Message from the ministers

Workplace violence in our health care sector is a growing matter that we are committed to addressing. We’ve seen a concerning increase in the frequency and severity of incidents of workplace violence in our hospitals, mainly experienced by nurses.

Nurses play an integral role in providing care to patients in our hospitals and, because of their level of interaction with patients, they are the primary victims of workplace violence. That is unacceptable. Every worker in Ontario should expect a safe and healthy workplace.

Our health care sector represents 11.7% of Ontario’s labour market and is the largest sector impacted by violence in the workplace. Fifty-six per cent footnote 1 of lost-time injuries due to workplace violence in the hospital sector occur among Registered Nurses.

Violence against our health care workers affects us all. It impacts our families and our communities.

Clearly, we need to take concrete steps to change attitudes, provide support for prevention, and make health care workplaces safer and more responsive to incidents of violence.

Together with our partners, including the Ontario Hospital Association, the Ontario Nurses’ Association, the Ontario Public Service Employees Union and others, we have brought together key stakeholders, experts and patient advocates to advise on how to reduce and prevent workplace violence for health care professionals. We thank these individuals and organizations for their work and valuable input throughout this process.

This advice has informed the recommendations in our Workplace Violence Prevention in Health Care Progress Report. They aim to make hospitals safer, reduce incidents of workplace violence, and improve attitudes and workplace safety culture.

The recommendations also include system enhancements, such as:

  • Including workplace violence policies in hospital Quality Improvement Plans going forward
  • Increased supports for patients with known aggressive or violent behaviours
  • Patient, family and staff input into triggers, behaviours and interventions
  • Creating reporting systems for workplace violence incidents

Ontario’s skilled and compassionate health care workers are our health care system’s greatest asset. By tackling violence in our health care sector we’ll be creating safer environments for our workers and improving patient care.

We urge you to read this report with the knowledge that our collective action will make a difference. While the work of the Leadership Table will continue into the future, we look forward to implementing these initial recommendations so we can move toward safer working environments.

Kevin Flynn
Ontario Minister of Labour

Dr. Eric Hoskins
Ontario Minister of Health and Long-Term Care

Acknowledgements

This report was prepared by the Project Secretariat of the Ministry of Labour and Ministry of Health and Long-Term Care with the guidance and advice of the Workplace Violence Prevention in Health Care Leadership Table and its Working Groups. The recommendations and products are the result of this collaborative partnership. We acknowledge the members of the Executive Committee, Leadership Table, and Co-Chairs of the Working Groups for their insightful, sincere guidance and dedication.

Executive committee

Linda Haslam-Stroud, President, Ontario Nurses’ Association
Anthony Dale, President and CEO, Ontario Hospital Association
Sophie Dennis, Deputy Minister of Labour
Dr. Bob Bell, Deputy Minister of Health and Long-Term Care

Leadership Table

Linda Haslam-Stroud, President, Ontario Nurses’ Association
Anthony Dale, President and CEO, Ontario Hospital Association
Warren “Smokey” Thomas, President, Ontario Public Service Employee Union
Dr. Joshua Tepper, President and CEO, Health Quality Ontario
Ron Kelusky, President and CEO, Public Services Health and Safety Association
Henrietta Van hulle, Executive Director – Healthcare, Public Services Health and Safety Association
Dr. Cameron Mustard, President and Senior Scientist, Institute for Work and Health
Kim Baker, CEO, Central LHIN
Marie Taylor, Patient Advocate, Ontario Shores
Angela Martin, Patient Advocate, Centre for Addiction and Mental Health
Sarah Downey, President and CEO, Michael Garron Hospital
Carol Lambie, President and CEO, Waypoint Centre for Mental Health Care
George Gritziotis, Chief Prevention Officer, Ministry of Labour
Denise Cole, Assistant Deputy Minister, Ministry of Health and Long-Term Care
Peter Augruso, Assistant Deputy Minister, Ministry of Labour
Carol Sackville-Duyvelshoff, Director, Ministry of Labour
Dr. Leon Genesove, Chief Physician and Director, Operations Division, Ministry of Labour

Working group co-chairs

Leadership and Accountability:
Janice Kaffer, CEO, Hotel Dieu Grace Healthcare
Erna Bujna, Occupational Health and Safety/Workers' Compensation Specialist, Ontario Nurses’ Association

Hazard prevention and control:
Terri Aversa, Health and Safety Officer, Ontario Public Service Employees Union
Wade Petranik, CEO, Dryden Regional Health Centre

Communications and knowledge translation
Kim Baker, CEO, Central LHIN
Carol Lambie, CEO, Waypoint Centre for Mental Health

Indicators, evaluation and reporting
Anna Greenberg, Vice-President Health System Performance, Health Quality Ontario
Dr. Peter Smith, Senior Scientist, Institute for Work and Health

Secretariat

Dr. Leon Genesove, Chief Physician and Director, Operations Division, MOL
Allison Henry, Director, Health Workforce Planning & Regulatory Affairs Division, MOHLTC
Hasan Makansi, Lead Consultant, MOL
Valerie Milburn, Provincial Specialist, Operations Division, MOL
Olena Chapovalov, Consultant, Health & Community Services, PSHSA
Juanita Jenkin, Provincial Specialist, Operations Division, MOL
Jennifer Stanley, Provincial Specialist, Health Care, Operations Division, MOL
Annette Mayes, Project Coordinator, MOL

Executive summary

There must be zero tolerance for workplace violence; one incident of workplace violence is one too many.

To create safe workplaces for all workers in the sector, the Ministry of Labour and the Ministry of Health and Long-Term Care established the Workplace Violence Prevention in Health Care Leadership Table. The goal of this joint initiative, which engaged over 100 workers, employers, government representatives, associations, unions, patient advocates and researchers, is to improve workplace safety culture towards violence, reduce violent incidents, and make health care settings safer for both staff and patients.

Over a period of about 16 months, the Leadership Table and its Working Groups identified concrete ways to strengthen policy, legislations, standards, physical environments, measures and procedures, programs and training. Members focused on enhancing four critical components of a safe workplace culture: leadership and accountability, hazard prevention and control, indicators, evaluation and reporting, and communication and knowledge translation.

This first Leadership Table report focuses specifically on reducing the risk of violence for nurses working in hospitals who, because of their close contact with patients and families, are the most common victims of workplace violence in the health care sector.

