Assessing the threat situation

Providing a safe working environment and safe working practices for employees is a relatively complex task for any large organisation. But 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 an enormous job but essential for both the organisation and its employees that it is done and done well.

Risk Assessments
In order to ensure the safety of staff, there are basic steps management needs 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 our risk assessments for hospital porters, for example – and then producing policies and procedures based on this. Each hospital, clinic or surgery has a different layout, location and patient profile. Therefore the safety risks will vary, meaning the safety policies and procedures for each health service venue and its staff, including those that work alone in the community – must be tailor-made to deal with its specific risks.

It is important that those who carry out the risk assessments really know the roles they are assessing. It is pointless to bring in someone from outside the department to assess the risks based on whatever tasks management tell them their staff undertake. 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 management to find out the real issues. 

Policies and 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 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 pointless. They must be tailored to suit the specific needs of the various roles at each individual venue. Hospital porters have totally different safety issues from a surgeon, whose safety needs bear no resemblance to the needs of a GP when making home visits.

No matter how good the risk assessments have been at identifying the risks, and how robust and tailored the policies and procedures put in place 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’s 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 previously been carried out or the previous policies and procedures were not thorough enough, and an incident happens, then the organisation could be at risk of litigation for not accepting that its work systems were inherently unsafe.

Training for Frontline Staff
Good conflict resolution training for frontline staff should include how to make dynamic risk assessments of the person you 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/drunk/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?
Frontline training should also give staff the knowledge and skills to recognise early warning signs of aggression. The earlier they can spot these signs, the easier it will be for them to take action to defuse the situation if possible, or to exit it or call for assistance if necessary.

Managing Behaviour
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 any feelings in ourself – 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. The greater the diversity of jobs within the organisation, the more essential it is that the training is bespoke. You can’t give the same advice on how to exit a situation safely to a nurse who works in A&E as you can to a nurse who makes home visits, for example, or a paramedic who deals with drunks in their ambulance every Saturday night.

If, as happens in many cases, training is to be cascaded down from an initial generic system, then it is vital that the ‘trainees’, who are then expected to give the training within their own department, 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.

Additional Elements
Hospitals and other large facilities are using security staff more and more. They play a vital role, however security staff must be registered with the SIA (Security Industry Authority) and have to operate within their remit. This could potentially clash with the NHS safety remit. It can also be tempting for clinical staff, who should be in charge of any conflict management, to hand over the management of aggressive situations to security (this is more likely to happen if they are not sufficiently trained in carrying out dynamic risk assessments). This would be fine if it was just calming down drunks or exiting them from the building if necessary, as they are trained for this. However it can cause problems if they are asked to manage the aggression coming from a patient whose violence is a result of their clinical condition, for example dementia, certain medications, pain, fear, and so on.        

Therefore it is essential that the use of security staff is not abused in order to compensate for the lack of relevant conflict management training of clinical staff.

Technology can be very useful if its use is clearly defined. Alarms and tracing systems can be extremely effective in summoning help and in warning of 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 in replace of 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. 

Management Responsibilities
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 and contribute to the creation of 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 health care employees – from dealing with people who are frightened, in pain, mentally ill or drunk, to getting home after finishing late or transporting drugs around.

The diversity of healthcare roles, 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. The ICM believes that the only way this can be done is for the training of both frontline staff and management to become less generic and more bespoke in the future.

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