On June 3, 2010 The Joint Commission, the accreditation organization for healthcare issued what they call a “Sentinal Event Alert,” which is an affirmation of a serious event issued by the Joint Commission to educate healthcare institutions on recent data, collected by them, that denotes a significant increase in a serious or deadly situation. In this case, The Joint Commission recently noted an increase in the number of reported assault, rape and homicides that have occurred in healthcare institutions.

Workplace violence within healthcare is not a new phenomenon. In 1994 the Bureau of Labor Statistics (BLS) Census of Fatal Occupational Injuries (CFOI) reported that healthcare providers had the highest rate of fatal injuries due to workplace violence compared to all other industry. In response, the Occupational Safety & Health Administration (OSHA) published “Guidelines for Preventing Workplace Violence for Health Care & Social Service Workers” in 2002.

The primary purpose of the OSHA document is to assist in the development of a comprehensive program to reduce the opportunity for violence to occur within the workplace. The key component recommended by these authors to reduce workplace violence happens to be the control of access and the identification of violence. Specifically, the OSHA document and other workplace violence reports and guidelines call for the manipulation of the environment in order to control or restrict access and the training of staff to identify potentially violent persons through behavior recognition.

All of the reports recommend the completion of a workplace analysis in order to start the process. This analysis is a security risk assessment or survey focused on the control and prevention of hazards related to violence. They recommend that the analysis focus on the use of engineering controls in order to reduce violence. That means restricting access through the manipulation of the physical environment, using physical barriers placed between people and hazards that allow for the screening of persons or the restriction of access and creating a work environment where people are continuously controlled and screened throughout the organization, where work spaces are designed to keep physical structures between staff and others.

As recommended, institutions can use the physical environment in order to reduce potentially violent acts. Physical barriers like doors, walls and partitions should be installed to restrict entry. Once persons enter a facility they must be screened in order to determine who they are going to visit and the purpose of their visit. A solid visitor management system can take a photo of the visitor and collect images of identifying documents as well as allow for the option of placing flags within the database so screeners are alerted to potentially dangerous persons.

Once inside of the building visitors should be restricted to where they can go. Access control can keep persons from straying into unauthorized areas and allow for authorized, announced entry into work areas. Installing doors, counter partitions, glass window or screens, installing door locks and card readers help to restrict unauthorized access.

Access control within individual work areas is paramount as well. Physically separating waiting and reception space from staff work space is important in violence reduction. In addition, the set up of an individual’s office can help to reduce violent acts. Workers should arrange desks and other furniture so that there is a physical barrier between visitors and the employee and so that they have the ability to leave their office without coming in contact with the violent visitor.

In order to successfully prevent violence within the workplace, it is imperative that all organizations establish workplace violence prevention programs. Every program needs to include the control of access and identification of violent behavior along with a zero tolerance policy and the implementation of criminal background checks for all employees in order to determine if a potential employee has previous violent behavior.