fbpx
01626 889268
Book Your Appointment

Violence and Aggression at Work (Zero Tolerance)

Violence and Aggression at Work (Zero Tolerance)

Statutory Duty

The practice management recognises that it has a statutory duty of care to ensure the health and safety at work of all employees, which includes a duty to protect against bullying and harassment as far as is reasonably practicable.

Violence is … 

The Health and Safety Executive (HSE) defines violence as ‘any incident in which an employee is verbally abused, threatened, or physically assaulted in circumstances related to their work.’ This includes, but is not limited to:

  • Verbal abuse (shouting, swearing).
  • Threats, stalking, or intimidating behaviour.
  • Physical assault.
  • Damage to property caused as a result of aggression.

You may wish to access this advice from HSE: http://www.hse.gov.uk/pubns/indg69.pdf

In our Practice

Violence or aggression against any member of staff will not be tolerated. Incidents which involve violent conduct towards members of staff will be reported to the police. General Dental Practitioners (GDPs) have the right to remove, with immediate effect, any patient who has been violent or threatened violence to the GDP or a member of their staff.

Effective management

  1. Risk assessment. 

Finding out if you have a problem.  The first step in risk assessment is to identify the hazard. You may think violence is not a problem at your workplace or that incidents are rare. However, your employees’ view may be very different. Ask your staff. 

Do this informally or use a short questionnaire to find out whether your employees ever feel threatened. Tell them the results of your survey so they realise that you recognise the problem. Keep detailed records – it is a good idea to record incidents, including verbal abuse and threats. You may find it useful to record the following information: 

  • an account of what happened; 
  • details of the victim(s), the assailant(s) and any witnesses; 
  • the outcome, including working time lost to both the individual(s) affected and to the organisation as a whole; 
  • the details of the location of the incident. For a variety of reasons some employees may be reluctant to report incidents of aggressive behaviour which make them feel threatened or worried. They may for instance feel that accepting abuse is part of the job. You will need a record of all incidents to enable you to build up a complete picture of the problem. Encourage employees to report incidents promptly and fully and let them know that this is what you expect. Classify all incidents – use headings such as place, time, type of incident, potential severity, who was involved and possible causes. 
  • It is important that you examine each incident report to establish whether there could have been a more serious outcome. Here is an example of a simple classification to help you decide how serious incidents are: 

Major injury; 

  • Injury or emotional shock requiring first aid, out-patient treatment, counselling, absence from work (record number of days); 
  • Feeling of being at risk or distressed. It should be easy to classify ‘major injuries’ but you will have to decide how to classify ‘serious or persistent verbal abuse’ for your organisation, so as to cover all incidents that worry staff. You can use the details from your incident records along with the classifications to check for patterns. Look for common causes, areas or times.   

 

  1. What action to take. 

Having found out that violence could be a problem for your employees you need to decide what needs to be done. Continue the risk assessment by taking the following steps to help you decide what action you need to take. 

  • Decide who might be harmed, and how Identify which employees are at risk – those who have face-to-face contact with the public are normally the most vulnerable. 
  • Where appropriate, identify potentially violent people in advance so that the risks from them can be minimised. 
  • Evaluate the risk Check existing arrangements, are the precautions already in place adequate or should more be done? 
  • Remember it is usually a combination of factors that give rise to violence.  

 

Factors which you can influence include: 

  • the level of training and information provided; 

Train your employees so that they can spot the early signs of aggression and either avoid it or cope with it. Make sure they fully understand any system you have set up for their protection. Provide employees with any information they might need to identify clients with a history of violence or to anticipate factors which might make violence more likely.

 

The environment; 

  • Provide better seating, decor, lighting in public waiting rooms and more regular information about delays. 

Consider physical security measures such as: 

  • video cameras or alarm systems; 
  • coded security locks on doors to keep the public out of staff areas; 
  • wider counters and raised floors on the staff side of the counter to give staff more protection. 
  • the design of the job.   
  • Use cheques, credit cards or tokens instead of cash to make robbery less attractive. Bank money more frequently and vary the route taken to reduce the risk of robbery.

The threat of violence does not stop when the work period has ended. It is good practice to make sure that employees can get home safely. Employees are likely to be more committed to the measures if they help to design them and put them into practice. 

A mix of measures often works best. Concentrating on just one aspect of the problem may make things worse in another. Try to take an overall view and balance the risks to your employees against any possible reaction of the public. Remember that an atmosphere that suggests employees are worried about violence can sometimes increase its likelihood. In one housing department it was found that protective screens made it difficult for staff and the public to speak to each other. This caused tension on both sides. Management and safety representatives agreed a package of measures including taking screens down, providing more comfortable waiting areas and better information on waiting lists and delays. This package of measures reduced tension and violent incidents. Record your findings Keep a record of the significant findings of your assessment. The record should provide a working document for both managers and employees. Review and revise your assessment Regularly check that your assessment is a true reflection of your current work situation. Be prepared to add further measures or change existing measures where these are not working. This is particularly important where the job changes. If a violent incident occurs, look back at your assessment, evaluate it and make any necessary changes.

  1. Take action. 

Your policy for dealing with violence may be written into your health and safety policy statement, so that all employees are aware of it. This will help your employees to co-operate with you, follow procedures properly and report any further incidents.

Publish a Notice of Zero Tolerance that is clearly seen by all who visit the practice. 

  1. Check the effect of what you have done. 

Check what you have done Check on a regular basis how well your arrangements are working, consulting employees as you do so. Consider appointing another Lead person to monitor this. Keep records of incidents and examine them regularly; they will show what progress you are making and if the problem is changing. If your measures are working well, keep them up. If violence is still a problem, try something else. Go back to Stages 1 and 2 and identify other preventive measures that could work. 

