Jazzy VPP - JS Aug 12 · Risk Assessment: 45 Minutes (10:30 – 11:15) Slides Notes Special 22 STEP...

Facilitator’s Overview Overall Goals:

Participants will be taken through the following workshop sections: • What exactly is Violence in the Workplace • Understand the legal framework regarding violence in the workplace (WCA, OHS

Regulation and Collective Agreement).. • Learn a six step problem-solving process to address violent hazards • Learn how to do a violence risk assessment. • Understand the key components of a violence prevention plan. • Learn how to facilitate actions to resolve OHS issues • Summary discussion.

Glossary of Images: The following icons are found throughout the facilitator overview and guide:

Group Work

Video

Flip-charting

Lecture/ Discussion

Break Time

Agenda & Timing Introduction: 30 Minutes (08:30 – 09:00)

Slides Notes Special 1 2 3 4

Introduce self Ice Breaker Activity Activity (20 mins)

• Break the room into groups • Have participants discuss relevant issues of violence

that they encounter in their workplace

Housekeeping Go through binder, remember the personal action plan at the front of the book Guidelines for session

5 6

OHSAH’s Mission Learning objectives

What Exactly is Violence in the Workplace/ Legal Framework: 60 Minutes (09:00 – 10:00)

Slides Notes Special 7 Why is Violence Experienced by Workers in Healthcare

Different From Other Industries?

8 Violence

9 What is Violence?

10, 11 Assaults and Treats Activity (10mins)

• Break into even numbered groups • Give each group a piece of flip chart paper • Assign each group to brainstorm either Assault or

Threats • facilitate out next two slides • Place flip chart papers on

12 More about Threats

13 General Duties under the Act

14 Others with Roles Responsibilities

15, 16 Why a Violence Prevention Plan? Activity (15 mins)

• Break participants into three groups • Give each group a piece of flip chart paper • Have each group look at the relevant regulations and

think about responsibilities and rights within the regulations

• Facilitate out responses

17 Facilitate out questions and concerns

Six steps to Problem Solving: 15 Minutes (10:15 – 10:30)

Slides Notes Special 18 ASK - Does the JOHSC DO all of these steps? Refer to Health

and Safety Matrix on PG, page 6.

19 Reinforce the six steps

20 STEP 1- OHS Issue Identification: Communication and

Support

21 What is the difference between hazard and risk?

Risk Assessment: 45 Minutes (10:30 – 11:15)

Slides Notes Special 22 STEP 2- Hazard Identification and Risk assessment

23 Which departments, occupational groups or work situations have the greatest risks?

24 Which departments, occupational groups or work situations have the greatest risks Activity (20 mins)

• Divide participants into groups • Use one of two scenarios on page. 12 Participant

Guide these are the Hazard Evaluation and Control Case Studies

• Have participants identify hazards in the scenarios and fill in Risk Factor (Hazards) for Violence worksheet on page 13 Participants Guide using the three categories in slide 23

• Use hyperlink to access slide 23

25 Risk Assessment

26 How to acess level of risk and set priorities Activity (15 mins)

• Have participants in groups • from the previous exercise have participants take

another look at the identified hazards and decide what level of risk that they are

• Use the worksheet on page 16 of the Participant Guide

Planning Interventions (Risk Controls): 45 Minutes (11:15 – 12:00)

Slides Notes Special 27 Discuss

28 Principles of controls

29 Examples of Controls

Activity (20 mins)

• In participant groups • Have participants identify controls that they would use

for two of the hazards identified in the previous activity.

• Use the Risk Reduction Planning worksheet 2 on page 16 of the Participant Guide

• Ask participants to consider what kind information they would want to see on for any controls in place such as policies and procedures

30 Questions

Lunch

Implementation of Controls/ Evaluation/Continuous Improvement: 60 Minutes (13:00 – 14:00)

Slides Notes Special 31 STEP 4- Implementation of Controls

Activity (20 min)

• Pick one of the controls over which you as a Joint Committee can act

• Develop an action plan using Worksheet 3 – Intervention Action Plan, on page 18 Participants Guide.

32 STEP 5 – Evaluation, Follow up and Monitor Activity (15 mins)

• In participant groups • Discuss way to monitor and evaluate controls • What are some of the barriers ot implementation • Flip chart responses

33 STEP 6- Continuous Improvement

Activity (15 mins)

• In participant groups • Brainstorm ways that there could be continuous

improvement • Facilitate discussion in larger group • Flip chart responses • Acknowledge successes

Prevention Planning Exercise: 90 mins including break and discussion (14:00 – 15:30)

Slides Notes Special 34 Introduce the ‘Downtown Clinic’ activity

35 Activity (45 mins)

• Review the steps of the exercise as on slide. • Divide into small groups to do this exercise (table

groups or otherwise) • Also note the sign-offs by worker and employer reps.

