Managing Safety at Lakeridge Health

Vanessa Aguiar, BSc. (Hons. Kin), MHSc. (OEH), CRSP, Director, Occupational Health, Safety & Healthy Workplace, Lakeridge Health Vanessa Aguiar is the Director of Occupational Health, Safety & Healthy Workplace at Lakeridge Health. Lakeridge Health is one of Ontario’s largest community hospitals, serving people across Durham Region and beyond. Its mission is to deliver high-quality healthcare—“because the people coming through our doors are our neighbours, family and friends.” Resource Magazine spoke with her about awareness and prevention of workplace harassment, and how Lakeridge Health ensures a safe and healthy workplace.

RM: How does Lakeridge Health raise awareness among employees about issues of harassment and violence including sexual harassment?

VA: Lakeridge does a number of things, first starting from new hire orientation. It is a strategic priority, so communication from day one is very important so that employees feel that safety is a part of their everyday job. We want employees to feel empowered to make decisions about what is acceptable and not acceptable behaviour starting from orientation.

We also have two committees who bring awareness and action to ongoing issues. One committee is involved in the messaging and communication in visible places, like the hallways and elevators, about our policies and procedures. Our committee came up with the communication that is in place currently and worked with HR collaboratively: the flyers in the hallways and elevators are all messages (with pictures) from members of the committee.

The result of this program has been much more reporting and metrics around how our programs are being managed. This campaign was launched last fall, and we are building on this success.

The second committee has strategic responsibilities regarding health and safety.

Additionally, we have other ways to sustain awareness of our policies and procedures regarding issues of harassment and violence. For example, we have a booth where employees can submit their concerns, mandatory in-person training, an annual Passport to Safety training, and established Joint Health and Safety Committees.

RM: Do you have a program that provides support to help victims feel safe and secure in the workplace?

VA: Typically, a manager is the first person to respond to an incident. Firstly, the manager needs to address how the victim feels. Depending on the situation, they would then take appropriate action, which may involve moving a patient or nurse, or placing an employee on leave. The follow-up usually includes a recommendation that the alleged victim talks to our Employee Assistance Program as well.

During the investigation, we recognize the validity of both parties but always err on the side of the victim. If the result of the investigation finds an infraction against policy, we would follow with disciplinary procedures.

RM: Do you take any additional steps to prevent or minimize bullying and harassment, outside of existing policies and procedures?

VA: We try to identify specific issues and continually assess if new programs need to be created to prevent or minimize bullying and harassment. For example, there is a new program being implemented by another healthcare institute that is geared to mental health, and we modified it so it could fit with Lakeridge Health. The concept behind the program is to find out what triggers patients [with mental health issues] so that we can better set expectations among all of our employees who work with them.

The newly implemented program is about understanding the needs of the patient so healthcare professionals can assess and react to what a patient may need while waiting for a doctor. We are looking at how to better prevent and minimize harassment in regards to nurses in cases like this, where the environment is often very stressful and sensitive.

RM: How do you evaluate the effectiveness of your programs?

VA: One of the primary ways we evaluate effectiveness is by using incident reporting. We also evaluate feedback from employees through annual engagement surveys and the outcomes of workplace violence risk assessments. We have a dedicated section in the annual engagement survey around work environment, which we use when action planning.

RM: WSIB lost-time claims statistics show healthcare workers experience significantly more violence-related injuries than those employed in fields often perceived to be more dangerous. What measures and processes do you have in place when it comes to patients attacking nurses?

VA: Our hospital does not have that many incidents; there were only a few in 2017. We have a de-escalation process that has resulted in fewer incidents overall. Having a deescalation process is something we have found to be successful given the amount of complex situations we can run into with providing healthcare to the public.

Especially with new mental health changes, there is no pre-established way to manage the numbers. We need to equip our workforce with the ability to manage the workload and be more resilient. For example, we may have an incident where a patient may attempt to use inappropriate behaviour with a nurse. It is important to handle things properly. We are looking at how we can flag patients who react in a manner that may not be acceptable. We have instances of repeat offenders, so we need to provide information that will help other nurses and healthcare workers know what triggers the patient.

One of the challenges we face is funding and resources. We have five locations with full-time, part-time and causal employees working 7 days a week, 24 hours a day. That creates challenges to having the optimal resources in place at all times throughout the day and year.

RM: Who manages workplace investigations at Lakeridge Health?

VA: It depends, but typically from an employee perspective, it starts with the manager. After the manager reviews the incident with them and completes an initial investigation, they include both the Director of HR and myself to review all the reports. If the issue is with a patient, the unit manager starts the investigation. We may also include an external third-party investigator if it is appropriate.

RM: How often do you reassess workplace violence risks at the hospital?

VA: It depends on the level of risk, but currently we review all potential workplace violence risks. We have guidelines for reviewing timelines based on their level of risk: once a year for high risk, every three years for lower risk and as needed for new or changing services or based on the number of reported incidents.

RM: What are some of the overall challenges Lakeridge has faced as an organization or you have faced as an HR professional in the implementation and maintenance of your workplace violence prevention program? What advice would you offer other employers and HR professionals going forward?

VA: One of the biggest challenges we face as a healthcare organization is that there are many unique challenges that come up in our industry. Maintaining a workplace violence prevention program and a healthy workplace needs to be balanced with maintaining a high quality of care for patients. We look at how we can address triggers related to violence and mitigate risk as much as possible, since we can’t always change or eliminate risk completely in our field. For example, we seek to answer questions like “How can we de-escalate patients and family members who are emotionally charged or fearful?” and “How can we address long wait times creatively?”

I would encourage other employers and HR professionals to look at all aspects of what impacts or incites violence. Looking at symptoms and situational factors that result in violence can better inform us as HR professionals on how to respond in a systematic and timely matter. We need to help managers through training and guidance on how to handle incidents, and follow up with them so they are comfortable being the first point of contact when it comes to investigations.

Within our community, we also need to learn from others facing similar challenges. In the healthcare industry, we are lucky to have learned from others that are facing similar patient and employee care challenges, and we try to lift and adapt programs that have worked at other locations.