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Employees at a major hospital face victimisation by patients as well as the general public. Occasionally patients or concerned family and friends become aggressive and hostile toward hospital staff. The hospital needs a crime prevention plan to help protect hospital staff and patients from victimisation.
While workplace violence affects virtually all areas and categories of employees, health workers are more at risk. Ironically, helping people at risk and providing health to others becomes a dangerous occupation for the providers (Anderson and West, 2011). Violence in this sector may constitute almost a quarter of all violence at work (Nordin, 1995). Health workers are at high risk of violence and most violence is performed by patients and visitors. Categories of health workers most at risk include nurses and other staff directly involved in patient care, emergency room staff and paramedics. Violence against health workers has a negative impact not only on their psychological and physical wellbeing, but it also affects their job motivation.
The risk of inappropriate behaviour and workplace bullying can be eliminated or minimised by taking steps to prevent it from occurring before it becomes a risk to health and safety by responding quickly when it does occur. Interventions to prevent violence against health workers in non-emergency settings focus on strategies to better manage violent patients and high risk visitors. Interventions for emergency settings focus on ensuring the physical security of health care facilities (Who.int, 2019).
The risk of violence occurring in the future is continuously growing yearly with the numerous events in the past (Anderson and West, 2011).
The focal objective is to apply prevention or intervention policies and approached to decrease the occurrence of violence in healthcare settings, while the understanding of practice are known to staff and are able to help staff understand and recognise the violent behaviour and strategies on how to manage the risk factors (Ferns, 2007). Some of these violent acts are directed against those professionals who are in charge of our health care. These professionals, frequently, are “among the first to see victims of violence” World Health Organization (2002).
It is important to recognise the reasons and intentions of the wrongdoers, the role of the situation and the extent of the violence. The main perpetrator in aggression inside hospitals toward workers, are patients and visitors and these individuals perceive health professionals as individuals just doing their job. Violence in the health sector against healthcare professionals refers to intentional verbal and physical actions usually verbal abuse, physical assaults as well as nasty comments, discrimination and bullying. This can also involve psychological harm as it affects the individual’s safety, wellbeing and health outside of the workplace.
All health organisations should have a violence prevention program in place which focuses on the elimination of violence associated possibilities. Where the risks cannot be eliminated, they should be reduced to the lowest possible level using control approaches which the staff are aware of and trained in.
The risk is the chance, that someone or something could be affected by the recognised individual. Risk is judged in terms of how probable the incident will occur and how bad the incident will be if it happens (NSW Health). Assessing risk in the workplace involves estimating the degree of the danger and determining whether it is tolerable or not. Some areas such as waiting rooms may contribute to a higher risk of violence where there is overcrowding, long waiting times and patients in pain as well as individuals in distress over injured or sick family members. Health care employees face amplified risks of workplace violence due to the stress that patients, their families and others find themselves under. Some risk factors include:
Felson (1979) argues that crime is the outcome of three contributers. The coming together at a particular time and place of a motivated offender, a potential target and the absence of capable guardianship. Targets can include not only people, but inanimate objects. Absence of capable guardianship will aggravate the likelihood of a crime occurring (Tillyer & Eck, 2011).
There are two approaches in regards to workplace violence in the healthcare sector which can contribute to mitigating the fear of crime in hospital settings towards the hospital workers.
An important approach to prevent workplace violence is the approach known as Crime Prevention through Environmental Design (CPTED) (Duarte, Lulham & Kaldor, 2011). an important way to making the environment safer are by changes to the environmental setting, which doesn’t always have to be expensive. There are a set of
Ideologies that CPTED involves which play a significant role in reducing crime and violence and it is related to the design (Hopper, 2013). CPTED is a procedure developed to control the event of crime, violent conduct and inapplicable action through the environmental plan and layout (British Columbia Housing Matters, 2014) based on four key codes such as natural surveillance, access control, territorial reinforcement and management and maintenance and these are constructed on the intention that misconducts against people and property are minimised when under surveillance, whether that be by cameras or other people. If people in public areas and areas are able to see what is going on and if people feel safe in the environment and how to respond to problems, it might help in encouraging the reduction of crime and the urge to engage in criminal behaviour. An effectively designed environment makes people feel safer and minimizes the chances for crime and violent acts to occur.
CTPED is an approach to problem solving that analyses and utilises environmental conditions and the operational opportunities they offer for crime and violence (Zahm, 2007). It is the most well known design-based crime and violence control and prevention theory as it supplies a procedure for a set of design approaches that can be made to suit a particular site or activity based on that space’s specific requirements and problems. It restructures the use of space to integrate barriers, increase space and natural surveillance (Crowe & Zahm, 1994). CTPED is widely tested and proven and the effect can be experienced within a short period of time. If this approach is fully implemented, it will decrease government spending in policing.