When the action plan and monitoring are complete. • Groups report back after risk factor/hazard

identification • Keep the flip charts to return to OHSAH • Groups report back verbally on controls considered for

two hazards, and then action plan for one control. Forms needed for the exercise are on the following pages in the participant’s guide:

• Community Clinic scenario, p. 20 PG • Floor plan, p. 21 PG • Risk Factor (Hazards) for violence – environmental,

individual, organizational – have each group write a flip chart to summarize hazards, use worksheet 1, p. 22 PG

• Risk Reduction Planning worksheet – write in controls for 2 hazards; there may not be a control in each category, use worksheet 2, p. 23 PG

• Intervention Action Plan – Worksheet 3, p. 24 PG – take one of risk factors (hazards) and use this form to do an action plan for a chosen control (intervention) – some of the needed information can be transferred from the risk reduction planning worksheet. Note the section on Monitoring and Evaluation – fill in suggested activities as well!

Break: 15 Minutes (14:30 – 14:45)

Understanding Key Components of a Violence Prevention Plan/ Wrap up: 60 Minutes (15:30 – 16:30)

Slides Notes Special 36 Elements of a Violence Prevention Plan

37 Resources for Developing a Violence Prevention Program

38 Legal framework for Violence Prevention

39-40 Resolving OH & S issues

41-42 Wrap up

43 Evaluation 44 Discuss

Ask participants to share something on their Personal Action Plan

Class Dismissed!

Occupational Health & Safety Agency for Healthcare in BC

“Making healthcare a healthier place to work.”


“Making healthcare a healthier place to work.”

Violence Prevention Planning

Healthcare Education & Learning Program (HELP)

• Welcome participants to Violence Prevention Planning!

• Introduce yourself and give a brief history of your OHS and healthcare experience.

2

2


Healthcare Education & Learning Program


2

Introductions

• Your name• Your workplace and job• What OH&S courses have you taken

previously?• Comments about expectations for

the day

• Ask participants to introduce themselves• Flip chart expectations for the day

Ice Breaker ActivityActivity (20 mins)• Break the room into groups• Have participants discuss relevant issues of violence that they encounter in their workplace

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Housekeeping

• Washrooms and exits• Parking• Sign-in sheet• Cell phones/pagers• Name badges• Course materials• Emergency procedures • Breaks and lunch

Discuss slide

Review of course material• Review sections in Participants Guide• Point out Personal Action Plan, talk about its uses• Let class know that you will be asking them to talk about an item off of their personal action plan at the end of the day.

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Session Guidelines• Be on time, especially when returning from breaks. • Turn pagers and cell phones to vibrate or off.• We welcome and encourage your participation. • Respect the contributions of others. • Only one person speaks at a time.• Respect confidentiality. • Acknowledge and value diversity.• Feel free to move and stretch as needed. • There is no such thing as a stupid question.

Remember to have fun

• Review the ground rules if needed • Would participants like to add to this, flipchart responses if any.

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OHSAH’s Mission

• To work with all members of the healthcare community to develop guidelines and programs designed to promote better health and safety practices and safe early return-to-work.

• To promote pilot programs and facilitate the sharing of best practices.

• To develop new measures to assess the effectiveness of programs and innovations in this area.

• For almost 10 years, OHSAH has remained committed to its mission, demonstrated leadership in the development of programs and innovations, and is currently embarking on new strategies to deepen its relationships with stakeholders, and increase its knowledge transfer activities to continue to deliver innovative approaches to workplace health and safety issues. It is also currently working monitor the state of healthcare in BC and measure the impact of its work. • Our desire to embark on a branding framework strategy is fuelled by the deliverable to measure OHSAH’s impact. • Thanks to you and those before you, OHSAH enjoys many successes and begins this project with strength, organizational focus and positive energy.

History of OHSAH• OHSAH is a non profit occupational health and safety agency for the BC healthcare sector which began in 1998 in a bipartite agreement between healthcare employers and unions.• Jointly governed by a Board made up of employers and healthcare unions including: BCNU, HEU, BCGEU, and the HSA• Gather, evaluate, and distribute workplace health and safety information and do research to identify best practices to enhanceworkplace health and safety.• OHSAH’s goal is to reduce workplace injuries and illnesses in healthcare workers and return injured workers back to the job in a timely and safe manner.

Instructors Note:Have samples/order forms available of OHSAH materials.Let participants know that they can order booklets and posters.Note OHSAH’s website: www.ohsah.bc.ca

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Learning Objectives

• What exactly is Violence in the Workplace?• Understand the legal framework regarding violence

in the workplace (WCA, OHS Regulation and Collective Agreement).

• Learn how to do a violence risk assessment.• Learn a six step problem-solving process to address

violent hazards.• Understand the key components of a violence

prevention plan. • Learn how to facilitate actions to resolve OHS issues• Summary discussion.

