Patient First, the UK's largest patient safety event, will return to London's ExCeL on 21-22 November 2017
Providing a safe working environment and safe working practices for employees is a relatively complex task for any large organisation. For an organisation as enormous, diverse and geographically widespread as the NHS, this is a huge undertaking and the complexity of it should never be underestimated. It is a massive job but essential for both the organisation and its employees that it is done – and done well. Intervention strategies to manage challenging situations have to be relevant and commensurate with the risks faced.
In order to ensure the safety of staff, there are basic steps managers need to undertake. The first of these is to carry out risk assessments. This means assessing the risks involved with the individual tasks members of staff undertake. These assessments have to be thorough and they have to be targeted.
There is no point carrying out risk assessments for some staff and then producing policies and procedures for the whole organisation based on this. Each hospital, clinic or surgery has a different layout, location and patient profile. Therefore the safety risks will vary, and the safety policies and procedures for each location and the staff based there must be tailor-made to deal with their specific risks. It is also crucial to consider clinicians and other professionals who may work alone in the community.
It is important that those who carry out the risk assessments have an understanding, knowledge and skill in the specialised area they are assessing. For risk assessments to be effective, the assessor must communicate directly with the frontline staff, in order to find out how the jobs are really carried out. Consulting with staff – whether via focus groups, questionnaires or reporting amnesties – will enable employers to find out what the real issues are.
Policies & procedures
Once the risks have been identified, this consultation with staff should continue through to the development of relevant policies and procedures. If safety procedures are to work, their input is invaluable. The frontline employees – whether that’s GPs receptionists, ambulance drivers or doctors in the A&E – know what really happens on a day-to-day basis, what procedures would be practical for them and, importantly, which procedures they would actually follow.
As with risk assessments, generic policies and procedures are not always helpful. They must be tailored to suit the specific needs of the various roles at each individual location. Hospital porters have totally different safety issues from a GP when making home visits.
No matter how thorough the risk assessments have been, and how robust and tailored the policies and procedures are, it is rarely possible to eliminate all risk. Therefore staff must be given the knowledge and skills that will enable them to deal with the residual risk. It is important that training is only introduced at this stage and not before. Training should only ever be used as part of an overall personal safety strategy and never in place of one. If the correct risk assessments have not been carried out previously or thorough enough policies and procedures have not been put in place, if an incident were to occur, the organisation could be at risk of litigation for not accepting that its work systems were inherently unsafe.
Training for frontline staff
Good personal safety/conflict resolution training for frontline staff should include how to make dynamic risk assessments of the person they are dealing with, the environment in which the situation is taking place and the task that is involved. Is the person they are dealing with under the influence of drugs/alcohol, are they frightened/in pain/angry? Are there colleagues/security nearby who could come to their assistance if any problems occurred? Do they have to tell the person something that might upset them? Could any of these factors compromise their safety and what should they do about it? Could a possible misconception of their duty of care to an aggressive individual potentially inhibit effective safe responses?
Frontline training should also give staff the knowledge and skills to recognise early warning signs of anger/aggression. The earlier they can spot these signs, the easier it will be for them to take action to defuse or de-escalate the situation if possible, or to exit it and call for assistance if necessary.
How to manage our own behaviour is a vital part of any personal safety training. A crucial element when dealing with others is the awareness of our own feelings – such as anger, disgust, fear or resentment – that could cause aggression in the other person. Good personal safety training should enable staff to act appropriately when dealing with aggression, rather than reacting in a way that could make the situation worse.
Employees should be trained in how to judge whether it is safe to stay and attempt to deal with any given situation – and how to defuse that situation if they do decide to stay. Likewise, they need to learn about strategies for exiting a difficult situation safely if they decide that is the safest option.
As with risk assessments and policies and procedures, the challenge with training is that it needs to be relevant to the individual and service area. The greater the diversity of jobs within an organisation, the more important it is for the training to be bespoke. The training needs for a nurse who makes home visits may be very different to those of a paramedic who may treat people under the influence of drugs or alcohol on a regular basis.
If training is to be cascaded down to other teams, then it is vital that the trainees are also taught how to transpose the generic advice to the specifics of their own department. Training the trainers sufficiently is essential if all frontline employees are to be given the necessary targeted knowledge and skills to keep themselves safe in their particular role.
Hospitals and other healthcare facilities are using security staff more and more and they play a vital role. However, if clinicians have not received sufficient personal safety/conflict management training themselves, it can be tempting for them to hand over the management of aggressive situations to security staff.
This can cause problems if security staff are asked to manage aggression caused by a patient’s clinical condition or treatment, e.g. dementia/certain medications/pain/fear etc. Although security staff can play a part in containing or defusing this type of situation, the situation should always be managed by the clinicians in charge of the patient. They are the ones who fully understand how the condition or treatment is affecting the patient’s behaviour and therefore how it should be addressed.
Training needs to complement other control measures in reducing and managing work related violence; therefore technology can be very useful if its use is clearly defined. Alarms and tracing systems can be extremely effective in summoning help and in alerting to possible problems. However, they cannot prevent a violent or aggressive incident from happening nor can they help an employee to deal with such an incident until help reaches them. Technology should never be used to replace good safety procedures and training.
Good reporting systems are essential if an employer is to keep risk assessments and procedures up-to-date. Employees should always be encouraged to report incidents and near misses. They will only do so if the system is simple, non-timing consuming and they can see a clear result/benefit of reporting.
Those responsible for staff safety need to ensure that thorough risk assessments are carried out and that safety policies and procedures are designed and fully implemented. They need to ensure that employees know about, contribute to the creation of and buy into these safety policies and procedures. They should also ensure that frontline employees receive relevant and targeted training and that personal safety is kept on the agenda and integrated into existing structures across the organisation. Finally, they need to create and implement a structured reporting and aftercare process to ensure that victims are supported.
There are numerous factors that can adversely affect the personal safety of healthcare employees – from dealing with people who are frightened/in pain/mentally ill or under the influence of drugs or alcohol, to making home visits, getting home after finishing late night shifts or transporting drugs.
The diversity of the roles in the health service, the locations where interactions with the public take place and the risk factors involved, make it extremely hard to provide effective personal safety solutions for all those in the health sector.
Following 25 years experience of safety training in the workplace, Suzy Lamplugh Trust believes that the only way this can be done is for the training – of both frontline staff and managers – to become less generic and more bespoke in the future.
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