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Workplace Violence Prevention

Best Practices

Created on October 31, 2017

“Insanity is doing things the way we’ve always done them and expecting different results.”
Albert Einstein

Number of workplace violence incidents (overall) is a new mandatory indicator for the Quality Improvement Plans (QIPs). This indicator measures the number of workplace violence incidents against hospital workers. The Occupational Health and Safety Act, 1990 defines workplace violence as the exercise or attempted exercise of physical force by a person against a worker that causes or could cause physical injury, and/or a statement(s) or behaviour(s) that could be interpreted as a threat to exercise physical force against a worker in the workplace.

Below are best practices for managing and reducing workplace violence. They are graded according to Type of Evidence. Evidence-informed best practices are based on high-quality evidence; they can optimize outcomes and should be implemented into practice where possible.

To help you move from best evidence to best practice, you can refer to Health Quality Ontario’s Quality Improvement Plan Guidance: Workplace Violence Prevention or browse the interactive table below for a quick summary of how to improve on workplace violence prevention in your hospital. To read about what organizations are doing to address workplace violence as described in their 2017/18 Quality Improvement Plans, refer to Health Quality Ontario’s report, Insights into Quality Improvement: Workplace violence prevention in the 2017/18 Quality Improvement Plans.

  1. Arnetz, J.E., Hamblin, L., Ager, J., Luborsky, M., Upfal, M.J., Russell, J., & Essenmacher, L. 2015.
    Underreporting of Workplace Violence: Comparison of Self-Report and Actual Documentation of Hospital Incidents.
    Workplace Health & Safety, 63, (5) 200-210.

  2. Health Quality Ontario.
    Quality Improvement Plan Guidance.
    Queens Printer for Ontario. 2017 Toronto ON.
    Retrieved from: http://www.hqontario.ca/Portals/0/documents/qi/qip/guidance-workplace-violence-en.pdf

  3. Health Quality Ontario.
    Insights into Quality Improvement: Workplace Violence Prevention from the 2017/18 Quality Improvement Plans.
    Queens Printer for Ontario. 2017 Toronto ON.
    Retrieved from: http://www.hqontario.ca/Portals/0/documents/qi/qip/guidance-workplace-violence-en.pdf

  4. Ontario Nurses Association (ONA).
    Workplace Violence and Harassment A Guide for ONA Members.
    October 2016.
    Retrieved from: https://www.ona.org/wp-content/uploads/ona_workplaceviolenceandharassmentguide_201610.pdf?x72008

  5. Workplace Safety and Insurance Board (WSIB) EIW Claim Cost Analysis Schema, May 2014 data snapshot.

Measurement

Created on October 31, 2017

“While all changes do not lead to improvement, all improvement requires change”
Institute for Healthcare Improvement

How do we know if a change is an improvement? Measurement is a critical step in QI to assess the impact of a change. Quality indicators are used in the QIPs to measure how well something is performing. There are three types of quality indicators used to measure QI efforts:

  • Outcome Indicators: capture clinical outcomes and or system performance,
  • Process Indicators: track the processes that measure whether the system is working as planned, and
  • Balancing Indicators: ensure that changing one part of the system does not cause new problems in another.

Indicator Number of workplace violence incidents (Overall)
Mandatory, Priority or Additional Mandatory
Quality Dimension Safety
Type of Indicator Outcome
Measure Number of workplace violence incidents reported by hospital workers
Data Source In house data collection. The number of reported workplace violence incidents is available via your organization’s internal reporting mechanisms.
Target (Direction of Improvement)

If your organization is focused on building your reporting culture, your QIP target for this indicator may be to increase the number of reported incidents.


If your organization’s reporting culture is already well-developed, your QIP target may be to decrease the number of incidents occurring.

Description This indicator measures the number of reported workplace violence incidents by hospital workers (as by defined by OHSA) within a 12 month period
How to Calculate

Number of workplace violence incidents reported by hospital workers within a 12 month period.

Inclusions: The terms “worker” and “workplace violence” as defined by under the Occupational Health and Safety Act (OHSA, 2016)

Note: While there is no denominator for this indicator, organizations are asked to include the total number of hospital employee full-time equivalents (FTE) in the measures section of the QIP Workplan.

HQO Reporting Tool Quality Improvement Plans (QIPs)

This data can be presented using Run Charts to track improvement over time. To read more about general measurement in QI refer to Measurement for Quality Improvement or the QI Getting Started Section.

Tools & Resources

Created on October 31, 2017

Health Quality Ontario’s Tools and Resources
Other Tools and Resources

Background

Created on October 31, 2017

Issue

Workplace violence in health care settings is a serious issue. In 2014, the health care sector had higher rates of lost-time injuries due to workplace violence than the manufacturing, construction, and mining sectors combined (WSIB, 2014). Evidence suggests that reporting of incidents of workplace violence to a formal reporting system is low: in one study in a hospital setting, 62% of staff surveyed had experienced at least one violent incident within the past year, but 88% of these staff who reported experiencing violent incident(s) had not documented any incidents in the organization’s electronic database in the past year (Arnetz et al, 2015).


Call to Action

In response to this issue, the Ministry of Health and Long-Term Care and the Ministry of Labour established the Workplace Violence Prevention in Health Care Leadership Table to drive province-wide efforts to address this issue and adopt a zero-tolerance stance toward workplace violence in Ontario’s health care sector (HQO, 2017).

In May 2017, this Leadership Table released a report, Preventing workplace violence in the health care sector, that includes 23 recommendations to implement effective workplace violence prevention programs in hospitals. One of these recommendations was to include workplace violence prevention in the Quality Improvement Plans (see Recommendation 19). Accordingly, the issue of workplace violence prevention will be integrated into the 2018/2019 Quality Improvement Plans (QIPs) submitted by hospitals, primary care organizations, long-term care homes, and local health integration networks, which oversee home and community care (HQO, 2017).

Workplace violence prevention will be incorporated into the QIPs in two ways: first, a free-text statement will be included in the QIP Narrative for all sectors (hospital, primary care, long-term care, and home care); and second, a mandatory indicator measuring workplace violence will be included in the QIP Workplan for the hospital sector only. The ultimate goal is to foster a culture of workplace safety across the health sector in Ontario. The ultimate goal is to foster a culture of workplace safety across the health sector in Ontario.

  1. Arnetz, J.E., Hamblin, L., Ager, J., Luborsky, M., Upfal, M.J., Russell, J., & Essenmacher, L. 2015.
    Underreporting of Workplace Violence: Comparison of Self-Report and Actual Documentation of Hospital Incidents.
    Workplace Health & Safety, 63, (5) 200-210.

  2. Health Quality Ontario. Quality Improvement Plan Guidance.
    Queens Printer for Ontario. 2017 Toronto ON.
    Retrieved from: http://www.hqontario.ca/Portals/0/documents/qi/qip/guidance-workplace-violence-en.pdf

  3. Health Quality Ontario.
    Insights into Quality Improvement: Workplace Violence Prevention from the 2017/18 Quality Improvement Plans.
    Queens Printer for Ontario. 2017 Toronto ON.
    Retrieved from:

  4. Workplace Safety and Insurance Board (WSIB) EIW Claim Cost Analysis Schema, May 2014 data snapshot.