Discuss• Ask the participants if this meets their expectations.• Point out that learning strategies include discussions, group work, etc.

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Why is Violence in Healthcare Different From Other Industries?

• Healthcare workers are “up close and personal”with patients and their families.

• Interaction is often under difficult, or even dire, circumstances.

• The healthcare system is “stressed” to the limit.

ASK “WHY DO YOU THINK Violence Prevention IS DIFFERENT in ` healthcare?”

StatisticsWCB • about 40% of all violence-related claims come from healthcare workers even

though they make up less than 10% of the workforce. BCFED stats • 50% of nurses and social service workers report some sort of violence annually

including threats and verbal abuse.

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Violence• Just another part of a healthcare worker’s job?

Yes or No?

• Catching a disease… part of the job?

Some examples of hazards in our workplace environment

ASK - What comes first – worker safety or patient safety? How does your roles as a caregiver influence your priority for your own safety?

• Even if there are no physical injuries, the verbal and physical abuse can lead to build up of stress and ultimately to job change or other health (mental health) problems not directly linked to violence.

• Violent incidents are notoriously underreported. Workers in 20 Long term care facilities were asked to write down everything for 3 days – 5000 incidents were noted from verbal to physical to actual injuries. Under normal reporting situations, only 1.5% of these incidents would be reported.

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What is “Violence”?

• Violence is “the attempted or actual exercise by a person, other than a worker, of any physical force so as to cause injury to a worker.”

• Violence also includes, “any threatening statement or behaviour which gives a worker reasonable cause to believe that he or she is at risk of injury.”

(BC OHS Reg: Section 4.27)

Discuss slide• Prior to putting up slide, get examples of definition and put on flip chart.• Review briefly section of the Regulation which recognizes violence as a workplace hazard, but it applies only to Violence of client on worker 4.27 - definition

4.28 – risk assessment for violence is required4.29 – controls to eliminate or minimize risk4.30 – instruction to workers about risk of violence in their workplace and training to deal with aggressive clients4.31 – advice to consult a physician if exposed to violence

• There are other parts of the Regulation that deal less directly with worker on worker violence (4.24-4.26 – improper conduct)• Section 4.21-4.23 Working Alone or in isolation – See p. 55 PG

Note Assaults/violence by co-workers are usually addressed under the Criminal Code of Canada; clients can also be charged; bullying and discrimination complaints are usually dealt with under Human Rights Code. Worksites may have respectful workplace policies that outline acceptable behaviour for coworkers.

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Types of Violence

• Assault: involves any act, gesture or attempt to apply force, whether or not an injury (physical or psychological) occurs.

Preventing Violence in Healthcare. WCB, 2000

kicking, biting, hitting, grabbing, pinching, scratching or spitting

injuring a person by using an object such as a chair, cane or weapon

verbal hostility and abuse

Covers the next two slides

Activity (10mins)• Break into even numbered groups• Give each group a piece of flip chart paper• Assign each group to brainstorm either Assault or Threats • facilitate out next two slides• Place flip chart papers on the walls

Note:• Assault is also a gesture or attempt.Reference to Criminal Code of Canada• An injury doesn’t have to occur in order for assault to occur.Assault – referenced WCB – Preventing Violence in Healthcare copyright 2000

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Types of Violence cont’d…• Threats: involve any communication of intent to

injure.threat delivered in person or through letters, phone calls or e-mailintimidating or frightening gesturesthrowing and striking objectsstalkingnot controlling a dog menacing a worker (dog growling)wielding a weapon to threatenconcealing a weapon to threaten

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More about Threats

• A threat against a worker’s family that has arisen out of the course of the worker’s employment is considered to be a threat against the worker for the purpose of Regulation Section 4.27.

– WSBC Regulation - Policies Part 4 - Violence in the Workplace

• Discuss how they saw the meaning of Threats in the previous slide

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General Duties under the ActThe employer is responsible for:

• ensuring H&S of all workers• correcting unsafe conditions• establishing policies and procedures• providing training and education• making workers aware of known hazards.

The worker is responsible for:• ensuring that they report any unsafe conditions to their supervisor• Correct unsafe condition if capable • Follow workplace policies and procedures• Participate in training and education

From: WC Act Part 3 Division 3 Section 115-117

Both are required to cooperate to improve OH&S conditions.