Workplace violence is a complex problem that requires a collaborative, multi-faceted response. The Leadership Table has endorsed 23 recommendations as well as 13 tools and resources that hospitals can use to implement effective workplace violence prevention programs. The recommendations are directed to the two ministries, to hospitals and to a number of other partners that can play a key role in reducing workplace violence. They highlight the need to engage everyone — patients and families, front-line staff, Joint Health and Safety Committees (JHSC), health and safety representatives, unions, people responsible for hospital security, managers, senior leadership, community-based services, police, professional associations, health and safety associations and the general public — in workplace violence prevention. They also emphasize the critical importance of understanding and addressing all factors that contribute to the violent incidents that occur in hospitals, and using all possible levers and strategies to reduce risk.

The Ministries of Labour and Health and Long-Term Care have made reducing workplace violence in health settings a priority. They have already begun to take action on these recommendations, and are committed to working with their partners to shift workplace culture in Ontario’s hospitals to create safer work environments for Ontario’s nurses.

Summary of recommendations and status

Full recommendations are available at Workplace Violence Prevention.

The status of each recommendation has been identified as follows:

  • Engaging: consulting with stakeholders
  • Planning: scope of work and timelines under development
  • In progress: activities underway
  • Complete: complete and implemented

Leadership and accountability

Recommendation 1

Create transition teams – sustainable groups of experts that can assist and provide advice with the implementation of workplace violence prevention (WVP) tools and leading to improve a hospital’s WVP journey to excellence.
Status: engaging.

Recommendation 2

Create a workplace safety environmental standard for healthcare workplaces.
Status: engaging.

Recommendation 3

Develop resources and supports to help hospitals create a psychologically safe and healthy workplace based on the CSA standard.
Status: planning.

Recommendation 4

Amend the Occupational Health and Safety Act to allow a designated worker member of the JHSC to be included in workplace violence investigations under certain circumstances.
Status: engaging

Recommendation 5

Amend the Occupational Health and Safety Act to create a requirement about the information to be provided to a worker who experienced a violent incident.
Status: engaging

Recommendation 6

Include more details on legislative compliance and requirements in the workplace violence section of the Ministry of Labour’s (MOL) health care sector plan.
Status: complete

Recommendation 7

Strengthen workplace violence language in Accreditation Canada’s Required Organizational Practice.
Status: engaging

Recommendation 8

Strengthen workplace violence language in Accreditation Canada’s Standard.
Status: engaging

Hazard prevention and control

Recommendation 9

Amend the Ministry of Labour Policy and Procedure manual to ensure all risk assessments conducted by hospitals are adequate.
Status: in progress

Recommendation 10

Promote the use of all existing and future Public Service Health and Safety Association (PSHSA) Violence, Aggression and Responsive Behaviour tools in all Ontario hospitals.
Status: in progress

Recommendation 11

Ask the PSHSA, in collaboration with stakeholders, to develop additional tools to support:

  1. incident reporting and investigation (root cause analysis)
  2. code white
  3. patient transit (inside the facility) and transfer (outside of the facility)
  4. work refusal procedures

Status: planning

Recommendation 12

Develop specific supplementary tools through the Leadership Table in the second phase and out-years of the project.
Status: planning

Recommendation 13

Provide more supports for patients with known aggressive or violent behaviour within health care facilities and in the community.
Status: planning

Recommendation 14

Create and implement a standard provincial form/process to engage a patient and/or family/caregiver in developing a patient’s care plan that includes safety for workers.
Status: engaging

Recommendation 15

Work with the College of Nurses of Ontario to provide more clarity related to nurses’ right to refuse to provide care to patients in hazardous situations, where the hazard is workplace violence.
Status: engaging

Recommendation 16

Require post-secondary institutions to provide students with enhanced training in workplace violence and prevention before entering the workforce.
Status: engaging

Recommendation 17

Develop and implement a consistent minimum provincial training standard for those performing the role or function of providing security in hospitals.
Status: engaging

Indicators, evaluation and reporting

Recommendation 18

Address issues related to workplace violence incident reporting systems, including:

  1. Conduct assessments (by hospitals) to ensure that reporting systems capture workplace violence incidents that result in psychological as well as physical injuries
  2. Communicate clear consistent messages (from hospital leadership and the joint ministries) about: how staff should report violence incidents, the action that will be taken based on workplace violence reports, and what staff can do if they feel action is not being taken
  3. Evaluate reporting system effectiveness across Ontario hospitals to capture all workplace violence incidents and ensure quality
  4. Collect information on resources hospitals require to develop reliable, valid and comprehensive reporting structures and to capture information in key indicators; identify actions to address any information gaps
  5. Develop clear definitions of flagging, root cause analysis, and appropriate use of force, and communicate them to hospitals and hospital staff
  6. Ensure that the calling of code whites is consistent across hospitals (i.e. in response to similar environmental factors), and that call response procedures are similar across hospitals; this will ensure these indicators are measured consistently across organizations
  7. Evaluate reporting systems in collaboration with other system stakeholders to ensure consistent data collection for both workplace violence incidents and prevention activities over time
  8. Attempt to better understand, address and communicate deficiencies in the use of workers’ compensation claim data as the only source of work-related injury surveillance

Status: engaging

Recommendation 19

Include workplace violence prevention in Quality Improvement Plans.
Status: in progress

Communication and knowledge translation

Recommendation 20

Create consistent communication protocols between hospitals and external care environments to limit the risk of violence to healthcare workers and patients.
Status: engaging

Recommendation 21

Expand an existing communication protocol to prepare a health care facility to receive an incoming patient for a psychiatric assessment.
Status: engaging

Recommendation 22

Implement a joint ministry public campaign regarding the Workplace Violence Prevention in Health Care project.
Status: planning

Recommendation 23

Post information about all MOL fines against employers in health care under $50,000.
Status: in progress

Background

The issue

The health care sector, which represents 11.7% of Ontario’s labour market, is the largest sector affected by violence in the workplace. 56% of lost-time injuries due to workplace violence in the hospital sector occur among Registered Nurses. footnote 2

The response

The Workplace Violence Prevention in Health Care Leadership Table

In August 2015, the Honourable Minister of Health and Long-Term Care Dr. Eric Hoskins and the Honourable Minister of Labour Kevin Flynn announced the Workplace Violence Prevention in Health Care Leadership Table (Leadership Table). The Leadership Table brought together a broad committed group of union leaders, hospital representatives, health professional associations, nursing advocates, patient advocates, and health and safety associations to share best practices in violence prevention and provide advice and recommendations based on the best available data and research. Its goals were to improve the culture/attitudes toward workplace violence prevention, and make health care settings safer.

The Leadership Table focused initially on preventing workplace violence against nurses in hospitals. Subsequent focus on preventing workplace violence against all hospital workers, and then preventing workplace violence against all workers in the broader health care sector.