The intervention policy includes organisation and managing engineering actions (World Health Organisation, 2002) and engineering implementations involves architecture. Architecture has an important impact in controlling workplace violence (Charney 2010). The CPTED approach proposes that appropriate design standards and use of the built environment and operational organisation can help reduce the risk of violence and the actual incidence of violent activity (Parnaby, 2006). Control strategies that are components could be replacement of dimmed lights to bright lighting both indoors and outdoors, a low number of items and furniture in rooms/waiting rooms to minimise the use of weapons, CCTV, changes in new plans for construction, physical changes or renovations, and comfortable waiting rooms.
Although this approach works great for preventing crime, there are some weaknesses which are common also. This approach is only applicable to a newly planned neighbourhood as it would be hard to apply and modify the design of already developed hospitals. It is resistant to change, so if it does go ahead and hospitals with these designs in mind are built, there is a chance it might need renovations later down the track if crime increases and changes.
Situational crime prevention (SCP) is maintained based on a problem-solving method which is observed as the key to successful crime prevention development and concentrates on diminishing opportunities for crime rather than trying to modify the nature to offend. SCP focuses on preventing the chance for crime to occur by concentrating on issues within a specific issue. SCP counteracts the prospect for future crimes to occur by addressing the environment and setting to which past crimes have occurred. With those opportunities absent, it becomes challenging for further similar crimes to take place. This includes the decrease of characteristics that may make people more susceptible to abuse and harassment because of certain situations. Increasing the effort of offending and rising the danger of being caught are ways to avoid situational crime. Preventing aggravation in hospitals toward health care workers is usually just an individual reacting and responding to a situation around them. SCP examines the circumstances and environment in which individuals commit crimes and why, and identifies further possible risks and explores resolutions specific to those conditions.
A great protection healthcare employers can offer their workers is to establish a zero-tolerance policy toward workplace violence to eliminate excuses, which is a common occurrence within hospital workplace violence (Intranet.nnswlhd.health.nsw.gov.au, 2019) which works under situational crime prevention. A zero tolerance approach means that in all incidents of violence, appropriate action will be taken to protect staff, patients and visitors from the effects of such behaviour with one tactic to non-acceptance of workplace violence. The zero tolerance approach will extend even to verbal and non-verbal threats and removes excuses for committing crime. The operational success of the zero-tolerance approach is based on the principles that all practicable strategies to reduce the probability of violence transpiring are recognised and applied.
Developed by Cohen and Felson (1979), routine activity theory requires three elements for a crime to occur, a motivated offender, a suitable target and the absence of a capable guardian. In hospitals, the motivated offender is usually either a patient or the patients family member or friend as they are in an unlucky situation and probably not in a good state of mine if they are attending the hospital , a suitable target in this case is the healthcare worker as they are very vulnerable to aggressive behaviour and violence, as the motivated offender is usually tired, fed up waiting, or under the influence of drugs or alcohol. The absence of a capable guardian could either be the absence of a security guard, or even use of natural surveillance, or CCTV itself just to at least scare the offender and make them think they are being watched. Routine activity theory is influenced by the pattern and the design of prevention strategies of repeat crime and victimisation. The downfall to this may be the time it will take to observe each violent behaviour and how long it takes to come up with a conclusion on how to manage the situation when it comes across again while the strength of this approach is pin pointing exactly what and how things should be done, and doing them.
The approach most recommended for limiting hospital workplace aggression is situational crime prevention as it comprises a range of measures that highlight the importance of targeting very specific forms of crime in certain circumstances (Clarke, 1997) which involves identifying, handling and controlling the situational or environmental impacts accompanying certain types of crime (Cornish and Clarke, 2003). It is also based upon assumptions regarding the nature of offending and of offenders through crime pattern and routine activity by identifying likely reactions and choosing and applying the most applicable response by concentrating on exact situations in which violence occurs and prevent those situations inclining or intensifying where violence is more possible.
Although situational crime prevention seems similar to crime prevention through environmental design, it is much more effective and cost efficient as you will not be spending too much money on things that may evolve over time, and that may not even have had an issue or participated to crime in the beginning. In comparison situational crime prevention is based off previous situations and it is definite that changing these factors will influence and prevent the crime and violence rate from patients and family members towards workers in the healthcare sector. Doing so by increasing the effort involved in offending, the risk associated with offending and reducing situational factors that influence an individual to offend.
In order to do so you will need to focus on crime patterns and examine all the factors that contribute to the situation that violence occurs (Indermaur, 1999).
It would be impossible to do this without analysis. Creating a safer environment stresses we attend to the circumstances in which hositility occurs and in turn effort to generate social surroundings that mitigate against growth of aggression by helping to diminish the appropriateness and use of violence not only in a hospital setting, but as a whole. The key indicators of success and failure would be the violence rate in the particular hospital. If the rate of aggression is growing, the approach obviously didn’t work, but if it begins to diminish, it is a sign of success.
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