Reducing Workplace Violence: Using Postvention for Prevention

One of the easiest ways to reduce and prevent workplace violence is to implement a concrete policy and plan for reviewing incidents of workplace violence after they occur. What you discover in a review can serve as a guide for changes that can assist you in preventing future occurrences of a similar nature. Doing or responding the same way time after time and expecting results is not so productive. In fact, I’ve heard it’s the definition of insanity. However, it's best to move away from saying, “Wow, glad that’s over!” and then thinking that we can just move on and hope it doesn’t happen again.

Here are five quick tips for using Postvention as prevention:

1. Make sure everyone is calm and rational, but debrief the incident as soon as possible.
   Who should debrief? Everyone! If you can debrief with the patient and/or family member, it may give you some insight into what triggered the incident in the first place. Certainly as a team of staff responding to the incident, it’s critical to gather everyone’s perspective and document the facts of the incident. Individual staff arrive at different points or may have a different perspective that will help you target areas for improvement. If the incident involved physical injuries or high-level threats or intensity, it may be appropriate to also debrief with bystanders and ensure that employees have access to critical incident stress debriefing or follow-up counseling services. Responding to incidents of workplace violence can have lasting traumatic effects on staff. It’s essential to take care of staff.
2. Look for patterns and trends.
   Are the incidents occurring only in certain areas? Are there environmental or staffing patterns that exist? Are incidents occurring only with certain staff members? Do you have a surge in incidents at different times of the month or the day or during a particular shift? Is there something about the “way” staff is responding that seems to be the Precipitating Factor? Gathering the data and making yourself aware of these patterns and trends can help you take a targeted approach to making changes to prevent these incidents from occurring.
   
   I once heard a story from a behavioral health unit about a marked increase in the use of mechanical restraint on the overnight shift. After much assessment, it was discovered that the staff, in preparation for their shift, would get the mechanical restraints out “in case” they needed to use them. The restraints were placed within the sight of patients. When staff refrained from this one step in their preparation, they found that they rarely needed to use the restraints. They had set an expectation about behavior by setting the restraints out. Keeping them put away sent a different message to patients about the expected level of behavior and the staff response for the evening.
3. Negotiate plans for change.
   Anytime you bring a group of professionals together, you might find a wide array of opinions on how something should be handled. The truth is that they all might be right. Agreeing to disagree at times and to compromise is critical. Crisis moments are by nature chaotic. Having staff responding in a disjointed fashion because they have not agreed upon a plan will not be helpful in reducing the chaos. Make plan A; be prepared to go to plan B or plan C. Collaborating is a great way to ensure that you have the best ideas compiled. You never know where the golden nugget may come from!
4. Focus on what went well.
   I think one of the reasons that debriefing is often skipped or seen as a waste of time is that it is not used to focus on what went well, and instead becomes a finger-pointing and blaming session. The purpose of a debrief is to focus on what went well, what might have gone differently based on a change in response, what if any patterns exist, and to come up with a plan for improving your response and preventing incidents of workplace violence from occurring in the future. This is not to say dismiss inappropriate or abusive behavior that may have occurred. It is to simply say that the debriefing session should be solution-focused and used to identify the strengths that exist while you assess for areas of improvement.
5. Celebrate successes.
   My hope is that all you have to talk about are near misses, but be sure to celebrate staff who are proactive and who catch situations early and effectively de-escalate. Making a big deal out of this type of staff behavior inspires others to work hard at preventing workplace violence. It’s a very scary subject. Many staff have sadly seen some really terrible incidents occur. The more we can build staff confidence through training and supporting their use of these acquired skills, the more others are moved to use the skills they have been given with a higher level of confidence.

We can’t expect situations to turn out differently or to be avoided if we never take a deeper look at the contributing factors. Organizations using CPI’s Nonviolent Crisis Intervention^® program can view each situation through the lens of our CPI Crisis Development Model^SM. What were the early warning signs and what, as staff, did we do to alleviate the anxieties, fears, or concerns we noticed? If the situation escalated, what limits did we set? What expectations did we clarify? As we sift through the details and save what worked, and formulate a new approach for things that didn’t go so well, we are well on our way to preventing future occurrences or at least reducing and minimizing the risks associated with workplace violence.