawed as, taking the NHS as an example, it failed to understand the nature of the problem it was trying to tackle and was based on the popular misconception that violence was just about nasty drunks in A&E. In fact 70% of assaults on NHS staff are related to an individual’s clinical condition and often involves complex needs that need to be better understood and managed.

Zero Tolerance campaigns were more suited and successful in the transport and retail sectors, especially in sending a message to travellers and customers that staff are not employed for their amusement and abuse. 

Zero Tolerance can however simply amount to little more than rhetoric in the absence of a considered strategy. It can also fuel an adversarial relationship between staff and customers/service users, which generates even more conflict. 

Along with Self-defence courses and Screech alarms I vote that Zero Tolerance has had its day and is consigned to room 101. Complex problems need more sophisticated solutions.

Strategies that can make the difference

Fortunately we are moving away from focusing on ‘problem individuals’ to organisational approaches in violence risk management, consistent with the World Health Organisation Public Health Model i.e.:

  • Primary Controls: Which focus on proactive approaches to reducing conflict and risk
  • Secondary Controls: Equipping staff with the knowledge and skills to defuse and resolve conflict before it escalates further
  • Tertiary Controls: Emergency responses and procedures to prevent harm and which may in some settings include use of physical interventions

Much is common sense, first we need to understand where the problems lie and their causes, and then to focus on how these can be prevented. This can involve reducing conflict flashpoints by delivering a positive and professional service and reducing exposure to risk through safer working practices and procedures. A violent incident can generate much emotion and pressure for reactive measures such as PPE before we have really understood the problem and first addressed primary and secondary controls.

We may still have to deal with people in difficult circumstances that are not of our making and need therefore to develop staff knowledge and skills to assess risk and defuse and resolve conflicts that arise. Training plays a key role here but is just one key strategy within a multi element model. Maybo has developed the ‘8 Element Violence Reduction Model’ to illustrate this, as shown above. 

This multi element model operates at different levels and across various functions in an organisation and part of the challenge is how to co-ordinate this. In our experience this is easier where there is a single owner of the ‘project’ with sufficient authority and who works with accountable functional representatives. Although HR, Training and Security functions have key roles to play the natural home for this area of risk in most organisations is Health & Safety.

Leadership starts with a commitment at the top to this strategy with close monitoring of progress against desired goals and outcomes. Inputs such as training are important but leaders need to focus on tangible outcomes and best value, especially in the current economic climate. Quality management information is the key to understanding the nature and extent of the problem and to measuring progress. This can include data and risk analysis plus qualitative surveys of staff confidence and perceived capability and engagement with service users and key stakeholders.

Supervision is critical at local level to ensure policy and training is put into practice and staff behaviours are monitored. In settings where staff need to be trained in restraint (a ‘tertiary’ control) it is important that we also target a reduction in restraints i.e. don’t just teach safer methods. Such activity carries risk for all involved and raises significant safeguarding issues where restraint is used inappropriately. Recruiting the right staff and effective supervision is critical as training will not fix poor attitudes.

Some work environments can be controlled more easily than others, for example we can have a reasonable level of control on a building or fixed site, but little control over the environment lone workers operate in. Fortunately improving technology brings a greater range of safety and communication devices to support those working alone and remotely. Layout, design, access control and security measures can all influence levels of conflict and risk. 

Some health and safety practitioners struggle with assessment of violence risks as there are many variables that influence these. It often helps to think in terms of risk behaviours presented by service users and tasks and activities performed by staff that increase exposure to risk. Through this approach and by actively consulting with staff we are more likely to identify safer practices and useful scenarios to cover in staff training.

Training has advanced considerably as developments in learning technologies provide greater flexibility to deliver, support and refresh learning in the workplace. A blended learning approach can work well with awareness/induction level training and underpinning knowledge being delivered through self-study such as e-learning, with the addition of practically based courses for key risk groups needing to develop further skills and confidence. A blended approach allows organisations to get more from their budgets and to focus resources where most needed. The ‘sheep dip’ approach that gives everybody a day of training can be over generic and wasteful; some roles need additional and/or more focused training and others need only basic awareness input that can be achieved through good e-learning.

In summary, we will be more effective in reducing violence risks if we take time to understand the nature, extent and causes of these, and focus on desired ‘outcomes’ rather than seductive inputs and simplistic ‘solutions’. Better still, the organisational multi element model will bring wider benefits in terms of service delivery and in promoting positive relationships with staff and service users.


Posted by Maybo on April 29, 2013


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