An Executive Committee, made up of the Deputy Minister of the Ministry of Labour, the Deputy Minister of the Ministry of Health and Long-Term Care, the President and CEO of the Ontario Hospitals Association (OHA) and the President of the Ontario Nurses’ Association, provided strategic direction.

The Leadership Table established four Working Groups to provide advice on how to strengthen violence prevention activities in the following focus areas:

  • leadership and accountability
  • hazard prevention and control
  • communications and knowledge translation
  • indicators, evaluation and reporting.

A total of 108 people, including government representatives, patient advocates, research experts, health and safety consultants, union representatives as well as senior executives and frontline staff, were involved in the Leadership Table and its Working Groups.

Each working group included a cross-section of health care employers, labour unions, associations (both employer and health and safety), occupational health and safety, human resources, patient advocates, front-line workers, nursing policy makers, researchers and the local health integration networks (LHINs). They assessed gaps and opportunities, recommended strategies to increase worker safety while improving patient care, and developed tools and products to increase prevention.

The Leadership Table and Working Groups were supported by a Secretariat that helped implement project plans and craft recommendations and products.

See Appendix A: Leadership Table for more information on the structure of the Leadership Table, the project timeline, and the objectives of each of the Working Groups.

The goal: a safe environment

Health care workers have the right to do their jobs in a safe environment, free of violence. Preventing and mitigating workplace violence in hospitals requires a multi-faceted approach. Everyone — hospital administrators, nurses, other health care workers and the public — must understand that workplace violence is not part of the job and must not be tolerated. One incident of workplace violence is one too many.

What a safe environment – free from workplace violence – can look and feel like

  • Members of the board of directors, CEOs, senior leadership, supervisors, managers and all workers know the hospital’s strategic plan to prevent all types of workplace violence and are aware of its expectations and achievements.
  • The hospital creates a culture that requires and encourages reporting, and understands that reporting keeps everyone safer. Incidents and hazards are reported without reprisal, and supervisors act on those reports to support workers, prevent injury and illness, and mitigate the risk of future incidents.
  • Everyone, from members of the board of directors to patients and their families, understand their rights and responsibilities as well as the hospital’s expectations for a workplace that is safe and free from violence.
  • To promote trust and encourage workers to make positive change, the hospital collaborates and shares information with the JHSC and unions.
  • Workers at all levels feel supported and engaged. They feel confident asking for help when needed and help is provided when they ask.
  • Health care workers and their supervisors receive training so they have the knowledge to protect themselves and other workers.
  • Care plans and flagging systems identify any risk of violent behaviour, including patient triggers, responsive behaviours and strategies to prevent, respond to or mitigate violence. Inter-professional health care teams keep each other safe by sharing this information and implementing the documented strategies to protect workers, patients, and the public.
  • The hospital is continually learning, evaluating its policies, measures and procedures, programs and training, striving to improve in areas where workplace violence persists.
  • The hospital engages with other health care facilities, sharing practices and plans to keep workers, patients, and the public safe, working together locally to close gaps.

1. Leadership and accountability

Effective leadership and enhanced accountability are critical in any workplace safety program — including violence prevention. Leadership’s commitment to preventing workplace violence provides the necessary resources and clarity for workers and employers to successfully implement a workplace violence prevention program and make it a priority to continually improve.

The Occupational Health and Safety Act (OHSA) establishes legal requirements that provide a foundation for the internal responsibility system (IRS). The IRS is a system within an organization in which everyone has a responsibility for workplace health and safety that is appropriate to one’s role and function within the organization.

Employers have the greatest responsibility with respect to health and safety in the workplace. The employer, typically represented by senior management, is responsible to take every precaution reasonable in the circumstances for the protection of a worker. They are also responsible for developing and implementing the workplace occupational health and safety program and ensuring that the IRS is established, promoted, and functions successfully to continually audit, evaluate, and improve the program. Strong leadership by senior executives, managers and supervisors is essential to setting the tone and establishing a corporate culture that nurtures the IRS and occupational safety.

Joint Health and Safety Committees (JHSC) help provide greater protection against workplace injury, illness and death. JHSCs include representatives from workers and employers and have specific roles and responsibilities in Section 9 of OHSA. The JHSC monitors the workplace health and safety system. This co-operative involvement helps support a well-functioning IRS.

The Leadership Table has endorsed a number of policy and legislative changes, as well as tools and resources, to support hospitals in their efforts to enhance leadership and accountability in preventing workplace violence.

In 2016, the Chief Prevention Officer established new standards for JHSC certification training in Ontario. The purpose of the new standard is to ensure quality and consistent training for all certified JHSCs members. The new standards have three elements which are; Part One training; Part Two workplace hazard training; and refresher training every three years. Part Two training is required to be on a minimum of six workplace hazards that are selected using a workplace hazard assessment. Workplace violence should be included as a hazard for health care sector workplaces and all Part two training programs must be approved by the Chief Prevention Officer. This would enable certified members to have the knowledge to recognize, assess, control and evaluate for workplace violence in their workplace.

Sharing leadership expertise

Several of Ontario hospitals have already made significant strides in reducing workplace violence, and their experience demonstrates the critical role of leadership and accountability. The examples below were shared directly from the Michael Garron Hospital and Hotel Dieu Grace Healthcare as examples of their experiences.

Michael Garron Hospital

In 2007, it became 'accidentally' clear that the Michael Garron Hospital (formerly the Toronto East General Hospital) needed to focus on workplace violence prevention. The opportunity presented itself during a casual hallway conversation between the then CEO and the Manager of Protection Services who had just completed a report on the weapons that had been found and confiscated on the Hospital’s premises. The number, type and risk surprised the CEO who had been unaware of what was happening at the front lines. The CEO vowed immediately to make a difference.

Nearly 10 years later, this hospital has a well-established workplace violence prevention program, developed in partnership with our major labour partner the Ontario Nurses’ Association. Key features of the program include comprehensive front line staff training; increased reporting and follow through on reviews; preventive risk assessments; improved communication technologies and emergency notification (personal alarms linked to security with GPS and two way voice communication that also allow the user to perform operational duties); better identification of and plans of care for patients with violent behaviors; clear policies, committee mandate and accountability for workplace violence; and a well-trained and supportive security staff who respond professionally in times of need. The Michael Garron Hospital shares its program, policies and approaches regularly and speaks out on the need to develop similar programs to protect patients and workers.

Hotel-Dieu Grace Healthcare

The people of Hotel Dieu Grace Healthcare (HDGH) will never forget the tragedy that happened in their hospital in 2005. It fundamentally changed who we were then, and informed who we are today as an employer and as a community leader. The journey to becoming who we are today has been characterized by significant improvements in practice, policy, culture and ongoing education/training. As a result, we have increased the safety and well-being of our staff, volunteers and physicians. We are on the leading edge of understanding the relationship that must exist between a quality and safe care environment and a safe and respectful workplace.

