Case Example: Two days after being admitted, a patient
attempted to light a cigarette in his room. His nurse reminded
him that smoking in the hospital is forbidden and that oxygen was
nearby making it a dangerous situation. Although he responded in
a disrespectful manner, he did not light the cigarette. After the
nurse left, however, the patient lit up a cigarette. The nurse
smelled the smoke from the hallway and ran into the room,
demanding that the patient put the cigarette out immediately. The
enraged patient screamed at the nurse and forcibly pushed her
away. She was able to grab the cigarette and put it out. The
hospital temporarily shut off the oxygen on that floor and
provided oxygen tanks to patients in need of them.
Integral to becoming a high-performing highly reliable
organization is workforce engagement, the core of which is
experiencing joy and meaning in their work. Simultaneously
managing safety and healing is complex. A variety of individuals
walk through the doors of health facilities: patients, visitors,
vendors and others. Unfortunately, some pose challenges that
could compromise patient and employee safety. In many cases,
these challenges require the attention of health care staff,
diverting their focus from delivering care.
Over the past several months, California’s division of
Occupational Safety and Health, better known as Cal/OSHA, held
five stakeholder meetings with the goal of developing workplace
violence prevention regulations. Legislation signed last year, SB
1299, requires Cal/OSHA to develop such regulations covering
acute care hospitals. Cal/OSHA, however, has indicated its intent
to expand the scope of its regulations to cover all healthcare
employers, from clinics and medical offices to home health and
While the regulations are still in development, the process thus
far reveals that health care employers will be required to
implement a workplace violence prevention plan (Plan) in addition
to the Injury and Illness Prevention Program (IIPP) required by
3203. Items likely to be required as part of the Plan
Procedures for the active involvement of employees in the
development, implementation and review of the Plan (e.g.
identification, evaluation and correction of workplace violence
hazards, design and implementation of training).
Methods the employer will use to coordinate the
implementation of the Plan, including how employees will be
trained, procedures for reporting, investigating and recording of
Procedures to ensure that employees comply with the Plan.
Procedures for communicating with employees regarding
workplace violence matters.
Assessment procedures for the identification and evaluation
of hazards including community-based risk factors for each
facility, unit, service or operation.
Procedures for the identification and evaluation of
patient-specific workplace violence risk factors.
Cal/OSHA is expected to make revisions on the draft discussion
document and begin the formal regulatory process in June with the
Office of Administrative Law.
Additionally, the Joint Commission issued a Sentinel Event Alert
in 2010 addressing violence in health care settings. The document
underscores suggested actions, such as working with the security
department to assess the facility’s risk of violence and ensuring
procedures for responding to incidents of workplace violence are
in place for employees to receive instruction.
One of the key places to start having these discussions is with
your facility’s organizational leadership. The third strategy
in Through the Eyes of the
Workforceis commitment to creating a
high-reliability organization. The leadership team needs to
engage the workforce in conversations related to connections
between respect, workforce safety and patient safety. Successful
leaders make a culture of safety a priority; in turn, the health
facility staff will feel valued and a part of the organization’s