Minimising violence in the healthcare setting

Morgan Liotta

22/11/2018 3:15:44 PM

New data shows that GPs and other healthcare workers are high on the list of people who may experience occupational violence.

Four out of five GPs report they have seen or experienced violence at their place of work, according to the 2018 Health of the Nation report.
Four out of five GPs report they have seen or experienced violence at their place of work, according to the 2018 Health of the Nation report.

The RACGP’s General Practice: Health of the Nation 2018 report includes survey responses collected from GPs who work in general practice, hospital settings and Aboriginal health services.
Almost one in 10 (8%) of these GPs responded that they had experienced violence weekly in the general practice workplace, 18% in a hospital setting and 24% in Aboriginal health services.
However, the Health of the Nation report advises these figures should not suggest that hospitals and Aboriginal health services are uniquely dangerous or unsafe places to work.
Dr Tim Senior is a GP with a special interest in Aboriginal health and advisor for the RACGP’s National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people. He has worked at Sydney’s Tharawal Aboriginal Corporation for 13 years and said any violent behaviour he has experienced has usually been abated from successful intervention.
‘I have not witnessed that much violent behaviour. There has been quite a few occasions where we worry about the threat of violence, but this has been de-escalated successfully, usually by Aboriginal staff, who know the patient and are trusted by them,’ Dr Senior told newsGP.
‘It’s been most difficult when patients have been drinking or using drugs. However, in my experience this is more common in emergency departments than in primary care.

Dr Caroline Johnson, a GP and senior lecturer at the University of Melbourne’s Faculty of Medicine, agrees that collaboration among patients, doctors and practice staff is the first step in helping to minimise the risk of occupational violence.
‘Good communication skills are key to early intervention to prevent violence escalating,’ Dr Johnson told newsGP
‘The general practice environment and the skills of those at the front-of-house, such as receptionists, have a crucial role to play.
‘All practice staff can benefit from regular training in how to assess and intervene safely when risks for violent outcomes are present.’ 
Dr Johnson also emphasises the importance of good partnerships within local communities.
‘Communities need to work collaboratively too, so that when problems arise the practice can rely on appropriate, timely support from local agencies, such as the police and ambulance,’ she said.

Dr-Caroline-Johnson-Article.jpgDr Caroline Johnson believes collaboration with staff and patients can help to minimise violence in the workplace.
Establishing the necessary policies and procedures, as well as staff training to create a welcoming service, are high on Dr Senior’s agenda to minimise the risk of occupational violence.
These, he says, are key contributors that work both ways – if patients are made to feel at ease, it can help to create a safer working environment for the staff.
‘Ultimately, a practice that has a welcoming environment with friendly staff goes a long way to minimise the threat of violence,’ Dr Senior said.
‘Patients should feel that they are heard. They may not get what they demand, but they can be listened to and have their concerns understood and given alternative, often more helpful options.’

Tim-Senior-Article-(1).jpgDr Tim Senior underlines the importance of creating a welcoming service to put patients at ease and reduce the risk of aggressive behaviour.
Dr Johnson has also found that that listening to patients’ needs is crucial.
‘At a practical level, patients who are unwell are vulnerable,’ she said. ‘Patients may act aggressively when they are frightened, ill or desperate to be heard and helped.
‘Practices may contribute to the triggering of violence by not hearing and responding to this distress in a timely, pro-active manner.
So being able to recognise the potential for violence and intervene early is important, but can be challenging for GPs in a time-pressured environment.’
Factors for patient-initiated violence are varied, and both Dr Senior and Dr Johnson cite environmental issues and mental health as prominent triggers for violence.
‘Symptoms such as pain or anxiety can make people more short-tempered and prone to violence,’ Dr Senior said.
‘Intoxication through alcohol or other drugs makes people disinhibited, so can predispose to violent behaviour.
‘People’s living circumstances can also contribute to their frustration, predisposing to anger. When people have a lack of income, poor housing, difficulty accessing food or transport, that contributes to feelings of powerlessness and frustration.
‘This can be compounded by their experience of services, including health services, where they feel dismissed or patronised.’
Dr Johnson said violence in general practice can also create practical challenges, such as retention of staff and patients, and believes practice policies should be carefully considered.
‘Violent acts by patients can impede their own access to appropriate, timely care when they are refused service due to unacceptable behaviour,’ Dr Johnson said.
‘This can flow onto access to care received by other patients, such as when practices put up signs announcing “zero tolerance” for drug-seeking behaviour.
‘At face value, this seems an entirely reasonable safeguard to deter potentially violent patients from attending, but it also risks alienating those patients who more likely require high-quality care.’ 
The ripple effect of personal issues escalating to violence can have profound impacts on patients, healthcare workers and the broader community, according to Dr Senior.
‘Practice staff can obviously be [physically] injured and they can also have severe psychological effects, even with just the perceived threat of violence,’ he said.
‘It is likely that more staff will suffer these effects than just those subjected to violence themselves; often frontline practice staff are subjected to more threatening behaviour than the GPs themselves.
‘The effect on [other] patients in our services is also important, especially as often they will be vulnerable because of their illness or age.’
The RACGP has a number of resources to assist general practices in preventing and managing occupational violence:

Aboriginal and Torres Strait Islander harm minimisation health of the nation occupational violence patient-initiated violence workplace safety

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Ikeroo   23/11/2018 7:34:43 AM

50% = 4/5. Unless this finding is used by Ahpra in cases against GPS the same way any justice system utilises impact of abuse to the offender...or do we not think this will impact performance and error rate? If not then lock the finding up some place safe cos this is a behavioral problem...of society today. On the up side ain't that proof that the dr patient equality perception thing is working? That patients feel free to act in their doctor's office the way they act at home or school?