We believe that the groundbreaking work we have undertaken has also significantly influenced the prevention of workplace violence both provincially and perhaps, nationally both by the sharing of our experiences/policies/practices and by our ongoing dedication to a culture where all forms of violence are addressed. HDGH’s “Prevention of Workplace Violence Policy” (first written in 2006 and updated regularly) is considered a best practice in the area of Workplace Violence. The establishment of our “Domestic Violence Policy” in 2007 followed, and is another leading edge program with many innovative features. We are recognized by the Provincial Program known as “Neighbours Friends and Family” and “Make it Our Business” (Workplace Violence Awareness program) as an “Employer Champion” due to our on-going commitment to Domestic and Workplace Violence prevention and awareness. We have introduced “staff stories” (similar to patient stories shared at the Quality Committee of the Board) to our Workplace Excellence Committee of the Board to ensure that our governors are attuned to the importance of safety in our hospital.

All of our staff and physicians attend annual mandatory training, including Workplace Violence Prevention, Harassment, Code of Conduct and Domestic Violence, in addition to Non-Violent Crisis Intervention Training. We have invested in two unique positions in our organization whose main focus and mandate is devoted to staff safety. The first is the Safety Officer who proactively works with management on workplace violence prevention, incident reporting and follow up ensuring corrective actions are taken to address concerns moving forward. A key function in this role is the reporting of trends and risks through the HR leadership team directly to the CEO and Executive Leadership Team. The second position is the Safe Workplace Advocate. This position has been in place since 2007, reports directly into the CEO and is primarily accountable for providing a consistent approach to handling conflict in the workplace inclusive of support to staff experiencing domestic violence issues that may arise both in and outside of the workplace.

We are proud of our work and remain committed to ensuring we provide a safe workplace for all of our staff, volunteers, and physicians. We are pleased to now be in a position to help other organizations do the same by sharing our tremendous knowledge and experience. It is our hope that others will reach out to us – we are here to help.

Recommendation

To take advantage of existing expertise, Ontario should:

  1. Create Transition Teams — sustainable groups of experts that can assist and provide advice with the implementation of Workplace Violence Prevention (WVP) tools and leading to improve a hospital’s WVP journey to excellence.

These transition teams should have a balance of best practice leaders including senior management, frontline staff, labour, workplace safety associations, organizational associations (e.g. OHA) and JHSC members. They would help hospitals achieve excellence in workplace violence prevention and go beyond OHSA requirements to protect workers.

Developing supportive standards and legislation

Standards and legislation are key tools in changing organizational culture and creating safer work environments.

Ontario does not currently have an environmental standard to ensure any new or renovated hospitals are designed to reduce the risk of violence — as it does, for example, to reduce the risk of exposure to infectious diseases or to ensure accessibility for Ontarians with disabilities. This type of standard would ensure that all architectural plans are reviewed by a certified specialist in Crime Prevention Through Environmental Design for their potential impact on crime prevention, workplace violence prevention and general safety. All designs would have to be modified to incorporate these principles.

Making a commitment to create a caring responsive culture is an essential part of a workplace violence prevention program. It also leads to better patient care. A culture of psychological safety encourages employees to report incidents. It builds a healthy atmosphere where people feel supported and know that they are an important part of the organization. In January 2013, the Canadian Standards Association issued a voluntary standard (CSA Z1003) — Psychological Health and Safety in the Workplace — to encourage organizations to provide psychologically safe and healthy workplaces. This standard stresses the importance of identifying and addressing factors (including workplace violence) that have a negative effect on workers’ physical and mental health. While the standard is in place, there are few tools or resources to help employers meet the standard.

Building a caring, responsive culture requires transparency and effective communication with and involvement of workers. At the current time, worker members of the JHSC do not have an automatic right to jointly investigate workplace violence incidents that are not considered critical. There is also no requirement for the employer to inform workers who have been involved in a violent incident about the results of an investigation or any actions taken.

Each year, the Ministry of Labour develops Sector Plans, which provide guidance on compliance issues. The health care sector plan provides an opportunity to ensure that employers have information on the legislative requirements and compliance initiatives related to workplace violence.

Another effective way to influence hospital culture, policy and practice is through the Accreditation Canada Standard and Required Organizational Practice. To be accredited all hospitals must meet those standards. To create a culture of safety, Accreditation Canada should require hospitals to have a policy and program for workplace violence, developed in consultation with the JHSC, and to provide evidence of both patient and staff safety initiatives, reinforcing the link between staff and patient well-being.

Recommendations

  1. Create a Workplace Safety Environmental Standard for Healthcare Workplaces
  2. Develop resources and supports to help hospitals create a psychologically safe and healthy workplace based on the CSA Standard
  3. Amend the Occupational Health and Safety Act to allow a designated worker member of the JHSC to be included in workplace violence investigations under certain circumstances
  4. Amend the Occupational Health and Safety Act to create a requirement about the information to be provided to a worker who experienced a violent incident
  5. Include more details on legislative requirements and compliance in the workplace violence section of the Ministry of Labour’s (MOL) health care sector plan (completed/implemented)

Strengthen workplace violence language in Accreditation Canada’s:

  1. Required Organizational Practice; and
  2. Standard.

Tools and resources

To enhance leadership and accountability for workplace violence prevention, the Leadership Table Working Groups and Secretariat developed the following tools:

  • Workplace Violence Prevention in Health Care Sustainable Framework, which identifies the external and internal support, policy, culture, roles and practices in workplace violence prevention Ontario’s hospitals should adopt.
  • A Transition Toolkit: a resource for Ontario hospitals  that will contain the tools and resources developed through the Leadership Table Working Groups, along with other endorsed tools in the following categories: footnote 3
    • leadership and cultural transformation
    • integrated incident management
    • policies, programs, measures and procedures
    • training
    • response team
    • physical environment.
  • An Organizational Assessment Tool, which helps hospitals work with their JHSCs to determine where they are in their workplace violence prevention journey and where they need to improve.
  • Workplace Violence Prevention: Program Assessment Checklist: a resource that will help hospitals develop standards of practice that go beyond complying with the OHSA. The checklist focuses on five key areas:
    • leadership support and worker participation
    • hazard identification and risk assessment
    • risk mitigation, hazard prevention and controls
    • education and training
    • performance reporting (key performance indicators) and evaluation.

2. Hazard prevention and control

A strong workplace violence prevention program should include a comprehensive risk assessment and a plan to reduce those risks. Workplace violence is a hazard that all workplaces should continually strive to prevent and control.

