W S H A & A S H N H A P A R T N E R S H I P F O R P A T I E N T SP R E S E N T E D B Y : C O U R T N E Y U L R I C H

AGGRESSIVE BEHAVIOR TOOLKIT

HIIN AND PARTNERSHIP FOR PATIENTS

• The Partnership for Patients initiative is a public-private partnership working to improve the quality, safety and affordability of health care

• The Partnership for Patients program focuses on the achieving two goals:• Making Care Safer• Improving Care Transitions

• The Hospital Improvement Innovation Network works at the regional, State, national or hospital system level to accelerate national progress and momentum towards continued harm reduction in the Medicare program and help identify solutions and disseminate them to other hospitals and providers

WSHA STRATEGIES AND GOALS FOR WORKFORCE SAFETY

• Safe Table Learning Collaborative with all hospitals• March 23rd , 2017 next Safe Table in

Seattle, WA• Monitor worker injury rates by hospital

• Goal: Reduce worker injuries related to workplace violence by 20% by September 2017

• Disseminate tools and resources, including best practice toolkits on workplace violence prevention• Goal: Increase number of effective

workplace violence prevention programs by 50%

AGGRESSIVE BEHAVIOR TOOLKIT

• Purpose: Document to disseminate to hospitals throughout WA and AK to help develop workforce violence prevention programs

• Development:• In depth literature review• Called on experts with knowledge and expertise in the field• Highlights from hospitals with solutions already in place

• Goal: Developed 14 best practices & prevention methods for a successful workplace violence prevention program

TOOL #1: COMPLIANCE

• Issue 45 of Joint Commission’s Sentinel Event Alert

• Federal OSHA standards vs. State approved OSHA standards• WA: State approved OSHA standards

and follows the required Workplace Violence Plan required by the law RCW 49.19

• AK: State approved OSHA standards but follows the Federal OSHA standards in regards to Workplace Violence

TOOL #2: ENGAGEMENT

• Engagement needs to come from two sources in hospitals and healthcare facilities:• Executive Team: must develop a clear message focused

on commitment to the safety of patients and workers• Frontline Staff: participating in task forces to promote open

dialogue and understand the importance of incident reporting

TOOL #3: ORGANIZATIONAL STRUCTURE

• Integrated approach and focus on safety requires tight interaction between Security, Quality and Employee Health

• Typical hospital organizations silo these three departments• Re-structuring to help coordination or using taskforces or

workgroups to integrate ideas

TOOL #4: INTEGRATING QUALITY MANAGEMENT

• High Reliability Organizations help improve clinical outcomes and address quality issues

• Joint Commission’s 2012 document: Improving Patient and Worker Safety: Opportunities for Synergy, Collaboration and Innovation• HRO tools and principles can also be used

to address initiatives in aggressive behavior• HRO five operational processes

TOOL #5: MARKETING SAFETY

• Importance of initial communication to staff on aggressive behavior prevention programs

• Utilizing internal marketing departments to provide staff contextual information defining the program:• Signage• Handouts• Videos

TOOL#6: INFORMATION TECHNOLOGY

• Many organizations struggle with reporting and incident management systems:• Inconsistency of information • Multiple computerized reporting systems

• Need to identify the root cause of the incident in order to solve the problem:• Alter existing system to accommodate entire organization• Adopt a new system to integrate across departments

TOOL #7: INCIDENT REPORTING

• Accurately capturing incidents requires standardization and communicated definition of “aggressive” behavior

• Organization needs to be aware of roadblocks to reporting aggressive behavior incidents:• Reporting is complicated and time consuming process• Little to no action will occur to change the reported

behavior• Staff fears the negative “consequences” of reporting an

incident

TOOL #8: ASSESSING THE RISK

• Assess the risk of intentional and unintentional scenarios in healthcare setting

• Components of a successful assessment can include:• Staff feedback from multiple disciplines• Analysis of five years of incident reporting• “Boots on the ground” analysis of facility security and safety

measures in place

TOOL #9: PREVENTION & CONTROL

• Outcomes and conclusions determined from risk assessment will fuel prevention and control methods

• Prevention & Control methods can be categorized into three main interventions:• People-centered (staff, visitors, patients)• Operational• Facility layout

TOOL #10: TRAINING & COMMUNICATIONS

• Gaps in training will be evident after determining the correct prevention & control methods

• Training & Communication methods can include:• Online or Classroom based• Role Playing• De-escalation techniques• Physical defense training• Understanding predictive factors

to the onset of aggressive behavior

TOOL #11: INCIDENT RESPONSE

• Many hospitals have discovered the effectiveness of using incident response protocols

• Incident response protocols can be used and set-up similar as “Code Blue” or “Code Red” currently in place

• Aggressive behavior is complex and no single incident response protocol solution works for all hospital environments

TOOL #12: POST INCIDENT FOLLOW-UP

• True commitment of the executive team to a culture of safety is shown through post incident follow-up

• Communications to staff following an incident should be treated as “second victim”

• Developing internal resources dedicated to aggressive behavior follow-up

• Provide outside support services to workers following an incident

• Post incident follow-up is critical to continuation of accurate incident reporting

TOOL #13: ADDRESSING MENTAL HEALTH CHALLENGES

• Dealing with mental health patients in acute care setting is a growing epidemic

• Hospitals are not equip to deal with patients long-term – causes depleted resources and staff

• Determining solution of care differs in each hospital environment – at the forefront of state initiatives

TOOL #14: RECORDKEEPING & SUSTAINABILITY

• Joint Commission standards and Federal OSHA regulations require recordkeeping

• Accuracy of these reports directly impact proper assessments – effective implementation

• Sustainability requires transparency of the organization – dashboards, continuous data tracking, ongoing training of staff

NEXT STEPS

• Working on getting the finalized toolkit completed by April 1st

• Toolkit will be posted onto WSHA’s website and copies can be found there• Let ALL WSHA and ASHNHA members know when the toolkit

is available• Continue to add to the toolkit as we see fit with any

additional knowledge and hospital successes we find

• Safe Table in Seattle, WA on 3/23/17

QUESTIONS?

Courtney Ulrich, MHSAWashington State Hospital Association

513-310-3285Culrich@riskcontrol360.com