General Duties (WC Act Part 3 Division 3) – see p. 75115 Employers

116 Workers

117 Supervisors• Employers are responsible for establishing policies and procedures and work environment to eliminate or minimize violence in the workplace.• Employers must inform workers of potentially violent clients and develop procedures ,e.g., reporting in when working alone (pre-incident - prevention) or procedures for response (post-incident)- how to obtain assistance, Code White, reporting, documenting, investigating incidents, CISD, EAP, coworker support or policies to support staff in criminal prosecution, e.g.If you are unionized, there may be specific language in the Collective Agreement that is even more specific than the WCA and Regulation – ask your union OSH steward and see Collective Agreement language in the Resources section, p. 96-118 in the back of participant’s book, especially re: violence.In a unionized workplace, employers must provide critical incident stress debriefing under the collective agreements, and WorkSafeBC has a Critical Incident Response line for you to call to get help – see Resources section, p. 122

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Others with Occupational Health and Safety Roles and responsibilities

• Supervisors• Occupational Health and Safety Committee

(JOHSC)• Owners/prime contractors

Roles and Responsibilities

•JOHS Committees are only one part of the H and S team. It is not their responsibility to do everything! Refer to handout in Participant’s Guide, p. 6. Explain that this is a way of showing the roles of the various parties in Health and Safety. It is useful to understand the relationships. Review these essential program elements and note the list is not exhaustive but these are the elements that have the biggest impact on safety. Specific duties of each group may vary from one worksite to another.Review JOHSC column: JOHSCs roles are to advise re: safety needs, review documents, safety programs (including policies and procedure), and make recommendations for improvement; they are to conduct inspections and participate in investigations and recommend corrective actions; they are to review department activities, training needs, and accident reports and make recommendations for needed actions. (this is all discussed in more detail later)

NOTE: beware of areas of role confusion, e.g., it is not the job of the JOHSC to write policies and procedures; JOHSCs can recommend the need for P & P’s, can give input and serve on a subcommittee of the employer to develop policies, can make suggestions for revisions, but it is the employer’s responsibility to develop policies and procedures to ensure safe workplaces and to implement them.

NOTE: discuss the responsibility of private owners and prime contractors to ensure safe worksites in this era of contracted services in healthcare.

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Why a Violence Prevention Plan?

OH&S Violence in the Workplace Regulation requires:

• risk assessments (4.28)• procedures, policies and work environment that:

– eliminate the risk to workers from violence on the job, or- if that is not possible,

– minimize the risk (4.29)

BC OHS Reg 4.28, .29, .30 & .31(see the Resource Section)

Covers next two slides

Activity (15 mins)• Break participants into three groups (or multiple of 3)• Give each group a piece of flip chart paper• Have each group look at the relevant regulations and think about responsibilities and rights within the regulations 4.28, 4.29, 4.30• Facilitate out responses• Put flip chart pages on the walls

WCB brought in “Violence in the Workplace” regulation in 1984. Violence is now recognized as a workplace hazard that comes under the general duties section of WCA – for both employers and employees – both have responsibilities and rights. Violence in the Workplace regulations refer only to client to worker violence, not worker to worker. Review violence regulation – see pp.57-58 PG Resources.4.27 is definition of violence4.28 – risk assessment4.29 – procedures, policies and work environment to eliminate or minimize risk4.30 – instruction to workers – notify about potentially violent clients, and provide training to deal with aggressive clients4.31 – advice to consult with physician if a violent incident occursThere are other relevant parts of the Regulation: see Resources section – highlight BRIEFLY!Rights and responsibilities – p 53 PG3.10 – reporting unsafe conditions3.12 – procedure for refusal (see also flowchart in resources)3.13 – no discriminatory actionWorking alone – p. 55 PG4.21 – Procedures4.22 – Training4.23 – Annual review

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Why a Violence Prevention Plan? (cont)

OH&S Violence in the Workplace Regulation requires:

• instruction to workers who may be exposed to violence, including the nature and extent of the risk, risk mitigation strategies and training to deal with aggressive clients (4.30)

• advice to consult with a physician (4.31).

BC OHS Reg 4.28, .29, .30 & .31(see the Resource Section)

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Questions?

• So far? So good!?!

• Maybe not!

• Facilitate out questions and concerns

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Six Steps to Problem Solving

1. OHS Issue Identification: Communication and Support

2. Hazard Identification and Risk Assessment3. Planning Intervention/Risk Controls4. Implementation of Controls*5. Evaluation: Follow-up and Monitor6. Continuous Improvement: Revise, Update and

Inform* JOHSC makes recommendations to employer of solutions to hazards. Employer is responsible for implementation of these risk controls.

• This is a summary slide to introduce the steps that are explained in detail in following slides. • It’s the linear (stepwise!) version of the process diagram on the next slide – good for both left and right brain thinkers!)• Problem solving is one of the key functions of the JOHSC. The committee is asked by workers and employers to review safety issues and recommend solutions. This requires a thoughtful and systematic process.

