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WASHINGTON — Workplace violence experts hope federal regulators will follow California's lead in drafting a standard to protect health care workers — a group particularly vulnerable to dangerous workplace incidents.
A potential standard was included on the U.S. Occupational Safety and Health Administration's regulatory agenda published in May, with the agency planning to issue a request for information in November from health care employers, workers and subject matter experts on the impact of violence and ways to prevent it.
“It will be most effective for us to just focus first on health care and social services rather than doing it much more widely, so that's where we're going to start,” David Michaels, assistant secretary of labor for occupational safety and health, said during a National Advisory Committee on Occupational Safety and Health meeting in Washington last week.
Health care workers experience substantially higher rates of violent but nonfatal workplace injuries compared with workers overall, but the full extent of the problem and its costs are unknown, partly because not all incidents are reported, the Government Accountability Office said in a March report.
The underreporting issue is one that Ascension Health, a Catholic, nonprofit health system with more than 150,000 associates at 1,900 locations, tackled head on. In 2014, it launched a process to evaluate and proactively address the risk, including defining workplace violence as a threat or an act of violent behavior against oneself, another person or a group that results in or has a high likelihood of resulting in injury, psychological harm or death.
“Our associates needed to be prepared on how to recognize and report a threat or an actual event,” said Bob Williamson, director of associate safety at Ascension Risk Services in St. Louis.
“We had to make it clear what workplace violence looks like. It's more than just physically being assaulted. It's a threat. It's the perception that somebody could cause harm.”
“We knew this was coming,” he said of a potential OSHA standard. “For us, it's better to prepare than to respond and react.”
While there is no current workplace violence prevention standard, OSHA has cited employers for hazards found during inspections — including violence in health care facilities — under the Occupational Safety and Health Act's general duty clause.
The agency increased its workplace violence inspections of health care employers from 11 in 2010 to 86 in 2014 and issued general duty clause citations in about 5% of cases, according to the GAO study. However, the GAO suggested OSHA consider additional action, including whether a standard is needed.
“In the past, OSHA really hasn't had a ton of enforcement behind it when it comes to this exposure because there's no specific regulation on workplace violence,” said David Barry, national technical director for casualty risk control at Willis Towers Watson P.L.C. in Overland Park, Kansas. “Unfortunately, I have seen or read about past incidents where somebody has been murdered because of a workplace violence incident in the health care field and the citations have been as little as $10,000.”
OSHA published voluntary health care employer guidelines in 1996 and updated them in 2014, but specific requirements will be critical, he said.
“It needs to be clearly defined and have what the expectations are for the employer,” he said.
In California, stakeholders have high praise for the draft regulation being promulgated by the Division of Occupational Safety and Health and urge OSHA to adopt elements of the state agency's proposal.
California's draft regulation is “outstanding” and includes requirements such as performing a physical risk assessment, developing a prevention plan and training employees on the plan, and requirements for acute care hospitals to submit incident reports to a central repository, said Joann Sullivan, San Jose, California-based senior vice president and managing consultant at Marsh Risk Consulting's workforce strategies practice.
“I think (a federal standard) is probably going to look similar to what California did,” she said.
California's plan, to be voted on later this summer, covers every health care worker in every kind of facility, service category or operation and has a strong training component, said Katherine Hughes, a registered nurse, member of the Service Employees International Union Local 121RN and a co-petitioner of the effort that launched the state's rulemaking process.
It also calls for employee involvement at each step, which is important because employees have the best knowledge and understanding of the hazards in specific situations such as layout of emergency rooms or employees working in isolated areas, she said.
“We want what we're doing in California to be the template and the driving force behind, hopefully, getting something similar to this done nationally because I don't think people realize the prevalence of workplace violence in health care,” Ms. Hughes said.