7 Steps to Establishing Workplace Violence Prevention Programs at Ambulatory Care Sites

If you were to list the top health care sites facing large numbers of workplace violence incidents, you’d likely start with hospitals, specifically emergency departments. But there is an often-overlooked place for workplace violence in health care; ambulatory care and alternative care sites.

In fact, according to the ECRI Patient Safety Organization (PSO) in 2019, workplace violence was one of the top four key risks in ambulatory care. And we know that risk grows annually with the increased stress on the health care climate.

Examples of ambulatory care sites include physician offices, dental offices, diagnostic imaging centers, home health, and hospice to name a few. While hospitals are certainly larger in scope, outpatient locations like ambulatory care and alternative care sites are seeing significant increases in patients due to their more affordable, convenient nature.

Ambulatory care site staff experience widespread incidents of verbal assault and abuse.

And as we’ve found all too often, verbal abuse can quickly escalate into physical incidents if not efficiently de-escalated. As noted in the Workplace Violence Prevention Handbook for Health Care Professionals, there are seven small, but effective, steps you can take to develop a workplace violence prevention program within ambulatory care and alternate care sites.

Let’s take a closer look.

1. Build the Foundation

Think of this as the “background information” step. In order to determine where you’re going, you need to understand what you’re starting with. Gather information on:

• What is already in place within your organization.
• What your current workplace violence policy says.
• Whether or not you have an active workplace violence committee.

2. Learn the Current Climate

During this step, you’ll gather specific data. Is there data currently being captured specific to workplace violence in your ambulatory care and alternate care settings? It’s important to remember during this step that verbal aggression—most common in these settings—is often underreported. If you do find statistics already existing, keep in mind that they may not be enough. Understanding the specific categories of violence being experienced is key.

Categorizing the types of verbal (and physical) abuse occurring helps establish expectations and train staff how to safely respond.

For a complete list of data to track for ambulatory and alternate care sites, visit page 147 of the Workplace Violence Prevention Handbook.

3. Start a Campaign

Once you’ve laid the groundwork and identified challenges, it’s time to raise awareness about your goal of addressing workplace violence. Find opportunities to be visible and heard about the focus on improving the current environment.

When you help staff feel heard and valued, they know the issues they silently tolerate every day are being recognized and addressed.

4. Find Your People

Now that a campaign has been started, you’ll begin to find people surfacing who want to help make an impact. Empower those people, and their connections, to have a voice about safety in their environments.

Several key players and departments to be represented in your committee include:

• Frontline staff
• Providers
• Nurses 
• Diagnostic hospital departments
• Senior leader(s)
• Impatient areas

5. Education

Kicking off your committee’s learning phase with de-escalation and limit setting will make the biggest impact.

"Staff should understand that they are a part of a chain of interactions and being observant of potentially escalating patient behaviors allows them to proactively respond and resolve concerns.”

Education not only empowers staff, but also equips them to understand that everyone has a role to play in shaping the patient experience. Cultures of safety begin being established the more these skills and scenarios are practiced and put into place.

6. Prevention in Action

Here, you’ll work toward implementing workplace violence prevention initiatives that are specific to your ambulatory care and alternate care sites. These initiatives and projects should align with the initial goals that were developed during the background and data collection steps. And don’t forget to require status updates to hold teams and committee members accountable.

7. Review

Now that your committee has been educated and progress is being made to put policies into action, you want to continuously monitor to determine effectiveness. This process allows your workplace violence initiatives to adapt to changing trends while making continuous improvements.

Graphing and surveying data are both effective ways to monitor incidents in relation to the education that has been provided.

Receive a Digital Copy of the Workplace Violence Prevention Handbook

The areas of consideration discussed here are from the Workplace Violence Prevention Handbook, published by CPI and authored by health care professionals and subject matter experts Kimberly Urbanek, system manager, administration and training of public safety, alongside Kyle Graham, clinical manager, child and youth mental health programs.