Joint Commission urges hospitals to address workplace violence

Updated 12:30 CT, April 20, 2018

The Joint Commission is advising healthcare facilities on how to address violence—physical and verbal—against staffers.

The nation's largest accrediting body this week released an alert that warns healthcare organizations to take seven steps to address workplace violence. They say hospitals need to more clearly define what constitutes violence, better follow up with and support victims, and develop and assess prevention initiatives. The moves are considered recommendations but employers must take action if an employee faces violence, a Joint Commission spokeswoman said. Should it receive complaints, the Joint Commission would evaluate whether an on-site survey is needed. An unsatisfactory survey can affect accreditation status.

"We encourage our accredited organizations to use the alert to help their healthcare workers recognize violence from patients and visitors, become prepared to handle it, and more effectively address the aftermath," said Dr. Ana Pujols McKee, executive vice president and chief medical officer of the Joint Commission.

The accreditor's data show 68 incidents of homicide, rape or assault of hospital staff members in the past eight years. The Occupational Safety and Health Administration has found only 30% of nurses report violent incidents. But approximately 75% of nearly 25,000 workplace assaults reported every year occurred in healthcare and social service settings.

The rates of incidents noted by the Joint Commission and OSHA differ as it's not mandatory to report workplace violence to the commission, a spokeswoman said.

Healthcare employees are four times more likely to be victimized than workers in other industries, according to OSHA.

Healthcare workers also are especially empathetic. They may believe patients are not be responsible for their actions if they suffer from illness or are taking medication that affects their mental state.

The industry has a bad reputation for addressing violence against its employees and as a result has trouble with morale and retention, said Steve Albrecht, a workplace safety consultant.

"Hospital and clinical settings can be a dangerous place to work," Albrecht said. "The days of treating or interacting with people who threaten or hurt medical professionals, without consequences for their behavior, needs to stop."

The Joint Commission could not say whether the incidents of violence they were made aware of led to a loss of accreditation.

Hospitals are working to address the matter both individually and as a group, according to the American Hospital Association's top lawyer.

Hospitals and health systems "view the safety and well-being of employees as a top priority and take seriously their responsibilities to ensure a safe workplace free of all forms of violence—whether such violence results from encounters between staff and patients and/or their families, staff-to-staff aggression and harassment or the intrusion of community conditions and community violence into the workplace environment," Melinda Hatton, the AHA's senior vice president and general counsel, said in an emailed statement.

Noting that the AHA's Hospitals Against Violence initiative is a tool available to hospitals, Hatton said "the Joint Commission's newest Sentinel Event Alert may provide an additional resource for hospitals on addressing workplace violence, namely physical and verbal violence, and its impact on employee morale, retention and well-being."

Until now, some professional associations believe they have been largely unprotected.

"In order to truly eliminate workplace violence, it is critical that nurses, other healthcare professionals, and their employers shift the professional and workplace culture to adopt a mindset of zero tolerance that diminishes barriers to reporting," said Cheryl Peterson, vice president of nursing programs at the American Nurses Association.

Dr. Paul Kivela, president of the American College of Emergency Physicians, thinks it'll take stiffer penalties at both the federal and state level to really curb the problem.

Currently, legal penalties vary around the country. For instance, in West Virginia a person can face a felony charge and up to three years in jail depending on the severity of the attack against a healthcare worker. In California, an assault or battery against a provider is viewed as a misdemeanor and is punishable by up to one year of jail time for the most severe cases.

Kivela argues that medical providers should be treated similarly to other front line professionals who regularly deal with combative individuals.

"If a police officer or fireman gets assaulted, there are serious ramifications," Kivela said. "The same thing should apply to healthcare providers."

Nationwide, the punishment for assaulting an officer is considered a felony and could carry up to three years in prison.

An edited version of this story can also be found in Modern Healthcare's April 23 print edition.