The Branch sits on more than 30 occupational violence and aggression (OVA) committees across the state and sees all sorts of initiatives being implemented by different health services to address OVA. This gives us plenty of insight into what is occurring, and what is and isn’t working.
In early November, the Branch’s occupational health and safety (OHS) team manager Kathy Chrisfield gave a presentation at the Victorian Public Sector OHS forum, a full-day event on psychosocial hazards and prevention that was put together by the Victorian Public Services Commissioner and WorkSafe Victoria. Her presentation was based on our committee insights.
The presentation comes after the revelation that there have been well over 100,000 incidents reported in public health facilities since the introduction of reporting requirements. But with research showing that OVA is underreported by as much as 70 per cent, this could equate to well over 350,000 incidents – with each incident involving a person or people whose health has been impacted. The need to do better to address and prevent OVA has never been more urgent.
What works
The most successful OVA committees we have seen are those where there is transparency around sharing information and a willingness to learn, coupled with not being scared of trying to tackle OVA. Having health and safety representatives (HSRs) on the committees is also a significant benefit that is paramount to reducing OVA. HSR involvement also increases awareness and reporting.
A key focus in Kathy’s presentation was that the ‘patient-centred care’ or ‘patient-first’ mottos perpetuated by many health services imply that staff are secondary (or worse). This in turn perpetuates the ‘just part of the job’ mentality of staff, which leads to under-reporting.
The Branch does not believe that ‘patient-centred’ or ‘patient-first’ care needs to be a competing priority with staff safety, and Kathy gave several examples of how they can be equal priorities, and work together to improve the safety of staff.
Broken down to reflect the 10 points of the ANMF (Vic Branch) 10-point plan to end violence and aggression; a guide for health services – which has been an EBA obligation for public sector services since 2016 – these examples, and further opportunities to improve, include:
1. Improve security
| Health service initiatives | Opportunities to improve |
| Security officers trained in recognising behaviours of concern via CCTV, who intervene as appropriate | Regular security audits to identify improvements required, and maintenance regimes |
| Review and installation of updated CCTV systems in public aged care facility | Monitoring and security systems for community/stand-alone clinics |
| Updating of Model of Care, including consideration of security | Security/code grey responses for small/remote health service and clinics |
2. Identify risk to staff and others
| Health service initiatives | Opportunities to improve |
| Relevant behaviours of concern chart development and implementation across the health service | Consistent use of patient alert systems and communication of information throughout patient stay |
| Security specials used in engagement of patients at risk of BOC for diversion (and not just observation) | Inclusion of behavioural risk of others (including family/visitors) in risk assessments and actions |
| Regular staff constant patient observers on high-risk wards | Use and implementation of risk assessments in home care settings, including controls |
3. Include family in the development of plans
| Health service initiatives | Opportunities to improve |
| Senior OVA clinical consultants/clinical nurse educators support development of appropriate care plans | Complete integration of OVA risk in care plan development and templates across health services |
| Non-judgemental conversations with family at pre-admission/admission to identify potential triggers and controls | Clear and consistent provision of behaviour expectations for family/visitors, and follow through |
| Risk assessment for home visits undertaken with clinician and family members as appropriate | Provision of time and resources to enable clear communication of processes and expectations of stay/treatment |
4. Report, investigate and act
| Health service initiatives | Opportunities to improve |
| Nursing research grant into code grey triggers and outcomes | Inclusion and involvement of HSRs and staff in investigation of OVA incidents |
| Developing and implementing process to facilitate police reporting | Provisions of details of incidents to Boards, not just numbers |
| Customisation of VHIMs/Riskman to facilitate faster, more accurate reporting | Clear action taken associated with incidents |
5. Prevent violence through workplace design
| Health service initiatives | Opportunities to improve |
| Building of infectious disease rooms specifically for high-risk mental health patients | Consideration of design principles in all refurbishments, redevelopments and works being done |
| Provision of prototype rooms/areas in new builds to allow appropriate consultation | Early consultation with all relevant stakeholders as part of the initial design phase |
| Development of specific furniture for different clinical areas – eg anti-ligature mental health beds | Sharing of learnings from other builds to be applied |
6. Provide education and training to healthcare staff
| Health service initiatives | Opportunities to improve |
| Implementation of SafeWards to assist in communication/understanding | Incident investigation training |
| Inclusion of security / community protections officers in OVA training | Standardised training for health workers (including medical staff) and security |
| Regular simulations of codes | Employer-specific face-to-face training |
7. Integrate legislation, policies and procedures
| Health service initiatives | Opportunities to improve |
| Dedicated code grey team who provide education and initiatives to staff when not attending codes | Integration of OVA and violence-prevention policies with all others, including clinical assessment, security, training and education |
| Trialling of responsible medical staff attendance at code greys on medical wards | Systemic policy changes in health services should consider impact on OVA |
| Use of technology to streamline and reduce double handling | Reviewing policies regularly, and inline with legislative changes – eg: decriminalisation of public intoxication |
8. Provide post-incident support
| Health service initiatives | Opportunities to improve |
| OVA pack that includes details of WorkCover, police reporting, other support (including NMHPV), and what to expect | Clear communication to staff of outcomes of investigations and actions that are going to be taken |
| Specific local action plans and forums where OVA hotspots identified | Manager education in how to provide appropriate support |
| Development of matrix for NUMs around actions to be taken as post of post-incident support | Depersonalising investigation processes to look at system, not individual actions |
9. Apply anti-violence approaches across all disciplines
| Health service initiatives | Opportunities to improve |
| Resourcing of project lead to oversee execution and implementation of OVA action plans | Embedding of team approach to all aspects of patient care, and prevention and management of OVA |
| Targeted information and education pieces for medical staff about staff safety and their role in OVA prevention and management | Building in nurse/midwife/HSR feedback on behaviours of concern into development of care plans and decisions about patient care and management |
| Funding of teams to assist with discharge planning for patients with high/complex behaviours | Sharing of information around how to deal with complex patients, and identifying pain points for policy intervention |
10. Empower staff to expect a safe workplace
| Health service initiatives | Opportunities to improve |
| CEO as an active member of OVA committee | Use of data to inform strategic communication around OVA |
| Resourcing external audit of OVA systems and implementing recommendations | Health services to transparently inform and engage with staff of data and outcomes |
| HSRs facilitated to attend OVA committee | ‘Safety Walks’ of executive to engage with staff and hear first-hand experiences |
| Development and distribution of ‘mythbusting’ posters |
In its work on OVA, the Branch sees a great amount of duplication of resources, with multiple committees working separately to achieve the same things. We know what works.
It’s time for health services to stop reinventing the wheel.
