New guidelines on aggression in health care

WorkSafe Western Australia and the other OHS regulators in Australia have produced a very good, and timely, guideline for the “Prevention and Management of Aggression in Health Services“.

The hazard has existed for many years and hospitals, in particular, are torn between the competing priorities of keeping their staff safe and maintaining  contact with their clients.   Glass screens and wire are effective barriers to violent attacks but it can be argued that such structures encourage aggression by implying that “violence happens here”.

The guidelines, or what the regulators call a “handbook for workplaces” (How does that fit in with the regulatory hierarchy for compliance?), provides good information on the integration of safe design into the health service premises.  But as with most of the safe design principles, as is their nature, they need to be applied from initial planning of a facility and so, therefore, are not as relevant to fitting-out existing facilities.  In health care, it often takes years or decades before upgrades are considered by the boards and safe design is still a new concept to most.

Another appealing element of the guide is that it does not only consider the high customer churn areas such as casualty or emergency.  It is good to see the important but neglected issue of cash handling mentioned even in a small way.

Another positive is the handbook includes a bibliography.  This is terrific for those who want to establish a detailed understanding of the issues and the current research.  For the OHS regulators, it allows them to share the burden of authority.  Just as in writing a blog, by referencing source material the reader understands the knowledge base for the opinions and the (blog) writer gains additional credibility by showing they have formed opinions and advice from the most current sources.

Having praised the bibliography, it is surprising that of all the Claire Mayhew publications and papers mentioned her CCH book “Guide to Managing OHS Risks in the Health Care Industry”, was omitted.

The regulators have often had difficulty determining whether checklists or assessment forms should be included in their guidances.  In Victoria one example of the conflict was in the Manual Handling Code of Practice that included a short and long assessment checklist.  Hardly anyone looked beyond the short version and many thought this undercut the effectiveness of the publication.

The fact is that safety management takes time and business want to spend as little time on safety as possible but still get the best results.  Checklists are an audience favourite and contribute to more popular and widely read guidelines, and broad distribution of the safety message is a major aim.

Interestingly amongst the checklist in this health services aggression publication a staff survey has been included.

(At least) WorkSafe WA has listened to the frustrations of readers who download a PDF version but then have to muck about with, or retype, the checklists.  This handbook is also available as an RTF file for use in word processing.

This is the first OHS publication that has come out from a government regulator with this combination of content, advice and forms.  It is easy to see how this will be attractive to the intended health services sector.

Kevin Jones

reservoir, victoria, australia

3 thoughts on “New guidelines on aggression in health care”

  1. Oh how sad this all is.2009 this brochure was published and yet the Health sector still refuses to follow the guidlines,if anything regressing back to the pre violence in the workplace,days.
    Budgets and bullshit have had management sneakily omitting to implement what can only be described as ‘Best Practice” yet apparently denying a safe work environment isnt as appealing as keeping the budget in check.
    One questions the reliability of a director,when someone being abused at the least to being physically assaulted and needing a trained Security unit to avoid these occurrences is outweighed by the lesser chance of a lawsuit for ‘duty of care’.
    This guideline is farcical given the current situation staff find themselves in daily.Its all good filling in incident reports but utterly pointless when they get filed in the ‘dont care’ basket,never to be heard of again.
    The system is corrupt and money is a greater care than the health and safety of staff and the general public.

  2. I recently experienced working with several departments in a local council, and this was a recurrent issue for them too. I started out not having high expectations of the level of risk in this work environment, but my eyes were quickly opened. Exposure to risk from that most dangerous of machines, the human, make this a really difficult area – sometimes in surprising ways.

    Risks to personal safety while working in youth services – yes, I could anticipate that. Child care centres and custody disputes – frightening, but not surprising. Customer service counter staff, and the odd irate ratepayer? – Check… But libraries? Places of refuge for the homeless, and the mentally ill – but how do staff and other patrons take refuge when a “feral” client starts acting out in a public place?

    1. Ross

      It is a hazard that is present in a range of workplaces. I have seen an angry middle-aged customer throw a burger back at the face of a young McDonald’s worker. It is unacceptable behaviour and could have a substantial negative affect on the attitudes of the young worker who is simply trying to earn a living.

      But then again at high school I sat next to someone who through a cake at a teacher who we didn’t like. To my eternal regret, that teacher resigned from the school and, I believe, teaching shortly after. I realise the classroom is different but the aggression and unfairness was the same.

      One of my frustrations with how OHS guidances are released is that the publications simply appear on a website and the regulators rely on people like me to promote and disseminate them. Surely the purpose of the regulator extends beyond simply making the publication available. They should be promoting the existence of them to the wider community. I can only reach so many and most of the readers are already OHS and safety advocates.

      The federal parliament places monthly half page ads in the newspapers announcing the release of their inquiry reports. I would like to see the State OHS regulators to publish a list of new publications in the newspapers. Perhaps just the local newspapers to start as the cost is less and local papers are avidly read by the small businesses the regulators struggle to reach.


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