It is important to remember that these four stages are not a one-off set of actions. If stage 4 shows there is still a problem then the process should be repeated again. The steps you take can then be targeted where they are needed most. A survey by a trade union after 12 separate shop robberies found that each incident occurred between 5 and 7 o’clock in the evening. This finding could have useful security lessons for late night opening of stores and shops. Try to predict what might happen – do not restrict your assessment to incidents which have already affected your own employees. There may be a known pattern of violence linked to certain work situations.

 

Taking appropriate action

Informal action

Where a patient or a member of the public is verbally abusive, threatening or acts in a threatening manner, the staff member will inform them that their remarks, actions or behaviour is unacceptable and will refer them to this policy. Members of staff who do not wish to directly address unacceptable behaviour may ask another member of staff to deal with the incident on their behalf. A member of staff who is asked to deal with such an incident will immediately act upon the request. In some cases it may also be appropriate to discuss an abusive patient’s behaviour with a carer or relative. 

Any staff member who witnesses any form of threatening or abusive behaviour will report it to Presh Mulay. They will also support any colleagues who have been subject to such behaviour; this could include talking to the person responsible for the behaviour at the time of the incident.

In many cases, the threatening or abusive behaviour may stop without the need for further action.

 

Formal action 

If the unacceptable behaviour persists after the informal approaches by members of staff, then a more formal approach will be made. This will take into account the seriousness of the incidents and the seriousness and urgency of the patient’s care needs.

Where the unacceptable behaviour was verbal or threatening in nature, Presh Mulay will write a formal letter to the patient informing them that their behaviour is unacceptable and any further incidents will not be tolerated.

This letter will refer, if appropriate, to an NHS employer’s responsibility to protect the human rights of those working for it. If the patient has asserted or asserts an entitlement under the Human Rights Act 1998 (for example, free speech), their attention will be drawn to Article 17 (in schedule one of the Act). Under this Article, persons whose actions are, ‘aimed at the destruction of any of the rights and freedoms’ or ‘at their limitation to a greater extent than is provided for in the Convention’, are not permitted to rely on their Convention rights.

 

Violent incidents

Where a member of staff was the victim of a violent assault or has been made fearful for their safety, Presh Mulay will meet to decide what action to take. This may include considering whether it is appropriate to withdraw services in line with national guidelines on withholding treatment from violent and abusive patients. Devon NHS Commissioning body may also need to be involved in any decisions about patients. In some cases, it may be necessary to involve the police or invoke legal action. This will be mandatory if violence is used to our staff. The practice has a Violent Incident Report Form to report these incidents to the police. 

 

What about the victims? 

If there is a violent incident involving your workforce you will need to respond quickly to avoid any long-term distress to employees. It is essential to plan how you are going to provide them with support, before any incidents. You may want to consider the following: 

  • debriefing – victims will need to talk through their experience as soon as possible after the event. Remember that verbal abuse can be just as upsetting as a physical attack; 
  • time off work – individuals will react differently and may need differing amounts of time to recover. In some circumstances they might need specialist counselling; 
  • legal help – in serious cases legal help may be appropriate; 
  • other employees – may need guidance and/or training to help them to react appropriately.  

The Home Office leaflet Victims of crime gives more useful advice if one of your employees suffers an injury, loss or damage from a crime, including how to apply for compensation. It should be available from libraries, police stations, Citizens Advice Bureaux and victim support schemes. Further help may be available from victim support schemes that operate in many areas. Your local police station can direct you to your nearest one. 

Alternatively, you can contact them yourself at the addresses below: In England and Wales: 

Victim Support National Office Cranmer House 39 Brixton Road London SW9 6DZ 

Tel: 0808 1689111  https://www.victimsupport.org.uk/

Where can I get further information? 

This guidance is aimed at giving employers an understanding of the general principles involved. In many cases, particularly in sectors where violence is a well – known problem, you should consult more specific guidance when developing an effective management system. 

Guidance on violence in specific sectors includes: 

Managing and preventing violence to lone workers: Case studies Health and Safety Laboratory/Report WIS/03/05. (A shorter version of the case studies is also available on the HSE website at https://www.hse.gov.uk/lone-working/index.htm)  

Violence at work A guide for employers https://www.hse.gov.uk/pubns/indg69.pdf

Violence and aggression to staff in health services: Guidance on assessment and management (Second edition) Guidance HSE Books 1997 ISBN 0 7176 1466 2 Work-related violence: Case studies – 

Managing the risk in smaller businesses HSG229 HSE Books 2002 ISBN 0 7176 2358 0 

Health risk management: A practical guide for managers in small and medium sized enterprises HSG137 HSE Books 1995 ISBN 0 7176 0905 7

HSE priced and free publications are available by mail order from HSE Books:- 

Email: [email protected]       

Tel: 0333 202 5070 

Text-phone: 0333 202 5077

Website: https://books.hse.gov.uk/bookstore.asp (HSE priced publications are also available from bookshops and free leaflets can be downloaded from HSE website:- https://www.hse.gov.uk/

For information about health and safety ring 

HSE Infoline Tel: 0300790 6787

Fax: 0845 408 9566 

Textphone: 0845 408 9577 

e-mail: [email protected] 

 

or write to 

HSE Information Services, 

Caerphilly Business Park, 

Caerphilly CF83 3GG. 

 

This document is available in priced packs of 10 from HSE Books, ISBN 0 7176 1271 6. Single free copies are also available from HSE Books. This guidance is issued by the Health and Safety Executive. Following the guidance is not compulsory and you are free to take other action. But if you do follow the guidance you will normally be doing enough to comply with the law. Health and Safety inspectors seek to secure compliance with the law and may refer to this guidance as illustrating good practice.