Conducting comprehensive workplace violence risk assessment

Under the OHSA, employers are required to assess the risks of workplace violence that may arise from the nature of the workplace, the type of work or the conditions of work.

A risk assessment is essential to identify the specific risks of exposure to violence in particular work settings. It also helps put in place controls to prevent and minimize workplace violence (e.g. modifying environmental design and physical layout of the unit/facility, developing administrative and work practice controls). To develop a successful violence prevention program, it is essential that workers, employers, the JHSC and unions participate and cooperate to identify and assess risks in the workplace.

To prevent workplace violence, hospitals must understand the nature of the risks and respond with appropriate supports, including policies, measures and procedures, programs and training.

The risk of workplace violence can be affected by:

  • the size of the hospital
  • physical design of hospital spaces
  • characteristics of the local community
  • patient acuity and the needs of the patient population
  • individual client assessment
  • the availability of an interprofessional team of staff with the skills and experience to provide quality patient care and a safe working environment
  • work flow
  • communication

Risk can be higher when staff are performing certain functions, such as moving patients within the hospital or within the system, or in certain situations, such as delivering difficult news to patients and family members. Within hospitals, special attention should be paid to the safety of the physical environment, particularly in emergency departments.

Hospitals are environments where people often feel vulnerable and anxious. This sense of vulnerability can lead to violent incidents. The source of violence may be a patient or family member. It can also be someone from outside the hospital or a current or former employee.

Under the OHSA, employers are required to take every precaution reasonable in the circumstances for the protection of a worker. In complying with this general duty requirement in the Act, it is good practice to consider the precautionary principle to guide the selection of the most appropriate controls. The precautionary principle implies that when an activity raises a reasonable suspicion of causing harm to … human health, though there is no scientific evidence, precautionary measures should be taken. footnote 4

Assessing and addressing violence

As part of a comprehensive workplace violence risk assessment, hospitals are advised to conduct a pre-risk assessment survey with staff. This survey is an important way to involve frontline staff and gather information on their concerns, perceptions and experience with workplace violence as well as their knowledge of prevention efforts and specific areas for improvement.

The Public Services Health and Safety Association (PSHSA), which receives funding from the Ontario Ministry of Labour, works with Ontario’s Public and Broader Public Sector employers and workers, providing training and resources to reduce workplace risks and prevent occupational injuries and illnesses. PSHSA, a key partner with both the Ministry of Labour and the Ministry of Health and Long-Term Care, has been leading a multi-stakeholder project to develop practical tools to help health care organizations address the pervasive problem of workplace violence. The Violence, Aggression and Responsive Behaviour (VARB) Project engages partners from across the health care sector, including government, labour unions, professional associations and representatives from community, home and acute care settings. Its goal was to deliver a model and toolkit that would give workplaces a consistent, scalable and consensus-based approach to reduce violent incidents and the impact of aggression, violence and responsive behaviours. The Leadership Table endorses the existing VARB tools:

  • Workplace violence risk assessment
  • Individual client risk assessment
  • Flagging
  • Security
  • Personal safety and response system.

It also identified other tools that would be useful. For example: root cause analysis, work refusal procedures, use and care of personal alarms, and security training.

Recommendations

To improve the quality and consistency of workplace violence risk assessments/responses:

  1. Amend the Ministry of Labour Policy and Procedure manual to ensure all risk assessments conducted by hospitals are adequate.
  2. Promote the use of all existing and future Public Service Health and Safety Association (PSHSA) Violence, Aggression and Responsive Behaviour tools in all Ontario hospitals.
  3. Ask the PSHSA, in collaboration with stakeholders, to develop additional tools to support:
    1. incident reporting and investigation (root cause analysis)
    2. code white
    3. patient transit (inside the facility) and transfer (outside of the facility)
    4. work refusal procedures.
  4. Develop specific supplementary tools through the Leadership Table in the second phase and out-years of the project.

Managing aggressive or violent behaviour

Violence in hospitals can be reduced when workers have the information they need about the patient, and are trained to manage aggressive or violent behaviour.

Some general hospital settings require additional supports to provide care for patients with complex mental health/behavioural health problems. The Ministry of Health and Long-Term Care has implemented several programs designed to improve behavioural management and avoid activities that might trigger aggression (e.g. transferring patients and seeing them in busy stressful emergency departments). These programs should be evaluated for their effectiveness and possible expansion into Hospitals, specifically in high risk areas such as Emergency Departments. More research is required to determine the types of clinical support needed across the continuum of care to ensure health care workers can deliver care safely to patients with responsive or aggressive behaviours.

The OHSA requires the employer to provide enough information about a person with a history of violent behaviour to all workers at risk. However, there is no consistent provincial process in place to gather that information from patients and families/caregivers — either during the triage assessment or after a violent incident or code white. A standard process would engage the patient and family members/caregivers in developing a care plan for the patient that identifies any triggers for violent behaviour as well as strategies to manage his or her behaviour.

When trying to manage aggressive patients, nurses may face a potential conflict: their code of practice requires them to continue to provide care but they also have the right to refuse a patient in a hazardous situation. The current instruction from the College of Nurses of Ontario related to a nurse’s right to refuse a patient when the hazard is workplace violence requires further clarity; better direction would help nurses and other members of the interprofessional team understand their rights where there is a risk of violence.

Recommendations

  1. Provide more supports for patients with known aggressive or violent behaviour within health care facilities and in the community.
  2. Create and implement a standard provincial process/form to engage a patient and/or family/caregiver in developing a care plan that includes safety for workers.
  3. Work with the College of Nurses of Ontario to provide more clarity related to nurses’ right to refuse to provide care to patients in hazardous situations, where the hazard is workplace violence.

Providing appropriate training

Education and training ensure that all staff members are aware of potential hazards and how to use established policies, measures and procedures to protect themselves and their co-workers.

New graduates should enter the workforce with some minimum standard training to effectively manage both violent situations and workplace incivility. Currently, the Ministry of Advanced Education and Skills Development does not require post-secondary institutions to provide students with enhanced training in workplace violence and prevention before entering the workforce. Graduates are often young, unaware and inexperienced in managing workplace violence. While many health care organizations may choose to train students in violence prevention when they start a co-op or practicum program, this practice is inconsistent and may differ greatly across organizations. As part of their training, students should also learn how dysfunctional work relationships and workplace incivility can affect quality of work life, quality of patient care and workplace violence.

Training would also enhance the ability of security staff to actively participate in workplace violence prevention; however, there is no consistent minimum provincial security training standard for people performing the role or function of security in hospitals. Some consistent minimum training requirements would enhance each organization’s ability to protect health care workers and patients, prevent incidents of workplace violence and reduce the use of force.