ASK - Does the JOHSC DO all of these steps? Refer to Health and Safety Matrix on PG, page 6• JOHSC is involved with all steps except implementation of a control which is the responsibility of the employer. • JOHSCs make recommendations to the employer to solve hazards they identify or are brought to their attention.The employer is responsible for implementing the controls.• JOHSCs have a big role in evaluation – follow-up and monitoring whether the control was implemented, were workers informed, was the control successful in dealing with the hazard?• JOHSCs also need to review OHS programs annually.

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Six Step Problem-solving ProcessOHS Issue

Identification: Communication

and Support Hazard Identification

and Risk Assessment

Planning Intervention/ Risk controls

Implementation of Controls

Evaluation: Follow-up and

Monitor

Continuous Improvement:

Review, Update and Inform

• Too often we start problem-solving by jumping to the first action we can think of (let’s just fix it!) before doing a proper assessment. Before we can do anything at all, we need to start with buy-in from employers and workers.

See talking points below:1. Get Buy-in: describe buy-in and what a stake holder is. Key is to build

commitment and support by workers and employer (and other stakeholders, if appropriate, e.g., client, family members)– Culture of Safety and Team work

2. Learn how to identify hazards and assess the risks; how likely is the hazard to cause an injury?

3. Plan interventions – actions that can eliminate or minimize risks – also known as risk controls;

4. Implement the risk controls (interventions) – take action as a committee or make recommendations to employer who implements the control

5. Monitor & Evaluate: Watch what happens. Is the recommendation being acted on? Did it work?

6. Continuous improvement: Review and update OHS program. Revise what didn’t work so well and inject new energy into the process. Celebrate success/learn from failure; communicate to workers and employers to show that actions were implemented and made a difference – this will continue to build trust, confidence, and buy-in! Success goes to Increased Buy-in. Failure goes to getting proper resources. It’s all a part of the ongoing process!

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Step 1- Issue Identification:Communication & Support

• How do OHS issues come to your committee?• Why don’t people report health and safety issues?• What are some communication strategies that may

be useful for JOHSCs to build support for safety in the workplace?

• Discuss slide• OHS issues – worker reports; employer; JOHSC safety campaign; incident reports; inspections;

worker surveys, etc.• WHY don’t workers report?

1. Healthcare workers don’t like to think of clients or patients as “hazards” in the usual OSH way – their job is to take care of people who are ill, in pain, stressed, anxious, chemically dependent, or not in their “right mind”. The clinical practice perspective (caregivers) is to use words such as “excessive and aggressive behaviour” since there is usually no intent to harm, e.g., someone with dementia or someone in pain. However, the worker still gets hurt, whether there is intention or not!

2. WORKERS MAY THINK THAT VIOLENCE IS A PART OF THE JOB. Workplace culture – don’t report, be tough, don’t be a wimp, fear of blame or reprisal

3. No serious injuries so not reported – there was no lost time.4. Lack of employee awareness of what “violence” is; no violence prevention plans or policies5. No action taken when violent incidents are reported.6. Violence is seen to be coming in from society rather than recognizing that the workplace is

unsafe.7. If you report a violent incident, you might be blamed for being incompetent or causing it

rather than learning from it!• Communication strategies: suggestion box, worker survey, build relationships/trust, bulletin

board, bipartite JOHSC-problem-solving, worker’s choices in safety needles, educate management about JOHSC roles – how you can help solve problems; tell people what you are doing – know who is JOHSC, celebrate successes, let workers know what happens, positive safety behaviour and leadership

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What is the Difference Between Hazard and Risk?

• A hazard is a thing or condition that may expose a person to injury or occupational disease.

• A risk is the likelihood that the hazard may expose a person to injury or occupational disease.

• Discuss hazard and risk • Get the class to give examples

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Step 2 - Hazard Identification and Risk Assessment

• Gather background information:obtain industry experienceincident reportsinspection reportsinvestigation reportscurrent policies and procedurescurrent prevention measures in place.Consult with workers – conduct employee survey and/or employee interviews/focus groups

• Complete a workplace inspection including a job task analysis.

• All hazards need to be addressed. • Determine areas/issues of greatest risk to help set

priorities for action.

• Satisfies Reg 4.28- Risk Assessment:

Risk assessment consists of:1. Identifying the hazards (risk factors)2. Assessing the level of risk and setting prioritiesNOTE: all hazards should be addressed, not just those with highest risk!

• Discuss where to get background information. NOTE – form in participant’s guide that can be used to collect and summarize information from a variety of sources to help with analysis of high risk areas or jobs, p. 11 PG.

• Describe a job task analysis – basic job steps, identify hazards, propose hazard control methods; identify high risk types of jobs

See resources for examples:• BCGEU Risk Factors checklist – p. 37• Sample Employee Survey – p. 39• Key elements of Workplace Violence Prevention Program – p. 44 NOTE: OHSAH is

facilitating a bipartite Provincial Violence Prevention Steering Committee who has created a more extensive list of elements – watch OHSAH’s website or contact OHSAH for details.

