Thank you for the opportunity to speak to you today.
My name is Henrietta Van hulle, and I am a nurse with 17 years of front-line care experience before shifting to occupational health nursing. I am the vice-president of Ontario's Public Services Health and Safety Association, PSHSA.
PSHSA is a non-profit organization, funded by the Ontario Ministry of Labour, with a mandate to reduce and prevent work-related injuries, illnesses and fatalities.
As a product and technology organization, we focus on advancing intelligent safety. We leverage technology to drive change in health and safety outcomes, which enables us to stay ahead of the curve.
PSHSA has been actively involved in furthering violence prevention efforts within Ontario's health care community, and I'd like to spend a few minutes sharing what we've been up to.
Our journey began when PSHSA, along with its stakeholders, noticed, similar to what we've heard today, an increase in the severity and frequency of violent events towards health care workers. Nurses and personal support workers, PSWs, here in Ontario were being stabbed, punched and sexually assaulted, and we knew it had to stop.
Along with the Ontario Nurses' Association, we met with the Ministry of Labour to discuss how we could lead the province with the development of some new resources. This led to our violence, aggression and responsive behaviour, VARB, project. We included the term “responsive behaviour” as there are many events, as you've heard from others, where there is no intent to cause harm to the health care worker. However, these situations still require strategies to mitigate the harm that could occur.
In our VARB project, we used an evidence-informed approach that started with a literature review, a jurisdictional scan and input from focus groups. We engaged multiple stakeholders from various levels and subsectors across the health care system in Ontario to identify priority areas that had a focus on prevention of injury.
We further refined those to make sure that the topics that we chose would produce usable tool kits and would support consistent, scalable and consensus-based approaches for violence prevention. This led us to the development of five tool kits.
The first began at the foundation for prevention and was designed for completing workplace violence risk assessments at the organizational and the departmental levels.
The second tool kit focuses on the patient as the source of the most common type of violence that occurs in health care, and it was designed for conducting individual client risk assessments that assess observed behaviours and are not focused on diagnoses.
We then moved to making sure that everyone would be aware of the risks that could be assessed, and we developed a risk communication or flagging tool kit that we've heard others speak about.
This was followed by a security tool kit to assess what type of security and/or training programs are needed in the health care setting.
The fifth tool kit is the personal safety response system, a guide to ensure that workers at risk of or involved in a violent event have the means to call for help.
The design and development of the tool kits was led by one of our health and safety specialists with support from a working group that included both management and front-line staff from across health care. We also engaged our product development team in the knowledge translation tools that were developed to support the tool kits.
We further refined the tool kits by combining technology and subject matter expertise. We created a website and automated interactive risk assessment that supports employer self-sufficiency and subsequently provides a cost-effective solution for organizations to improve their workplace violence prevention programs.
The tool kits were so well regarded that, in 2017, a joint Ministry of Labour and Ministry of Health and Long-Term Care leadership table on workplace violence in Ontario recommended the use of PSHSA's tools in all Ontario hospitals.
Two years following the launch of our VARB tools, there have been over 20,000 visitors to our website, and a recent evaluation of the tool kits found that 75% of Ontario's public hospitals are aware of the tools and that 67% are actively using at least one of the tool kits. The researchers have told us that this degree of awareness and uptake is unprecedented for this type of complex intervention.
Since then, we've used the same approach to develop four additional tool kits at the express request of the joint leadership table, many of which, we've heard today, are needed. These tool kits focus on incident reporting and investigation, patient transit and transfer, code white and work refusals. They will be released this summer. We believe the path forward for Canada is to scale some of these regional successes to effect sustainable change. In fact, we have already shared our resources with members of the National Alliance for Safety and Health in Health Care, and four provinces outside of Ontario are actively using at least one of the tool kits. We shared our approach at the recent International Conference on Violence in the Health Sector, and have been approached by other countries for use of the tools.
While regional adaptations may be needed, the general solutions required to address workplace violence are fairly consistent, as we've heard, and we're happy to share our work. We also support many of the previous speakers’ recommendations on things such as the need for staffing ratios, human resource strategies that will make sure we have sufficient staffing available, infrastructure investments, and the need for a national standard for workplace violence. In fact, PSHSA and the CSA Group are currently working together on a research project to identify whether there is a need for a national standard on workplace violence and harassment. A report will be published this summer by the CSA Group. Based on our experience thus far, we have five additional recommendations to put forward.
Number one is to spark a paradigm shift.
This first recommendation speaks to the way violence is viewed in health care workplaces. We believe that a fundamental shift in thinking needs to take place in two key areas. First, health care employers consider violence an occupational health and safety issue, but it needs to be considered a care issue. There is absolutely no hope for quality care without considering worker safety. Having safe health care workers means having better care. Second, there is an inequality in the way many organizations treat physical safety versus psychological safety. The prevention of psychological harm has been less of a focus, and there are fewer supports available. It needs to be reinforced that workers’ psychological safety is just as important as their physical safety.
Number two is to conduct actionable research.
We feel strongly that there is sufficient evidence—as Dr. Keith mentioned, over 1,000 studies—around the risks, occurrence, severity, effects and contributing factors to workplace violence, but now it is time to evaluate leading practices and the types of interventions that are being used to make sure they're reducing the risk of violence or to tell us more about what is and what isn’t working.
Number three is to supplement health care curricula.
Beyond the necessary clinical knowledge, health care students require base-level safety training to ensure they're work-ready in a way that allows them to deal with escalating behaviours. This would include awareness, effective communication skills, recognition of escalating behaviours, de-escalation techniques and situational awareness. This training is not intended to replace existing leading practices, such as those that have been mentioned: the GPA program for older adults, which is in use in all but two provinces and territories across Canada; or the organization-specific training that may be required for dealing with specific populations.
Recommendation four is to enhance accountability.
Unless organizations are held accountable, we can't blindly hope for change. In our province, there is no mention of workplace health and safety within health care organizations’ service accountability agreements. As a result, we recommend that all funders explicitly require health care workplaces to integrate worker safety into care practices.
The last one is to amplify public awareness.
While those of us working in the health care sector and those close to it are aware that violence is a pressing issue, there is little awareness on a mass scale about the risks that health care workers face on a daily basis. A public awareness campaign that communicates the government’s position would call attention to the issue. Further, we encourage support for Bill C-434, under which assault of a health care worker will be considered an aggravating circumstance for the purposes of sentencing.
This bill will send a strong message that those who provide critical services such as health care must be treated with respect and have their safety and security protected.
Thank you, again, for the opportunity to speak to you today. We are grateful and heartened to see that the federal government is taking this issue seriously. We look forward to working together to effect healthier and safer workplaces.