Education and training should be delivered in a way that adequately protects all staff against common risks, while recognizing that some staff working in certain environments and roles may require more specific workplace violence training.

Recommendations

  1. Require post-secondary institutions to provide students with enhanced training in workplace violence and prevention before entering the workforce.
  2. Develop and implement a consistent minimum provincial training standard for those performing the role or function of providing security in hospitals.

Tools and resources

To help implement the hazard prevention and control recommendations, the Leadership Table Working Groups and Secretariat developed the following tools:

  • A pre-risk assessment survey: a series of questions employers can ask staff to help understand employees’ concerns and perceptions with respect to violence in their workplace
  • Terms of Reference for a Workplace Violence Prevention Committeeto help organizations develop or improve their own terms of reference document
  • Triggers and Care Planning in Workplace Violence Prevention: a resource to help hospital staff identify common patient triggers and develop an individualized care plan to mitigate risk of workplace violence. It includes:
    • violence risk identification including systems communication and management strategies
    • trigger identification and management strategies
    • the use of care plans to reduce risks and triggers
    • analyzing code whites as a means to prevent incidents of violence
    • using safety huddles/shift changes as a means to communicate risk
    • sample/example care plans
  • Engaging Patients and Families in Workplace Violence Prevention: a resource to help patients and families understand their role in contributing to a safe and healthy work environment
  • Engaging Patients and Families Sample Brochure Content that hospitals can modify for their setting and give to patients, family members and visitors
  • A Training Matrix to help employers provide comprehensive training based on the risk of violence to workers, supervisors, physicians, members of the board of directors, and others in their setting.

3. Indicators, evaluation and reporting

To evaluate the effectiveness of sector activities related to workplace violence, we need quality information. This requires:

  • Reliable, valid and comprehensive reporting structures
  • Collection of actionable, interpretable and relevant indicators

The tracking and analysis of established/standardized key performance indicators provides a basis for assessing an organization’s strengths and weaknesses in addressing risks associated with workplace violence. Findings from the analysis can be used to inform action plans that address persistent areas of concern. When hospitals maintain data on workplace violence key performance indicators, they ensure their workplace violence programs can be evaluated, which is essential to fulfill the commitment to continuous improvement, transparency and accountability.

In addition to identifying indicators, organizations must develop a reporting system, which determines how the information on indicators will be measured. Evaluating the impacts of workplace violence activities involves both collecting data on indicators that are relevant, actionable and interpretable, and maintaining reporting systems that capture this information consistently across hospitals over time. If either of these areas is not optimal, hospitals will not have the high quality information they need to evaluate and improve their programs.

Identifying indicators

A consensus process was used to identify a set of indicators at both the provincial and local level to measure workplace violence prevention and monitor incidents of workplace violence. To select indicators, members considered their relevance, actionability and interpretability, as well as their feasibility and measurability.

The final indicators were recommended because: they reflect issues that are important and relevant to the prevention of workplace violence (relevant); measuring them is likely to inform and influence policy or funding, and/or alter the behaviour of health care leaders (actionable); and they are clear and understandable to a range of audiences (interpretable).

Developing reporting systems

The current structures for reporting workplace violence were documented and evaluated. Peer-reviewed and grey literature on reporting systems was also reviewed. In the process, members identified many gaps and issues related to reporting violent incidents that should be addressed.

…healthy and safe work environments for workers are associated with patient safety and service quality.

Health Quality Ontario, A Framework for Public Reporting on Healthy Work Environments in Ontario Healthcare Settings, 2010

Recommendation

Recommendation

  1. Address issues related to workplace violence incident reporting systems, including:
    1. conduct assessments (by hospitals) to ensure that reporting systems capture workplace violence incidents that result in psychological as well as physical injuries
    2. communicate clear consistent messages (from hospital leadership and the joint ministries) about: how staff should report violence incidents, the action that will be taken based on workplace violence reports, and what staff can do if they feel action is not being taken
    3. evaluate reporting system effectiveness across Ontario hospitals to capture all workplace violence incidents and ensure quality
    4. collect information on resources hospitals require to develop reliable, valid and comprehensive reporting structures and to capture information in key indicators; identify actions to address any information gaps
    5. develop clear definitions of flagging, root cause analysis, and appropriate use of force, and communicate them to hospitals and hospital staff
    6. ensure that the calling of code whites is consistent across hospitals (i.e. in response to similar environmental factors), and that call response procedures are similar across hospitals; this will ensure these indicators are measured consistently across organizations
    7. evaluate reporting systems in collaboration with other system stakeholders to ensure consistent data collection for both workplace violence incidents and prevention activities over time
    8. attempt to better understand, address and communicate deficiencies in the use of workers’ compensation claim data as the only source of work-related injury surveillance.

Integrating workplace violence prevention into quality improvement plans

To ensure that workplace violence prevention becomes part of the quality improvement culture, it should be integrated into the Quality Improvement Plan (QIP) process submitted annually to Health Quality Ontario. QIPs are a public commitment to meet quality improvement goals. When developing a QIP, an organization must outline how it will improve the quality of care it provides to its patients, residents or clients.

To date, there have been no indicators related to staff safety and workplace violence in QIPs. As this report was being written, the Ministry of Health and Long-Term Care posted a regulatory proposal for a 45-day consultation, which would amend O. Reg. 187/15 under the Excellent Care for All Act, 2010, to require health care organizations to include in their QIPs, indicators specified by the minister. Current indicators relate to accessibility, appropriateness, effectiveness, efficiency, equity, integration, patient centeredness, population health, quality of care, and patient safety. The Ministry of Health and Long-Term Care will be introducing indicators specific to worker safety and is proposing that these be the first mandatory indicators.

Recommendation

  1. Include workplace violence prevention in QIPs.

Tools and resources

To support hospitals’ efforts to measure their progress in reducing workplace violence, the Leadership Table endorses the following workplace violence indicators:

  • Ready for collection at the provincial level:
    • Rates of workplace violence, overall and stratified by consequence of violence
    • Percent of hospitals with an organizational strategic priority focused on workplace violence
  • In development for collection at the provincial level: footnote 5
    • Rates of workplace violence stratified by whether: (a) a flagged patient was involved; (b) force was used; (c) a root cause analysis was undertaken; and (d) a code white was called.
    • • Percent of hospitals who have achieved risk-based training targets for staff

4. Communication and knowledge translation

Sharing information is part of a safety culture. Communication and knowledge translation — internally within the hospital, between health care facilities and with the general public — is an effective way to prevent workplace violence.