• Lit review on Preventing Violent and Aggressive Behaviour – p. 47 – an update is being done by OHSAH.

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Step 2 – Hazard Identification and Risk Assessment

Which departments, occupational groups or work situations have the greatest risks?

Risk Factors to consider:

Individual (client/ worker)Mental illnessAgitationClinical practicesExperience

EnvironmentalIsolated areaHigh crime areaWeaponsLighting

OrganizationalProceduresWork loadWorking aloneCommunications

• Discuss which departments, occupational groups, or work situations have the greatest risks? Ways to organize thinking about risk factors: ASK PARTICIPANTS TO GIVE EXAMPLES FIRST OF EACH TYPE. (Can divide into 3 groups and have each one write ideas on flip chart and share – one for environmental, one for organizational, one for individual.)

Environmental risk factors• physical environment: noise levels, workspace design, clutter, home-like

environment, lighting, air quality• Social environment: safety culture, team work and co-worker support,

interpersonal relationships, communication stylesOrganizational risk factors• Operational systems such as communication processes; Policies,

procedures, work processes (e.g., working alone or in isolation,scheduling, staff development), training, budget considerations

Individual risk factors• Client – physiological and psychological health status, medication use,

family support, activity levels• Worker – knowledge, skills and ability, experience and demographics

(age, ethnicity, etc.)

SEE A MORE COMPLETE LIST OF RISK FACTORS (HAZARDS) ON HAND OUT – P. 11

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Which departments, occupational groups or work situations have the greatest risks?

• Discuss answer to this question using relevant workplace examples

Activity (20 mins)• Divide participants into groups• Use one of two scenarios on page. 12 Participant Guide these are the

Hazard Evaluation and Control Case Studies• Have participants identify hazards in the scenarios and fill in Risk Factor

(Hazards) for Violence worksheet on page 13 Participants Guideusing the three categories in slide 23

• Use hyperlink to access slide 23

EnvironmentalOrganizationalIndividual

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Basic Elements of a Risk Assessment

ConsequencesHow severe is the injury

or outcome?

Exposure (frequency)How often does this

risk factor take place?

HazardsWhat are the Violence issues

associated with the task?

ProbabilityHow likely is it to happen?

• Discuss slide

High risk:•Frequently place workers at risk•The consequences may be severe•It is likely that the worker will be exposed to workplace violence

Moderate risk:•Workers at risk less often•Consequences less severe•Possible that worker will be exposed to violence

Low risk:•Workers rarely or never exposed to risk•Consequences minimal•Unlikely worker will be exposed

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How to Assess Level of Risk and Set Priorities

• Risks should be assessed as follows:

– Frequency - how often does this risk factor take place?

– Severity - how severe is the injury or outcome?

– Probability - how likely is it to happen?

• High risk areas include: emergency departments, psychiatric treatment centers, long term care facilities.

• Assess level of risk and set priorities• Discuss how to decide whether the risk factor is high, medium or low risk.

Activity (15 mins)• Have participants in groups• from the previous exercise have participants take another look at the identified hazards and decide what level of risk that they are• Use the worksheet on page 16 of the Participant Guide

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Step 3 – Planning Interventions (Risk Controls)

• Discuss slide• All identified hazards should be addressed whether they are high, medium or low! • Try to identify hazards before they result in an incident • Risk controls (interventions) are designed to correct hazards so that they do not result in injury later down the road!• Assessing high risk areas or jobs can help you set priorities for action, but sometimes the low risk areas may be easier to address and action can begin right away.

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Principles of Risk Control• At the Source

– ELMINATE – SUBSTITUTE e.g., less violent client

• Along the Path– ENGINEERING e.g., locked doors, plexiglass– ADMINISTRATIVE e.g., policies, procedures,

training

• With the Worker– PERSONAL PROTECTIVE EQUIPMENT e.g.,

gloves, gowns, footwear, cell phones; bulletproof vests

Least

Most

Effective

• Explain in detail the concept of the Principles of Controls. • Give examples of what a control would be at:

the sourceSend violent resident to higher level facility, introduce new resident to you

facility

along the pathLocked doors, plexiglass

the workerBullet proof vest

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Examples of ControlsEliminate/Substitute• restrict visitors during homecare visits• require a client to receive service at a health unit.

Minimize risk by:Engineering Controls• changes to the workplace• deep counters; Plexiglas barriers; locks; panic buttons

Administrative Controls• changes in how people work• patient flagging policy; working alone procedures; management of

aggressive behaviour training; scheduling systemsPersonal Protective Equipment• cell phones; bulletproof vests

Activity (20 mins)• In participant groups • Have participants identify controls that they would use for two of the hazards identified in the previous activity.• Use the Risk Reduction Planning worksheet 2 on page 23• Ask participants to consider what kind information they would want to see on for any controls in place such as policies and procedures

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Questions?

