From workplace design to forward planning, prevention is the watchword as trusts aim for a trouble free future

According to the British crime survey, employees reported 627,000 incidents of violence and abuse in the workplace from 2008-09, including 928 major injuries and four fatalities.

Abuse, threats and assaults cause significant physical and psychological injury, while employers face poor morale, loss of productivity, lost time and poor retention levels

While 1.4 per cent of working adults were the victims of one or more violent incidents at work, the figures rose to 3.8 per cent when it came to healthcare professionals.

The potential cost of workplace violence within NHS trusts to both staff and employers is considerable. Abuse, threats and assaults cause significant physical and psychological injury, while employers face poor morale, loss of productivity, lost time and poor retention levels.

In a bid to counter this, NHS trusts are calling on the services of the police at a massive cost.

Recent newspaper reports suggest that the Royal Infirmary and the Western Infirmary in Glasgow pay £60,000 a year for four officers to provide support on Friday and Saturday nights. In 2009, Arrowe Park Hospital in the Wirral spent £28,980 while Royal Liverpool University Hospital spent £22,950 on weekend police cover.

Security guards are now a common sight in hospitals, brought in to protect staff and the public.

But this can cause additional problems.

One trust is being sued for £300,000 by a patient who had lunged at a male nurse and attempted to punch him. Security staff intervened and allegedly held his arm behind his back, pushing him to the floor until he struggled to breathe and required resuscitation. He claims he suffered a heart attack and brain damage as a result.

At the other end of the spectrum, security officers demanded that a thief be let go after he was caught trying to steal laptops; they were concerned that the thief could sue the hospital if they restrained him.

So what steps can trusts take to protect themselves against liability should a member of staff get injured?

The law requires all employers to take reasonable care to ensure the health, safety and welfare of their employees. Health and safety legislation such as the Health and Safety at Work Act 1974 imposes a legal duty to assess and control risks to employees in the workplace.

What are the risks?

The starting point is to identify where, when and why threats and violence occur in the workplace. Assessments should be undertaken and reviewed at set intervals. Recording systems must support and inform the assessment, as should the previous experiences.

Having identified these risks and why they occur, employers must implement reasonable measures to reduce risks, for example ensuring an employee is never left to deal with a potentially violent situation alone.

An assessment should look at a wide range of factors, such as the workplace environment. Design and layout can create flash points, for example overcrowding in waiting areas is likely to increase the possibility of workplace violence.

Using the transport sector as an example, potential flashpoints that lead to outbreaks of violence against staff have been removed by keeping passengers informed of delays and providing open and visible places to wait.

Primary controls are intended to prevent a potentially violent situation from arising and involve measures such as adequate training or improving poor work practices.

Secondary controls will focus on action taken to prevent any instances of conflict escalating into violence, such as conflict management or communication training that could help members of staff to defuse a potentially violent situation. 

Tertiary controls refer to action taken when violence is occurring and after it has occurred to prevent or reduce the potential for physical and psychological harm, such as the use of exit strategies or physical intervention tactics.

Employers’ duties do not stop with the prevention of physical harm to their employees but extend to how the employee is rehabilitated back into the workplace should they become a victim of assault.

A comprehensive “return to work” policy that provides reasonable levels of support should be implemented.

Employers may wish to consider moving the employee elsewhere for a short period and the provision of counselling.

If every stage of the process is well documented, the likelihood of a successful claim can be reduced.

Tips for trusts

  • Ensure that a full assessment of the risks of the workplace is made and is updated regularly
  • Implement reasonable measures to deal with these threats to the safety of both staff and patients
  • Primary controls should prevent a potentially violent situation from arising
  • Secondary controls should prevent any instances of conflict escalating into violence
  • Tertiary controls should outline action to be taken when violence occurs or after it has occurred