Improving communication between health care facilities

Reducing workplace violence requires increased communication within and between health care facilities.

Ontario does not currently have a consistent approach to document/communicate a patient’s triggers/behaviours and effective ways to manage those behaviours when transferred inter- facility.

Under the Mental Health Act, physicians, police and justices of the peace who identify a person exhibiting violence can order that person to be examined by a physician. This means that the person will be entering a health care facility; however, there is no consistent process for notifying that health care facility that it is about to receive an incoming patient who might be violent.

These are both gaps in workplace violence prevention that should be addressed.

Recommendations

  1. Create consistent communication protocols between hospitals and external care environments to limit the risk of violence to health care workers and patients.
  2. Expand an existing communication protocol to prepare a health care facility to receive an incoming patient for a psychiatric assessment.

Improving public communication

Building awareness with the general public is an important step in preventing workplace violence in hospitals. For the most part, the general public is unaware of the extent and complexity of the problem of workplace violence in hospitals, including the impact on health-care workers and on publicly funded health care. The more the public knows about the risk of workplace violence and their role in workplace violence prevention, the more likely the potential for workplace violence will decrease.

In addition to creating general messages for the public, it will be important for workplace violence prevention programs to target communication to specific audiences, such as hospital leadership, nurses and families/patients/visitors. Key messages should emphasize that working together to prevent violence will benefit staff, patients and family members and that violence will not be tolerated.

Public communication can also be a way to increase hospitals’ compliance with workplace safety legislation. According to new research published by Institute for Work and Health, footnote 6 there is strong evidence that several occupational health and safety policy levers are effective in terms of reducing injuries and/or increasing compliance with legislation. Researchers suggested that regulators could raise awareness by actively communicating the consequences of non-compliance and making information about non-compliers easily available to the general public. When the Ministry of Labour investigates a workplace violence incident and finds that the employer was not complying with occupational health and safety requirements, the Ministry of Labour can prosecute the employer. Right now in Ontario, the Ministry of Labour only publicly reports fines above $50,000, which may not capture all fines related to violent incidents in the workplace.

Recommendations

  1. Implement a joint ministry public campaign regarding the Workplace Violence Prevention in Health Care project.
  2. Post information about all Ministry of Labour fines against employers in health care under $50,000.

Tools and resources

To support hospitals’ communication and knowledge translation efforts, the Leadership Table working groups and Secretariat developed the following tools and resources:

  • A Workplace Knowledge Translation Plan, which identifies key audiences within the hospital, key messages, communication goals and strategies for communicating with particular groups. Workplace audiences include: members of boards of directors, the senior leadership team, other management staff, JHSC members, health and safety representatives or worker designates, union leadership, all employed staff in the organization as well as volunteers and students, physicians who are not hospital employees, service providers onsite (e.g. vendors, contractors, paramedics, police), patients and visitors to the workplace (including family members of patients).
  • A guide to External Communication, which identifies external audiences/stakeholder groups as well as suggested messages. External stakeholders include: the Ministry of Health and Long-Term Care, the Ministry of Labour, the Ministry of Community Safety and Correctional Services, the police service, Local Health Integration Networks, Accreditation Canada, labour union groups, the Ontario Hospital Association, professional colleges, professional nursing associations and Health Quality Ontario.
  • Public Awareness Campaign — Marketing Brief: a resource that provides details on designing and conducting a workplace violence awareness campaign to the public (i.e. general public, family members, caregivers visiting and caring for family and friends in hospitals).

Conclusion

Workplace violence is a complex issue that requires multiple interventions. To reduce violence, leaders must move from a culture of reacting to workplace violence events to a culture of violence prevention. Preventing workplace violence protects workers, improves patient care and makes the care environment a more positive place for all. One incident of workplace violence is one too many.

The goal for hospitals should be to: eliminate workplace violence, implement appropriate controls, and measure their progress using standardized indicators. Hospitals should work together with other health care organizations in their communities and across Ontario to share best practices and improve communication both within the hospital and across sectors.

Hospitals must continue to collaborate with unions, JHSCs, health and safety representatives, patient advocates, frontline staff, and health and safety associations to continuously improve existing controls, and identify new ones, to protect workers from workplace violence.

Both the Ministry of Labour and the Ministry of Health and Long-Term Care are committed to being active partners in efforts to prevent workplace violence and create safer work environments and are already acting on the recommendations in this report. For example, the Ministry of Labour is using the hazard prevention tools to enhance its enforcement strategy and compliance expectations for the health care sector, and the Ministry of Health and Long-Term Care is in the process of integrating indicators related to workplace violence prevention into Quality Improvement Plans (QIPs).

Over the next few months, the ministries will work closely with their partners to ensure meaningful implementation of the recommendations and further tool development. The ministries will also consider these recommendations during any future proposals for legislative and/or regulatory change.

The Leadership Table — including representatives from health care employers, labour, government, research experts and patient advocates — will re-convene in the near future to begin work on phase two of the Workplace Violence Prevention in Health Care project.

Appendices

Appendix A: Leadership Table

Structure

Below is the hierarchical structure of the project, with the top level assigned to the Executive Committee.

  • Executive Committee
    • Secretariat (supports the leadership table and working groups)
    • Leadership Table
      • Working group 1: leadership and accountability
      • Working group 2: hazard prevention and control
      • Working group 3: communication and knowledge translation
      • Working group 4: indicators, evaluation, and reporting

Project timeline

Meetings

Leadership Table meetings:

  • September 2015
  • February 2016
  • April 2016
  • July 2016
  • November 2016
  • December 2016: report, recommendations and products

Working groups met in person and virtually during this time.

Implementation

  • Phase 1: nurses in hospitals
  • Phase 2: all workers in hospitals and long-term care homes
  • Phase 3: all workers in the broader healthcare sector

Working group objectives

Leadership and Accountability Working Group
  • Create a sustainable workplace violence prevention accountability framework which included enhanced accountability for workplace violence at all levels of the system
  • Document all legislation, regulations, standards, guidelines, policies and accountability agreements relating to workplace violence prevention as a useful tool for hospital leadership (to be completed in phase 2)
  • Make recommendations to close gaps in legislation, regulations, standards, policies and system linkages
  • Create a Transition Toolkit that includes enhanced accountability for workplace violence and helps hospitals develop a culture of safety and a sustainable program of workplace violence prevention.
Hazard Prevention and Control Working Group
  • Identify leading practices and gaps in existing workplace violence tools and policies related to prevention, supports, and workplace safety culture
  • Engage hospital staff, including frontline workers and end-users
  • Identify existing training programs and courses related to workplace violence prevention and management.
Indicators, Evaluation and Reporting Working Group
  • Identify a common set of indicators to measure workplace violence prevention and efficacy of supports
  • Describe a streamlined process for evaluating effectiveness and outcomes in relation to workplace violence prevention.
Communication and Knowledge Translation Working Group
  • Develop a communication and knowledge translation plan for two audiences: in the workplace (within the hospital) and external (outside of the hospital)
  • Develop a marketing brief for a future public awareness campaign specific to raising awareness on the problem of workplace violence in hospitals
  • Engage hospital staff, including frontline workers, labour unions, patient advocates, marketing experts and other stakeholders, who will contribute creatively to this work.