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Step 4 - Implementation of Controls

1. Identify a risk factor to address (from risk assessment).2. What current policies/procedures already exist to address

the risk?3. What risk controls (interventions) are possible? What are the

critical priorities? Choose one.4. Implement control using measurable objectives, person

responsible, timeline.5. Write recommendation to employer if required.

Preparing an Intervention Action Plan

Step 4 – Implementation of Controls• Discuss process in steps 2 and 3 • Step 4 is Implementation of Controls – there are two processes for

implementation:1. JOHSC implements the control itself through an action plan with

measurable objectives, person responsible, and timelines. or requests others to do it, e.g., maintenance requests.2. JOHSC can’t implement directly so writes a formal recommendation to the

employer which requires a response within 21 days – see WCA, Part 3, Division 4, Section 133 for information about 21 day response ofemployer to recommendations done by Joint Committee p. 80

. Instructor’s note: In VPP, we only discuss writing an action plan and do not

do a formal recommendation.Activity (20 min)• Pick one of the controls over which you as a Joint Committee can act• Develop an action plan using Worksheet 3 – Intervention Action Plan, on

page 18 Participants Guide.

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Step 5 – Evaluation: Follow-up and Monitor

• Did anything happen?• Was the control implemented?• Were workers informed?• Did anything change?

Activity (15 mins)• In participant groups • Discuss way to monitor and evaluate controls • What are some of the barriers ot implementation• Flip chart responses

• Were workers consulted during the process? • Were worker suggestions for controls considered?• Were final recommendations implemented?• Have controls eliminated/minimized risks?• Did implementation create another hazard?• Are new procedures being followed?• Is additional education/training needed or required?• Has a date been set for further follow-up?

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Step 6 – Continuous Improvement:

Review, Update and Inform

• Revise plan based on outcomes• Conduct an annual plan review.• Inform workers of interventions and outcomes• Celebrate success

Activity (15 mins)• In participant groups• Brainstorm ways that there could be continuous improvement• Facilitate discussion in larger group • Flip chart responses• Acknowledge successes

• recognize staff for making a positive difference• Conduct a formal review of your program • check your objectives and action plans• revise and up date them and set new priorities.• Continually monitor and evaluate your risk controls (interventions) • adapt to changing conditions• Communicate results to staff • Build a caring and supportive organizational culture that subscribes to the care, welfare, safety and security of all concerned – clients and staff, visitors and volunteers.

34




Planning Exercise

Violence Prevention at the

“Community Clinic”

• Introduce activity on following slide• Explain that the participants will now do an exercise to follow through with all the

steps to reducing risk to issues of violence in the workplace

35




Planning Exercise - Community Clinic

1. Read the scenario and review clinic floor plan.

2. Identify risk factors (hazards - environmental, individual, organizational).

3. Assess level of risk - (High, Moderate, Low).

4. Choose two risk factors and develop controls (risk reduction planning worksheet).

5. Choose one risk factor to develop an intervention action plan.

Activity (45 mins)• Review the steps of the exercise as on slide. • Divide into small groups to do this exercise (table groups or otherwise)• Also note the sign-offs by worker and employer reps. When the action plan and monitoring are complete.• Groups report back after risk factor/hazard identification • Keep the flip charts to return to OHSAH• Groups report back verbally on controls considered for two hazards, and then action plan for one control.

Forms needed for the exercise are on the following pages in the participant’s guide:• Community Clinic scenario, p. 20 PG• Floor plan, p. 21 PG• Risk Factor (Hazards) for violence – environmental, individual, organizational – have each group write a flip chart to summarize hazards, use worksheet 1, p. 22 PG• Risk Reduction Planning worksheet – write in controls for 2 hazards; there may not be a control in each category, use worksheet 2, p. 23 PG• Intervention Action Plan – Worksheet 3, p. 24 PG – take one of risk factors (hazards) and use this form to do an action plan for a chosen control (intervention) – some of the needed information can be transferred from the risk reduction planning worksheet. Note the section on Monitoring and Evaluation – fill in suggested activities as well!NOTE:• GROUPS NEED TO BE ENCOURAGED AND MONITORED THROUGH THIS LONG ACTIVITY OR THEY TEND TO DRIFT FROM THEIR TASKS!!!! • They may need input and direction to keep them from floundering since this is a somewhat complex exercise. But once they’ve done it here, it should be a snap to use these forms when they are looking at their own site! They should understand the process!

36




Violence Prevention Planning Program Review

Commitment and continued buy-in from all stakeholders is needed for success.

