Audit, Compliance and Risk Blog

Health care and social service workers suffer workplace violence at much higher rates than in most other sectors, because of the higher risk from their patients and clients. In response, worker protection laws and regulations have begun to require workplace violence prevention in these sectors. The California Occupational Safety and Health Standards Board (OSHSB) just adopted a new regulation, implementing 2014 legislation that expands state requirements for hospital security plans, to include specified workplace violence prevention programs. Compliance begins in phases during 2017-2018, and will be administered by the Division of Occupational Safety and Health (Cal/OSHA)).

Even organizations that are not California hospitals, or even in the healthcare sector at all, can benefit from evaluation of risks from customers and responses.

Existing Requirements For Security Plans

All California employers are required to prepare and implement Injury and Illness Prevention Programs (IIPPs) to systematically identify and address workplace hazards (IIPPs are California’s mandate that employers create safety and health programs; I recently blogged about changes to national recommendations here). Since 2010, state-licensed hospitals must also implement security plans with all of the following actions:

• Conduct a security and safety assessment at least annually

• Use the assessment to develop a security plan with measures to protect personnel, patients, and visitors from aggressive or violent behavior. Each plan is to include security considerations relating to all of the following:

  • Physical layout

  • Staffing

  • Security personnel availability

  • Policy and training related to appropriate responses to violent acts

  • Cooperation with local law enforcement regarding violent acts at the facility

• Provide appropriate training to appropriate employees, which must include all hospital employees regularly assigned to an emergency room.

• Report all assault and battery cases to law enforcement within 72 hours.

New Requirement For Workplace Violence Prevention Programs

Cal/OSHA will require licensed hospitals to expand their IIPPs to include workplace violence prevention plans. The final version of these requirements contains substantial technical changes from a proposal issued in December 2015 (I discussed them here). These new requirements apply to the following:

• Health facilities, which include in-patient hospitals and nursing facilities providing services for a wide variety of physical and mental illnesses (the adopted rule drops proposed coverage of ancillary facilities)

•  Home health care and home-based hospice services

•  Emergency medical services and medical transport, including those provided by firefighters and other emergency responders

•  Drug treatment programs

•  Outpatient medical services to the incarcerated in correctional and detention settings

These employers are to prepare Workplace Violence Prevention Plans including all of the following:

• Names or job titles of the persons responsible for implementing the Plan.

• Effective procedures to obtain the active involvement of employees and their representatives in developing, implementing, and reviewing the Plan, including training and reporting elements.

• Methods the employer will use to coordinate implementation of the Plan with other employers with employees at the same facility, service, or operation.

• Effective procedures for obtaining assistance from law enforcement whenever necessary during work times. These must include a policy against preventing, or retaliating after, employee efforts to seek such assistance when a violent incident occurs.

• Effective procedures to accept and respond to reports of workplace violence, including inter-employee (“Type 3”) violence, and to prohibit retaliation against an employee who makes such a report.

• Procedures to ensure that supervisory and non-supervisory employees comply with the Plan.

• Procedures to communicate with employees regarding workplace violence matters, including:

  • How employees will document and communicate to other employees and between shifts and units, information regarding conditions that may increase the potential for workplace violence incidents.

  • How an employee can report a violent incident, threat, or other workplace violence concern, including special reporting requirements that acute care hospitals, acute psychiatric hospitals, and special hospitals report violent incidents within 24 hours.

  • How employees can communicate workplace violence concerns without fear of reprisal.

  • How employee concerns will be investigated, and how employees will be informed of the results of the investigation and any corrective actions to be taken.

• Procedures to develop and provide required training.

• Procedures to identify and evaluate environmental risk factors.

• Procedures to identify and evaluate patient-specific risk factors and assess visitors and other non-employees.

• Procedures to correct workplace violence hazards in a timely manner.

• Procedures for post-incident response and investigation.

These employers must also prepare and maintain a violent incident log, and to report specified information about violent incidents to Cal/OSHA. Cal/OSHA will post annual reports of violent incidents (protecting employee privacy).

Record keeping requirements are specified. Employers are also to review the effectiveness of their plans, annually and whenever an incident or change in available information arises.

Employers are to provide training for all employees. This includes initial training for all employees when the Plan is initiated and for each new employee thereafter, additional training when changing conditions or information warrant, and annual refresher training for employees who perform patient contact activities. Training is to address:

• Identified workplace violence hazards.

• The employer’s Plan, policies and procedures.

• How to recognize the potential for violence, and appropriate ways to avoid or de-escalate.

• How to recognize and respond appropriately to incidents underway, including shelter or exit, contact to security or law enforcement, etc.

• How to report incidents.

• Post-incident procedures, including support.

Employers must provide additional initial and refresher training to employees whose assignments include responding to internal incident alarms or notifications, or confronting or controlling people exhibiting aggressive or violent behavior.

Phased Compliance Deadlines

The following deadlines apply for initial compliance:

• April 1, 2017:

  • All subject employers create a violence incident log, and begin record-keeping

  • Acute care hospitals, acute psychiatric hospitals, and special hospitals also are subject to requirement to report violent incidents to Cal/OSHA within 24 hours

• April 1, 2018: All subject employers must prepare and begin implementation of Workplace Violence Prevention Plan and associate training.

And … OSHA’s Request For Information

Self-Assessment Checklist

Does the organization operate any activities or facilities that will be subject to Cal/OSHA’s workplace violence prevention plan requirements?

- If so, does it maintain a workplace violence prevention plan?

Whether or not the organization is subject to these requirements, does it:

- Have a plan for workplace violence prevention, including procedures to ensure appropriate prevent and response activities?

- Have established communication and cooperation procedures with local emergency responders and law enforcement?

- Record incidents of workplace violence?

- Procedures and method(s) for reporting incidents?

- Provide employees training in workplace violence hazards, prevention and responses?

Has the organization ever had a workplace violence incident at one of its operations?

- If so, how has the organization responded?

Where Can I Go For More Information?

• California OSHSB webpage for health sector WVP rule  

• Cal/OSHAIIPP webpage 

• OSHA:

  - Workplace violence webpage 

  - OSHA request for information on workplace violence prevention in healthcare and social assistance 

Specialty Technical Publishers (STP) provides a variety of single-law and multi-law services, intended to facilitate clients’ understanding of and compliance with requirements. These include:

• OSHA Auditing - Federal Compliance Guide: Facilities: The Complete Safety & Health Audit Checklist 

• OSHA Compliance: A Simplified National Guide

• OSHA State Differences Summaries and Checklists

• OSHA Auditing - California Occupational Health and Safety Audit Guide

• Workplace Violence Prevention: A Practical Guide to Security on the Job

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