Appendix B: products

For product details and documents, see Workplace Violence Prevention.

Focus area: leadership and accountability

  • Accountability framework: the Sustainable Accountability Framework will be used as a guidance tool for hospitals to outline who is accountable for what in a hospital organization.
  • A toolkit which encompasses leading practices and provides assistance to leaders in hospitals through the transition: an online resource for hospitals which contains leading/good practices in six key areas. The toolkit will house all of the products created and/or recommended by the working groups.
  • An organizational assessment tool that assists hospitals in identifying where they are in their workplace violence prevention journey: the assessment tool is intended to assist hospitals in self-identifying where they are in their workplace violence prevention journey. This tool is not intended to identify risks or hazards, merely to accompany the transition toolkit in providing organizations a starting point to identify any key component that they could improve upon such as policies and programs, and incident investigation/reporting.
  • Workplace violence program assessment checklist: workers in health care facilities face significant risks of workplace violence. This health care checklist is designed as a prevention tool to enable health care and community care facilities to adopt leading practices when establishing systems and practices to prevent workplace violence.

Focus area: hazard prevention and control

  • Pre-risk assessment survey: a set of questions to be asked prior to conducting a risk assessment.
  • Workplace violence prevention committee - sample terms of reference: sample document that outlines the terms of reference for a Workplace Violence Prevention Committee in a hospital.
  • Triggers and care planning: resource to assist caregivers with identifying common patient triggers and mitigate risk of workplace violence through individualized care plans and other risk minimizing strategies.
  • Engaging patients and families in workplace violence prevention for leaders: resource to help patients and families understand their role in their care and ability to contribute to a safe and healthy work environment, and sample brochure for patients, family members and visitors.
  • Training matrix: the training matrix is intended to be used as a guide to assist employers in ensuring that workers are trained to prevent and react to incidents of workplace violence, and internal policies and procedures, and roles and responsibilities based on their occupation and potential exposure to risk. The use of the training matrix is not mandatory but should be provided to all hospitals.

Focus area: indicators, evaluation and reporting

  • A set of organizational and provincial indicators: a recommended list of leading and lagging metrics to be used at the system and organizational level that can be used to measure improvement in workplace violence.

Focus area: communication and knowledge translation

  • Workplace knowledge translation plan for workplace parties: resource to help stakeholders within the hospital setting to improve the knowledge translation practices and communication specific to workplace violence prevention.
  • Guide to external communication: suggested communication/messages to stakeholders outside of the hospital setting.
  • Public awareness campaign: marketing brief with details on designing and conducting a workplace violence awareness campaign in the public.

Appendix C: recommendations

Full recommendations are available at Workplace Violence Prevention.

The status of each recommendation has been identified as follows:

  • Engaging: consulting with stakeholders
  • Planning: scope of work and timelines under development
  • In progress: activities underway
  • Complete: complete and implemented

Short term deliverables

  • Recommendation 1: Transition teams
    Status: engaging
  • Recommendation 17: Develop consistent minimum security training standard for the province
    Status: engaging

System enhancements

  • Recommendation 2: Workplace Safety Environmental Standard for Healthcare Workplaces
    Status: engaging
  • Recommendation 13: More supports (in facilities and community) for patients with known aggressive or violent behaviour
  • Status: engaging
  • Recommendation 14: Engage patient, family and staff in identifying triggers, behaviours and interventions
    Status: engaging
  • Recommendation 15: Engage the College of Nurses of Ontario to clarify a nurses’ right to refuse to provide care to patients in hazardous (workplace violence) situations
    Status: engaging
  • Recommendation 19: Include workplace violence in Quality Improvement Plans
    Status: in progress
  • Recommendation 20: Create consistent communication protocols between hospitals and external care environments
    Status: engaging
  • Recommendation 21: Expand existing communication protocol to prepare a health care facility to receive an incoming patient for whom a psychiatric assessment has been ordered
    Status: engaging

Recommendations for Ministry of Labour

  • Recommendation 23: The Ministry of Labour should post all fines against employers in health care under $50,000
    Status: in progress

Improving hospital safety culture:

  • Recommendation 3: Create psychologically safe and healthy hospitals
    Status: planning

Occupational Health and Safety Act (OHSA):

  • Recommendation 4: Amend OHSA to allow the inclusion of a designated worker member of the JHSC in workplace violence investigations under certain circumstances
    Status: engaging
  • Recommendation 5: Amend OHSA to create a requirement about information provided to the worker who experienced a violent incident
    Status: engaging

Health Care Sector Plan and Policy and Procedures Manual:

  • Recommendation 6: Enhance workplace violence section in Health Care Sector Plan
    Status: complete

Recommendations for Accreditation Canada

  • Recommendation 7: Changes to the Accreditation Canada Required Organizational Practice
    Status: engaging
  • Recommendation 8: Changes to the Accreditation Canada Standard
    Status: engaging

Recommendations for the Ministry of Labour and Ministry of Health and Long-Term Care

Improving hospital safety culture:

  • Recommendation 9: Ensure adequate risk assessments
    Status: in progress

Regarding reporting systems that capture workplace violence incidents and workplace violence prevention activities:

  • Recommendation 18: Improve reporting systems for workplace violence incidents and workplace violence prevention activities
    Status: engaging

External communications:

  • Recommendation 10: Promote the Public Services Health and Safety Association’s (PSHSA) Violence, Aggression and Responsive Behaviour tools
    Status: in progress
  • Recommendation 22: Develop public awareness campaign about the Workplace Violence Prevention in Health Care Project
    Status: planning

Recommendations for the PSHSA

  • Recommendation 11: Develop additional tools
    Status: planning

Recommendations for the Secretariat

  • Recommendation 12: Future work to be developed by the Leadership Table working groups
    Status: planning

Recommendations for the Ministry of Advanced Education and Skills Development

Expanding the curriculum to include workplace violence:

  • Recommendation 16: Develop mandatory workplace violence prevention curriculum in educational settings (college and university programs)
    Status: engaging