Bill Fox takes stock of how far we have come in our understanding and management of violence risks and shares his views on strategies that work best.
Standards and guidance concerning violence risks have leapt forward over the past 12 years and ‘violence reduction’ is now a respected discipline in which practitioners can even get a degree!
Violence is a complex area of risk and human behaviour that requires a multi-element strategy. Informed practitioners realise early on that responses that focused on personal safety training and ‘screech alarms’ rarely delivered tangible and sustained results. So, what works and what doesn’t?
Consigned to ‘Room 101’
Ten years ago, ‘zero tolerance’ as a policy was in vogue, with even the NHS running a high-profile campaign under that banner. The campaign raised awareness of this workplace hazard and helped educate staff that being assaulted was not ‘just part of the job’, but the flaw in it was that it failed to understand the nature of the problem it was trying to tackle and was based on the popular misconception that violence was just about nasty drunks in A&E. In fact, 70 per cent of assaults on NHS staff are related to an individual’s clinical condition and often involve complex requirements that need to be better understood and managed.
Zero-tolerance campaigns were more suited and successful in the transport and retail sectors, especially in sending a message to travellers and customers that staff are not employed for their amusement and abuse. I have spent 30 years managing violence across most work settings and I was stunned at the levels of unprovoked abuse I witnessed at London’s Waterloo rail station towards staff who had the temerity to ask courteously to see a ticket.
Zero tolerance can, however, simply amount to little more than rhetoric in the absence of a considered strategy. It can also fuel an adversarial relationship between staff and customers/service users, which generates even more conflict. When it comes to air travel I imagine I am not alone in being scared to complain about the service for fear of being read the riot act and strapped to my seat. On numerous occasions I have seen staff with limited communication and conflict-management skills playing the zero-tolerance card when a customer is simply being assertive. I have also seen similar situations handled superbly.
Along with self-defence courses and screech alarms I vote that zero tolerance has had its day and should be consigned to Room 101. Complex problems need more sophisticated solutions.
Strategies that can make the difference
Fortunately, we are moving away from focusing on ‘problem individuals’ to organisational approaches in violence risk management, consistent with the WHO Public Health Model, i.e:
Much is common sense; first, we need to understand where the problems lie and their causes, and then we can focus on how these can be prevented. This can involve reducing conflict flashpoints by delivering a positive and professional service and reducing exposure to risk through safer working practices and procedures. A violent incident can generate much emotion and pressure for reactive measures, such as providing PPE, before we have really understood the problem and first addressed primary and secondary controls.
We may still have to deal with people in difficult circumstances that are not of our making and therefore need to develop staff knowledge and skills to assess risk and defuse and resolve conflicts that arise. Training plays a key role here but it’s just one key strategy within a multi-element model.
This model operates at different levels and across various functions in an organisation, and part of the challenge is how to coordinate this. This is generally easier where there is a single owner of the ‘project’ who has sufficient authority and who works with accountable functional representatives. Although HR, Training and Security functions have key roles to play, the natural home for this area of risk in most organisations is Health & Safety.
Leadership starts with commitment to the strategy from those at the top of the organisation, followed up by close monitoring of progress against desired goals and outcomes. Inputs such as training are important but leaders need to focus on tangible outcomes and best value, especially in the current economic climate. Quality management information is the key to understanding the problem and to measuring progress. This can include data and risk analysis plus qualitative surveys of staff confidence, and perceived capability and engagement with service users and key stakeholders.
Supervision is critical at local level to ensure policy and training are put into practice and staff behaviours are monitored. In settings where staff need to be trained in restraint (a ‘tertiary’ control) it is also important to target a reduction in restraints, i.e. don’t just teach safer methods. Such activity carries risk for all involved and raises significant safeguarding issues where restraint is used inappropriately. Recruiting the right staff and effective supervision is critical, as training alone will not fix poor attitudes.
Some work environments can be controlled more easily than others — for example, we can have a reasonable level of control on a building or fixed site, but little control over the environment in which lone workers operate. (Fortunately, improving technology brings a greater range of safety and communication devices to support those working alone and remotely.) Layout, design, access control and security measures can all influence levels of conflict and risk and, as an example, when the much-abused ticket-checkers at Waterloo were replaced by a barrier system levels of conflict and abuse reduced considerably.
Some health and safety practitioners struggle with assessment of violence risks, as there are many variables that influence these. It often helps to think in terms of risk behaviours presented by service users, and tasks and activities performed by staff that increase exposure to risk. Through this approach, and by actively consulting with staff, it is easier to identify safer practices and useful scenarios to cover in staff training.
Training has advanced considerably as developments in learning technologies provide greater flexibility to deliver, support and refresh learning in the workplace. A blended learning approach can work well, with awareness/ induction-level training and underpinning knowledge being delivered through self-study, such as e-learning. For key risk groups that need to develop further skills and confidence, practically-based courses can be provided in addition.
A blended approach allows organisations to get more from their budgets and to focus resources where they are most needed. The ‘sheep dip’ approach that gives everybody a day of training can be too generic and wasteful; some roles need additional and/or more focused training, and others need only basic awareness input that can be achieved through good e-learning.
Summary
We will be more effective in reducing violence risks if we take time to understand the nature, extent and causes of these, and focus on desired ‘outcomes’ rather than seductive inputs and simplistic ‘solutions’. Better still, the organisational multi-element model will bring wider benefits in terms of service delivery and in promoting positive relationships with staff and service users.
Bill Fox is chair of conflict-management specialist Maybo and will be presenting on this subject in the Health and Well-Being Theatre at Safety & Health Expo at 12.30pm on Wednesday 15 May.
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