Regulatory Compliance: Don't Wait To Prevent Workplace Violence

CDA Practice Support

At the time of this writing, the nation experienced a series of violent acts with multiple fatalities — shootings at a grocery store, elementary school, hospital and other workplaces. In the midst of these events, Cal/OSHA released another draft of a proposed workplace violence prevention regulation. The regulation will apply to most businesses, including dental practices and clinics. California already has a workplace violence prevention regulation for hospitals and other larger health care facilities. [1] A hearing on the regulatory proposal has not been scheduled, but the agency is accepting comments on its second draft.

Dental practices need not wait for a regulation to take effect before acting to prevent workplace violence. Elements of the proposed regulation can guide employers on steps to take. The proposal calls for employers to have a written violence prevention plan, conduct workplace training and maintain incident logs. “Workplace violence” is defined in the draft regulation as any act of violence or threat of violence that occurs in a place of employment. It includes (1) the threat or use of physical force against an employee that results in or has a high likelihood of resulting in injury, psychological trauma or stress, regardless of whether the employee sustains an injury and (2) an incident involving the threat or use of a firearm or other dangerous weapon, including the use of common objects as weapons, regardless of whether the employee sustains an injury. Acts of self-defense are excluded. [2]

Employers should involve employees in all aspects of identifying and assessing risks. The following subjects should be discussed either as a team or individually with each employee:

■ Physical security, such as locked doors, security cameras and alarm systems.

■ Aggressive patients.

■ Staff conflict, among themselves and

in their personal lives. An employer does not have the right to know the details of an employee’s personal life but should maintain awareness of unusual behavior and signs of domestic violence. When discussing such concerns with an individual employee, an employer should link the discussion to the importance of the employee to the team and performance of the entire practice.

Workplace violence prevention training programs are not difficult to find. Although news media brings a lot of attention to gun violence, many training programs focus on anger de-escalation techniques, such as communicating empathically and neutrally, and on improving awareness and recognition of potentially violent situations. An employer can also use other training resources; for example, a recent TDIC Liability Lifeline newsletter focused on how to manage difficult patients. Everyone can practice de-escalation techniques until they become comfortable using them. Training should also include reviewing procedures staff should follow to ensure safety during violent situations. Procedures can include the use of a code phrase to put other staff on alert or to alert staff to call police.

Earlier this year, a “difficult patient,” as described in police documents, was charged with the murder of two Texas dentists. 3 Gun violence at the workplace, although rare, can occur. It is important that employee training prepare them to run and hide, for example, by discussing escape routes or to fight using available items if left with no other choice.

It is important for a dental practice employee manual to have a policy statement on workplace violence, such as the following statement included in the sample manual provided to CDA members: We all deserve to work in an environment that is free from violence or hostility. [Employer] has zero tolerance for violent acts or threats of violence against our employees, applicants, patients or vendors. No employee should commit or threaten to commit any violent act against a co-worker, applicant, patient or vendor. This includes discussions of the use of dangerous weapons or of bringing such weapons onto office property, even in a joking manner. Any employee who is subjected to or threatened with violence by a co-worker, patient or vendor or is aware of another individual who has been subjected to or threatened with violence is to report this information to [employer] as soon as possible. Please bring all threats to our attention so that we can deal with them appropriately. All threats will be thoroughly investigated and all complaints, which are reported to management, will be treated with as much confidentiality as possible.

A written violence prevention plan details the actions taken by an employer to implement this policy. It also serves as a record of an employer’s intent. Employees should participate in the plan’s development and implementation. The proposed Cal/OSHA regulation will require a prevention plan to include:

■ Procedures for employees to report incidents of workplace violence without fear of retaliation and a description of how employees will be informed about these procedures. Procedures may differ based on the type of incident.

■ Methods of implementing the plan.

■ Procedures for investigating employee concerns and incidents of violence and how employees will be informed of investigation results and actions, if any.

■ Procedures for responding to workplace violence emergencies, including where to evacuate or shelter and how to reach out for security personnel or law enforcement.

■ Description of training, such as what topics are covered and how training is delivered to employees.

■ Procedures for identifying and evaluating risk, including employment involvement, frequency of review and maintaining an incident log.

■ Procedures for regularly reviewing and updating the prevention plan. n

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REFERENCES

1. California Department of Industrial Relations. Violence Prevention in Healthcare, 8 CCR §3342.

2. California Department of Industrial Relations. Workplace Violence Prevention in General Industry, May 17, 2022 discussion draft.

3. Wood S. Documents: Man accused of fatally shooting two Tyler dentists was a ‘difficult patient’. Tyler Morning Telegraph Mar 23, 2022, updated May 1, 2022.