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To engage the epidemic of violence against health care workers, The Joint Commission (TJC) recently established some new requirements to help organizations better provide for the safety of their employees.
This change in accreditation requirements comes amid a growing international discussion on the need for the health care field to take violence prevention more seriously. The endemic nature of health care violence highlights the need for reform as reports from the Occupational Health and Safety Administration (OSHA) and the International Association for Healthcare Safety and Security (IAHSS) show violence against health care workers at an all-time high.
This conversation is even happening at the federal level as House Resolution (HR) 1195, the Workplace Violence Prevention for Healthcare and Social Service Workers Act, is working its way through the Senate, having passed the House earlier in 2021. If passed, HR 1195 will direct OSHA to outline regulatory requirements for violence prevention programming in health care facilities. Until that becomes law, TJC’s new requirements will help every hospital prepare for compliance and better protect their staff.
TJC’s new requirements represent some of the most expansive requirements for workplace violence prevention ever put forward by an accreditation body. The requirements include multiple elements of performance that work in unison to help outline a comprehensive violence prevention program.
One of the primary requirements is an annual worksite analysis (EC.02.01.01, EP17). TJC outlines the need to utilize this analysis to better understand the reality of violence within a facility, understand how the facility's policies and procedures for workplace violence prevention work, and how best to meet regulatory requirements for violence prevention. The worksite analysis is seen as a gap analysis that helps a facility prioritize work for continuous improvement of the program.
The worksite analysis requirement is supported by workplace violence incident monitoring and reporting requirements (EC.04.01.01, EP1 and EP 6). The requirement for reporting is coupled with a requirement to investigate all incidents of violence.
Another requirement is the leadership requirement. TJC now requires the health care organization to designate a single leader, typically the security leader, tasked with leading a multidisciplinary team to manage the workplace violence prevention program (LD.03.01.01, EP9).
One of the most vital elements of the new requirements is the new requirements for education and training. This requirement is for workplace violence prevention training for all staff and licensed practitioners at the time of hire, annually and whenever changes to the program are made. This training must include defining workplace violence, roles and responsibilities, de-escalation skills, physical and nonphysical interventions, and reporting processes (HR.01.05.03, EP29).
Each of these elements of performance underscores a specific need within the context of a holistic prevention program. They are designed to work in tandem to ensure the safest possible environment and, as of January 2022, TJC is surveying to these standards.
The robustness of these requirements further highlights two things. First is the great need for action within the field due to the overwhelming amount of violence faced by the health care workforce. The second highlight is the need to grow legitimate expertise in violence prevention in health care facilities. A health care facility's primary resource for violence prevention expertise should be the security leader. The question remains, is the security leader up for the challenge?
The complexity of security management in health care has changed dramatically within the last few decades, and the need to grow security expertise and capability has increased significantly. This reality is true of every aspect of security management, but it is made only more significant by the daily violence crisis.
When nursing staff is more likely to be assaulted at work than police officers, the need for security professionals to be highly trained violence interventionists is critical. This need to invest in security expertise is crucial for both security leadership and security officers. Knowledge of both violence prevention methods and violence response procedures takes more than a passing interest; it takes a dedicated professional who is well trained and committed to the work.
Health care facilities that take violence prevention seriously must invest in the growth and development of their security teams. There are multiple resources available to help grow the expertise of health care security leadership. Organizations like OSHA provide excellent guidelines for violence prevention within the health care sector. IAHSS has well-developed guidelines for security operations and physical security design, and provides a multilevel training program. Recently, the IAHSS has put together a certificate program for security leaders to help prepare them to build and manage a comprehensive workplace violence prevention program.
The IAHSS Workplace Violence Prevention Certificate Program is an excellent way to grow expertise around violence prevention. The course of study includes in-depth education on workplace violence policy development; building and leading a multidisciplinary team; leveraging an intelligence program for worksite analysis, threat assessment, violence prevention and reaction tools; and training and education programs for security and non-security staff. The course of study provides expertise to anyone seeking to lead violence prevention for their facility.
As TJC implements new standards and Congress works to pass new legislation to promote violence prevention efforts in health care, it is incumbent on the health care facility to grow the expertise needed to serve these requirements and their employees. Safer environments benefit every part of health care, from helping to improve the quality of care to reducing employee turnover and increasing employee engagement. Less violence means better business for health care.
Mike Hodges, CHPA, CPP, is system director for public safety at Piedmont Healthcare in Athens, Ga.