Montefiore workplace violence penalty highlights hospitals' prevention plan needs

The Occupational Safety and Health Administration fined Montefiore Medical Center for failing to keep workers safe in several incidents, as violence against healthcare workers continues to increase during the COVID-19 pandemic.

Montefiore will pay $17,555 over its handling of an attack on staff members. In early 2021, a psychiatric patient assaulted multiple workers during observation and during an attempted escape. OSHA said Montefiore had not developed and implemented adequate measures to protect employees from recurring serious hazards, and for not recording injuries properly.

"We are in the process of responding to OSHA's claims; certainly the health and safety of our staff and patients are our highest priority," a Montefiore spokesperson said.

The latest fine serves as a reminder for other providers that rigorous workplace violence prevention plans are a requirement by regulatory and accreditation bodies.

Violence against healthcare workers has increased over the past decade, and hospitals say it's only gotten worse during the pandemic.

While regulatory bodies like OSHA serve as a last stop for enforcing a safe workplace, other groups like the American Hospital Association and the Joint Commission have taken steps to help hospital leaders ensure workplace safety.

"Building a safer workplace in your hospital begins with the CEO," said American Hospital Association Senior Vice President and Chief Nursing Officer Robyn Begley. "Of course, some of the work can be delegated, but it really does need to be strongly promoted and led by them: what is important to the CEO is important to every other leader in an organization, and by prioritizing safety in the workplace, it's also putting resources toward it."

Those resources can include providing staff with tools like covert safety button that alerts nearby staff and security, like Cooperstown, New York-based Bassett Healthcare Network did last year. Last year, the AHA collaborated with a healthcare security and safety group to develop guidelines for hospitals, that include things like providing trauma support to affected staff, violence intervention strategies, creating a culture of safety and reporting and mitigating risks.

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OSHA won't be alone inspecting facilities after worker safety complaints. Starting in January, hospitals accredited by the Joint Commission have to meet workplace violence prevention requirements, developed after an assessment of what hospital's had in place, and what was missing.

This includes a workplace violence prevention plan that clearly states the roles and responsibilities that different staff carry, and one designated leader to coordinate programming around the plan. The Joint Commission requires providers to analyze the potential and existing hazards by unit, and develop a system to understand bigger trends from multiple incident reports.

"There also has to be an easily accessible reporting process, so that staff feel comfortable and are encouraged to do so," said Kathryn Petrovic, director of standards and survey methods at the Joint Commission. "The reports need to be analyzed after to look at if there are things that could have been done differently."

The Joint Commission requires hospitals to provide de-escalation training and have workplace violence reports reviewed by governing bodies.

"When all this doesn't happen, it can negatively impact patient care, lead to psychological distress, job dissatisfaction, absenteeism and a high cost to organizations, and that was clear in our literature review—these are the negative consequences of workplace violence from a systems perspective," Petrovic said.