An effective plan has at least the following elements:• A working group that includes employer and worker reps

- Ensures the communication plan is effective throughout the process• Detailed risk assessment procedures to identify hazards/risks• Control measures to minimize risks (both pre- & post-incident)

- Engineered controls (e.g. locks)- Admin (e.g. procedures, education and training, CISD, etc.)- Personal protective measures

• A comprehensive implementation schedule- Designates a person responsible- Target dates for implementation of control measures

• Mechanisms to monitor, evaluate, revise & update the program

• Discuss elements of a violence prevention plan. • Review and reinforce what has been discussed. • Reinforce the importance of forming a working group that includes employer and worker reps • importance of clear communication throughout the whole process of planning and identifying hazards and choosing and implementing and evaluating controls!

NOTE:The poster of violence prevention as a process is also included just before the last 3 slides on p. 27 PG – you could use it to summarize as well.

37




Resources for Developing a Violence Prevention Plan

• Forming an effective working group• Workgroup planning guide• Planning worksheets• Key elements of a violence prevention plan• Information gathering tools: checklist, worker survey• Violence prevention plan evaluation criteria

• Discuss RESOURCES for developing a violence prevention plan:• See ideas for forming an effective working group on the first page 31 of the resource section• call their attention to a violence prevention program planning guide on the next page, p.32• blank forms for the whole process done in the exercises are also found in the Resources section, p. 33-36• See also, some information gathering tools: Risk Factor Checklist and worker survey samples, p. 37-43• Key elements of a violence prevention program, p. 44-46• Criteria for evaluating a violence prevention program is found in the lit. review, p. 47-52•Some relevant sections of WCA and Reg, p. 53-58

38




Legal Framework for Violence Prevention

• Workers Compensation Act• OHS Regulation

3.12 – 3.13 Right to Refuse Unsafe Work4.21 – 4.23 Working alone4.24 – 4.26 Workplace Conduct4.27 – 4.31 Violence in the workplace

• Collective Agreement language• Critical Incident Response (CIR) Program

• Discuss slide.• Resources, p. 53 – 58 PG for part of Regulation and, p. 71 – 93 for WCA - more information• WCA and Reg are minimum requirements; the CA articles may exceed these minimums-see 96-118• CIR – employer is required to provide Critical Incident Response to a worker who has been traumatized at work; check with your union or call WorkSafeBC; seek support from others right away; ask for counseling; act immediately to avoid PTSD. See page 122 Common Resources for help phone from WSBC.

39




Resolving OHS Issues

• The JOHS Committee can resolve issues by using internal processes or making a formal recommendation to the employer.

• At any time, workers can refuse unsafe work or file a grievance.

What should the Committee do if they cannot agree on action to take to address OHS issues? See p. 121 – Resolving OHS Issues. • Joint Committee takes action on its own or makes recommendations to employer.• If Joint Committee feels employer’s response is inadequate or if they can’t agree as a committee on what action to take, there are resources available:• OHS professionals for advice• WorkSafeBC – discuss the details of what WorkSafeBC can doContact WorksafeBC Infoline for information and guidance on the issue at 1-888-621-7233; or the committee may also invite a WorkSafeBC board officer to attend the JOHSC meeting to provide information informally; or a co-chair can ask WorkSafeBC to “investigate and attempt to resolve the matter” (Section 132 WC Act)• Unions

Worker representatives may consult with their respective unions for additional advice. Healthcare collective agreements contain articles pertaining to Occupation Health and Safety that may provide additional guidance. The Workers Compensation Act and Regulation are minimum standards. OHS articles in collective agreements may exceed the minimum requirements.

40




Resolving OHS IssuesFollow the process set out in your workplace using the tools given to you in this course, speak to:• Supervisor• Contact your local OHS professionals• Worker Representatives may contact their

respective Union for advice.• Contact WorksafeBC Info line or local officers

• At any time, workers can refuse unsafe work (which may involve the JOHSC) or they can file a grievance, which is outside of the JOHSC structure.

41




Wrap Up

• Make your workplace safer for you and your co-workers by being aware. Know the risks.

• Use the safeguards (e.g. policies, procedures, training, etc.)

• Report hazardous situations even if you handled things well. Help everyone learn!

• Support efforts to reduce violence potential.• Never give up.

• Discuss slide

42




A violence prevention plan is the key to a more positive and healthy work environment.

ANIMATED PICTURE

Thank participants for attending the day.

43




Session Evaluation

• Administer Evaluation located at the back of the Participant Guide page 29 and 30.• Let Participant know that all the forms that they have been using are located in the resource section of the Participants Guide.• Point out the checklists samples in the resource section

44




Thank You!For more information about OHSAH’s work, resources,

and programs:

Jolene SimpsonTraining Coordinator

Healthcare Education and Learning Program (HELP)[email protected]

Or visit OHSAH’s website:www.ohsah.bc.ca

Ask participants to give one thing off of their Personal Action Plan, close the class by making comments and thanking them for their time.

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