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abuse drugs or alcohol, gang members, and relatives of patients or clients; ■ Transporting patients and clients; ■ Working alone in a facility or in patients’ homes; ■ Poor environmental design of the workplace that may block employees’ vision or interfere with their escape from a violent incident; ■ Poorly lit corridors, rooms, parking lots and other areas;4 ■ Lack of means of emergency communication; ■ Prevalence of firearms, knives and other weapons among patients and their families and friends; and ■ Working in neighborhoods with high crime rates. Organizational Risk Factors ■ Lack of facility policies and staff training for recognizing and managing escalating hostile and assaultive behaviors from patients, clients, visitors, or staff; ■ Working when understaffed—especially during mealtimes and visiting hours; ■ High worker turnover; ■ Inadequate security and mental health personnel on site; 4 CDC/NIOSH. Violence. Occupational Hazards in Hospitals. 2002. Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers 5 ■ Long waits for patients or clients and overcrowded, uncomfortable waiting rooms; ■ Unrestricted movement of the public in clinics and hospitals; and ■ Perception that violence is tolerated and victims will not be able to report the incident to police and/or press charges. Violence Prevention Programs A written program for workplace violence prevention, incorporated into an organization’s overall safety and health program, offers an effective approach to reduce or eliminate the risk of violence in the workplace. The building blocks for developing an effective workplace violence prevention program include: (1) Management commitment and employee participation, (2) Worksite analysis, (3) Hazard prevention and control, (4) Safety and health training, and (5) Recordkeeping and program evaluation. A violence prevention program focuses on developing processes and procedures appropriate for the workplace in question. Specifically, a workplace’s violence prevention program should have clear goals and objectives for preventing workplace violence, be suitable for the size and complexity of operations and be adaptable to specific situations and specific facilities or units. The components are interdependent and require regular reassessment and adjustment to respond to changes occurring within an organization, such as expanding a facility or changes in managers, clients, or procedures. And, as with any occupational safety and health program, it should be evaluated and reassessed on a regular basis. Those developing a workplace violence prevention program should also check for applicable state requirements. Several states have passed legislation and developed requirements that address workplace violence. Occupational Safety and Health Administration 6 1. Management Commitment and Worker Participation Management commitment and worker participation are essential elements of an effective violence prevention program. The leadership of management in providing full support for the development of the workplace’s program, combined with worker involvement is critical for the success of the program. Developing procedures to ensure that management and employees are involved in the creation and operation of a workplace violence prevention program can be achieved through regular meetings— possibly as a team or committee.5 Effective management leadership begins by recognizing that workplace violence is a safety and health hazard. Management commitment, including the endorsement and visible involvement of top management, provides the motivation and resources for workers and employers to deal effectively with workplace violence. This commitment should include: ■ Acknowledging the value of a safe and healthful, violence-free workplace and ensuring and exhibiting equal commitment to the safety and health of workers and patients/clients; ■ Allocating appropriate authority and resources to all responsible parties. Resource needs often go beyond financial needs to include access to information, personnel, time, training, tools, or equipment; ■ Assigning responsibility
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